Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register

Abstract

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.

Complication rates after total ankle arthroplasty in one hundred consecutive prostheses

“…Other important outcomes like gait and postoperative joint alignment are neglected. However, to our knowledge there is no standardised score in foot and ankle surgery that has a similar validity and we use it like other authors [3,8,10].…”

“…However, while some studies report encouraging mid-term results, the rate of complications after TAA is high compared to total hip and knee replacement [6][7][8][9][10].…”

Computed Tomography of Osteolysis Related to Total Ankle Replacement

“…For example, the medium and long term results are not comparable to total hip and knee replacements. Common complications after total ankle replacement are osteolysis and aseptic loosening (Berquist, 2006;Fevang et al, 2007;Henricson et al, 2007;Pyevich et al, 1998;Skytta et al, 2010;Spirt et al, 2004). More studies of materials and designs of total ankle prosthesis are needed to improve survival of these prostheses.…”

“…Results from Swedish, Norwegian and Finnish national registries have been slightly inferior with survival rates of 78% to 89% at five years and 62% to 72% at ten years (Fevang et al, 2007;Henricson et al, 2007;Skytta et al, 2010). In studies based on these registers with over 1300 patients altogether, aseptic loosening has been the most frequent reason for revision (31 -48 %) (Fevang et al, 2007;Henricson et al, 2007;Skytta et al, 2010).…”

“…Some centers have reported 5-year survival rates Knecht et al, 2004;San Giovanni et al, 2006;Spirt et al, 2004;Wood et al, 2008;Wood et al, 2009) and 10-to 12-year survival rates even from 85 to 95 % (Bonnin et al, 2010;Buechel et al, 2004;Knecht et al, 2004;Kofoed, 2004). Results from Swedish, Norwegian and Finnish national registries have been slightly inferior with survival rates of 78% to 89% at five years and 62% to 72% at ten years (Fevang et al, 2007;Henricson et al, 2007;Skytta et al, 2010). In studies based on these registers with over 1300 patients altogether, aseptic loosening has been the most frequent reason for revision (31 -48 %) (Fevang et al, 2007;Henricson et al, 2007;Skytta et al, 2010).…”