| TOTAL
ANKLE ARTHROPLASTY IN INFLAMMATORY JOINT DISEASE WITH
USE OF TWO |
BY H.
CORNELIS DOETS, MD, RONALD BRAND, PHD, AND ROB G.H.H. NELISSEN,
MD, PHD
Investigation performed at the Department of Orthopaedic Surgery,
Slotervaart Hospital, Amsterdam,
and the Departments of Orthopaedic Surgery and Medical Statistics,
Leiden University Medical Center, Leiden, The Netherlands
Background:
Interest
in mobile-bearing total ankle arthroplasty has increased in
recent years. However, to our knowl¬edge, no study has
focused exclusively on patients with the diagnosis of inflammatory
joint disease or has provided a detailed analysis of the risk
factors for failure.
Methods: A prospective observational study of the results
of cementless mobile-bearing total ankle arthroplasty in patients
with inflammatory joint disease (mainly rheumatoid arthritis)
was conducted at two centers. Ninety-three to¬tal ankle
arthroplasties were performed. The LCS (low contact stress)
prosthesis was used initially, in nineteen an¬kles, between
1988 and 1992, and a modification of the LCS prosthesis, the
Buechel-Pappas design, was used in seventy-four ankles between
1993 and 1999. Clinical and radiographic follow-up was performed
at yearly intervals. Three clinical scoring systems were used,
and any complication was recorded throughout follow-up. Actuarial
survival (with revision as the end point), multivariate analysis,
and a competing risk approach were used to describe the long-term
outcome.
Results:
The clinical result at one year after surgery showed a significant
improvement in the scores on all three scoring systems (p
< 0.05). Ankle dorsiflexion (mean, 7°) also improved
significantly (p < 0.05) compared with the preoperative
state. The most frequent complication was a malleolar fracture,
which occurred in twenty ankles. Only when it occurred in
combination with a deformity in the frontal plane did this
complication have an adverse effect on the end result. At
a mean follow-up of eight years, seventeen patients (twenty-one
ankles) had died and fifteen ankles had been revised because
of aseptic loosening (six ankles), primary or secondary axial
deformity with edge-loading (six ankles), deep infection (two
ankles), and a severe wound-healing problem (one ankle), leaving
fifty-seven ankles (61%) that were evaluated. The mean overall
survival rate at eight years was 84%. An increased failure
rate was en¬countered in ankles with a preoperative deformity
in the frontal plane of >10° (p = 0.03) and in ankles
in which an un¬dersized tibial component had been implanted
(p = 0.02).
Conclusions:
Mobile-bearing total ankle arthroplasty is a valid treatment
option for the rheumatoid ankle if proper in¬dications
are used. Aseptic loosening and persistent deformity are the
most important modes of failure.
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