Ankle arthrodesis after failed joint replacement.

UNLABELLED

Report of four patients.

OBJECTIVE

Restoration of a painless gait through ankle arthrodesis after failed total ankle replacement.

INDICATIONS

Loosened or infected total ankle replacement.

CONTRAINDICATIONS

Poor general health. Absent patient compliance.

SURGICAL TECHNIQUE

Removal of total joint components. Filling of the defect with tricortical bone grafts harvested from the ipsilateral iliac crest and internal fixation. In instances of suspected infection a two-stage procedure is recommended, the first stage consisting of a removal of the components, a meticulous debridement, and filling of the defect with gentamycin-laden PMMA beads. Second stage: arthrodesis.

RESULTS

The goal of surgery was reached without complications in two out of four patients. An absence of bony bridging was noted in the fourth patient after 9 months. A revision adding cancellous bone grafts and resorting to an intramedullary fixation led to a success.