Two-Year Outcomes After Total Ankle Replacement With a Novel Fixed-Bearing Implant

Abstract

Background: The Integra Cadence total ankle replacement (TAR) is a fourth-generation anatomic, fixed-bearing implant requiring minimal tibial and talar resection, which has been in clinical use since June 2016. The primary purpose of this study is to assess its short-term clinical and radiographic outcomes after TAR using this prosthesis. Methods: This is a prospective case series of consecutive patients that underwent TAR using this novel fourth-generation prosthesis between June 2016 and November 2017. The primary outcome of interest was the Ankle Osteoarthritis Scale (AOS). Secondary outcomes included Short Form Health Survey–36 (SF-36) scores, radiographic alignment, complications, reoperations, and revisions. Results: In total, 69 patients were included in our study. Fifty-one patients (73.9%) required a total of 91 ancillary procedures. Postoperatively, AOS pain scores decreased significantly by an average of 17.8±30.1 points from 45.9±18.2 to 28.4±27.3 ( P < .001). AOS disability scores also decreased significantly following surgery by an average of 22.0±30.5 points from 53.9±18.5 to 32.5±27.9 ( P < .001). The SF-36 physical component summary score improved 10.4±9.8 points from 33.1±9.1 to 42.6±9.1 ( P < .001). Radiographic analysis demonstrated significant improvement to neutral coronal plane alignment, which was achieved in 97% of patients ( P < .01) with no cyst formation at 2 years. There was 1 reported complication, 9 reoperations, and no metal or polyethylene component revisions. Overall, the 2-year implant survivorship was 100% in our cohort. Eighteen patients (26.1%) demonstrated fibrous ingrowth of the tibial component. However, outcome scores for these patients did not demonstrate any negative effects. Conclusions: In our hands, this TAR system demonstrated excellent early clinical and radiographic outcomes. Patients reported improved physical health status, pain, and disability in the postoperative period. Total ankle instrumentation allowed for accurate and reproducible implantation with correction of coronal and sagittal plane deformities. Early results for the clinical use of this TAR system are promising, but further long-term prospective outcome studies are necessary. Level of Evidence: Level IV, case series.

Early Radiographic and Clinical Outcomes of a Novel, Fixed-Bearing Fourth-Generation Total Ankle Replacement System

“…Few outcome studies on this novel fourth-generation TAA system have been conducted, and these have been limited by industry funding or authorship by inventors. 8,23,32 It is important to evaluate outcomes by independent groups because survivorship may differ between surgeon designers and those not affiliated with implant development. In this non-inventor, non-industry funded study, we found a survivorship of 93.8% and a reoperation rate of 6.3%.…”

“…11 To date, 3 studies have investigated short-term outcomes of this new TAA system, reporting survivorship ranging from 93.7% to 100%, improved patient-reported outcomes, improved coronal alignment, and good postoperative range of motion. 8,23,32 However, all previous reports were either funded or investigated by inventors of the implant, which raises a need for non-industry funded research on this TAA system to support these early clinical and radiographic results.…”

Outcomes of trabecular metal total ankle replacement: a longitudinal observational cohort study of 239 consecutive cases from the Swedish Ankle Registry

“…2 other fixed-bearing designs have been introduced quite recently, the Cadence and the Infinity. For Cadence, short-to mid-term results are promising but studies are few and small (33,34). For Infinity, promising results have been shown in one mid-term study (35); potential problems around the tibial component have, however, been observed (36,37).…”

Decreased Mechanical Work Demand in the Chopart Joint After Total Ankle Replacement

“…The prosthesis is characterized by an anatomic-shaped bone-anchored talar component (cobalt chrome alloy) and a polyethylene meniscal insert attached to a bone-anchored tibial component (titanium alloy). 21,29 The articular surface pattern of talar dome is characterized by 2 condylar surfaces. 34 The lateral condyle of the talar dome has a larger radius of curvature compared with the medial condyle of the talar dome.…”