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Revision of Failed Primary Agility and Agility LP Total Ankle Replacements

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Primary and Revision Total Ankle Replacement

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Abstract

The Agility and Agility LP Total Ankle Replacement Systems were the most frequently implanted prosthesis in the USA for over a decade prior to falling into disuse and ultimately being abandoned. Therefore, it is reasonable to assume that surgeons unfamiliar with primary implantation of the Agility and Agility LP Total Ankle Replacement Systems will encounter patients with failure of these prostheses that would benefit from revision. Unfortunately, at present there are no “standard principles” associated with revision of the Agility and Agility LP Total Ankle Replacement Systems. What is clear is that the current approaches are technically complex and fraught with complications, and no one approach represents the only answer. Exchange of the metallic components to LP or revision components is a viable option with limited occurrence of complications. Explantation and conversion to custom-design long-stemmed components have proven effective in the short term but are not currently available in the USA. Explantation and conversion to another total ankle replacement system are high risk and have strong potential for complications. The use of metal-reinforced polymethylmethacrylate cement augmentation, tibio-talo-calcaneal arthrodesis with or without bulk allograft, and below-knee amputation should be reserved for very select situations where other options are not possible. Given the anticipated volume of patients with retained Agility and Agility LP Total Ankle Replacement Systems in the USA, there is a real need for long-term survivorship following revision of these prostheses and future efforts ought to be directed in this area.

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References

  1. Alvine FG. Total ankle arthroplasty: new concepts and approach. Contemp Orthop. 1991;22(4):397–403.

    CAS  PubMed  Google Scholar 

  2. Alvine FG. The Agility ankle replacement: the good and the bad. Foot Ankle Clin. 2002;7(4):737–53.

    Article  PubMed  Google Scholar 

  3. No authors listed. [cited 2014 Dec 21]. http://www.accessdata.fda.gov/cdrh_docs/pdf5/K053569.pdf.

  4. Alvine FG. Design and development of the Agility ankle. Foot Ankle Spec. 2009;2(1):45–50.

    Article  PubMed  Google Scholar 

  5. Pyevich MT, Saltzman CL, Callaghan JJ, Alvine FG. Total ankle arthroplasty: a unique design. Two to twelve-year follow-up. J Bone Joint Surg Am. 1998;80(1):1410–20.

    Article  CAS  PubMed  Google Scholar 

  6. Rippstein PF. Clinical experiences with three different designs of ankle prosthesis. Foot Ankle Clin. 2002;7(4):817–31.

    Article  PubMed  Google Scholar 

  7. Saltzman CL, Alvine FG. The Agility total ankle replacement. AAOS Instructional Course Lectures. 2002;51:129–33.

    Google Scholar 

  8. Spirit AA, Assal M, Hansen Jr ST. Complications and failure after total ankle arthroplasty. J Bone Joint Surg Am. 2004;86(6):1172–8.

    Article  Google Scholar 

  9. Knecht SI, Estin M, Callaghan JJ, Zimmerman MB, Alliman KJ, Alvine FG, et al. The Agility total ankle arthroplasty: seven to sixteen-year follow-up. J Bone Joint Surg Am. 2004;86(6):1161–71.

    Article  PubMed  Google Scholar 

  10. Vienne P, Nothdurft P. OSG-totalendoprothese Agility: indikationen. Operationstechnik und ergebnisse. Fuss Sprungg. 2004;2(1):17–28. German.

    Article  Google Scholar 

  11. Gould JS. Revision total ankle arthroplasty. Am J Orthop. 2005;34(8):361.

    PubMed  Google Scholar 

  12. Raikin SM, Myerson MS. Avoiding and managing complications of the Agility total ankle replacement system. Orthopaedics. 2006;29(1):931–8.

    Google Scholar 

  13. Schuberth JM, Patel S, Zarutsky E. Perioperative complications of the Agility total ankle replacement in 50 initial, consecutive cases. J Foot Ankle Surg. 2006;45(3):139–46.

    Article  PubMed  Google Scholar 

  14. Alvine FG, Conti SF. Die Agility-sprunggelenksprothese: Mittel- und langfristige erfahrungen. Orthopade. 2006;35(5):521–6. German.

    Article  CAS  PubMed  Google Scholar 

  15. Kopp FJ, Patel MM, Deland JT, O’Malley MJ. Total ankle arthroplasty with the Agility prosthesis: clinical and radiographic evaluation. Foot Ankle Int. 2006;27(2):97–103.

