Prosthetic Replacement of the Ankle in Posttraumatic Arthrosis 10-Year Experience with the Cementless ESKA Ankle Prosthesis

Abstract

Background: As a result of numerous failed implantations of cemented ankle prostheses since the early 70s, ankle arthrodesis represented the "gold standard" in the treatment of ankle arthrosis. Due to a change to cementless implantations in the 90s it came to a remarkable reduction in early loosening, bone necrosis and sintering of the prosthesis which were the main reasons for former failures. In cooperation with ESKA Implants, Lübeck, we have developed a cementless anatomic ankle prosthesis. Patients and Methods: At our hospital, the ESKA prosthesis has been implanted in 56 patients (72% posttraumatic) since 1990. In our study, we report the examination results of 40 out of these 56 patients at least 1 year post implantation (21 of them more than 5 years). For evaluation, we used the Kofoed ankle score, which allows an easier comparison with other studies. This score showed an average improvement from 34.75 points preoperatively to 91.25 points postoperatively. Results: The persistent preoperative pain had completely disappeared in all patients; only twelve patients complained of intermittent pain under fairly heavy loading. 23 patients were able to walk > 2 km and 13 > 5 km without pain. The overall range of motion was 40-60° in 14 patients, 25-40° in 21, and < 25° in only five. We did not see any kind of secondary arthrosis in the adjacent joints. An arthrodesis which posed no problems had to be performed only three times: in two cases in 1991, during the 1st postoperative year, with both patients showing infections of the prosthesis; in the third case, the prosthesis had to be changed after 9 years.Conclusions: According to our good results and those of other studies on cementless ankle prostheses, we consider a cementless upper ankle prosthesis, implanted by a highly experienced surgeon, the preferable alternative to upper ankle arthrodesis.

Incidence of Revision After Primary Implantation of the Salto® Mobile Version and Salto Talaris™ Total Ankle Prostheses: A Systematic Review

“…Taken collectively, total ankle replacement requires precise implantation because mobile-bearing UHMWPE inserts or more incongruity between the fixed-bearing UHMWPE insert and talar component geometry are incapable of predictably accommodating appreciable malalignment. Finally, the withdrawal in 2009 of the B€ uechel-Pappas total ankle system (Endotec, South Orange, NJ) (83), which was the predicate mobilebearing design and had good 20-year patient outcomes and survivorship (84), combined with the good 14-year patient outcomes and survivorship with the ESKA fixed-bearing total ankle (GmbH & Co, L€ ubeck, Germany) (85), and lack of clinically significant differences in outcomes or survivorship between mobile-and fixed-bearing prosthesis types (16) indicates that the bearing type should not be the main criteria for surgeon adoption of a particular prosthesis.…”

Biomechanics of the ankle joint and clinical outcomes of total ankle replacement

“…The surface area of the ankle joint is just 1/3 that of the knee or hip joints whereas the forces acting on the ankle joint are 64% more than the forces of knee joint and 45% more than the forces of hip joint. The stability of the ankle joint depends (Rudigier et al, 2001). b (Carlsson, 2006).…”

“…The outcomes of ESKA (Rudigier et al, 2001), STAR (Carlsson, 2006), HINTEGRA , and New Jersey LCS (Buechel et al, 1988) prostheses are summarized in Table 13. Details of complication and survival rates in case of ESKA prostheses were not provided.…”

History and evolution in total ankle arthroplasty

“…It has a shallow groove on the talar component that is congruous to the UHMWPE bearing attached to the tibial component and is able to control rotational forces. The inventor of the prosthesis prospectively followed his patients and published his results in 2001 64 and longer term results in 2004 65 and 2005 66 (Table 5). Improved ankle range of motion, reduction in pain and ability to walk Fig.…”