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. 2022 Apr;104-B(4):472-478.
doi: 10.1302/0301-620X.104B4.BJJ-2021-0167.R5.

Transfibular total ankle arthroplasty : a new reliable procedure at five-year follow-up

Camilla Maccario  1 , Tommaso Paoli  1 , Fausto Romano  2   3 , Riccardo D'Ambrosi  4 , Cristian Indino  1 , Federico G Usuelli  1
Affiliations

Transfibular total ankle arthroplasty : a new reliable procedure at five-year follow-up

Camilla Maccario et al. Bone Joint J. 2022 Apr.

Abstract

Aims: This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years.

Methods: We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients' clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up.

Results: A total of 86 patients were evaluated at a mean follow-up of 65.4 months (60 to 90). At five-year follow-up, statistically significant improvements (p < 0.001) were found in the mean American Orthopaedic Foot & Ankle Society Ankle Hindfoot Score (from 33.8 (SD 14.3) to 86.1 (SD 8.8)), visual analogue scale for pain (from 8.5 (SD 1.7) to 1.5 (SD 1.2)), Short Form-12 Physical and Mental Component Scores (from 29.9 (SD 6.7) and 43.3 (SD 8.6) to 47.3 (SD 7.5) and 52.2 (SD 8.0), respectively), and mean ankle dorsiflexion and plantarflexion (from 6.2° (SD 5.5°) and 9.6° (SD 5.8°) to 23.9° (SD 7.7°) and 16.9° (SD 7.2°), respectively). Radiologically, the implants maintained neutral alignment without subsidence. Tibial or talar radiolucency was found in eight patients, but none of these patients was symptomatic. At five-year follow up, 97.7% of implants (95% confidence interval 91.2 to 99.4) were free from revision or removal with 84 implants at risk. We recorded two cases (2.3%) of failure for septic loosening.

Conclusion: Transfibular TAA is safe and effective with a high survival rate at mid-term follow-up and satisfactory clinical and radiological results. Further studies are required to determine the long-term performance of these implants. Cite this article: Bone Joint J 2022;104-B(4):472-478.

Keywords: Ankle osteoarthritis; American Orthopaedic Foot and Ankle Society; Ankle; Fixed bearing; Hindfoot Score; Lateral transfibular approach; Radiolucency; Short Form-12; Total ankle arthroplasty; Trabecular metal; Transfibular total ankle arthroplasty; ankle dorsiflexion; end-stage osteoarthritis; septic loosening; visual analogue scale (VAS) for pain.

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