TITLE:
Buechel-Pappas Total Ankle Replacement: Use of Highly Cross-Linked Polyethylene Meniscal Bearings over a 13 - 15 Year Interval
AUTHORS:
Frederick F. Buechel, Michael J. Pappas
KEYWORDS:
Cementless Total Ankle Replacement, Meniscal Ankle Replacement, Osteolysis, Bone Graft of Cysts
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.13 No.8,
August
8,
2023
ABSTRACT: Background: The Buechel-Pappas (BP) meniscal bearing total ankle replace-ment was initially developed as a “shallow-sulcus” talar component device using cobalt-chromium-molybdenum alloy, in 1978, and later, modified to a “deep-sulcus” talar component device using titanium nitride (TiN) ceramic and porous coating in 1989. Wear related osteolytic cysts were noted in the tibia and talus surrounding these devices that compromised long term fixation and stability when using standard ultra-high molecular weight polyethylene (UHMWPe) as a bearing material. This study explores the use of highly cross-linked UHMWPe (HXLPe) to minimize osteolysis by replacing standard UHMWPe with this more wear-resistant material. Methods: There were 12 primary and 8 revision total ankle replacements followed for 13 to 15 years. HXLPe was used in all meniscal bearings, either as primary or revision implants. All stable metallic tibial and talar components were retained in revision cases. Osteolytic cysts greater than 10 mm in diameter were bone grafted with homologous morselized banked bone through cortical windows in the tibia or talus. No adjuvant screw fixation was used to stabilize any metallic implant. Results: No HXLPe bearings failed in this study, and no re-revisions were performed. No primary total ankle replacement failed in this study, and there were no substantial osteolytic cysts (>2 mm) observed in primary total ankle replacements on plain X-rays. All bone grafted osteolytic cysts in revision ankle replacements remained stable, even though partial resorption of the grafted material was identified in most of the ankles. No loosening of porous coated and TiN coated tibial and talar components were seen; the longest surviving metal components in the revision group was 24 years with the revised bearing at 15 years. Conclusions: HXLPe has greatly improved wear resistance in meniscal-bearing BP total ankle replacements in both primary and revision arthroplasties. Osteolytic cysts can be successfully bone grafted during bearing exchange revisions. Primary and revision, cementless BP metallic total ankle components have remained well-fixed to bone in the long term (greater than 20 years), without the use of adjuvant screw fixation.