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Atesok K, Scott DJ, Hurwitz S, Gross CE. Diagnosis and Management of Periprosthetic Joint Infections After Total Ankle Arthroplasty. J Am Acad Orthop Surg 2024; 32:728-737. [PMID: 38759226 DOI: 10.5435/jaaos-d-23-01266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/14/2024] [Indexed: 05/19/2024] Open
Abstract
Periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a dreaded complication that may lead to catastrophic outcomes. Risk factors include a history of surgery on the operated ankle, low preoperative function scores, diabetes, extended surgical time, and postoperative wound-healing problems. Clinical presentation varies and may include increasing ankle pain and swelling, high temperature, local erythema, wound drainage, and dehiscence. The initial diagnostic evaluation should include plain radiographs, erythrocyte sedimentation rate, C-reactive protein levels, and leukocyte count. In suspected cases with elevated erythrocyte sedimentation rate and C-reactive protein, aspiration of the ankle joint for synovial fluid analysis, Gram staining, and culture should be performed. Antibiotic therapy should be based on the pathogen identified, and the surgical strategy should be determined based on the time lines of PJI. Early PJI can be treated with irrigation and débridement with polyethylene exchange. The surgical treatment of choice for late PJI is two-stage revision arthroplasty, which includes removal of the implant, insertion of an antibiotic spacer, and reimplantation of a TAA. In certain chronic PJI cases, permanent articulating antibiotic spacers can be left in place or an ankle arthrodesis can be performed. Below-knee amputation is considered as the final option after limb-sparing procedures have failed.
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Affiliation(s)
- Kivanc Atesok
- From the Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC (Atesok, Scott, and Gross), Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Hurwitz)
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Abaydi A, Radi J, Tbatou A, Lahrach K, Boutayb F. Tibio-Talo-Calcaneal Arthrodesis: Evaluation of the Effectiveness of a Specific Surgical Technique in 17 Cases. Cureus 2024; 16:e62014. [PMID: 38887747 PMCID: PMC11182152 DOI: 10.7759/cureus.62014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Ankle arthrodesis is a crucial surgical intervention for advanced hindfoot conditions, aiming to restore plantigrade walking and alleviate pain. This study evaluates the effectiveness of a specific surgical approach for tibiotalocalcaneal arthrodesis (TTCA), focusing on rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, and assesses the outcomes of this approach in terms of bone fusion and reduction of postoperative complications. MATERIALS AND METHODS This retrospective analysis includes 17 patients who underwent TTCA in a trauma-orthopedic department over seven years. Data were collected from medical records, the HOSIX software, and patient consultations. Preoperative assessments, surgical techniques, postoperative care, and follow-up evaluations were documented. RESULTS The mean age of patients was 42.4 years, with a male predominance. Surgical indications included post-traumatic arthropathy (53%), inflammatory arthropathy, ankle infectious pathologies, and Charcot foot and ankle prosthesis failures. All patients underwent standard preoperative evaluations and received corticocancellous grafts. An angled retrograde femoral nail in the sagittal plane was used for internal fixation. Postoperative immobilization lasted 6 to 8 weeks, with subsequent rehabilitation. The bone fusion rate was 100%, with a low complication rate (23.5%). DISCUSSION Our study showed a younger patient population with a male predominance, different from some previous studies. Surgical techniques, including the anterior approach combined with a lateral subtalar approach, were consistent with some studies but differed from others. Corticocancellous grafts and the angled retrograde femoral nail in the sagittal plane demonstrated favorable outcomes in terms of fusion. Complication rates were lower compared to some previous reports, highlighting potential improvements in postoperative management. CONCLUSION The surgical approach described for TTCA, emphasizing rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, led to satisfactory bone fusion and reduced postoperative complications. These results underscore the importance of this approach in achieving optimal functional outcomes in ankle arthrodesis.
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Affiliation(s)
- Anass Abaydi
- Orthodontics, University Hospital Center Hassan II, Fès, MAR
| | - Jihad Radi
- Traumatology and Orthopedic Surgery Department A, University Hospital Center Hassan II, Fès, MAR
| | - Amine Tbatou
- Traumatology and Orthopedic Surgery Department A, University Hospital Center Hassan II, Fès, MAR
| | - Kamal Lahrach
- Traumatology and Orthopedic Surgery Department A, University Hospital Center Hassan II, Fès, MAR
| | - Fawzi Boutayb
- Traumatology and Orthopedic Surgery Department A, University Hospital Center Hassan II, Fès, MAR
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3
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Rougereau G, Stiglitz Y, Franqueville C, Bauer T, Hardy A, Gaudot F. Revision of total ankle arthroplasty: Survival and medium-term functional results. Foot Ankle Surg 2024; 30:57-63. [PMID: 37827896 DOI: 10.1016/j.fas.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/20/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The objective of this study was to analyze the results and survivorship of total ankle arthroplasty (TAA) revision surgery with standard (Salto Talaris®) or revision (Salto Talaris XT®) implants. METHODS Between January 2005 and December 2017, all patients undergoing TAA revision at our hospital were included. Indications for revision, type of surgery performed, improvement in function assessed with the AOFAS score, occurrence of complications and implant survival at last follow-up were analyzed. RESULTS In the end, 25 TAA patients who had undergone revision (11 unipolar, 14 bipolar) were included. The mean follow-up time was 5.1 ± 1.9 years. At the last follow-up, function was improved compared to the preoperative AOFAS score (51.3 ± 17.5 vs. 83.5 ± 10.1; p < .001), but not plantar flexion (17.5 ± 5.7 vs. 15.4 ± 7.1; p = 0.28) or dorsal flexion (7 ± 5.6 vs. 8.3 ± 4.9; p = 0.3). Complications occurred in six patients (24 %) that led to reoperation: three infections, one lateral impingement, one implant malposition, and one hindfoot alignment disorder. At the last follow-up, implant survival was 96 %, but the probability of survival without reoperation was 78.7 ± 8.5 % at 4 years. CONCLUSION TAA revision by arthroplasty is feasible, produces good functional results in the medium term, but has a high risk of complications. The challenge of revision TAA is managing the loss of bone stock and anchoring the new implants.
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Affiliation(s)
- Grégoire Rougereau
- Department of Orthopedic Surgery, Hospital Ambroise Paré, University UVSQ, Boulogne-Billancourt, France; Department of Orthopedic Surgery, Hospital Raymond Poincaré, University UVSQ, Garches, France.
| | - Yves Stiglitz
- Department of Orthopedic Surgery, Clinique Victor Hugo, Paris, France
| | - Charles Franqueville
- Department of Orthopedic Surgery, Private Hospital of Vitry, Vitry-sur-Seine, France
| | - Thomas Bauer
- Department of Orthopedic Surgery, Hospital Ambroise Paré, University UVSQ, Boulogne-Billancourt, France
| | - Alexandre Hardy
- Department of Orthopedic Surgery, Clinique du Sport, Paris, France
| | - Fabrice Gaudot
- Department of Orthopedic Surgery, Ramsay Santé, Clinique Jouvenet, Paris, France
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4
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Zunarelli R, Fiore M, Lonardo G, Pace A, Persiani V, De Paolis M, Sambri A. Total Ankle Replacement Infections: A Systematic Review of the Literature. J Clin Med 2023; 12:7711. [PMID: 38137779 PMCID: PMC10743530 DOI: 10.3390/jcm12247711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Periprosthetic infection (PJI) after TAR is a serious complication, often requiring further surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. This systematic review aims to summarize the current evidence on the management of TAR PJI and provide a comprehensive overview of this topic, especially from an epidemiologic point of view. Three different databases (PubMed, Scopus, and Web of Science) were searched for relevant articles, and further references were obtained by cross-referencing. Seventy-one studies met the inclusion criteria, reporting on cases of TAR PJI. A total of 298 PJIs were retrieved. The mean incidence of PJI was 3.8% (range 0.2-26.1%). Furthermore, 53 (17.8%) were acute PJIs, whereas most of them (156, 52.3%) were late PJIs. Most of the studies were heterogeneous regarding the treatment protocols used, with a two-stage approach performed in most of the cases (107, 35.9%). While the prevalence of ankle PJI remains low, it is potentially one of the most devastating complications of TAR. This review highlights the lack of strong literature regarding TAR infections, thus highlighting a need for multicentric studies with homogeneous data regarding the treatment of ankle PJI to better understand outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.Z.); (M.F.); (G.L.); (A.P.); (V.P.); (M.D.P.)
