Periprosthetic osteolysis after AES total ankle replacement: Conventional radiography versus CT-scan

Background: The aim of this study was to compare conventional X-rays and CT-scan in detecting periprosthetic osteolytic lesions, a major concern after total ankle replacement (TAR). Methods: We prospectively assessed 50 patients (mean age 56 years), consecutively operated on by the same senior surgeon, between 2003 and 2006 and with a mean follow-up period of 4 years (range, 2-6.2). The component used was AES (R) total ankle replacement. The etiologies for total ankle arthroplasty were: posttraumatic in 50%, osteoarthritis secondary to instability in 36%. Plain radiographs were analyzed by 4 independent observers, using a 10-zone protocol (location) and 5 size categories. Results: At 4-year follow-up, all patients had been CT-scan assessed with the same protocol by 2 independent observers. Plain radiographs showed dramatic progression of severe periprosthetic lyses (> 10 mm): from 14% to 36% of interface cysts for the tibial component respectively at 2 and 4-year follow-up and from 4% to 30% for the talar implant. The talar component was more accurately assessed by CT-scan (mean frontal and sagittal talar lesion: from 270 mm(2) to 288 mm(2) for CT-scan versus 133 mm(2) to 174 mm(2) for X-rays). For tibial cysts, axial views showed larger lesions (313 mm(2)) than frontal (194 mm(2)) or sagittal (213.5 mm(2)) views. At 4-year follow-up, 24% of patients had revision with curetage or arthrodesis, and at 7 years follow-up 38% were revised. Conclusion: These results are similar to recent X-series, justifying withdrawal of this device. CT-scan was more accurate than X-rays for detecting and quantifying periprosthetic osteolysis. We recommend a yearly radiological control and CT-scan in case of lesion on X-rays. (c) 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.