A Closer Look At Total Ankle Replacement Revision
Failure of the Agility total ankle replacement system leading to revision involves two main etiologies: (1) distal tibio-fibular syndesmosis nonunion and (2) aseptic osteolysis of the tibial and/or talar components with or without secondary component subsidence. Depending on the alignment and integration of the components and size of the osseous defect, multiple revision possibilities exist such that surgeons can revise approximately 80 percent of the failed systems. The revision possibilities include reinforcement of the osseous defects utilizing polymethylmethacrylate cement with or without geometric metal augmentation; use of revision or LP talar components and UHMWPE exchange; or conversion to the INBONE or Salto Talaris Total Ankle Replacement Systems.
Although they are no longer available for use in the U.S., custom stemmed tibial and/or talar components represented viable options and should also be relevant in the future once the FDA loosens the current restrictions and the Salto Talaris XT Revision Total Ankle Prosthesis (Tornier) is cleared for use. Surgeons should reserve arthrodesis or below-knee amputation for select non-reconstructable cases or situations in which the patient does not desire or is medically unable to undergo revision surgery.
Dr. Roukis is an attending foot and ankle surgeon within the Department of Orthopaedics, Podiatry, and Sports Medicine with the Gundersen Health System in La Crosse, Wisconsin. He is a Fellow and President-Elect of the American College of Foot and Ankle Surgeons.
Dr. Prissel is a third-year resident with the Gundersen Medical Foundation in La Crosse, Wisconsin.