Total ankle arthroplasty: A radiographic outcome study

OBJECTIVE. Total ankle arthroplasty (TAA) is becoming a popular alternative to arthrodesis for patients with end-stage ankle arthrosis. Prior outcome studies have primarily focused on surgical findings. Our purpose is to determine the radiographic outcome of TAA and to correlate it with clinical outcome. MATERIALS AND METHODS. In a 9-year retrospective review of patients with TAA, all available ankle radiographs and clinical data were reviewed. Data analysis included descriptive statistics, Fisher exact test, and Kaplan-Meier survival curves for radiographic and clinical survival. RESULTS. Two hundred sixty-two TAAs in 260 patients were reviewed; 55% were in women, and the mean patient age was 61.5 years. The mean radiographic follow-up was 142 weeks, with an average of six radiographs per patient. One hundred sixty-three patients (62.2% of TAAs) developed one or more radiographic complications, including periprosthetic lucency (34.0%), hardware subsidence (24.4%), perihardware fracture (11.1%), syndesmotic screw loosening (10.3%), and screw fracture (6.5%). One hundred nineteen patients (45.4% of TAAs) developed symptoms of ankle pain or instability, and 71 patients (27.1% of TAAs) underwent at least one reoperation. In patients with radiographic complications, 41.7% developed ankle pain and 5.1% developed ankle instability, compared with 23.7% and 2.2%, respectively, of patients with no radiologic complications (p < 0.05). Of the patients with radiographic complications, 33.1% had at least one additional surgery compared with 17.1% of patients without radiographic complications (p < 0.05). CONCLUSION. Radiographic complications are common in patients after total ankle arthroplasty. There is a strong positive association between postoperative radiographic findings and clinical outcome. Knowledge of common postoperative radiographic findings is important for the practicing radiologist.