Clinical comparison of two total ankle replacements

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Biomaterials Science

Background:

• Rheumatoid arthritis (RA) frequently affects the ankle joint, necessitating surgical intervention.
• Total ankle replacement (TAR) aims to alleviate pain and restore function in RA patients with severe ankle arthritis.
• Comparing cemented and cementless prosthesis designs is crucial for optimizing long-term outcomes.

Purpose of the Study:

• To compare the clinical and radiographic outcomes of the cemented Thompson Parkridge Richards (TPR) and cementless Scandinavian Total Ankle Replacement (STAR) prostheses.
• To evaluate the survivorship and complication rates of these two TAR designs in rheumatoid arthritis patients.

Main Methods:

• A retrospective comparison of 14 consecutive total ankle arthroplasties in 12 rheumatoid arthritis patients.
• Patients were treated by a single surgeon, receiving either cemented TPR or cementless STAR prostheses.
• Follow-up assessment included clinical evaluation and radiographic analysis at a minimum of five years post-surgery.

Main Results:

• Four out of six cemented TPR tibial components showed radiographic loosening within two years.
• Two cases with TPR loosening required conversion to ankle fusion.
• All cementless STAR prostheses demonstrated satisfactory clinical and radiographic results at the five-year follow-up.

Conclusions:

• Cementless STAR total ankle replacement demonstrates superior radiographic stability and clinical outcomes compared to cemented TPR prosthesis in rheumatoid arthritis patients.
• The high rate of tibial component loosening with the cemented TPR design suggests potential limitations for long-term efficacy in this patient population.
• Cementless designs may offer a more durable solution for total ankle replacement in rheumatoid arthritis, warranting further investigation.