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
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Article info
Publication history
Published online: September 19, 2021
Footnotes
Financial Disclosure: This study was supported by the FY2017 SingHealth Duke-NUS Musculoskeletal Sciences Academic Clinical Programme Research Support Programme grant under the Nurturing Clinical Scientist Scheme (NCSS) (13/FY2017/P1/16-A30).
Conflict of Interest: Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
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