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5
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Abstract
Aims When a total ankle arthroplasty (TAA) fails, it can be converted to a fusion or a revision arthroplasty. Despite the increasing numbers of TAAs being undertaken, there is little information in the literature about the management of patients undergoing fusion following a failed TAA. The primary aim of this study was to analyze the survival of fusions following a failed TAA using a large dataset from the National Joint Registry (NJR). Methods A data linkage study combined NJR and NHS Digital data. Failure of a TAA was defined as a fusion, revision to a further TAA, or amputation. Life tables and Kaplan-Meier graphs were used to record survival. Cox proportional hazards regression models were fitted to compare the rates of failure. Results A total of 131 patients underwent fusion as a salvage procedure following TAA. Their mean age was 65.7 years (SD 10.6) and 73 (55.7%) were male. The mean follow-up was 47.5 months (SD 27.2). The mean time between TAA and fusion was 5.3 years (SD 2.7). Overall, 32 (24.4%) underwent reoperations other than revision and 29 (22.1%) failed. Of these 24 (18.3%) underwent revision of the fusion and five (3.8%) had a below-knee amputation. No patients underwent conversion to a further TAA. Failure usually occurred in the first three postoperative years with one-year survival of fusion being 96.0% (95% confidence interval (CI) 90.7 to 98.3) and three-year survival in 69 patients being 77.5% (95% CI 68.3 to 84.4). Conclusion Salvage fusion after a failed TAA shows moderate rates of failure and reoperations. Nearly 25% of patients required revision within three years. This study is an extension of studies using the same methodology reporting the failure rates and risk factors for failure, which have recently been published, and also one reporting the outcome of revision TAA for a failed primary TAA, using the same methodology, which will shortly be published.
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Affiliation(s)
- Toby Jennison
- Plymouth Hospitals NHS Trust, Plymouth, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew J Goldberg
- Wellington Hospital, London, UK
- UCL Division of Surgery, Royal Free Hospital, London, UK
- Imperial College London, London, UK
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Hur ES, Mehta N, Lee S, Bohl DD. Management of Periprosthetic Bone Cysts After Total Ankle Arthroplasty. Orthop Clin North Am 2023; 54:109-119. [PMID: 36402507 DOI: 10.1016/j.ocl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Modern improvements in total ankle arthroplasty (TAA) have increased the performance of this procedure for treatment of end-stage ankle arthritis. A common finding after TAA is the formation of periprosthetic bone cysts, which can be clinically silent or result in TAA failure. The exact cause of periprosthetic bones cysts has not been established, but major theories are related to osteolysis secondary to implant wear, micromotion, and stress shielding. Treatment can be nonoperative with clinical observation for small, asymptomatic cysts. Large, progressive, and symptomatic cysts often merit surgical treatment with debridement and grafting, revision TAA, or salvage arthrodesis.
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Affiliation(s)
- Edward S Hur
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Simon Lee
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Daniel D Bohl
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA.
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7
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Jennison T, Spolton-Dean C, Rottenburg H, Ukoumunne O, Sharpe I, Goldberg A. The outcomes of revision surgery for a failed ankle arthroplasty. Bone Jt Open 2022; 3:596-606. [PMID: 35880516 PMCID: PMC9350690 DOI: 10.1302/2633-1462.37.bjo-2022-0038.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed. Results Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed. Conclusion Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques. Cite this article: Bone Jt Open 2022;3(7):596–606.
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Affiliation(s)
- Toby Jennison
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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8
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Cifaldi A, Thompson M, Abicht B. Tibiotalocalcaneal Arthrodesis with Structural Allograft for Management of Large Osseous Defects of the Hindfoot and Ankle: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2022; 61:900-906. [PMID: 35585002 DOI: 10.1053/j.jfas.2022.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/26/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
Large osseous defects of the hindfoot and ankle pose a surgical challenge. Tibiotalocalcaneal (TTC) arthrodesis utilizing a structural allograft may be required to fill the osseous void, preserve limb length and achieve fusion. Several authors have reported small case series on this topic, however outcomes have varied and no systematic review of this data has been published to date. The primary aim of this study is to report rates of osseous union, limb salvage and complications in patients undergoing TTC arthrodesis with a structural allograft. A total of 11 publications were identified that met the inclusion criteria. One hundred seventy-five patients were included with a weighted mean age of 60.5 (range 50-72) years and follow-up period of 29.7 (range 3-62) months. Femoral head allograft was the most commonly utilized structural graft and a retrograde intramedullary nail was the most common fixation construct. Results demonstrated an overall union rate of 67.4%, limb salvage rate of 92.5% and complication rate of 26.6%. Allograft-related complications were rare with an allograft fracture rate of 0.1% and allograft collapse rate of 1.2%. There was no significant difference in union rate when using a retrograde intramedullary nail versus a plate construct (p = .9148). TTC arthrodesis with use of a structural allograft is a viable treatment option for limb salvage when faced with complex hindfoot and ankle pathology involving large osseous defects. Despite high rates of radiographic nonunion, this approach can provide patients with a stable and functional limb while avoiding amputation.
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Affiliation(s)
- Andrea Cifaldi
- Podiatric Medicine and Surgery Resident, Gundersen Medical Foundation, La Crosse, WI.
| | - Mitchell Thompson
- Podiatric Medicine and Surgery Resident, Gundersen Medical Foundation, La Crosse, WI
| | - Bradley Abicht
- Department Chair and Attending Staff, Podiatry Department within Orthopaedic Center, Gundersen Health System, La Crosse, WI
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9
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Abstract
Open ankle arthrodesis remains a reliable solution for ankle arthritis, especially in the setting of deformity. Careful preoperative evaluation needs to be performed, both clinically and radiographically. The specific deformity present helps determine the approach used and the fixation choices. Deformity is most commonly seen intraarticularly, though deformity can also be present anywhere along the lower extremity, including compensatory deformity in the foot. Multiple different techniques can be used to address both the deformity and achieve a successful ankle arthrodesis. Patient outcomes reported in the literature are generally good, with high union rates and improved functional outcomes.
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10
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Buchhorn T, Baumbach SF, Böcker W, Szymski D, Polzer H. [Salvage options following failed total ankle arthroplasty]. Unfallchirurg 2022; 125:211-218. [PMID: 35091802 DOI: 10.1007/s00113-022-01141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
The number of patients with osteoarthritis of the ankle, which are treated by arthroplasty, has continuously increased in recent years. The survival time of these implants is far below the results following hip and knee arthroplasty. In some cases a failure rate of approximately 1% per year or a survival rate of 70% after 10 years has been reported. The most frequent reasons for revision of an ankle prosthesis are aseptic loosening, technical implantation errors and persisting pain. For the revision of an ankle prosthesis there are basically two treatment options. For a long time, ankle arthrodesis was considered the gold standard after a failed prosthesis. In recent years, there has been an increasing trend towards re-implantation of an ankle prosthesis, as this preserves the functionality and mobility of the ankle joint as far as possible. Depending on the reason for failure and the size of the bony defect, a decision must be made regarding a one-stage and a two-stage procedure with bone augmentation. This article presents the advantages and disadvantages of arthrodesis and revision arthroplasty after failed primary ankle arthroplasty and highlights the special features of surgery.
