Hospital for Special Surgery, New York, NY, USA.
OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA.
Foot Ankle Int. 2020 Dec;41(12):1510-1518. doi: 10.1177/1071100720947036. Epub 2020 Aug 14.
Treatment of failed total ankle arthroplasty (TAA) is challenging. Limited literature is available on options and outcomes of revision arthroplasty despite failure rates ranging from 10% to 23% within 10 years after primary TAA. This study reports the clinical and radiographic outcomes of revision TAA using a fixed-bearing, intramedullary-referencing implant.
A retrospective review was performed of 18 consecutive revision TAA cases between 2008-2015 using an intramedullary-referencing, fixed-bearing, 2-component total ankle system. Demographic and radiographic data were collected preoperatively, immediately postoperatively, and at the most recent follow-up. Functional outcome data were collected immediately postoperatively and at mean follow-up 47.5 months.
Eighteen patients underwent revision TAA, with 77.8% (14/18) implant survival. Index revision was performed most commonly for aseptic talar subsidence (55.6%) or implant loosening (tibia, 29.4%; talus, 58.9%). Following revision, 22.2% (4/18) patients required reoperation at a mean 57.3 (39-86) months. Osteolysis of the tibia, talus, and fibula was present preoperatively in 66.7% (12/18), 38.9% (7/18), and 38.9% (7/18) of patients, respectively, with progression of osteolysis in 27.8% (5/18), 11.1% (2/18) and 11.1% (2/18) of patients, respectively. Subsidence of the tibial and talar revision components was observed in 38.9% (7/18) and 55.6% (10/18) of patients, respectively. The median American Orthopaedic Foot & Ankle Society (AOFAS) score was 74.5 (26-100) and Foot Function Index (FFI) score 10.2 (0-50.4).
Early results of intramedullary-referencing revision TAA demonstrated good patient-reported outcomes with maintenance of radiographic parameters at mean follow-up of 47.5 months. Aseptic talar subsidence or loosening were the main postoperative causes of reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant was a viable option for the failed TAA.
Level IV, case series.
全踝关节置换术（TAA）失败后的治疗具有挑战性。尽管初次 TAA 后 10 年内失败率为 10%至 23%，但有关翻修关节成形术的选择和结果的文献却有限。本研究报告了使用固定轴承、髓内参考植入物进行 TAA 翻修的临床和影像学结果。
对 2008-2015 年间使用髓内参考、固定轴承、2 部分全踝关节系统进行的 18 例连续 TAA 翻修病例进行回顾性分析。收集术前、术后即刻和最近随访时的人口统计学和影像学数据。术后即刻和平均随访 47.5 个月时收集功能结果数据。
18 例患者接受了 TAA 翻修，其中 77.8%（14/18）的植入物存活。索引翻修最常见的原因是无菌性距骨下沉（55.6%）或植入物松动（胫骨，29.4%；距骨，58.9%）。翻修后，22.2%（4/18）的患者在平均 57.3（39-86）个月时需要再次手术。术前胫骨、距骨和腓骨的骨溶解分别为 66.7%（18/18）、38.9%（18/18）和 38.9%（18/18），进展性骨溶解分别为 27.8%（5/18）、11.1%（2/18）和 11.1%（2/18）。胫骨和距骨翻修组件的下沉分别在 38.9%（7/18）和 55.6%（10/18）的患者中观察到。美国矫形足踝协会（AOFAS）评分中位数为 74.5（26-100），足部功能指数（FFI）评分为 10.2（0-50.4）。
髓内参考 TAA 翻修的早期结果显示出良好的患者报告结果，并在平均 47.5 个月的随访中保持影像学参数。无菌性距骨下沉或松动是术后再次手术的主要原因。使用髓内参考植入物的翻修关节成形术是治疗 TAA 失败的可行选择。
IV 级，病例系列。
