Midterm Survivorship of the INBONE II Total Ankle Arthroplasty

Abstract

Background: The use of total ankle arthroplasty (TAA) in the treatment of ankle arthritis has grown substantially as advancements are made in design and surgical technique. Among the criteria guiding the choice between arthroplasty and arthrodesis, the long-term survival and postoperative outcomes are of crucial importance. Although outcomes of the INBONE I have been published, there is limited midterm survival data for the INBONE II. The purpose of this study was to determine the radiographic and patient-reported outcomes, and survivorship of this prosthesis in patients with a minimum 5-year follow-up. Methods: We retrospectively identified 51 ankles (46 patients) from 2010 to 2015 who underwent TAA with the INBONE II prosthesis at our institution. Of these, 44 cases had minimum clinical follow-up of 5 years (mean, 6.4; range 5-9). Median age was 66 years (range 42-81) and median BMI was 27.5 (range 20.1-33.0). A chart review was performed to record the incidence of revision and reoperation. Preoperative and postoperative radiographs were analyzed to assess the coronal tibiotalar alignment (TTA), the talar inclination angle, and the presence of periprosthetic lucencies and cyst formation. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Survivorship was determined by incidence of revision, defined as removal of a metallic component. Results: The survivorship at 5 years was 98% and the rate of reoperation was 7.8% (n = 4); 2 patients underwent irrigation and debridement for infection, 1 patient underwent a medializing calcaneal osteotomy, and 1 patient underwent open gutter debridement, 1 patient underwent a revision of a subsided talar component at 3.2 years after index surgery. Average postoperative TTA was 88.6 degrees, with 42 rated as neutral (85-95 degrees), 2 varus (<85 degrees), and no valgus (>95 degrees) ankles. At final follow-up, asymptomatic periprosthetic cysts were observed in 8 patients. All FAOS domain scores improved between preoperative and final follow-up. Conclusion: At midterm follow-up, we observed significant improvement in radiographic alignment and patient-reported outcome scores for the INBONE II total ankle prosthesis. In addition, this cohort has had a relatively low reoperation rate and high survivorship. Level of Evidence: Level IV, case series.

Total ankle replacement for treatment of complex congenital fibular hemimelia

“…While several case studies and reports have demonstrated complex and successful surgical correction of the fibula and tibia, there is lack of documentation supporting the use of ankle arthroplasty in deformity-driven ankle arthritis secondary to fibular deficiency (3)(4)(5)(6). With the increasing technology and biomechanical advancements in ankle joint arthroplasty in the last 20 years, modular stemmed implants have demonstrated exceptional longevity and success (7,8). In this report we present a case of Type IA fibular hypoplasia treated with total ankle replacement arthroplasty and successful results recorded with over 12 years of follow-up after implantation.…”

Retrospective Comparison of Midterm Survivorship, Radiographic, and Clinical Outcomes of the INBONE II and Salto Talaris Total Ankle Arthroplasty Systems

“…Patients who underwent primary INBONE II or Salto Talaris TAA were found through an institutional review board (IRB) approved registry database search as described by Day et al 4 and Gagne et al 6 The same cohorts from these outcome studies were used for analysis in the present report. After applying exclusion criteria from these studies, the final INBONE II and Salto Talaris patient cohorts included 44 consecutive cases (40 patients) in the INBONE II group and 85 consecutive cases (82 patients) in the Salto Talaris group.…”

“…After applying exclusion criteria from these studies, the final INBONE II and Salto Talaris patient cohorts included 44 consecutive cases (40 patients) in the INBONE II group and 85 consecutive cases (82 patients) in the Salto Talaris group. 4,6 All cases from the INBONE II group were performed by 4 fellowship-trained foot and ankle orthopaedic surgeons. The same 4 surgeons performed TAA in the Salto Talaris group, with the addition of 1 extra surgeon who was not involved in the INBONE II cohort.…”

“…Preoperative and minimum 5-year postoperative weightbearing anteroposterior and lateral radiographs were measured using Picture Archiving and Communications System (PACS) software, Sectra IDS7, using the methods described by Day et al 4 and Gagne et al, 6 by a new rater. On anteroposterior radiographs, tibiotalar alignment (TTA), and medial distal tibial angle (MDTA) were measured and classified as valgus (over 95 degrees), varus (under 85 degrees), or neutral (between 85 and 95 degrees).…”

“…Recent studies investigating midterm outcomes of the INBONE II (Wright Medical Group, Memphis, TN) and Salto Talaris (Integra, Plainsboro, NJ) total ankle arthroplasty (TAA) systems have been conducted at our institution. 4,6 Although both implants demonstrated favorable outcomes in their respective studies, the Salto Talaris had a higher reoperation rate than the INBONE II. However, it is unclear whether this difference was significant and if this led to subsequent differences in clinical or radiographic outcomes.…”