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End-stage ankle osteoarthritis, Ankle replacement, Age at surgery, Survivorship rate
High physical demand and younger age are currently considered contraindications for total ankle replacement. The number of Total Ankle Replacements (TAR) is widespread increasing and indications are expanding thanks to a steady improvement in prosthetic designs and better outcome. Commentary of the literature: in 1999 a study of 100 uncemented STAR™ (Waldemar-Link, Hamburg, Germany) prostheses showed a survival rate of 75% at 6.8 years in patients under 50 years old. Other studies (es, Barg et Al.) shows the risk of failure age-related in young patients compared to older group. A report of 780 TAR from the Swedish Ankle Register showed patients with primary or post-traumatic osteoarthritis under 60 years of age to have a 1.8 higher chance of revision compared to older patients. Discussion: ankle replacement has been traditionally reserved for patients older 50 years old and with low physical demand. Contrariwise this belief, TAR have already been used with a wide range of ages, sometimes even patients younger than 30 years old. Most of the “negative” score and results showed before are related to “second-generation” prosthetic designs, while recent studies used a “third-generation” prosthetic design. Conclusions: recent evidences showed better clinical results and higher satisfaction in people under the age of 50 compared to ankle arthrodesis with comparable rate of complications and survivorship. Younger people will have however a higher rate of reoperation but in the meantime, they will prevent progressive degeneration of adjacent joints.
2) Singh JA, Ramachandran R. Time trends in total ankle arthroplasty in the USA: a study of the National Inpatient Sample. Clin Rheumatol. 2016;35(1):239–245
3) Tomlinson M, Harrison M. The New Zealand Joint Registry: report of 11-year data for ankle arthroplasty. Foot Ankle Clin. 2012;17(4):719–723
4) Doets HC, van der Plaat LW, Nelissen R. The current and future role of total ankle arthroplasty in the treatment of the arthritic ankle. A review. Minerva Ortop Traumatol. 2007;58(5):401–421
5) Krause FG, Schmid T. Ankle arthrodesis versus total ankle replacement: how do I decide? Foot Ankle Clin. 2012;17(4):529–543.
6) Doets HC, van der Plaat LW, Nelissen R. The current and future role of total ankle arthroplasty in the treatment of the arthritic ankle. A review. Minerva Ortop Traumatol. 2007;58(5):401–421
7) Alvine FG. The agility ankle replacement: the good and the bad. Foot Ankle Clin. 2002;7(4):737–53, vi.
8) Doets HC, van der Plaat LW, Nelissen R. The current and future role of total ankle arthroplasty in the treatment of the arthritic ankle. A review. Minerva Ortop Traumatol. 2007;58(5):401–421
9) Gougoulias NE, Khanna A, Maffulli N. History and evolution in total ankle arthroplasty. Br Med Bull. 2009;89:111–151
10) Conti SF, Wong YS. Complications of total ankle replacement. Clin Orthop Relat Res. 2001;391:105–114
11) Glazebrook M, Daniels T, Younger A, Foote CJ, Penner M, Wing K, et al. Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. Journal of Bone and Joint Surgery American Volume 2008;90(March (3)):499–505
12) Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, et al. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthopaedic Journal 2005; 25:44–6.
13) Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clinical Orthopaedics and Related Research 2009;467(July (7)):1800–6.
14) Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis: implications for research. Clinical Orthopaedics and Related Research 2004;(October (427 Suppl.): S6–15.
15) Hintermann B, editor. Total ankle arthroplasty: historical overview, current concepts and future perspectives. New York: Springer Wien New York; 2005
16) Saltzman CL, Mann RA, Ahrens JE, Amendola A, Anderson RB, Berlet GC, et al. Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot and Ankle International 2009;30(June (7)):579–96
17) Knecht SI, Estin M, Callaghan JJ, Zimmerman MB, Alliman KJ, Alvine FG, et al. The Agility total ankle arthroplasty. Seven to sixteen-year follow-up. Journal of Bone and Joint Surgery American Volume 2004;86-A (June (6)):1161–71.
18) Valderrabano V, Pagenstert G, Horisberger M, Knupp M, Sports Hintermann B. recreation activity of ankle arthritis patients before and after total ankle replacement. American Journal of Sports Medicine 2006;34(June (6)):993–9.
