Prosthetic Replacement of the Ankle in Posttraumatic Arthrosis 10-Year Experience with the Cementless ESKA Ankle Prosthesis

Background:

As a result of numerous failed implantations of cemented ankle prostheses since the early 70s, ankle arthrodesis represented the “gold standard” in the treatment of ankle arthrosis. Due to a change to cementless implantations in the 90s it came to a remarkable reduction in early loosening, bone necrosis and sintering of the prosthesis which were the main reasons for former failures. In cooperation with ESKA Implants, Lübeck, we have developed a cementless anatomic ankle prosthesis.

Patients and Methods: At our hospital, the ESKA prosthesis has been implanted in 56 patients (72% posttraumatic) since 1990. In our study, we report the examination results of 40 out of these 56 patients at least 1 year post implantation (21 of them more than 5 years). For evaluation, we used the Kofoed ankle score, which allows an easier comparison with other studies. This score showed an average improvement from 34.75 points preoperatively to 91.25 points postoperatively.

Results: The persistent preoperative pain had completely disappeared in all patients; only twelve patients complained of intermittent pain under fairly heavy loading. 23 patients were able to walk > 2km and 13 > 5 km without pain. The overall range of motion was 40–60° in 14 patients, 25–40° in 21, and < 25° in only five. We did not see any kind of secondary arthrosis in the adjacent joints. An arthrodesis which posed no problems had to be performed only three times: in two cases in 1991, during the 1st postoperative year, with both patients showing infections of the prosthesis; in the third case, the prosthesis had to be changed after 9 years.

Conclusions: According to our good results and those of other studies on cementless ankle prostheses, we consider a cementless upper ankle prosthesis, implanted by a highly experienced surgeon, the preferable alternative to upper ankle arthrodesis.