Background: 

Periprosthetic osteolysis after total ankle arthroplasty (TAA) is a challenging problem. This study aimed to evaluate the prevalence of and predisposing factors for osteolysis and its effects on clinical outcomes.

Methods: 

We enrolled 236 patients (250 ankles) who underwent primary TAA using a mobile-bearing HINTEGRA prosthesis, with a mean follow-up of 83.5 months (range, 36 to 182 months), and subsequently divided them into 2 groups: the osteolysis group (79 ankles) and non-osteolysis group (171 ankles). Clinical and radiographic outcomes were compared between the 2 groups, and a bivariable logistic regression analysis was performed to identify predisposing factors for the development of osteolysis.

Results: 

In the osteolysis group (31.6% of the 250 ankles), the mean time of detection was 28.8 months postoperatively. Forty of these ankles were closely monitored without surgical treatment. Another 29 ankles underwent bone grafting and exchange of the polyethylene inlay, and the remaining 10 ankles underwent revision TAA or arthrodesis. All clinical outcome variables were significantly lower in patients with osteolysis, compared with those without osteolysis, at the final follow-up (p < 0.05). In the investigation of predisposing factors, only rheumatoid arthritis was identified as having a significant association with an increased prevalence of osteolysis (p = 0.030).

Conclusions: 

This study demonstrated that the prevalence of periprosthetic osteolysis after TAA was considerable and that the development of osteolysis negatively affected the clinical outcome. Therefore, the prevention and appropriate treatment of osteolysis are crucial for the satisfactory long-term survival of TAA.

Level of Evidence: 

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

中文翻译：

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假体周围溶骨作为全踝关节置换术后翻修的危险因素：250 例连续病例的单中心经验

背景： 

全踝关节置换术 (TAA) 后的假体周围骨质溶解是一个具有挑战性的问题。本研究旨在评估骨溶解的患病率和易感因素及其对临床结果的影响。

方法： 

我们招募了 236 名患者（250 名脚踝），他们使用活动轴承 HINTEGRA 假体接受了初次 TAA，平均随访时间为 83.5 个月（范围为 36 至 182 个月），随后将他们分为 2 组：骨溶解组（ 79 脚踝）和非溶骨组（171 脚踝）。比较两组的临床和影像学结果，并进行双变量逻辑回归分析以确定发生骨溶解的易感因素。

结果： 

在溶骨组（250 个踝关节的 31.6%）中，平均检测时间为术后 28.8 个月。这些脚踝中有 40 个在未经手术治疗的情况下被密切监测。另有 29 只脚踝接受了骨移植和聚乙烯嵌体置换，其余 10 只脚踝接受了 TAA 翻修或关节固定术。在最终随访中，与无骨溶解患者相比，骨溶解患者的所有临床结果变量均显着降低（p < 0.05）。在对诱发因素的调查中，只有类风湿性关节炎被确定为与骨溶解患病率增加显着相关（p = 0.030）。

结论： 

这项研究表明，TAA 后假体周围骨溶解的发生率相当高，并且骨溶解的发展对临床结果产生负面影响。因此，骨溶解的预防和适当治疗对于TAA的长期满意生存至关重要。

证据等级： 

治疗级别 IV。有关证据级别的完整描述，请参见作者说明。