Aitchison Alexandra Hunter, Anastasio Albert T, Wu Kevin A, Poehlein Emily, Green Cynthia, Adams Samuel B, DeOrio James K, Easley Mark E, Nunley James A
Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Duke University Hospital, Durham, NC, USA.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.
Foot Ankle Orthop. 2025 Apr 18;10(2):24730114251329349. doi: 10.1177/24730114251329349. eCollection 2025 Apr.
Total ankle replacement (TAR) is an established treatment for end-stage ankle arthritis, offering pain relief and improved functionality. The Scandinavian Total Ankle Replacement (STAR) was first used in the United States in 1998 and although unilateral STAR has been extensively studied, there is limited documentation on the outcomes of simultaneous bilateral STAR procedures. This study aimed to evaluate the survivability and patient-reported outcomes of simultaneous bilateral STAR, focusing on implant survival rates and improvements in quality of life, function, and pain relief.
A retrospective cohort study was conducted on all patients managed with primary TAR performed simultaneously with bilateral STAR prostheses at our institution from July 1998 to February 2008. Demographics and perioperative characteristics were collected. Poisson regression was used for analyzing implant survivability, and generalized linear mixed models were applied to assess patient-reported outcomes, including the visual analog scale (VAS), Short Musculoskeletal Function Assessment (SMFA), 36-Item Short Form Health Survey (SF-36), and American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot, at multiple follow-up time points.
Twenty-one patients were included for a total of 42 implants. The average length of follow up was 4.9 ± 2.7 years. The implant failure rate at 5 years was 12.0% (95% CI 4.5%-32.0%). The last recorded failure occurred at 8 years postimplant, with an implant failure rate of 19.2% (95% CI 17.2%-51.1%). Statistically significant improvements were observed in all patient-reported outcome measures from baseline to the 5-year follow-up ( < .05) except SMFA bother because of high variability and small sample size.
At midterm follow-up, patients who underwent bilateral simultaneous TAR with the STAR prosthesis experienced a significant and durable improvement in patient-reported outcome scores across multiple functional indices. Failure rates were within range to those reported in previous studies evaluating unilateral STAR, with an estimated average survivorship of 80.8% at 8 years.
Level IV, case series.
全踝关节置换术（TAR）是终末期踝关节关节炎的既定治疗方法，可缓解疼痛并改善功能。斯堪的纳维亚全踝关节置换术（STAR）于1998年首次在美国使用，尽管单侧STAR已得到广泛研究，但关于同期双侧STAR手术结果的文献报道有限。本研究旨在评估同期双侧STAR的生存率和患者报告的结局，重点关注植入物存活率以及生活质量、功能和疼痛缓解方面的改善情况。
对1998年7月至2008年2月在本机构接受双侧STAR假体同期进行初次TAR治疗的所有患者进行了一项回顾性队列研究。收集了人口统计学和围手术期特征。采用泊松回归分析植入物存活率，并应用广义线性混合模型在多个随访时间点评估患者报告的结局，包括视觉模拟量表（VAS）、简短肌肉骨骼功能评估（SMFA）、36项简短健康调查（SF-36）以及美国矫形足踝协会（AOFAS）后足评分。
纳入21例患者，共植入42枚假体。平均随访时间为4.9±2.7年。5年时的植入物失败率为12.0%（95%CI 4.5%-32.0%）。最后一次记录的失败发生在植入后8年，植入物失败率为19.2%（95%CI 17.2%-51.1%）。从基线到5年随访，除SMFA困扰外，所有患者报告的结局指标均有统计学意义的改善（P<.05），SMFA困扰因变异性高和样本量小而未显示改善。
在中期随访中，接受双侧同期STAR假体TAR的患者在多个功能指标上的患者报告结局评分有显著且持久的改善。失败率在先前评估单侧STAR的研究报告范围内，估计8年时的平均生存率为80.8%。
IV级，病例系列。
