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 Foot/Ankle Test 3: Surgical Considerations
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The Journal of Bone and Joint Surgery (American) 86:1161-1171 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

The Agility Total Ankle Arthroplasty

Seven to Sixteen-Year Follow-up

Stephen I. Knecht, MD1, Miriam Estin1, John J. Callaghan, MD1, Miriam B. Zimmerman, PhD1, Kyle J. Alliman, BS1, Frank G. Alvine, MD2 and Charles L. Saltzman, MD1

1 Departments of Orthopaedics and Rehabilitation (S.I.K., M.E., J.J.C., K.J.A., and C.L.S.) and Public Health (M.B.Z.), University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for C.L. Saltzman: charles-saltzman{at}uiowa.edu
2 Alvine Orthopaedics, 2908 East 26th, Sioux Falls, SD 57103

Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa

In support of their research or preparation of this manuscript, one or more of the authors received an Orthopaedic Research and Education Foundation Career Development Grant. One author (F.G.A.) received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (royalties from DePuy for the Agility Implant). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

A video supplement to this article has been developed by the American Academy of Orthopaedic Surgeons and JBJS and may be viewed for a limited time as the featured streaming video for June 2004 at the JBJS web site, www.jbjs.org. To obtain a copy of the video, contact the AAOS at 800-626-6726 or go to their web site, www.aaos.org, and click on Educational Resources Catalog.

Background: We previously reported the intermediate-term results with the early version of the Agility total ankle replacement, a unique design that takes advantage of arthrodesis of the tibiofibular syndesmosis for tibial component support. The purpose of this study was to report longer-term results of this procedure in the treatment of disabling ankle arthritis.

Methods: We conducted an independent review of all Agility total ankle replacements performed by a single surgeon between 1984 and 1994. Follow-up evaluation consisted of completion of a validated ankle osteoarthritis scale and a short questionnaire and a review of the radiographs. All radiographs were evaluated for evidence of the development of progressive hindfoot arthritis, nonunion of the tibiofibular syndesmosis, progressive radiolucent lines, osteolysis, and component subsidence.

Results: One hundred and thirty-two arthroplasties were performed in 126 patients. After a mean follow-up period of nine years, thirty-three patients (thirty-six implants) had died, fourteen patients (11%) had a revision of the implant or an ankle arthrodesis, and one had the leg amputated because of an unrelated cause. Of the remaining seventy-eight patients (eighty-one ankles), sixty-seven (sixty-nine ankles) were followed clinically. More than 90% of them reported that they had decreased pain and were satisfied with the outcome of the surgery. We found modest differences in a comparison of the pain and disability scores with those of age-matched controls. Of the 117 ankles that had been followed radiographically for a minimum of two years, twenty-two (19%) had progressive subtalar arthritis, seventeen (15%) had progressive talonavicular arthritis, and nine (8%) had a syndesmosis nonunion. Eighty-nine (76%) of the 117 ankles had some evidence of peri-implant radiolucency.

Conclusions: Arthrodesis of the tibiofibular syndesmosis impacts the radiographic and clinical outcomes with the Agility total ankle replacement. The relatively low rates of radiographic hindfoot arthritis and revision procedures at an average of nine years after the arthroplasty are encouraging. Agility total ankle replacement is a viable and durable option for the treatment of ankle arthritis in selected patients.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.


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