SALVAGE OF PSEUDARTHROSIS AFTER TIBIOTALAR ARTHRODESIS

We retrospectively reviewed the treatment of a selected group of 23 pa tients with pseudoarthrosis after ankle arthrodesis who underwent revi sion arthrodesis at an average of 1.7 years (range, 0.3-17.0 years) af ter the initial, unsuccessful procedure. Fourteen patients underwent i solated revision tibiotalar arthrodesis, and 9 had an additional hindf oot arthrodesis (7 tibiotalocalcaneal, 2 pantalar) performed at the ti me of the procedure. Rigid internal fixation with screws was performed when possible, and, in patients with poor bone quality, an external f ixator was used. Autogenous bone grafting was used in 14 patients wher e bone loss was present. Twenty-one of 23 patients had successful unio n (average, 14 weeks; range, 6-48 weeks), Two patients had persistent ankle nonunions; one was asymptomatic, and one had symptomatic subtala r arthritis. Two patients underwent successful arthrodesis but had per sistent pain from reflex sympathetic dystrophy. Overall, 19 of 23 pati ents were satisfied with the surgery. We conclude that revision arthro desis for tibiotalar pseudoarthrosis is a worthwhile procedure.