Total ankle survivorship rates are low, but improvements are underway, surgeon says

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NEW ORLEANS — Although total ankle replacement survivorship rates are considerably lower compared to those of hip and knee replacements, a leading foot and ankle surgeon said that the success rates for total ankles will improve.

Based on a literature review, Charles L. Saltzman, MD, president of the American Orthopeaedic Foot and Ankle Society (AOFAS), said that the 5-year survivorship of total ankle replacements (TAR) is approximately 80%.

“What do we expect from primary total knee and primary total hips at 5 years? Well if you are a primary total knee or hip surgeon and you have got 78% survivorship at 5 years, you are out of business,” Saltzman said at the AOFAS Specialty Day Meeting, here. The Specialty Day presentations were part of the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Saltzman presented a brief history of TARs and commented on the progress made in areas such as bone-implant fixation, bone resection and surgical equipment. He also provided his opinion regarding the future of TAR.

Refined instrumentation

Significant improvements have been made to TAR surgical instrumentation with the help of engineers and industry involvement, Saltzman said.

“Surgical equipment has gotten better, and that is an important point I think, because it reduces variation, and it improves the likelihood of a good outcome,” he said.

Saltzman said that future improvements could include navigation and robotic-controlled surgery.

The big picture

“I think in 2010 and the future, we may see porous metals coming in [TAR],” Saltzman said, and noted the potential of porous metals to solve current problems with fixation and load transfer.

Saltzman said that the question of optimal bone resection is still up in the air, but that there is a trend toward respecting the natural architecture of bone.

“In 2010, we have got better fixation, more focused joint surface replacement, improving approaches tobone resection, better prosthetic articular geometry and more sophisticated surgical equipment,” he said. “I believe the future is bright for total ankles.”

  • Reference:

Saltzman CL. The big picture: total ankle replacement in 2010. Presented at the American Orthopaedic Foot and Ankle Society Specialty Day Meeting, part of the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 13. New Orleans.

Saltzman is a board member/owner/officer/committee appointments of American Orthopaedic Foot and Ankle Society and the Association of Bone and Joint Surgeons; he receives royalties from Nexa Orthopaedics; he is a paid consultant of paid employee of Link Orthopaeidcs, Nexa Orthopaedics and Zimmer; He has received research or institutional support from Biomet, DePuy, A Johnson & Johnson Company, and Zimmer; he has stock or stock options with Tornier; and he has received financial/material support from Saunders/Mosby-Elsevier.

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