    Article  PubMed  Google Scholar 

  16. Castro MD. Insufficiency fractures after total ankle replacement. Tech Foot Ankle Surg. 2007;6(1):15–21.

    Article  Google Scholar 

  17. Horowitz EJ, Gould JS, Fleisig GS, Fowler R. Outcome analysis of Agility total ankle replacement with prior adjunctive procedures: two to six year follow-up. Foot Ankle Int. 2007;28(3):308–12.

    Article  Google Scholar 

  18. Myerson MS, Won HY. Primary and revision total ankle replacement using custom-designed prosthesis. Foot Ankle Clin. 2008;13(3):521–38.

    Article  PubMed  Google Scholar 

  19. Jung H-G, Nicholson JJ, Parks B, Myerson MS. Radiographic and biomechanical support for fibular plating of the Agility total ankle. Clin Orthop Relat Res. 2004;424:118–24.

    Article  Google Scholar 

  20. Cerrato R, Myerson MS. Total ankle replacement: the Agility LP prosthesis. Foot Ankle Clin. 2008;13(3):485–94.

    Article  PubMed  Google Scholar 

  21. Castro MD. Agility low profile: short-term update and representative case presentation. Semin Arthroplast. 2010;21(4):267–74.

    Article  Google Scholar 

  22. Henricson A, Carlsson Å, Rydholm U. What is revision of total ankle replacement? Foot Ankle Surg. 2011;17(3):99–102.

    Article  PubMed  Google Scholar 

  23. Roukis TS. Incidence of revision after primary implantation of the Agility total ankle replacement system: A systematic review. J Foot Ankle Surg. 2012;51(2):198–204.

    Article  PubMed  Google Scholar 

  24. Criswell BJ, Douglas K, Naik R, Thomson AB. High revision and reoperation rates using the Agility total ankle system. Clin Orthop Relat Res. 2012;470(7):1980–6.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Anderson JG. Agility LP ankle arthroplasty outcomes. ClinicalTrials.gov registration number: NCT01366872. [cited 2014 Dec 21]. http://www.clinicaltrials.gov/ct2/show/results/NCT01366872?term=Agility+LP&rank=1&sect=X867015#outcome3.

  26. Claridge RJ, Sagherian BH. Intermediate term outcome of the Agility total ankle arthroplasty. Foot Ankle Int. 2009;30(9):824–35.

    Article  PubMed  Google Scholar 

  27. Gupta S, Ellington JK, Myerson MS. Management of specific complications after revision total ankle replacement. Semin Arthroplast. 2010;21(4):310–9.

    Article  Google Scholar 

  28. Jonck JH, Myerson MS. Revision total ankle replacement. Foot Ankle Clin. 2012;17(4):687–706.

    Article  PubMed  Google Scholar 

  29. McCollum G, Myerson MS. Failure of the Agility total ankle replacement system and the salvage options. Clin Podiatr Med Surg. 2013;30(2):207–23.

    Article  PubMed  Google Scholar 

  30. Gaden MTR, Ollivere BJ. Periprosthetic aseptic osteolysis in total ankle replacement: cause and management. Clin Podiatr Med Surg. 2013;30(2):145–55.

    Article  PubMed  Google Scholar 

  31. Kobayashi A, Minoda Y, Kadoya Y, Ohashi H, Takaoka K, Saltzman C. Ankle arthroplasties generate wear particles similar to knee arthroplasties. Clin Orthop. 2004;424:69–72.

    Article  Google Scholar 

  32. Vaupel Z, Baker EA, Baker KC, Kurdziel MD, Fortin PT. Analysis of retrieved Agility total ankle arthroplasty systems. Foot Ankle Int. 2009;30(9):815–23.

    Article  PubMed  Google Scholar 

  33. Nicholson JJ, Parks BG, Stroud C, Myerson MS. Joint contact characteristics in Agility total ankle arthroplasty. Clin Orthop Relat Res. 2004;424:125–9.

    Article  Google Scholar 

  34. Saltzman CL, Tochigi Y, Rudert MJ, McIff TE, Brown TD. The effect of Agility ankle prosthesis misalignment on the peri-ankle ligaments. Clin Orthop Relat Res. 2004;424:137–42.

    Article  Google Scholar 

  35. Conti S, Lalonde KA, Martin R. Kinematic analysis of the Agility total ankle during gait. Foot Ankle Int. 2006;27(11):980–4.

    Article  PubMed  Google Scholar 

  36. Fukuda T, Haddad SL, Ren Y, Zhang L-Q. Impact of talar component rotation on contact pressure after total ankle arthroplasty: a cadaveric study. Foot Ankle Int. 2010;31(5):404–11.

