Are Biointegrative Fixations (OSSIO) in Ankle Replacements Safer than Traditional Hardware?

Hardware removal is a common but costly side of orthopedic and musculoskeletal care. Surgeons and hospitals disagree on allowing patients to take home explanted hardware, with 88% of surgeons in favor and only 66% of hospitals permitting it. This raises an important question: Can using metal implants be avoided in areas with high removal rates?

One promising solution is biointegrative fixation. A recent study explored this approach in the context of total ankle arthroplasty (TAA). This Level 3 retrospective cohort study reviewed 150 primary TAA cases, performed by one fellowship-trained foot and ankle surgeon, from December 2018 to February 2024, with a minimum follow-up of one year. The study compared outcomes between patients who received biointegrative medial malleolar fixation and those who did not.

Key study findings include:

• Biointegrative fixation had a lower postoperative complication rate (1.64%) compared to no fixation (5.65%).

• No intraoperative complications occurred with biointegrative fixation, unlike 60% in the no fixation group.

• Patient demographics and comorbidities were controlled.

Why it matters

Biointegrative implants may reduce intraoperative and postoperative complications in total ankle arthroplasty, suggesting that using them for medial malleolus fixation could enhance safety without traditional hardware drawbacks.

Next step

Prospective studies should compare biointegrative implants to metal screws and assess their impact on local bone physiology.