Outcomes of Non-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 replacement (TAR) is a viable treatment option for patients with ankle osteoarthritis. The debate continues regarding the effectiveness of stemmed versus non-stemmed designs in terms of stability, functionality, and long-term outcomes, with existing literature presenting conflicting results. This systematic review aims to evaluate the mid- and long-term clinical outcomes of non-stemmed TAR and assess the level of evidence (LOE) supporting these findings. Methods: A systematic review was conducted to evaluate the outcomes of non-stemmed total ankle replacement (TAR) for ankle osteoarthritis. Searches were performed across three databases (MEDLINE, EMBASE, and the Cochrane Library) following PRISMA guidelines. Data extracted included patient demographics, follow-up periods, subjective clinical scores, ankle range of motion (ROM), implant survival, and complications. The level of evidence (LOE) for each study was assessed to support the overall evaluation. Results: Forty studies involving 6,227 patients and 6,684 ankles treated with non-stemmed total ankle replacement (TAR) were included. The majority of studies were classified as Level III (21) or Level IV (11) evidence, reflecting moderate to low quality. The average patient age was 59.7 years, with a mean follow-up period of 8.3 years. The STAR and HINTEGRA implants were the most frequently used, accounting for 40% and 37.5% of cases, respectively. Significant improvements in ankle function were noted, with AOFAS scores rising from 42.45 preoperatively to 82.42 postoperatively. Ankle range of motion (ROM) increased by an average of 8.0 degrees. Implant survival rates were 89% at 5-7.5 years and 79% at 7.5-10 years. Complications occurred in 5% of cases, primarily involving loosening and fractures. Conclusion: This review highlights positive mid- to long-term outcomes for non-stemmed total ankle replacement, with survival rates comparable to those of stemmed implants. Despite the variability in evidence quality, non-stemmed implants offer notable advantages, including reduced bone loss and simpler revision surgeries, enhancing their reliability as a primary TAR option. The findings emphasize the effectiveness of non-stemmed TAR and provide valuable insights for patient management and treatment planning, highlighting its potential benefits in clinical practice.