Foot & Ankle

Tantalum for failed ankle arthroplasty?

The challenges facing the ankle arthroplasty surgeon are well described in this month’s feature article. One of the major challenges is dealing with bone loss following arthroplasty failure, infection or loosening. While in most centres revision for failed arthroplasty is limited to arthrodesis, the bone loss can compromise function, as a short stiff limb can be very disabling. One potential solution is to restore length using graft, in the form of either auto- or allograft. Bulk allograft causes issues with integration, and autograft runs the risk of donor site morbidity. Surgeons in Beirut (Lebanon) describe the use of tantalum to manage shortening associated with significant bone loss.⁵ Tantalum augments have become commonplace in the management of bone loss in arthroplasty. The open porous structure of the tantalum augment allows for a bony through growth. The surgical team report a small series of three patients, all with failed ankle arthrodesis and all managed with tantalum trabecular metal. The salvage procedures were all performed at least six years following arthroplasty. While this article really serves as an illustration of a new technique, the authors do report some outcome measures including the American Orthopaedic Foot and Ankle Society (AOFAS) scores, time to arthrodesis and complication rates. Following arthrodesis, AOFAS score improved from 30.7 pre-operatively (range 20 to 39) to 72.7 at final follow-up (range 65 to 77), with a mean time to bony union reported as around three months, and the authors report that there were no complications observed in this small series.