Journal of Foot and Ankle Surgery - 2026-09-12 - Journal Article
Association of Component Sizing on Total Ankle Arthroplasty Survivorship.
Schwab A, Cook H, Ramdass R, Nowak J, Strand G
Topics
Key Takeaway
Polyethylene inserts ≤7 mm carried a 3.05× higher reoperation rate (33.3% vs 19.3%, p=0.04), while talar downsizing showed no significant effect on revision risk (OR 0.66, p=0.36) at mean 4.1-year follow-up.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This retrospective cohort examined whether talar downsizing, polyethylene thickness, and coronal alignment predict revision or polyethylene exchange in 173 TAA procedures. Talar downsizing (performed in 66.5% of cases) did not significantly reduce revision risk (OR 0.66, p=0.36), but polyethylene inserts ≤7 mm were associated with significantly higher reoperation rates versus ≥8 mm inserts (33.3% vs 19.3%, OR 3.05, p=0.04). Overall implant survivorship was 86.9% at mean 4.1 years, consistent with published registry benchmarks.
Key Limitation
Retrospective design with mixed implant systems prevents attribution of the polyethylene thickness effect to a specific prosthesis design or bearing surface, limiting generalizability.
Original Abstract
BACKGROUND
Component sizing and alignment are critical to total ankle arthroplasty (TAA) longevity, yet the relationship between talar downsizing, polyethylene thickness, and revision risk remains unclear.
PURPOSE
This retrospective cohort study evaluated whether talar downsizing improves survivorship and examined secondary associations between polyethylene thickness, coronal alignment, and revision.
STUDY DESIGN
Level III Retrospective Study
METHODS
A retrospective cohort study with 173 TAA procedures was performed. Variables included talar downsizing status, tibial and talar component sizes, initial polyethylene thickness, and comorbidities. Primary outcomes were revision or polyethylene exchange. Logistic regression assessed the relationship between downsizing, polyethylene size, and revision risk; correlation analysis examined polyethylene size versus preoperative tibiotalar angle.
RESULTS
Talar downsizing was performed in 115 of 173 ankles (66.5%). Patients with a downsized talar component showed a lower, though nonsignificant, likelihood of revision (OR 0.66; p = 0.36). Smaller polyethylene components (≤7 mm, n = 12) were associated with significantly higher reoperation rates than components ≥8 mm (33.3% vs 19.3%; OR = 3.05; p = 0.04) Mean preoperative coronal alignment was 0.98° valgus ± 8.9° (95% CI -0.35 to 2.31), with no correlation between polyethylene (PE) thickness and deformity (r = -0.01; p = 0.90). Hindfoot fusion was not statistically significantly associated with revision risk (p = 0.07). Implant survivorship was 86.9% at a mean clinical follow-up duration of 4.1 ± 2.2 years (range, 1.0-9.3 years).
CONCLUSION
Talar component downsizing was not significantly associated with revision risk in this cohort. While downsizing may offer potential biomechanical benefits related to edge-loading and alignment, further investigation is needed to determine whether these factors translate to improved clinical outcomes.