What is Revisional Ankle Surgery?

Revisional ankle surgery refers to procedures performed to correct problems that remain or develop after a previous ankle surgery. While many ankle surgeries—such as fracture repair, ligament reconstruction, or ankle replacement—are successful, some patients may experience complications, implant failure, or persistent pain. Revisional surgery is designed to restore function, relieve pain, and correct deformities when the initial procedure does not achieve the desired outcome.

Causes

Revisional ankle surgery may be needed for several reasons, including:

  • Implant failure or loosening after ankle replacement

  • Infection around the surgical site or prosthetic joint

  • Malalignment or deformity that was not corrected or has recurred

  • Scar tissue buildup (arthrofibrosis) causing stiffness and pain

  • Nonunion or poor healing after fracture fixation or fusion

  • Persistent instability due to weakened ligaments or tendon failure

  • Progressive arthritis in or around the ankle joint

Symptoms

Patients who may require revisional ankle surgery often experience:

  • Ongoing or worsening ankle pain despite prior surgery

  • Swelling, stiffness, or limited range of motion

  • Instability or difficulty bearing weight on the ankle

  • Visible deformity or collapse of the ankle joint

  • Signs of infection, such as redness, warmth, or drainage

  • Grinding, clicking, or mechanical failure of an implant

Diagnosis

A thorough evaluation is essential before planning revisional surgery. This may include:

  • Medical history and physical exam to assess pain, function, and alignment

  • Imaging studies such as X‑rays, CT scans, or MRI to evaluate bone healing, implant position, or soft tissue damage

  • Laboratory tests if infection is suspected

  • Gait analysis to assess how the ankle functions during walking

Nonsurgical Treatment

Before considering revisional surgery, nonsurgical options may be attempted, such as:

  • Bracing or orthotics to support the ankle and reduce pain

  • Physical therapy to improve strength, flexibility, and mobility

  • Medications including anti‑inflammatory drugs or antibiotics (if infection is present)

  • Injections for temporary pain relief in surrounding joints

  • Activity modification to reduce stress on the ankle

These measures may provide relief, but if symptoms persist or worsen, surgery is often necessary.

When is Surgery Needed?

Revisional ankle surgery is typically recommended when:

  • Pain and disability significantly affect daily activities

  • Imaging shows implant loosening, bone loss, or deformity

  • Infection cannot be controlled with nonsurgical treatment

  • The ankle joint is unstable or collapsing

  • Previous fusion or fracture repair has failed to heal properly

Surgical options may include:

  • Revision of ankle replacement – replacing or adjusting prosthetic components

  • Ankle fusion (arthrodesis) – fusing bones together to eliminate painful motion

  • Osteotomy – realigning bones to restore proper function

  • Debridement – removing scar tissue, infection, or damaged tissue

  • Bone grafting – rebuilding bone where there is loss or defect

The specific approach depends on the underlying problem, the patient’s health, and the goals of treatment.