Tobillo y pie

Agilidad de la atroplastia total de tobillo.

Agilidad de la artroplastia total de tobillo. Seguimiento de siete a dieciséis años.

Stephen I. Knecht, MD1, Miriam Estin1, John J. Callaghan, MD1, Miriam B. Zimmerman, PhD1, Kyle J. Alliman, BS1, Frank G. Alvine, MD2 and Charles L. Saltzman, MD1

1 Departments of Orthopaedics and Rehabilitation (S.I.K., M.E., J.J.C., K.J.A., and C.L.S.) and Public Health (M.B.Z.), University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for C.L. Saltzman: 2 Alvine Orthopaedics, 2908 East 26th, Sioux Falls, SD 57103

Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa

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 radiolucency.

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.

The Journal of Bone and Joint Surgery (American) 86:1161-1171 (2004)

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