Background: We previously reported the intermediate-term results
with the early version of the Agility total ankle replacement, a unique design
that takes advantage of arthrodesis of the tibiofibular syndesmosis for tibial
component support. The purpose of this study was to report longer-term results
of this procedure in the treatment of disabling ankle arthritis.
Methods: We conducted an independent review of all Agility total
ankle replacements performed by a single surgeon between 1984 and 1994.
Follow-up evaluation consisted of completion of a validated ankle
osteoarthritis scale and a short questionnaire and a review of the
radiographs. All radiographs were evaluated for evidence of the development of
progressive hindfoot arthritis, nonunion of the tibiofibular syndesmosis,
progressive radiolucent lines, osteolysis, and component subsidence.
Results: One hundred and thirty-two arthroplasties were performed in
126 patients. After a mean follow-up period of nine years, thirty-three
patients (thirty-six implants) had died, fourteen patients (11%) had a
revision of the implant or an ankle arthrodesis, and one had the leg amputated
because of an unrelated cause. Of the remaining seventy-eight patients
(eighty-one ankles), sixty-seven (sixty-nine ankles) were followed clinically.
More than 90% of them reported that they had decreased pain and were satisfied
with the outcome of the surgery. We found modest differences in a comparison
of the pain and disability scores with those of age-matched controls. Of the
117 ankles that had been followed radiographically for a minimum of two years,
twenty-two (19%) had progressive subtalar arthritis, seventeen (15%) had
progressive talonavicular arthritis, and nine (8%) had a syndesmosis nonunion.
Eighty-nine (76%) of the 117 ankles had some evidence of peri-implant
Conclusions: Arthrodesis of the tibiofibular syndesmosis impacts the
radiographic and clinical outcomes with the Agility total ankle replacement.
The relatively low rates of radiographic hindfoot arthritis and revision
procedures at an average of nine years after the arthroplasty are encouraging.
Agility total ankle replacement is a viable and durable option for the
treatment of ankle arthritis in selected patients.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.