Five to Sixteen Year Follow-Up of the STAR Total Ankle Replacement

Abstract

Category: Ankle Arthritis Introduction/Purpose: Limited intermediate and long-term follow-up data has been published for total ankle arthroplasty in the United States (U.S.). This is a report of clinical follow-up data of a prospective, consecutive cohort of patients that underwent total ankle arthroplasty by a single surgeon at a single institution from 1999 to 2009 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing total ankle arthroplasty at a single U.S. institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination and radiographs; American Academy of Orthopaedic Foot and Ankle Surgeons (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Implant survival was defined as retention of both initial tibial and talar components at final follow up. Patients undergoing the surgical procedure from 1999 to 2009 were selected for inclusion. Results: Between 1999 and 2009, eighty-five STAR total ankle arthroplasties were performed in eighty-one patients; fifty patients were female. The mean age at surgery was 59.8 ± 12.8 years (range, 30-88 years). Thirteen patients died with implants in place and one patient with bilateral arthroplasties was lost to follow up. The mean duration of follow up for living patients that retained both initial components at final follow up was 11.3 ± 3.3 years (range, 5.5-16.75 years). The mean change in AOFAS Ankle-Hindfoot scores from baseline to final follow up was 34.4 ± 16.3 (range, -5-67). There were fifteen (17.6%) implant failures that occurred at a mean 5.2 ± 3.9 years postoperative. Eight glidecores (9.4%) required replacement for fracture at an average 8.6 years postoperative. Conclusion: This cohort of patients with true intermediate to long-term follow-up after total ankle arthroplasty with the STAR prosthesis demonstrates maintained acceptable revision rates, maintained improved patient reported outcomes scores and low major complication rates. Further intermediate and long-term outcome studies with follow up over 15-20 years on total ankle arthroplasty are needed to further understand the survivability of these implants.