Ankle arthroplasty. A comparative study of cemented metal and uncemented ceramic prostheses

From 1975 to 1980, total ankle arthroplasty was performed using a metal and polyethylene prosthesis on 30 ankles in 28 patients with painful arthritis. However, because loosening and sinking of the prosthesis were significant, a ceramic total prosthesis was designed in 1980 to be used without cement. Between 1980 and 1987, 39 ankles in 35 patients with osteoarthritis, rheumatoid arthritis, and hemophilic arthritis were replaced using the ceramic prosthesis. Out of 39 ankles, nine were replaced with cement and 30 without cement. The follow-up period for the cemented metal and ceramic cases ranged from 13.4 to 6.2 years, with an average of 8.1 years, and for uncemented ceramic cases from 1.2 to 6.4 years, with an average of 4.1 years. Based on a rating scale for ankle evaluation, 27% of the cemented cases and 67% of the uncemented cases are satisfactory. Five metal ankles and one ceramic ankle were reoperated upon, with one revision and five arthrodeses performed. Ceramic total ankle arthroplasty, performed without cement, has to date provided mostly excellent stable results.