Survivorship and clinical evaluation of cementless, meniscal-bearing total ankle replacements.
A porous-coated, cementless, congruent-contact, meniscal-bearing total ankle replacement with a centrally placed trochlear groove and a cylindrical articulating axis representing the lateral talar curvature was developed and used clinically over a 10-year period.  An initial clinical series of 40 ankle replacements involved the use of cobalt-chromium-molybdenum tibial and talar components with sintered-bead porous coating of 275-mum pore size and a shallow-sulcus trochlear groove with a central fixation fin for the talar onlay component.  The congruent meniscal bearing, made of ultrahigh molecular-weight polyethylene (UHMWPe), was flat superiorly and matched the shallow-sulcus and cylindrical geometry inferiorly. Two bearings in two patients subluxed laterally and required revision within 2 years.  The overall cumulative survival at the 10-year interval for this group using revision as an end point was 94.75%.  The clinical results, using a strict ankle evaluation scoring scale, demonstrated 85% overall good to excellent results.  Three patients required further treatment for intermalleolar exostoses, one patient required a debridement for infection, two ankles had medially subluxed bearings, eight ankles developed talar component subsidence, and two patients suffered from chronic reflex-sympathetic dystrophy. A second clinical series of 14 ankle replacements involved the use of polished titanium-nitride-coated titanium-6 aluminum-4 vanadium tibial and talar components with sintered-bead porous coating of 350-mum pore size and a deep-sulcus trochlear groove with two lateral fixation fins for the talar onlay component.  The bearing element was similar to the initial series except that it had a deeper engagement in the trochlear groove to prevent subluxation.(ABSTRACT TRUNCATED AT 250 WORDS)
University of Medicine and Dentistry of New Jersey.
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Buechel
M J
MJ
Pappas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000601:surgery; D000843:Ankle Joint / Q000601:surgery*; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000601:surgery; D001696:Biomechanical Phenomena; D005069:Evaluation Studies as Topic; D006801:Humans; D007595:Joint Prosthesis / Q000295:instrumentation*; D008875:Middle Aged; D010003:Osteoarthritis / Q000453:epidemiology / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013314:Stress, Mechanical; D016019:Survival Analysis