Aims

The purpose of this study was to assess the success rate and functional outcomes of bone grafting for periprosthetic bone cysts following total ankle arthroplasty (TAA). Additionally, we evaluated the rate of graft incorporation and identified associated predisposing factors using CT scan.

Aims. Implant failure has become more common as the number of primary total ankle arthroplasties (TAAs) performed has increased. Although revision arthroplasty has gained attention for functional preservation, the long-term results remain unclear. This study aimed to assess the long-term outcomes of revision TAA using a mobile-bearing prosthesis in a considerably large cohort; the risk factors for failure were also determined. Methods. This single-centre retrospective cohort study included 116 patients (117 ankles) who underwent revision TAA for failed primary TAA between July 2000 and March 2010. Survival analysis and risk factor assessment were performed, and clinical performance and patient satisfaction were evaluated preoperatively and at last follow-up. Results. The mean duration from initial revision TAA to last follow-up was 15.0 years (SD 3.0; 11.2 to 20.5). The cumulative survival rates of the revised ankles were 81% (95% confidence interval (CI) 74% to 88%), 74% (65% to 82%), and 70% (61% to 79%) at five, ten, and 15 years, respectively. Comorbidities prior to primary TAA, aseptic loosening, instability, or grafting of cysts were found to be the most common risk factors for secondary revision. The median value for preoperative pain, as assessed using the visual analogue scale, declined from 6 (interquartile range (IQR) 5 to 8) to 2 (IQR 0 to 5) (p < 0.001) and the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from 43 (SD 17) preoperatively to 70 (SD 20) (p < 0.001) at last follow-up. Conclusion. Revision TAA offers acceptable survival rates after 15 years; it therefore offers a valuable option for treatment of implant failure in carefully selected cases. Although patient-reported outcomes improve substantially, the degree of improvement reported following primary TAA is not achieved. Cite this article: Bone Joint J 2024;106-B(1):46–52

Aims

The number of revision total ankle arthroplasties (TAAs) which are undertaken is increasing. Few studies have reported the survival after this procedure. The primary aim of this study was to analyze the survival of revision ankle arthroplasties using large datasets. Secondary aims were to summarize the demographics of the patients, the indications for revision TAA, further operations, and predictors of survival.

Aims. The Vantage Total Ankle System is a fourth-generation low-profile fixed-bearing implant that has been available since 2016. We aimed to describe our early experience with this implant. Methods. This is a single-centre retrospective review of patients who underwent primary total ankle arthroplasty (TAA) with a Vantage implant between November 2017 and February 2020, with a minimum of two years’ follow-up. Four surgeons contributed patients. The primary outcome was reoperation and revision rate of the Vantage implant at two years. Secondary outcomes included radiological alignment, peri-implant complications, and pre- and postoperative patient-reported outcomes. Results. There were 168 patients (171 ankles) included with a mean follow-up of 2.81 years (2 to 4.6) and mean age of 63.0 years (SD 9.4). Of the ten ankles with implant failure (5.8%), six had loosening of the tibial component. In the remaining four failed implants, one was due to periprosthetic joint infection (PJI), one was due to loosening of the talar component, and two were due to loosening of both the tibial and talar components. Seven patients underwent reoperation: irrigation and debridement for superficial infection (n = 4); bone grafting for cysts (n = 2); and open reduction internal fixation (n = 1). Asymptomatic peri-implant lucency/subsidence occurred in 20.1% of ankles, with the majority involving the tibial component (n = 25). There were statistically significant improvements in PROMs in all domains. Conclusion. Short-term results of this implant demonstrate early survival comparable to the reported survivorship of similar low-profile, non-stemmed implants. Radiological lucency occurred more commonly at the tibial component, and revisions occurred primarily due to loosening of the tibial component. Further research is needed to evaluate longer-term survivorship. Cite this article: Bone Joint J 2023;105-B(10):1099–1107

Aims

When a total ankle arthroplasty (TAA) fails, it can be converted to a fusion or a revision arthroplasty. Despite the increasing numbers of TAAs being undertaken, there is little information in the literature about the management of patients undergoing fusion following a failed TAA. The primary aim of this study was to analyze the survival of fusions following a failed TAA using a large dataset from the National Joint Registry (NJR).

