A New Surgical Method for the End-Stage Ankle Arthritis–Total Ankle Arthroplasty with Artificial Talus

Abstract

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is a popular surgical treatment for the patients with end-stage ankle arthritis. Along with development of the implant, indication for TAA has been extended to the severe deformity due to osteoarthritis or rheumatoid arthritis. However, a certain rate of complication after TAA is still remaining. The main reasons for failed TAA are the complications of talar component such as aseptic loosening or subsidence. We developed artificial talar prosthesis and indicated for the patient with idiopathic necrosis of the talus. This time we applied this new implant combined with tibial component of the TAA for the patient with end-stage ankle arthritis having severe collapse of the talus. The purpose of this study is to evaluate the outcomes of TAA with artificial talus. Methods: 【Materials】Thirteen patients (13 ankles) treated by TAA with artificial talus since 2007 to 2014 were investigated. The mean duration of follow-up was 35 months (range; 12 to 66 months). Twelve patients (12 ankles) were suffering from osteoarthritis of the ankle, and 1 was from rheumatoid arthritis. The mean age at the surgery was 71 year-old(range; 61 to 81 year-old). 【Methods】Clinical outcomes were evaluated by Visual Analog Scale (VAS) scores. Functional outcomes were assessed by scoring system produced by the Japanese Society for Surgery of the Foot (JSSF ankle-hindfoot scale) before surgery and at the final follow- up. Results: Postoperative VAS was improved from 8.9 to 2.3. Postoperative JSSF scale were improved from 41 to 87. There were no case that required the revision surgery due to implant failure or deep infection. Conclusion: The ankle has small joint surface compared with other weight-bearing joints, that causes the complications of talar component. For the patients with severe deformity or osteonecrosis of the talus, indications of TAA should be applied carefully. Patients of end-stage ankle arthritis with poor bone stock in the talus may have been unsatisfied with use of previous implant models of TAA. The artificial talus could be a possible option to solve this problem. In the current study, TAA with artificial talus remained favorable clinical and functional results for the patient with severe deformity or poor bone stock in the talus.