Schuberth John M, Christensen Jeffrey C, Rialson John A
The Permanente Medical Group, Department of Orthopaedic Surgery, San Francisco, CA, USA.
J Foot Ankle Surg. 2011 Nov-Dec;50(6):766-72. doi: 10.1053/j.jfas.2011.06.013. Epub 2011 Aug 4.
There are limited options for failed total ankle arthroplasty (TAA) with major talar bone loss and component subsidence. Surgical options for this condition include revision arthroplasty, salvage arthrodesis, or amputation. Revision arthroplasty generally has been considered in situations of loose components with minimal bone loss or use of expensive custom-fabricated prosthetic components with elongated stems. Historically, failure that involves major talar bone loss has been considered resistant to reconstruction, and responsive only to complex arthrodesis or amputation. In this report, we describe a unique method of restoring talar support and preserving ankle function after failed TAA with major talar bone loss and component subsidence. Talar reconstruction using metal-reinforced bone cement augmentation is combined with the Inbone (Wright Medical Technology, Inc., Arlington, TN) total ankle system to restore talar height and ligamentous support. This technique has been used successfully in the last 4 years for various patterns of talar bone loss and obviates the need for custom components. When successfully performed, the revision technique results in restoration of mechanical alignment, anatomic height, and component support, in addition to providing substantial symptomatic relief.
对于伴有距骨严重骨质流失和假体下沉的全踝关节置换术（TAA）失败，可供选择的方案有限。针对这种情况的手术选择包括翻修关节成形术、挽救性关节融合术或截肢。翻修关节成形术通常适用于假体松动且骨质流失极少的情况，或者使用带有延长柄的昂贵定制假体组件。从历史上看，涉及距骨严重骨质流失的失败一直被认为难以重建，只能通过复杂的关节融合术或截肢来解决。在本报告中，我们描述了一种独特的方法，用于在伴有距骨严重骨质流失和假体下沉的TAA失败后恢复距骨支撑并保留踝关节功能。使用金属增强骨水泥增强进行距骨重建，并结合Inbone（Wright Medical Technology, Inc., Arlington, TN）全踝关节系统，以恢复距骨高度和韧带支撑。在过去4年中，该技术已成功应用于各种距骨骨质流失模式，无需定制组件。成功实施翻修技术后，除了能显著缓解症状外，还能恢复机械对线、解剖高度和假体支撑。
