Sagherian, Bernard H.

Ankle arthrodesis remains the gold standard for the treatment of end-stage ankle arthritis, despite the significant improvement in the clinical outcomes of total ankle arthroplasty because of newer designs. Posttraumatic degeneration is the most common cause of ankle arthritis. Other causes include infection, systemic arthritides, and avascular necrosis. Many tibiotalar arthrodesis techniques have been described with varying fusion and complication rates. This paper describes a reliable and reproducible technique of ankle arthrodesis based on the tension-band technique and modern internal fixation principles. This technique results in very high fusion rates with few complications. Level of Evidence: Diagnostic Level 4. See Instructions for Authors for a complete description of levels of evidence.

Background: Although newer generations of total ankle arthroplasty designs have better clinical outcomes, failure due to aseptic loosening remains a frequent major complication. Arthrodesis is the most common salvage procedure for a failed total ankle replacement. There are several arthrodesis techniques each with its advantages and disadvantages. We present a technique of ankle arthrodesis for failed total ankle replacements using tantalum Trabecular Metal™ (Zimmer, Warsaw, IN) with internal fixation, thus sparing the subtalar joint. Methods: Three patients who had undergone arthrodesis for a failed total ankle replacement using tantalum Trabecular Metal were retrospectively reviewed. The mean follow-up period was 57 (range, 31-86) months. The mean age at ankle arthroplasty was 57 (range, 33-72) years and at ankle arthrodesis was 63 (range, 44-74) years. The mean time from arthroplasty to arthrodesis was 7 (range, 2-11) years. Results: The American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 30.7 (range, 20-39) preoperatively to 72.7 (range, 65-77) postoperatively at the time of last follow-up. Arthrodesis was achieved at a mean of 3 months, and there were no complications. Conclusion: The technique described has several advantages when compared to other methods of salvage ankle arthrodesis. The subtalar joint is not included in the fusion unless it is degenerative and symptomatic. Height of the ankle is maintained throughout the fusion process. Furthermore, Trabecular Metal is abundantly available; it avoids donor site morbidity and eliminates the risk of transmissible diseases. Level of Evidence: Level V, expert opinion.