Background and purpose In failed total ankle replacements (TARs), fusion is often the procedure of preference; the outcome after exchanging prosthetic components is debated. We analyzed prosthetic survival, self-reported function, and patient satisfaction after component exchange.Patients and methods We identified patients in the Swedish Ankle Registry who underwent exchange of a tibial and/or talar component between January 1, 1993 and July 1, 2013 and estimated prosthetic survival by Kaplan-Meier analysis. We evaluated the patient-reported outcome measures (PROMs) SEFAS, EQ-5D, EQ-VAS, SF-36, and patient satisfaction by direct questions.Results 69 patients underwent revision TAR median 22 (0–110) months after the primary procedure. 24 of these failed again after median 26 (1–110) months. Survival analysis of revision TAR showed a 5-year survival rate of 76% and a 10-year survival of 55%. 29 patients with first revision TAR in situ answered the PROMs at mean 8 (1–17) years after revision and had the following mean scores: SEFAS 22, SF-36 physical 37 and mental 49, EQ-5D index 0.6, and EQ-VAS 64. 15 of the patients were satisfied, 5 were neither satisfied nor dissatisfied, and 9 were dissatisfied.Interpretation Revision TAR had a 10-year survival of 55%, which is lower than the 10-year survival of 74% for primary TAR reported from the same registry. Only half of the patients were satisfied. Future studies should show which, if any, patients benefit from revision TAR and which patients should rather be fused directly.

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A rapid intravenous injection of ALG into splenectomized dogs induced an almost complete elimination of lymphocytes and an extensive but partly reversible thrombocytopenia during which platelets were trapped in the lung. During this trapping there was a significant decrease in arterial blood pressure, pulmonary blood volume and cardiac output concomitant with a marked increase in the portal pressure. The pulmonary arterial pressure remained unchanged. The hemodynamic effects are probably caused by a release of vasoactive substances which induced a decreased venous return from splanchnic pooling and stasis. Prostaglandins and histamine seem to play a dominant role, since Aspirin, promethazine and 48/80 markedly reduced the side-effects.

Xenogenic antilymphocyte globulin (ALG) given as a rapid intravenous injection into dogs caused a significant decrease in arterial blood pressure and oxygenation as well as an increase in portal pressure. At the same time, there was an almost complete elimination of lymphocytes and an extensive but almost completely reversible thrombocytopenia. Lymphocytopenia induced by a previous injection of ALG was found to eliminate completely the circulatory response to a second injection of ALG in spite of the fact that an extensive thrombocytopenia was induced. Extensive thrombocytopenia induced by injection of an antiplatelet globulin was also found to prevent completely the hemodynamic effects of ALG although as many lymphocytes were eliminated as in the intact dogs. Thus both platelets and lymphocytes are necessary to trigger the circulatory response induced by ALG.