Background: Contemporary recommendations for primary and revision ankle arthrodesis favor internal compression techniques involving the use of screw and/or plate fixation. While tibiotalocalcaneal arthrodesis with internal fixation may be a suitable method of salvage for the treatment of a failed tibiotalar arthrodesis in selected patients, ring external fixation has been reported as an alternative. We reviewed our experience with revision tibiotalar arthrodesis, with a focus on ring external fixation.
Methods: Forty-five consecutive patients underwent revision tibiotalar arthrodesis with use of repeat internal fixation (eleven patients), ring external fixation (twenty-two patients), or tibiotalocalcaneal arthrodesis (twelve patients). Union rates were assessed radiographically, and functional outcome was determined with use of preoperative and postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scores.
Results: All forty-five patients were available for follow-up at an average of 50.3 months. The average ankle-hindfoot score improved from 31.1 points preoperatively to 65.8 points at the time of the most recent follow-up. At the time of the most recent follow-up, the union rate was 88.9% (forty of forty-five). Fusion was achieved with revision tibiotalar arthrodesis in thirty-six (80%) of forty-five patients, including eight of the eleven patients in the repeat internal fixation group, nineteen of the twenty-two patients in the ring external fixation group, and nine of the twelve patients in the tibiotalocalcaneal arthrodesis group. Re-revision led to union in four of five patients. The overall union rate for ring external fixation, including revision and re-revision tibiotalar arthrodeses, was 84.6% (twenty-two of twenty-six). The five patients with persistent nonunion following revision ankle arthrodesis opted for transtibial amputation.
Conclusions: Revision tibiotalar arthrodesis leads to satisfactory limb salvage in a majority of patients. Ring external fixation may facilitate clinically acceptable limb salvage in complex cases when methods of internal fixation are limited or even contraindicated.
Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.