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Ankle and Tibio-talo-calcaneal Arthrodesis After Failed Total Ankle Replacement

  • Falk Mittag
  • Markus Wünschel
Chapter

Abstract

Although survivorship of modern total ankle replacement has obviously improved compared to early prostheses, it still does not reach that of total knee or hip arthroplasty. Aseptic loosening and acute or chronic infection are the main causes of failed total ankle replacement. Due to excessive loss of bone stock especially of the talus, revision total ankle replacement is often impossible or involves substantial risks. Therefore ankle or tibio-talo-calcaneal arthrodesis with autograft or allograft of bone is a salvage procedure. Sacrificed ankle joint mobility results in a stable bony situation with negligible loss of leg length in most cases. In the rare case of enough bone stock of the talus after removal of the implant, ankle arthrodesis with screws and plates with additional bone insertion could be performed. In most other cases of substantial bone loss of the talus, additional arthritis of the subtalar joint, or comorbidities such as rheumatoid arthritis, authors prefer a retrograde intramedullary nailing system. Because those implants have only been established within the last 15 years, just a few articles have been published on that topic with overall good results. Since tibio-talo-calcaneal arthrodesis by retrograde intramedullary nail is a challenging procedure, it should only be performed by experienced surgeons.

Keywords

Ankle fusion Bone defect Complications Revision surgery Salvage procedure Tibio-talo-calcaneal arthrodesis 

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryUniversity TuebingenTuebingenGermany
  2. 2.Foot and Ankle Center KarlsruheKarlsruheGermany

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