Ten-year evaluation of cementless Buechel-Pappas meniscal bearing total ankle replacement

A porous-coated, cementless, congruent-contact, three-piece, meniscal-bearing total ankle replacement was developed and used clinically over a 2- to 10-year period for patients with disabling ankle arthritis. Polished titanium-nitride ceramic-coated Ti6Al4V tibial and talar components with a deep-sulcus trochlear groove and two lateral fixation fins for the talar onlay component were used. The ultra-high-molecular-weight polyethylene (UHMWPe) meniscal bearing congruently conformed to the flat upper tibial component surface and the deep sulcus and cylindrical geometry of the lower talar component surface. Fifty deep-sulcus (Buechel-Pappas) total ankle replacements were implanted in 49 patients. Diagnoses were 8 osteoarthritis (16%), 7 rheumatoid arthritis (14%), 2 avascular necrosis (4%), and 33 post-traumatic arthritis (66%). Ages ranged from 26 to 71 years (mean 49 years). Clinical results using a strict ankle scoring system demonstrated good/excellent results in 88% of cases. Postoperative ankle motion ranged from 12 degrees to 46 degrees total arc (mean 28 degrees), which was similar to the preoperative motion. Revision for malalignment was necessary in two cases (4%). Mechanical complications included one case of meniscal bearing wear (2%) in a patient with post-traumatic arthritis with component malalignment and one case of talar component subsidence (2%) in a patient with avascular necrosis of the talus. No tibial component loosening was seen. Cumulative survivorship using an end point of revision of any component for any reason was 93.5% at 10 years (confidence interval 61-100%).