INTERMEDIATE RESULTS OF BUECHEL PAPPAS UNCONSTRAINED UNCEMENTED TOTAL ANKLE REPLACEMENT

Abstract

We present the functional and radiological results after implantation of thirty four uncemented Buechel Pappas total ankle replacements. The average follow-up period was 5 years. All consecutive uncemented Buechel Pappas total ankle replacements were performed by the senior author (MSA) between 1990 and 2005, at Corbett District General Hospital, Dudley. Thirty four ankle replacements were performed. One patient died before follow-up. All ankle replacements were performed for osteoarthritis. The patients were assessed clinically and radiologically.

Thirty four ankle replacements were performed on thirty three patients. There were eight female and twenty five male patients. One patient had died 2 years after her ankle replacement. The average age of the patients was 69(58–84). All ankle replacements were performed for osteo-arthritis. 59% had post traumatic osteoarthritis.

The average body mass index was 30 (22–37). One hundred percent of patients were happy with their ankle replacement. Fifty nine percent of patients were completely pain-free, or had occasional twinges. All patients were mobile, forty seven percent of patients required no walking aids and only six percent required 2 walking aids. One patient complained of occasional instability. One patient sustained a medial malleolar fracture intra-operatively which was fixed with two partially threaded cancellous screws. The patients were placed in a back-slab post-operatively and were non-weight bearing for a period of 6 weeks. No revision operations were performed to date.

Clinical examination revealed forty two (5–57) degrees of movement in the ankle replacement at follow-up. Radiological examination revealed forty five (0–57) degrees of movement in the ankle joint. Pearson Correlation coefficient was 0.956, p< 0.001. There was excellant correlation between clinical and radiological assessment of range of movement.

Examination of the radiographs demonstrated no evidence of gross subsidence, or lucency. One implant had a poorly positioned talar component, but so far this has been assymptomatic.

The American Foot and Ankle Society Scores were 34.6(20–56) pre-operatively compared with 76(54–100) at follow-up. This was significant improvement p< 0.001. Average scores for pain, function and alignment were 30(20–40),40(29–50) and 9(5–10).

There was one intra-operative fractured medial malleolus and two superficial wound infections (with negative swabs) treated with antibiotics.

We compare our results with others published and feel the Buechel Pappas Uncemented Total Ankle replacement performs well and is a good alternative to ankle arthrodesis preserving ankle movement and biomechanics. The results are comparable to other uncemented total ankle replacements.