Total ankle arthroplasty in France

Summary Objectives After more than 10 years’ experience in France, the French Foot Surgery Association ( Association francaise de chirurgie du pied [AFCP]) presents an update on mobile-bearing ankle prostheses, based on a multicenter study. Meta-analysis – Biomechanics – Assessment and indications A preliminary comparative meta-analysis of the literature studies on ankle and prosthesis biomechanics, reviews validated indications and contra-indications, and details clinical and radiological outcomes assessment protocols. Professional survey Sixty-three surgeons (95% AFCP members) answered a professional online survey, by email or regular post: 70% performed total ankle replacement (TAR), 39% of them at least two per year and 16% more than 10 per year, resulting in 317 TARs per year or 50% of the French activity and 312 arthrodeses per year or 17% of the French activity – which gave the survey considerable power. In 2004–2005, 46% of the TARs implanted were AES ® , 38% Salto ® and 9% Hintegra ® . Gait analysis following TAR This study included two series of patients (15 in Brussels and six in Paris) with laboratory gait analysis preoperatively and at 6 months’ and 1 year's FU. Following TAR, speed, cadence and strides increased and mean total work approximated normal values. These two independent studies quantified the advantages of TAR over arthrodesis. Multicenter study This retrospective study had a minimum follow-up of 1 year. Results were not distinguished between the four types of prosthesis (approved by the French Healthcare Agency [HAS]) involved. Inclusion criteria for operators were: AFCP membership, and experience of more than 20 prostheses of a given type. Twelve out of 15 centers responded and undertook to include continuous series. Data were centralized on a dedicated anonymous online site. Five hundred and ninety-two TARs (388 Salto ® , 173 AES ® , 22 Hintegra ® , nine Star ® ) in 555 patients (mean age, 56.4 years; range 17–84 yrs) were included. Indications were post-traumatic arthritis (48%), arthritis associated with laxity (15%), inflammatory arthropathy (20%), primitive arthritis (9%), prosthetic revision (2%), and miscellaneous (5%). Sixty-one percent of operations included associated procedures: 208 Achilles lengthenings, 45 subtalar arthrodeses, nine calcaneal osteotomies and 45 lateral ligament reconstructions. Complications comprised 53 malleolar fractures, and 39 cutaneous and seven infections (9%). At a mean 37 months’ FU, 87.5% of patients were satisfied or very satisfied; mean functional score was 82.1/100; radiographic mobility, 23.2°; and total SF 36 score (on the Short Form Health Survey), 66. X-ray found stable anchorage in 98% of cases, cysts in 15%, and calcification in 4%. Revision for failure Overall cumulated survivorship was 88% at 71 months: 22 patients underwent arthrodesis (61% satisfied), and 10 implant replacement (50% satisfied). Conclusion This multioperator, multi-implant series of 592 patients confirmed literature data. Prospective follow-up of the cohorts managed in these expert centers is essential, in order to make available long-term data.