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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 8, 1039-1047.
doi: 10.1302/0301-620X.88B8.16768  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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The management of failed ankle replacement

R. Kotnis, MRCS, Specialist Registrar in Trauma & Orthopaedics1; C. Pasapula, FRCS(Trauma & Orth), Specialist Registrar in Trauma & Orthopaedics1; F. Anwar, MRCS, Senior House Officer2; P. H. Cooke, ChM, FRCS, Consultant Orthopaedic Surgeon1; and R. J. Sharp, BMBChm MA, FRCS, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon1

1 Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK.
2 Dumfries & Galloway Royal Infirmary, Bankend Road, Dumfries DG1 4AT, UK.

Correspondence should be sent to Mr R. Kotnis, c/o Mr R. Sharp, secretary; e-mail: rkotnis{at}hotmail.com

Advances in the design of the components for total ankle replacement have led to a resurgence of interest in this procedure.

Between January 1999 and December 2004, 16 patients with a failed total ankle replacement were referred to our unit. In the presence of infection, a two-stage salvage procedure was planned. The first involved the removal of the components and the insertion of a cement spacer. Definitive treatment options included hindfoot fusion with a circular frame or amputation. When there was no infection, a one-stage salvage procedure was planned. Options included hindfoot fusion with an intramedullary nail or revision total ankle replacement. When there was suspicion of infection, a percutaneous biopsy was performed. The patients were followed up for a minimum of 12 months.

Of the 16 patients, 14 had aseptic loosening, five of whom underwent a revision total ankle replacement and nine a hindfoot fusion. Of the two with infection, one underwent fusion and the other a below-knee amputation. There were no cases of wound breakdown, nonunion or malunion.

Management of the failed total ankle replacement should be performed by experienced surgeons and ideally in units where multidisciplinary support is available. Currently, a hindfoot fusion appears to be preferable to a revision total ankle replacement.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General