SURGICAL MANAGEMENT OF PATIENTS WITH TOTAL FAILURE OF ANKLE REPLACEMENT (A SYSTEMATIC REVIEW)
Objective - the systematic review of Russian and foreign practices of surgical management of patients with the total failures of ankle replacements. Material and methods. We performed a keyword search of papers retrieved from electronic medical databases PubMed, Google Scholar, eLIBRARY, the Central Scientific Medical Library of I.M. Sechenov First Moscow State Medical University, the Federal State Budgetary Institution of Science All-Russian Institute of Scientific and Technical Information of the Russian Academy of Sciences by ankle implant loosening, arthrodesis after total ankle replacement, total ankle replacement complications, failed total ankle replacement published in English and Russian in 20002020. We retrieved 78 studies and used the following withdrawal criteria to refine the search: the lack of surgical technique description (the complex of surgical methods), or complications in the post-surgical period as well as anatomy or functional outcomes. 42 papers were eventually analyzed, 37 of these were clinical studies and 5 were systematic reviews. 31 researchers were used to analyze the contemporary methods of surgical management for total failure of ankle replacement, another 11 papers were used to additionally assess the evolution of techniques of ankle replacement and bone-grafting arthrodesis. Results. The improvements in total ankle replacement techniques and designs of the third generation implants resulted in the expansion of surgical indications as total replacement provides an adequate range of motions as opposed to arthrodesis. With the number of ankle replacements boosting, the number of complications inexorably increases too, but their incidence does not exceed that of larger joint replacements, as the analyzed studies suggest. We claim two major reasons for revision surgeries after total ankle replacements - the aseptic loosening with the migration of implant components and infectious complications. Low 5-year survival rates of revision implants, major defects that form after removal of primary implants, and poor functioning make osteoplastic arthrodesis the adequate method for managing these cases. Nowadays the features of the most promising combinations of various auto- and allografts, as well as fixators (intramedullary, extramedullary, or transosseous) depending on the types of bone defects that form after removal of implant components, have been debated a lot. Conclusion. As of today, there is no optimal technique for the surgical management of patients with loosened ankle implants. Most experts claim arthrodesis to be the reliable technique of surgical rehabilitation that predictably leads to satisfactory outcomes as long as the ankle was ankylosed. Further studies should focus on searching for a perfect combination of implanted surgical hardware and type of bone graphing depending on the defect in ankle bones.