SLR - December 2009 - Nathaniel J. Voshel
Reference:
Claridge, R., Sagherian, B. (2009). Intermediate Term Outcome of the Agility Total Ankle Arthroplasty. Foot and Ankle International, 30 (9), 824-835.
Scientific Literature Reviews
Reviewed by: Nathaniel J. Voshel, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
Ankle arthrodesis has long been the gold standard for operative treatment of severe ankle degeneration. The newer generation total ankle arthroplasty designs go one step further by addressing the biomechanical, anatomical, and kinematic properties of the ankle.
Methods:
This retrospective study was performed on 28 total ankle arthroplasty prodedures utilizing the Agility Total Ankle Arthroplasty system between 1999 and 2004. All patients involved were given the choice of ankle arthroplasty or arthrodesis. The mean age at time of surgery was 68.5 (41-81) years. 11 males and 17 females were in the study group. After two patients were lost to follow-up and one patient received an ankle arthrodesis after total ankle arthroplasty failure, the remaining patients in the study was 25 with a mean follow-up period of 59.8 (21-104)months. The AOFAS Ankle-Hindfoot questionnaire was used to assess the patient at initial visit as well as follow-up visits.
Results:
The mean AOFAS Ankle-Hindfoot score was 34.9 (15-61) preoperatively and 76.4 (41-97) postoperatively at last follow-up. Pain relief contributed significantly in improvement of the score as well as improved functional component. Eighty-one percent reported increased activity level and 83% reported increased walking distance following total ankle arthroplasty. Sixty-seven percent had improvement in ankle range of motion and 81% related improvement in their gait. Complications included delayed wound healing, wound infection, painful hardware, iatrogenic malleolar fracture and arterial injury. All the complications were successfully treated and most patients were satisfied at final follow-up.
Conclusions:
The Agility Total Ankle Arthroplasty prosthesis offers increased activity level and ankle functionality compared to traditional ankle arthrodesis. High compliation rates, which were treated successfully in this study, require the surgeon and patient to weigh the risks and benefits of the procedure. Newer designs and techniques in total ankle arthroplasty that can also help reduce complication rates may lead to more widespread use.