Conversion of Painful Ankle Arthrodesis to Total Ankle Arthroplasty

Pain related to a primary ankle arthrodesis can be addressed by revision arthrodesis for nonunion, realignment osteotomies for malposition, and extension of the arthrodesis to the hindfoot for adjacent arthritis; however, the results are often not as favorable as anticipated. Based on the first results, takedown of an ankle fusion and conversion to a total ankle arthroplasty is a reasonable alternative. Conversion of a painful ankle fusion to a replacement is technically possible, depending on how the fusion was done. The less destructive fusions are easier to convert, with better long-term results. The absence of a distal fibula is critical and should thus be a contraindication for conversion to a total ankle arthroplasty. From a technical perspective, using a flat cut instead of a chamfer cut talus for conversions is easier. Several studies have shown significant pain relief and functional improvement, including increased ankle range of motion. Of note, though overall improvement in motion is less than after primary total ankle arthroplasty, empirically, almost all patients are delighted with the range of motion that they obtained.