Strategies for Revision Total Ankle Replacement: 全踝關節置換翻修手術的策略

As the frequency of primary total ankle replacement (TAR) continues to build, revision will become more commonplace. At present there are no “standard principles” associated with revision TAR. What is clear is that the current approaches are technically complex, fraught with complications and no one approach represents the only answer. Exchange of TAR metallic components to the same system standard or dedicated revision components are viable options with limited occurrence of complications. Explantation and conversion to custom-design long stemmed components has limited availability. Explantation and conversion to another TAR system is high-risk and has strong potential for complications. The use of metal reinforced polymethylmethacrylate cement augmentation of failed TAR systems and tibio-talo-calcaneal arthrodesis should be reserved for very select situations where other options are not possible. There is a real need for long-term survivorship following revision TAR and future efforts ought to be directed in this area.

中 文 摘 要隨著全踝關節置換術(total ankle replacement)的持續增長，翻修手術將變得更加普遍。目前並沒有關於全踝關節置換翻修手術的標準原則。有一點很清楚的，就是目前的進路都是技術性複雜，充滿了併發症的風險，並沒有一種進路提供了唯一的答案。使用同一個系統的標準組件或專用版本組件，來更換全踝關節置換的金屬部件的方法是可行的選擇，併發症的出現較少。使用外植和轉換到用戶定製設計長柄組件的方法，選擇性很有限。外植和轉換到另一個全踝關節置換系統則是高風險的方法，併發症的風險高。為失敗的全踝關節置換系統使用金屬加固骨水泥，和脛骨-距骨-跟骨關節融合術的方法，應保留作為當其他選項都是不可能的情況下的選擇。在將來我們需要努力，使全踝關節置換翻修手術有高的長期存活率。