Wagener J, Gross C E, Schweizer C, Lang T Horn, Hintermann B
Clinic of Orthopaedic Surgery, Kantonsspital Baselland, CH-4410 Liestal, Switzerland.
Medical University of South Carolina, Department of Orthopaedic Surgery, Charleston, South Carolina, USA.
Bone Joint J. 2017 Feb;99-B(2):231-236. doi: 10.1302/0301-620X.99B2.BJJ-2016-0504.R2.
A failed total ankle arthroplasty (TAA) is often associated with much bone loss. As an alternative to arthrodesis, the surgeon may consider a custom-made talar component to compensate for the bone loss. Our aim in this study was to assess the functional and radiological outcome after the use of such a component at mid- to long-term follow-up.
A total of 12 patients (five women and seven men, mean age 53 years; 36 to77) with a failed TAA and a large talar defect underwent a revision procedure using a custom-made talar component. The design of the custom-made components was based on CT scans and standard radiographs, when compared with the contralateral ankle. After the anterior talocalcaneal joint was fused, the talar component was introduced and fixed to the body of the calcaneum.
At a mean follow-up of 6.9 years (1 to 13), 11 ankles were stable with no radiological evidence of loosening. Only one was lost to follow-up. The mean arc of movement was 21 (10 to 35). A total of nine patients (75%) were satisfied or very satisfied with the outcome, two (17%) were satisfied but with reservations and one (8%) was not satisfied. All but one patient had an improvement in the American Orthopaedic Foot and Ankle Society hindfoot score (p = 0.01). Just one patient developed deep infection, leading to arthrodesis.
A custom-made talar component yielded satisfactory results with regard to function, stability and satisfaction. This should encourage the use of such components as an alternative to arthrodesis of the ankle in patients with a failed TAA. Cite this article: Bone Joint J 2017;99-B:231-6.
全踝关节置换术（TAA）失败常伴有大量骨质流失。作为关节融合术的替代方法，外科医生可考虑使用定制距骨组件来弥补骨质流失。本研究的目的是评估中长期随访使用此类组件后的功能和影像学结果。
12例TAA失败且距骨有大的缺损的患者（5名女性和7名男性，平均年龄53岁；36至77岁）接受了使用定制距骨组件的翻修手术。与对侧踝关节相比，定制组件的设计基于CT扫描和标准X线片。距骨前关节融合后，将距骨组件植入并固定于跟骨体。
平均随访6.9年（1至13年），11例踝关节稳定，无松动的影像学证据。仅1例失访。平均活动弧度为21°（10°至35°）。共有9例患者（75%）对结果满意或非常满意，2例（17%）满意但有所保留，1例（8%）不满意。除1例患者外，所有患者的美国足踝骨科协会后足评分均有改善（p = 0.01）。仅1例患者发生深部感染，导致关节融合。
定制距骨组件在功能、稳定性和满意度方面取得了满意的结果。这应鼓励在TAA失败的患者中使用此类组件作为踝关节融合术的替代方法。引用本文：《骨与关节杂志》2017年；99-B：231 - 6。
