Comparison of Clinical Outcomes of INBONE II Total Ankle Arthroplasty in Patients Under 50 and Over 65 Years: A 4-Year Retrospective Study

Xiangyu Xu; Baozhou Zhang; Xuewen Wang; Yong Wu; Hui Du; Xiaofeng Gong

doi:10.1111/os.70326

Orthopaedic Surgery ›› 2026, Vol. 18 ›› Issue (6) :1233 -1240. DOI: 10.1111/os.70326

CLINICAL ARTICLE

Comparison of Clinical Outcomes of INBONE II Total Ankle Arthroplasty in Patients Under 50 and Over 65 Years: A 4-Year Retrospective Study

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Abstract

Objective: There is no consensus on the age restriction for total ankle arthroplasty (TAA) patients. The aim of our study was to analyze the clinical function, radiographic outcomes, patient satisfaction, and complications between patients under 50 years old and those over 65 years old who underwent TAA with the INBONE II prosthesis for end-stage ankle arthritis.

Methods: Patients who received TAA with the INBONE II prosthesis between September 2016 and August 2021 were included in the study. A total of 68 patients were enrolled and divided into two groups based on age: the younger group (28 patients age ≤ 50 years) and the elderly group (40 patients age ≥ 65 years). Demographic data and patient-reported outcomes, including 36-Item Short-Form Health Survey (SF-36), American Orthopedic Foot & Ankle Society (AOFAS), Foot Function Index (FFI), and Visual Analogue Scale (VAS) scores, were collected preoperatively and at the latest follow-up. Radiographic measurements, including tibial articular surface angle (TAS), talar tilt angle (TT), and tibial lateral surface angle (TLS), were evaluated on weight-bearing images preoperatively and at the latest follow-up. Range of motion (ROM) and complications were documented. Patient satisfaction was assessed using a five-point Likert scale.

Results: With a median follow-up of 4 years, there were no statistically significant differences in AOFAS and SF-36 scores between the two groups at the latest follow-up. However, the elderly group showed slightly lower VAS and FFI scores compared to the younger group, while the younger group demonstrated slightly greater dorsiflexion angles. There were no statistically significant differences in radiographic evaluations, patient satisfaction, and complications between the two groups.

Conclusion: The 4-year postoperative outcomes of TAA using the INBONE II prosthesis were comparable between patients younger than 50 years and those older than 65 years, indicating that age alone may not serve as a definitive criterion for patient selection in TAA with this implant.

Trial Registration: Retrospectively registered.

Level of Evidence: 4.

Keywords

age / complications / INBONE II / total ankle arthroplasty

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Xiangyu Xu, Baozhou Zhang, Xuewen Wang, Yong Wu, Hui Du, Xiaofeng Gong. Comparison of Clinical Outcomes of INBONE II Total Ankle Arthroplasty in Patients Under 50 and Over 65 Years: A 4-Year Retrospective Study. Orthopaedic Surgery, 2026, 18 (6) : 1233-1240 DOI:10.1111/os.70326

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References

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[1]	A. J. Pugely, X. Lu, A. Amendola, J. J. Callaghan, C. T. Martin, and P. Cram, “Trends in the Use of Total Ankle Replacement and Ankle Arthrodesis in the United States Medicare Population,” Foot & Ankle International 35, no. 3 (2014): 207–215.

[2]	J. A. Singh and R. Ramachandran, “Time Trends in Total Ankle Arthroplasty in the USA: A Study of the National Inpatient Sample,” Clinical Rheumatology 35, no. 1 (2016): 239–245.

[3]	C. L. Saltzman, M. L. Salamon, G. M. Blanchard, et al., “Epidemiology of Ankle Arthritis: Report of a Consecutive Series of 639 Patients From a Tertiary Orthopaedic Center,” Iowa Orthopaedic Journal 25 (2005): 44–46.

[4]	V. Valderrabano, M. Horisberger, I. Russell, H. Dougall, and B. Hintermann, “Etiology of Ankle Osteoarthritis,” Clinical Orthopaedics and Related Research 467, no. 7 (2009): 1800–1806.

[5]	T. D. Brown, R. C. Johnston, C. L. Saltzman, J. L. Marsh, and J. A. Buckwalter, “Posttraumatic Osteoarthritis: A First Estimate of Incidence, Prevalence, and Burden of Disease,” Journal of Orthopaedic Trauma 20, no. 10 (2006): 739–744.

[6]	M. Glazebrook, T. Daniels, A. Younger, et al., “Comparison of Health-Related Quality of Life Between Patients With End-Stage Ankle and Hip Arthrosis,” Journal of Bone and Joint Surgery. American Volume 90, no. 3 (2008): 499–505.

[7]	J. M. Cottom, C. T. Graney, S. M. Douthett, C. Sisovsky, K. K. McConnell, and B. S. Plemmons, “Age-Related Outcomes in Total Ankle Arthroplasty: An Analysis of 112 Patients,” Journal of Foot and Ankle Surgery 59, no. 4 (2020): 739–742.

[8]	G. W. Lee, J.‑. K. Seon, N. S. Kim, and K. B. Lee, “Comparison of Intermediate-Term Outcomes of Total Ankle Arthroplasty in Patients Younger and Older Than 55 Years,” Foot & Ankle International 40, no. 7 (2019): 762–768.

[9]	A. T. Anastasio, B. I. Kim, C. M. Wixted, et al., “Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes,” Journal of Bone and Joint Surgery. American Volume 106, no. 1 (2024): 10–20.

[10]	C. Stadler, M. Luger, S. Stevoska, et al., “High Reoperation Rate in Mobile-Bearing Total Ankle Arthroplasty in Young Patients,” Medicina (Kaunas, Lithuania) 58, no. 2 (2022): 288.