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Affiliation(s)
- T Buchhorn
- Sporthopädicum Straubing-Regensburg-Berlin, 94315, Straubing, Deutschland
| | - S F Baumbach
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland
| | - W Böcker
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland
| | - D Szymski
- Sporthopädicum Straubing-Regensburg-Berlin, 94315, Straubing, Deutschland.,Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland
| | - H Polzer
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland.
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11
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Hussain RM. Metallic 3D Printed Total Talus Replacement: A Case Study. J Foot Ankle Surg 2021; 60:634-641. [PMID: 33509721 DOI: 10.1053/j.jfas.2020.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 02/03/2023]
Abstract
Total talar replacement is a viable treatment option for talar injuries and pathologies. We present a single case study of a 73-year-old female with idiopathic necrosis of the talar which was treated with a total talar replacement prosthesis. A patient specific custom talar prosthesis was created using the mirror image of the contralateral healthy talus obtained using a CT scan of the contralateral limb. The patient underwent surgical resection of the pathologic talus with implantation of the custom talar prosthesis. At the 12 month mark the foot function index (FFI) score improved from 95.9% pre-op to 4.7% post op and american orthopedic foot and ankle score 0 pre-op to 94 post op. Further research and longer followup will be needed, but the current results are very favorable.
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Affiliation(s)
- Raafae M Hussain
- Podiatric Surgeon, Complete Foot and Ankle Care of North Texas, Dallas TX
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12
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Alsayel F, Alttahir M, Wiewiorski M, Barg A, Herrera M, Valderrabano V. Two-Staged Revision Total Ankle Arthroplasty Surgery with Primary Total Ankle Arthroplasty System: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00053. [PMID: 33914712 DOI: 10.2106/jbjs.cc.20.00339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Case of a 2-staged revision surgical technique for the treatment of an aseptic total ankle arthroplasty (TAA) loosening: first surgery: removal of the loosened and painful TAA Scandinavian Total Ankle Replacement, with exclusion of infection, and reconstruction of the large bone defect (bone-defect downsizing surgery); proof of successful ankle bone reconstruction by CT-scan imaging; second surgery: implantation of a primary VANTAGE TAA (ankle reconstruction with new primary TAA). CONCLUSION The present case shows the management of a failed TAA with bone defect by performing a 2-step surgical approach: removal of loosened TAA with simultaneous bone stock restoration and then implantation of a new primary TAA. This concept is a possible alternative to a post-TAA ankle arthrodesis or to the use of a TAA revision system.
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Affiliation(s)
- Faisal Alsayel
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mustafa Alttahir
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia
| | - Martin Wiewiorski
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Alexej Barg
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Mario Herrera
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Victor Valderrabano
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland
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13
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Dang LHN, Lee KB. Effect of bone morphogenetic protein-2/hydroxyapatite on ankle fusion with bone defect in a rabbit model: a pilot study. J Orthop Surg Res 2020; 15:366. [PMID: 32859231 PMCID: PMC7455904 DOI: 10.1186/s13018-020-01891-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/13/2020] [Indexed: 12/01/2022] Open
Abstract
Background Revision ankle-fusion surgery after a failure of total ankle arthroplasty has a problem with bone-defect management by implant removal. For the reconstruction of bone defects, autogenous bone often causes minor and major complications. Recombinant human-bone morphogenetic protein-2 (rhBMP-2) plays essential roles in bone regeneration strategies, and hydroxyapatite (HA) is beneficial as the rhBMP-2 carrier. In this study, we evaluate whether rhBMP-2/HA can replace autogenous bone in a rabbit ankle-fusion model with distal tibia bone defect. Methods The bone defect was created in the distal tibia. The ankle fusion was performed by a cannulated screw from lateral malleolus and various treatments on bone defect. Thirty male white New Zealand rabbits were divided into three groups of 10 animals on each group dependent on treatment methods as control group (no treatment into defect), auto-bone group (autogenous bone treatment), and rhBMP-2/HA group (40 μL of 1 μg/mL rhBMP-2/100 μL HA). Bone formation on defect and the union of the ankle joint were evaluated by X-ray, micro-CT, and histological analysis at 8 weeks and 12 weeks, postoperatively. Results Radiographic assessment found the control and auto-bone groups still had the bone defect present, but rhBMP-2/HA group showed complete replacement of the defect with newly formed bone at 12 weeks. Micro-CT showed significantly higher new bone formation within the defect in the rhBMP-2/HA group than in the auto-bone and control groups at 8 weeks (p > 0.05 and p < 0.01, respectively) and 12 weeks (p < 0.05, p < 0.001, respectively). Fusion rate (%) analysis of micro-CT showed a higher percentage of union in the rhBMP-2/HA group than in the auto bone and control groups at 8 weeks (p > 0.05, p < 0.001, respectively) and 12 weeks (p < 0.001 and p < 0.001, respectively). The histological showed the highest osteointegration between distal tibia and talus in the rhBMP-2/HA group at 12 weeks. Conclusions This study indicated that rhBMP-2/HA showed much better bone fusion than did the autogenous bone graft and was effective in promoting fusion rate and improving the quality of the ankle joint fusion.
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Affiliation(s)
- Le Hoang Nam Dang
- Department of Orthopedic Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Hospital, 634-18, Keumam-dong, Jeonju-shi, Jeonbuk, South Korea
| | - Kwang Bok Lee
- Department of Orthopedic Surgery, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Hospital, 634-18, Keumam-dong, Jeonju-shi, Jeonbuk, South Korea.
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Langan T, Lalli TAJ, Smith CN, Wukich DK. Talectomy as Part of Chronic Foot and Ankle Deformity Correction Procedure: A Retrospective Study. J Foot Ankle Surg 2020; 59:16-20. [PMID: 31699585 DOI: 10.1053/j.jfas.2019.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/03/2019] [Accepted: 05/11/2019] [Indexed: 02/03/2023]
Abstract
Severe foot and ankle deformities can be associated with high complication rates and impaired quality of life in patients. Surgical correction using a talectomy procedure has previously been described in many lower extremity pathologies and is a powerful tool for the correction of severe foot and ankle deformity. This study aimed to describe the role of talectomy and the outcomes of this procedure in patients presenting with severe foot and ankle deformity. A review of 45 patients undergoing talectomy by a single surgeon was completed. Data extracted included the cause of deformity, history of infection, body mass index, and relevant comorbidities. Outcome measures of interest were minor or major complications and limb functionality at final follow-up. Statistical analysis was performed by using a Wilcoxon rank sum test and a Fisher exact test looking at variables affecting selected outcome measures. Limb salvage occurred in 38 of 45 patients (84.4%). Patients with an infection history had 89% lower odds of a functional limb at final follow-up (p = .0389). Six of 7 patients (85.7%) who ultimately underwent amputation had a history of prior infection. Women had 8.25 times higher odds of having a functional limb compared with men (p = .047). All 13 patients with major complications had neuropathy (p = .024). Patients with chronic lower extremity deformities can successfully be treated with a talectomy as a part of the reconstructive procedure. This is a challenging patient population that is associated with a high complication rate. Patients with a history of infection should be counseled on the possibility of requiring major amputation.
