Poor prosthesis survival and function after component exchange of total ankle prostheses

Abstract

Background and purpose In failed total ankle replacements (TARs), fusion is often the procedure of preference; the outcome after exchanging prosthetic components is debated. We analyzed prosthetic survival, self-reported function, and patient satisfaction after component exchange.Patients and methods We identified patients in the Swedish Ankle Registry who underwent exchange of a tibial and/or talar component between January 1, 1993 and July 1, 2013 and estimated prosthetic survival by Kaplan-Meier analysis. We evaluated the patient-reported outcome measures (PROMs) SEFAS, EQ-5D, EQ-VAS, SF-36, and patient satisfaction by direct questions.Results 69 patients underwent revision TAR median 22 (0–110) months after the primary procedure. 24 of these failed again after median 26 (1–110) months. Survival analysis of revision TAR showed a 5-year survival rate of 76% and a 10-year survival of 55%. 29 patients with first revision TAR in situ answered the PROMs at mean 8 (1–17) years after revision and had the following mean scores: SEFAS 22, SF-36 physical 37 and mental 49, EQ-5D index 0.6, and EQ-VAS 64. 15 of the patients were satisfied, 5 were neither satisfied nor dissatisfied, and 9 were dissatisfied.Interpretation Revision TAR had a 10-year survival of 55%, which is lower than the 10-year survival of 74% for primary TAR reported from the same registry. Only half of the patients were satisfied. Future studies should show which, if any, patients benefit from revision TAR and which patients should rather be fused directly.

Total ankle replacement

“…It is important to realize that the results after revision TAR, as in the above-mentioned study, or the results of ankle fusion as salvage procedure for a failed TAR, are inferior to the results after a primary TAR or primary fusion. Kamrad et al (2015) analyzed prosthetic survival, self-reported function, and patient satisfaction after component exchange in 69 cases in the Swedish Ankle Registry. 24 of these patients had a new failure after a median of 2 years.…”

“…Nieuwe Weme et al (2015) reported a survival rate of 87% in the postfracture group and 79% in the instability group at 6 years. Kamrad et al (2015) , using the failure criteria for TAR as defined by Henricson et al (2011) , found a survival rate of 84% for primary TARs after 5 years and 74% after 10 years in the Swedish Ankle Registry. The survival rates after hip and knee replacement are considerably higher.…”

“…This issue of Acta Orthopaedica includes 3 articles on total ankle replacement (TAR), motivating this Guest Editorial (Nieuwe Weme et al 2015 , Kamrad et al 2015 , Horisberger et al 2015 ).…”

Total Ankle Arthroplasty: Long-term Survival and Factors that Influence it

“…The reported 5-year survival rate in United Sytes was 90.1% [40] . Kamrad et al found that revision TAA has a 10year survival of 55%, which is lower than the 10-year survival of 74% for primary TAA published from the same registry [41] .…”

Failed Agility™ LP Total Ankle Replacement Salvaged with Tibio-Talo- Calcaneal Arthrodesis and Vascularized Pedicled Medial Malleolus and Fibula Onlay Bone Grafts

“…Controversy exists regarding the most predictable salvage for failed total ankle replacement [18][19][20]. Revision total ankle replacement with soft-tissue release/reconstruction or explantation with tibio-talocalcaneal arthrodesis with bulk structural allograft are the most common procedures performed.…”