Single Stage Revision Total Ankle Replacement, Is it Safe?

P Pekhale, M Raglan, S Dhar

Background: The number of total ankle replacements (TAR) is increasing each year and with that an associated rise in the burden of revision ankle arthroplasty (RAA). The preferred option in our center, following network discussion, is to convert the failing TAR to a RAA. There is uncertainty whether this is best done in a single staged approach or two stages. The aim of this review was to assess the safety of single to two staged approaches in RAA.

Method: A review was carried out of the prospectively collected data of all RAA performed in our center between Nov 2016 and Jan 2024. We reviewed; preoperative micro sampling, intraop micro and histology results, infection rate, tourniquet time, length of hospital stay, wound complications and PROMS of all patients who had undergone single staged RAA, compared to two staged.

Results: We identified 88 RAA patients, with mean age of 71.4 (38-88) with a minimum of 2 year follow up, range 2 - 6 years. There were 44 Left and 44 Right failing total ankle replacements. 14 were two staged procedures and 74 were single staged. Neither group had any significant intraoperative microbiology growth. There was a significant difference in tourniquet times but with no associated significant complication rate in single stage group. There was one infection in the single staged group that went onto have a successful DAIR. There was no difference in wound complications post op. Both groups showed improvement in PROMS, with no difference between the groups or in increase in length of hospital stay.

Conclusion: In our series, which is the largest in the literature, we have found single staged revision arthroplasty to be safe and effective compared to two stage in patients where there is a low index of suspicion of infection.