Abstract
Statement of purpose
To describe the results and technique of ankle fusion following failed Total Ankle Replacement (TAR) in a limb reconstruction unit.
Methods
Retrospective case note, microbiology and imaging review was performed on four consecutive patients referred to the limb reconstruction unit for salvage of infected total ankle replacement surgery since 2009. The patients were identified from operative list and tertiary referral records. A review of the current literature regarding TAR was performed.
Results
Three patients were treated with a two stage surgical approach with initial removal of metalwork, debridement of infected tissue and temporary spanning external fixation. Local and systemic antibiotic therapy was then implemented for an average period of 53 days (range 48–61 days), before definitive fixation with a circular frame. One patient showed no clinical evidence of infection during preoperative investigation or intraoperatively, and was therefore treated with a single stage procedure with application of a circular frame. All four patients grew Staphylococci on culture of excised tissue and in one case there was additional growth of Proteus species. Bony union was achieved after fusion with a circular frame in all cases.
Conclusion
TAR is gaining popularity for the treatment of severe talocrural arthritis, and several series with medium term results report low numbers of infected cases requiring revision. This case series discusses and describes the management strategy for failed TAR due to infection employed by a limb reconstruction unit.