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Affiliation(s)
- Travis Langan
- Resident, Podiatric Medicine and Surgery Residency Program, Department of Orthopaedics, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Trapper A J Lalli
- Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Clair N Smith
- Clinical Research Associate, Clinical Outcomes Research Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Dane K Wukich
- Professor and Chairman, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Professor, Department of Orthopaedic Surgery, University of Texas Southwestern School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Velasco BT, Briceño J, Miller CP, Ye MY, Savage-Elliott I, Ellington JK, Kwon JY. Peri-implant fractures around hindfoot fusion nails: A systematic literature review and classification system. Injury 2020; 51:1497-1508. [PMID: 32389394 DOI: 10.1016/j.injury.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibio-talo calcaneal (TTC) arthrodesis is increasingly performed for hindfoot arthrosis and other indications. Peri-implant fracture around hindfoot fusion nails has been previously reported and can be problematic to treat given multiple surgical considerations including the status of hindfoot arthrodesis at time of fracture. We present a systematic review of the literature regarding peri-implant fractures around hindfoot fusion nails and propose a classification system to help guide treatment based on findings from the current literature as well as the collective experience of the senior authors. METHODS A review of the literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify clinical investigations in which peri-implant fractures or other hardware failures were observed as complications following TTC arthrodesis using hindfoot nails. The electronic database of PubMed/Medline/Cochrane Library was explored using specific search terms. Inclusion criteria was any clinical investigation that reported on outcomes after TTC arthrodesis using a hindfoot nail in at least one patient. Cadaveric and non-clinical investigations were excluded. RESULTS A total of 36 studies were identified which met inclusion criteria and reported clinical outcomes after TTC arthrodesis using a hindfoot fusion nail. Of the 36 studies, there was a total of 13 intraoperative fractures, 43 tibial stress fractures and 24 peri-implant fractures recorded in 12 of the 36 studies. CONCLUSION Peri-implant fracture following tibio-talo calcaneal arthrodesis using a hindfoot intramedullary nail is an uncommon but problematic condition to treat. General heterogeneity of patients and indications as well as a lack of descriptive detail in the current literature makes meta-analysis difficult. Given the lack of consensus on treatment, a classification system may be helpful to guide clinical practice.
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Affiliation(s)
- Brian T Velasco
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA 18510, United States.
| | - Jorge Briceño
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | - Christopher P Miller
- Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, United States.
| | - Michael Y Ye
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, United States.
| | - Ian Savage-Elliott
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States.
| | - J Kent Ellington
- Department of Orthopaedic Surgery, OrthoCarolina, 250 N Caswell Rd, Charlotte, NC 28207, United States.
| | - John Y Kwon
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States.
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Kruidenier J, van der Plaat LW, Sierevelt IN, Hoornenborg D, Haverkamp D. Ankle fusion after failed ankle replacement in rheumatic and non-rheumatic patients. Foot Ankle Surg 2019; 25:589-593. [PMID: 30321923 DOI: 10.1016/j.fas.2018.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/19/2018] [Accepted: 08/15/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND With longer follow-up, survival rate of total ankle replacements (TAR) diminishes. It is therefore important to have a reliable fall-back option in case of failed TAR. Revision arthroplasty is often impossible because of loss of bonestock or infection. Conversion to ankle fusion is then indicated. We investigated the clinical, radiographic and patient reported results for fusion after failed TAR in a consecutive group of patients. We concentrated on the influence of inflammatory joint disease (IJD) on union rate. METHODS Patient files and radiographic images of 46 consecutive patients (47 ankles) were reviewed. There were 22 patients with IJD. Fixation methods included; anterior plating, blade plate fixation, intramedullary nailing, compression screws and external fixation. Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM) were used to determine patient related outcomes. RESULTS Forty out of 47 ankles (85%) Fused. Union rate in the non-IJD group (96%) was significantly higher compared to the IJD-group (73%, p=0.04). Revisions and complications were more frequent in the IJD group, but numbers were too small to detect a significant difference. Mean PROM scores were: FAOS-symptoms; 68.5, FAOS-pain; 70.3, FAOS-QoL; 43.7, FAOS-ADL; 68.1 and FAAM-ADL; 52.1, with no significant difference between IJD and non-IJD patients. CONCLUSIONS IJD-patients have a higher nonunion rate after ankle fusion for failed TAR. However, patient reported outcome is not significantly different between the two groups. LEVEL OF EVIDENCE IV, retrospective cohort.
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Affiliation(s)
- J Kruidenier
- MC Slotervaart, Department of Orthopedics, Louwesweg 6, 1066EC Amsterdam, Noord-Holland, The Netherlands
| | - L W van der Plaat
- Noordwest Ziekenhuisgroep, Department of Orthopedics, Wilhelminalaan 12, 1815 JD Alkmaar, Noord-Holland, The Netherlands
| | - I N Sierevelt
- MC Slotervaart, Department of Orthopedics, Louwesweg 6, 1066EC Amsterdam, Noord-Holland, The Netherlands
| | - D Hoornenborg
- MC Slotervaart, Department of Orthopedics, Louwesweg 6, 1066EC Amsterdam, Noord-Holland, The Netherlands
| | - D Haverkamp
- MC Slotervaart, Department of Orthopedics, Louwesweg 6, 1066EC Amsterdam, Noord-Holland, The Netherlands.
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Egrise F, Parot J, Bauer C, Galliot F, Kirsch M, Mainard D. Complications and results of the arthrodesis after total ankle arthroplasty failure: a retrospective monocentric study of 12 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:373-381. [PMID: 31563987 DOI: 10.1007/s00590-019-02561-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Total ankle arthroplasty (TAA) has the objective to maintain the range of motion of the tibiotarsal joint and to preserve the nearby joints. However, the complication rate and failures remain quite high after TAA. The main objective of the study was to evaluate the improvement in the functional scores of the tibiotarsal arthrodesis after TAA failure. The secondary objective was to assess the specific complications. MATERIALS AND METHODS This monocentric retrospective series includes 12 patients (nine men, three women, average age 52.5 years) operated between 2003 and 2018. An iliac graft was used in all cases. The arthrodesis was stabilized either by screws or by retrograde nailing. RESULTS The reoperation was due to painful malleolar conflicts or loosening. The AOFAS score increased from 38/100 to 67/100 (51-86) post-operatively. The fusion was acquired at 3.7 months (3-6) except in two cases. DISCUSSION AND CONCLUSION The 83% primary fusion rate is in the low average of the literature and 92% fusion rate in the high average after reoperation. All patients were improved even in two non-unions. The results of this study confirm that the arthrodesis after TAA failure is a reliable alternative to the TAA replacement. However, they are lower than those after a first-line arthrodesis.
