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Similar outcomes seen with mobile-bearing vs fixed-bearing implants for total ankle replacement

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BOSTON — Patient-reported and clinical outcomes favored both mobile-bearing and fixed-bearing implants for total ankle replacement, according to research presented at the American Orthopaedic Foot & Ankle Society Annual Meeting.

James A. Nunley II

“At this time, there is no statistically significantly difference in clinical improvement between the two implants,” James A. Nunley II, MD, said during his presentation. “But the incidence of tibial lucency and cyst formation, while similar for the mobile-bearing and fixed-bearing tibial components, the mobile-bearing has greater talar lucency and tibial talar subsidence.”

Nunley and colleagues performed a prospective, randomized controlled trial that compared the use of mobile-bearing and fixed-bearing implants for total ankle replacement (TAR) in 84 patients with end-stage ankle osteoarthritis who failed nonoperative treatment. On average, the follow-up was 4.5 years. At 6 and 12 months postoperatively, investigators obtained patient-reported outcomes, physical exams and standardized weight-bearing ankle radiographs. Outcomes collected included VAS, SF-36, foot and ankle disability index, short musculoskeletal functional assessment and AOFAS ankle-hindfoot score.

Results showed statistically significant improvements between the preoperative evaluation to the most recent follow-up visit for all patients. The clinical outcomes were not statistically significantly different between the mobile-bearing and fixed-bearing groups. Based on radiographs, the tibial lucency/cyst formation for mobile-bearing TAR and fixed-bearing TAR was 26.8% and 20.9%, respectively. Investigators found tibial settling/subsidence in 7.3% of mobile-bearing TAR group. Talar lucency/cyst formation occurred in 24.3% of the mobile-bearing TAR group vs. 2% for the fixed-bearing TAR group. In 21.9% of mobile-bearing TARs, investigators observed talar subsidence compared with 2% of the fixed-bearing TAR group.

Clinical and patient-reported outcomes favored both mobile-bearing and fixed-bearing implants for total ankle replacement.

Monica Jaramillo

There were eight reoperations in mobile-bearing TAR group and three reoperations in fixed-bearing TAR group. Most reoperations were performed to relieve impingement or to treat cysts and were not performed to revise or remove metal implants. – by Monica Jaramillo

Reference:

Nunley J, et al. Prospective randomized trial comparing mobile-bearing and fixed-bearing total ankle replacement. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; July 11-14, 2018; Boston.

Disclosure s : Nunley reports research support Acumed LLC, Breg and Integra; is a paid consultant for DT MedTech, Mirus, Orthofix Inc., SciMed and Wright Medical Technology Inc.; has stock or stock options in Bristol-Myers Squibb; receives publishing royalties and financial or material support from Springer and DataTrace; is a paid presenter or speaker for Treace and TriMed; and has intellectual property royalties and is a paid consultant for Exactech Inc.