Wimmer M D, Hettchen M, Ploeger M M, Hintermann B, Wirtz D C, Barg A
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
Klinik für Orthopädie und Traumatologie des Bewegungsapparates, Kantonsspital Baselland, Liestal, Schweiz.
Oper Orthop Traumatol. 2017 Jun;29(3):207-219. doi: 10.1007/s00064-017-0492-x. Epub 2017 Apr 25.
To remove loosened prosthesis components, to perform augmentation, to address osseous defects, to perform neutrally aligned ankle arthrodesis, and to achieve postoperative pain relief.
Symptomatic, aseptic loosening of total ankle replacement (TAR) with/without substantial bone defect of the tibial and/or talar bone stock.
General surgical or anesthesiological risks, periprosthetic infection, local or systemic infection, nonmanageable soft tissue problems.
Removal of both prosthesis components using the previous incision (mostly using anterior ankle approach). Careful debridement of bone stock at the tibial and talar side. Osseous augmentation of defects using autologous or homologous cancellous bone, if needed, using structural allografts.
A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts on postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot or cast for 6-8 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually after progressive osseous healing has been confirmed.
Between January 2007 and December 2012, ankle arthrodesis was performed in 9 patients with failed TAR (6 men and 3 women, mean age 56.4 ± 7.0 years, range 47.8-66.0 years). The mean time between the initial TAR and revision surgery was 4.5 ± 2.4 years (range 1.2-7.9 years). In one patient irrigation and debridement was performed due to superficial wound infection. Another patient had a delayed osseous healing 11 months after the revision surgery.
移除松动的假体部件，进行骨增量，处理骨缺损，进行中立位踝关节融合术，并实现术后疼痛缓解。
有症状的全踝关节置换（TAR）无菌性松动，伴有或不伴有胫骨和/或距骨骨量的大量骨缺损。
一般外科或麻醉风险、假体周围感染、局部或全身感染、无法处理的软组织问题。
使用先前的切口（大多采用踝关节前入路）移除两个假体部件。仔细清理胫骨和距骨侧的骨量。如有需要，使用自体或同种异体松质骨对缺损进行骨增量，必要时使用结构性同种异体骨移植。
使用柔软的伤口敷料。建议进行血栓预防。术后第1天开始让患者活动，使用稳定的步行靴或石膏进行15公斤部分负重，持续6 - 8周。在术后6周进行临床和影像学随访后，确认骨愈合进展后逐渐开始完全负重。
在2007年1月至2012年12月期间，对9例TAR失败的患者进行了踝关节融合术（6例男性和3例女性，平均年龄56.4 ± 7.0岁，范围47.8 - 66.0岁）。初次TAR与翻修手术之间的平均时间为4.5 ± 2.4年（范围1.2 - 7.9年）。1例患者因浅表伤口感染进行了冲洗和清创。另1例患者在翻修手术后11个月出现骨愈合延迟。
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