Transfibular total ankle arthroplasty : a new reliable procedure at five-year follow-up

Aims This study reports updates the previously published two year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow up extended to a minimum of five years. Methods We prospectively evaluated 89 patients who underwent transfibular TAA for end stage osteoarthritis. Patients' clinical and radiological examinations were collected pre-and postoperatively at six months and then annually for up to five years of follow up. Three patients were lost at the final follow up with a total of 86 patients at the final follow up. Results A total of 86 patients were evaluated at a mean follow up of 65.4 months (60 to 90). At fiveyear follow up, statistically significant improvements (p < 0.001) were found in the mean American Orthopaedic Foot & Ankle Society Ankle Hindfoot Score (from 33.8 (SD 14.3) to 86.1 (SD 8.8)), visual analogue scale for pain (from 8.5 (SD 1.7) to 1.5 (SD 1.2)), Short Form 12 Physical and Mental Component Scores (from 29.9 (SD 6.7) and 43.3 (SD 8.6) to 47.3 (SD 7.5) and 52.2 (SD 8.0), respectively), and mean ankle dorsiflexion and plantarflex- ion (from 6.2 degrees (SD 5.5 degrees) and 9.6 degrees (SD 5.8 degrees) to 23.9 degrees (SD 7.7 degrees) and 16.9 degrees (SD 7.2 degrees), respective- ly). Radiologically, the implants maintained neutral alignment without subsidence. Tibial or talar radiolucency was found in eight patients, but none of these patients was symptomatic. At five year follow up, 97.7% of implants (95% confidence interval 91.2 to 99.4) were free from revision or removal with 84 implants at risk. We recorded two cases (2.3%) of failure for septic loosening. Conclusion Transfibular TAA is safe and effective with a high survival rate at mid term follow up and satisfactory clinical and radiological results. Further studies are required to determine the long term performance of these implants. Cite this article: Bone Joint J 2022;104-B(4):472-478.