Preliminary experience of scandinavian total ankle replacement / 中华骨科杂志

ABSTRACT

Objective To investigate the preliminary results of total ankle replacement with a three components of mobile bearing scandinavian total ankle replacement(STAR). Methods From October 1999 to February 2003, 13 cases of total ankle replacement were performed with STAR system (Waldemar Link, Hamburg, Germany). There were 8 males and 5 females with an average age of 63.4 years (range, 58 to 69 years). The diagnoses were posttraumatic arthritis in 6, osteoarthritis in 3, Kaschin-Beck disease in 2 and rheumatoid arthritis in 2. An anteromedial curve incision extended distally and proximally from the center of ankle joint. After the exposure and osteotomy, the uncemented tibial and talar components were implanted, a suitable sliding nucleus should be checked in order to keep the soft tissue balance. One total ankle arthroplasty was converted to ankle arthrodesis because of fracture of lateral malleolus occurred during operation. Results Among 12 total ankle arthroplasties, 8 had detailed follow-up data. The average period of follow-up was 16 months (range, 6 to 38 months). All the followed-up ankles were scored with Kofoed total ankle scoring system. The average preoperative and postoperative ankle score were 29 (6-49) and 82 (56-99) respectively. None of prosthetic loosening and migration was found radiologically. However, one case of delayed wound healing treated with dressing change for 4 weeks. One case of fractured medial malleolus was internally fixed with K wire, and the stability of tibial component was not compromised. Conclusion With current ankle arthroplasty designs, total ankle replacement is a viable treatment for symptomatic ankle arthritis that has no responses to nonoperative treatment. Although the preliminary results of total ankle arthroplasty are encouraging, there is still need for careful, long term analysis to estimate to what extent current ankle arthroplasty can relieve pain and restore ankle function. Further attention must be paid to more accurate implantation techniques that will result in a well balanced ligament and allow the ligament to act together with the replaced surfaces in a most physiologic manner.