[Ankle arthrodesis after failed joint replacement]

UNLABELLED: Report of four patients.

OBJECTIVE: Restoration of a painless gait through ankle arthrodesis after failed total ankle replacement.

INDICATIONS: Loosened or infected total ankle replacement.

CONTRAINDICATIONS: Poor general health. Absent patient compliance.

SURGICAL TECHNIQUE: Removal of total joint components. Filling of the defect with tricortical bone grafts harvested from the ipsilateral iliac crest and internal fixation. In instances of suspected infection a two-stage procedure is recommended, the first stage consisting of a removal of the components, a meticulous debridement, and filling of the defect with gentamycin-laden PMMA beads. Second stage: arthrodesis.

RESULTS: The goal of surgery was reached without complications in two out of four patients. An absence of bony bridging was noted in the fourth patient after 9 months. A revision adding cancellous bone grafts and resorting to an intramedullary fixation led to a success.