Salvage of the Failed Ankle

When a total ankle arthroplasty fails, revision arthroplasty is often impossible owing to a severe loss of tibia or talus bone stock, soft tissue problems, or infection, and a salvage arthrodesis becomes a reliable treatment option. A tibiotalar arthrodesis is generally preferred over tibiotalocalcaneal arthrodesis to maintain function across the subtalar joint and because the union rate is higher for tibiotalar arthrodesis. In cases of inadequate talus bone stock, tibiotalocalcaneal arthrodesis is necessary. Autograft or allograft bone can be used to maintain length. Metal implants have been proposed as an alternative, but they must prove their reliability in further studies. Whatever technique is used, the fibula should be preserved as it significantly stabilizes the arthrodesis construct. The reported union rate in the literature varies significantly, averaging between 80% and 95%.