# Salvage Procedure for a Failed Tibiotalar Arthrodesis: A Trans‐Achilles Approach for Ankle Fusion Using a Posterior Plate—Case Reports and Literature Review

## TL;DR

This paper presents a successful salvage procedure for failed ankle fusions using a trans-Achilles approach with a posterior plate, based on two clinical cases.

## Contribution

The paper introduces a trans-Achilles approach as a novel salvage option for failed tibiotalar arthrodesis.

## Key findings

- A trans-Achilles approach with posterior plate achieved successful arthrodesis in a patient with nonunion after ankle fusion.
- A posterior approach for arthrodesis was effective in treating talar avascular necrosis with no complications after 2 years.
- The trans-Achilles approach is suggested as a suitable option when the anterior approach risks soft tissue compromise.

## Abstract

Treatment of ankle osteoarthritis (OA) is controversial. The early age of onset and the lack of consensus about the moment and type of surgical intervention among experts have pointed this disease as a matter for debate. Nonunion is a rather common complication after a tibiotalar arthrodesis. Several approaches have been described in the literature for failed ankle replacement, but there are fewer salvage alternatives for a failed arthrodesis. In this article, we present two clinical cases. The first one involves a 57‐year‐old woman diagnosed with primary ankle OA who underwent ankle arthrodesis (AA), which subsequently resulted in nonunion. A rescue procedure was suggested, and a trans‐Achilles approach using a plate for fixation was proposed. Arthrodesis was successfully achieved, and the patient remains satisfied with the outcomes. In the second case, we present a 44‐year‐old man with talar avascular necrosis after a AA. Due to persistent pain, a new arthrodesis via posterior approach was performed allowing good exposure of the necrosis area. No complications were reported after 2 years of postoperative follow‐up. As a conclusion, in our experience, trans‐Achilles rearthrodesis with a posterior plate after ankle fusion failure could be a suitable salvage option in patients in whom the anterior approach may involve soft tissue compromise.