Outcomes of Salvage Arthrodesis and Arthroplasty for Failed Osteochondral Allograft Transplantation of the Ankle

Florian Gaul; Cameron R Barr; Julie C McCauley; Steven N Copp; William D Bugbee

doi:10.1177/1071100718824082

Outcomes of Salvage Arthrodesis and Arthroplasty for Failed Osteochondral Allograft Transplantation of the Ankle

Foot Ankle Int. 2019 May;40(5):537-544. doi: 10.1177/1071100718824082. Epub 2019 Jan 30.

Authors

Florian Gaul^{1

2

3}, Cameron R Barr⁴, Julie C McCauley¹, Steven N Copp⁴, William D Bugbee^{1

4}

Affiliations

¹ 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA.
² 2 Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA.
³ 4 Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Germany.
⁴ 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA.

PMID: 30698469
DOI: 10.1177/1071100718824082

Abstract

Background: Osteochondral allograft (OCA) transplantation is a useful treatment for posttraumatic ankle arthritis in young patients, but failure rates are high and reoperations are not uncommon. The aim of this study was to evaluate the outcomes of failed ankle OCA transplantation converted to ankle arthrodesis (AA) or total ankle arthroplasty (TAA).

Methods: We evaluated 24 patients who underwent salvage procedures (13 AA and 11 TAA) after primary failed ankle OCA transplantation. Reoperations were assessed. Failure of the salvage procedure was defined as an additional surgery that required a revision AA/TAA or amputation. Evaluation among nonfailing ankles included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM), pain, and satisfaction.

Results: In the salvage AA cohort, 3 patients were classified as failures (2 revision AA and 1 amputation). The 10 nonfailing patients had a mean follow-up of 7.4 years. Eighty-eight percent were satisfied with the procedure, but 63% reported continued problems with their ankle (eg, pain, swelling, stiffness). Mean pain level was 1.9 and AAOS-FAM core score was 83±13. In the salvage TAA cohort, 2 patients were classified as failures (both revision TAA). The 9 nonfailing patients had a mean follow-up of 3.8 years. Fifty percent were satisfied with the procedure, but 40% reported continued problems with their ankle. The mean pain level was 1.3, and the median AAOS-FAM core score was 82±26.

Conclusion: Revision and reoperation rates for salvage procedures following failed OCA transplantation of the ankle are higher compared to published data for primary AA and TAA procedures. However, we believe OCA transplantation can serve as an interim procedure for younger patients with advanced ankle joint disease who may not be ideal candidates for primary AA or TAA at the time of initial presentation.

Level of evidence: Level IV, case series.

Keywords: ankle; arthrodesis; arthroplasty; cartilage repair; failed osteochondral allograft transplantation; salvage procedures.

MeSH terms

Adult
Aged
Allografts
Ankle Joint / pathology
Ankle Joint / surgery*
Arthrodesis*
Arthroplasty, Replacement, Ankle*
Cartilage, Articular / transplantation*
Female
Humans
Male
Middle Aged
Osteoarthritis / surgery*
Pain Measurement
Patient Satisfaction
Reoperation
Salvage Therapy*
Surveys and Questionnaires
Treatment Failure