The treatment of ankle arthrosis can be performed with arthroplasty or arthrodesis, the second being much more performed in practice. When arthroplasty fails, the patient may undergo revision arthroplasty, arthrodesis, or below-the-knee amputation. According to British data, the five-year revision rate is 6.86% for ankle replacements, 2.29% for hip replacements and 2.66% for knee replacements.
The most common indications for revision surgery after placement of an ankle prosthesis are loosening of the material, pain, malalignment and infection. However, there is a scarcity in the literature on the surgical management of failures in this type of surgery, with controversial evidence. It was published last month in the magazine Bone and Joint Open, a systematic review aimed at evaluating functional outcomes and complications after treatment of failed ankle arthroplasty with revision or arthrodesis.
The systematic review was performed in PubMed, Medline, Embase, Cinahl and Cochrane with the acronym (ankle AND (salvage OR arthrodesis OR fusion OR reconstruction)) AND ((revision ankle arthroplasty) OR (revision ankle arthroplasty)). Articles with less than 12 months of follow upcase reports or those who evaluated the results of primary surgeries together with revision or arthrodesis.
Six studies analyzed all causes of reoperations for revision ankle arthroplasties and 14 articles analyzed the outcomes of conversion of arthroplasties into arthrodesis. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of ankle arthroplasties reviews and 13.0% (95% CI 4.9% to 23.4 %) of conversions to arthrodesis required additional surgical intervention. In addition, 14.4% (95% CI 8.4% to 21.4%) of revisions of ankle arthroplasties and 8% (95% CI 4% to 13%) of arthrodesis after arthroplasties failed.
Read too: What is the most cost-effective immobilization for ankle fractures?
Revision of total ankle arthroplasty can be an effective procedure with better functional results, but it has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those undergoing conversion from arthroplasty to arthrodesis, there are high rates of pseudarthrosis. Additional comparative studies are needed to generate more evidence of differences between both surgical techniques.
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