J Korean Orthop Assoc.  2009 Jun;44(3):377-385. 10.4055/jkoa.2009.44.3.377.

Short-term Results of the Agility Total Ankle Arthroplasty

• Lee KT
• Young KW
• Kim JY
• Kim HS
• Joh JW
• Cha SD

• KMID: 2186347
• DOI: http://doi.org/10.4055/jkoa.2009.44.3.377

Abstract

PURPOSE: Recently, there has been increasing interest in total ankle arthroplasty as an alternative to ankle arthrodesis. This study examined the short-term results of total ankle arthroplasty using an Agility prosthesis.
MATERIALS AND METHODS
This study reviewed the results of 11 patients who underwent total ankle arthroplasty using the Agility prosthesis between May, 2003 and May, 2004. With a postoperative follow-up period of 2 years, 10 patients (10 ankles) were available for review at the time of the follow-up. The clinical evaluation included the ankle range of motion, the personal type of preferred shoe, walking pain (VAS score) and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score. In addition, the patients were asked whether they were satisfied with the outcome and if they would choose to undergo the same procedure again. The radiologic evaluation included the loosening of the prosthesis, osteolysis and syndesmosis union. The anterior surgical approach was used. The syndesmosis area was fixed using 2 cannulated screws inserted percutaneously in 9 cases and a plate in 1 case.
RESULTS
The patients consisted of two men and eight women. The average age was 51.8 years (range 41 to 67) with an average follow-up of 30.3 (range 24 to 36) months. The mean preoperative and postoperative AOFAS ankle scores were 38.2 and 73.8, respectively, demonstrating significant improvement. The mean preoperative and final follow-up walking pain was 8.9 and 2.8, respectively. The ankle range of motion was decreased slightly at the final follow-up. Five patients required a cane to walk. Radiographic analysis showed no prosthesis failure, even though osteolysis occurred around the prosthesis in all cases. Only one case showed further progression. Union in the syndesmosis area occurred within 6 months in 5 cases and delayed union was observed in 3 cases, and nonunion was observed in 2 cases. Sensory loss in the area innervated by the deep peroneal nerve and a fracture in the lateral malleolus was encountered in one case, but this recovered with conservative treatment. Subtalar joint arthritis was noted in one case.
CONCLUSION
Agility total ankle arthroplasty results in a favorable outcome at the short-term follow-up. However, total ankle arthroplasty is associated with radiographic complications including syndesmosis nonunion and osteolysis. Only syndesmosis nonunion was associated with the clinical results. Therefore, long-term follow-up is considered to be necessary to demonstrate osteolysis and loosening with their clinical association.

Keyword

Ankle osteoarthritis; Agility total ankle prosthesis; Total ankle arthroplasty

MeSH Terms

Animals
Ankle
Arthritis
Arthrodesis
Arthroplasty
Canes
Female
Follow-Up Studies
Foot
Humans
Male
Osteolysis
Peroneal Nerve
Prostheses and Implants
Prosthesis Failure
Range of Motion, Articular
Shoes
Subtalar Joint
Walking

Figure

• 

  Fig. 1 (A) Preoperative standing AP radiograph of a 67 years female patient showing a collapsed medial joint space and varus tilting of the talus. The syndesmosis area was fixed using a plate and screws. (B) At 12 months after surgery, the standing AP radiograph shows proximal screw loosening, circumferential lucency and syndesmosis nonunion. (C) At 24 months after surgery, the standing AP radiograph shows persistent proximal screw loosening and syndesmosis nonunion. However, lucency from zones 1 to zone 5 had disappeared.

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  Fig. 2 A 44 years old female patient underwent total ankle arthroplasty using an Agility implant. (A) Preoperative standing anteroposterior radiograph showing advanced osteoarthritis. (B) Postoperative AP radiograph taken 6 months after surgery showing mild osteolysis around the lateral side of tibial component. Syndesmosis fusion is not complete. (C) At 31 month after surgery, the standing AP radiograph shows further progression of lysis at zone 6 and lucency at zone 1.

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  Fig. 3 (A) Preoperative standing AP radiograph of a 41 year old female patient showing a collapsed joint space, sclerotic margin and osteophytes. (B) Postoperative AP radiograph shows a transverse fracture of the lateral malleolus immediately below the tibial component. (C) At 24 months after surgery, the standing AP radiograph shows complete healing of the lateral malleolar fracture. However, syndesmosis nonunion and lucency at zone 6 can be seen.

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