Revision Rates After Total Ankle Arthroplasty in Sample-Based Clinical Studies and National Registries

ArticleinFoot & Ankle International 32(8):740-5 · August 2011with35 Reads
DOI: 10.3113/FAI.2011.0740 · Source: PubMed
Abstract
The aim of this study was to evaluate the outcome of specific implants in total ankle arthroplasty as reported in clinical studies and determined by national registries. MATERIALS and A structured literature review was conducted regarding sample-based clinical studies and national registry data. To allow for comparative analyses, registry data had to be available for the implants included. These were STAR Ankle, Büchel-Pappas, Hintegra, Mobility, Agility, and Ramses Total Ankle Arthroplasty. The revision rate was used as the main outcome parameter. On average, the revision rates published in sample-based clinical studies were about half the value found in registries. Implant developers represent a share of almost 50% of the published content and are therefore over-represented in scientific publications. The inventors of STAR Ankle and BP total ankle implants published data which was statistically significantly superior to the outcome achieved in average patients as documented in registries. Irrespective of the implant, the average revision rate to be expected according to the registry data available is 21.8% after 5 years, and 43.5% after 10 years. The average revision rate published in peer-reviewed scientific articles was significantly lower than the outcome achieved according to national arthroplasty registry data, which reflect actual average patient care in the respective countries. Publications by some research groups, particularly by implant inventors, show a deviation from the outcome published by other users and those shown in registry data.
    • "doi: 10.4172/2329-910X.1000124 revision rates published in sample-based clinical studies were about half the value found in registries [27]. Total ankle replacement is a technically challenging procedure with a steep learning curve [28][29][30][31]Lee et al. reported on their 50 initial HINTEGRA® TAAs and compared the perioperative complications from the first 25 cases with the subsequent 25 cases. "
    Article · Jan 2014
    • "doi: 10.4172/2329-910X.1000124 revision rates published in sample-based clinical studies were about half the value found in registries [27]. Total ankle replacement is a technically challenging procedure with a steep learning curve28293031 Lee et al. reported on their 50 initial HINTEGRA® TAAs and compared the perioperative complications from the first 25 cases with the subsequent 25 cases. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Total ankle arthroplasty provides an alternative to arthrodesis for management of ankle osteoarthritis. The results of the third generation total ankle replacements have been promising. The purpose of the present study was to investigate the clinical and radiographical outcome and implant survival of 16 consecutive patients suffering from symptomatic ankle osteoarthritis treated with the HINTEGRA® (Newdeal SA, Lyon, France) prosthesis. Methods: The first 16 implanted HINTEGRA® total ankle replacements (between 2001 and 2006) by a fellowship-trained foot and ankle surgeon were assessed clinically and radiographically after a mean of 61,8 months (range, 7–116). Eight female and eight male patients were operated at a mean age of 55 years (range, 34–77). Diagnosis was post-traumatic osteoarthritis in 10 (62,5%), primary osteoarthritis in 3 (18,7%) and arthritis secondary to infection in 3 (18,7%) patients. Results: The mean AOFAS score at final follow-up was 77 (range, 49–91). Mean ankle ROM as determined clinically and fluoroscopically was 23,72 degrees (range, 12,0–47,5). Six patients required revisional surgery (37,5%). The mean follow up period until revisional surgery occured was 50,6 months (range, 24–116). In total, implant survival in all followed ankles was 66,7%. Discussion: Our study demonstrated that the functional results of the HINTEGRA® ankle were comparable to most high volume centres but the implant survival was lower. With regards to the steep learning curve of total ankle arthroplasty these results seem compatible.
    Full-text · Article · Dec 2013 · Journal of Biomechanics
    • "The implant survival rate of total ankle replacement (TAR) is only 70–98% at 5–6 years, 80–95% at 8–10 years (Easley et al., 2011), and can drop to 45% at 15 years (Brunner et al., 2013). Failure causes include aseptic loosening, subsidence, cysts formation , peri-prosthetic and polyethylene fracture (Conti and Wong, 2001; Besse et al., 2009; Bonnin et al., 2011; Labek et al., 2011; Brunner et al., 2013). Most current finite element models of TAR are limited to the intra-articular aspects or to the prosthetic components (Anderson et al., 2006Anderson et al., , 2010 Reggiani et al., 2006; Espinosa et al., 2010; Barg et al., 2011). "
    [Show abstract] [Hide abstract] ABSTRACT: Total ankle replacement remains a less satisfactory solution compared to other joint replacements. The goal of this study was to develop and validate a finite element model of total ankle replacement, for future testing of hypotheses related to clinical issues. To validate the finite element model, an experimental setup was specifically developed and applied on 8 cadaveric tibias. A non-cemented press fit tibial component of a mobile bearing prosthesis was inserted into the tibias. Two extreme anterior and posterior positions of the mobile bearing insert were considered, as well as a centered one. An axial force of 2kN was applied for each insert position. Strains were measured on the bone surface using digital image correlation. Tibias were CT scanned before implantation, after implantation, and after mechanical tests and removal of the prosthesis. The finite element model replicated the experimental setup. The first CT was used to build the geometry and evaluate the mechanical properties of the tibias. The second CT was used to set the implant position. The third CT was used to assess the bone-implant interface conditions. The coefficient of determination (R-squared) between the measured and predicted strains was 0.91. Predicted bone strains were maximal around the implant keel, especially at the anterior and posterior ends. The finite element model presented here is validated for future tests using more physiological loading conditions.
    Full-text · Article · Dec 2013
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