Background and purposeAlthough total ankle replacement (TAR) is a recognized procedure for treatment of the painful arthritic ankle, the best choice of implant and the long-term results are still unknown. We evaluated the survival of two TAR designs and factors associated with survival using data from the nationwide arthroplasty registry in Finland.Methods573 primary TARs were performed during the period 1982–2006 because of rheumatic, arthritic, or posttraumatic ankle degeneration. We selected contemporary TAR designs that were each used in more than 40 operations, including the S.T.A.R. (n = 217) and AES (n = 298), to assess their respective survival rates. The mean age of the patients was 55 (17–86) years and 63% of operations were performed in women. Kaplan-Meier analysis and the Cox regression model were used for survival analysis. The effects of age, sex, diagnosis, and hospital volume were also studied.ResultsThe annual incidence of TAR was 1.5 per 105 inhabitants. The 5-year overall survivorship for the whole TAR cohort was 83% (95% CI: 81–86), which agrees with earlier reports. The most frequent reasons for revision were aseptic loosening of one or both of the prosthesis components (39%) and instability (39%). We found no difference in survival rate between the S.T.A.R. and AES designs. Furthermore, age, sex, diagnosis, and hospital volume (< 10 and > 100 replacements in each of 17 hospitals) did not affect the TAR survival.InterpretationBased on our findings, we cannot conclude that any prosthesis was superior to any other. A high number of technical errors in primary TARs suggests that this low-volume field of implant arthroplasty should be centralized to fewer units.

Background and Aims: the coronal alignment of the lower limb is important for planning and assessing outcome after total knee arthroplasty.this study compared postoperative estimation of alignment and measurement of angles using both hip-to-ankle radiographs and anteroposterior (ap) knee radiographs in standing position.Patients and Methods: Consecutive standard ap knee and hip-to-ankle radiographs in 83 patients (103 knees) after total knee arthroplasty were analyzed.Results: the tibiofemoral angle measured from both hip-to-ankle and knee radiographs correlated moderately with the mechanical axis (r =0 .646 and r=0 .540, respectively). the correlation between tibiofemoral angles in the two radiographs was excellent (r =0.860). furthermore, measurements of tibial and femoral component alignment between the two radiographs correlated highly (r =0.718 and r=0.773, respectively). intraand interobserver correlations were high in all analyses.Conclusions: the standard ap knee radiograph appears to be avalid alternative to the hip-to-ankle radiograph for determining knee coronal plane alignment in routine followup after total knee arthroplasty. however, the hip-to-ankle radiograph alone provides accurate information on weight-bearing mechanical axis in patients with suspected lower limb malalignment.

Background and purpose The use of hip arthroplasties is evidently increasing, but there are few published data on the incidence in young patients.Methods We used data on total and resurfacing hip arthroplasties (THAs and RHAs) from the Finnish Arthroplasty Register and population data from Statistics Finland to analyze the incidences of THA and RHA in patients aged 30–59 years in Finland, for the period 1980 through 2007.Results The combined incidences of THAs and RHAs among 30- to 59-year-old inhabitants increased from 9.5 per 105 inhabitants in 1980 to 61 per 105 inhabitants in 2007. Initially, the incidence of THA was higher in women than men, but since the mid-90s the incidences were similar. The incidence increased in all age groups studied (30–39, 40–49, and 50–59 years) but the increase was 6-fold and 36-fold higher in the latter two groups than in the first. The incidence of THA was constant; the increased incidence of overall hip arthroplasty was due to the increasing number of RHAs performed.Interpretation We have found a steady increase in the incidence of hip arthroplasty in patients with primary hip osteoarthritis in Finland, with an accelerating trend in the past decade, due to an increase in the incidence of RHA. As the incidence of hip osteoarthritis has not increased, the indications for hip arthroplasty appear to have become broader.

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