Objective To evaluate results and demonstrate problems of Scandinavian total ankle replacement (STAR) in patients with ankle arthritis and clarify its role as a growing alternatives to ankle fusion.Methods Retrospectively analyzed 43 patients who had total ankle replacement from May 1999 to January 2013.All cases were evaluated with interview focusing on pain,daily activities and clinical and radiologic examinations.The average age of patients was 46 (range,35 to 56) years old.Among these cases,9 patients suffered from posttraumatic arthritis,25 osteoarthritis,5 rheumatoid arthritis and 4 avascular necrosis of the talar body.All patients complained about ankle joint pain and swelling as well as limited ROM of joint.Results Mean follow-up was 6.7 (1.5 to 12 years) years.37 cases had complete follow-up.The average preoperative ankle score was 27.0± 10.5,pain degree score was 16.5± 12.8,joint function score was 10.6±7.4,ROM score was 8.2±5.2.The average preoperative ankle score was 86.5±13.2,pain degree score was 49.5±4.5,joint function score was 19.7±9.5,ROM score was 19.2±3.2.The indicatiors compared with preoperative,postoperative differences have statistical significance.The score of postoperative Kofoed were divided into excellent 35 cases,good 1 case and poor 1 case,excellent and good rate was 97.3％.The American orthopaedic foot and ankle society (AOFAS) scoring system was improved from 40.5 preoperatively to 80.6 postoperatively.No postoperative loosening or migrating of the prosthesis was noted.Conclusion It was demonstrated that the standardized and normalized operative techniques as well as operative tools closely matched to the prosthesis could achieve favorable outcomes according to the clinical and radiographic outcomes and overall acceptable cornplication rates in the present study.STAR was a choice for the patients with advanced osteoarthritis,posttraumatic arthritis,rheumatic arthritis and avascular necrosis of the talar body.

Osteoporosis is a metabolic bone disease characterized by decreased bone mass and degenerative changes in the microstructure of bone tissue, leading to increased bone brittleness and fracture risk. Bone fracture after osteoporosis is the most common and serious complication, which often leads to serious consequences in cases of inadequate prevention and late diagnosis. Therefore, more attention should be paid to prevention of osteoporosis and risk assessment of fracture and refracture after osteoporosis. This paper reviews the research progress in risk assessment of fracture and refracture after osteoporosis from the aspects of imaging, clinical manifestations and laboratory examination indexes. In recent years, the imaging methods have developed from dual-energy X-ray absorption, trabecular bone scoring and CT to high resolution peripheral quantitative CT; concern for their clinical manifestations has developed from independent risk factors to fracture risk assessment tools; the laboratory tests have developed from bone turnover markers and serotonin to microRNA. Although these developments have consistently increased the sensitivity of risk assessment for fracture and refracture after osteoporosis, problems still exist and need to be resolved.