Category: Ankle, Trauma
Keywords: Total Ankle Replacement, Revision Total Ankle Arthroplasty, Outcomes Measures
Introduction/Purpose: Aseptic loosening and subsidence is the most common cause of failure after total ankle arthroplasty (TAA) with bone loss posing one of the most significant challenges in the setting of revision TAA. The purpose of this study was to analyze clinical outcomes and implant survivorship of patients who underwent total talus combination ankle replacement in the setting of a failed TAA.
Methods: A retrospective analysis was performed on patients who underwent total talus combination ankle replacement for a failed TAA at a single academic institution from 2019-2024. Patient demographics, procedure details, complications, and revisions were collected and analyzed. Patients were contacted via telephone to obtain Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM) scores as well as current level of function and surgical satisfaction scores.
Results: A total of 11 patients (12 ankles) were included in this study. There were 5 females (42%) and an average age of 65.9 years (range, 50.0-80.7). At a mean follow up of 3.1 years (range, 1.1-5.9), the average FAAM score was 64.2 (+/- 18.8) and the average VAS score was 0.3 (+/- 1.9), which was significantly improved compared to preoperatively (0.6 +/- 0.2, p < 0.01). Average level of function was 73% (+/- 16%), with 80% of patients reporting being either very satisfied or satisfied with their procedure (Likert > 4/5).
There were no reported complications, and one patient underwent revision total talus with subtalar and talonavicular fusion for adjacent joint arthritis 5.5 years after their procedure, yielding an overall implant survivorship of 91.6%.
Conclusion: Failed TAA with talar bone loss presents a significant challenge to both patients and surgeons. The current case series demonstrates that total talus combination ankle replacement in this setting is a safe and viable option for limb salvage, yielding favorable mid-term outcomes while preserving ankle joint motion.
