Total Ankle Arthroplasty in End-Stage Ankle Osteoarthritis: Functional Outcomes, Sports Activity, and Hybrid Revision Techniques

Background. The widespread adoption of total ankle arthroplasty (TAA) for end-stage ankle osteoarthritis (OA) has resulted in an increased frequency of revision procedures. Aseptic loosening remains the most common cause of TAA failure, typically manifesting as isolated loosening of the talar component. In mobile-bearing TAA designs, revision through isolated exchange of the talar component and polyethylene inlay, utilizing a hybrid total ankle arthroplasty (H-TAA) approach, allows for preservation of the stable tibial component and restoration of ankle function. Concurrently, primary mobile-bearing TAA has become an established intervention for end-stage ankle OA, with objectives including pain relief, restoration of ankle motion, and enhancement of patient quality of life. Although return to sports is a critical functional and patient-reported outcome, the literature offers limited information on postoperative sports participation, including activity levels, frequency, and types of sports pursued after TAA. Objectives. The primary objective of this PhD project was to evaluate clinical and radiological outcomes following hybrid TAA revision surgery for isolated aseptic loosening of the talar component in mobile-bearing implants. The secondary objective was to assess clinical and radiological outcomes, as well as sports activity rates, frequency, and types, after primary mobile-bearing TAA in patients with end-stage ankle osteoarthritis. Methods. A prospective case series included nine patients (six women and three men; mean age 59.8 years, range 41–80 years) with symptomatic isolated aseptic loosening of the talar component in a three-component mobile-bearing TAA. All patients underwent revision surgery with isolated talar component and polyethylene inlay exchange using an H-TAA approach. In each case, a VANTAGE TAA talar component and insert were implanted; six patients received a flatcut talar component and three received a standard talar component. Clinical evaluation comprised the Visual Analog Scale (VAS) for pain, ankle dorsiflexion/plantarflexion (DF/PF) range of motion (ROM), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score, Sports Frequency Score (levels 0–4), and Subjective Patient Satisfaction Score. A separate prospective case series involved 103 patients (105 implants; 52 females and 51 males) with end-stage ankle OA who underwent primary TAA using a three-component, uncemented, mobile-bearing VANTAGE Total Ankle System. The mean age at surgery was 60.5 years (range 23–84 years), with a mean follow-up of 2.9 years (range 2–5 years). Clinical assessment included VAS pain score, ankle DF/PF ROM, AOFAS Ankle/Hindfoot Score, Subjective Patient Satisfaction Score, Sports Activity Rate, Sports Frequency Score, and types of sports practiced. Results. In the H-TAA revision cohort, the mean VAS pain score decreased significantly from 6.7 preoperatively to 1.1 postoperatively (p < 0.001). Mean ankle DF/PF ROM increased from 21.7° to 45.6° (p < 0.001), and the mean AOFAS Ankle/Hindfoot Score improved from 47.7 to 92.3 (p < 0.001). None of the patients participated in sports preoperatively; postoperatively, eight patients resumed sports, with a mean Sports Frequency Score of 1.4. The mean postoperative Subjective Patient Satisfaction Score was 9.3. In the primary TAA cohort, the mean VAS pain score improved from 6.7 preoperatively (range 3–10) to 0.2 postoperatively (range 0–3) (p < 0.001). Mean ankle DF/PF ROM increased from 24.9° (range 0–60°) to 52.9° (range 15–85°) (p < 0.001), and the mean AOFAS Ankle/Hindfoot Score improved from 39.5 (range 4–57) to 97.8 (range 75–100) (p < 0.001). The mean postoperative Subjective Patient Satisfaction Score was 9.7 (range 7–10). Sports Activity Rate increased significantly from 31.1% to 85.4% (p < 0.001), with significant improvements in Sports Frequency Score at all activity levels (p < 0.001). The most frequently practiced sports were hiking, cycling, fitness training, and swimming. Conclusions. Hybrid total ankle arthroplasty revision involving talar component and polyethylene inlay exchange is an effective treatment for isolated aseptic loosening of the talar component in mobile-bearing implants. This method offers significant pain relief, enhanced ankle range of motion, functional restoration, and enables return to sports, with high patient satisfaction. Furthermore, primary mobile-bearing TAA provides a notable improvement in clinical and functional outcomes, including a considerable rise in postoperative sports participation.