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Affiliation(s)
- F Egrise
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France.
| | - J Parot
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - C Bauer
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - F Galliot
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - M Kirsch
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - D Mainard
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
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Escudero MI, Poggio D, Alvarez F, Barahona M, Vivar D, Fernandez A. Tibiotalocalcaneal arthrodesis with distal tibial allograft for massive bone deficits in the ankle. Foot Ankle Surg 2019; 25:390-397. [PMID: 30321970 DOI: 10.1016/j.fas.2018.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to assess the outcomes of distal tibial structural allograft to obtain a stable TTC fusion. METHODS Retrospectively, ten patients were carried out with a minimum one year follow-up. The median age was 72 (33-81). The median BMI was 28 (24-33). Indications for TTC arthrodesis included failed total ankle arthroplasty (n=7 patients), prior nonunion (n=2 patients), and a trauma injury. RESULTS Union rate was 80%. The median initial height of the distal tibial allograft was 19mm (14-24mm). In seven cases the allograft did not lose height. The AOFAS score median was 69 (31-84). SF-12 median physical component was 39 (30-53), and 59 (23-62) for mental component. The VAS median was 2 (0-8). CONCLUSIONS TTC using distal tibial allograft shows a lower rate of collapse than other structural grafts and provides a fusion rate higher or in accordance with the literature. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Mario I Escudero
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; Department of Orthopedics, Hospital Clinico, University of Chile, Santiago 8380456, Chile.
| | - Daniel Poggio
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Fernando Alvarez
- Department of Orthopedics, Hospital San Rafael, Passeig de la Vall d'Hebron, 107, 08035 Barcelona, Spain
| | - Maximiliano Barahona
- Department of Orthopedics, Hospital Clinico, University of Chile, Santiago 8380456, Chile
| | - Diego Vivar
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Alvaro Fernandez
- Department of Orthopedics, Hospital Clinic, Universitat Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain
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Lachman JR, Ramos JA, Adams SB, Nunley JA, Easley ME, DeOrio JK. Revision Surgery for Metal Component Failure in Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011418813026. [PMID: 35097311 PMCID: PMC8500383 DOI: 10.1177/2473011418813026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Metal component failure in total ankle arthroplasty (TAA) is difficult to treat. Traditionally, conversion to an arthrodesis has been advocated. Revision TAA surgery has become more common with availability of revision implants and refinement of bone-conserving primary implants. The goal of this study was to analyze the clinical results and patient-reported outcomes for patients undergoing revision total ankle arthroplasty. Methods: We retrospectively reviewed prospectively collected data on 52 patients with a mean age of 63.5 ± 9.6 years who had developed loosening or collapse of major metal components following primary TAA. These patients were compared to a case-matched control group of 52 primary TAAs performed at the host institution with a minimum of 2 years’ follow-up. Cases of isolated polyethylene exchange, infection, or extra-articular realignment procedures were excluded. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), and pain scores were prospectively collected. Clinical data was collected through review of the electronic medical record to identify reasons for clinical failure, where clinical failure was defined as second revision or conversion to arthrodesis or amputation. Results: The identified causes of failure of primary TAA were aseptic loosening of both components (42%), talar component subsidence/loosening (36%), coronal talar subluxation (12%), tibial loosening (8%), and talar malrotation (2%). Thirty-one patients (59.5%) underwent revision of all components, 20 (38.5%) just the talar and polyethylene components, and one (2%) the tibial and polyethylene components. The average time to revision was 5.5 years ± 5.4 with a follow-up of 3.1 years ± 1.5 after revision. Eleven (21.2%) revision arthroplasties required further surgery: 6 required conversion to arthrodesis and 5 required second revision TAA. Pain scores, SF-36 scores, SMFA scores, and AOFAS Hindfoot scores all improved after revision surgery but never reached the same degree of improvement seen after primary TAA. Conclusions: Clinical and patient-reported outcomes of revision ankle arthroplasty after metal component failure significantly improved after surgery, although the recovery time was longer. In this series, 21.2% of revision TAAs required a second revision TAA or arthrodesis surgery. Various prostheses performed similarly when used for revision surgery. Revision TAA can offer significant improvements postoperatively. Level of Evidence: Level III, therapeutic.
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20
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Lachman JR, Ramos JA, Adams SB, Nunley JA, Easley ME, DeOrio JK. Patient-Reported Outcomes Before and After Primary and Revision Total Ankle Arthroplasty. Foot Ankle Int 2019; 40:34-41. [PMID: 30160185 DOI: 10.1177/1071100718794956] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Studies examining the clinical outcomes of revision total ankle arthroplasty (TAA) are sparse. Revision TAA surgery has become more common with availability of revision implants and refinement of bone-conserving primary implants. In this study, patient-reported results and clinical outcomes were analyzed for a cohort of patients who underwent both primary and revision TAA at a single high-volume institution. METHODS: We retrospectively reviewed prospectively collected data on 29 patients with failed primary total ankle arthroplasty. Cases of isolated polyethylene exchange, infection, or extra-articular realignment procedures were excluded. Patient-reported outcome (PRO) measures and clinical results were reviewed in this longitudinal study. RESULTS: Fifteen patients (51.7%) underwent revision of just the talar and polyethylene components while 13 patients (44.8%) underwent revision of all components. The most common cause was talar subsidence (51.7%). The average time to revision was 3.9 years with a follow-up of 3.2 years after revision, and 3 (10.3%) revision arthroplasties required further surgery; 2 required conversion to arthrodesis and 1 required second revision TAA. Improvements in PROs were better after primary than revision TAA. CONCLUSIONS: Clinical and patient-reported results of revision ankle arthroplasty after metal component failure improved significantly but never reached the improvements seen after primary ankle arthroplasty. In our series, 10.3% of revision TAAs required a second revision TAA or arthrodesis surgery. LEVELS OF EVIDENCE: Therapeutic Level III, comparative series.
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Affiliation(s)
| | - Jania A Ramos
- 2 Duke University School of Medicine, Durham, NC, USA
| | | | | | - Mark E Easley
- 2 Duke University School of Medicine, Durham, NC, USA
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Miller J, Hoang V, Yoon RS, Liporace FA. Staged Treatment of Infected Tibiotalar Fusion Using a Combination Antibiotic Spacer and Antibiotic-Coated Intramedullary Nail. J Foot Ankle Surg 2018. [PMID: 28645549 DOI: 10.1053/j.jfas.2017.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pilon fractures are notoriously difficult injuries to treat. The current published data on salvage procedures after failed pilon fractures includes both total ankle arthroplasty (TAA) and tibiotalar fusion, each with its own specific indications. However, no acceptable treatment algorithm addressing the complications of these limb salvage procedures is available. We present the case of a 23-year-old patient, who sustained a complex pilon fracture after a motor vehicle accident. The patient was referred to our institution after an initial fixation attempt, followed by subsequent failed TAA, which was complicated by an infected fusion attempt. We describe a staged treatment approach to clearing the infection and obtaining the final fusion goals.
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Affiliation(s)
- Justin Miller
- Resident, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ
| | - Victor Hoang
- Medical Student, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ
| | - Richard S Yoon
- Director of Orthopaedic Research, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ
| | - Frank A Liporace
- Chairman, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ.
