Conversion of Painful Ankle Arthrodesis to Total Ankle Arthroplasty

Hintermann, Beat; Barg, Alexej; Knupp, Markus; Valderrabano, Victor
March 2010
Journal of Bone & Joint Surgery, American Volume;Mar2010 Supplement 1, Vol. 92-A, p55
Academic Journal
BACKGROUND: Pain following an ankle arthrodesis continues to be a challenging clinical problem. Recent reports on semiconstrained two-component ankle implants have demonstrated the feasibility of reversing a problematic ankle fusion and converting it to a total ankle arthroplasty. However, the failure rate is high. The objective of the present prospective study was to evaluate the intermediate-term outcome associated with the use of an unconstrained three-component ankle implant after taking down an ankle arthrodesis. METHODS: Thirty painful ankles in twenty-eight patients (average age, 58.2 years) who were managed with takedown of a fusion and total ankle arthroplasty were followed for a minimum of thirty-six months (average, 55.6 months). The outcome was assessed on the basis of clinical and radiographic evaluations. RESULTS: In twenty-nine ankles in twenty-seven patients, the American Orthopaedic Foot and Ankle Society hindfoot score increased from 34.1 preoperatively to 70.6 at the time of the latest follow-up. Twenty-four patients (82.7%) were satisfied with the results. While five ankles were completely pain-free, twenty-one ankles were moderately painful, and three remained painful. The average clinically measured range of motion of 24.3° amounted to 55.1% of that of the contralateral, unaffected ankle. Radiographically, the tibial component was stable in all ankles but one. The talar component was found to have migrated in four ankles but was asymptomatic in two of them. One ankle had to be revised to a tibiocalcaneal arthrodesis because of persistent pain and loosening of the talar component. CONCLUSIONS: For patients with pain at the site of a failed ankle arthrodesis, conversion to total ankle arthroplasty with the use of a three-component ankle implant is a viable treatment option that provides reliable intermediate-term results. Key factors for the success of this procedure may be the intrinsic coronal plane stability provided by the ankle implants and the use of wider talar implants. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis. Haddad, S. L.; Coetzee, J. C.; Estok, R.; Fahrbach, K.; Banel, D.; Nalysnyk, L. // Journal of Bone & Joint Surgery, American Volume;Sep2007, Vol. 89-A Issue 9, p1899 

    Background: The efficacy of total ankle replacement compared with that of ankle fusion continues to be one of the most debated topics in foot and ankle surgery. The purpose of this study was to determine whether there are sufficient objective cumulative data in the literature to compare the two...

  • Small-Joint Implants Market Will Hit $1.8 Billion in 2015.  // Orthopedic Design & Technology;Jul/Aug2009, Vol. 5 Issue 4, p30 

    The article offers information on the report by Life Science Intelligence Inc. which expects the global market for small-joint implants to reach about $1.8 billion in 2015. There has been a renewed interest in total ankle arthroplasty (TAA) in the U.S. A range of joint replacement products is...

  • Complication rates after total ankle arthroplasty in one hundred consecutive prostheses. Noelle, Stephanie; Egidy, Claus; Cross, Michael; Gebauer, Matthias; Klauser, Wolfgang // International Orthopaedics;Sep2013, Vol. 37 Issue 9, p1789 

    Introduction: Total ankle arthroplasty is increasingly used as an alternative to arthrodesis to treat advanced ankle arthritis. However, the outcomes and postoperative complications are poorly described. Patients and methods: Between March 2005 and May 2010 114 S.T.A.R. prostheses were implanted...

  • Hammer Toe Surgical Correction: Arthrodesis of the Proximal lnterphalangeal (PIP) Joint Using a New Shape Memory Intramedullary Implant. Delmi, Marino // Podiatry Management;Oct2009, Vol. 28 Issue 8, p164 

    The article presents a study using an intramedullary implant in hammer toe surgical correction with the aim of increasing fusion rate, decreasing complications and improving patient's comfort. The procedure was conducted on 170 patients and assessments taken in 12 months. The result showed a...

  • Extraction of Broken Long Intramedullary Nails Used in Knee Arthrodesis. Khanduja, Vikas; Vemulapalli, Krishna K.; El-Zebdeh, Mustafa // Journal of Knee Surgery (SLACK Incorporated);Apr2006, Vol. 19 Issue 2, p117 

    Presents a surgical technique for extraction of broken long intramedullary nails used in knee arthrodesis. Information on knee arthrodesis; Explanation on an intramedullary nail; Details of two medical cases of women who underwent an arthrodesis.

  • Popliteal block with transfibular approach in ankle arthrodesis: a case series. Akra, Gabriel A.; Middleton, Alan; Adedapo, Akinwande O.; Finn, Paul // Journal of Medical Case Reports;2010, Vol. 4 Issue 1, p1 

    Introduction: Ankle arthrodesis is primarily undertaken to control severe pain in the ankle joint. Immediate postoperative pain is usually treated using oral analgesics, intravenous opiates and regional anaesthesia. The outcomes of ankle fusion, including patient satisfaction studies, are well...

  • Arthroscopic Versus Open Ankle Arthrodesis: A Multicenter Comparative Case Series. Townshend, David; Di Silvestro, Matthew; Krause, Fabian; Penner, Murray; Younger, Alastair; Glazebrook, Mark; Wing, Kevin // Journal of Bone & Joint Surgery, American Volume;1/16/2013, Vol. 95-A Issue 2, p98 

    Background: Ankle arthrodesis results in measurable improvements in terms of pain and function in patients with end-stage ankle arthritis. Arthroscopic ankle arthrodesis has gained increasing popularity, with reports of shorter hospital stays, shorter time to solid fusion, and equivalent union...

  • arthrodesis. Peters, Michael // BMA A-Z Family Medical Encyclopedia;2004, p70 

    An encyclopedia entry for "arthrodesis" is presented. It refers to a surgical procedure in which the two bones in a diseased joint are fused to prevent the joint from moving. The entry discusses how the procedure is done. Additional immobilization of the joint is necessary in arthrodesis of the...

  • Chromosomal Aberrations in the Peripheral Blood of Patients with Metal-on-Metal Hip Bearings. Dunstan, E.; Ladon, D.; Whittingham-Jones, P.; Carrington, R.; Briggs, T. W. R. // Journal of Bone & Joint Surgery, American Volume;Mar2008, Vol. 90-A Issue 3, p517 

    Background: Approximately one-third of patients undergoing joint replacement are under sixty years of age. Many of these patients may be exposed to wear debris from the orthopaedic implant for several decades. Clinical follow-up of this group of patients has been short compared with the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics