LONG TERM OUTCOME OF THE BUECHEL-PAPPAS TOTAL ANKLE REPLACEMENT

Abstract

Introduction The Buechel-Pappas Total Ankle Replacement (BP TAR) has been used in Cornwall since 1991. The early results were presented to the Foot Society in 1997. The only published long term results of this pros-thesis are from the designer’s unit.

Method We present the clinical and radiological outcome of a prospective series of 22 BP TARs implanted in 19 patients with a mean follow-up of 9 years (range 6–13). The primary diagnosis was rheumatoid arthritis (RA) in 11 and osteoarthritis in eight patients. Twelve patients were female. Mean patient age was 64 years (range 39–81). Patients were reviewed at yearly intervals. None were lost to follow-up.

Results At the time of review, four patients (six ankles) had died between 12 and 69 months post-operatively of unrelated causes with their prostheses in situ. One patient had a below knee amputation for chronic venous ulceration, 11 years after a BP TAR which was functioning well. One patient with severe RA had the implant removed at 8 weeks for deep infection. A second patient with RA had the TAR revised to a tibiotalocalcaneal fusion 59 months post-operatively for talar avascular necrosis. One patient has pain from impingement and another patient with RA has intermittent pain at 8 years following TAR. Every other implant remains asymptomatic. The New Jersey LCS ankle assessment scores increased from a mean of 35 pre-operatively to 82 post-operatively. The increases were largely due to pain relief and improved function with the pre-operative range of motion being preserved. These scores have been maintained in the long term. No surviving implant is radiologically loose.

Conclusion Our results suggest that the BP TAR offers good clinical and radiological long-term results to patients with often disabling ankle arthritis.