Total ankle replacement. The results in 200 ankles

Area of Science:

• Orthopedic surgery
• Biomaterials science
• Medical device technology

Background:

• Total ankle replacement is a surgical procedure to alleviate pain and restore function in severe ankle arthritis.
• Cementless, mobile-bearing designs aim to improve implant longevity and patient outcomes.
• The Scandinavian Total Ankle Replacement (STAR) system is one such implant used in clinical practice.

Purpose of the Study:

• To evaluate the clinical outcomes and survival rates of cementless, mobile-bearing STAR total ankle replacements.
• To identify common complications and factors influencing implant performance.
• To assess the relationship between radiological findings and surgical technique.

Main Methods:

• A retrospective review of 200 consecutive cementless, mobile-bearing STAR total ankle replacements implanted between 1993 and 2000.
• Patient follow-up was conducted for a mean of 46 months, with no loss to follow-up except for patient death.
• Complications, revisions, fusions, and radiological assessments were recorded.

Main Results:

• The cumulative five-year survival rate was 92.7% (95% CI 86.6 to 98.8), with revision or fusion as the endpoint.
• Eight ankles (4%) experienced complications requiring further surgery, and 14 (7%) were revised or fused.
• The most frequent complications were delayed wound healing and malleolar fracture, which decreased with surgical experience.

Conclusions:

• Cementless, mobile-bearing STAR total ankle replacement demonstrates a favorable five-year survival rate.
• Surgical experience positively impacts complication rates, particularly wound healing and malleolar fractures.
• Tibial implant interface appearance is linked to operative fit and bioactive coating type, suggesting importance for long-term success.