PROMS Behaviour and Survivorship of Total Ankle Replacement Revisions

Carlos Albarran, Marianne Koolen, Sultan Alharbi, Tudor Trache, Andrea Veljkovic, Alastair Younger, Murray Penner, Kevin Wing

Introduction: Rising numbers of primary total ankle replacements (TARs) inevitably lead to more revisions, yet the evolution of patient-reported outcome measures (PROMs) and implant longevity after TAR-to-TAR exchange is poorly defined.

Method: All metallic-component revisions registered prospectively between 2003 and 2023 were reviewed; amputations and arthrodesis were excluded. Demographics and PROMs—SF-36 Physical (SF-36PC), SF-36 Mental (SF-36MC) and Ankle Osteoarthritis Scale (AOS)—were compared with unrevised TARs using non-parametric statistics. PROM trajectories were assessed at baseline, immediately before revision, and 1–2 years post-revision. Survivorship was calculated with Kaplan–Meier analysis.

Results: Among 631 primary TARs, 48 revisions (7.6 %) occurred and 43 received a TAR-to-TAR exchange. Revised patients were younger than unrevised counterparts (61.6 ± 8.2 vs 65.2 ± 9.8 years; p < 0.01). At baseline they showed higher SF-36PC (66.4) and SF-36MC (46.7) but worse AOS (78.5) than unrevised cases (all p < 0.01). Between baseline and pre-revision, SF-36 scores declined while AOS improved. Two years after revision, AOS had improved further to 35.9 but remained inferior to unrevised TARs (16.1; p < 0.01); SF-36PC and SF-36MC were 32.1 and 50.1, still below pre-revision values. Ten-year survivorship of revised implants was 58.9 %, and 51.1 % required a second revision by year 13.

Conclusion: TAR-to-TAR revision reliably relieves pain and improves function, yet physical and mental health scores do not return to the levels achieved by well-functioning primary implants, and durability is modest. Functional recovery remains suboptimal, and patients continue to experience limitations even after revision.