RESEARCH - Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs

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J Bone Joint Surg Am. 2006 Jun;88(6):1272-84.

Total ankle arthroplasty in inflammatory joint disease with use of two

mobile-bearing designs.

Department of Orthopaedic Surgery, Slotervaart Hospital, Louwesweg 6, 1066

EC Amsterdam, The Netherlands. orkdo@...

BACKGROUND: Interest in mobile-bearing total ankle arthroplasty has

increased in recent years. However, to our knowledge, no study has focused

exclusively on patients with the diagnosis of inflammatory joint disease or

has provided a detailed analysis of the risk factors for failure. METHODS: A

prospective observational study of the results of cementless mobile-bearing

total ankle arthroplasty in patients with inflammatory joint disease (mainly

rheumatoid arthritis) was conducted at two centers. Ninety-three total ankle

arthroplasties were performed. The LCS (low contact stress) prosthesis was

used initially, in nineteen ankles, between 1988 and 1992, and a

modification of the LCS prosthesis, the Buechel-Pappas design, was used in

seventy-four ankles between 1993 and 1999. Clinical and radiographic

follow-up was performed at yearly intervals. Three clinical scoring systems

were used, and any complication was recorded throughout follow-up. Actuarial

survival (with revision as the end point), multivariate analysis, and a

competing risk approach were used to describe the long-term outcome.

RESULTS: The clinical result at one year after surgery showed a significant

improvement in the scores on all three scoring systems (p < 0.05). Ankle

dorsiflexion (mean, 7 degrees ) also improved significantly (p < 0.05)

compared with the preoperative state. The most frequent complication was a

malleolar fracture, which occurred in twenty ankles. Only when it occurred

in combination with a deformity in the frontal plane did this complication

have an adverse effect on the end result. At a mean follow-up of eight

years, seventeen patients (twenty-one ankles) had died and fifteen ankles

had been revised because of aseptic loosening (six ankles), primary or

secondary axial deformity with edge-loading (six ankles), deep infection

(two ankles), and a severe wound-healing problem (one ankle), leaving

fifty-seven ankles (61%) that were evaluated. The mean overall survival rate

at eight years was 84%. An increased failure rate was encountered in ankles

with a preoperative deformity in the frontal plane of >10 degrees (p = 0.03)

and in ankles in which an undersized tibial component had been implanted (p

= 0.02).

CONCLUSIONS: Mobile-bearing total ankle arthroplasty is a valid treatment

option for the rheumatoid ankle if proper indications are used. Aseptic

loosening and persistent deformity are the most important modes of failure.

PMID: 16757761

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16757761

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