Operative Technique of Two Parallel Compression Screws and Autologous Bone Graft for Ankle Arthrodesis After Failed Total Ankle Replacement

摘要

Four patients presented with aseptic loosening following total ankle replacement. Initial indications for ankle replacement were osteoarthritis in three patients and rheumatoid post-traumatic arthritis in one patient. The patients ranged in age from 58 to 73 years and three were male. At surgery the previous scar was used to carry a deep dissection between the tibialis anterior and extensor hallucis longus tendon. The prosthesis was removed and the joint was debrided of all fibrous tissue. Bleeding cancellous bone was exposed and fish-scaling was performed with a small osteotome. The medial malleolus was decorticated. With the hindfoot in neutral position two guide wires were passed, one lateral through the lateral process of the talus and one medial just inferior and slightly anterior and parallel to the first. Two parallel 6.5-mm screws were inserted over the guide wires in opposite directions. The correct position of the screws was confirmed and the defect was packed with autologous cancellous bone graft. The screws were then tightened sequentially to compress the graft using care to prevent vams or valgus deformity. A short leg cast was applied and weight bearing was not allowed for 6 weeks.