| TEN-YEAR EVALUATION OF CEMENTLESS MOBILE BEARING TOTAL ANKLE REPLACEMENTS |
Frederick
F. Buechel, Sr., M.D.*; Frederick F. Buechel, Jr., M.D.†;
Michael J. Pappas, Ph.D.‡
ABSTRACT
A porous-coated,
cementless, congruent-contact, three-piece, meniscal-bearing
total ankle replacement was developed and used clinically
over a 2-to 10-year period for patients with disabling ankle
arthritis. Polished titanium-nitride ceramic-coated Ti6Al4V
tibial and talar components with a deep-sulcus trochlear groove
and two lateral ?xation ?ns for the talar onlay component
were used. The ultra-high-molecular-weight polyethylene (UHMWPe)
meniscal bearing congruently conformed to the ?at upper tibial
component surface and the deep sulcus and cylindrical geometry
of the lower talar component surface. Fifty deep-sulcus (Buechel-Pappas)
total ankle replacements were implanted in 49 patients. Diagnoses
were 8 osteoarthritis (16%), 7 rheumatoid arthritis (14%),
2 avascular necrosis (4%), and 33 post-traumatic arthritis
(66%). Ages ranged from 26 to 71 years (mean 49 years). Clinical
results using a strict ankle scoring system demonstrated good/excellent
results in 88% of cases. Postoperative ankle motion ranged
from 12? to 46? total arc (mean 28?), which was similar to
the preoperative motion. Revision for malalignment was necessary
in two cases (4%). Mechanical complications included one case
of meniscal bearing wear (2%) in a patient with posttraumatic
arthritis with component malalignment and one case of talar
component subsidence (2%) in a patient with avascular necrosis
of the talus. No tibial component loosening was seen. Cumulative
survivorship using an end point of revision of any component
for any reason was 93.5% at 10 years (con?dence interval 61–100%).
*Department
of Orthopaedic Surgery, UMDNJ –New Jersey Medical School,
Newark, NJ
†Pennsylvania Hospital, University of Pennsylvania,
Adult Reconstruction Fellow, Philadelphia, PA
‡Department of Mechanical Engineering, New Jersey Institute
of Technology, Newark, NJ
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