Background and purpose There have been few reports of large series of ankle replacements. The aim of this study was to document and evaluate the early results of a nationwide series of total ankle replacements (TARs) performed using second-and third-generation implants.Methods Records of total ankle replacements performed between February 2000 and November 2005 were retrieved from the New Zealand National Joint Registry and retrospectively reviewed at a mean of 28 months after the primary procedure. At 6 months post surgery, patient scores were generated from questionnaires. Comparisons between patient scores and categorical variables were made using ANOVA. Regression analyses using Cox proportional-hazards modeling were performed to determine predictors of failure. A Kaplan-Meier survivorship curve was used to describe the rate of prosthetic survival.Results 202 total ankle replacements were performed in 183 patients. 14 prostheses (7%) failed. The overall cumulative 5-year failure-free rate was 86%. An unfavorable patient score at 6 months after the initial procedure turned out to be a good predictor of subsequent failure. The cumulative 5-year failure-free rate was 65% at 5 years for patients with an unfavorable score, and 95% for those who had a favorable patient score. Each 1-point increase in the patient score (i.e. poorer outcome) corresponded to a 5% relative increase in the risk of failure (p < 0.05). In addition, longer operative time for the primary procedure was found in the group of TARs that subsequently failed (p < 0.05).Interpretation The National Joint Registry appears to be a useful tool for monitoring the trends in TAR surgery.
To investigate the causes of, pathologic changes associated with, and treatment results after traumatic peroneal tendon subluxation or dislocation, we reviewed 11 cases in 10 patients at a mean followup of 29 months. We also describe a technique of superior peroneal retinacular repair combined with fibular rotational osteotomy. Excellent clinical and functional results were achieved in 9 of the 11 cases, enabling the patients to return to previous competitive sports by 3 months. There was one persisting subluxation that required further surgery. Another ankle, with chronic sepsis from previous surgery and documented degeneration of the ankle joint, had a recurrence of the infection and sequestration of the osteotomized fragment. The personal tendons, however, remained stabilized by the resultant scar tissue. We conclude that superior peroneal retinacular repair, with or without fibular rotational osteotomy, is a successful technique in treating both acute and recurrent instability of the peroneal tendons. It can be combined with a Bröstrom repair when there is concurrent peroneal tendon and anterolateral ankle instability. Peroneal tenosynovitis and tendon splitting were commonly found at operation, especially in cases of recurrent instability. The degree of pathologic change in the tendon did not affect the clinical result.
We performed a retrospective review of a consecutive series of 178 Mobility total ankle replacements (TARs) performed by three surgeons between January 2004 and June 2009, and analysed radiological parameters and clinical outcomes in a subgroup of 129 patients. The mean follow-up was 4 years (2 to 6.3). A total of ten revision procedures (5.6%) were undertaken. The mean Ankle Osteoarthritis Scale (AOS) pain score was 17 (0 to 88) and 86% of patients were clinically improved at follow-up. However, 18 patients (18 TARs, 14%) had a poor outcome with an AOS pain score of > 30. A worse outcome was associated with a pre-operative diagnosis of post-traumatic degenerative arthritis. However, no pre- or post-operative radiological parameters were significantly associated with a poor outcome. Of the patients with persistent pain, eight had predominantly medial-sided pain. Thirty TARs (29%) had a radiolucency in at least one zone. The outcome of the Mobility TAR at a mean of four years is satisfactory in > 85% of patients. However, there is a significant incidence of persistent pain, particularly on the medial side, for which we were unable to establish a cause.
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