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. 2023 Jan 27;8(1):24730114221148172.
doi: 10.1177/24730114221148172. eCollection 2023 Jan.

Short-term Results of Hemiarthroplasty of the Ankle Joint for Talar-Sided Cartilage Loss

Manuel J Pellegrini  1   2 , Franco Mombello  2 , Aaron Cortes  2 , Felipe Chaparro  2 , Cristian Ortiz  2 , Giovanni Carcuro  2
Affiliations

Short-term Results of Hemiarthroplasty of the Ankle Joint for Talar-Sided Cartilage Loss

Manuel J Pellegrini et al. Foot Ankle Orthop. .

Abstract

Background: Ankle hemiarthroplasty is a 1-piece implant system replacing the talar side of the tibiotalar joint. Hemiarthroplasty offers limited bone resection and may provide easier revision options than joint-ablating procedures.

Methods: Prospective, multicenter, noncomparative, nonrandomized clinical study with short term follow-up on patients undergoing hemiarthroplasty of the ankle. Radiologic and functional outcomes (Foot and Ankle Outcome Score FAOS, Foot and Ankle Ability Measure [FAAM], Short Form-36 Health Survey [SF-36], Short Musculoskeletal Functional Assessment [SMFA], and visual analog scale [VAS] pain scores) were obtained at 3 and 12 months and the last follow-up (mean 31.9 months).

Results: Ten patients met the inclusion criteria. Three were converted to total ankle replacement at 14, 16, and 18 months. Pain VAS scores improved on average from 6.8 to 4.8 (P = .044) of the remaining 7 at a mean of 31.9 months' follow-up. For these 7 in the Survival Group, we found that SF-36 physical health component improved from 25.03 to 42.25 (P = .030), SMFA dysfunction and bother indexes improved from 46.36 to 32.28 (P = .001), and from 55.21 to 30.14 (P = .002) in the Survival Group, and FAAM sports improved from 12.5 to 34.5 (P = .023).

Conclusion: Patients undergoing hemiarthroplasty of the ankle joint for talar-sided lesions had a 30% failure rate by 18 months. Those who did not have an early failure exhibited modest pain reduction, functional improvements, and better quality of life in short-term follow-up. This procedure offers a possible alternative for isolated talar ankle cartilage cases.

Level of evidence: Level IV, prospective case series.

Keywords: ankle arthritis; ankle spacer; hemiarthroplasty; osteochondral lesion.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Manuel J. Pellegrini, MD, reports consulting fees from Arthrex. Giovanni Carcuro, MD, reports consulting fees and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
Left. After an anterior ankle approach between the tibialis anterior and extensor hallucis longus tendon, the tibiotalar joint is distracted using a Hintermann distractor. Right. All remaining cartilage over the talar dome is mechanically debrided to expose the subchondral bone and all necrotic bone at the osteochondral lesion of the talus is removed using a curette. The subchondral bone at the talar dome is drilled to enhance bony ingrowth into the Ankle Spacer. The defect is filled with autogenous bone until a smooth and congruent surface is checked.
Figure 2.
Figure 2.
Clinical and radiologic view of trial size. Left. The Ankle Spacer is trialed until the desired size is selected. The goal is to achieve the best mediolateral (left picture) an anteroposterior (right picture, fluoroscope) coverage that avoids impingement on bony structures. Right. Intraoperative radiographs assess the correct position of the desirable size of the device.
Figure 3.
Figure 3.
Holes are used to perform 2 drills of the anterior surface of the talus for the correct implant adaptation.
Figure 4.
Figure 4.
Final clinical view of the Ankle Spacer.
Figure 5.
Figure 5.
(A) VAS improvements with statistically significant differences only in the survival group between preoperation and 3 months, 12 months, and last follow-up. (B) SF-36 improvements with statistically significant differences only in the survival group between preoperation and last follow-up. VAS, visual analog scale for pain; SF-36, Short Form–36 Health Survey. *Statistical difference, p < 0.05.
Figure 6.
Figure 6.
Kaplan-Meier survival analysis with 100% survivorship at 13 months, 83% at 14 months, 71% at 16 months, and 62.5% at 18 months.
Figure 7.
Figure 7.
Radiograph of a patient at 3 years of follow-up, where no loosening, subsidence, or progression of osteoarthritis is observed in adjacent joints.
See this image and copyright information in PMC

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