TOTAL ANKLE REPLACEMENT – THE LEARNING CURVE AND SHORT TERM RESULTS

Abstract

Purpose: To describe the first 22 cases of Total Ankle Replacement (TAA) performed by the same team. The learning curve and the complications due to technical problems or medical problems are discussed

Patients : 22 patients underwent TAA during the last two and half years in our department. There were 6 males and 7 females. The average age was 63 ranging from 22 –79 years old. 11 patients developed osteoarthritis after trauma to the ankle, 9 had primary osteoarthritis and 2 patients suffered from rheumatoid arthritis.

Results: The average time of operation was 111 minutes (range 148–90) and 12 patients were operated under general anesthesia and the rest had spinal epidural anesthesia. During the operations the medial malleolus was fractured three times and one patient had fracture of the lateral malleolus fixated with KW. In two patients Achilles lengthening was performed as well. There was fracture of the posterior lip of the tibia during insertion of the tibial component in one patient. All the patients recovered with no primary wound healing problem. There was deep infection after 6 weeks in one patient who was treated by drainage debridment of synovium and recovered uneventfully. One patient had synovitis 6 months after the operation and underwent synovectomy proved to be non infected.

One patient still had pain after a year after the operation and x ray disclosed medial talar osteophyte which had to be resected and one patient progressed to subtalar arthritis and had to be fused. The same patient had superficial nerve neuralgia as well and the nerve was resected at the same procedure.

Altogether there were five fractures during the insertion, 2 late operations and one deep infection. The average follow up was two years (ranging from 7 months to 30 months). The patients had free painless ankle range of motion of 40 degrees and could walk few hundreds meters without pain. All the patients were satisfied from the procedure except for one patient with the medial talar osteophyte.

Clinical relevance: The outcome of TAA is good and leads to high satisfaction from the patients. However it is demanding procedure and has long learning curve with high rate of technical complications which can be overcome leading to complete recovery.