title: Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register.
abstract: OBJECTIVE
  Although total ankle replacement (TAR) is a recognized procedure for treatment of the painful arthritic ankle, the best choice of implant and the long-term results are still unknown. We evaluated the survival of two TAR designs and factors associated with survival using data from the nationwide arthroplasty registry in Finland.
  
  
  METHODS
  573 primary TARs were performed during the period 1982-2006 because of rheumatic, arthritic, or posttraumatic ankle degeneration. We selected contemporary TAR designs that were each used in more than 40 operations, including the S.T.A.R. (n = 217) and AES (n = 298), to assess their respective survival rates. The mean age of the patients was 55 (17-86) years and 63% of operations were performed in women. Kaplan-Meier analysis and the Cox regression model were used for survival analysis. The effects of age, sex, diagnosis, and hospital volume were also studied.
  
  
  RESULTS
  The annual incidence of TAR was 1.5 per 10(5) inhabitants. The 5-year overall survivorship for the whole TAR cohort was 83% (95% CI: 81-86), which agrees with earlier reports. The most frequent reasons for revision were aseptic loosening of one or both of the prosthesis components (39%) and instability (39%). We found no difference in survival rate between the S.T.A.R. and AES designs. Furthermore, age, sex, diagnosis, and hospital volume (< 10 and > 100 replacements in each of 17 hospitals) did not affect the TAR survival.
  
  
  CONCLUSIONS
  Based on our findings, we cannot conclude that any prosthesis was superior to any other. A high number of technical errors in primary TARs suggests that this low-volume field of implant arthroplasty should be centralized to fewer units.
authors.affiliation: COXA Hospital for Joint Replacement, Tampere, Finland. eerik.skytta@fimnet.fi
authors.forename: Eerik T
authors.initials: ET
authors.lastname: Skyttä
authors.forename: Helka
authors.initials: H
authors.lastname: Koivu
authors.forename: Antti
authors.initials: A
authors.lastname: Eskelinen
authors.forename: Mikko
authors.initials: M
authors.lastname: Ikävalko
authors.forename: Pekka
authors.initials: P
authors.lastname: Paavolainen
authors.forename: Ville
authors.initials: V
authors.lastname: Remes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000473:pathology / Q000601:surgery; D000843:Ankle Joint / Q000473:pathology / Q000601:surgery*; D001172:Arthritis, Rheumatoid / Q000601:surgery; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods; D005260:Female; D005387:Finland; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation; D016896:Treatment Outcome; D055815:Young Adult