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 Foot/Ankle Test 3: Surgical Considerations
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The Journal of Bone and Joint Surgery (American) 86:1172-1178 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Complications and Failure After Total Ankle Arthroplasty

Adrienne A. Spirt, MD, PhD1, Mathieu Assal, MD1 and Sigvard T. Hansen, Jr., MD1

1 The Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359798, Seattle, WA 98105. E-mail address for A.A. Spirt: aaspirt{at}hotmail.com

Investigation performed at the Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. One of the authors (S.T.H Jr.) works as a consultant for DePuy on a "piece-work" basis (expenses and an honorarium for teaching). That work is unrelated to the present study. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. 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).

Background: Second-generation total ankle arthroplasty has been reported to have good intermediate-term results. The purpose of the present study was to report on the cause and frequency of reoperation and failure after total ankle arthroplasty and to determine demographic and clinical predictors of reoperation and failure.

Methods: Three hundred and six consecutive primary total ankle arthroplasties were performed with use of the DePuy Agility Total Ankle System between 1995 and 2001. At a mean of thirty-three months after the arthroplasty, we retrospectively reviewed the records with regard to patient age, gender, the indications for the index procedure, adjuvant procedures, the timing and frequency of reoperation, and the indications for and the type of reoperations performed. Kaplan-Meier analysis was performed to determine the rate of prosthetic survival, and Cox regression analysis was performed to determine predictors of reoperation and failure.

Results: Eighty-five patients (28%) underwent 127 reoperations (involving 168 procedures) after primary total ankle arthroplasty. The most common procedures at the time of reoperation were débridement of heterotopic bone (fifty-eight), correction of axial malalignment (forty), and component replacement (thirty-one). Eight patients underwent below-the-knee amputation. Age was found to be the only significant predictor of reoperation and failure after total ankle arthroplasty. The five-year survival rate with reoperation as the end point was 54%. The five-year survival rate with failure as the end point was 80% for all patients and 89% for patients who were more than fifty-four years of age. The prosthesis could not be salvaged in nine ankles (2.9%); the inability to salvage the prosthesis was most often due to loosening or infection.

Conclusions: We noted a relatively high rate of reoperation after total ankle arthroplasty with this second-generation device. Younger age was found to have a negative effect on the rates of reoperation and failure. Most prostheses could be salvaged; however, the functional outcome of this procedure is uncertain.

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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