Revision arthroplasty could provide alternative to arthrodesis

http://www.healio.com/orthopedics/foot-ankle/news/online/%7Be2a5c0e0-b34c-4984-a200-26926e525064%7D/revision-arthroplasty-could-provide-alternative-to-arthrodesis

Revision arthroplasty could provide alternative to arthrodesis

Ellington JK. J Bone Joint Surg Am. 2013;doi:10.2106/JBJS.K.00920.

• December 12, 2013

When treating patients with a failed Agility total ankle implant, revision arthroplasty may be considered as an alternative to arthrodesis, even though there were obvious functional limitations, according to study results published in the Journal of Bone and Joint Surgery.

Researchers performed a retrospective review of 53 patients who underwent revision total ankle replacement (TAR) between January 2002 and July 2008 and had a minimum 2-year follow-up. Researchers assessed patients radiographically and with outcome scores, as well as rates of conversion to amputation or fusion.

Forty-one of the 53 patients were available for follow-up. In five of the 41 patients, revision arthroplasty was converted to an arthrodesis, and two patients underwent amputation. According to the study, the most common indication for revision TAR was talar subsidence. At the time of the revision arthroplasty, 22 patients had a subtalar arthrodesis performed, with 19 of those having a custom-designed long-stem talar component placed simultaneously. According to study results, the mean radiographic measurements of component position did not change significantly postoperatively.

For the 34 patients with a retained TAR, researchers found the mean postoperative scores were 4.4 of 10 on a Visual Analog Pain scale, 65 of 100 on the AOFAS hindfoot scale, 93.5 of 100 on the Short-Form 12, 137.9 of 204 on the Revised Foot Function Index and 64 of 180 on the Ankle Osteoarthritis Scale (AOS). The mean arc of motion radiographically was 18° preoperatively and 23° postoperatively, with all improvements occurring in plantar flexion. Based on the AOFAS hindfoot score and the AOS score, a lesser amount of preoperative talar subsidence was a significant predictor of a good outcome.

Although 30 patients were able to return to previous job responsibilities, 18 were able to return to their previous level of activity.

"In conclusion, although most patients reported satisfaction with the revision surgery, the complication rate remains high and the technical demands of this surgery are substantial," the researchers wrote. "Finally, we strongly emphasize the need for close surveillance of both primary and revised total ankle replacements to monitor for early signs of failure, particularly talar subsidence."

Disclosure: The researchers report no relevant financial disclosures.