Revision Total Ankle Arthroplasty: Epidemiology and Causes

Abstract

The reported rates of revision after total ankle arthroplasty (TAA) range from approximately 2.5% to 15%. The primary forms of failure are loose talar component, loose tibial component, dislocation, instability, misalignment, deep infection, fracture (near implant), pain, and defective polyethylene. The main risk factors for revision TAA (RTAA) are inadequate patient selection, deficient surgeon experience, obesity (body mass index [BMI] >30), posttraumatic and end-stage osteoarthritis, poor restoration of bone stock, inadequate prosthetic device selection (poor implant features), insufficient control of risk factors for periprosthetic joint infection (age < 65 years, BMI < 19, BMI >30, tobacco use, diabetes mellitus, inflammatory arthritis, peripheral vascular disease, chronic lung disease, hypothyroidism, previous ankle surgery, wound healing problems more than 14 days postoperatively), and ipsilateral hindfoot fusion. Loosening happens more commonly in fixed-bearing designs than in the mobile-bearing designs. Gamma-sterilized polyethylene inserts experience fatigue damage or fracture in vivo, resulting in the need for revision. The Salto mobile design has a higher rate of revision than the Salto-Talaris design; however, the reported frequency of revision for the Salto mobile version and Salto-Talaris TAAs is lower than that reported for the Agility and STAR systems without obvious selection (inventor) or publication (conflict of interest) bias. The reported overall 10-year survival of the Ankle Evolutive System (AES) prosthesis, a mobile-bearing TAA evolved from the Buechel Pappas model TAA, is lower than with other designs, particularly due to cyst lesions. At 20 months’ follow-up, the two-component Infinity prosthesis had shown a high early revision rate due to tibial component loosening compared with other implant systems. The INBONE I prosthesis is at a significantly higher risk of implant failure than the INBONE II, STAR (Swedish Total Ankle Replacement), and Salto-Talaris prostheses.