Revision Total Ankle Replacement

INTRODUCTION: The technique for revision total ankle replacement described in this article addresses the subsidence and loosening that occur when an Agility total ankle replacement fails. STEP 1: INDICATIONS AND CONTRAINDICATIONS: The main indications for revision total ankle arthroplasty include loosening and subsidence of the talar component, with no limit to the extent of subsidence or loss of talar bone stock as neither precludes use of a revision system, particularly when a flat cut on the talus can be made. STEP 2: ANTERIOR INCISION AND JOINT EXPOSURE: Make the incision employing the prior anterior midline incision, create full-thickness flaps of tissue to diminish the risk of wound dehiscence, and completely expose and debride the joint as this is critical to revising the total ankle replacement correctly. STEP 3: REMOVE THE TALAR COMPONENT AND POLYETHYLENE: Remove the talar component, which is rarely difficult as it is usually loose. STEP 4: REMOVE THE TIBIAL COMPONENT: When removing the tibial component, it is critical to preserve as much of the anterior tibial cortex as possible to provide support for the revision tibial component. STEP 5: MAKE THE TIBIAL BONE CUT: Tibial cuts can be made proximal or distal to tibial osseous defects. STEP 6: MAKE THE TALAR BONE CUT: It is preferable to use a cutting block for the talus that attaches to the tibial guide. STEP 7: MANAGING LOOSENING AND CAVITARY DEFECTS: If there is substantial bone loss around the tibia after component removal, consider impaction bone-grafting, as better bone quality makes it is easier to obtain a press fit and allow immediate weight-bearing. STEP 8: PLACE TRIAL COMPONENTS: Size the tibia and talus and subsequently insert the tibial and talar trials and polyethylene simultaneously. STEP 9: CEMENTING TECHNIQUE: In revision settings, manual cement insertion is important because there is no medullary canal to work around. RESULTS: We previously reported the outcomes of revision of failed Agility total ankle replacements (DePuy, Warsaw, Indiana) in forty-one patients. Pitfalls & Challenges