Peri-prosthetic bone cysts after total ankle replacement. A systematic review and meta-analysis

• Published in: Foot and ankle surgery Vol. 25; no. 2; pp. 96 - 105
• Main Authors: Arcângelo, Joana, Guerra-Pinto, Francisco, Pinto, André, Grenho, André, Navarro, Alfons, Martin Oliva, Xavier
• Format: Journal Article
• Language: English
• Published: France Elsevier Ltd 01-04-2019
• Subjects: Ankle arthroplasty; Ankle Joint - diagnostic imaging; Ankle Joint - surgery; Arthroplasty, Replacement, Ankle - adverse effects; Bone cysts; Bone Cysts - diagnosis; Bone Cysts - etiology; Bone Cysts - surgery; Cystic osteolysis; Humans; Joint Prosthesis - adverse effects; Peri-prosthetic osteolytic lesions; Postoperative Complications; Tomography, X-Ray Computed; Total ankle replacement; Bone cysts; Total ankle replacement; Cystic osteolysis; Ankle arthroplasty; Peri-prosthetic osteolytic lesions
• ISSN: 1268-7731; 1460-9584
• DOI: 10.1016/j.fas.2017.11.002

•Total ankle replacement periprosthetic osteolysis causal mechanisms are multifactorial.•Reportedly bone osteolysis is induced by an inflammatory response to wear debris particles.•Implant design and material properties influence wear debris production.•Non-anatomic, mobile-bearing, hydroxyapatite-coated and non tibial-stemmed ankle replacements are associated with more osteolysis.
Periprosthetic cystic osteolysis is a well-known complication of total ankle replacement. Several theories have been proposed for its aetiology, based on individual biomechanical, radiological, histopathology and outcome studies.
Studies that met predefined inclusion/exclusion criteria were analysed to identify literature describing the presence of peri-prosthetic ankle cystic osteolysis. Quantitative data from the selected articles were combined and statistically tested in order to analyse possible relations between ankle peri-prosthetic bone cysts and specific implant characteristics.
Twenty-one articles were elected, totalizing 2430 total ankle replacements, where 430 developed peri-prosthetic cystic osteolysis.
A statistically significant association (P<.001) was found between the presence of bone cysts and non-anatomic implant configuration, hydroxyapatite-coating, mobile-bearing and non tibial-stemmed implants. No significant association existed between the type of constraining and the presence of cysts (P>.05).
Non-anatomic, mobile-bearing, hydroxyapatite-coated and non tibial-stemmed total ankle replacements are positively associated with more periprosthetic bone cysts.