Sport and Physical Activities in Total Ankle Replacement: Mobile‑ and Fix‑Bearing

Document Type : Original Article


1 IRCCS Istituto Ortopedico Galeazzi, CASCO Department, Foot and Ankle Division

2 IRCCS Istituto Ortopedico Galeazzi, CASCO Department, Foot and Ankle Division, Department of Biomedical Sciences, University of Milan, Milan, Italy,

3 Department of Orthopaedics, Medical University of South California, Charleston, SC, USA



Background: The number of total ankle replacements (TARs) is rapidly increasing in consequence of the availability of new designs
allowing to save the range of motion and to preserve against adjacent joints degeneration. This study aimed to compare participation in sports
12 months after TAR with either mobile‑bearing or fix‑bearing prosthesis. Materials and Methods: One hundred and seventeen primary
TARs were performed (77 Hintegra, 40 Zimmer Trabecular Metal Total Ankle). We retrospectively assessed pain and function using the visual
analogue scale (VAS) pain scale, American Orthopedic Foot and Ankle Society (AOFAS), Short‑Form Health Survey (SF‑12 divided into
Mental (MCS) and Physical (PCS) score) obtained preoperatively, 6 and 12 months postoperatively. Activity levels were determined using
the Halasi ankle activity scale and the University of California at Los Angeles (UCLA) score obtained preoperatively and 12 months after the
surgery. Radiographic examination included plain radiographs with full weight‑bearing taken preoperatively and 12 months postoperatively.
Results: All patients showed a significant improvement for AOFAS, VAS, and SF‑12 scores (P < 0.05). The Halasi activity scale and UCLA
score were 4.2 ± 1.2 and 6.6 ± 1.8, respectively, for the fix‑bearing group and 3.7 ± 1.5 and 6.3 ± 2.3 for the mobile‑bearing 12 months
after the surgery. In our series, jogging, dancing, and skiing represented the three most frequent sports. In the fix‑bearing group, 60% of the
patients practiced sport 1 year after surgery and 49.4% in the mobile‑bearing group. The fix‑bearing prosthesis had a quicker recovery and
better functional outcomes within the first 6 months after the operation. At 1 year, there was not a significant difference in return to sport and
physical activities between patients treated with a mobile‑bearing implant and a fix‑bearing implant. Conclusions: At 1 year, both fixed and
mobile bearing present significant improvements in functional and recreational scores, with neither prove superior.


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