Long-term Follow-up Results of Buechel-Pappas Ankle Arthroplasty

Abstract

Background: Total ankle replacement (TAR) is gaining popularity as a treatment option for ankle osteoarthritis. Long-term implant survival is a critical outcome to determine the success of the TAR implant. The Buechel-Pappas (BP) implant is a second-generation mobile bearing implant. The aim of this study was to analyze the BP implant survivorship at 10-year follow-up, make a subanalysis between patient groups, and evaluate long-term functional outcomes. Methods: Data of 86 patients who received 101 BP implants between 1993 and 2010 were obtained from a prospectively documented database. Subanalyses were done for patients diagnosed with inflammatory joint disease and noninflammatory joint disease, and patients with preoperative tibiotalar neutral and nonneutral alignment. A Kaplan-Meier curve was used for survival analysis. Long-term functional outcomes were assessed with the following patient-reported outcome measures: Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Stand Version 2.0 Health Survey and 3 anchor questions. Results: The survival rate of the BP implant at 10 years was 86% (95% confidence interval, 78%-93%). A total of 31 patients (36%) required 55 reoperations, and in 13 patients (15%) a revision procedure was performed. In this series, no significant difference in 10-year survival rate was found between neither the inflammatory joint disease and noninflammatory joint disease group ( P = .47), nor the tibiotalar neutral and nonneutral alignment group ( P = .16). At a mean follow-up of 16.8 years for 21 patients, the mean FAOS activities of daily living (ADL) and FAAM ADL subscale scores were 75/100 and 56/100 points. The mean physical component summary (PCS) and mental component summary (MCS) of the SF-36 were 34/100 and 51/100 points, respectively. Conclusion: A survival rate of 86% was found at 10-year follow-up for the Buechel-Pappas implant. Our series demonstrated no significant difference in 10-year survival rates between the 2 patient subgroups. Long-term results of the various functional outcomes varied between poor and moderate. Level of Evidence: Level II, prospective cohort study.

Influence of Preoperative Tibiotalar Alignment in the Coronal Plane on the Survival of Total Ankle Replacement: A Systematic Review

“…However, this study did not analyze the additional procedures and postoperative tibiotalar alignment, and only 17 ankles had preoperative varus or valgus deformity. Krishnapillai et al 20 observed the same BP ankle implant cohort of Doets et al 7 with more TARs (n = 101) and longer follow-up, and they reported a 10-year implant survival of preoperative neutral alignment (91%; 95% confidence interval [CI], 83%-99%), varus alignment (87%; 95% CI, 70%-100%), and valgus alignment (72%; 95% CI, 53%-91%). Although no significant difference in survival between alignment groups was reported, they recommended caution in valgus ankles compared to varus ankles.…”

“…The items “outcome of interest” and “comparability of cohorts” corresponded with the highest risk of bias across studies. Seven studies scored no stars for the item “outcome of interest,” 14,15,31,32,34,37,38 6 studies scored no stars for the item “comparability of cohorts,” 4,14,20,31,37,38 and 3 studies scored 1 of 2 stars for this item. 13,15,34 For the other items of the checklist, where a maximum of 1 star could be obtained, 2 studies did not obtain a star.…”

“…† However, 6 studies defined neutral alignment as less than 5 degrees of varus and valgus. 15,18,20,22,27,31 One study did not define neutral alignment at all. 32 Utilization of this less than 10 degrees threshold would result in more TARs in the varus and valgus alignment groups with higher degrees of varus or valgus deformity.…”

Predicting ground reaction and tibiotalar contact forces after total ankle arthroplasty during walking

“…Total ankle arthroplasty (TAA) has gradually become a more common procedure for the treatment of end-stage ankle arthritis, which can eliminate pain, restore ankle functions and allow patients to continue normal daily activities after surgery. 1–3 However, complications of TAA, such as wear, aseptic loosening and osteolysis, are still the obstacles to the longevity of TAA, and the survival rate of TAA is still lower than that of total hip and knee arthroplasty. 2,4,5 The reasons for the lower survival rate of TAA may include improper prosthetic designs, unfamiliar surgical techniques and unsuitable patient selections.…”

“…1–3 However, complications of TAA, such as wear, aseptic loosening and osteolysis, are still the obstacles to the longevity of TAA, and the survival rate of TAA is still lower than that of total hip and knee arthroplasty. 2,4,5 The reasons for the lower survival rate of TAA may include improper prosthetic designs, unfamiliar surgical techniques and unsuitable patient selections. More specifically, the crucial factor for the failures of the TAA is that the artificial replacement does not completely duplicate the natural ankle joint, which has complex kinematics, contact mechanics and close interactions between muscles and ligaments.…”