P003 - Outcomes of Salvage Arthrodesis and Arthroplasty for Failed Osteochondral Allograft Transplantation of the Ankle.
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 salvage procedures after failed ankle OCA transplantation to determine if they are comparable to primary ankle arthrodesis (AA) and total ankle arthroplasty (TAA).
Methods and Materials
We evaluated 24 patients who underwent salvage procedures (13 AA and 11 TAA) after primary failed ankle OCA transplantation. All patients had a minimum follow-up of 2 years. Reoperations were assessed. Failure of the salvage procedure was defined as an additional surgery that required a revision AA/TAA or amputation. Evaluation among non-failing ankles included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM), pain, and satisfaction.
In the salvage AA cohort, 3 patients were classified as failures (2 revision AA and 1 amputation). The 10 non-failing 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 (i.g. pain, sewlling, 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 non-failing 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. Mean pain level was 1.3 and median AAOS-FAM core score was 82±26.
Revision and reoperations rates for salvage procedures following failed OCA transplantation of the ankle are higher compared to published data for primary procedures. However, OCA transplantations can buy some time for young patients with significant ankle joint disease to delay further procedures. A careful patient selection is critical and proper patient information is required.