SLR - February 2024 - Wolverton
Title: Early outcomes of the Exactech Vantage fixed-bearing total ankle replacementReference: Henry JK, Shaffrey I, Wishman M, Palma Munita J, Zhu J, Cody E, Ellis S, Deland J, Demetracopoulos C. Early outcomes of the Exactech Vantage fixed-bearing total ankle replacement. Bone Joint J. 2023 Oct 1;105-B(10):1099-1107.
Level of Evidence: III
Reviewed By: Spencer Wolverton, DPM
Residency Program: Mount Auburn Hospital, Cambridge MA
Podiatric Relevance: The authors goals were to layout and examine their experience with the named implant in its early stages postoperatively. The increasing usage of total ankle implants as an alternative to ankle joint fusion is an area of ongoing focus in podiatric medicine and surgery. The development of new implants, as well as the refinement of surgical technique, to further improve patient outcomes, are important pursuit as we seek to provide the best possible solutions to our patients.
Methods: A level III single-centre retrospective review. Cases reviewed were of total ankle arthroplasty patients with Vantage implant, between November 2017 and February 2020, and a minimum two year follow up. The primary outcome examined was reoperation/revision rate of the implant in question at two years. Secondary outcomes included radiographic alignment, peri-implant complications, and patient reported outcomes from pre and postop. There were four contributing surgeons.
Results: 10 of 168 (171 ankles) patients experience implant failure (5.8%). Of these ten, eight included tibial component failure. Specifically, six were exclusively tibial component, two were tibial and talar, one was talar only, and one was periprosthetic joint infection. There was documented asymptomatic lucency or subsidence in 20.1%, with the 25 (14.5%) cases involving the tibial component. Reoperation occurred in seven cases, with four due to superficial infection, two related to bone grafting of cysts, and one for ORIF.
Conclusions: The authors concluded that early results showed survival rates comparable to other “low-profile, non-stemmed implants.” They further noted that lucency on radiograph occurred most commonly with the tibial implant and revision occurred most commonly in the setting of loosening of the tibial component. This article left me curious as to how the named implant, and other non-stemmed tibial implants compare to those that are stemmed. A commonly shared reason for using a non-stemmed tibial implant is to preserve more bone. However, it is also common in the event of revision of these implants to then progress to a stemmed implant. However, if rates of revision are higher with these non-stemmed implants, and complications involving the tibial component lead to reoperation/revision most often, then it may be found that an effort to preserve bone initially is not worth exposing the patient to the significantly increased risks associated with a reoperation. Ongoing comparative analysis of the two classes of tibial implant will help to determine what is ultimately most beneficial for the patient.