SLR - June 2023 - Jonathan D. Nigro
Title: Fixed-Bearing Trabecular Metal Total Ankle Arthroplasty Using the Transfibular Approach for End-Stage Ankle Osteoarthritis An International Non-Designer Multicenter Prospective Cohort StudyReference: D'Ambrosi R, Tiusanen HT, Ellington JK, Kraus F, Younger A, Usuelli FG. Fixed-Bearing Trabecular Metal Total Ankle Arthroplasty Using the Transfibular Approach for End-Stage Ankle Osteoarthritis: An International Non-Designer Multicenter Prospective Cohort Study. JB JS Open Access. 2022 Sep 22;7(3):e21.00143. doi: 10.2106/JBJS.OA.21.00143. PMID: 36159081; PMCID: PMC9489156.
ACFAS Scientific Literature Review
Level of Evidence: Level III
Reviewed by: Jonathan D. Nigro
Residency Program: West Penn Hospital, Allegheny Health Network, Pittsburgh, PA
Podiatric Relevance: This study is relevant to the field of podiatry as the number of total ankle implants have increased drastically worldwide over the last decade. This is a vital procedure that podiatric surgeons should be confident in as current patient populations want to remain active with a mobile ankle joint.
Methods: TThe purpose of this multi-center prospective study was to evaluate total ankle arthroplasty survival rate and revision rate. The authors also monitored clinical and radiographic parameters by administering AOFAS, EQ-5D, AOS Pain, and AOS difficulty scores. Complications were classified using the COFAS system. There were 121 consecutive patients that qualified for the study across 11 different centers worldwide, all using the same trabecular metal total ankle system. These patients were evaluated at 6 weeks, 6 months, 1 year, 2 years and at 3 years.
Results: The Kaplan- Meier survival estimates for the total ankle arthroplasty procedure showed 98.32% survivorship at 1 year and 97.35% at years 2 and 3. There were 3 revisions, one being due to infection and the other 2 due to valgus malalignment. During their 3-year follow-up, 9 patients showed abnormal radiographic finding (radiolucency, osteolysis, heterotopic ossifications or potential subtalar impingement), 2 patients had intraoperative complication (partial tears of the peroneal tendon and tibialis posterior tendon) and there were 38 patients that had complication that were non-surgical or device-related. Clinical markers such as the AOFAS, EQ-5D, AOS pain, and AOS difficulty all showed statistical improvement (p<0.001) compared with pre-operative baseline at 6 weeks, 6 months, and years 1-3.
Conclusions: This study shows that there are high patient satisfaction rates with total ankle arthroplasty and that implant survival is well maintained at 3 years. This study also proves that there is a low rate of significant complications when this procedure is accurately performed. Current literature, including this study, demonstrates that total ankle arthroplasty is a viable option for patients who are motivated to maintain motion across their ankle joint.