RESEARCH - Eight-year results of a ninmally constrained total ankle arthroplasty

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Foot Ankle Int. 2006 Jun;27(6):418-26.

Eight-year results of a minimally constrained total ankle arthroplasty.

Department of Orthopaedic Surgery, UHZ Sports Medicine Institute, Coral

Gables, FL 33146, USA. tsangiovanni@...

BACKGROUND: Few studies have reported the intermediate to long-term results

of minimally constrained total ankle replacements. The purpose of this study

was to investigate the efficacy and safety of a minimally constrained total

ankle prosthesis in a select low-demand patient population. METHODS: We

reviewed a consecutive series of patients with rheumatoid arthritis who

underwent a Buechel-Pappas total ankle replacement (BP TAR) between 1990 to

1997. Thirty-one ankle arthroplasties were performed in 23 patients with

rheumatoid arthritis. One patient was lost to followup (deceased) and two

ankles that failed resulted in fusion (overall survivorship - 93%). This

left 28 ankles (21 patients) that were re-evaluated clinically and

radiographically with an average followup of 8.3 (range 5.0 to 12.2) years.

Preoperative and postoperative ranges of motion were measured and AOFAS

hindfoot scores were calculated. Recent weightbearing radiographs were

reviewed for evidence of component subsidence, radiolucent lines, and

osteolysis. RESULTS: In 25 of 28 ankles (89%), patients were completely

satisfied with the result of their ankle replacement and rated their pain as

only mild to none; three (11%) patients were dissatisfied. Radiographic

analysis revealed stable, well-positioned implants with evidence of biologic

ingrowth in 23 ankles (82%), while five implants were interpreted as being

at risk for impending failure because of marked tibial or talar component

subsidence (18%). Component subsidence did not correlate with the presence

or absence of radiolucent lines. Only one ankle demonstrated clear evidence

of osteolysis. Ten intraoperative medial malleolar fractures occurred (32%

of ankles) during implantation of the prosthesis, though in only one did

this adversely affect patient outcome. Nine postoperative complications

(29%) occurred; four wound dehiscences, four stress fractures, and one

medial malleolar nonunion.

CONCLUSIONS: Improvements in prosthetic design

such as cementless fixation and decreased constraint appear to make total

ankle arthroplasty a more predictable procedure over this period of

followup. Despite a variety of complications, we are encouraged by the

intermediate-term results in a select low-demand arthritic population.

PMID: 16764798

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

ctPlus & list_uids=16764798

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