Advertisement

Mid-Term Functional and Radiological Outcomes of Total Ankle Replacement in an Asian Cohort

Published:September 19, 2021DOI:https://doi.org/10.1053/j.jfas.2021.09.014

      Abstract

      There are limited studies looking at longer-term outcomes of the total ankle replacement (TAR) in the Asian cohort. Asian ankles are smaller in size and are more varus compared to Western cohorts. Cultural differences also require increased ankle range of motion demands. Therefore, assessment of longer-term functional and radiological outcomes in the Asian cohort is warranted. Between 2007 and 2015, 43 consecutive patients received a 3-component, cementless, unconstrained, fully congruent TAR. Patients were followed up over a mean 8 (range 5-14 years). Preoperative and postoperative AOFAS ankle-hindfoot score (AOFAS-AHS), visual analogue score (VAS), physical and mental component scores of the SF-36 (PCS and MCS respectively) were calculated. European Foot and Ankle Score was also recorded at 8 years. Radiographs were reviewed postoperatively to assess implant position and study evidence of implant loosening and impingement. At 8 years, survivorship was 83.5%. Reasons for implant removal included infection (n = 2) and aseptic loosening (n = 5). AOFAS-AHS, VAS MCS at 8 years postoperatively were comparable to outcomes at 2 years postoperatively (p > .05). PCS at 8 years demonstrated improvement compared to 2 years postoperatively (49 ± 7 vs 42 ± 11, p = .048). Radiographic impingement was noted in 9 cases (20.9%). Radiological loosening was noted in 8 cases with 5 cases requiring revision surgery. At 8 years postoperatively, clinical outcomes, radiological outcomes and survivorship following TAR in an Asian cohort are satisfactory and comparable to that found in existing literature. Long-term studies are required to ascertain survivorship of TAR. Implant design with the Asian cohort in mind may yield improved outcomes.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kim SJ
        • Sung I-H
        • Song SY
        • Jo Y-H.
        The epidemiology and trends of primary total ankle arthroplasty and revision procedure in Korea between 2007 and 2017.
        J Korean Med Sci. 2020; 35: e169
        • Saltzman CL
        • Mann RA
        • Ahrens JE
        • Amendola A
        • Anderson RB
        • Berlet GC
        • Brodsky JW
        • Chou LB
        • Clanton TO
        • Deland JT
        • Deorio JK
        • Horton GA
        • Lee TH
        • Mann JA
        • Nunley JA
        • Thordarson DB
        • Walling AK
        • Wapner KL
        • Coughlin MJ.
        Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results.
        Foot Ankle Int. 2009; 30: 579-596
        • Bolton-Maggs BG
        • Sudlow RA
        • Freeman MA.
        Total ankle arthroplasty. A long-term review of the London Hospital experience.
        J Bone Joint Surg Br. 1985; 67: 785-790
        • Haddad SL
        • Coetzee JC
        • Estok R
        • Fahrbach K
        • Banel D
        • Nalysnyk L.
        Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature.
        J Bone Joint Surg Am. 2007; 89: 1899-1905
      1. History of total ankle arthroplasty [Internet].
        in: Hintermann B Total Ankle Arthroplasty: Historical Overview, Current Concepts and Future Perspectives. Springer, Vienna2005: 43-57
        • Gittins J
        • Mann RA.
        The history of the STAR total ankle arthroplasty.
        Foot Ankle Clin. 2002; 7 (vii): 809-816
        • Pappas M
        • Buechel FF
        • Depalma AF
        Cylindrical total ankle joint replacement: surgical and biomechanical rationale.
        Clin Orthop Relat Res. 1976; : 82-92
        • Schweitzer KM
        • Adams SB
        • Viens NA
        • Queen RM
        • Easley ME
        • Deorio JK
        • Nunley JA.
        Early prospective clinical results of a modern fixed-bearing total ankle arthroplasty.
        J Bone Joint Surg Am. 2013; 95: 1002-1011
        • Angthong C
        • Chumchuen S
        • Khadsongkram A.
        A systematic review of intermediate-term outcomes and failure rates for total ankle replacements: an Asian perspective.
        Foot Ankle Surg. 2013; 19: 148-154
        • Kim BS
        • Choi WJ
        • Kim YS
        • Lee JW.
        Total ankle replacement in moderate to severe varus deformity of the ankle.
        J Bone Joint Surg Br. 2009; 91: 1183-1190
        • Eun SS
        • Lee W-C
        • Lee S-H
        • Paik DJ
        Hwang Y-IL. Compatibility of the HINTEGRA prostheses with Korean ankles as evaluated on the basis of cadaveric measurements.
        Clin Anat N Y N. 2012; 25: 1087-1092
        • Tan SM
        • Bin Abd Razak HR
        • Singh RI
        Early functional, radiological outcomes and satisfaction rates of total ankle arthroplasty in an Asian population.
        Foot Ankle Spec. 2018; 11: 425-432
        • Hosman AH
        • Mason RB
        • Hobbs T
        • Rothwell AG.
        A New Zealand national joint registry review of 202 total ankle replacements followed for up to 6 years.
        Acta Orthop. 2007; 78: 584-591
        • Skyttä ET
        • Koivu H
        • Eskelinen A
        • Ikävalko M
        • Paavolainen P
        • Remes V.
        Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register.
        Acta Orthop. 2010; 81: 114-118
