Treatment of failed total ankle arthroplasty is a challenge. To date, several revision modalities and techniques have been described, but there is still no ideal concept that fits for every patient. Surgical options comprise revision ankle arthroplasty, amputation, or salvage arthrodesis, with the latter being a viable approach because it has been proven to be reliable in achieving a stable and plantigrade foot. The goals of revision surgery include maximum pain relief, restoration of stability and length, and correction of alignment. When properly done, arthrodesis yields a significant improvement regarding pain and ensures stability and an adequate gait pattern.
Massive bone loss associated with or without deformity of the hindfoot and/or coexisting subtalar osteoarthrosis pose specific problems. In such cases, tibiotalocalcaneal arthrodesis must be combined with reconstruction of the ankle region by filling the defect with a structural allograft. Among all the described techniques, the use of locked intramedullary nails offers several advantages, particularly in combination with allograft interposition.