Barg A, Wiewiorski M, Valderrabano V
Orthopädische Klinik, Universität Utah, 590 Wakara Way, 84108, Salt Lake City, UT, USA.
Harold K. Dunn Orthopädisches Forschungslabor, Orthopädische Klinik, Universität Utah, Salt Lake City, UT, USA.
Oper Orthop Traumatol. 2017 Jun;29(3):236-252. doi: 10.1007/s00064-017-0500-1. Epub 2017 May 22.
To remove loosened ankle prosthesis components, perform osseous defect augmentation, and reimplant definitive prosthesis components to preserve ankle range of motion.
Aseptic loosening of the tibial and/or talar ankle prosthesis components with substantial bone defect.
General surgical/anesthesiological risks, infections, critical soft tissue conditions, nonmanageable hindfoot instability, neurovascular impairment of the lower extremity, neuroarthropathy, substantial nonreconstructable osseous defects with or without cysts on the tibial and/or talar side, noncompliance, primary total ankle replacement (TAR) using intramedullary fixation (stem fixation), severely reduced bone quality, insulin-dependent diabetes mellitus, smoking, unrealistic patients' expectations, high activity in sports.
Exposure of the ankle joint using the previous incision. Mobilization and removal of loosened prosthesis components. Debridement of bone stock. Assessment and measurement of osseous defects. Harvesting of iliac crest autograft. Screw fixation of iliac crest autograft. Placement of polyethylene inlay as a spacer. Wound closure in layers at the ankle and the iliac crest. Implantation of definitive prosthesis components.
A soft wound dressing. Thromboprophylaxis recommended. Mobilization on postoperative day 1 using a stabilizing walking boot/cast for 6 weeks (sole contact but no weight bearing). Clinical and radiographic follow-up 3 months postoperatively including computed tomography to assess osseous consolidation. After the second surgery, patient mobilization on postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot/cast for 6 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually.
From January 2007 to December 2012, a two-stage revision TAR was performed in 5 patients (46.8 and 71.4 years). The time between the initial TAR and revision was 2.4-11.5 years. No intra-/perioperative complications. Substantial pain relief in all patients. Comparable preoperative and postoperative ankle range of motion.
移除松动的踝关节假体组件，进行骨缺损扩大术，并重新植入确定性假体组件以保留踝关节活动范围。
胫骨和/或距骨踝关节假体组件无菌性松动且伴有大量骨缺损。
一般外科手术/麻醉风险、感染、严重软组织状况、难以处理的后足不稳、下肢神经血管损伤、神经性关节病、胫骨和/或距骨侧有或无囊肿的大量不可重建骨缺损、不配合、使用髓内固定（柄固定）的初次全踝关节置换（TAR）、骨质严重下降、胰岛素依赖型糖尿病、吸烟、患者期望不切实际、运动活跃度高。
采用先前的切口暴露踝关节。松动假体组件的松动和移除。骨存量清创。骨缺损的评估和测量。采集髂嵴自体骨。髂嵴自体骨的螺钉固定。放置聚乙烯嵌体作为间隔物。踝关节和髂嵴分层缝合伤口。植入确定性假体组件。
使用柔软的伤口敷料。建议进行血栓预防。术后第1天使用稳定的步行靴/石膏固定6周（仅足底接触但不负重）进行活动。术后3个月进行临床和影像学随访，包括计算机断层扫描以评估骨愈合情况。第二次手术后，患者术后第1天使用稳定的步行靴/石膏固定，部分负重15公斤，持续6周。6周进行临床和影像学随访后，逐渐开始完全负重。
2007年1月至2012年12月，对5例患者（年龄46.8岁和71.4岁）进行了两阶段翻修TAR。初次TAR与翻修之间的时间为2.4 - 11.5年。无术中/围手术期并发症。所有患者疼痛均显著缓解。术前和术后踝关节活动范围相当。