The August 2023 Foot & Ankle Roundup³⁶⁰ looks at: Achilles tendon rupture: surgery or conservative treatment for the high-demand patient?; First ray amputation in diabetic patients; Survival of ankle arthroplasty in the UK; First metatarsophalangeal joint fusion and flat foot correction; Intra-articular corticosteroid injections with or without hyaluronic acid in the management of subtalar osteoarthritis; Factors associated with nonunion of post-traumatic subtalar arthrodesis; The Mayo Prosthetic Joint Infection Risk Score for total ankle arthroplasty.

Aims

The primary aim of this prospective, multicentre study is to describe the rates of returning to golf following hip, knee, ankle, and shoulder arthroplasty in an active golfing population. Secondary aims will include determining the timing of return to golf, changes in ability, handicap, and mobility, and assessing joint-specific and health-related outcomes following surgery.

Aims

Despite the increasing numbers of ankle arthroplasties, there are limited studies on their survival and comparisons between different implants. The primary aim of this study was to determine the failure rates of primary ankle arthroplasties commonly used in the UK.

Aims

Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations.

Aims

The purpose of this study was to determine the functional outcome and implant survivorship of mobile-bearing total ankle arthroplasty (TAA) performed by a single surgeon.

Aims

Total ankle arthroplasty (TAA) surgery is complex and attracts a wide variety of complications. The literature lacks consistency in reporting adverse events and complications. The aim of this article is to provide a comprehensive analysis of each of these complications from a literature review, and to compare them with rates from our Unit, to aid clinicians with the process of informed consent.

Background. Total ankle arthroplasty is an accepted alternative to arthrodesis of the ankle. However, complication and failure rates remain high compared to knee and hip arthroplasty. Long-term results of the Scandinavian Total Ankle Replacement (STAR) are limited, with variable complication and failure rates observed. This prospective study presents the long-term survivorship and the postoperative complications of the STAR prosthesis. Additionally, clinical outcomes and radiographic appearance were evaluated. Methods. Between May 1999 and June 2008, 134 primary total ankle arthroplasties were performed using the STAR prosthesis in 124 patients. The survivorship, postoperative complications and reoperations were recorded, with a minimum follow-up period of 7.5 years. Clinical results were assessed using the Foot Function Index (FFI) and the Kofoed score. The presence of component migration, cysts and radiolucency surrounding the prosthesis components, heterotopic ossifications and progression of osteoarthritis in adjacent joints were determined. Results. The cumulative survival was 78% after a 10-year follow-up period (Figure 1). An ankle arthrodesis was performed in the 20 ankles that failed. Fourteen polyethylene insert fractures occurred. Other complications occurred in 29 ankles, requiring secondary procedures in 21 ankles. Nevertheless, the postoperative clinical results improved significantly. Osteolytic cysts were observed in 59 ankles and the surface area of these cysts increased during follow-up, without any association with the prosthesis alignment or clinical outcome. Heterotopic ossifications at the medial malleolus were present in 58 cases and at the posterior tibia in 73 cases, with no effect on clinical outcome. Osteoarthritis of the subtalar joint and talonavicular joint developed in 9 and 11 cases, respectively. Conclusion. The long-term clinical outcomes for the STAR were found to be satisfactory. These results are consistent with previous studies; however, the survival and complication rates are still disappointing compared to the results obtained in knee and hip arthroplasty. Higher rates of successful outcomes following ankle arthroplasty are required, and these results highlight the need for further research to clarify the origin and significance of the reported complications. Figure 1. Kaplan-Meier survivorship analysis with revision or removal of the tibia and/or the talus component for any reason as the endpoint, showing 78% (95% confidence interval 0.63–0.88) survival at 10.28 years follow-up. For figure, please contact authors directly

