Medial malleolar osteotomy for the correction of tibiotalar varus deformity during total ankle arthroplasty: Results in 95 ankles

Lower risk of revision in fixed-bearing compared to mobile-bearing total ankle arthroplasties: A register based evaluation of 1246 patients in the Netherlands

BACKGROUND

Total ankle arthroplasty (TAA) has been developed as treatment for disabling tibiotalar osteoarthritis. TAAs are divided into mobile- and fixed-bearings. The aim was to determine the incidence and trends of fixed- and mobile bearings over time and investigate the association of bearing type and risk of revision after primary TAA in the Netherlands.

METHODS

Using data from the Dutch Arthroplasty Register (LROI) (2014-2023), we analyzed trends in use of bearing type, reasons for revision and implant survival (n = 1246).

RESULTS

Fixed bearings were more often used than mobile bearings (67 % versus 33 %). Revision risk at 3, 5 and 7 years was respectively 2.8 %, 3.3 %, and 5.4 % for fixed bearings, versus 6.5 %, 10.4 %, and 11.3 % for mobile bearings. The adjusted hazard ratio was 2.5 (95 %CI 1.4-4.4) for mobile bearings.

CONCLUSION

Fixed bearings were associated with a lower revision risk than mobile bearings in total ankle arthroplasties based on Dutch registry data.

LEVEL OF EVIDENCE

II.

Outcomes of Total Ankle Replacement with Preoperative Varus Deformity

Historically, coronal plane deformities of greater than 10° to 15° have been deemed contraindications for total ankle replacement (TAR). However, recent studies show satisfactory results in TAR with severe preoperative varus deformity. When correctly applying ancillary procedures, preoperative varus deformity can be structurally corrected, resulting in similar clinical scores to those obtained with "regular TAR." However, complications and revisions appear to increase with increasing deformity. Unfortunately, results of TAR in varus ankles consist of heterogeneous data (eg, with regards to prosthetic brands, bearing-types, duration of follow-up, and ancillary procedures) precluding strict conclusions. This could be solved by an international consensus group.