ReviewPositive and negative factors for the treatment outcomes following total ankle arthroplasty? A systematic review
Introduction
Early result of total ankle arthroplasty (TAA) experienced many clinical failures and the design rationale of the first-generation implants have been invalidated [1], [2]. Newly designed prostheses, based on the studies of ankle anatomy and kinematics, consist of two or three components and have improved clinical outcomes [3], [4], [5]. Advantages of current TAA include restoring ankle kinematics and decreasing the risk of subtalar arthritis [6], [7], [8].
The survivorship of the second and third-generation implants has remarkably improved with a 10-year implant survival rate now about 70% [9], [10], [11]. Nevertheless long-term implant survival is not yet comparable to hip or knee arthroplasty [12], [13]. Also the complication rate is also much higher than hip or knee arthroplasty [3], [4], [14], [15]. Recent publications have shown that the incidence of complications after TAA is higher in patients with post-traumatic arthritis and therefore refined patient selection could possibly improve outcomes [16]. Also complications decreased after surgeons completed a training course [17], [18]. Another study found many complications could be avoided with increased surgical experience however others persisted unchanged [19]. Unlike the implants of hip or knee, the designs of current ankle systems are quite different [1], [2], [20], [21], [22], [23], and it has also been suggested that different implant design might affect the outcomes [22], [24].
Patient factors including age, etiology and preoperative deformity, surgeon’s factors, prosthetic factors, or a combination of these factors could all affect the treatment outcome of TAA [25], [26], [27], [28], [29]. However, it is inappropriate to attribute any complication or radiographic finding to a single factor without taking all factors into comprehensive consideration and analyze the potential positive and negative attributes in each and their relationship to each other. The purpose of the present study was to determine the positive and negative factors for the different clinical and radiographic outcomes which have been observed.
Section snippets
Search strategy and study selection
A manual systematic literature search of MEDLINE, EMBASE™ and Cochrane Library for “total ankle arthroplasty” OR “total ankle replacement” OR “total ankle arthroplasties” OR “total ankle replacements” was performed by three of the authors (DZ, DH, GZ). The search was performed by each reviewer independently with any disagreements in article eligibility resolved by consensus discussion among all authors. Each study was read as a full-text. Inclusion criteria were: (1) studies of primary TAA with
Patient factors for treatment outcome
Older patients reported less postoperative pain or stiffness comparing to younger patients (P = 0.009, odds ratio = 0.89). Implant loosening in either the tibia or talus, which was not symptomatic to require surgical intervention, was less common in older patients (P = 0.008, odds ratio = 0.88; P = 0.006, odds ratio = 0.86). Patients with traumatic arthritis were more likely to experience adjacent joint degeneration after TAA (P = 0.007, odds ratio = 100.03). Age, primary etiology and preoperative deformity
Discussion
The survival rates of TAA have been improving [3], [4]. However, the majority of the studies with superior results were conducted by the implant designer, and the etiology of the arthritis or preoperative deformity was often different from subsequent studies. Furthermore, a wide variety of implants is currently available, which are different from each other in term of bearing type, articular congruency, surface geometry, size of component, and bone cut or fixation [1], [2], [21], [22]. To the
Conflict of interest
The authors declare no conflicts of interest to disclose.
Funding
This work was funded by National Natural Science Foundation of China (Grant No. 81702109), China Postdoctoral Science Foundation Grant (Grant No. 2016M601508 and Grant No. 2018T110349), Scientific and Technological Innovation of Shanghai Science and Technology Committee (Grant No: 18441902200).
