What are the risks for early failure of total ankle replacement? Is there a valid classification?

R.J. Gadd, T.W. Barwick, E. Paling, M.B. Davies, C.M. Blundell

Introduction: Prompted by the success of hip and knee arthroplasty, total ankle replacement (TAR) has become increasingly popular as a treatment for end stage arthritic complaints of the ankle. Glazebrook et al proposed a three grade classification of complications to assist prediction of early implant failure. We have compared the experience of a tertiary referral centre in the UK to Glazebrook’s proposed system.

Method: A retrospective review of the Sheffield Foot and Ankle Unit TAR database was performed from 1995 to 2010. All complications were recorded and categorised using Glazebrook’s proposed system. Glazebrook described eight main complications of increasing severity. Low grade complications; Post operative bone fracture, Intra-operative bone fracture and wound healing problems were very unlikely to lead to revision. Medium grade complications; technical error and subsidence, lead to failure < 50% of the time. High grade complications; deep infection, aseptic loosening and implant failure lead to revision >50% of the time.

Results: 217 TAR were implanted in 198 patients with a minimum follow up of 30 months. The complication rate was 23% with a revision rate of 17%. All complications recorded in our study except intraoperative bone fracture and wound healing had a failure rate of at least 50%.

Conclusion: The proposed classification system of Glazebrook et al was the first step towards an international system of classifying TAR complications. Most complications associated with TA R have a significant impact on the lifespan of a TAR. Glazebrook et al’s proposed three tier system did not reliably reflect our experience. We would categorise complications as either high or low risk for early failure of TAR.