J Korean Foot Ankle Soc.  2014 Jun;18(2):76-79. 10.14193/jkfas.2014.18.2.76.

Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report

• Park MJ
• Eun IS
• Jung CY
• Ko YC
• Yoo CI
• Kim MW
• Hwang KM

• KMID: 2181665
• DOI: http://doi.org/10.14193/jkfas.2014.18.2.76

Abstract

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

Keyword

Total ankle replacement; Limb salvage; Bone defect; Internal fixation

MeSH Terms

Ankle Joint
Ankle*
Arthroplasty*
Arthroplasty, Replacement, Ankle
Dislocations
Female
Head
Humans
Limb Salvage
Middle Aged
Necrosis
Prostheses and Implants
Talus
Transplants

Figure

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  Figure 1. Preoperative ankle anteroposterior view (A) and lateral view (B) show bony destruction with fracture of distal tibia, large bone defect of ankle joint and implant loosening around talar component.

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  Figure 2. Intraoperative photograph shows the separated implants, bone fragments and cement matarials.

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  Figure 3. Immediate postoperative ankle anteroposterior view (A) and lateral view (B) show the results of salvage procedure with cancellous bone grafting using allo-femoral head.

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  Figure 4. Eight-years follow-up ankle anteroposterior view (A) and lateral view (B) show that ankle alignment was maintained with fibrous union of grafted material. Ankle coronal view (C) and sagittal view (D) of computed tomography show bone absorption of talus and mild subcidense of calcaneus.

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  Figure 5. Follow-up gross photos at postoperative 8-years. Anterior view with standing (A) and lateral view (B).

Reference

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