        • Zaidi R
        • Cro S
        • Gurusamy K
        • Siva N
        • Macgregor A
        • Henricson A
        • Goldberg A.
        The outcome of total ankle replacement: a systematic review and meta-analysis.
        Bone Joint J. 2013; 95-B: 1500-1507
        • Henricson A
        • Carlsson Å.
        Survival analysis of the single- and double-coated STAR ankle up to 20 years: long-term follow-up of 324 cases from the Swedish ankle registry.
        Foot Ankle Int. 2015; 36: 1156-1160
        • Clough T
        • Bodo K
        • Majeed H
        • Davenport J
        • Karski M.
        Survivorship and long-term outcome of a consecutive series of 200 Scandinavian Total Ankle Replacement (STAR) implants.
        Bone Joint J. 2019; 101-B: 47-54
        • Haskell A
        • Mann RA.
        Perioperative complication rate of total ankle replacement is reduced by surgeon experience.
        Foot Ankle Int. 2004; 25: 283-289
        • Clough TM
        • Alvi F
        • Majeed H.
        Total ankle arthroplasty: what are the risks?.
        Bone Joint J. 2018; 100-B: 1352-1358
        • Lee K-B
        • Cho S-G
        • Hur C-I
        • Yoon T-R.
        Perioperative complications of HINTEGRA total ankle replacement: our initial 50 cases.
        Foot Ankle Int. 2008; 29: 978-984
        • Schuberth JM
        • Patel S
        • Zarutsky E.
        Perioperative complications of the agility total ankle replacement in 50 initial, consecutive cases.
        J Foot Ankle Surg. 2006; 45: 139-146
        • Bestic JM
        • Bancroft LW
        • Peterson JJ
        • Kransdorf MJ.
        Postoperative imaging of the total ankle arthroplasty.
        Radiol Clin North Am. 2008; 46 (v–vi): 1003-1015
        • King CM
        • Schuberth JM
        • Christensen JC
        • Swanstrom KM.
        Relationship of alignment and tibial cortical coverage to hypertrophic bone formation in Salto Talaris® total ankle arthroplasty.
        J Foot Ankle Surg. 2013; 52: 355-359
        • Valderrabano V
        • Hintermann B
        • Dick W.
        Scandinavian total ankle replacement: a 3.7-year average follow-up of 65 patients.
        Clin Orthop. 2004; : 47-56
        • Wood PLR
        • Deakin S.
        Total ankle replacement. The results in 200 ankles.
        J Bone Joint Surg Br. 2003; 85: 334-341
        • Kim D-R
        • Choi YS
        • Potter HG
        • Li AE
        • Chun K-Y
        • Jung YY
        • Kim J-S
        • Young K-W.
        Total ankle arthroplasty: an imaging overview.
        Korean J Radiol. 2016; 17: 413-423
        • Yau WP
        • Chiu KY
        • Tang WM
        • Ng TP.
        Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning.
        J Orthop Surg Hong Kong. 2007; 15: 32-36
        • Joo S-D
        • Lee K-B.
        Comparison of the outcome of total ankle arthroplasty for osteoarthritis with moderate and severe varus malalignment and that with neutral alignment.
        Bone Joint J. 2017; 99-B: 1335-1342
        • Waly FJ
        • Yeo NE
        • Penner MJ.
        Computed navigation guidance for ankle replacement in the setting of ankle deformity.
        Clin Podiatr Med Surg. 2018; 35: 85-94
        • Adams SB
        • Demetracopoulos CA
        • Viens NA
        • DeOrio JK
        • Easley ME
        • Queen RM
        • Nunley JA.
        Comparison of extramedullary versus intramedullary referencing for tibial component alignment in total ankle arthroplasty.
        Foot Ankle Int. 2013; 34: 1624-1628
        • Kuo C-C
        • Lu H-L
        • Leardini A
        • Lu T-W
        • Kuo M-Y
        • Hsu H-C.
        Three-dimensional computer graphics-based ankle morphometry with computerized tomography for total ankle replacement design and positioning.
        Clin Anat. 2014; 27: 659-668
        • Kim BS
        • Choi WJ
        • Kim J
        • Lee JW
        Residual pain due to soft-tissue impingement after uncomplicated total ankle replacement.
        Bone Joint J. 2013; 95-B: 378-383
        • Kurup HV
        • Taylor GR.
        Medial impingement after ankle replacement.
        Int Orthop. 2008; 32: 243-246
        • Schuberth JM
        • Babu NS
        • Richey JM
        • Christensen JC.
        Gutter impingement after total ankle arthroplasty.
        Foot Ankle Int. 2013; 34: 329-337
        • Gross CE
        • Adams SB
        • Easley M
        • Nunley JA
        • DeOrio JK.
        Surgical treatment of bony and soft-tissue impingement in total ankle arthroplasty.
        Foot Ankle Spec. 2017; 10: 37-42
        • Muir D
        • Aoina J
        • Hong T
        • Mason R
        The outcome of the Mobility total ankle replacement at a mean of four years: Can poor outcomes be predicted from pre- and post-operative analysis?.
        Bone Joint J. 2013; 95-B: 1366-1371
        • Esparragoza L
        • Vidal C
        • Vaquero J.
        Comparative study of the quality of life between arthrodesis and total arthroplasty substitution of the ankle.
        J Foot Ankle Surg. 2011; 50: 383-387
        • Schuh R
        • Hofstaetter J
        • Krismer M
        • Bevoni R
        • Windhager R
        • Trnka H-J.
        Total ankle arthroplasty versus ankle arthrodesis. Comparison of sports, recreational activities and functional outcome.
        Int Orthop. 2012; 36: 1207-1214