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Revision Total Ankle Replacement in the Setting of Significant Bone Loss. TECHNIQUES IN FOOT AND ANKLE SURGERY 2018. [DOI: 10.1097/btf.0000000000000189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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DeFontes KW, Vaughn J, Smith J, Bluman EM. Tibiotalocalcaneal Arthrodesis With Bulk Talar Allograft for Treatment of Talar Osteonecrosis. Foot Ankle Int 2018. [PMID: 29542351 DOI: 10.1177/1071100718761036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
UNLABELLED Talar body osteonecrosis can be a devastating, painful condition that is difficult to manage surgically when conservative treatments have failed. With early disease, nonoperative treatments can prolong the need for operative correction in the young patient. Later stage disease with extensive involvement may require a tibiotalocalcaneal (TTC) arthrodesis to retain functionality of the limb. This situation frequently requires a structural bone graft. Using the technique described in this article, the void resulting from collapse of the talar body is filled with talar allograft, which offers a more anatomic and structurally rigid construct than previously described methods using an allograft femoral head. We have found this technique to be more resilient and successful than other methods. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
| | - Joshua Vaughn
- 1 Brigham & Women's Faulkner Hospital, Boston, MA, USA
| | - Jeremy Smith
- 1 Brigham & Women's Faulkner Hospital, Boston, MA, USA
| | - Eric M Bluman
- 1 Brigham & Women's Faulkner Hospital, Boston, MA, USA
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The AES total ankle arthroplasty analysis of failures and survivorship at ten years. INTERNATIONAL ORTHOPAEDICS 2017; 41:2525-2533. [PMID: 28871360 DOI: 10.1007/s00264-017-3605-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AES mobile-bearing total ankle replacement was developed from the Buechel Pappas model. It was withdrawn in 2009, after identification of a higher than expected complication rate. The purpose of the current study was to analyse clinical outcomes, failures and survival of the initial series of 50 AES published in 2009. METHODS In this single-centre continuous prospective study (2003-2006), 50 AES prostheses were included. Pre-operative osteoarthritis was mainly post-traumatic (50%) and secondary to instability (36%). All patients were assessed with clinical and radiographic follow-up at six months, one year, two years and every two to three years thereafter. A CT-scan was systematically performed before procedure, and at two years, five years and ten years. At last follow-up, all patients with TAR had a functional (SF 36, AOFAS) and clinical assessment. All complications or surgical events were analysed. RESULTS The mean follow-up was ten ± two years (range, 9-13). The mean AOFAS score was 75 points (range, 26-100). The mean SF 36 score was 69 points (range, 35-97). There was a significant deterioration in AOFAS score at five years and at last follow-up (p < 0.05). Fifteen TARs underwent reoperation for cyst curettage-graft because of development of periprosthetic lesions. Six of them ended up with prosthesis removal-arthrodesis. At the last follow-up, 14 TARs were removed for arthrodesis. Of the 30 prostheses seen at last follow-up, four are awaiting prosthesis removal-arthrodesis and one for cyst curettage-graft. The ten year survivorships free of any prosthesis removal or arthrodesis and free of any reoperation were 68% (95% CI, 55-85) and 57% (95% CI, 44-74), respectively. CONCLUSION Our data suggested a high rate of reoperation. Overall ten year survival was lower than with other designs, particularly due to cyst lesions. LEVEL OF EVIDENCE Level IV, prospective case series.
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25
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Tricot M, Deleu PA, Detrembleur C, Leemrijse T. Clinical assessment of 115 cases of hindfoot fusion with two different types of graft: Allograft+DBM+bone marrow aspirate versus autograft+DBM. Orthop Traumatol Surg Res 2017; 103:697-702. [PMID: 28416462 DOI: 10.1016/j.otsr.2017.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 02/13/2017] [Accepted: 03/02/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Nonunion is a common complication (15%) of hindfoot and ankle arthrodesis. Autograft can improve the fusion rate because of its osteoconductive, osteoinductive and osteogenic properties. However, autograft harvesting is a source of morbidity. One alternative is to combine allograft with demineralized bone matrix (DBM) and iliac bone marrow aspirate (BMA). This combination graft has similar biological properties to healthy bone. When used alone, allograft has osteoconductive and sometimes structural properties. DBM provides osteoinduction and improves the osteconductivity. BMA adds cells and thereby osteogenic potential. HYPOTHESIS Given its intrinsic properties, allograft-DBM-BMA is as effective as autograft-DBM treatment while simplifying the clinical practice. MATERIAL AND METHODS One hundred and fifteen cases of ankle and hindfoot arthrodesis were studied in 82 patients divided in two groups: autograft-DBM vs allograft-DBM-BMA. Treatment effectiveness was assessed using clinical (time to fusion, fusion rate) and radiological (trabecular bone bridge, disappearance of joint space) criteria. A CT scan was done in 60% of cases when fusion could not be confirmed using the clinical and radiological criteria. RESULTS There was no significant difference between the two groups in terms of fusion rate, time to fusion, number of heterotopic ossifications, revision rate and quantity of DBM used. The nonunion rate was 18% in the autograft group and 13% in the allograft group. The infection rate was 11% in the autograft and 4% in the allograft group. DISCUSSION Allograft-DBM-BMA is an alternative to autograft-DBM that provides similar effectiveness without increasing the number of nonunion or complications. Osteonecrosis and surgical revision are risk factors. LEVEL OF EVIDENCE III retrospective study.
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Affiliation(s)
- M Tricot
- Service d'orthopédie et de traumatologie de l'appareil locomoteur, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Bruxelles, Belgium.
| | - P-A Deleu
- Foot and Ankle Institute, 5, avenue Ariane, 1200 Bruxelles, Belgium
| | - C Detrembleur
- Université catholique de Louvain, pôle de recherche CARS, institut de recherche expérimentale et clinique, 53, avenue Mounier, 1200 Bruxelles, Belgium
| | - T Leemrijse
- Foot and Ankle Institute, 5, avenue Ariane, 1200 Bruxelles, Belgium
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26
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Abstract
Component subsidence has been found to be the top complication that leads to failure of the total ankle arthroplasty (TAA). The cause of subsidence formation is unclear, and is multifactorial. Talar subsidence is more frequently met than tibial subsidence, and the subsequent big bone loss is demanding to handle. As a revision treatment option, neither a revision TAA nor a salvage ankle and/or hindfoot arthrodesis procedure is easy to perform or can obtain a definite outcome. The Salto XT can be used to treat most of the TAA systems available for use in the United States with acceptable short-term outcomes.
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Affiliation(s)
- Shu-Yuan Li
- The Foot and Ankle Association, Inc., 1209 Harbor Island Walk, Baltimore, MD 21230, USA.
| | - Mark S Myerson
- The Foot and Ankle Association, Inc., 1209 Harbor Island Walk, Baltimore, MD 21230, USA
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Alrashidi Y, Galhoum AE, Wiewiorski M, Herrera-Pérez M, Hsu RY, Barg A, Valderrabano V. How To Diagnose and Treat Infection in Total Ankle Arthroplasty. Foot Ankle Clin 2017; 22:405-423. [PMID: 28502355 DOI: 10.1016/j.fcl.2017.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Periprosthetic infection after total ankle arthroplasty (TAA) is a serious complication, often requiring revision surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. Risk factors for periprosthetic ankle infection include prior surgery at the site of infection, low functional preoperative score, diabetes, and wound healing problems. The clinical presentation of patients with periprosthetic ankle joint infection can be variable and dependent on infection manifestation: acute versus chronic. The initial evaluation in patients with suspected periprosthetic joint infections should include blood tests: C-reactive protein and erythrocyte sedimentation rate. Joint aspiration and synovial fluid analysis can help confirm suspected periprosthetic ankle infection.
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Affiliation(s)
- Yousef Alrashidi
- Orthopaedic Department, College of Medicine, Taibah University, P.O. Box 30001, Almadinah Almunawwarah 41411, Kingdom of Saudi Arabia
| | - Ahmed E Galhoum
- Nasser Institute for Research and Treatment, Cairo, Egypt; Department of Orthopaedics and Traumatology, Swiss Ortho Center, Schmerzklinik Basel, Hirschgässlein 15, Basel 4010, Switzerland
| | - Martin Wiewiorski
- Orthopaedic and Trauma Department, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Mario Herrera-Pérez
- Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Calle El Pilar 50 4 piso, 38002 Tenerife, Spain
| | - Raymond Y Hsu
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Victor Valderrabano
- Orthopaedic Department, Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, Basel 4010, Switzerland.
