Ankle Arthrodesis with Structural Grafts Can Work for the Salvage of Failed Total Ankle Replacement. Adam L. Halverson, DO Gregory C.

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1 Ankle Arthrodesis with Structural Grafts Can Work for the Salvage of Failed Total Ankle Replacement Adam L. Halverson, DO Gregory C. Berlet MD, FRCS

2 Adam L. Halverson, DO Ankle Arthrodesis with Structural Grafts Can Work for the Salvage of Failed Total Ankle Replacement Our disclosures are in the Final AOFAS Mobile App. There are no potential conflicts with this presentation

3 Statement of Purpose Surgical treatment options after failed Total Ankle Replacement (TAR) are revision arthroplasty, bone block interposition arthrodesis, and in very rare circumstances, below knee amputation

4 Statement of Purpose This study aims to report short-term and midterm outcomes and radiographic results in a single surgeon group of patients with failed TAR who underwent TTC Fusion with structural femoral head interposition allograft

5 Study Methods Inclusion criteria: Failed TAR treated with TTC nail and structural femoral head allograft Longitudinal, IRB approved: Prospectively collected patient outcome scores Prospective scanogram x-rays for limb length Retrospective chart review Average midterm follow-up 5.2 years 1 year minimum follow-up

6 Study Methods FFI and AOFAS clinical outcomes measures Radiographs were collected and analyzed for fusion mass Scanograms used to judge leg length as an indirect measure of graft collapse

7 Key Technical Points Only dynamically locked retrograde IM nails were used to allow for controlled graft collapse Grafts were fashioned with flat cuts to mate with tibia and residual talus Bone marrow aspirate used to seed allograft femoral head

8 Results 5 Patients enrolled o Age 63.2 (range 56-69) at surgery o Enrollment visits at 1.68 years post-op o 3/5 patients returned for midterm follow-up at 5.2 years post-op AOFAS scores improved from 66.6 (61-77) at enrollment to (54-88) at midterm

9 Results 4 of 5 patients had radiographic union at enrollment as judged by x-rays Limb length discrepancy (average): 1.4 cm at enrollment 1.6 cm at midterm No amputations at any point

10 Discussion Successful limb salvage can be obtained with interposition femoral head grafts in the setting of large defect from failed TAR Leg length discrepancy is less than 2 cm in our case series Dynamically locked nail is key so that graft can see mechanical load

11 Conclusions Tibiotalocalcaneal (TTC) fusion with femoral head allograft is a salvage technique that can lead to a functional arthrodesis and limb salvage in a situation where options are challenging Our results show continued improvement in patient reported outcomes moving from short to midterm follow-up with no trend towards structural allograft resorption

12 References 1. Bartoníček J, Kozánek M, Jupiter JB. History of operative treatment of forearm diaphyseal fractures. J Hand Surg. 2014;39(2): doi: /j.jhsa Berkowitz MJ, Clare MP, Walling AK, Sanders R. Salvage of failed total ankle arthroplasty with fusion using structural allograft and internal fixation. Foot Ankle Int. 2011;32(5):S doi: /fai Carlsson AS, Montgomery F, Besjakov J. Arthrodesis of the ankle secondary to replacement. Foot Ankle Int. 1998;19(4): Chou LB, Mann RA, Yaszay B, et al. Tibiotalocalcaneal arthrodesis. Foot Ankle Int. 2000;21(10): Clowers BE, Myerson MS. A novel surgical technique for the management of massive osseous defects in the hindfoot with bulk allograft. Foot Ankle Clin. 2011;16(1): doi: /j.fcl Culpan P, Le Strat V, Piriou P, Judet T. Arthrodesis after failed total ankle replacement. J Bone Joint Surg Br. 2007;89(9): doi: / x.89b Doets HC, Zürcher AW. Salvage arthrodesis for failed total ankle arthroplasty. Acta Orthop. 2010;81(1): doi: / Donnenwerth MP, Roukis TS. Tibio-talo-calcaneal arthrodesis with retrograde compression intramedullary nail fixation for salvage of failed total ankle replacement: a systematic review. Clin Podiatr Med Surg. 2013;30(2): doi: /j.cpm Hopgood P, Kumar R, Wood PLR. Ankle arthrodesis for failed total ankle replacement. J Bone Joint Surg Br. 2006;88(8): doi: / x.88b Jeng CL, Campbell JT, Tang EY, Cerrato RA, Myerson MS. Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle. Foot Ankle Int. 2013;34(9): doi: / Johl C, Kircher J, Pohlmannn K, Jansson V. Management of failed total ankle replacement with a retrograde short femoral nail: a case report. J Orthop Trauma. 2006;20(1): Kamrad I, Henricson A, Magnusson H, Carlsson Å, Rosengren BE. Outcome After Salvage Arthrodesis for Failed Total Ankle Replacement. Foot Ankle Int. 2016;37(3): doi: / Kile TA, Donnelly RE, Gehrke JC, Werner ME, Johnson KA. Tibiotalocalcaneal arthrodesis with an intramedullary device. Foot Ankle Int. 1994;15(12): Kitaoka HB, Romness DW. Arthrodesis for failed ankle arthroplasty. J Arthroplasty. 1992;7(3): Kotnis R, Pasapula C, Anwar F, Cooke PH, Sharp RJ. The management of failed ankle replacement. J Bone Joint Surg Br. 2006;88(8): doi: / x.88b Millett PJ, O Malley MJ, Tolo ET, Gallina J, Fealy S, Helfet DL. Tibiotalocalcaneal fusion with a retrograde intramedullary nail: clinical and functional outcomes. Am J Orthop Belle Mead NJ. 2002;31(9): Mulhern JL, Protzman NM, White AM, Brigido SA. Salvage of Failed Total Ankle Replacement Using a Custom Titanium Truss. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg. 2016;55(4): doi: /j.jfas Thomason K, Eyres KS. A technique of fusion for failed total replacement of the ankle: tibio-allograft-calcaneal fusion with a locked retrograde intramedullary nail. J Bone Joint Surg Br. 2008;90(7): doi: / x.90b