Author’s contributions
Dahang Zhao: manual literature search, reviewed and screened all the papers, collected the data, wrote the manuscript, revised the manuscript. Dichao Huang: manual literature search, reviewed and screened all the papers, collected the data. Gonghao Zhang: manual literature search, reviewed and screened all the papers, collected the data. Xu Wang: collected the data. Tiansong Zhang: designed the study, analyzed the data and reviewed the manuscript, revised the manuscript. Xin Ma: designed the
Acknowledgments
We thank Henricson Anders MD, Alexej Barg MD, Fabrice Gaudot MD, Daniël Haverkamp MD, C. Thomas Haytmanek Jr MD, Kurt J. Hofmann MD, Andrew R. Hsu MD, Yeok Gu Hwang MD, Dong Oh Lee MD, Gun Woo Lee MD, Jin Woo Lee MD, Keun Bae Lee MD, Jan Willem K. Louwerens MD, Caio A. Nery MD, James A. Nunley MD, Charles L. Saltzman MD, Nelson F. SooHoo MD, Peter LR. Wood MD who unselfishly retrieved their raw data for us, and also thank our friends Stephen Eisenstein MD, Ken N. Kuo MD, Soon Hyuck Lee MD, Jose
References (126)
- et al.
A brief history of total ankle replacement and a review of the current status
Med Eng Phys
(2007) - et al.
History of total ankle replacement
Clin Podiatr Med Surg
(2013) - et al.
Primary and revision total ankle replacement using custom-designed prostheses
Foot Ankle Clin
(2008) - et al.
Revision total ankle replacement
Foot Ankle Clin
(2012) Geometry and mechanics of the human ankle complex and ankle prosthesis design
Clin Biomech (Bristol, Avon)
(2001)- et al.
Total ankle replacement: early results during learning period
Foot Ankle Surg
(2007) - et al.
Biological fixation of ankle arthroplasty: a sequential consecutive prospective clinico-radiographic series of 20 ankles with arthrosis followed for 1-4 years
Foot
(1995) - et al.
Total ankle replacement in patients with end-stage ankle osteoarthritis: clinical results and kinetic gait analysis
Foot Ankle Surg
(2014) - et al.
Total ankle arthroplasty: Brazilian experience with the Hintegra prosthesis
Rev Bras Ortop
(2010) - et al.
Short term results of the mobility total ankle system: clinical and radiographic outcome
Foot Ankle Surg
(2016)
Medium to long-term results of 130 ankle evolutive system total ankle replacements-Inferior survival due to peri-implant osteolysis
Foot Ankle Surg
The AES total ankle replacement: a mid-term analysis of 93 cases
Foot Ankle Surg
Medium term follow-up of the AES ankle prosthesis: high rate of asymptomatic osteolysis
Foot Ankle Surg
Tri-component, mobile bearing, total ankle replacement: mid-term functional outcome and survival
J Foot Ankle Surg
Intermediate results of Buechel Pappas unconstrained uncemented total ankle replacement for osteoarthritis
J Foot Ankle Surg
Results at a minimum follow-up of 5 years of a ligaments-compatible total ankle replacement design
Foot Ankle Surg
Early radiographic and clinical results of Salto total ankle arthroplasty as a fixed-bearing device
Foot Ankle Surg
How successful are current ankle replacements? : a systematic review of the literature
Clin Orthop Relat Res
The outcome of total ankle replacement: a systematic review and meta-analysis
Bone Joint J
Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis
Arch Orthop Trauma Surg
Ankle function and sports activity after total ankle arthroplasty
Foot Ankle Int
In vivo kinematics of the salto total ankle prosthesis
Foot Ankle Int
Habitual physical activity and sports participation after total ankle arthroplasty
Am J Sports Med
Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results
Foot Ankle Int
10-year survival of total ankle arthroplasties: a report on 780 cases from the Swedish Ankle Register
Acta Orthop
Comparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty
J Bone Joint Surg Am
Failure rate of cemented and uncemented total hip replacements: register study of combined Nordic database of four nations
BMJ
Total knee arthroplasty at 15-17 years: does implant design affect outcome
Int Orthop
Complications and failure after total ankle arthroplasty
J Bone Joint Surg Am
Revision rates after total joint replacement: cumulative results from worldwide joint register datasets
J Bone Joint Surg Br
Total ankle arthroplasty outcome comparison for post-traumatic and primary osteoarthritis
