Salvage procedures for complications of total ankle arthroplasty.

Total ankle arthroplasty (TAA) has been a satisfactory procedure with a low failure rate only when applied to the rheumatoid patient. For the active, posttraumatic patient, ankle joint fusion is superior and avoids the attendant high failure rate. In general, salvage of failed TAA is best solved by ankle fusion. Only in one of five cases (a compliant patient with a clear-cut correctable technical error) was a good result achieved with a revision arthroplasty. To maintain limb length, the authors transplanted iliac crest autogenic bone to fill a large defect. When tightly packed with bone, the joint is slightly distracted and compression enhances fusion. For septic loosening, osteotomy of the malleoli and fusion without grafting is recommended. Persistent pain unassociated with loosening an infection may be treated by removal of impingement of bone overgrowth. Soft tissue release to improve motion is rarely successful. Marginal skin slough was a problem in 8.5% of 71 cases. To facilitate healing, debridement of nonfunctional exposed tendons may be advisable.