Longevity of 2 Piece vs 2+ Piece Stemmed Total Ankle Replacement; Is there an Optimal Length?

Abstract

Total ankle arthroplasty (TAA) has grown in popularity influenced by new implant designs and patient specific options. Tibial fixation options are varied, and modular tibial stems have offered a promise of enhanced mechanical stability of the tibial component. Historically, literature has compared tibia fixation strategies including stemmed implants, peg, cruciate and bar designs; however, modularity in tibial stem length has yet to be explored. Adding to this confusion, fixed post designs often are confused with modular stem designs. The primary goal of this study was to compare outcomes and complications among 2 and 3 stem piece tibial stemmed INBONE® TAA used for primary ankle arthroplasty. The authors retrospectively reviewed a single surgeon operative database (GCB) from 2013-2024. Patient demographics, complications, and replacement longevity was recorded. We found the 2 stem group return to operating room time pertaining to TAA revision was significantly sooner compared to the 3 stem group (p = 0.046). The number of complications was deemed not significant in the 2 stem group requiring operative intervention compared to the 3 stem group (p = 0.057). Variable stem length appears to impact long term sustainability of total ankle replacement. More prospective studies are necessary comparing tibial stem length and risk of failure and complication.