Abstract
Introduction:
In 1994 Kofoed and Stürup already confirmed that within a follow-up of 10 years total ankle arthroplasty demonstrated a significant clinical improvement for the patients.
In recent studies a 12 – year survival rate even of 84% was described (Kofoed, 1995).
Methods:
In a retrospective study we evaluated the short – and midterm results in 44 patients with unconstrained total ankle arthroplasty and cementless fixation. These ankle replacements were performed between 8/1997 and 12/2000. A critical assessment concerning the indications and contraindications of this arthroplasty was performed due to the fact, that this surgical technique is not yet mentioned as a routinely performed surgical procedure of the ankle. The advantages in comparison to the open or arthroscopically assisted arthrodesis of the ankle were described.
As initial diagnosis rheumatoid arthritis (n:16), post-traumatic osteoarthritis (n:10) or idiopathic osteoarthritis of the ankle (n:18) was mentioned. The patients age varied from 24 to 78 years; the 24 years old patient suffered from a posttraumatic osteoarthritis, in the 78 years old patient contralateral total ankle arthroplasty was performed 13 years ago.
Results:
There was a delay in superficial wound healing in 11 cases, in 4 cases soft tissue revision and once plastic surgery had to be performed. One female patient with RA had a postoperative deep infection after preoperative radiosynoviorthesis of the ankle.
Additionally osteosynthetical reconstruction of the fibula (n:2) and the talus (n:1) was necessary. One patient underwent revisional surgery due to progressive wear and fracture of the polyethylene inlay. Furthermore three patients suffered from continuing instability, that one had a secondary open arthrodesis and two a syndesmoplasty combined with revision of the PE inlay.
The radiological examination offered migration and progredient radiolucency lines especially near to the tibial part of the prosthesis in three cases.
Nevertheless more than 80% of the patients were satisfied or very satisfied with their ankle arthroplasty, only 4 patients now would have denied the surgical procedure. As main improvements reduction of pain and increased mobility (ROM: > 40°) were mentioned.
Conclusions:
The success of total ankle arthroplasty may depend on exact technique, correct hindfoot alignment and sufficient capsuloligamentous stability of the ankle. So this surgical procedure may provide a high rate of functional improvement for the patients and may prevent the probably necessary arthrodesis.