    Article  PubMed  Google Scholar 

  37. Espinosa N, Walti M, Favre P, Snedeker JG. Misalignment of total ankle components can induce high joint contact pressures. J Bone Joint Surg Am. 2010;92(5):1179–87.

    Article  CAS  PubMed  Google Scholar 

  38. McInnes KA, Younger ASE, Oxland TR. Initial instability in total ankle replacement: a cadaveric biomechanical investigation of the STAR and Agility prostheses. J Bone Joint Surg Am. 2014;96(14):147.

    Article  Google Scholar 

  39. Roukis TS, Prissel MA. Management of extensive tibial osteolysis with the Agility total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. J Foot Ankle Surg. 2014;53(1):101–7.

    Article  PubMed  Google Scholar 

  40. Roukis TS, Prissel MA. Management of extensive talar osteolysis with the Agility total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. J Foot Ankle Surg. 2014;53(1):108–13.

    Article  PubMed  Google Scholar 

  41. 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(23):2112–8.

    Article  PubMed  Google Scholar 

  42. Alvine GS, Steck JK, Alvine F. Early results for the Agility stemmed talar revisional component for total ankle arthroplasty. In: Trepman E, Lutter LD, Richardson EG, Brodsky JW, Donley BG, (eds.) Special report: Highlights of the 22nd Annual Summer Meeting of the American Orthopaedic Foot and Ankle Society, La Jolla, CA, July 14–16, 2006. Foot Ankle Int 2007;28(5): 646–53.

    Google Scholar 

  43. Ketz J, Myerson M, Sanders R. The salvage of complex hindfoot problems with use of a custom talar total ankle prosthesis. J Bone Joint Surg Am. 2012;94(13):1194–200.

    Article  PubMed  Google Scholar 

  44. Noriega F, Villanueva P, Moracia I, Martinez J. Custom-made talar component in primary young patients and total ankle replacement revision: short-term results. J Bone Joint Surg Br. 2011;93(Suppl II):148.

    Google Scholar 

  45. Roukis TS. Salvage of a failed DePuy Alvine total ankle prosthesis with Agility LP custom stemmed tibia and talar components. Clin Podiatr Med Surg. 2013;30(1):101–9.

    Article  PubMed  Google Scholar 

  46. Sanders RW. Failed total ankle arthroplasty, chapter 30. In: Nunley JA, Pfeffer GB, Sanders RW, Trepman E, editors. Advanced reconstruction: foot and ankle. Rosemont: American Academy of Orthopaedic Surgeons; 2004. p. 201–8.

    Google Scholar 

  47. Myerson MS. Revision total ankle replacement, chapter 25. In: Myerson MS, editor. Reconstructive foot and ankle surgery: management of complications. 2nd ed. Philadelphia: Elsevier Saunders; 2010. p. 295–316.

    Chapter  Google Scholar 

  48. Sanders R. Recognition and salvage of the failed ankle replacement arthroplasty, chapter 20. In: Coetzee JC, Hurwitz SR, editors. Arthritis & arthroplasty: the foot and ankle. Philadelphia: Saunders Elsevier; 2010. p. 178–86.

    Google Scholar 

  49. Haddad SL. Revision Agility total ankle arthroplasty, chapter 76. In: Easley ME, Wiesel SW, editors. Operative techniques in foot and ankle surgery. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 622–42.

    Google Scholar 

  50. Conti S, Miller M. Agility ankle component design: preventing subsidence, a finite element study. Warsaw: DePuy Orthopaedics, Inc; 2007.

    Google Scholar 

  51. Rodrigues D. Biomechanics of the total ankle arthroplasty: Stress analysis and bone remodeling. [Cited 2014 Dec 27]. https://fenix.tecnico.ulisboa.pt/downloadFile/395145522892/Resumo.pdf.

  52. McIff TE, Alvine FG, Saltzman CL, Klaren JC, Brown TD. Intraoperative measurement of distraction for ligament tensioning in total ankle arthroplasty. Clin Orthop Relat Res. 2004;424:111–7.

    Article  Google Scholar 

  53. No authors listed. [cited 2014 Dec 21]. http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2011/ucm287552.htm.

  54. DeVries JG, Scott RT, Berlet GC, Hyer CF, Lee TH, DeOrio JK. Agility to INBONE: anterior and posterior approaches to the difficult revision total ankle replacement. Clin Podiatr Med Surg. 2013;30(1):81–96.

    Article  PubMed  Google Scholar 

  55. Meeker J, Wegner N, Francisco R, Brage M. Revision techniques in total ankle arthroplasty utilizing a stemmed tibial arthroplasty system. Tec Foot Ankle. 2013;12(2):99–108.