Foot Ankle Int
Short-term perioperative complications and mortality after total ankle arthroplasty in the United States
Foot Ankle Spec
Effects of total ankle arthroplasty training course on physician practice patterns and complication rates
Foot Ankle Spec
The total ankle arthroplasty learning curve with third-generation implants: a single surgeon’s experience
Foot Ankle Spec
Current Concepts in Total Ankle Replacement for Radiologists: Complications
AJR Am J Roentgenol
Current concepts in total ankle replacement for radiologists: features and imaging assessment
AJR Am J Roentgenol
Design features of current total ankle replacements: implants and instrumentation
J Am Acad Orthop Surg
Current and future designs for total ankle replacement
Curr Orthop Pract
Design rationale for total ankle arthroplasty systems: an update
J Am Acad Orthop Surg
Initial instability in total ankle replacement: a cadaveric biomechanical investigation of the STAR and agility prostheses
J Bone Joint Surg Am
Mobility of the human ankle and the design of total ankle replacement
Clin Orthop Relat Res
Survival of the Scandinavian total ankle replacement (STAR): results of ten to nineteen years follow-up
Int Orthop
Long-term results of Scandinavian total ankle replacement
Foot Ankle Int
Long-term functional and radiographic outcome of a mobile bearing ankle prosthesis
Foot Ankle Int
Radiographic outcomes of a mobile-bearing total ankle replacement
Foot Ankle Int
Long-term follow-up of mobile bearing total ankle arthroplasty in the United States
Foot Ankle Int
Comparison of the short-term results of the first and last 50 Scandinavian total ankle replacements: assessment of the learning curve in a consecutive series
Foot Ankle Int
The Scandinavian total ankle replacement: long-term, eleven to fifteen-year, survivorship analysis of the prosthesis in seventy-two consecutive patients
J Bone Joint Surg Am
STAR™ ankle: long-term results
Foot Ankle Int
The Scandinavian total ankle replacement: survivorship at 5 and 8 years comparable to other series
Clin Orthop Relat Res
Cited by (14)
Cone-Beam Weight-Bearing Computed Tomography of Ankle Arthritis and Total Ankle Arthroplasty
2023, Foot and Ankle ClinicsComparison of joint load, motions and contact stress and bone‐implant interface micromotion of three implant designs for total ankle arthroplasty
2022, Computer Methods and Programs in BiomedicineCitation Excerpt :Although these ankle implants did not perform poorly in the short and medium term, the medium and long term results were still not ideal, compared with hip and knee arthroplasty [3]. In addition, previous studies have shown that asymmetric implants, which are more anatomically similar, such as HINTEGRA and Salto Talaris, can reduce the incidence of degenerative arthritis in adjacent joints and have a lower failure rate than symmetric implants [10–15]. HINTEGRA and Salto Talaris implants were designed with a lateral condyle radius larger than the medial condyle.
Anatomic ankle implant can provide better tibiotalar joint kinematics and loading
2022, Medical Engineering and PhysicsCitation Excerpt :The ultimate purpose of the study was to investigate how the geometry of the joint surface of the implant impacted the biomechanics and motion of the ankle joint, hence offering direction for implant design improvement. One step in this direction was to design the articular surface geometry based on the anatomy of the previous literatures [9, 15], particularly the talar dome, which was simplified in the contemporary ankle implants [12, 13]. Normal inversion-eversion and internal-external rotation of the tibiotalar joint were maintained by the asymmetric shape of the talar dome with different medial and lateral radius and different medial and lateral heights [9, 15].
Long-Term Survival Analysis of 5619 Total Ankle Arthroplasty and Patient Risk Factors for Failure
2024, Journal of Clinical MedicineArticular geometry can affect joint kinematics, contact mechanics, and implant-bone micromotion in total ankle arthroplasty
2023, Journal of Orthopaedic Research
- 1
Dahang Zhao, Dichao Huang and Gonghao Zhang contributed equally to this work and should be considered as co-first authors.