Introduction: Ankle Arthroplasty is an alternative to arthrodesis for patients with disabling ankle arthritis. It aims to remove pain and preserve joint motion. We aimed to review the outcome of all total ankle replacements carried out in our institution between 2002 and 2006.

Materials and Methods: We retrospectively reviewed the results of all patients who underwent the Agility ankle replacement performed by a single surgeon. Case notes and radiographs were reviewed and outcome assessment included standardised questionnaires.

Results: 30 arthroplasties were performed in 30 consecutive patient. 11 males, 19 females, Pre operative diagnosis was rheumatoid arthritis (16), primary osteoarthritis (12) and post-traumatic osteoarthritis (2) with a mean age of 61.8 yrs. 8 patients required an additional procedure at the time of arthroplasty : tendoachilles lengthening (6); Calcaneal osteotomy (2); triple arthrodesis (2); tip post reconstruction (1). Intra operative technical complications included: Fracture of medial malleolus (3); nerve injury (3); tendon injury (1). 8 patients had wound problems: Delayed healing > 3/52 (8); Superficial infection (2); Deep infection (2). 1 patient had delayed union of the syndesmosis (> 6 months) and 6 had non-union (> 12 months).

After a mean follow up of 3.2 years 2 patients had died and 9 patients had required further surgery: Implant removal for infection (1); Talar revision for loosening (1); Re-fusion of the syndemosis (4); Removal of syndesmosis screws (3); Calcaneal osteotomy for valgus hindfoot (1).

Discussion: We found a high rate of complications which may be related to the surgeons learning curve, although some are specific to the design of implant which requires a tibio-fibular fusion.

Conclusion: The first 30 agility ankle replacements performed in our centre demonstrates several potential complications and shows that there is often a need for subsequent surgery. Short term survivorship of the implant is acceptable and long term review is required.