Outcomes of Stemmed Total Ankle Replacement for Ankle Osteoarthritis: A Minimum 5-Year Follow-Up Evaluation

Research Type: Level 5 - Case report, Expert opinion, Personal observation Introduction/Purpose: Total ankle replacements (TAR) are increasingly recognized as an effective alternative to ankle arthrodesis for the management of end-stage ankle arthritis, offering benefits such as enhanced joint mobility and reduced pain. Despite their growing clinical adoption, comprehensive data on the mid- to long-term outcomes of stemmed TAR implants remain sparse. This study aims to address this gap by systematically evaluating the effectiveness and durability of stemmed ankle implants with a minimum follow-up of five years, thereby providing valuable insights into their long-term performance and reliability. Methods: A comprehensive search was conducted across MEDLINE, EMBASE, and the Cochrane Library databases, following PRISMA guidelines. The studies included in this review focused on patients who underwent primary total ankle replacement (TAR) with stemmed implants and reported outcomes with a minimum mean follow-up of five years. The data collected included AOFAS scores, VAS scores, FAOS, and range of motion (ROM) at the final follow-up. Results: The review encompassed 28 studies involving a total of 2,523 ankles treated with a stemmed total ankle replacement. The average patient age was 61.6 years, with a mean follow-up duration of 7.3 years. The Salto-Talaris implant was the most frequently utilized (43%), followed by the Buechel-Pappas implant (18%). AOFAS scores improved from 37.31 preoperatively to 75.52 postoperatively, while VAS scores decreased from 7.83 to 2.18. FAOS scores increased from 33.09 to 71.41, and ankle range of motion improved by 2.5 degrees. Implant survival rates were 90.1% at 5-7.5 years and 80.56% at 7.5-10 years. Complications occurred in 12% of cases, with loosening and fractures being the most prevalent. Conclusion: This review highlights that stemmed total ankle replacements result in favorable clinical outcomes during mid- to long-term follow-up. Notable improvements were seen in functional scores and range of motion (ROM), although the complication rate was moderate at 12%. The survivorship of stemmed implants was comparable to that of non-stemmed implants. Overall, stemmed total ankle replacements are a reliable option for managing end-stage ankle arthritis, delivering effective long-term results and providing valuable insights for clinical practice.