In our experience, revision ankle arthroplasty with a three-component total ankle prosthesis following a failed total ankle replacement has provided encouraging midterm results with substantial pain relief while preserving the range of motion of the replaced ankle.
Step 1: Preoperative Assessment and Planning
Determine the treatment using a decision algorithm.
Step 2: Patient Positioning
Use spinal or general anesthesia, administer intravenous antibiotics, position the patient supine, and apply a tourniquet.
Step 3: Surgical Approach to the Failed Prosthesis
Use an anterior approach to expose the failed ankle prosthesis.
Step 4: Removal of the Prosthesis
Remove the polyethylene insert, the talar component, and the tibial component, making sure to not compromise any remaining bone stock.
Step 5: Revision Ankle Arthroplasty
Prepare the tibial and talar bone stock to obtain solid osseous surfaces, and use the appropriate prosthetic components.
Step 6: Additional SurgicalProcedures (If Necessary)
If necessary, perform arthrodesis of adjacent joints, correcting osteotomies of the distal parts of the tibia and fibula, calcaneal osteotomy, and/or ligamentoplasty.
Step 7: Closure of All Incisions
Close all incisions.
Step 8: Postoperative Care
A short leg splint is worn for two days, followed by partial weight-bearing; the ankle is protected in a splint at night and with a walking boot during the day for six to eight weeks.
Between 2000 and 2010, 117 ankles in 116 patients (fifty-six female and sixty male; mean age, 55.0 ± 12.0 years) who presented with a failed total ankle arthroplasty after a mean of 4.3 ± 3.9 years were treated by revision arthroplasty with use of the HINTEGRA three-component total ankle prosthesis12.
What to Watch For
Pitfalls & Challenges