Abstract
Background:
This study investigated performance and safety differences between cemented and cementless fixation of trabecular metal total ankle arthroplasty (TAA) using a lateral transfibular approach.
Methods:
This nonrandomized, multicenter, prospective study included 59 cemented and 61 cementless TAA patients with mean follow-ups of 7.2 years (cemented) and 6.2 years (cementless). All cemented ankles were performed in North America; cementless fixation was performed in Europe. Implant survival (revision of tibial or talar implant for any reason) was the primary outcome. Secondary outcomes were radiographic measures and range of motion. Tertiary outcomes included American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Ankle Osteoarthritis Scale (AOS), and EuroQol 5-Dimension 5-Level (EQ-5D-5L).
Results:
At average 7 years’ combined follow-up, there were no significant differences (P = .08) in survival between cemented (100%) and cementless (94.88%, 95% CI 84.94%-98.32%) fixation. More mid- and hind-foot fusions were performed in the cemented (n = 16) vs cementless cohort (n = 1, P < .05). Plantarflexion was similar between the cohorts through 7 years postoperative. Dorsiflexion was significantly greater in the cementless cohort from 6 weeks through 5 years postoperative. At 6 weeks postoperative, AOFAS, AOS pain, AOS disability, and EQ-5D-5L scores were significantly better in the cementless cohort (P < .05). AOS disability and EQ-5D-5L scores remained better in the cementless cohort through 2 years and 1 year postoperative, respectively. Outcomes were similar between the groups at later time points. Postoperative patient satisfaction rates were similar for the groups: 95.9% (6 weeks), 90.0% (6 months), and 91.3% (1 year).
Conclusion:
TAA using a trabecular metal ankle implant with a transfibular approach was associated with excellent survival regardless of fixation. Greater improvements in function, pain, range of motion, and quality of life 6 weeks postoperative suggest faster recovery with cementless fixation; however, this may reflect an increased number of additional procedures performed in the cemented cohort.
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