Low-profile total ankle arthroplasty may be associated with radiographic lucency at 1 year
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Key takeaways:
- Low-profile total ankle arthroplasty implants may be associated with an increased risk of tibial loosening.
- At 1 year, 6.8% of patients had global lucency and revision for loosening.
Newer, low-profile total ankle arthroplasty implants may be associated with an increased risk of tibial loosening, with a 6.8% incidence of global lucency and revision for loosening at 1 year, according to presented results.
“Low-profile total ankle replacements have proliferated in recent years, for good reason. They have less bone resection than earlier implants, they're generally simpler and easier techniques and most of them have patient-specific cutting guides, which can make the procedure even simpler,” Elizabeth A. Cody, MD, assistant attending orthopedic surgeon at Hospital for Special Surgery, said in her presentation at the American Orthopaedic Foot & Ankle Society Annual Meeting. “However, relatively high rates of revision for tibial loosening have been reported with all of these implants.”
Cody and colleagues used a prospectively collected total ankle arthroplasty (TAA) registry to analyze 616 TAAs performed before January 2021 with a mean radiographic follow-up of 27 months. They assessed outcomes intraoperatively and at 1- and 2-year follow-ups.
Overall, 44.4% of TAAs were performed with the Vantage prosthesis (Exactech), 41.1% were performed with the Infinity prosthesis (Wright Medical Group), 8.4% were performed with the Cadence prosthesis (Smith & Nephew) and 6% were performed with the Infinity Adaptis prosthesis (Wright Medical Group).
According to the abstract, the primary outcome measure was radiographic lucency, which was defined as a radiolucent line adjacent to the tibial tray of at least 1 mm in thickness and present in more than 50% of tibial zones. In addition, Cody noted poorly defined lucency around the tibial component in all four tibial zones was considered “global lucency.”
Among all 616 TAAs, Cody and colleagues found 4.5% of patients required revision (n = 28), 3.4% required revision for symptomatic tibial loosening (n = 21) and 6.8% (n = 42) had global lucency and revision for loosening at 1 year.
Cody and colleagues noted intraoperative lucencies were not predictive of global lucency or revision for loosening at 1 year. They noted the only risk factor of global lucency was male sex (adjusted OR = 2.6).
“We think that looking into this topic of research will be important for making our ankle replacement patients do better and have better survivorship, and also for determining what kind of implants we're using for which patients,” Cody concluded.
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Cody E, et al. Periprosthetic tibial lucency following low-profile total ankle arthroplasty. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 11-14, 2024; Vancouver, British Columbia, Canada (hybrid meeting).
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