SLR - October 2022 - Kayla Wright, DPM
Reference:
Yoon, YK,Park, HK, Park, JH, Lee,W, Han, SH, Lee, JW. Long-Term Clinical Outcomes and Implant Survivorship of 151 Total Ankle Arthroplasties Using the HINTEGRA Prosthesis, A Minimum 10-Year Follow-up. J Bone Joiint Surg Am. 2022 Aug. 17; 104(16):1483-1491. doi:10.2106/JBJS.22.00060. PMID: 35726878
Level of Evidence: Level IV.
Scientific Literature Review
Reviewed by: Kayla Wright, DPM
Residency Program: Carl T. Hayden VA Medical Center – Phoenix, AZ
Podiatric relevance: Total ankle arthroplasty is a common podiatric surgical procedure. Little evidence exists for long term follow up and/or survivorship of ankle implant devices. This article highlights the long-term survivorship and complications of total ankle arthroplasty, as well as identifies risk factors for revisional surgery.
Methods: Retrospective review of 213 total ankle arthroplasties in 194 patients with 10 year follow up. After applying exclusion criteria, there remained a total of 151 consecutive patients who underwent standard total ankle arthroplasty with or without concomitant procedures. Demographics were evaluated as well as visual analog scale pain scores, ankle osteoarthritis scale pain and disability subscores, American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale score, and ankle range of motion both preoperatively, 2 years post operatively, 4-6 years post operatively, and at >10 years post operatively. Radiographic analysis was also performed preoperatively and postoperatively.
Results: All ankle scores and ankle motion improved postoperatively, but improvement declined over long term follow up. There was no significant difference in VAS pain scores at long term follow up. Radiographic analysis showed minimal change in angular relationships from 6 weeks post operatively to >10 years post operatively. However, there was noted to be radiologic evidence of osteolytic cysts in 58.9% of patients at >10 years post operatively. Heterotopic ossification was also noted in 39.1% of patients at final follow up. 28.5% of patients underwent revisional surgery, including tibial component revision, conversion to tibiotalocalcaneal arthrodesis, inlay exchange, and/or valgus correction. If only metal component revision was considered failure, survivorship at >10 years was calculated as 93.5%. If revision of any prosthetic component was included, including polyethylene inlay exchange, survivorship was calculated as 75.2%. Univariate analysis confirmed chronic therapeutic oral anticoagulation as the only statistically significant risk factor for revision surgery in this cohort of patients.
Conclusions: Positive results following total ankle arthroplasty appear to be maintained at long term follow up, although functional outcomes and range of motion steadily decrease over long term follow up. The authors suggest yearly radiographic examination and periodic CT evaluation of all total ankle arthroplasty patients post operatively for monitoring of any cyst formation or potential implant subsidence, suggesting early identification and treatment can prevent major revisional surgery. Chronic anticoagulant use was associated with increased risk of revisional surgery, which could possibly be due to the negative effect these medications can have on bone remodeling. Long term survivorship of 93.5% in a large cohort of patients indicate that the total ankle arthroplasty is an acceptable procedure for surgical treatment of ankle arthritis and can provide long term relief. It is expected that functional outcome and pain score improvement decreases over the long-term post operative course.