With the increasing number of implantation of total ankle arthroplasty a higher rate of pitfalls and failures has to be expected. Intra- and postoperative complications in total ankle arthroplasty, their sources of failure and revision options are demonstrated. In the time of 7/97 until 1/06 269 S.T.A.R. total ankle prostheses have been implanted at our hospital. Intraoperative complications occurred in 7 cases (4 fractures of the malleolus medialis, 2 fractures of distal fibula, 1 fissure of talus). We observed early complications in form of delayed wound healing (n=31) and 4 deep infections. A higher incidence of secondary wound healing is shown in rheumatoid arthritis patients in comparison to patients with OA. Late complications included persisting intraarticular synovitis, especially in rheumatoid arthritis, an impingement (11 cases) and osteolysis (4 cases). Revision surgery was performed in 45 cases (16.7%) 1.5 years after primary implantation (14 operations with problems in secondary wound healing, 9 lengthenings of the Achilles tendon with a dorsal capsulotomy (2 rheumatoid arthritis patients), 11 revisions of the PE gliding core with resection of periarticular hypertrophic bone formation, 4 revisions of singular components, 2 complete revisions of the prosthesis, 4 ankle fusions, 1 amputation. Only in 18 cases (6.7%) these complications and the following surgical procedures influenced the satisfaction of the patients. Despite the demonstrated complications, total ankle arthroplasty is more than an alternative to open ankle arthrodesis in the progressive phases of arthritic joint destruction, also in RA at a LDE stage ≥ III.
