Mobile- vs. Fixed-Bearing Total Ankle Prostheses
Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is a well-accepted treatment option in patients with end-stage ankle osteoarthritis. In general, TAR designs can be classified based on their number of components: 2-components (fixed-bearing) vs. 3- components (mob...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2017-09-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011417S000108 |
| _version_ | 1818054627425255424 |
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| author | Alexej Barg MD Phinit Phisitkul MD Charles Saltzman MD |
| author_facet | Alexej Barg MD Phinit Phisitkul MD Charles Saltzman MD |
| author_sort | Alexej Barg MD |
| collection | DOAJ |
| description | Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is a well-accepted treatment option in patients with end-stage ankle osteoarthritis. In general, TAR designs can be classified based on their number of components: 2-components (fixed-bearing) vs. 3- components (mobile-bearing). In the U.S. the STAR prosthesis is the only one mobile-bearing TAR with FDA approval. It remains unclear whether 3-component TAR designs have superior clinical outcomes including prosthesis survivorship. Therefore we performed a systematic review and meta-analysis of the available TAR designs to determine prosthesis survivorship and whether there is a statistically significant difference between mobile- and fixed-bearing TAR designs. Methods: We reviewed literature using common data bases. All searches were unlimited. For the search we used the subject heading terms: “ankle”, “replacement”, “arthroplasty”, and “prosthesis”. For meta-analysis a checklist was used as described by Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group. The quality of included studies was assessed using Coleman’s Methodology Score. The following parameters were reviewed: type of study, inventor bias, number of patients/ankles, mean age with range, gender, etiology of underlying ankle osteoarthritis, average and maximum follow-up, number of TAR failures, and total exposure time. For each study, failure rate was estimated as the number of failures/total exposure years. N-year (here, 5 or 10 years) failure rate was calculated as 1-exp(-N*failure rate). The pooled estimate of failure rate was a weighted average across studies using the inverse variance weighting method. The test for heterogeneity was not significant so fixed effects models were used. Results: In total, 32 studies with 3968 ankles were included into the analysis. Nine studies included 844 fixed-bearing TARs and 23 studies included 3124 mobile-bearing TARs. Patient characteristics were comparable in both study groups. For fixed-bearing TAR, the 5-year and 10-year failure rate was 0.077 and 0.149 with an average annual failure rate of 0.016 (95%CI 0.008-0.025). For mobile-bearing TAR, the 5-year and 10-year failure rate was 0.074 and 0.142with an annual failure rate of 0.015 (95%CI 0.011- 0.020). Two studies with fixed-bearing TAR and six studies with mobile-bearing TAR had inventor bias. The average annual failure rate was comparable in both groups (P = 0.88), with and without inventor bias, 0.013 vs. 0.018 (P = 0.87). Conclusion: We have shown that TAR has an overall failure rate of 0.149 and 0.142 at 10 years in patients with fixed-bearing and mobile-bearing TAR design, respectively. No superiority of one implant design over another can be supported by the available data. |
| first_indexed | 2024-12-10T12:00:03Z |
| format | Article |
| id | doaj.art-adc27cb1edeb4a2682f69225b70c5c2a |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-12-10T12:00:03Z |
| publishDate | 2017-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-adc27cb1edeb4a2682f69225b70c5c2a2022-12-22T01:49:40ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142017-09-01210.1177/2473011417S000108Mobile- vs. Fixed-Bearing Total Ankle ProsthesesAlexej Barg MDPhinit Phisitkul MDCharles Saltzman MDCategory: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is a well-accepted treatment option in patients with end-stage ankle osteoarthritis. In general, TAR designs can be classified based on their number of components: 2-components (fixed-bearing) vs. 3- components (mobile-bearing). In the U.S. the STAR prosthesis is the only one mobile-bearing TAR with FDA approval. It remains unclear whether 3-component TAR designs have superior clinical outcomes including prosthesis survivorship. Therefore we performed a systematic review and meta-analysis of the available TAR designs to determine prosthesis survivorship and whether there is a statistically significant difference between mobile- and fixed-bearing TAR designs. Methods: We reviewed literature using common data bases. All searches were unlimited. For the search we used the subject heading terms: “ankle”, “replacement”, “arthroplasty”, and “prosthesis”. For meta-analysis a checklist was used as described by Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group. The quality of included studies was assessed using Coleman’s Methodology Score. The following parameters were reviewed: type of study, inventor bias, number of patients/ankles, mean age with range, gender, etiology of underlying ankle osteoarthritis, average and maximum follow-up, number of TAR failures, and total exposure time. For each study, failure rate was estimated as the number of failures/total exposure years. N-year (here, 5 or 10 years) failure rate was calculated as 1-exp(-N*failure rate). The pooled estimate of failure rate was a weighted average across studies using the inverse variance weighting method. The test for heterogeneity was not significant so fixed effects models were used. Results: In total, 32 studies with 3968 ankles were included into the analysis. Nine studies included 844 fixed-bearing TARs and 23 studies included 3124 mobile-bearing TARs. Patient characteristics were comparable in both study groups. For fixed-bearing TAR, the 5-year and 10-year failure rate was 0.077 and 0.149 with an average annual failure rate of 0.016 (95%CI 0.008-0.025). For mobile-bearing TAR, the 5-year and 10-year failure rate was 0.074 and 0.142with an annual failure rate of 0.015 (95%CI 0.011- 0.020). Two studies with fixed-bearing TAR and six studies with mobile-bearing TAR had inventor bias. The average annual failure rate was comparable in both groups (P = 0.88), with and without inventor bias, 0.013 vs. 0.018 (P = 0.87). Conclusion: We have shown that TAR has an overall failure rate of 0.149 and 0.142 at 10 years in patients with fixed-bearing and mobile-bearing TAR design, respectively. No superiority of one implant design over another can be supported by the available data.https://doi.org/10.1177/2473011417S000108 |
| spellingShingle | Alexej Barg MD Phinit Phisitkul MD Charles Saltzman MD Mobile- vs. Fixed-Bearing Total Ankle Prostheses Foot & Ankle Orthopaedics |
| title | Mobile- vs. Fixed-Bearing Total Ankle Prostheses |
| title_full | Mobile- vs. Fixed-Bearing Total Ankle Prostheses |
| title_fullStr | Mobile- vs. Fixed-Bearing Total Ankle Prostheses |
| title_full_unstemmed | Mobile- vs. Fixed-Bearing Total Ankle Prostheses |
| title_short | Mobile- vs. Fixed-Bearing Total Ankle Prostheses |
| title_sort | mobile vs fixed bearing total ankle prostheses |
| url | https://doi.org/10.1177/2473011417S000108 |
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