Background: Second-generation total ankle arthroplasty has been
reported to have good intermediate-term results. The purpose of the present
study was to report on the cause and frequency of reoperation and failure
after total ankle arthroplasty and to determine demographic and clinical
predictors of reoperation and failure.
Methods: Three hundred and six consecutive primary total ankle
arthroplasties were performed with use of the DePuy Agility Total Ankle System
between 1995 and 2001. At a mean of thirty-three months after the
arthroplasty, we retrospectively reviewed the records with regard to patient
age, gender, the indications for the index procedure, adjuvant procedures, the
timing and frequency of reoperation, and the indications for and the type of
reoperations performed. Kaplan-Meier analysis was performed to determine the
rate of prosthetic survival, and Cox regression analysis was performed to
determine predictors of reoperation and failure.
Results: Eighty-five patients (28%) underwent 127 reoperations
(involving 168 procedures) after primary total ankle arthroplasty. The most
common procedures at the time of reoperation were débridement of
heterotopic bone (fifty-eight), correction of axial malalignment (forty), and
component replacement (thirty-one). Eight patients underwent below-the-knee
amputation. Age was found to be the only significant predictor of reoperation
and failure after total ankle arthroplasty. The five-year survival rate with
reoperation as the end point was 54%. The five-year survival rate with failure
as the end point was 80% for all patients and 89% for patients who were more
than fifty-four years of age. The prosthesis could not be salvaged in nine
ankles (2.9%); the inability to salvage the prosthesis was most often due to
loosening or infection.
Conclusions: We noted a relatively high rate of reoperation after
total ankle arthroplasty with this second-generation device. Younger age was
found to have a negative effect on the rates of reoperation and failure. Most
prostheses could be salvaged; however, the functional outcome of this
procedure is uncertain.
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.