[11]	L. Dagneaux, E. Nogue, J. Mathieu, D. Demoulin, F. Canovas, and N. Molinari, “Survivorship of 4,748 Contemporary Total Ankle Replacements From the French Discharge Records Database,” Journal of Bone and Joint Surgery. American Volume 104, no. 8 (2022): 684–692.

[12]	D. W. Consul, A. Chu, T. M. Langan, C. F. Hyer, and G. Berlet, “Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years,” Foot & Ankle Specialist 15, no. 3 (2022): 283–290.

[13]	C. A. Demetracopoulos, S. B. Adams, R. M. Queen, J. K. DeOrio, J. A. Nunley, II, and M. E. Easley, “Effect of Age on Outcomes in Total Ankle Arthroplasty,” Foot & Ankle International 36, no. 8 (2015): 871–880.

[14]	S. Tenenbaum, J. Bariteau, S. Coleman, and J. Brodsky, “Functional and Clinical Outcomes of Total Ankle Arthroplasty in Elderly Compared to Younger Patients,” Foot and Ankle Surgery 23, no. 2 (2017): 102–107.

[15]	F. G. Usuelli, C. Maccario, R. D'Ambrosi, M. F. Surace, and E. Vulcano, “Age-Related Outcome of Mobile-Bearing Total Ankle Replacement,” Orthopedics 40, no. 3 (2017): e567–e573.

[16]	E. Clugston, N. Ektas, C. Scholes, et al., “Early Clinical Outcomes and Complications of Transfibular Total Ankle Arthroplasty: The Australian Experience,” Foot & Ankle International 44, no. 1 (2023): 40–47.

[17]

Y. K. Yoon, K. H. Park, J. H. Park, W. Lee, S. H. Han, and J. W. Lee, “Long-Term Clinical Outcomes and Implant Survivorship of 151 Total Ankle Arthroplasties Using the HINTEGRA Prosthesis: A Minimum 10-Year Follow-Up,” Journal of Bone and Joint Surgery. American Volume 104, no. 16 (2022): 1483–1491.

[18]	G. W. Lee, S. H. Wang, and K. B. Lee, “Comparison of Intermediate to Long-Term Outcomes of Total Ankle Arthroplasty in Ankles With Preoperative Varus, Valgus, and Neutral Alignment,” Journal of Bone and Joint Surgery. American Volume 100, no. 10 (2018): 835–842.

[19]	O. J. Gagne, J. Day, J. Kim, et al., “Midterm Survivorship of the INBONE II Total Ankle Arthroplasty,” Foot & Ankle International 43, no. 5 (2022): 628–636.

[20]	E. Loewy, M. S. Conti, C. P. Jones, et al., “Midterm Outcomes of the INBONE(TM) II Total Ankle Arthroplasty,” Journal of Foot and Ankle Surgery 62, no. 4 (2023): 651–656.

[21]	E. A. Cody, L. Bejarano-Pineda, J. R. Lachman, et al., “Risk Factors for Failure of Total Ankle Arthroplasty With a Minimum Five Years of Follow-Up,” Foot & Ankle International 40, no. 3 (2019): 249–258.

[22]	J. A. Kipp, B. D. Vesely, T. A. Lance, B. N. White, A. W. Medda, and A. T. Scott, “Age Influence on Total Ankle Arthroplasty Outcomes: A Systematic Review,” Journal of Foot and Ankle Surgery 63, no. 6 (2024): 765–768.

[23]	K. A. Wu, A. T. Anastasio, K. Mitra, et al., “Younger Age Correlates With Increased Gutter Impingement Rates After Total Ankle Arthroplasty,” Foot and Ankle Surgery 31, no. 2 (2025): 148–152.

[24]	R. Flavin, S. C. Coleman, S. Tenenbaum, and J. W. Brodsky, “Comparison of Gait After Total Ankle Arthroplasty and Ankle Arthrodesis,” Foot & Ankle International 34, no. 10 (2013): 1340–1348.

[25]	L. M. Coester, C. L. Saltzman, J. Leupold, and W. Pontarelli, “Long-Term Results Following Ankle Arthrodesis for Post-Traumatic Arthritis,” Journal of Bone and Joint Surgery. American Volume 83, no. 2 (2001): 219–228.

[26]	T. J. Dekker, K. S. Hamid, M. E. Easley, J. DeOrio, J. A. Nunley, and S. B. Adams, “Ratio of Range of Motion of the Ankle and Surrounding Joints After Total Ankle Replacement: A Radiographic Cohort Study,” Journal of Bone and Joint Surgery. American Volume 99, no. 7 (2017): 576–582.

[27]

I. Pasqualini, J. R. Teplensky, O. Turan, et al., “Establishment of Minimum Clinically Important Difference and Patient Acceptable Symptom State Thresholds for Foot and Ankle Ability Measure and Visual Analog Scale Scores After Hallux Valgus Surgery,” Foot & Ankle International 46, no. 1 (2025): 83–91.

[28]	A. Agarwalla, A. K. Gowd, E. A. Cody, et al., “Timeline for Maximal Subjective Outcome Improvement Following Total Ankle Arthroplasty,” Foot and Ankle Surgery 27, no. 3 (2021): 305–310.

[29]	L. Desomer, N. van Beek, A. van Riet, and S. Verfaillie, “Outcomes of Platelet-Rich Plasma Infiltration and Weightbearing Cast Immobilization in Distal Tibialis Anterior Tendinopathy: A Prospective Cohort Study,” Foot & Ankle International 45, no. 2 (2024): 158–165.