The reported rates of revision after total ankle arthroplasty (TAA) range from approximately 2.5% to 15%. The primary forms of failure are loose talar component, loose tibial component, dislocation, instability, misalignment, deep infection, fracture (near implant), pain, and defective polyethylene. The main risk factors for revision TAA (RTAA) are inadequate patient selection, deficient surgeon experience, obesity (body mass index [BMI] >30), posttraumatic and end-stage osteoarthritis, poor restoration of bone stock, inadequate prosthetic device selection (poor implant features), insufficient control of risk factors for periprosthetic joint infection (age < 65 years, BMI < 19, BMI >30, tobacco use, diabetes mellitus, inflammatory arthritis, peripheral vascular disease, chronic lung disease, hypothyroidism, previous ankle surgery, wound healing problems more than 14 days postoperatively), and ipsilateral hindfoot fusion. Loosening happens more commonly in fixed-bearing designs than in the mobile-bearing designs. Gamma-sterilized polyethylene inserts experience fatigue damage or fracture in vivo, resulting in the need for revision. The Salto mobile design has a higher rate of revision than the Salto-Talaris design; however, the reported frequency of revision for the Salto mobile version and Salto-Talaris TAAs is lower than that reported for the Agility and STAR systems without obvious selection (inventor) or publication (conflict of interest) bias. The reported overall 10-year survival of the Ankle Evolutive System (AES) prosthesis, a mobile-bearing TAA evolved from the Buechel Pappas model TAA, is lower than with other designs, particularly due to cyst lesions. At 20 months’ follow-up, the two-component Infinity prosthesis had shown a high early revision rate due to tibial component loosening compared with other implant systems. The INBONE I prosthesis is at a significantly higher risk of implant failure than the INBONE II, STAR (Swedish Total Ankle Replacement), and Salto-Talaris prostheses.
Revision Total ankle arthroplasty Epidemiology Causes Risk factors
This is a preview of subscription content, log in to check access.
Prissel MA, Roukis TS. Incidence of revision after primary implantation of the Scandinavian Total Ankle Replacement system: A systematic review. Clin Podiatr Med Surg. 2013;30:237–50.CrossRefGoogle Scholar
Roukis TS, Elliott AD. Incidence of revision after primary implantation of the Salto ® mobile version and Salto Talaris ™ total ankle prostheses: a systematic review. J Foot Ankle Surg. 2015;54:311–9.CrossRefGoogle Scholar
Labek G, Todorov S, Iovanescu L, Stoica CI, Böhler N. Outcome after total ankle arthroplasty-results and findings from worldwide arthroplasty registers. Int Orthop. 2013;37:1677–82.CrossRefGoogle Scholar
Noelle S, Egidy CC, Cross MB, Gebauer M, Klauser W. Complication rates after total ankle arthroplasty in one hundred consecutive prostheses. Int Orthop. 2013;37:1789–94.CrossRefGoogle Scholar
Lai WC, Arshi A, Ghorbanifarajzadeh A, Williams JR, Soohoo NF. Incidence and predictors of early complications following primary and revision total ankle arthroplasty. Foot Ankle Surg. 2018 . pii: S1268-7731(18)30325-4; https://doi.org/10.1016/j.fas.2018.10.009.
Law TY, Sabeh KG, Rosas S, Hubbard Z, Altajar S, Roche MW. Trends in total ankle arthroplasty and revisions in the Medicare database. Ann Transl Med. 2018;6(7):112.CrossRefGoogle Scholar
Sadoghi P, Roush G, Kastner N, Leithner A, Sommitsch C, Goswami T. Failure modes for total ankle arthroplasty: a statistical analysis of the Norwegian Arthroplasty Register. Arch Orthop Trauma Surg. 2014;134:1361–8.CrossRefGoogle Scholar
Horisberger M, Henninger HB, Valderrabano V, Barg A. Bone augmentation for revision total ankle arthroplasty with large bone defects. Acta Orthop. 2015;86:412–4.CrossRefGoogle Scholar
Patton D, Kiewiet N, Brage M. Infected total ankle arthroplasty: risk factors and treatment options. Foot Ankle Int. 2015;36:626–34.CrossRefGoogle Scholar
Demetracopoulos CA, Adams SB Jr, Queen RM, DeOrio JK, Nunley JA 2nd, Easley ME. Effect of age on outcomes in total ankle arthroplasty. Foot Ankle Int. 2015;36:871–80.CrossRefGoogle Scholar
Steck JK, Schuberth JM, Christensen JC, Luu CA. Revision total ankle arthroplasty. Clin Podiatr Med Surg. 2017;34:541–64.CrossRefGoogle Scholar
Di Iorio A, Viste A, Fessy MH, Besse JL. The AES total ankle arthroplasty analysis of failures and survivorship at ten years. Int Orthop. 2017;41:2525–33.CrossRefGoogle Scholar
Elliott AD, Roukis TS. Anterior incision offloading for primary and revision total ankle replacement: a comparative analysis of two techniques. Open Orthop J. 2017;11:678–86.CrossRefGoogle Scholar
Althoff A, Cancienne JM, Cooper MT, Werner BC. Patient-related risk factors for periprosthetic ankle joint infection: an analysis of 6977 total ankle arthroplasties. J Foot Ankle Surg. 2018;57:269–72.CrossRefGoogle Scholar
Sansosti LE, Van JC, Meyr AJ. Effect of obesity on total ankle arthroplasty: a systematic review of postoperative complications requiring surgical revision. J Foot Ankle Surg. 2018;57:353–6.CrossRefGoogle Scholar
Gramlich Y, Neun O, Klug A, Buckup J, Stein T, Neumann A, Fischer S, Abt HP, Hoffmann R. Total ankle replacement leads to high revision rates in posttraumatic end-stage arthrosis. Int Orthop. 2018;42:2375–81.CrossRefGoogle Scholar
Cody EA, Bejarano-Pineda L, Lachman JR, Taylor MA, Gausden EB, DeOrio JK, Easley ME, Nunley JA 2nd. Risk factors for failure of total ankle arthroplasty with a minimum five years of follow-up. Foot Ankle Int. 2018. doi: https://doi.org/10.1177/1071100718806474.