Hello everyone. I'd like to thank the AOFAS for this opportunity as well as my co-authors for their support. These are our disclosures. We know that total ankle replacement is rapidly increasing in both America as well as across the world. And we're really past the debate of fusion versus replacement. Instead, the bigger question is how to choose the optimal implant for each patient. And this is complicated by the fact that at least seven fixed-bearing, low-profile implants have entered the United States market since 2013, really underscoring the need for accurate reporting of early results. One of those implants that has entered the market is the Xactech Vantage Total Ankle Implant. It's a fixed-bearing, semi-constrained, two-component total ankle. And it's currently in its first generation, which was released in 2016. It's low-profile and it minimizes bony resection. On the talar side, there's a curved talar dome. There is also a flat-cut option available. And on the tibial side, the tibial fixation is perpendicular to the axis of the tibia with a central cage and surrounding pegs. There's a locking clip to facilitate polyethylene exchange. And unique to this implant, any size tibia fits with any size talus. And so our objective in this study was to describe the early survivorship, reoperations, and revisions of the Vantage Ankle Implant. This is a retrospective review of prospectively collected data in a single institution's total ankle replacement registry. Four surgeons contributed patients undergoing primary total ankle with the Vantage Implant who all had minimum two years follow-up. We excluded revisions and ankle fusion takedowns with conversion to total ankle. We collected demographics, operative data, and post-operative complications. We reviewed pre-op and post-op radiographs looking at coronal and sagittal alignment, as well as post-op peri-implant lucency and cyst formation. We also looked for subsidence or other radiographic complications. We collected data on reoperations and revisions, as well as PROMIS scores. And a biostatistician assisted with our statistical analysis. In terms of our results, there were 190 eligible patients in the database. And of those, 171 had minimum two-year follow-up, achieving a 90% follow-up rate with a range follow-up of 2 to 4.6 years. When you look at our table of demographics here, you see this is quite typical for a total ankle patient. Mean age was 63 years, mean BMI was 28, and just over half were men. In terms of the etiology of their ankle arthritis, the majority of patients had a post-traumatic cause. 45% were post-traumatic due to a prior fracture, and 34% were post-traumatic due to a history of ankle sprain or instability. This graph shows the preoperative coronal plane deformity for our patient cohort. And you'll see that just under half of our patients had a varus or valgus deformity of greater than 10 degrees preoperatively. Additional procedures performed at the time of surgery were common, including Achilles, lengthening and gastroc recession, and medial malprophylactic fixation. You'll see we also had a fair number of patients who underwent a medializing calcaneal osteotomy, first TMT fusion, first right dorsiflexion osteotomy, or Brostrom. Overall, we reported a 94.2% survivorship at final follow-up. We identified 10 revisions which occurred at a mean 1.5 years after the primary surgery. Six of those were loosening on the tibial side, one was loosening on the talar side, two were loosening on both the tibial and talar sides of the implant, and the final was a periprosthetic joint infection. Fortunately, all 10 were able to be converted to a revision total ankle, nine of those were converted to a tibial and talar stem implant, and that talar loosening patient was converted to a revision talar implant only. Factors like BMI, weight, hindfoot fusion, and preoperative coronal deformity were not significant risk factors for revision. When it comes to reoperations, just over 6% of our patients underwent reoperation for things like gutter impingement, superficial wound IND, ORIF for peri-implant fracture, bone grafting for cysts, and debridement and polyexchange for arthrofibrosis. Looking at our patients radiographically, we identified significant improvements in coronal malalignment and sagittal plane talar translation from pre- to post-surgery. Among our patients who did not undergo revision or reoperation, 17% had asymptomatic lucency on the tibial side and one had tibial subsidence. On the talar side, just under 3% of patients had asymptomatic talar lucencies and again, there was one patient with talar subsidence and then there was one patient who had incongruent valgus tilt of the talar component. And finally, we had significant improvement in all PROMIS domains meeting criteria for the MCID in the physical and pain-based domains. So overall, we can conclude that we demonstrated good survivorship in early follow-up of the Vantage implant. If you look at prior series of the Vantage implant, they actually have all to date reported 100% survivorship, but these have been limited. There was one fixed-bearing series which had two-year follow-up with only 22 patients and then two mole-bearing series from Europe which only included one-year follow-up. What's notable also about this series is that 45% of our patients had coronal plane deformity of at least 10 degrees or more and additional procedures were common to balance those more challenging angles. These results are comparable to other short-term results from low-profile implants on the market. If you look at the Infinity, the Cadence, the Zimmer, they're all reporting somewhere in the low 90s to 100% survivorship for this time period. What we're seeing though for the Vantage and these other low-profile modern implants is that the early failures are occurring on the tibial side. And so that really begs the question, is this due to loosening or is this actually an early lack of osseous integration to the implant? There certainly is a balance between minimizing tibial resection and achieving early stable tibia fixation, and this is certainly an area for further study. In addition, in this series, we identified few reoperations, but we did have 22% asymptomatic peri-implant lucencies. And further research is definitely needed to determine the optimal evaluation and treatment of these lucencies when they do occur. And of course, there are limitations to this study. This is a single institution study with short follow-up, and there's limited data in the literature for comparison. So we certainly look forward to more research in the future. Thank you all so much.

Xactech Vantage Total Ankle Implant

ankle replacement

early survivorship

reoperations

implant revisions