Early Osteolysis and Component Revision of CADENCE Total Ankle Arthroplasty at Midterm Follow Up

Abstract

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) for the treatment of end-stage ankle arthritis has continued to grow in popularity as a favorable alternative to ankle arthrodesis. Amongst the fourth-generation implants released over the past decade is the CADENCE Total Ankle System (CTAS) which became available for clinical use in 2016. Our previous publication revealed a concerning incidence of radiographic osteolysis of the CADENCE tibial component interface at short-term follow-up of 24 months. Though there were limited cases of symptomatic loosening or component revision in this report, there was concern this trend may worsen with longer follow-up. The purpose of this study was to evaluate the radiographic and clinical outcomes of TAA with the CTAS, with a minimum of 1-year follow-up. Methods: This single-center retrospective study evaluated 63 consecutive patients who underwent TAA with the CTAS between August 2016 and October 2021 by a single fellowship-trained foot and ankle surgeon and co-design surgeon. Patients were included in our study on the basis of at least one year of clinical and radiographic follow-up; there were no other exclusion criteria. Results: Fifty-four TAA cases utilizing the CTAS in 50 patients were included in the current study. Preoperatively, eleven ankles had neutral alignment, 18 ankles demonstrated varus alignment, and 25 ankles demonstrated valgus alignment. Twelve patients underwent staged procedures for management of severe coronal plane deformity. Radiographic parameters changed significantly preoperatively to postoperatively. At final follow-up, PPL was demonstrated in 39 (72.2%) ankles in this cohort. Symptomatic PPL was present in 13.0% of ankles in this cohort. Talar subsidence was observed in 7 ankles within our cohort. Nine ankles underwent subsequent operations related to TAA complications. Seven ankles underwent revision procedures, resulting in a final implant survivorship of 87.0%. Four ankles, 7.4% underwent non-revision reoperations. No additional complications were encountered within this cohort. Conclusion: In this study of 54 CADENCE TAA, we observed a high rate of component loosening and bone interface osteolysis over time. This ultimately led to poorer implant survivorship over time and a higher than acceptable revision rate. Though the lead author is a co-designer of the CADENCE implant, we believe it prudent to share our clinical findings and experience as we all gain further knowledge and understanding about implant design and TAA. Based upon our results, we have abandoned use of this prosthesis as the midterm results fail to achieve parity with other TAA systems available on the market.