The outcomes of revision surgery for a failed ankle arthroplasty

Author:

Jennison Toby1ORCID,Spolton-Dean Claire1,Rottenburg Hannah2,Ukoumunne Obioha2,Sharpe Ian1,Goldberg Andrew3

Affiliation:

1. Royal Devon and Exeter NHS Foundation Trust, Exeter, UK

2. University of Exeter, Exeter, UK

3. Wellington Hospital, London, UK

Abstract

Aims Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed. Results Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed. Conclusion Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques. Cite this article: Bone Jt Open 2022;3(7):596–606.

Publisher

British Editorial Society of Bone & Joint Surgery

Subject

Pharmacology (medical),Complementary and alternative medicine,Pharmaceutical Science

Reference43 articles.

1. The demand incidence of symptomatic ankle osteoarthritis presenting to foot & ankle surgeons in the United Kingdom

2. National Joint Registry Steering Committee. 16th Annual Report 2019: National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. 2019. https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2016th%20Annual%20Report%202019.pdf (date last accessed 12 May 2022).

3. What is a revision of total ankle replacement?

4. HINTEGRA Revision Arthroplasty for Failed Total Ankle Prostheses

5. Outcome After Salvage Arthrodesis for Failed Total Ankle Replacement

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