Clinic of Orthopaedic Surgery, Kantonsspital Baselland Liestal, Rheinstrasse 26, CH-4410 Liestal, Switzerland.
J Bone Joint Surg Am. 2013 Jul 3;95(13):1166-74. doi: 10.2106/JBJS.L.00538.
When a total ankle replacement fails, arthrodesis has been advocated as the treatment of choice. With the availability of a wide spectrum of implants, revision arthroplasty may become a viable alternative.
We reviewed a consecutive series of 117 cases (116 patients [fifty-six female and sixty male]; mean age, 55.0 ± 12.0 years) in which a total ankle arthroplasty failed after a mean of 4.3 years and was revised with use of the HINTEGRA three-component total ankle prosthesis. The reason for revision involved the metallic components in sixty ankles (51%), the bone in twenty-eight (24%), the soft tissues in twenty (17%), and infection in nine (8%). The talar component was revised in 104 ankles (89%) and the tibial component, in 106 (91%).
Early complications included a fracture of the malleoli in two ankles and a dislocation of the polyethylene insert in one. Seventeen (15%) of the revision arthroplasties required further revision surgery, in most cases for loosening of one or two of the prosthetic components. The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score for the remaining 100 ankles (85%) improved from 44 ± 18 preoperatively to 72 ± 19 (p < 0.01) at the time of the latest follow-up (mean, 6.2 years). The estimated survival of the revision arthroplasties at nine years, with loosening of components as the end point, was 83%. The prevalence of component loosening was higher (p < 0.005) with the use of single-coated hydroxyapatite components (six of twenty-three ankles, 26%) than with double-coated components (five of ninety-four ankles, 5%). The correlation between the extent of bone loss at the resection surface and the prevalence of component failure was weak and not significant.
The medium-term results of revision arthroplasty after a failed total ankle arthroplasty were similar to those after primary arthroplasty. The key to success was firm anchorage of the components to primary bone stock. A single hydroxyapatite component coating should no longer be used for revision total ankle arthroplasty.
当全踝关节置换失败时，融合术已被推荐为首选治疗方法。随着各种植入物的出现，翻修关节成形术可能成为一种可行的选择。
我们回顾了一组连续的 117 例（116 例患者[56 名女性，60 名男性]；平均年龄 55.0 ± 12.0 岁）病例，这些患者在初次全踝关节置换后平均 4.3 年后因全踝关节置换失败而接受了 HINTEGRA 三组件全踝关节假体翻修。翻修的原因涉及 60 例（51%）踝关节中的金属部件、28 例（24%）的骨、20 例（17%）的软组织和 9 例（8%）的感染。104 例（89%）翻修了距骨组件，106 例（91%）翻修了胫骨组件。
早期并发症包括 2 例踝部骨折和 1 例聚乙烯插入物脱位。17 例（15%）翻修关节成形术需要进一步翻修手术，大多数情况下是由于一个或两个假体部件松动。100 例（85%）剩余踝关节的美国矫形足踝协会（AOFAS）后足评分平均从术前的 44 ± 18 分提高到末次随访时的 72 ± 19 分（p < 0.01）（平均随访时间 6.2 年）。以假体部件松动为终点，翻修关节成形术在 9 年时的估计生存率为 83%。使用单涂层羟基磷灰石部件（23 例中的 6 例，26%）的组件松动发生率高于使用双涂层部件（94 例中的 5 例，5%）（p < 0.005）。切除表面骨丢失程度与部件失败之间的相关性较弱且无统计学意义。
初次全踝关节置换失败后翻修关节成形术的中期结果与初次置换相似。成功的关键是将部件牢固地固定在原始骨上。单涂层羟基磷灰石部件不应再用于翻修全踝关节置换术。
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