Revision Total Ankle Arthroplasty: Surgical Technique

  • Inmaculada Moracia-Ochagavía
  • Fernando Noriega-Díaz
  • E. Carlos Rodríguez-Merchán


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.


Revision ankle arthroplasty Aseptic loosening Talar collapse Modular tibial stem Bone stock deficit Septic loosening 


  1. 1.
    Fevang BT, Lie SA, Havelin LI, Brun JG, Skredderstuen A, Furnes O. 257 Ankle arthroplasties performed in Norway between 1994 y 2005. Acta Orthop. 2007;78:575–83.CrossRefGoogle Scholar
  2. 2.
    Henricson A, Nilsson JA, Carlsson A. 10-Year survival of total ankle arthroplasties: a report on 780 cases form the Swedish Ankle Register. Acta Orthop. 2011;82:655–9.CrossRefGoogle Scholar
  3. 3.
    Henricson A, Skoog A, Carlsson A. The Swedish Ankle Arthroplasty Register: an analysis of 531 arthroplasties between 1993 and 2005. Acta Orthop. 2007;78:569–74.CrossRefGoogle Scholar
  4. 4.
    Prissel MA, Troukis TS. Incidence of revision after primary implantation of the Scandinavian Total ankle Replacement System: a systematic review. Clin Podiatr Med Surg. 2013;30:237–50.CrossRefGoogle Scholar
  5. 5.
    Lachman JR, Ramos JA, Adams SB, NunleyII JA, Easley ME, DeOrio JK. Patient-reported outcomes before and after primary and revision total ankle arthroplasty. Foot Ankle Int. 2019;40:34–41.CrossRefGoogle Scholar
  6. 6.
    Dekker TJ, Walton D, Vinson EN, Hamid KS, Federer AE, Easley ME, et al. Hindfoot arthritis progression and arthrodesis risk after total ankle replacement. Foot Ankle Int. 2017;38:1183–7.CrossRefGoogle Scholar
  7. 7.
    Lawton CD, Bennet AB, Dekker RG, Prescott A, Kadakia AR. Total ankle arthroplasty versus ankle arthrodesis: a comparison of outcomes of the last decade. J Ortho Surg Res. 2017;12:76.CrossRefGoogle Scholar
  8. 8.
    Berkowitz J, Clare MP, Walling AK, Sanders R. Salvage of failed total ankle arthroplasty with fusión using structural allograft and internal fixation. Foot Ankle Int. 2011;32:S493–502.CrossRefGoogle Scholar
  9. 9.
    Kitaoka HB, Romness DW. Arthrodesis for failed ankle arthroplasty. J Arthroplast. 1992;7:255–61.CrossRefGoogle Scholar
  10. 10.
    Myerson MS, Aiyer AA, Ellington JK. Revision total ankle replacement. Based on an original article. J Bone Joint Surg Am. 2013;95:2112–8.CrossRefGoogle Scholar
  11. 11.
    Zajonz D, Prager F, Edel M, Möbius R, Daikos A, Fakler JK, et al. The significance of the vitamin D metabolism in the development of periprosthetic infections after THA and TKA: a prospective matched-pair analysis of 240 patients. Clin Interv Aging. 2018;13:1429–35.CrossRefGoogle Scholar
  12. 12.
    Maier GS, Horas K, Seeger JB, Roth KE, Kurth AA, Maus U. Is there an association between periprosthetic joint infection and low vitamin D levels? Int Orthop. 2014;38:1499–504.CrossRefGoogle Scholar
  13. 13.
    Hintermann B, Zwicky L, Knupp M, Henninger HB, Barg A. Hintegra revision arthroplasty for failed total ankle prosthesis. J Bone Joint Surg Am. 2013;95:1166–74.CrossRefGoogle Scholar
  14. 14.
    Ellington JK, Gupta S, Myerson MS. Management of failures of total ankle replacement with the agility total ankle arthroplasty. J Bone Joint Surg Am. 2013;95:2112–8.CrossRefGoogle Scholar
  15. 15.
    Love C, Marwin SE, Palestro CJ. Nuclear medicine and the infected joint replacement. Semin Nucl Med. 2009;39:66–78.CrossRefGoogle Scholar
  16. 16.
    Teller RE, Christie MJ, Martin W, Nance EP, Haas DW. Sequential indium-labeled leukocyte and bone scans to diagnose prosthetic joint infection. Clin Orthop Relat Res. 2000;373:241–7.CrossRefGoogle Scholar
  17. 17.
    Bibbo C, Patel DV, Gehrmann RM, Lin SS. Chlorhexidine provides superior skin decontamiantion in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res. 2005;438:204–8.CrossRefGoogle Scholar
  18. 18.
    Scorzolini L, Lichtner M, Iannetta M, Mengoni F, Russo G, Panni AS, et al. Sonication technique improves microbiological diagnosis in patients treated with antibiotics before surgery for prosthetic joint infections. New Microbiol. 2014;37:321–8.PubMedGoogle Scholar
  19. 19.
    Roukis TS, Berlet GC, Bibbo C, Hyer CF, Penner MJ, Wünschel M. Primary and revision total ankle replacement: evidence-based surgical management. Cham: Springer; 2016.CrossRefGoogle Scholar
  20. 20.
    Ortega-Andreu M, Talavera G, Padilla-Eguiluz NG, Perez-Chrzanowska H, Figueredo-Galve R, Rodríguez-Merchán EC, et al. Tranexamic acid in a multimodal blood loss prevention protocol to decrease blood loss in revision total knee arthroplasty: a cohort study. Open Orthop J. 2016;10:439–47.CrossRefGoogle Scholar
  21. 21.
    Hsu AR, Franceschina D, Haddad SL. A novel method of postoperative wound care following total ankle arthroplasty. Foot Ankle Int. 2014;35:719–24.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Inmaculada Moracia-Ochagavía
    • 1
  • Fernando Noriega-Díaz
    • 2
  • E. Carlos Rodríguez-Merchán
    • 1
  1. 1.Department of Orthopedic Surgery“La Paz” University HospitalMadridSpain
  2. 2.Instituto Internacional de Cirugía Ortopédica del Pie (IICOP)MadridSpain

Personalised recommendations