Wrightington Hospital, Wigan, UK.
Locum Consultant Foot and Ankle Surgeon, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK.
Bone Joint J. 2019 Jan;101-B(1):47-54. doi: 10.1302/0301-620X.101B1.BJJ-2018-0801.R1.
We report the long-term clinical and radiological outcomes of a consecutive series of 200 total ankle arthroplasties (TAAs, 184 patients) at a single centre using the Scandinavian Total Ankle Replacement (STAR) implants.
Between November 1993 and February 2000, 200 consecutive STAR prostheses were implanted in 184 patients by a single surgeon. Demographic and clinical data were collected prospectively and the last available status was recorded for further survival analysis. All surviving patients underwent regular clinical and radiological review. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scoring system. The principal endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan-Meier survival curves were generated with 95% confidence intervals and the rate of failure calculated for each year.
A total of 84 patients (87 ankles) were alive by the end of this study. Of the surviving 84 patients (87 ankles; rheumatoid arthritis (RA), n = 40; OA, n = 47), 45 were women and 39 were men, with a mean age of 54 years (18 to 72 years) at the time of surgery. A total of 32 implants failed (16%), requiring revision surgery. The mean time to revision was 80 months (2 to 257). The implant survival at 15.8 years, using revision as an endpoint, was 76.16% (95% confidence interval (CI) 64.41 to 87.91). We found a steady but low decrease in survival over the study period. The mean AOFAS score improved from 28 (10 to 52) preoperatively to 61 (20 to 90) at long-term follow-up.
STAR prostheses in the United Kingdom have now been largely superseded by newer design TAAs, potentially with improved characteristics and surgical techniques. The long-term survivorship for the STAR prosthesis can provide a benchmark for these later designs of ankle arthroplasty.
我们报告了在单一中心使用斯堪的纳维亚全踝关节置换术（STAR）植入物对 200 例全踝关节置换术（TAA，184 例患者）连续系列的长期临床和影像学结果。
1993 年 11 月至 2000 年 2 月，由一位外科医生对 184 例患者连续植入 200 个 STAR 假体。前瞻性收集人口统计学和临床数据，并记录最后可用状态以进行进一步的生存分析。所有存活的患者均接受定期的临床和影像学检查。使用美国矫形足踝协会（AOFAS）后足评分系统评估疼痛和功能。该研究的主要终点是需要对一个或所有组件进行翻修的植入物失效。使用 95%置信区间生成 Kaplan-Meier 生存曲线，并计算每年的失效率。
本研究结束时，共有 84 例患者（87 例踝关节）存活。在存活的 84 例患者（87 例踝关节；类风湿关节炎（RA），n=40；骨关节炎（OA），n=47）中，女性 45 例，男性 39 例，手术时的平均年龄为 54 岁（18 至 72 岁）。共有 32 个植入物失效（16%），需要进行翻修手术。平均翻修时间为 80 个月（2 至 257 个月）。以翻修为终点，15.8 年时的植入物存活率为 76.16%（95%置信区间（CI）64.41 至 87.91）。我们发现研究期间生存率呈稳定但较低的下降趋势。AOFAS 评分从术前的 28 分（10 至 52 分）提高到长期随访时的 61 分（20 至 90 分）。
在英国，STAR 假体已被新一代设计的 TAA 所取代，这些设计可能具有更好的特性和手术技术。STAR 假体的长期存活率可为这些新型踝关节置换术的设计提供基准。
