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Revision Total Ankle Arthroplasty: Managing Osteolysis and Subsidence
In total joint arthroplasties, the mode of failure varies with the duration of implantation; infection and malalignment predominate early on, whereas aseptic loosening dominates in the later stages. Aseptic loosening occurs as a result of osteolysis, which is characterized by a chronic granulomatous inflammatory response that is stimulated and maintained by implant-derived wear debris. Symptoms generally do not occur before osteolysis has progressed to the point of implant loosening. Overwhelming data in the arthroplasty literature indicate that implant wear particles are the initiator of osteolysis. Any particulate wear debris, including polyethylene, polymethyl methacrylate, or metallic particles, can initiate an osteolytic reaction. The choice of prosthesis and bearing surface affects the composition, size, shape, and concentration of the generated particulate matter. Polyethylene, the predominant particulate debris, is dispersed with joint motion and then occupies the effective joint space. This chapter reviews techniques for managing ostgeolysis and subsidence in revision total ankle arthroplasty.