Scandinavian Total Ankle Replacement (STAR)

Fifty-eight patients with either rheumatoid arthritis or osteoarthritis were treated with meniscal-bearing ankle prostheses. The concept was to mobilize, align, and stabilize the ankle before resurfacing it. Cement was used for prostheses fixation in 33 patients (1986–1989) and 25 patients had fixation without cement (1990–1995). All patients in one prospective series were followed up yearly with radiographs and with a clinical scoring system giving a maximum of 100 points. This allowed for a patient-controlled prospective study. No patients were lost to followup. The only detectable difference in the treatment was the fixation mode. For the purpose of comparing patients with cemented and uncemented prostheses, the patients who had surgery between 1986 and 1989 were not followed up after 1997, and patients who had surgery between 1990 and 1995 were not followed up after 2002. The mean followup was 9.4 years. Failure was defined as prosthesis revision or change to arthrodesis for any reason. In the cemented group, nine of 33 patients had revision surgery or fusion. In the uncemented group, one of 25 patients had revision surgery. Survivorship analysis for 12 years based on life tables showed a 70% survival rate (confidence limit, 60.3–78.5) for the cemented group and 95.4% survival rate (confidence limit, 91.0–99.9) for the uncemented group. The average clinical scores at the latest followup were 74.2 ± 19.3 for the cemented group and 91.9 ± 7.4 points for the uncemented group. Therefore, unconstrained meniscal-bearing ankle prostheses should be uncemented.