In this prospective study, the novel transfibular total ankle arthroplasty system is found to be safe and effective at early to midterm follow-up. The 2-year results were equivalent or superior to other ankle implants placed via an anterior technique. The clinical scores and range of motion all portrayed meaningful improvement with this approach to total ankle arthroplasty.  

Ankle arthritis is a highly limiting pathology causing pain and functional limitation with subsequent deterioration of the quality of life. With the recent advances in surgical instrumentation and methods, prosthetic replacement of the ankle has proven to be a valid replacement to arthrodesis with comparable outcomes. The purpose of this study was to investigate the clinical and radiological findings in a transfibular total ankle replacement with at least 2 years follow-up. 

This prospective study comprised of 89 patients who underwent transfibular total ankle arthroplasty from May 2013- February 2016, with the mean age of 53.2 ± 13.5 years. All the patients were followed for at least 24 months postoperatively with an average follow-up of 42.0 ± 23.5 months. Patients were examined clinically and radiographically preoperatively and at 6, 12, and 24 months postoperatively. 

At 24 months postoperatively, patients revealed statistically significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score from 33.8 ± 14.3 to 88.5 ± 6.6 and VAS from 80.5 ± 17.0 to 14.1 ± 9.2. The Short Form-12 Physical and Mental Composite Scores varied from 29.9 ± 6.7 and 43.3 ± 8.6 to 47.0 ± 7.6 and 53.3 ± 8.1, respectively. Also, ankle dorsiflexion and plantarflexion ameliorated from 6.2 ± 5.5 and 9.6 ± 5.8 degrees to 24.2 ± 7.9 and 18.1 ± 7.6 degrees. Radiographically, the patients maintained a neutral alignment of the ankle at 24 months. No patient had any radiographic evidence of tibial or talar lucency at the final follow-up. All in all, 7 patients underwent reoperation for removal of symptomatic hardware (6 fibular plates, 1 syndesmotic screw); 2 patients had delayed wound healing. One of them was treated with plate removal and flap coverage and the other needed fibular plate removal. A postoperative prosthetic infection developed in one patient requiring operative debridement, removal of implants, and placement of an antibiotic spacer.

This study proved that transfibular total ankle replacement was a safe and effective option for patients who had ankle arthritis resulting in improvements in patient-reported outcomes, range of motion, and radiographic parameters. Future studies are needed to determine the mid- and long-term performance of these implants.