A Sticky Subject in Total Ankle Arthroplasty (TAA)

by Vince Vacketta, DPM

Cement fixation in TAA is a controversial topic. While the FDA requires the use of bone cement for on-label use of most implants available in the US market, there remains a large, unspoken, variability in surgeon use.

What does the literature say?

Due to the controversy, limited research exists comparing cemented and non-cemented TAA. A case series by Younger et al. demonstrated favorable outcomes with cementless TAA implantation compared to cemented TAA, supporting the use of uncemented implants.

A new publication specifically focusing on this topic of cement use in TAA, has now doubled our literature bank. It is based on a small retrospective cohort study by Millstead et al. and has again demonstrated no benefit in terms of implant osteolysis with cemented fixation compared to non-cemented TAA implantation. 

Factoring in the potential complications associated with bone cement, the lack of evidence backing its use, and the ongoing advancements in implant design to improve boney ingrowth, should we we follow the science or the administration?