Revision Total Ankle Arthroplasty: Surgical Technique

Abstract

Increased prosthetic ankle surgeries have led to a corresponding increase in prosthetic revision surgeries. It is important first to identify the appropriate candidates on whom to perform a revision and implant a new prosthesis. A thorough physical examination allows us to identify a malalignment of the hindfoot or tibia in different planes, which will need to be corrected with additional surgeries during the revision. Imaging tests identify the cause of the prosthetic failure, which in most cases is due to loosening with or without subsidence of the talar component. A CT scan can assess the bone stock deficit (a fundamental aspect in deciding on the prosthetic model to be implanted), the need for autograft/cancellous or structural allograft, and the performance of other complementary surgeries. The surgical technique does not differ much from revision surgery of the knee or hip prosthesis, but it is crucial that it be performed by a surgeon experienced in prosthetic ankle surgery. Most important is to perform an extensive debridement of the fibrous tissues and a posterior capsulotomy, then send intraoperative samples to microbiology to rule out an infectious process, and be thorough in extracting the components, avoiding excessive bone loss. When there is suspicion or a clear diagnosis of prosthetic infection, the implantation of a new prosthesis can also be considered, provided that a series of circumstances are met: identifying the pathogenic agent to establish a specific antibiotic treatment, debriding and removing prosthetic implants, and only performing a new arthroplasty if the clinical, laboratory, and imaging parameters have normalized after 6–8 weeks of antibiotic treatment.