• INTRODUCTION
    • 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.
  • RESULTS
    • 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
    • IndicationsContraindicationsPitfalls & Challenges.