We present the early results of 220 Rebalance Total Ankle Replacements performed in 6 centres in 4 different countries. The Rebalance Total Ankle Replacement is a new 3 component uncemented mobile bearing prosthesis with a surface coating of ‘bonemaster’ and an ‘e’ poly bearing. The prosthesis was released in a limited way in May 2011. Since then 220 replacements have been implanted in 218 patients in 6 centres in 4 different countries (UK, Sweden, Canada, Czech Republic). All the x-rays and case notes were reviewed.63 prostheses have a minimum follow up of 2 years. Outcome measures included revision of the prosthesis, and the incidence of progressive and non-progesssive radiolucent lines around the prosthesis.Introduction:
Methods:
Different resurfacing implants offer different kinds of positioning instruments. As it is of outmost importance to position the components within rather narrow limits to diminish the risk of femoral notching or impingement we decided to measure the position achieved in 72 hips resurfaced with the Durom® resurfacing hip and instruments. There were 38 males and 27 females with 72 hips (7 bilateral). The indication was OA in 51 cases, RA in 12 and ON in 2. We compared 2 groups, 26 hips operated with an antero-lateral approach (A) and 46 with a postero-lateral approach (B). The acetabular cup anteversion angle was 22±11° in group A and 15±9° in group B. The abduction angle was 38±9 ° in group A and 44±7° in group B. The acetabular gap was 2±1 mm, resp. 2±2 mm. The stem-shaft angle was 140±5° resp. 141±6°. Retroverted cups averaged 7±4°. The difference between pre- and postoperative acetabular size was 3 mm in group A (mostly RA patients) and 5 mm in group B (mostly OA patients).
25 RA patients with their ankles fused with an intramedullary nail were compared to 35 RA patients with their ankles fused with compression screws. 24/25 nailed patients showed radiographic healing at follow-up after 3 (1–8) years, and 26/35 ankles in the compression screw group examined after 6 (1–14) years healed after the first attempt and another 5 after repeat surgery. In the nailed group 23 patients were satisfied and 2 somewhat satisfied. In the compression screw group 20 were satisfied, 12 somewhat satisfied and 3 dissatisfied. There were 4 deep infections (3 healed after nail extraction and antibiotics, one unhealed) in the nail group and 1 deep infection (healed after antibiotics) in the compression screw group. Six patients in the nailed group also had a permanent plantar sensory loss.
RA patients with a normal subtalar joint are of course only managed by compression screws.
Modern pharmaceutical treatment of RA seems to result in less need of prophylactic surgery but the burden of secondary osteoarthrosis of the the large joints in the lower extremity will be present for a foreseeable future. The results of hip an knee arthroplasty are well known from the Swedish Arthroplasty Registers. Severe deformities of the hip and knee are nowadays very seldom seen, but the same does not hold true for the ankle and foot. As more RA patients are offered hip and knee replacement they will start loading their feet to an extent which the feet are not always able to withstand. Effetcive pain-killing pharmaceuticals also means a possibility to put weight even on an arthritic deformed foot. Thus, severe foot and ankle deformities are still rather frequently seen. Improved surgical methods for correction have evolved and in most cases reconstructive ankle and foot surgery will restore the weightbearing capacity of the RA foot.
