Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kessler, M.
Survival rate of total ankle arthroplasty: a comparative analysis of clinical studies and national arthroplasty registers.
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2020. pp. 58
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Hauer Georg
- Sadoghi Patrick
- Altmetrics:
- Abstract:
- Introduction For a long time, Total Ankle Replacement (TAR) has been considered to have a high failure rate and a high risk of complications. With the introduction of uncemented fixation in the 1990s, the outcome has constantly improved. The aim of this study is to show if this trend is continuing and if it affects national registries and independent studies, or if the development can only be found in dependent studies trying to favor their financer. Materials and Methods A systematic review of 39 clinical studies (48 study groups), published in indexed, peer-reviewed international scientific journals and found via Ovid SP, was performed. Inclusion criteria were the following: all prostheses were implanted after January 1st 1998, average follow- up was at least 24 months; revision was defined as exchange of at least one part of the prosthesis, and we included only primary revisions. Main outcome was defined as the number of revisions per 100 component years (CY). An overall revision rate was calculated in order to compare to survival rates from national joint registries. Furthermore, the studies were divided into various subgroups in accordance with their dependency on funding, the generation of the prosthesis device and the number of components as well as fixed- or mobile- bearing designs. Results 3993 prostheses were implanted, with an average follow-up time of 4.52 years. In 18066.72 CY, 306 revisions were reported, which corresponds to 1.69 revisions per 100 CY. While the outcome of the dependent subgroup was 1.82 per 100 CY, the outcome of the independent group was better with 1.48 per 100 CY. Second generation devices performed worse than third- generation devices (2.04 per 100 CY vs. 1.52 per 100 CY, respectively). Revision rates from fixed- bearing and mobile- bearing prostheses were comparable, with a revision rate of 1.84 per 100 CY and 1.74 per 100 CY, respectively. Our overall calculated mean revision rate was comparable to those of the national registries of New Zealand, Sweden, and the NJR. Those registries show different outcomes, depending on their year of starting, with newer registries showing better results. Conclusion TAR has become a safe alternative to ankle arthrodesis. It allows a wider range of movement and the outcome is continuously improving. However, the implantation is demanding and should be done by surgeons who are experienced in this field of surgery. Experience seems to matter more than the type of prosthesis, but newer devices in general show superior outcome. Level of evidence: Level II