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Study finds low overall survival rate for total ankle arthroplasty

However, implant survival significantly improves with surgical experience.

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Although total ankle arthroplasty can be a valuable alternative to ankle arthrodesis, such procedures are technically demanding and the survival rate is lower than that of total hip and knee arthroplasty, according to an analysis of data in the Swedish Ankle Arthroplasty Register.

However, "It is obvious that with increasing experience, the results — including prosthetic survival — will improve," the study authors noted.

Anders Henricson, MD, and colleagues, reviewed data for 531 total ankle arthroplasty (TAA) prostheses implanted in Sweden between April 1993 and June 2006. The study included 318 STAR prostheses (Waldemar Link), 92 Buechel-Pappas prostheses (Wright Cremasoli and Endotec), 69 AES prostheses (Biomet), 29 HINTEGRA prostheses (Newdeal) and 23 Mobility prostheses (DePuy International), according to the study, published in Acta Orthopaedica.

As of June 15, 2006, 101 TAAs had been revised, with an overall survival rate of 0.78 at 5 years and 0.62 at 10 years.

Of the 531 procedures, 73% have been performed at four hospitals by three surgeons. For these three surgeons, the 5-year survival rate significantly improved after their first 30 cases and was estimated to be 0.86, the authors noted.

"The 5-year survival increased from 0.7 for their first 90 cases to 0.86 for the following 132 cases (P = .01)," they wrote.

"Lower age at index surgery implied increased risk of revision whereas diagnosis or gender did not," the authors added.

"[The] somewhat low overall survival rate and high revision rate in this material reflects the demanding surgical procedure and the long learning curve. Experience, strict indications, improved designs and especially, improved instrumentation will probably lead to better results in the future," they wrote.

For more information:

• Henricson A, Skoog A, Carlsson A. The Swedish ankle arthroplasty register. An analysis of 531 arthroplasties between 1993 and 2005. Acta Orthop. 2007;75:569-574.