    Article  Google Scholar 

  56. Williams JR, Wegner NJ, Sangeorzan BJ, Brage ME. Intraoperative and perioperative complications during revision arthroplasty for salvage of a failed total ankle arthroplasty. Foot Ankle Int. 2014. doi:10.1177/1071100714554452.

    Google Scholar 

  57. Roukis TS. Tibialis posterior recession for balancing varus ankle contracture during total ankle replacement. J Foot Ankle Surg. 2013;52(5):686–9.

    Article  PubMed  Google Scholar 

  58. Roukis TS. Modified Evans peroneus brevis lateral ankle stabilization for balancing varus ankle contracture during total ankle replacement. J Foot Ankle Surg. 2013;52(6):789–92.

    Article  PubMed  Google Scholar 

  59. Roukis TS, Prissel MA. Reverse Evans peroneus brevis medial ankle stabilization for balancing valgus ankle contracture during total ankle replacement. J Foot Ankle Surg. 2014;53(4):497–502.

    Article  PubMed  Google Scholar 

  60. Donnenwerth M, Roukis TS. Tibio-talo-calcaneal arthrodesis with retrograde intramedullary compression nail fixation for salvage of failed total ankle replacement: A systematic review. Clin Podiatr Med Surg. 2013;30(2):199–206.

    Article  PubMed  Google Scholar 

  61. Paul J, Barg A, Horisberger M, Herrera M, Henninger HB, Valderrabano V. Ankle salvage surgery with autogenous circular pillar fibula augmentation and intramedullary hindfoot nail. J Foot Ankle Surg. 2014;53(5):601–5.

    Article  PubMed  Google Scholar 

  62. Horisberger M, Paul J, Wiewiorski M, Henninger HB, Khalifa MS, Barg A, et al. Commercially available trabecular metal ankle interpositional spacer for tibiotalocalcaneal arthrodesis secondary to severe bone loss of the ankle. J Foot Ankle Surg. 2014;53(3):383–7.

    Article  PubMed  Google Scholar 

  63. Schuberth JM, Christensen JC, Rialson JA. Metal-reinforced cement augmentation for complex talar subsidence in failed total ankle arthroplasty. J Foot Ankle Surg. 2011;50(6):766–72.

    Article  PubMed  Google Scholar 

  64. Ferrao P, Myerson MS, Schuberth JM, McCourt MJ. Cement spacer as definitive management for postoperative ankle infection. Foot Ankle Int. 2012;33(3):173–8.

    Article  PubMed  Google Scholar 

  65. Myerson MS, Shariff R, Zonno AJ. The management of infection following total ankle replacement: demographics and treatment. Foot Ankle Int. 2014;35(9):855–62.

    Article  PubMed  Google Scholar 

  66. Lee H-S, Ahn J-Y, Lee J-S, Lee JY, Jeong JJ, Choi YR. Cement arthroplasty for ankle joint destruction. J Bone Joint Surg Am. 2014;96(17):1468–75.

    Article  PubMed  Google Scholar 

  67. Penner MJ. Failed ankle replacement and conversion to arthrodesis: a treatment algorithm. Tech Foot Ankle. 2012;11(3):125–32.

    Article  Google Scholar 

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Authors and Affiliations

  1. Orthopedic Center, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA

    Thomas S. Roukis DPM, PhD

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  1. Thomas S. Roukis DPM, PhD
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Correspondence to Thomas S. Roukis DPM, PhD .

Editor information

Editors and Affiliations

  1. Gundersen Health System, La Crosse, Wisconsin, USA

    Thomas S. Roukis

  2. Orthopedic Foot and Ankle Center, Westerville, Ohio, USA

    Gregory C. Berlet

  3. Wisconsin Foot and Ankle Institute, Marshfield, Wisconsin, USA

    Christopher Bibbo

  4. Orthopedic Foot and Ankle Center, Westerville, Ohio, USA

    Christopher F. Hyer

  5. Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada

    Murray J. Penner

  6. Foot and Ankle Center Karlsruhe, Karlsruhe, Germany

    Markus Wünschel

  7. Atlantic Foot & Ankle Center of Chesapeake, Chesapeake, Virginia, USA

    Mark A. Prissel

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Roukis, T.S. (2016). Revision of Failed Primary Agility and Agility LP Total Ankle Replacements. In: Roukis, T., et al. Primary and Revision Total Ankle Replacement. Springer, Cham. https://doi.org/10.1007/978-3-319-24415-0_29

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  • DOI: https://doi.org/10.1007/978-3-319-24415-0_29

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  • Publisher Name: Springer, Cham

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