Department of Orthopaedic Surgery, Tongji Hospital of Tongji University, Foot and Ankle Center of Tongji University, Shanghai, China.
Int Orthop. 2011 Dec;35(12):1751-8. doi: 10.1007/s00264-011-1339-y. Epub 2011 Sep 1.
The purpose of this study was to provide cumulative data about the intermediate to long-term outcome of Scandinavian total ankle replacement (STAR) in the literature and to provide a summary of survival rate, implant failure rate and reasons.
A comprehensive search for all relevant articles published in English and German from January 1995 to May 2011 was conducted. Two reviewers evaluated each study to determine whether it was eligible for inclusion and, if so, collected data of interest. The intermediate to long-term outcomes were determined. Evidence-based meta-analytic pooling of results across studies was performed to determine survival and failure rates.
Sixteen primary studies with 2,088 implants were identified. The mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 77.8 points, and the mean Kofoed ankle score was 76.4 points. The pooled mean five year survival rate was 85.9% [95% confidence interval (CI) 80.9-90.3], and the pooled mean ten year survival rate was 71.1% (95% CI 60.9-81.5). Pooled failure rate was 11.1% (95% CI 7.6 -14.9), with a mean follow-up time of 52 months; 41% failed within one year of initial operation. The first three reasons associated with implant failure were aseptic loosening (5.2%), malalignment (1.7%) and deep infection (1.0%).
We found that STAR prosthesis achieved encouraging results in terms of intermediate to long-term outcome. The five and ten year survival rates were acceptable. However, the failure rate was still high. The major reasons for implant failure were aseptic loosening and malalignment. Maybe the increase of surgeons' experience and patient selection could improve outcomes and decrease failure rate.
本研究旨在提供斯堪的纳维亚全踝关节置换术（STAR）文献中关于中期至长期结果的累积数据，并总结存活率、植入物失败率及其原因。
对 1995 年 1 月至 2011 年 5 月期间发表的所有英文和德文相关文章进行了全面检索。两名评审员评估了每一项研究，以确定其是否符合纳入标准，如果符合，收集相关数据。确定了中期至长期结果。对研究结果进行了基于证据的荟萃分析汇总，以确定存活率和失败率。
确定了 16 项包含 2088 例植入物的主要研究。平均美国矫形足踝协会（AOFAS）评分为 77.8 分，Kofoed 踝关节评分为 76.4 分。汇总的 5 年平均存活率为 85.9%（95%可信区间[CI] 80.9-90.3），10 年平均存活率为 71.1%（95% CI 60.9-81.5）。汇总的失败率为 11.1%（95% CI 7.6-14.9），平均随访时间为 52 个月；41%的患者在初次手术后一年内失败。与植入物失败相关的前三个原因是无菌性松动（5.2%）、对线不良（1.7%）和深部感染（1.0%）。
我们发现 STAR 假体在中期至长期结果方面取得了令人鼓舞的结果。5 年和 10 年的存活率是可以接受的。然而，失败率仍然很高。植入物失败的主要原因是无菌性松动和对线不良。也许增加外科医生的经验和患者选择可以改善结果并降低失败率。
