Outcomes of revision surgery for failed total ankle replacement: revision arthroplasty versus arthrodesis
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ORIGINAL PAPER
Outcomes of revision surgery for failed total ankle replacement: revision arthroplasty versus arthrodesis Anthony Egglestone 1
&
Rajesh Kakwani 1 & Murty Aradhyula 1 & Angela Kingman 1 & David Townshend 1
Received: 9 April 2020 / Accepted: 25 August 2020 # SICOT aisbl 2020
Abstract Purpose To compare the short-term outcomes of surgical management of failed ankle arthroplasty with revision ankle arthroplasty and conversion to arthrodesis. Methods Single-centre retrospective review of revision procedures for failed ankle arthroplasty between January 2012 and June 2019. Implant survival, union rates, and PROMS data—Pain Visual Analogue Score (VAS), Ankle Osteoarthritis Score (AOS) and Manchester-Oxford Foot Questionnaire (MOxFQ)—were compared between the two groups. Results Twenty-nine patients (31 ankles) underwent surgical management for failed ankle arthroplasty, with either revision arthroplasty (n = 21) or arthrodesis (n = 10). Revision arthroplasty had 87% survival at four years. Arthrodesis had an overall union rate of 80%. Two-year PROMS showed greater results for the revision arthroplasty group compared with that for arthrodesis group (Pain VAS 10 vs 50, p = 0.03; total AOS 12 vs 87, p = 0.04; average MOxFQ 17 vs 73.5, p 0.02). Conclusion Revision arthroplasty demonstrates good short-term survival data with improvements in PROMS compared with arthrodesis. Further long-term follow-up is required to monitor if these benefits continue. Keywords Total ankle replacement . Revision ankle replacement . Ankle arthrodesis . Failed total ankle replacement . Ankle arthritis
Introduction Arthrodesis is considered the reference standard for management of pain and deformity secondary to ankle arthritis, and although successful union rates and patient satisfaction scores can be achieved [1], it is not without its own problems. The alterations in gait mechanics following ankle arthrodesis can produce degenerative changes in adjacent joints, resulting in further pain and disability [2]. Total ankle replacement (TAR) aims to provide patients with a pain-free and mobile ankle, thereby preventing the complications associated with arthrodesis. Early attempts at TAR by Lord and Marotte [3] in the 1970s used an inverted hip prosthesis with disappointing outcomes. Since then, greater understanding of hindfoot biomechanics, improvements in prosthesis design and surgical
* Anthony Egglestone [email protected] 1
Northumbria Healthcare Foundation Trust, North Shields, UK
technique have improved the longevity of implants resulting in TAR becoming a viable method for management of ankle arthritis [1]. One of the main factors for successful TAR is patient selection. Generally, arthroplasty is indicated for lower demand patients with adjacent joint degenerative disease, a wellaligned ankle and well-preserved range of movement [4]. The main contraindications for TAR include infection, osteonecrosis, neurogenic joint disease, severe malalignment and compromise of vascular or soft tissue status. The National Jo
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