Revision tibiotalar arthrodesis

J Bone Joint Surg Am. 2008 Jun;90(6):1212-23. doi: 10.2106/JBJS.G.00506.

Abstract

Background: Contemporary recommendations for primary and revision ankle arthrodesis favor internal compression techniques involving the use of screw and/or plate fixation. While tibiotalocalcaneal arthrodesis with internal fixation may be a suitable method of salvage for the treatment of a failed tibiotalar arthrodesis in selected patients, ring external fixation has been reported as an alternative. We reviewed our experience with revision tibiotalar arthrodesis, with a focus on ring external fixation.

Methods: Forty-five consecutive patients underwent revision tibiotalar arthrodesis with use of repeat internal fixation (eleven patients), ring external fixation (twenty-two patients), or tibiotalocalcaneal arthrodesis (twelve patients). Union rates were assessed radiographically, and functional outcome was determined with use of preoperative and postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scores.

Results: All forty-five patients were available for follow-up at an average of 50.3 months. The average ankle-hindfoot score improved from 31.1 points preoperatively to 65.8 points at the time of the most recent follow-up. At the time of the most recent follow-up, the union rate was 88.9% (forty of forty-five). Fusion was achieved with revision tibiotalar arthrodesis in thirty-six (80%) of forty-five patients, including eight of the eleven patients in the repeat internal fixation group, nineteen of the twenty-two patients in the ring external fixation group, and nine of the twelve patients in the tibiotalocalcaneal arthrodesis group. Re-revision led to union in four of five patients. The overall union rate for ring external fixation, including revision and re-revision tibiotalar arthrodeses, was 84.6% (twenty-two of twenty-six). The five patients with persistent nonunion following revision ankle arthrodesis opted for transtibial amputation.

Conclusions: Revision tibiotalar arthrodesis leads to satisfactory limb salvage in a majority of patients. Ring external fixation may facilitate clinically acceptable limb salvage in complex cases when methods of internal fixation are limited or even contraindicated.

MeSH terms

  • Aftercare
  • Ankle Joint / diagnostic imaging
  • Ankle Joint / surgery*
  • Arthrodesis / instrumentation*
  • Arthrodesis / methods*
  • Female
  • Humans
  • Limb Salvage
  • Logistic Models
  • Male
  • Orthopedic Fixation Devices*
  • Postoperative Complications
  • Radiography
  • Reoperation
  • Subtalar Joint / diagnostic imaging
  • Subtalar Joint / surgery*
  • Tibia / diagnostic imaging
  • Tibia / surgery*
  • Treatment Outcome