Total Ankle Replacement Compatible with Ligament Function Produces Mobility, Good Clinical Scores, and Low Complication Rates: An Early Clinical Assessment

Abstract

Background A three-part ankle replacement was developed to achieve compatibility with the natural ligaments by allowing fibers on the medial and lateral sides to remain isometric during passive motion. Unlike all current prostheses, the new design uses nonanatomically shaped components on the tibia and talus and a fully conforming interposed meniscal bearing.Questions/purposes Does this new design restore ankle mobility, improve clinical score, and result in low complication and early revision rates? Patients and Methods We reviewed 51 patients in whom 51 prostheses were implanted in a seven-center trial from July 2003 to July 2006. The mean age of the patients at surgery was 61.5 years (range, 35.1-82.5 years). We used the AOFAS score to assess clinical outcome. We used lateral radiographs to assess function. The minimum followup was 24 months (mean, 30 months; range, 24-48 months). Results The mean preoperative AOFAS score of 38.5 increased to 76.9, 79.1, 76.4, and 79.0 at 12, 24, 36, and 48 months, respectively. We observed a correlation between meniscal bearing movement on the tibial component (mean, 3.4 mm; range, 2-12 mm) and range of flexion at the replaced ankle (mean, 27.48; range, 168-538). We revised one arthroplasty in the second postoperative year for lateral impingement, providing a 3-year cumulative survival rate of 97% and performed one other secondary operation for hindfoot pain. Conclusions These data suggest the new prosthesis can provide short-term restoration of ankle mobility, a good clinical score, and low complication and failure rates. Longer followup with larger numbers is required.

The Bologna–Oxford total ankle replacement

“…14 The New Zealand registry reports a five-year survival rate of 86% and the Finnish registry a seven-year survival rate of 78%. 15,16 Despite the fact that our survival rate was similar to those reported in the literature, it was still low compared with that reported by Giannini et al 2 In our study, there was a discrepancy between the range of movement measured clinically and radiologically. The range of movement measured clinically is the combined range of movement of the joints of the midfoot and hindfoot.…”

“…It aims to maintain normal collateral ligament function, thereby keeping the articular surfaces in contact throughout the entire range of movement. 2,3 Giannini et al 2 recently reported the results of a prospective multicentre study of the first 51 BOX TARs, implanted between 2003 and 2006, with a mean follow-up of 30 months. This showed a three-year cumulative survival rate of 97% and a mean American Orthopedic Foot and Ankle Society (AOFAS) score 4 of 76.9 points.…”

“…This showed a three-year cumulative survival rate of 97% and a mean American Orthopedic Foot and Ankle Society (AOFAS) score 4 of 76.9 points. 2 The aim of our study was to analyse the survival of this arthroplasty from a large single-centre series and to report the midterm results and complication rates.…”

In vivo kinematics and articular surface congruency of total ankle arthroplasty during gait

“…Other studies showed that kinematics of the natural ankle were mimicked using other anatomical (Valderrabano et al, 2003) and non-anatomical (Reggiani et al, 2006) three-component designs during in vitro experiments. However, during in vivo conditions, other factors such as periarticular ligaments and implant position may be different from in vitro simulation, and they contribute to its kinematics (Giannini et al, 2010). Further research is necessary to elucidate in vivo function of each TAA design.…”

Orthopaedic Research in Italy: State of the Art

“…Unlike all current prostheses, the new design uses non-anatomically shaped components on the tibia and talus, and a fully conforming interposed meniscal bearing. The new prosthesis can provide short-term restoration of ankle mobility, a good clinical score, and low complication and failure rates (134).…”