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March 15, 2015
Contributors: Matteo Romagnoli, MD; Cesare Faldini, MD; Andrea Ensini, MD; Michele D'Amato, MD; Paolo Barbadoro, MD; Antonio Mazzotti, MD; Sandro Giannini, MD; Sandro Giannini, MD
INTRODUCTION: Total ankle replacement (TAR) goals include relieving pain and restoring the ankle motion, allowing normal daily activities. Nowadays there are many kinds of TAR models available: despite that, the results obtained are still not completely satisfactory in terms of pain reduction and functional outcomes. For this reason, the last prosthetic models developed try to respect both the ankle joint biomechanics and anatomy.
METHODS: The indications for TAR, by our clinical experience, include primary and posttraumatic osteoarthritis in patients over 50 years old; younger patients with low functional demands; rheumatoid arthritis with reduced functional compensation of the other joints involved; osteoarthritis in patients with less than 20° of flexion-extension in the other foot joints; and patients who refuse an arthrodesis procedure. Fifteen patients were treated with a new TAR model by one manufacturer, characterized by an anatomic design and implanted through a lateral trans-malleolar approach. Patients mean age was 62.9. Patients were clinically and radiographically evaluated using the AOFAS score and through standard and weightbearing radiographs at eight months follow up.
DISCUSSION: Clinical evaluation showed an increase in the AOFAS score, from a mean of 62 preoperatively to a mean of 89 at the last follow up. No complications were observed. In one case a lateral wound dehiscence occurred and the fibular plate was removed. Radiographic analysis showed no delay in the osteotomy consolidation or implant loosening. This recent TAR system consists of two implant components, a talar component, and a tibial base component attached to a modular tibial articular surface; the implant trabecular metal coating contributes to provide initial stability and rapid bone ingrowth and the lateral approach allows to perform a wide ankle release improving the range of motion.
RESULTS: Despite that, this procedure requires longer surgical time, if compared to other TAR prosthetic models. No intraoperative or postoperative complications occurred. Results were satisfactory in terms of clinical and radiographical outcomes. Patients treated with the new ankle prosthesis achieved excellent clinical outcomes and preliminary results are very satisfactory; despite that, a longer follow up is necessary to evaluate the behavior of the implant over time.