SLR - May 2015 - Troy Fowler

Total Ankle Replacement for Postraumatic Arthritis Similar Outcome in Postfracture and Instability Arthritis: A Comparison of 90 Ankles

Reference: Weme RA, van Solinge G, N Doornberg J, Sierevelt I, Haverkamp D, Doets HC. Total ankle replacement for posttraumatic arthritis. Acta Orthop. 2015 Mar 14: 1-6.

Scientific Literature Review

Reviewed By: Troy Fowler, DPM
Residency Program: Northern Colorado Podiatric Medicine and Surgical Residency

Podiatric Relevance: Total ankle implants are becoming more common as implants are improving in quality and durability. One of the most difficult aspects of this procedure is patient selection. This article compares two groups. Group 1 is 50 post-traumatic arthritis patients with history of intra-articular fracture and group 2 is 40 post-traumatic patients with history of ligamentous injury. Knowing which groups of patients may be better suited for TAR vs fusion will can help with future successes and hopefully prevent poor outcomes.  

Methods: All 90 patients had a TAR done from March 2001 to December 2009. They were divided into the two groups previously mentioned. The first 15 TARs were performed with the Buechel-Pappas mobile bearing prosthesis and the latter 75 were performed with the Ceramic coated implant from Wright Medical. Revision was defined as removal or exchange of one or more of the prosthetic components, with the exception of incidental exchange of the polyethylene insert, e.g. during open debridement. Reoperation was defined as any subsequent non-revision surgery with involvement of the joint. The AOFAS, Kofoed, FAAM scores and SF-36 questionnaire were used in the evaluation.  Radiographic evaluation was performed using AP and lateral radiographs.  

Results: Thirteen ankles underwent revision or had undergone a salvage fusion and three patients had died. Seventy-four were left for follow-up. The six year survival was 87 percent for the post-fracture group and 79 percent for the instability group. There was no significant difference between the groups. Twenty-three complications occurred, 12 in post-fracture group and 11 in instability group. A preoperative varus deformity of 10 degrees or more was present in 23 ankles in the instability group.

Conclusion: Both of the groups performed similarly even with a high rate of preoperative varus deformity in the instability group. They did state this improved outcome with varus deformity may be due to the balancing procedures used such as lengthening osteotomy of the medial malleolus. This article helps support other literature showing that total ankle replacements can be a viable option for patients with a varus deformity.  

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