Total ankle arthroplasty and national registers: What is the impact on scientific production?

Purpose: The purpose of this systematic review was to analyze clinical studies on total ankle replacement (TAR) whose data were extracted from national registers. Methods: A systematic review of the literature, to identify all studies reporting outcomes after TAR, was performed. Two independent investigators performed the research using MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase and Cochrane Databases (1950 to December 2017). The search terms used were “total ankle replacement” or “total ankle arthroplasty” AND “register” or “registers” or “registry” or “registries” or “national registry” or “national register”. Results: Analysis of the literature included 18 articles from 2007 to 2017. Of these 5 articles performed a comprehensive analysis of the national registers, 5 articles evaluated complications and reasons of failure after TAR, 6 articles made a specific outcome register analysis, one article compared TAR and ankle arthrodesis while the last one analyzed the role of TAR in patients with rheumatoid arthritis. Conclusions: Scientific publications extracted from national joint registers for total ankle replacement provide useful but heterogeneous information on implants survivorship, implant models and risk factors. There is still a discrepancy between the data reported by designers in clinical studies and the data reported by the registries. The centralization of registers in specialized hospitals with dedicated surgeons, the use of patient reported outcomes (PROMs) in association with surgeon assessments and periodical publications can improve the development of registries and consequently of the literature in this regard.