Introduction: Few intermediate term studies have presented data on modern total ankle replacement designs. This independent, prospective study provides clinical and radiographic results for 50 Scandinavian Total Ankle Replacements with at least 5 years follow up.

Methods: 50 consecutive STAR total ankle replacements were performed in 46 patients, aged 33–79 (mean 63) between 1999 and 2002 by a single surgeon. These were prospectively followed up on annually for a mean of 6 years (5–8 years).

Results: 34 replacements were performed for osteoarthritis, the remainder for inflammatory arthropathy. 13 ankles had a preoperative varus or valgus deformity of more than 10 degrees. There were 3 deaths, therefore 47 ankles reviewed.

5 revisions were performed; 2 for stiffness (1 tibial component, 1 insert), 2 for stress fractures (tibial component only) and 1 insert fracture. 3 of these cases required further surgery following their first revision (1 fusion for deep infection, 1 insert exchange for edge loading and one arthoscopic debridement plus calcaneal osteotomy for painful varus deformity).

There were no primary revisions for aseptic loosening or deep infection. 3 radiographs demonstrated non-progressive lucent lines behind the tibial component.

Further surgery was required in 8 other ankles (6 calcaneal osteotomies and 2 arthroscopic debridements). Complete correction of pre-operative deformity was ultimately achieved in all but 4 ankles.

The mean postoperative American Orthopaedic Foot and Ankle Society Score was 77.

Discussion: At a minimum follow up of 5 years after Scandinavian Total Ankle Replacement, all but one of our ankles have well functioning prostheses in situ. However, 13/47 ankles required further surgery of some kind, including 5 component revisions (90% survival).

Conclusion: Total ankle arthroplasty is a reliable procedure for ankle arthrosis at intermediate term follow up. It provides good functional results and symptomatic benefit, although additional operative procedures may be required.

Introduction: Total ankle replacement is proving a reliable procedure for ankle arthrosis. Some authors have recommended that significant hindfoot deformity should be a contraindication. This study aims to provide guidance on the management of this difficult problem.

Methods: 170 consecutive total ankle replacements were performed in 147 patients, aged 32–83 (mean 65) between 1999 and 2006 by a single surgeon. All surviving patients (5 deaths) were followed up prospectively on an annual basis, for a mean of 3 years (1–8 years). Comparison was made between Group A (45 ankles with a hindfoot deformity of > 10° varus or valgus) and Group B (the remaining 120 ankles).

Results: There was no statistical difference between the 2 groups for age, sex or indication for surgery (osteoarthritis in 81%). Group A comprised 8 valgus and 36 varus ankles. 23/36 varus ankles had a deformity of > 20°.

6 revisions (13%) were performed in Group A (5 of these related to instability – all preoperatively varus of > 20 degrees). 10 revisions (8%) were performed in Group B (2 related to instability).

6 ankles underwent intra-operative deltoid release and 6 had pre or post-operative calcaneal osteotomy. Only one of these required revision for instability. 4 ankles underwent post-operative lateral ligament reconstruction. These ankles all failed due to instability.

The mean postoperative American Foot and Ankle Society score in Group A was 85, compared to 78 in Group B.

Discussion: Our study reveals that patients with significant hindfoot deformity may benefit from total ankle replacement. However, the risk of revision due to instability and need for further surgery is higher, especially with a varus deformity of > 20°. Almost a quarter of these ankles required revision. Potential solutions may be to correct the deformity with additional calcaneal osteotomy or medial release, whereas lateral ligament reconstruction alone is inadequate.

Introduction: Good intermediate term results have been reported using a hybrid primary total hip arthroplasty (uncemented acetabular component with cemented stem) for osteoarthritis. Concerns have been highlighted recently regarding osteolysis behind the acetabular component. We present our results using the uncemented Aesculap plasma cup with an Exeter cemented femoral stem.

Methods: Outcome of 142 primary hip replacements (124 patients) at Derby Royal Infirmary between 1992–1998 was assessed. Most cases had a 28mm articulation, either Orthinox or ceramic. There were 60 men and 64 women, of mean age 55 (range 33–71). Mean time to follow up was 8.65 years (Range 7–13 years). Radiographic assessment was made to assess wear, acetabular lysis and loosening of the components. A clinical assessment and case note review was also performed.

Results: Of 142 hips, 2 were lost to follow up and 4 patients (6 hips) had died (unrelated causes). Of these, 7 revisions were performed; 3 for osteolysis, and 1 each for infection, acetabular wear, recurrent dislocation and early cup aseptic loosening. 9 hips were identified to have asymptomatic osteolysis (6 acetabular and 2 femoral). Mean rate of linear wear was 0.2mm/year for all hips, but 0.4mm/year for those with osteolysis. No cups without supplementary screw fixation developed acetabular osteolysis.

Conclusions: Our data suggests that there is a significant rate of acetabular osteolysis at intermediate (10 year) follow up of this combination of primary hybrid total hip replacement, often in association with increased acetabular wear. This can be asymptomatic and may lead to the need for complex revision surgery in the future. The failure rate is however significantly lower than in other reported studies with the same basic implants, but differing bearing diameters. This study highlights the need for close radiographic follow up of these patients, and the issue of subtle differences in the articulating surface.