19) Wood PL, Prem H, Sutton C. Total ankle replacement: medium-term results in 200 Scandinavian total ankle replacements. Journal of Bone and Joint Surgery British Volume 2008;90(May (5)):605–9.
20) Hosman AH, Mason RB, Hobbs T, Rothwell AG. A New Zealand national joint registry review of 202 total ankle replacements followed for up to 6 years. Acta Orthop. 2007;78(5):584–591
21) Hurowitz EJ, Gould JS, Fleisig GS, Fowler R. Outcome analysis of agility total ankle replacement with prior adjunctive procedures: two to six year followup. Foot Ankle Int. 2007;28(3):308–312
22) Kofoed H, Lundberg-Jensen A. Ankle arthroplasty in patients younger and older than 50 years: a prospective series with long-term follow-up. Foot Ankle Int. 1999;20(8):501–506
23) Barg A, Zwicky L, Knupp M, Henninger HB, Hintermann B. HINTEGRA total ankle replacement: survivorship analysis in 684 patients. J Bone Joint Surg Am. 2013;95(13):1175–1183
24) Spirt AA, Assal M, Hansen ST Jr. Complications and failure after total ankle arthroplasty. J Bone Joint Surg Am. 2004;86-A(6):1172–1178
25) Rodrigues-Pinto R, Muras J, Martín Oliva X, Amado P. Total ankle replacement in patients under the age of 50. Should the indications be revised? Foot Ankle Surg. 2013;19(4):229–233
26) Demetracopoulos CA, Adams SB Jr, Queen RM, DeOrio JK, Nunley JA 2nd, Easley ME. Effect of age on outcomes in total ankle arthroplasty. Foot Ankle Int. 2015;36(8):871–880
27) Henricson A, Nilsson JA, Carlsson A. 10-year survival of total ankle arthroplasties: a report on 780 cases from the Swedish Ankle Register. Acta Orthop. 2011;82(6):655–659
28) Wood PL, Prem H, Sutton C. Total ankle replacement: medium-term results in 200 Scandinavian total ankle replacements. Journal of Bone and Joint Surgery British Volume 2008;90(May (5)):605–9.
29) Valderrabano V, Pagenstert G, Horisberger M, Knupp M, Sports Hintermann B. recreation activity of ankle arthritis patients before and after total ankle replacement. American Journal of Sports Medicine 2006;34(June (6)):993–9
30) Giannini S, Romagnoli M, O'Connor JJ, Catani F, Nogarin L, Magnan B, Malerba F, Massari L, Guelfi M, Milano L, Volpe A, Rebeccato A, Leardini A. Early clinical results of the BOX ankle replacement are satisfactory: a multicenter feasibility study of 158 ankles. J Foot Ankle Surg. 2011;50(6):641-7
31) Magnan B., Samaila E., Bartolozzi P. Protesi di tibio-tarsica. Evoluzione degli impianti. In Magnan B., Ceccarelli F., Malerba F. Patologia degenerativa del retropiede, Timeo Editore Bologna, 2009, vol.18, 103-113.
32) Laurens W van der Plaat, Daniël Haverkamp. Patient selection for total ankle arthroplasty. Orthopedic Research and reviews 31 July 2017
33) Cort D.Lawton, Bennet A.Butler, Robert G.Dekker, Adam Prescott, Anish R. Kadakia. Total ankle arthroplasty versus ankle arthodesis-a comparison of outcomes over the last decade. Journal of Orthopaedic Surgery and Research (2017) 12:76
34) Easley ME, Adams Jr SB, Hembree WC, DeOrio JK. Results of total ankle arthroplasty. Journal of Bone and Joint Surgery American Volume 2011;93(August (15)):1455–68
35) Esparragoza L, Vidal C, Vaquero J. Comparative study of the quality of life between arthrodesis and total arthroplasty substitution of the ankle. Journal of Foot and Ankle Surgery 2011;50(June–August (4)):383–7.
36) Guyton GP. Theoretical limitations of the AOFAS scoring systems: an analysis using Monte Carlo modeling. Foot and Ankle International 2001;22(October (10)):779–87.
37) Soo Hoo NF, Shuler M, Fleming LL. Evaluation of the validity of the AOFAS Clinical Rating Systems by correlation to the SF-36. Foot and Ankle International 2003;24(January (1)):50–5.