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Custom-Made Alumina Ceramic Total Talar Prosthesis for Idiopathic Aseptic Necrosis of the Talus: Report of Two Cases. Case Rep Orthop 2017. [PMID: 28634561 PMCID: PMC5467319 DOI: 10.1155/2017/8290804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Two women aged 65 years and 78 years presented to our center with idiopathic necrosis of the talus. In both cases, imaging examinations showed collapse and sclerotic changes of the talar body caused by the necrosis. Both women underwent resection and placement of a third-generation custom-made alumina ceramic total talar prosthesis. Immobilization of the ankle in a short-leg cast for 3 weeks was followed by early rehabilitation. One year and 6 months after surgery, both women were able to walk without pain. Their Japanese Society for Surgery of the Foot ankle-hindfoot scale scores improved from 22 and 29/100 points to 90 and 95/100 points, respectively. To the best of our knowledge, the successful treatments of these two rare cases of idiopathic necrosis of the talus are among only a few reported cases of using a third-generation alumina ceramic prosthesis.
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Aseptische Lockerung einer OSG-Endoprothese. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:236-252. [DOI: 10.1007/s00064-017-0500-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/29/2016] [Accepted: 11/15/2016] [Indexed: 12/30/2022]
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[Aseptic loosening of total ankle replacement and conversion to ankle arthrodesis]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:207-219. [PMID: 28444407 DOI: 10.1007/s00064-017-0492-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/25/2017] [Accepted: 02/12/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To remove loosened prosthesis components, to perform augmentation, to address osseous defects, to perform neutrally aligned ankle arthrodesis, and to achieve postoperative pain relief. INDICATIONS Symptomatic, aseptic loosening of total ankle replacement (TAR) with/without substantial bone defect of the tibial and/or talar bone stock. CONTRAINDICATIONS General surgical or anesthesiological risks, periprosthetic infection, local or systemic infection, nonmanageable soft tissue problems. SURGICAL TECHNIQUE Removal of both prosthesis components using the previous incision (mostly using anterior ankle approach). Careful debridement of bone stock at the tibial and talar side. Osseous augmentation of defects using autologous or homologous cancellous bone, if needed, using structural allografts. POSTOPERATIVE MANAGEMENT A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts on postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot or cast for 6-8 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually after progressive osseous healing has been confirmed. RESULTS Between January 2007 and December 2012, ankle arthrodesis was performed in 9 patients with failed TAR (6 men and 3 women, mean age 56.4 ± 7.0 years, range 47.8-66.0 years). The mean time between the initial TAR and revision surgery was 4.5 ± 2.4 years (range 1.2-7.9 years). In one patient irrigation and debridement was performed due to superficial wound infection. Another patient had a delayed osseous healing 11 months after the revision surgery.
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Georgiannos D, Lampridis V, Bisbinas I. Fragility fractures of the ankle in the elderly: Open reduction and internal fixation versus tibio-talo-calcaneal nailing: Short-term results of a prospective randomized-controlled study. Injury 2017; 48:519-524. [PMID: 27908492 DOI: 10.1016/j.injury.2016.11.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/16/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of ankle fractures in the elderly remains unpredictable, secondary to their various co-morbidities. Although tibiotalocalcaneal (TTC) nailing has been an effective option for ankle arthrodesis due to ankle arthritis or Charcot arthropathy there are few reports regarding the use of TTC nail for the treatment of ankle fractures. PURPOSE Aim of this study was to compare the results of ORIF versus TTC nailing for the treatment of unstable ankle fractures in the elderly. We hypothesized that the elderly may benefit from TTC nailing, as it allows the patient to be mobilized immediately after surgery and minimizes the risk of wound or bone problems. PATIENTS AND METHODS This was a prospective, randomized-controlled, comparative study. Between 2009 and 2015, 43 patients were treated with a TTC nail (Group A) and 44 with ORIF (Group B). The Olerud-Molander ankle score was obtained and intraoperative-postoperative complications, length of hospital stay, mobility status and reoperation rate were recorded. The nail fixation was performed with the TrigenR hindfoot nail after closed reduction. ORIF was performed, using a 1/3 tubular plate and 3.5mm screws for the lateral malleolus and two 4.0 mm cannulated screws for the medial. RESULTS Mortality rate at one year was 13.9% for Group A and 18.1% for Group B. Mean follow-up was 14 months (12-18m). There were no intraoperative complications. Three complications in Group A (8.1%) and twelve (33.3%) in Group B were encountered postoperatively (p<0.05). There was significant shorter hospital stay in Group A (5.2±3.1d) than in Group B (8.4±5.2d). In Group A, 28 patients returned to their pre-injury mobility status (75.6%) while 9 declined one level of the mobility scale (24.3%). In Group B, 26 patients remained at the same mobility level (72.2%) and 10 declined one level (27.7%). There was no significant difference between the postoperative OMAS scores in the two Groups (56.9±9.85 and 56.6±9.3 respectively). CONCLUSIONS We believe that TTC nailing is a safe and effective method of treatment of unstable ankle fractures in the elderly because it has a low risk of complications and restores function and mobility allowing an immediate return to full weight-bearing.
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Affiliation(s)
- D Georgiannos
- 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Greece.
| | - V Lampridis
- 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Greece
| | - I Bisbinas
- 1st Orthopaedic Department, 424 Military General Hospital, Thessaloniki, Greece
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Abstract
Bone graft is a common adjunct procedure in orthopedic surgery used for fusions, fracture repair, and the reconstruction of skeletal defects in the foot and ankle. Autologous graft, or autograft, involves the transport of bone from a donor site to another location in the same patient. It is considered by many to be the gold standard of bone grafting, as it is provides all biologic factors required for functional graft. Further, autograft is 100% histocompatible with no risk of disease transmission.
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Iwata T, Ito H, Furu M, Ishikawa M, Azukizawa M, Yoshitomi H, Fujii T, Akiyama H, Matsuda S. Subsidence of total ankle component associated with deterioration of an ankle scale in non-inflammatory arthritis but not in rheumatoid arthritis. Mod Rheumatol 2016; 27:417-424. [DOI: 10.1080/14397595.2016.1220049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Takahiro Iwata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
| | - Moritoshi Furu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
- Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
| | - Masahiro Ishikawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
- Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
| | - Masayuki Azukizawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
| | - Hiroyuki Yoshitomi
- Department of Tissue Regeneration, The Institute for Frontier Medical Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan, and
| | - Takayuki Fujii
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan,
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Kamrad I, Henricson A, Magnusson H, Carlsson Å, Rosengren BE. Outcome After Salvage Arthrodesis for Failed Total Ankle Replacement. Foot Ankle Int 2016; 37:255-61. [PMID: 26582180 DOI: 10.1177/1071100715617508] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In cases with total ankle replacement (TAR) failure, a decision between revision TAR and salvage arthrodesis (SA) must be made. In a previous study, we analyzed revision TAR and found low functional outcome and satisfaction. The aims of the current study were to analyze SA concerning failure rate and patient-related outcome measures (PROMs). METHODS Until September 2014, a total of 1110 primary TARs were recorded in the Swedish Ankle Registry. Of the 188 failures, 118 were revised with SA (and 70 with revision TAR). Patient- and implant-specific data for SA cases were analyzed as well as arthrodesis techniques. Failure of SA was defined as repeat arthrodesis or amputation. Generic and region-specific PROMs of 68 patients alive with a solid unilateral SA performed more than 1 year before were analyzed. RESULTS The first-attempt solid arthrodesis rate of SA was 90%. Overall, 25 of 53 (47%) patients were very satisfied or satisfied. Mean Self-reported Foot and Ankle Score (SEFAS) was 22 (95% confidence interval 20-24), Euro Qol-5 Dimensions 0.57 (0.49-0.65), Euro Qol-Visual Analogue Scale 59 (53-64), Short Form-36 physical 34 (31-37) and mental 50 (46-54). The scores and satisfaction were similar to those after revision TAR but the reoperation rate was significantly lower in SA (P < .05). CONCLUSION Salvage arthrodesis after failed TAR had a solid arthrodesis rate of 90% at first attempt, but similar to revision TAR, less than 50% of the patients were satisfied and the functional scores were low. Until studies show true benefit of revision TAR over SA, we favor SA for failed TAR. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ilka Kamrad
- Department of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Anders Henricson
- Department of Orthopedics, Falu Central Hospital, and Center of Clinical Research Dalarna, Falun, Sweden
| | - Håkan Magnusson
- Department of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Åke Carlsson
- Department of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Department of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö, Sweden
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Abstract
Tibiotalocalcaneal fusion is an effective salvage procedure for combined end-stage ankle and subtalar arthrosis and for the management of severe planar deformities of the ankle and hindfoot. Although the procedure results in a rigid ankle and hindfoot, it is often the only means of providing patients with a stable and painless foot and ankle for ambulation. Some patients who require the procedure have substantial bone loss that can be managed with a variety of autograft and allograft options. Options for tibiotalocalcaneal fixation include both internal and external devices, the selection of which depends on the underlying pathology, amount of bone loss, and type of bone graft selected. Relatively high complication rates associated with tibiotalocalcaneal fusion have been reported, with complications ranging from superficial infection to ultimate amputation; however, proper patient selection and careful graft and fixation planning can minimize the postoperative complications of the procedure.
