Comparing Mid- to Long-Term Outcomes of Stemmed and Non-Stemmed Total Ankle Replacements: A Minimum 5-Year Follow-Up

Research Type: Level 5 - Case report, Expert opinion, Personal observation Introduction/Purpose: Total ankle replacements (TAR) are increasingly recognized as a viable alternative to ankle arthrodesis for the treatment of end-stage ankle arthritis, with recent advancements in implant technology contributing to improved clinical outcomes. Despite these developments, there remains a paucity of comprehensive data comparing mid- to long-term outcomes between TARs with tibial stemmed components and those with non-stemmed components. This study aims to address this gap by systematically evaluating and comparing the outcomes reported in multiple studies, each with a minimum follow-up period of five years. Methods: A comprehensive multi-database search was performed to identify studies on primary total ankle replacement (TAR) with a minimum follow-up of five years. Data collected included American Orthopaedic Foot and Ankle Society (AOFAS) scores, Visual Analog Scale (VAS) scores, Item Short Form Health Survey (SF-36) scores, and range of motion (ROM). These outcome measures were chosen to assess functional improvement, pain reduction, quality of life, and joint mobility in patients following primary TAR. Results: We included 82 studies in the analysis: 35 focused on stemmed implants (4,270 ankles) and 47 on non-stemmed implants (7,676 ankles). The average follow-up was 83.3 months for stemmed implants and 96.5 months for non-stemmed implants. The mean age of patients was 62.3 years for stemmed implants and 69 years for non-stemmed implants. Stemmed implants had a slightly higher survivorship rate of 86.5% compared to 82.74% for non-stemmed implants. The average time to revision was 60.4 months for stemmed implants and 43.9 months for non-stemmed implants. Revisions occurred in 447 cases with stemmed implants and 812 with non-stemmed implants, with implant loosening being the most frequent cause. Both groups showed similar improvements in AOFAS, SF-36, and VAS scores, along with increases in range of motion. Conclusion: Both stemmed and non-stemmed total ankle replacement (TAR) implants showed favorable mid- to long-term outcomes. Stemmed implants were associated with a longer time to revision, indicating potentially superior survivorship compared to non-stemmed implants. This suggests that stemmed implants may offer advantages in longevity and durability, which could influence future implant selection and design decisions. Further research is needed to evaluate the long-term effectiveness of both implant types. Additionally, refining patient selection criteria could improve the generalizability of these findings and assist in clinical decision-making for managing end-stage ankle arthritis.