Clinical Orthopaedics and Related Research®

, Volume 468, Issue 1, pp 199–208

How Successful are Current Ankle Replacements?: A Systematic Review of the Literature

  • Nikolaos Gougoulias
  • Anil Khanna
  • Nicola Maffulli
Clinical Research

Abstract

Total ankle arthroplasty provides an alternative to arthrodesis for management of ankle arthritis. What is the outcome of total ankle arthroplasty implants currently in use? We conducted a systematic literature search of studies reporting on the outcome of total ankle arthroplasty. We included peer-reviewed studies reporting on at least 20 total ankle arthroplasties with currently used implants, with a minimum followup of 2 years. The Coleman Methodology Score was used to evaluate the quality of the studies. Thirteen Level IV studies of overall good quality reporting on 1105 total ankle arthroplasties (234 Agility™, 344 STAR, 153 Buechel-Pappas™, 152 HINTEGRA®, 98 Salto™, 70 TNK, 54 Mobility™) were included. Residual pain was common (range, 27%–60%), superficial wound complications occurred in 0% to 14.7%, deep infections occurred in 0% to 4.6% of ankles, and ankle function improved after total ankle arthroplasty. The overall failure rate was approximately 10% at 5 years with a wide range (range, 0%–32%) between different centers. Superiority of an implant design over another cannot be supported by the available data.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Anderson T, Montgomery F, Carlsson A. Uncemented STAR total ankle prostheses: three to eight-year follow-up of fifty-one consecutive ankles. J Bone Joint Surg Am. 2003;85:1321–1329.PubMedGoogle Scholar
  2. 2.
    Bonnin M, Judet T, Colombier JA, Buscayret F, Graveleau N, Piriou P. Midterm results of the Salto total ankle prosthesis. Clin Orthop Relat Res. 2004;424:6–18.CrossRefPubMedGoogle Scholar
  3. 3.
    Buechel FF Sr, Buechel FF Jr, Pappas MJ. Twenty-year evaluation of cementless mobile-bearing total ankle replacements. Clin Orthop Relat Res. 2004;424:19–26.CrossRefPubMedGoogle Scholar
  4. 4.
    Centre for Evidence-Based Medicine. Levels of evidence and grades of recommendation. Available at: http://www.cebm.net/index.aspx?o=1025. Accessed May 18, 2009.
  5. 5.
    Chou LB, Coughlin MT, Hansen S Jr, Haskell A, Lundeen C, Saltzman CL, Mann RA. Osteoarthritis of the ankle: the role of arthroplasty. J Am Acad Orthop Surg. 2008;16:249–259.PubMedGoogle Scholar
  6. 6.
    Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Institute of Sport Tendon Study Group. Scand J Med Sci Sports. 2000;10:2–11.CrossRefPubMedGoogle Scholar
  7. 7.
    Cracchiolo A 3rd, Deorio JK. Design features of current total ankle replacements: implants and instrumentation. J Am Acad Orthop Surg. 2008;16:530–540.PubMedGoogle Scholar
  8. 8.
    Giannini S, Leardini A, O’Connor JJ. Total ankle replacement: review of the designs and of the current status. Foot Ankle Surg. 2000;6:77–88.CrossRefGoogle Scholar
  9. 9.
    Glasziou P, Vandenbroucke JP, Chalmers I. Assessing the quality of research. BMJ. 2004:328:39–41.CrossRefPubMedGoogle Scholar
  10. 10.
    Gougoulias NE, Khanna A, Maffulli N. History and evolution in total ankle arthroplasty. Br Med Bull. 2009;89:111–151.CrossRefPubMedGoogle Scholar
  11. 11.
    Guyer AJ, Richardson G. Current concepts review: total ankle arthroplasty. Foot Ankle Int. 2008;29:256–264.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    Henricson A, Skoog A, Carlsson A. The Swedish Ankle Arthroplasty Register: an analysis of 531 arthroplasties between 1993 and 2005. Acta Orthop. 2007;78:569–574.CrossRefPubMedGoogle Scholar
  14. 14.
    Hintermann B, Valderrabano V, Dereymaeker G, Dick W. The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res. 2004;424:57–68.CrossRefPubMedGoogle Scholar
