Tibiotalar Salvage Procedures for Failed Ankle Arthrodesis

Description: Tibiotalar fusion remains the mainstay of surgical treatment for end-stage arthritis of the ankle joint. Pseudoarthrosis may occur for a variety of reasons including concomitant medical illness, previous high energy trauma, sepsis, technical failure, inadequate bone stock and noncompliance. The rate of pseudoarthrosis after ankle arthrodesis has been reported to range from 0% to 41%. A symptomatic nonunion of an ankle fusion can be managed with revision arthrodesis. The patient should be carefully evaluated and any factors contributing to the nonunion should be identified and, if possible, eliminated. Any risk factor which can be controlled, such as smoking, noncompliance, or steroid use, should be addressed prior to surgery. Surgical planning is essential prior to revision arthrodesis. Technical reasons for failure, such as inadequate fixation or poor bony apposition may be evident on radiograph. If infection is found, debridement and treatment with the appropriate antibiotics are necessary. At the time of surgery, all fibrous tissue and avascular bone in the nonunion site must be removed to allow apposition of good bleeding bone. Good bone stock and adequate circulation is critical for a good result. While results comparable to those seen in primary arthrodesis have been reported, revision procedures may be technically difficult with a higher complication rate and decreased patient satisfaction.
Stuart E. Levine, MD, and Michael F. Harrer, MD Medscape General Medicine. 1999;1(1) Full text