How Successful are Current Ankle Replacements?: A Systematic Review of the Literature

Abstract

Total ankle arthroplasty provides an alternative to arthrodesis for management of ankle arthritis. What is the outcome of total ankle arthroplasty implants currently in use? We conducted a systematic literature search of studies reporting on the outcome of total ankle arthroplasty. We included peer-reviewed studies reporting on at least 20 total ankle arthroplasties with currently used implants, with a minimum followup of 2 years. The Coleman Methodology Score was used to evaluate the quality of the studies. Thirteen Level IV studies of overall good quality reporting on 1105 total ankle arthroplasties (234 Agility TM , 344 STAR, 153 Buechel-Pappas TM , 152 HINTEGRA 1 , 98 Salto TM , 70 TNK, 54 Mobility TM ) were included. Residual pain was common (range, 27%-60%), superficial wound complications occurred in 0% to 14.7%, deep infections occurred in 0% to 4.6% of ankles, and ankle function improved after total ankle arthroplasty. The overall failure rate was approximately 10% at 5 years with a wide range (range, 0%-32%) between different centers. Superiority of an implant design over another cannot be supported by the available data.

Bone Microarchitecture of the Talus Changes With Aging

“…Therefore, given that the mean patient age at total ankle replacement implantation is between 50 and 60 years, knowledge of a potential age effect on bone quality of the talus is of paramount importance [23,42]. It is noteworthy that the anatomical partner of the talus for conferring the contact energy of the foot to the ground, the calcaneus, displays age-related changes in its microarchitecture similar to the proximal humerus or the distal radius [7,8,37].…”

Unipedal Balance Is Affected by Lower Extremity Joint Arthroplasty Procedure 1 Year Following Surgery

“…Similarly, common limitations reported after total knee arthroplasty (TKA) include diminished walking speed, difficulty ascending and descending stairs, and inability to return to sports played prior to surgery with up to 37% of patients reporting limited function post-operatively [20][21][22][23]9]. Common problems reported after total ankle arthroplasty (TAA) include residual pain, superficial wound complications, and deep infections as well as limitations in walking speed and gait mechanics [24,25]. These limitations have been attributed in part to deficits in balance, proprioception, muscle strength and postural control [13,3,10,[26][27][28][29][30][31].…”

Total Ankle Arthroplasty in Patients with Hereditary Hemochromatosis

“…TAA is becoming an increasingly recommended treatment for patients with rheumatoid or posttraumatic arthritis of the ankle [4,10]. One report suggests patients have pain relief and high satisfaction after surgery [4].…”

“…Also, the component stability in TAA is lower than after arthroplasty of the knee or hip. The overall failure rate is approximately 10% at 5 years with a wide range in published studies (0% to 32%) [10]. The choice of fusion versus TAA remains controversial, and how TAA performs in patients with HH is not well understood.…”