Bone Quality & Total Ankle Arthroplasty (TAA)​

A core principle in major joint arthroplasty is achieving immediate and stable fixation of the implant. This principle also applies to the tibial fixation in total ankle arthroplasty, but it is challenged by the relatively poor bone quality in the distal tibia.

Implant choice may reduce odds of total ankle replacement (TAR) failure

In their study published in JBJS this spring, Henry et al. reviewed 731 patients who underwent TAR, focusing on the revision of the tibial component as the primary outcome. They concluded that hindfoot arthrodesis is associated with 2.7 times greater risk of failure. However, the study also revealed that more extensive tibial fixation lowered the odds of failure by 95%.

Pegs, posts, and stems

In TAR, the choices for tibial fixation include: 

• Pegs: fixed-length devices less than 1 cm long, impacted into metaphyseal bone

• Posts: also fixed-length devices, but are 3 cm long or less and similarly impacted into the metaphyseal bone

• Stems: modular devices that extend from the metaphysis into the diaphysis and are 3 cm or longer 

Enhanced tibial bone fixation options are particularly beneficial for patients with poor tibial bone quality or those who have undergone hindfoot arthrodesis.