Background. Ankle arthroplasty is increasingly used to reduce pain and improve or maintain joint mobility in end-stage ankle arthritis. Both treatments show similar results with regard to functional outcome scores and sport related activities. However, the rates of complications and reoperations were higher after ankle replacement. Particularly for the first implant designs, with more promising results for newer designs. One of these newer designs is the Mobility Total Ankle System. Short term results in recent literature describe an improvement of functional outcomes; however complication rates vary widely, ranging from 9 to 37% and the 4-year survival rates ranging between 84 and 98 percent. Therefore, the aim of this study was to assess the clinical and radiographic short term results of the Mobility prosthesis. Methods. Between March 2008 and September 2013, 67 primary total ankle arthroplasties with the Mobility prosthesis were performed, in 64 patients, by one experienced foot and ankle surgeon. Complications, reoperations, failures and the survival rate were retrospectively examined. Patient reported outcomes were assessed with the use of the FFI score and visual analogue scale (VAS) for pain. Prosthesis alignment was measured on the first weightbearing radiographs of the ankle according to the procedure described by Rippstein et al.1 (Fig. 1). Results. The mean follow-up period was 40 months (range 12–78 months). There were two intraoperative and 13 postoperative complications, requiring seven reoperations. The reason for reoperation was painful impingement of the medial and/or lateral gutter (n=4), a deep infection (n=1), subsidence of the talus component (n=1) and a cyst located in the tibiofibular joint (n=1). Failure occurred in three of the 67 cases, with one early deep infection with a loose tibia component, one case of aseptic loosening and one case of chronic ankle pain without an assignable cause. A two-stage revision, ankle arthrodesis and amputation of the lower leg was performed, respectively. The mean cumulative survival after 61.4 months was 95% (CI 84–98) (Fig. 2). There was a significant decrease in the median FFI pain and disability score. The pain subscore decreased from 56.4 to 22.2 points and the disability score from 61.1 to 33.3 points. The mean VAS pain was 26.5 for the ankle region. The tibial components were placed in a mean of 1.5° varus relative to the mechanical axis of the tibia in the frontal plane. Malalignment (>5°) was observed in four cases with a mean of 6.0° varus. In the sagittal plane, a mean posterior slope of 1.6° relative to the mechanical axis of the tibia was measured, with one case of 7.5° of anterior slope. The talar component was centred too far posteriorly in five cases, which was considered as malalignment. Conclusion. Despite few intraoperative complications and satisfactory clinical and radiological outcome, the incidence of postoperative complications, reoperations and failure indicate the importance of further development and research in the field of ankle arthroplasty. To view tables/figures, please contact authors directly

The incidence of periprosthetic fractures of the ankle is increasing. However, little is known about the outcome of treatment and their management remains controversial. The aim of this study was to assess the impact of periprosthetic fractures on the functional and radiological outcome of patients with a total ankle arthroplasty (TAA).

A total of 505 TAAs (488 patients) who underwent TAA were retrospectively evaluated for periprosthetic ankle fracture: these were then classified according to a recent classification which is orientated towards treatment. The outcome was evaluated clinically using the American Orthopedic Foot and Ankle Society (AOFAS) score and a visual analogue scale for pain, and radiologically.

A total of 21 patients with a periprosthetic fracture of the ankle were identified. There were 13 women and eight men. The mean age of the patients was 63 years (48 to 74). Thus, the incidence of fracture was 4.17%.

There were 11 intra-operative and ten post-operative fractures, of which eight were stress fractures and two were traumatic. The prosthesis was stable in all patients. Five stress fractures were treated conservatively and the remaining three were treated operatively.

A total of 17 patients (81%) were examined clinically and radiologically at a mean follow-up of 53.5 months (12 to 112). The mean AOFAS score at follow-up was 79.5 (21 to 100). The mean AOFAS score in those with an intra-operative fracture was 87.6 (80 to 100) and for those with a stress fracture, which were mainly because of varus malpositioning, was 67.3 (21 to 93). Periprosthetic fractures of the ankle do not necessarily adversely affect the clinical outcome, provided that a treatment algorithm is implemented with the help of a new classification system.

Cite this article: Bone Joint J 2015;97-B:950–6.