Lian George, Ip William, Hankins Andrea, Guillen Michele, Parise Carol
Sutter Independent Physicians, Sacramento, CA, USA.
University of California at Davis Medical Center, Sacramento, CA, USA.
Foot Ankle Orthop. 2025 Jul 21;10(3):24730114251351636. doi: 10.1177/24730114251351636. eCollection 2025 Jul.
Previous studies of conversion of failed ankle arthrodesis to total ankle arthroplasty showed failure in patients with an absent distal fibula, and more recently that has been considered a contraindication. However, these conclusions were based on limited case series with older prosthetic designs, and the potential for successful conversion in this challenging patient population remains unclear. This retrospective study examines the midterm follow-up of 21 patients treated for a conversion of failed ankle arthrodesis by a single surgeon using a standard technique with a single prosthesis, with a focus on the treatment of 5 patients with a deficient distal fibula.
Between May 2010 and August 2019, 27 patients underwent conversion using a prosthesis with an intramedullary tibial component, 21 of which were available for the study. Six patients had a deficient distal fibula, and 5 were available for follow-up. Our primary outcome measure was having a total ankle arthroplasty in place. Secondary outcomes were evaluated postoperatively with a visual analog scale, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, a satisfaction survey, and radiographic assessment of the arthroplasty and any concomitant hindfoot fusions.
Mean follow-up for all patients was 7.6 (2.6-11.8) years, with follow-up of the deficient fibula group of 8.2 (4.9-11.8) years. Complications included malleolar fracture with or without subsequent surgery (n = 5), varus deformity (n = 1), and wound dehiscence or infection (n = 2). At final follow-up, all patients, including the 5 with a deficient distal fibula, had an intact ankle arthroplasty, although 3 with intact fibulas had undergone prosthetic revision. Postoperative dorsiflexion was 4.5 ± 5.1 degrees and plantarflexion 20.9 ± 13.37 degrees. There were no pseudarthroses in the 11 patients with concomitant hindfoot arthrodesis. Mean (±SD) VAS score was 4.4 ± 3.0 and AOFAS score was 71.2 ± 21.7. Sixty-seven percent reported that they were satisfied or very satisfied, with 16% dissatisfied or very dissatisfied. One of the deficient fibula patients was very dissatisfied. Seventy-six percent had no limitations with activities of daily living and two-thirds of those had no limitations at all.
Consistent with previous studies, we find that total ankle arthroplasty can be a satisfactory salvage procedure for patients with a failed ankle arthrodesis. Unlike previous reports, we observed high prosthetic retention in patients with a deficient fibula, although pain relief and range of motion outcomes were mixed, and some patients required revision surgery. These findings should be interpreted in light of the intrinsic limitations of a small sample size, lack of preoperative comparison data, and incomplete follow-up in the deficient fibula group.
Level IV, clinical research.
既往关于失败的踝关节融合术转换为全踝关节置换术的研究表明，在腓骨远端缺如的患者中手术会失败，最近这已被视为一项禁忌证。然而，这些结论是基于采用较旧假体设计的有限病例系列得出的，在这一具有挑战性的患者群体中成功转换的可能性仍不明确。本回顾性研究对21例由单一外科医生采用标准技术和单一假体治疗的失败踝关节融合术转换患者进行了中期随访，重点关注5例腓骨远端缺损患者的治疗情况。
2010年5月至2019年8月期间，27例患者接受了使用带髓内胫骨部件的假体进行的转换手术，其中21例可供研究。6例患者腓骨远端缺损，5例可供随访。我们的主要结局指标是全踝关节置换术在位。次要结局在术后通过视觉模拟评分、美国矫形足踝协会（AOFAS）踝关节与后足评分、满意度调查以及对关节置换术和任何伴随的后足融合术的影像学评估来进行评价。
所有患者的平均随访时间为7.6（2.6 - 11.8）年，腓骨缺损组的随访时间为8.2（4.9 - 11.8）年。并发症包括伴有或不伴有后续手术的踝关节骨折（n = 5）、内翻畸形（n = 1）以及伤口裂开或感染（n = 2）。在最终随访时，所有患者，包括5例腓骨远端缺损的患者，踝关节置换术均完好，尽管3例腓骨完整的患者接受了假体翻修。术后背屈为4.5±5.1度，跖屈为20.9±13.37度。11例伴有后足融合术的患者中无假关节形成。平均（±标准差）视觉模拟评分（VAS）为4.4±3.0，AOFAS评分为71.2±21.7。67%的患者报告他们感到满意或非常满意，16%的患者不满意或非常不满意。1例腓骨缺损患者非常不满意。76%的患者日常生活活动无受限，其中三分之二的患者完全无受限。
与既往研究一致，我们发现全踝关节置换术对于失败的踝关节融合术患者可以是一种令人满意的挽救手术。与既往报告不同，我们观察到腓骨缺损患者的假体保留率较高，尽管疼痛缓解和活动范围结果不一，且一些患者需要翻修手术。鉴于样本量小、缺乏术前对照数据以及腓骨缺损组随访不完全等固有局限性，对这些发现应谨慎解读。
IV级，临床研究。
