Ankle Arthroplasty Using Three Generations of Metal and Ceramic Prostheses

Abstract

Ankle arthroplasties using metal and polyethylene prostheses were done on 28 patients (30 ankles) with painful osteoarthritis or rheumatoid arthritis between 1975 and 1980. Significant loosening and subsidence of the metal prostheses occurred in most patients, and ceramic prostheses were introduced in 1980. Ceramic prostheses with or without cement were used to replace 60 ankles in 56 patients with painful arthritis between 1980 and 1991. Revision surgery was required for five patients (five ankles) during the followup period (mean, 12 years 6 months). Loosening and subsidence of the prostheses were seen in 50% of patients within 5 years after the index procedure. As a result, a new design of bead-formed alumina coated with hydroxyapatite was used. A tibial prosthesis fixed to the posterior cortex of the tibia with a screw was used from 1991. These new ceramic prostheses were used to replace 70 ankles in 62 patients between 1991 and 2000. Thirty-six patients (36 ankles) with a mean age of 71 years (range, 50-87 years) had osteoarthritis, and 26 patients (31 ankles) with a mean age of 60 years (range, 41-76 years) had rheumatoid arthritis. During followup, with an average of 5 years 2 months, three patients (three ankles) required revision surgery (one for infection, two for talar necrosis). Overall results for patients with osteoarthritis were excellent in 21 ankles, good in 10 ankles, fair in two, ankles and poor in zero ankles. Results in patients with rheumatoid arthritis were excellent in five ankles, good in 16 ankles, fair in three ankles, and poor in two. In the intermediate study, 29 patients (31 ankles; 91.2%) with osteoarthritis and 19 patients (21 ankles; 76.9%) with rheumatoid arthritis were satisfied with the short-time results of arthroplasty.

How Successful are Current Ankle Replacements?: A Systematic Review of the Literature

“…We evaluated the quality of studies using the CMS [6,29]. The substantial interobserver and intraobserver agreement is indicative of the reliability of the CMS, although formal validation was not performed.…”

“…We also excluded data for prostheses that have been replaced by new versions of similar design but with fundamental differences as the older designs would not be relevant to current practice. The excluded devices include the LCS prosthesis replaced by the Buechel-Pappas TM [3], the shallow sulcus design of the Buechel-Pappas TM prosthesis replaced by the deep sulcus design [3], the early design of the Scandinavian Total Ankle Replacement (STAR) prosthesis for cemented implantation [20], and the early generation implants of the TNK prosthesis [29]. Finally we excluded data for prostheses without documented use in the last 10 years (Thompson-Richards prosthesis) [10].…”

Arthroplasty versus arthrodesis for end-stage ankle arthritis: decision analysis using Markov model

“…In total ankle arthroplasty, the tenyear implant survival rate was 77% (95% confidence interval, 63.3-90.8%) [5][6][7][8][9][10][11][12][13][14][15][16]. A revision during the follow-up period was required in 9.8% (95% confidence interval, 3.1-16.5%) of patients who had undergone total ankle arthroplasty [17,18], which meant clinical failure.…”

Ankle Arthritis: Which to Choose – Arthrodesis or Arthroplasty

“…Ankle arthritis is generally a debilitating condition that can cause limitation of movement that leads to poor quality of life (1,2). It is a challenging task in managing due to the complex interplay of the joints surrounding the ankle.…”

“…Ankle arthritis has an increased incidence over the past few decades due to more injuries during sport event and increased life span of the population. Approximately 1% of the adult population is affected by ankle arthritis (1,2).…”