Transfibular total ankle arthroplasty

Abstract

Aims This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. Methods We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up. Results A total of 86 patients were evaluated at a mean follow-up of 65.4 months (60 to 90). At five-year follow-up, statistically significant improvements (p < 0.001) were found in the mean American Orthopaedic Foot & Ankle Society Ankle Hindfoot Score (from 33.8 (SD 14.3) to 86.1 (SD 8.8)), visual analogue scale for pain (from 8.5 (SD 1.7) to 1.5 (SD 1.2)), Short Form-12 Physical and Mental Component Scores (from 29.9 (SD 6.7) and 43.3 (SD 8.6) to 47.3 (SD 7.5) and 52.2 (SD 8.0), respectively), and mean ankle dorsiflexion and plantarflexion (from 6.2° (SD 5.5°) and 9.6° (SD 5.8°) to 23.9° (SD 7.7°) and 16.9° (SD 7.2°), respectively). Radiologically, the implants maintained neutral alignment without subsidence. Tibial or talar radiolucency was found in eight patients, but none of these patients was symptomatic. At five-year follow up, 97.7% of implants (95% confidence interval 91.2 to 99.4) were free from revision or removal with 84 implants at risk. We recorded two cases (2.3%) of failure for septic loosening. Conclusion Transfibular TAA is safe and effective with a high survival rate at mid-term follow-up and satisfactory clinical and radiological results. Further studies are required to determine the long-term performance of these implants. Cite this article: Bone Joint J 2022;104-B(4):472–478.

Two to Five-Year Outcomes of Total Ankle Arthroplasty with the Infinity Fixed-Bearing Implant

“…Penner et al 21 24 months. Early studies reported potential problems involving lateral wound complications 24,26 . Three studies of the Cadence TAA reported revision rates of 12.5% at 12 to 33 months 27 , 5.2% at a minimum of 2 years 28 , and 0% at a minimum of 2 years 29 .…”

“…TAA with the Zimmer Trabecular Metal implant is characterized by a lateral surgical approach. Maccario et al 24 reported a 2.3% revision rate among 86 patients at 60 to 90 months, and Barg et al 25 reported a 7% revision rate among 55 patients at a mean of 24 months. Early studies reported potential problems involving lateral wound complications 24 , 26 .…”

Application of the Mayo Periprosthetic Joint Infection Risk Score for Total Ankle Arthroplasty

“…The procedure features a lateral approach with distal fibular osteotomy and transection of the anterior inferior talofibular ligament, cementless implantation of total ankle prosthesis, fibular fixation, and ligament repair (Figure 1). 24,40 Patients with minimum follow-up of 6 months after TAA were included. PJI was diagnosed when one of the following criteria was met: (1) positive bacterial cultures of joint aspiration or (2) sinus tract/wound communicating with the joint or visualization of prosthesis through the wound.…”

“…The procedure features a lateral approach with distal fibular osteotomy and transection of the anterior inferior talofibular ligament, cementless implantation of total ankle prosthesis, fibular fixation, and ligament repair (Figure 1). 24,40…”

What’s New in Foot and Ankle Surgery

“…Intermediate-term osteolysis rates using this procedure have begun to be reported. Maccario et al 43 reported radiographic osteolysis in 8 (9.3%) of 86 cases at a mean follow-up of 65 months. Using more sensitive CT imaging, Kormi et al 44 reported osteolytic lesions in 8 (10%) of 80 cases at a mean follow-up of 39 months.…”