Kopp Franz J, Patel Mihir M, Deland Jonathan T, O'Malley Martin J
San Diego Orthopaedic Associates, 4060 4th Avenue, 7th Floor, San Diego, CA 92103-2181, USA. franz
Foot Ankle Int. 2006 Feb;27(2):97-103. doi: 10.1177/107110070602700205.
Although ankle arthrodesis remains a standard operative procedure for disabling ankle arthritis, it has potential long-term problems. Total ankle arthroplasty offers preserved joint motion and may be a more favorable option in select patients. The purpose of this study was to report the intermediate-term clinical and radiographic results of total ankle arthroplasty using the Agility prosthesis.
We retrospectively reviewed the results of total ankle arthroplasty in 41 consecutive patients (43 ankles). Evaluation included preoperative and postoperative questionnaires, physical examination, and radiographs.
At the time of followup, 38 patients (40 ankles) were available for review. The most common preoperative diagnoses included posttraumatic arthritis (24 of 40 ankles, 60%) and rheumatoid arthritis (eight of 40 ankles, 20%). Average age at surgery was 63 (range 32 to 85) years. Average followup was 44.5 (range 26 to 64) months. Preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores averaged 33.6 and 83.3, respectively, demonstrating significance (p < 0.001). Postoperative Medical Outcomes Study Short Form-36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores averaged 49.5 and 56.1, respectively. Although 34 of 40 ankles demonstrated radiographic lucency or lysis, the degree of involvement varied. Migration or subsidence of components was noted in 18 ankles. Overall, 37 of 38 patients were satisfied with the outcome of their surgery and would have the same procedure under similar circumstances.
Agility total ankle arthroplasty results in a favorable clinical outcome and patient satisfaction in most patients at intermediate-term followup. However, total ankle arthroplasty is associated with potential complications and the need for subsequent operative intervention. Radiographic followup commonly reveals periprosthetic lucency, lysis, and component migration or subsidence, but this does not appear to adversely affect the intermediate-term clinical outcome. The long-term consequences of such radiographic findings are of concern, and surgeons and patients choosing this procedure need to be cautious.
尽管踝关节融合术仍是治疗致残性踝关节炎的标准手术方法，但它存在潜在的长期问题。全踝关节置换术可保留关节活动度，对于部分患者可能是更合适的选择。本研究的目的是报告使用Agility假体进行全踝关节置换术的中期临床和影像学结果。
我们回顾性分析了连续41例患者（43个踝关节）的全踝关节置换术结果。评估包括术前和术后问卷、体格检查及X线片。
随访时，38例患者（40个踝关节）可供评估。最常见的术前诊断包括创伤后关节炎（40个踝关节中的24个，60%）和类风湿关节炎（40个踝关节中的8个，20%）。手术时的平均年龄为63岁（范围32至85岁）。平均随访时间为44.5个月（范围26至64个月）。术前和术后美国矫形足踝协会（AOFAS）踝-后足评分平均分别为33.6和83.3，差异有统计学意义（p < 0.001）。术后医学结局研究简明健康调查问卷（SF-36）身体成分总结（PCS）和精神成分总结（MCS）评分平均分别为49.5和56.1。虽然40个踝关节中有34个出现影像学透亮区或骨质溶解，但受累程度各不相同。18个踝关节出现假体移位或下沉。总体而言，38例患者中有37例对手术结果满意，在类似情况下愿意接受相同手术。
在中期随访中，大多数患者接受Agility全踝关节置换术可获得良好的临床效果和患者满意度。然而，全踝关节置换术存在潜在并发症，且需要后续手术干预。影像学随访常见假体周围透亮区、骨质溶解以及假体移位或下沉，但这似乎并未对中期临床结果产生不利影响。此类影像学表现的长期后果令人担忧，选择该手术的外科医生和患者需谨慎。
