Severe periprosthetic osteolytic lesions after the Ankle Evolutive System total ankle replacement

Abstract

Between 2002 and 2008, 130 consecutive ankles were replaced with an hydroxyapatite (HA) and titanium-HA-coated Ankle Evolutive System total ankle prosthesis. Plain radiographs were analysed by two independent observers. Osteolytic lesions were classified by their size and location, with cavities > 10 mm in diameter considered to be 'marked'. CT scanning was undertaken in all patients with marked osteolysis seen on the plain radiographs. Osteolytic lesions were seen on the plain films in 48 (37%) and marked lesions in 27 (21%) ankles. The risk for osteolysis was found to be 3.1 (95% confidence interval 1.6 to 5.9) times higher with implants with Ti-HA porous coating. Care should be taken with ankle arthroplasty until more is known about the reasons for these severe osteolyses.

Computed Tomography of Osteolysis Related to Total Ankle Replacement

“…It has been characterised as early-onset and usually non-progressive lesion, when in turn expansile lysis was characterised as late-onset, progressive lesion due to implant wear. In our study the lesions were both early-onset, as first lesions were seen on radiographs one to two years after the operation, and rapidly progressive (Koivu et a., 2009).…”

“…Therefore our own TAR patients were analyzed and a large amount of osteolysis with AES implants was found. The results were published in Journal of Bone and Joint Surgery British version at 2009 (Koivu et al 2009). Other reports with similar findings have been published afterwards (Besse et al, 2009;Besse et al, 2010;Kokkonen et al, 2011;Rodriguez et al, 2010).…”

“…Cahir et al (2007) and Keogh et al (2003) have shown the usefulness of CT in imaging painful hip after total hip replacement. Periprosthetic osteolysis and aseptic loosening are common complications after TAR (Berquist, 2006;Besse et al, 2009;Koivu et al, 2009;Kokkonen et al, 2011;Rodriguez et al, 2010). CT reveals osteolytic changes around prosthesis components in ankle better than radiographs (Besse et al, 2009;Hanna et al, 2007;Koivu et al, 2009;Rodriguez et al, 2009).…”

“…Periprosthetic osteolysis and aseptic loosening are common complications after TAR (Berquist, 2006;Besse et al, 2009;Koivu et al, 2009;Kokkonen et al, 2011;Rodriguez et al, 2010). CT reveals osteolytic changes around prosthesis components in ankle better than radiographs (Besse et al, 2009;Hanna et al, 2007;Koivu et al, 2009;Rodriguez et al, 2009). CT may also be useful in other total ankle replacement related conditions, e.g.…”

Total ankle replacement in moderate to severe varus deformity of the ankle

“…14 A high incidence of osteolysis has recently been reported with the use of the Ankle Evolution TAR. 15 When failure occurred, additional procedures have usually been conducted as a secondary operation or a revision. Without correcting the accompanying deformity at the time of the TAR, the results in ankles with moderate or severe varus are generally unsatisfactory.…”