Ankle Arthrodesis for Salvage of the Failed Total Ankle Arthroplasty

Examination/Imaging

• A careful history and physical examination remain critical for the clinician to begin planning intervention in this situation. Any history of trauma, infection, or pattern of discomfort can give important clues as to the nature of the TAA failure. There are situations wherein the history will reveal definitive circumstances that cause pain and that can reduce the discomfort for the patient.

• The clinical examination includes careful evaluation of ankle position, skin condition, previous incisions, swelling, range of motion, and specific areas of tenderness. In addition, clinical evaluation of the ipsilateral foot, particularly as it pertains to deformity and whether it is supple or fixed, is recommended. Attention to contracture of the Achilles tendon and/or gastrocnemius should be standard.

• The radiographic evaluation includes standing anteroposterior, lateral, and mortise views of both ankles in the standing position as well as standing radiographs of the feet. The weight-bearing position is critical in this assessment, as are the foot radiographs, to help establish an accurate assessment of the lower extremity. Particular attention should be paid to the component position, osteolysis and cyst formation, fractures, bone loss, and the condition of the ipsilateral subtalar joint and foot.

• Computed tomography (CT) is another useful diagnostic tool. This study allows for the planning of the arthrodesis as it pertains to bone loss/defects and the status of the subtalar joint. Although scatter from the metal implants can make complete visualization of the bone directly associated with the TAA difficult, CT remains very useful.