Total ankle arthroplasty: a radiographic outcome study.

Abstract

Total ankle arthroplasty (TAA) is becoming a popular alternative to arthrodesis for patients with end-stage ankle arthrosis. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TAA and to correlate it with clinical outcome. In a 9-year retrospective review of patients with TAA, all available ankle radiographs and clinical data were reviewed. Data analysis included descriptive statistics, Fisher exact test, and Kaplan-Meier survival curves for radiographic and clinical survival. Two hundred sixty-two TAAs in 260 patients were reviewed; 55% were in women, and the mean patient age was 61.5 years. The mean radiographic follow-up was 142 weeks, with an average of six radiographs per patient. One hundred sixty-three patients (62.2% of TAAs) developed one or more radiographic complications, including periprosthetic lucency (34.0%), hardware subsidence (24.4%), perihardware fracture (11.1%), syndesmotic screw loosening (10.3%), and screw fracture (6.5%). One hundred nineteen patients (45.4% of TAAs) developed symptoms of ankle pain or instability, and 71 patients (27.1% of TAAs) underwent at least one reoperation. In patients with radiographic complications, 41.7% developed ankle pain and 5.1% developed ankle instability, compared with 23.7% and 2.2%, respectively, of patients with no radiologic complications (p < 0.05). Of the patients with radiographic complications, 33.1% had at least one additional surgery compared with 17.1% of patients without radiographic complications (p < 0.05). Radiographic complications are common in patients after total ankle arthroplasty. There is a strong positive association between postoperative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist.