Foot & Ankle International - September 2019 - 1037

851469
research-article2019

FAIXXX10.1177/1071100719851469Foot & Ankle InternationalYano et al

Article

Radiographic Outcomes of
Mobile-Bearing Total Ankle
Arthroplasty for Patients With
Rheumatoid Arthritis

Foot & Ankle International®
2019, Vol. 40(9) 1037--1042
© The Author(s) 2019
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https://doi.org/10.1177/1071100719851469
DOI: 10.1177/1071100719851469
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Koichiro Yano, MD, PhD1 , Katsunori Ikari, MD, PhD1, and Ken Okazaki, MD, PhD1

Abstract
Background: Ankle disorders in patients with rheumatoid arthritis (RA) reduce their quality of life and activities of daily
living. The aim of this study was to evaluate the midterm clinical and radiographic outcomes of TAA in patients with RA.
Methods: This retrospective study included patients with a minimum follow-up of 2 years. A total of 37 RA patients (39
ankles) were enrolled in this study from August 2006 to March 2016. All the patients had undergone primary cemented
mobile-bearing total ankle arthroplasty (TAA). Nine ankles received arthrodesis of the subtalar joint simultaneously.
Patient-reported outcomes were measured preoperatively and at the latest follow-up by Self-Administered FootEvaluation Questionnaire (SAFE-Q). Radiographs of the ankle were analyzed preoperatively and at all follow-up visits to
measure the periprosthetic radiolucent line, migration of the tibial component, and the subsidence of the talar component.
Intraoperative and postoperative complications were recorded. The average duration of follow-up for the entire cohort
was 5.0 ± 2.0 years (range 2.1-10.1 years).
Results: All subscales of the SAFE-Q had improved significantly at the latest follow-up. No significant difference was
found between the range of motion of the ankle before and after the surgery. Radiolucent lines were observed in 28
(73.7%) ankles. Migration of the tibial component and subsidence of the talar component were found in 8 (21.1%) and 11
(28.9%) ankles, respectively. Intraoperative malleolus fractures occurred in 3 (7.7%) ankles and delayed wound healing in
10 (25.6%) ankles. Four ankles were removed because of deep infection or noninfective loosening, resulting in an implant
survival rate of 88.4% (95% CI, 0.76-1.0) at 10 years.
Conclusion: The midterm patient-reported outcomes and implant retention rate after cemented mobile-bearing TAA for
RA patients were satisfactory. However, a low radiographic implant success rate was observed.
Level of Evidence: Level IV, retrospective case series.
Keywords: FINE, mobile-bearing, rheumatoid arthritis, total ankle arthroplasty, total ankle replacement

Introduction
Rheumatoid arthritis (RA) is a systemic and inflammatory
autoimmune disease that can destroy many joints. Joint
problems in patients with RA cause a decline in the quality
of life and activities of daily living. The ankle joints are
involved in 30% to 60% of RA patients.24 Although the
28-joint evaluation of disease activities for RA does not
include ankle joints, Naniwa et al reported that the presence
of ankle joint involvement in patients with a swollen joint
count ≤1 and tender joint count ≤1 in 28 joints appeared to
be related to a worse global assessment of current disease
activity by the patient.12,22

Tibiotalar arthrodesis has been the standard treatment for
decades when conservative treatment for ankle disorders
fails.11 However, arthrodesis has several disadvantages,
including loss of range of motion, delayed union/nonunion,
and additional stress on the adjacent midfoot and subtalar
1

Department of Orthopedic Surgery, Tokyo Women's Medical
University, Shinjuku, Tokyo, Japan
Corresponding Authors:
Koichiro Yano, MD, PhD, and Katsunori Ikari, MD, PhD, Department of
Orthopedic Surgery, Tokyo Women's Medical University, 8-1, Kawada,
Shinjuku, Tokyo 162-8666, Japan.
Email: yano.koichiro@twmu.ac.jp and kikari@twmu.ac.jp

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