Use of non metallic implant for medial malleolar prophylactic fixation in total ankle arthroplasty, a noninferiority study

Abstract

Metal screw fixation has been standard in orthopedic procedures but carries drawbacks including migration, breakage, and need for removal. New bio-integrative options have shown promise in fracture repair; but the use with prophylactic fixation in total ankle arthroplasty (TAA) is unclear. The purpose of this study was to compare outcomes of biointegrative implants versus no fixation in prophylactic medial malleolar fixation with TAA.

A retrospective review via surgeon operative database was performed including patients with primary total ankle arthroplasty by a single fellowship trained orthopedic foot and ankle surgeon between December 2018 and February 2024. Search was verified by billing documentation with a minimum of 1 year follow up. Objective patient data including age, comorbidities, smoking and social history were all recorded. Postoperative data was reviewed to assess perioperative complications specific to the two cohorts.

The authors reviewed 150 cases of a single surgeon performing total ankle replacement. When comparing postoperative complications between use of non metallic fixation to no fixation, this was 1.64% (n=1) to 5.65% (n=5) respectively. Intraoperative complications occurred in 60% (n=3/5) of patients without fixation while none were seen in the non metallic prophylactic cohort.

Non metallic implant designs continue to improve with bio-integrative benefits compared to no fixation of the medial malleolus in TAA. We found that intraoperative and postoperative complications are less likely with prophylactic fixation of the medial malleolus with a biointegrative implant. Further prospective studies are warranted to evaluate the long term benefit.

Level Of Evidence: Level 3, Retrospective Cohort Study.