Abstract
Introduction: The use of total ankle arthroplasty for the management of end stage arthritis of the ankle is gaining in popularity. We performed a review of the literature on Total Ankle Arthroplasty to assess the methodology of studies and to detect possible variation in the reported surgical outcomes.
Material and Methods: All relevant articles in peer-reviewed journals were retrieved except those not mentioning outcomes, case reports, review of literature and letters to editors. Studies reporting on implants presently used, with at least 20 subjects followed for a mean of at least two years were included. Two authors independently scored the quality of the studies using the Coleman Methodology Score (CMS). We collected data for type of study, patient numbers, length of follow-up, complications, outcome and prosthesis survival with revision or fusion as an endpoint. Where appropriate, pooling of data was performed.
Results: Twenty-one level IV studies, published from 2003 to 2008, reporting on 2167 ankle replacements followed for a mean of 5.6 years, were included. The CMS was 65 (SD 15), with substantial agreement between the two examiners. Inflammatory arthropathy was present in 31% of ankles. The intra-operative fracture rate was 10.5%. Superficial wound healing complication rate was 6.4%, and deep infections occurred in 1.2% of ankles. Patients’ satisfaction rate was 94%. The failure rate of the primary ankle prosthesis was 11.6% (Agility: 12.2% at 4 years, STAR: 11.7% at 4.6 years and Buechel-Pappas (BP): 12.8% at 7.3 years). Pooling the data the six-year survivorship for the Agility was 0.70 (CI 95%, 0.50–0.90), whereas the 10-year survivorship for the STAR was 0.79 (CI 95%, 0.56–1.00) and for the BP 0.87 (CI 95%, 0.69–1.00).
Conclusions: Studies reporting on total ankle arthroplasty are of overall moderate quality. Survivorship analysis revealed superior results for mobile-bearing implants. Patients’ satisfaction rate was high.
Correspondence should be addressed to A.H.N. Robinson, BOX 37, Department of Orthopaedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Hills Road, Cambridge. CB2 0QQ, England.
