Outcome of revision surgery for failed ankle arthroplasty: revision arthroplasty vs arthrodesis

A. Egglestone, R. Kakwani, A.N. Murty, D. Townshend

Introduction: When ankle arthroplasty fails the options are revision to arthrodesis or revision to arthroplasty. We report early outcomes of revision procedures for failed total replacement.

Methods: Retrospective review of prospectively collected data including post-operative complications, union, survivorship and PROMS scores to compare revision to arthrodesis and revision to arthroplasty.

Results: 31 revision procedures (10 revision to arthrodesis and 21 revision to arthroplasty) were performed for failed primary ankle arthroplasty (30 patients) between January 2012 and June 2019. 23 males: 8 females, average age of 68. Indications for revisions were aseptic loosening (13), cysts/lysis (6), pain (5), periprosthetic infection (3), fracture (2), fibula erosion (1), polyethylene dislocation (1).
Union rate following arthrodesis was 77.9% after primary revision procedure. Impaction bone grafting technique was utilised in seven patients with a union rate of 83%. Survivorship following revision to arthroplasty was 100% at two years; 87.5% at three years and 75% at four years Failed revision arthroplasty was revised to arthrodesis successfully. Median MOxFQ was 73.5 for the arthrodesis group versus 17 in the arthroplasty group (p=0.02). Median AOS was 87 for the arthrodesis group versus 12 for the arthroplasty group (p=0.04)

Discussion: This study demonstrated the potential advantages in the short term of revision arthroplasty over conversion to arthrodesis with statistically significant improvements in MOxFQ and AOS within the first two years following revision.