  15. 15.
    Hurowitz EJ, Gould JS, Fleisig GS, Fowler R. Outcome analysis of Agility total ankle replacement with prior adjunctive procedures: two to six year follow up. Foot Ankle Int. 2007;28:308–312.CrossRefPubMedGoogle Scholar
  16. 16.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481.CrossRefGoogle Scholar
  17. 17.
    Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349–353.PubMedGoogle Scholar
  18. 18.
    Knecht SI, Estin M, Callaghan JJ, Zimmerman MB, Alliman KJ, Alvine FG, Saltzman CL. The Agility total ankle arthroplasty: seven to sixteen-year follow-up. J Bone Joint Surg Am. 2004;86:1161–1171.PubMedGoogle Scholar
  19. 19.
    Kofoed H. Cylindrical cemented ankle arthroplasty: a prospective series with long-term follow-up. Foot Ankle Int. 1995;16:474–479.PubMedGoogle Scholar
  20. 20.
    Kofoed H. Scandinavian Total Ankle Replacement (STAR). Clin Orthop Relat Res. 2004;424:73–79.CrossRefPubMedGoogle Scholar
  21. 21.
    Kopp FJ, Patel MM, Deland JT, O’Malley MJ. Total ankle arthroplasty with the Agility prosthesis: clinical and radiographic evaluation. Foot Ankle Int. 2006;27:97–103.PubMedGoogle Scholar
  22. 22.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.CrossRefPubMedGoogle Scholar
  23. 23.
    Lord G, Marotte JH. [Total ankle prosthesis: technic and first results. Apropos of 12 cases] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1973;59:139–151.PubMedGoogle Scholar
  24. 24.
    Mazur JM, Schwartz E, Simon SR. Ankle arthrodesis: long-term follow-up with gait analysis. J Bone Joint Surg Am. 1979;61:964–975.PubMedGoogle Scholar
  25. 25.
    Moher D, Schulz KF, Altman DG; CONSORT. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1:2.Google Scholar
  26. 26.
    Naal FD, Impellizzeri FM, Loibl M, Huber M, Rippstein PF. Habitual physical activity and sports participation after total ankle arthroplasty. Am J Sports Med. 2009;37:95–102.CrossRefPubMedGoogle Scholar
  27. 27.
    San Giovanni TP, Keblish DJ, Thomas WH, Wilson MG. Eight-year results of a minimally constrained total ankle arthroplasty. Foot Ankle Int. 2006;27:418–426.PubMedGoogle Scholar
  28. 28.
    Stengel D, Bauwens K, Ekkernkamp A, Cramer J. Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2005;125:109–119.CrossRefPubMedGoogle Scholar
  29. 29.
    Takakura Y, Tanaka Y, Kumai T, Sugimoto K, Ohgushi H. Ankle arthroplasty using three generations of metal and ceramic prostheses. Clin Orthop Relat Res. 2004;424:130–136.CrossRefPubMedGoogle Scholar
  30. 30.
    Tallon C, Coleman BD, Khan KM, Maffulli N. Outcome of surgery for chronic Achilles tendinopathy: a critical review. Am J Sports Med. 2001;29:315–320.PubMedGoogle Scholar
  31. 31.
    Valderrabano V, Hintermann B, Dick W. Scandinavian total ankle replacement: a 3.7-year average followup of 65 patients. Clin Orthop Relat Res. 2004;424:47–56.CrossRefPubMedGoogle Scholar
  32. 32.
    Valderrabano V, Pagenstert G, Horisberger M, Knupp M, Hintermann B. Sports and recreation activity of ankle arthritis patients before and after total ankle replacement. Am J Sports Med. 2006;34:993–999.CrossRefPubMedGoogle Scholar
  33. 33.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4:e296.CrossRefGoogle Scholar
  34. 34.
    Wood PL, Prem H, Sutton C. Total ankle replacement: medium-term results in 200 Scandinavian total ankle replacements. J Bone Joint Surg Br. 2008;90:605–609.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Nikolaos Gougoulias
    • 1
  • Anil Khanna
    • 1
  • Nicola Maffulli
    • 1
  1. 1.Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and DentistryMile End HospitalLondonUK

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