Total ankle replacement: Early results during learning period

IntroductionTotal ankle replacement is now becoming a popular surgical procedure for a painful arthritic ankle. We report the results of the first consecutive 50 total ankle replacements during learning period from a single surgeon series.Material and methods50 consecutive Scandinavian total ankle replacements (STAR) in 43 patients were carried out between March 1999 and February 2003. It included 28 male and 15 female patients. The average age of patients was 63.3 (33–80 years). The indication for surgery was primary osteoarthritis in 27 ankles, rheumatoid arthritis in 16 and secondary osteoarthritis in seven ankles. All radiographs were reviewed along with clinical examination including American Orthopaedic Foot & Ankle Society (AOFAS) score. We compared the results of surgery in first 25 patients with next 25 patients during learning period.ResultsThe average functional score improved from 50.5 to 77.3 at an average follow-up of 36 months (18–60 months). Three patients needed revisions; two for malalignment of the tibial component after stress fracture and one for persistent ankle pain. Of the remaining 40 patients, 30 patients (75%) were very satisfied following surgery, 9 (23%) were satisfied and only one patient was dissatisfied with the final result. Radiologically, three tibial components were considered loose. Main complications included stress fracture of the medial malleolus in three patients and the lateral malleolus in one patient, superficial wound problems in seven and rupture of tendoachillis in one patient. Patients in the second half of this series performed better as compared with the first 25 cases with respect to prostheses alignment, less number of peroperative and postoperative complications and the final functional score.ConclusionsEarly results indicate a significant symptomatic relief in the majority of patients with increased activity level and a high satisfaction rate. Initially, however, there is a long learning curve for the surgeon and the surgery may be associated with technical difficulties.