Outcomes of Bone Graft for Periprosthetic Osteolysis after Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Periprosthetic osteolysis after total ankle arthroplasty (TAA) is a substantial problem. It has potential to affect implant survival. To prevent implant failure, it is important to decide an appropriate timing of surgical intervention such as bone graft. We report our outcomes of bone graft for osteolysis after TAA. Methods: We retrospectively evaluated our consecutive series of 470 primary TAAs performed between May 2004 and August 2019 and identified those who received operative management for periprosthetic osteolysis. A total of 43 bone graft procedures were performed. Location of osteolytic lesion, bone grafting method, histologic findings and clinical outcome parameters using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, Ankle Osteoarthritis Scale (AOS) pain and disability score were evaluated. Mean follow-up period was 52.9 months (range, 24 to 120). Results: Total 61 osteolytic lesion were observed. 31 tibial cysts (50.8%), 24 talar cyst (39.3%) and 6 fibular cyst (9.8%) were treated and 17 ankles (39.5%) had multiple lesions. Autogenous iliac bone graft with polyethylene inlay exchange was performed in most of patients. All clinical scores improved significantly at the last follow-up (p<0.05) after operation. Five patients needed a repetitive bone graft procedure and one patient needed bone graft and additional bone cementation twice. There was one implant failure and overall survival rate after bone graft was 97.7%. Conclusion: Bone graft for periprosthetic osteolysis could improve clinical outcomes and implant survivorship. However, further study is needed for demonstrating etiology of newly developed osteolysis even after the bone graft.