Ankle fusion is often the best way to treat severe ankle arthritis. But major problems can occur. The patient can end up with a painful and very stiff joint that doesn't allow for walking on uneven ground or climbing stairs. This study looks at the results of a new treatment option after ankle fusion: total ankle replacement (TAR).
The first 18 patients to have TAR after ankle fusion were followed for an average of three years. Results were measured for pain, function, and motion. Condition of the joint and alignment were also viewed on X-ray as part of the results.
All but three patients had a good outcome. Most had relief from pain and improved function even without increased motion. The joint implant prevented amputation for 15 patients. The three who had the implant removed would not have tried to convert the ankle fusion if they could do it over again. Three others had to have a second operation to revise the TAR.
When faced with amputation after a failed ankle fusion, TAR is a possible option. The patients most likely to do well converting from fusion to implant have a clear source of pain. They also have intact ankle bones on both sides and a strong deltoid ligament.
The authors conclude that converting to a TAR isn't perfect and doesn't work for everyone. But the results of this first study are encouraging. They think fusion can be improved with this operation.Justin Greisberg, MD, et al. Takedown of Ankle Fusion and Conversion to Total Ankle Replacement. In Clinical Orthopaedics and Related Research. July 2004. Vol. 424. Pp. 80-88.