Total ankle arthroplasty, also known as ankle replacement surgery, is a procedure that’s been increasingly recognized as a viable alternative to ankle fusion, or arthrodesis. This surgical procedure involves replacing the damaged parts of the three bones that make up the ankle joint with artificial joint parts. However, it’s important to note that while this procedure can offer relief from pain and improved mobility, it also comes with a relatively high rate of complications and failures.
One of the devices used in this procedure is the Scandinavian Total Ankle Replacement (STAR) prosthesis. The STAR prosthesis is a mobile-bearing device, meaning it allows for a range of motion in the ankle joint. However, long-term results of the STAR prosthesis are limited and variable, with different studies reporting different rates of complications and failures.
In a recent prospective study, researchers examined the long-term survivorship and postoperative complications of the STAR prosthesis. The study included 134 primary total ankle arthroplasties performed using the STAR prosthesis in 124 patients between May 1999 and June 2008. The researchers recorded the survivorship, postoperative complications, and reoperations, with a minimum follow-up period of 7.5 years. They assessed clinical results using the Foot Function Index and the Kofoed score, and determined the presence of component migration, cysts, and radiolucency surrounding the prosthesis components, heterotopic ossification, and progression of osteoarthritis in adjacent joints.
The results of the study showed that the cumulative survival of the STAR prosthesis was 78% after the 10-year follow-up period. However, an ankle arthrodesis was performed in 20 ankles (14.9%) that failed. Fourteen polyethylene insert fractures occurred (10.4%), and other complications occurred in 29 ankles (21.6%), requiring secondary procedures in 21 ankles (15.7%). Despite these complications, the postoperative clinical results improved significantly.
Interestingly, the researchers observed osteolytic cysts in 61 ankles (59.8%) and the surface area of these cysts increased during follow-up. However, there was no association between these cysts and the prosthesis alignment or clinical outcome. Heterotopic ossification, or the presence of bone in soft tissue where bone normally does not exist, was present at the medial malleolus in 58 cases (56.8%) and at the posterior tibia in 73 cases (71.6%), but this did not affect the clinical outcome. Osteoarthritis of the subtalar and talonavicular joint developed in 9 (8.8%) and 11 cases (10.8%), respectively.
In conclusion, the long-term clinical outcomes for the STAR prosthesis were found to be satisfactory. However, the survival and complication rates were disappointing compared to knee and hip arthroplasty. This highlights the need for further research to clarify the origin and significance of the reported complications.
In the grand scheme of things, these results underscore the importance of continued research and development in the field of ankle arthroplasty. While the STAR prosthesis has shown promise, it’s clear that there’s still room for improvement. As we continue to refine these procedures and devices, we can hope to see better outcomes for patients in the future.
To read the full journal article, head to http://feedproxy.google.com/~r/FootAnkleInternational/~3/Lej6yJ2EgQc/1292