The Scandinavian Total Ankle Replacement

The prosthesis discussed in this study was never made available in the U.S., and the manufacturer discontinued the use of this particular implant in favor of the titanium-spray design. This is discussed in an exchange between two of the authors and a reader in letters published as a data supplement attached to this article.

Background: The objective of this study was to determine the long-term survivorship and clinical and radiographic results of the Scandinavian Total Ankle Replacement (STAR).

Methods: From February 1996 to March 2000, seventy-seven ankles in seventy-two patients (thirty-seven female and thirty-five male patients, with an average age of fifty-six years) underwent total ankle replacement using the STAR prosthesis with a single coating of hydroxyapatite. Two patients were lost to follow-up, and twelve patients with thirteen ankle replacements died. The average duration of follow-up for the patients without revision was 12.4 years (range, 10.8 to 14.9 years). Sixty-two of the seventy-seven ankles were available for final follow-up.

Results: Twenty-nine (38%) of the seventy-seven ankles had a revision of at least one of the metallic components. The probability of implant survival was 70.7% at ten years and 45.6% at fourteen years. The main reasons for revision were aseptic loosening, subsidence of the talar component, and progressive cyst formation. Polyethylene insert fractures were observed in eleven ankles.

Conclusions: While the midterm to short-term results for patients managed with the STAR prosthesis have been encouraging at 3.7 years, the long-term survivorship of the same cohort was considerably inferior. The subjective and clinical results of the patients with retained prostheses are generally good and comparable with results reported in the current literature.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.