Foot & Ankle International - June 2017 - 662

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FAIXXX10.1177/1071100717701232Foot & Ankle InternationalRaikin et al

research-article2017

Article

Midterm Outcome of the Agility
Total Ankle Arthroplasty

Foot & Ankle International®
2017, Vol. 38(6) 662-670
© The Author(s) 2017
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https://doi.org/10.1177/1071100717701232
DOI: 10.1177/1071100717701232
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Steven M. Raikin, MD1, Kristin Sandrowski, MD2, Justin M. Kane, MD3,
David Beck, MD2, and Brian S. Winters, MD1

Abstract
Background: Ankle arthritis is a debilitating condition that causes severe functional impairment. While arthrodesis has
been the gold standard of surgical treatment for this condition, significant improvements in total ankle arthroplasty have
made it a viable alternative. The purpose of this study was to look at the midterm follow-up of the Agility total ankle.
Methods: A retrospective review of prospectively collected data was conducted on 127 consecutive Agility total ankles
implanted between 2002 and 2009. Charts were reviewed to collect patient demographics. In addition, coronal alignment,
overall arc of motion, tibiotalar component motion, syndesmotic fusion, zones of osteolysis, and subsidence were
determined. A Kaplan-Meier survival and linear regression analysis were used to predict implant failure. A multivariate
regression analysis was used to assess whether radiographic measures were predictive of patient satisfaction.
Results: Ninety (78.2%) of 115 patients retained their primary implant, of which 105 were available for evaluation, with an
average follow-up of 9.1 years. Twenty-five had their implant removed. The average score for the Foot and Ankle Ability
Measure (FAAM) activities of daily living subscale was 82.4, FAAM sport subscale 55.3, postoperative visual analog scale
(VAS) for pain 12.7, and Short Form-12 (SF-12) Health Survey physical component 45.8 and SF-12 mental component 56.1.
Average arc of motion across the implant was 22.3 and 6.3 degrees in adjacent joints. Osteolysis most commonly occurred
in zones 1 and 6. No statistical differences were found in the rate or location of subsidence. Linear regression analysis
demonstrated that age at the time of surgery was predictive of failure (P = .036). Inflammatory and atraumatic arthritis
demonstrated higher likelihoods of revision. No correlation was detected between radiographic parameters and outcomes
scores (P > .05; rho >0.2). A significant reduction in mean VAS pain scores by 67.6% was maintained at an average of 8
years.
Discussion: Our results were improved over the nondesigner outcomes published in the current literature. Survivorship
approached 80% at 9 years, with Kaplan-Meier 14-year survival calculated at 70.4%. Patients with their original implant
were functioning with a high level of satisfaction based on statistically validated outcome scores, which was independent
of the radiographic appearance of their implant. Age at the time of surgery and inflammatory/atraumatic arthritis were
predictive of failure.
Level of Evidence: Level IV, case series.
Keywords: arthritis, outcome studies, total ankle replacement, total ankle arthroplasty

Introduction
For patients with end-stage ankle arthritis, the associated
disabling morbidity is significant, matching that of degenerative hip and knee arthrosis, end-stage renal disease, and
congestive heart failure.10,32,33 For patients who have failed
nonoperative treatment modalities, tibiotalar fusion has
long been the standard operative intervention for end-stage
ankle arthritis. Although short and midterm outcomes after
tibiotalar fusion have resulted in durable pain relief with
good overall function, Coester et al demonstrated that at
long-term follow-up there was a substantial degree of
arthritic changes noted at the subtalar joint (91%) and talonavicular joint (57%), resulting in limited functionality due

to pain.6 The degree of dysfunction seen at long-term follow-up has been attributed to the altered biomechanics at
the adjacent joints after tibiotalar fusion. Mann and
Rongstad reported that patients undergoing tibiotalar fusion
experienced a 74% reduction in sagittal plane motion and a

Rothman Institute, Philadelphia, PA, USA
Thomas Jefferson University Hospital, Philadelphia, PA, USA
3
Baylor University Medical Center, Dallas, TX, USA
2

Corresponding Author:
Steven M. Raikin, MD, Rothman Institute, 925 Chestnut Street,
5th Floor, Philadelphia, PA 19107, USA.
Email: steven.raikin@rothmaninstitute.com

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