Abstract
Introduction
Total ankle arthroplasty is increasingly used as an alternative to arthrodesis to treat advanced ankle arthritis. In an attempt to assess the survivorship and patient outcome as well as peri- and postoperative complications and possible risk factors, we retrospectively analyzed the demographics, clinical outcome and radiographic characteristics of 100 ankle prostheses (97 patients).
Patients and methods
Between 3/2005 and 5/2010 114 S.T.A.R. Prostheses were implanted by one surgeon at our institution. Indication for TAA was primary and secondary osteoarthritis, 81 cases were posttraumatic. From the 53 female and 44 male patients the mean age was 63 and the mean BMI was 28,4.
11 patients had been smoking for longer than 12 years, 29 patients either had a history of diabetes, peripheral vascular or cardiovascular disease or varicosis.
All operations were performed with a tourniquet, using a standard anterior midline incision. All patients received the same postoperative rehabilitation and follow up program. Postoperative evaluation included the AOFA Score and clinical radiographic follow ups 6 weeks after surgery and yearly thereafter. Additional procedures during surgery included lengthening of the Achilles tendon for 12 patients and fusion of the subtalar ankle for 5 patients.
Results
The average follow up was 36 months. The preoperative AOFA Score of 36.87 (22–58) increased to 75.99 postoperative. 87 cases reported a better life quality and 82 cases would go for surgery again. 27 ankles incurred complications after primary surgery. 21 prostheses had to go for revision surgery. Most complications were due to aseptic loosening/ implant failure. Other complications include arthrofibrosis and impingement as well as delayed wound healing and deep infection. Four patients had to be revised to an athrodesis.
Conclusion
Our study shows a high satisfaction rate after total ankle replacement and clear pain relief which is the primary indication for ankle arthroplasty. Patients with a body mass Index higher than 30 as well as patients with a history of diabetes or peripheral vascular disease and smokers showed a higher rate of complications. Although these are encouraging results, the rate of complications should be discussed with patients. Compared with ankle fusion, the rates of complications seem to be comparable.