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Barg A, Wimmer MD, Wiewiorski M, Wirtz DC, Pagenstert GI, Valderrabano V. Total ankle replacement. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:177-84. [PMID: 25837859 DOI: 10.3238/arztebl.2015.0177] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND About 1% of adults suffer from painful osteoarthritis of the ankle. The current literature contains no information on the percentage of such patients who derive long-term relief of symptoms from conservative treatment. Advanced ankle osteoarthritis can be treated with non-joint-preserving measures, such as total ankle replacement and ankle fusion. METHODS This review is based on selected relevant publications, guidelines from Germany and abroad, and the authors' personal experience. RESULTS Before surgery is considered, conservative measures such as physiotherapy and orthopedic aids should be used to the fullest possible extent. No randomized trials have yet been published comparing total ankle replacement with ankle fusion. Total ankle replacement with newer types of prosthesis yields good to very good intermediate-term and long-term results, with mean success rates of up to 90% at 10 years (range, 68-100%). Independent risk factors for the failure of ankle replacement are age over 70 years (odds ratio [OR] 3.84), primary osteoarthritis (OR 7.19), post-traumatic osteoarthritis (OR 6.2), and type of prosthesis (e.g., single hydroxyapatite coating: OR 15.04). The average range of motion of the replaced ankle joint is 25° to 30°, with values as high as 60°. CONCLUSION Total ankle replacement is a good treatment option for complete, end-stage ankle arthritis. It can restore joint function and make the patient mobile with little or no pain. There are, however, many contraindications to be taken into account. There is a need for further studies of the biomechanics of arthritic and replaced ankle joints and for long-term follow-up studies of total ankle replacement.
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Affiliation(s)
- Alexej Barg
- Shared authorship: Barg and Wimmer have equally contributed to the article, Department of Orthopaedics, University of Utah, USA, Department of Orthopedic and Trauma Surgery, University Hospital Bonn, Osteoarthritis Research Center Basel, University Hospital Basel, Switzerland, Department of Orthopedics and Traumatology, Schmerzklinik Basel, Switzerland
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Lareau CR, Deren ME, Fantry A, Donahue RMJ, DiGiovanni CW. Does autogenous bone graft work? A logistic regression analysis of data from 159 papers in the foot and ankle literature. Foot Ankle Surg 2015; 21:150-9. [PMID: 26235852 DOI: 10.1016/j.fas.2015.03.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/25/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND While autogenous cancellous iliac crest bone graft is the gold standard for foot and ankle surgery, it lacks Level I evidence. Although one third of all graft cases performed in the United States today rely on allograft, some surgeons believe no graft is necessary. We hypothesized that a systematic review of the foot and ankle literature would reveal that (1) autogenous bone graft during foot and ankle arthrodesis would demonstrate healing rates that were superior to the use of either using allograft or no bone graft at all, and (2) these differences would be even more dramatic in patients having risk factors that impair bone healing. To our knowledge, neither of these assessments to date has ever been performed with this body of literature. The goal of this study was to review the use and union rates of bone graft during foot and ankle arthrodesis and determine if autogenous bone graft was superior. METHODS A literature search was performed to include articles between 1959 and 2012 using autograft, allograft, and/or no bone graft for foot and/or ankle arthrodesis. Case reports involving fewer than four patients, investigations failing to incorporate outcome data, those involving orthobiologic augmentation, and those including vascularized graft, xenograft, or pediatric patients were excluded. Recorded search results included patient demographics, comorbidities, pre-operative diagnosis, surgical procedure, bone graft type and indication, union rate, method of fixation, patient satisfaction, all outcome scores, definition of healing/success, and any listed complications including revision. Final data were stratified based upon the type of graft material. RESULTS This search generated 953 related articles, of which 159 studies (5327 patients) met inclusion criteria. The majority (153/159) were retrospective case series. Systematic review demonstrated a trend toward higher union rates for cancellous autograft (OR 1.39, p=0.11), structural autograft (OR 1.52, p=0.09), and cancellous allograft (OR 1.31, p=0.52) relative to no graft material, but none reached statistical significance. Compared to no graft, structural allograft trended toward worse performance (OR 0.62, p=0.17). The overall probability of union was 93.7% for cancellous autograft, 94.2% for structural autograft, 93.3% for cancellous allograft, 91.4% for no graft, and 86.9% for structural allograft. When only comparing the 19 papers that included a no graft arm (91.9% union rate), data revealed the highest union using cancellous autograft (95.1%, OR 1.73, p=0.09) and structural autograft (96.3%, OR 2.33, p=0.06) while only 76% for structural allograft. No significant statistical association existed between union rates and other recorded variables. CONCLUSION Systematic analysis of bone graft use in foot and ankle fusions favors the use of autograft and cancellous allograft for optimized healing rates, although no differences were statistically significant. If we assume that graft material been chosen for more complex procedures having lower anticipated union rates, then these data lend further support to the use of autograft and cancellous allograft. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Craig R Lareau
- Department of Orthopaedics, OrthoCarolina Foot and Ankle Institute, Charlotte, NC, United States
| | - Matthew E Deren
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, United States
| | - Amanda Fantry
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, United States.
| | - Rafe M J Donahue
- Department of Biostatistics, Vanderbilt University School of Medicine, 1161 21st Avenue South S-2323 Medical Center North, Nashville, TN 37232, United States
| | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 3300, 3F, Boston, MA 02114, United States
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Kamrad I, Henricsson A, Karlsson MK, Magnusson H, Nilsson JÅ, Carlsson Å, Rosengren BE. Poor prosthesis survival and function after component exchange of total ankle prostheses. Acta Orthop 2015; 86:407-11. [PMID: 25673048 PMCID: PMC4513593 DOI: 10.3109/17453674.2015.1018760] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE In failed total ankle replacements (TARs), fusion is often the procedure of preference; the outcome after exchanging prosthetic components is debated. We analyzed prosthetic survival, self-reported function, and patient satisfaction after component exchange. Patients and methods We identified patients in the Swedish Ankle Registry who underwent exchange of a tibial and/or talar component between January 1, 1993 and July 1, 2013 and estimated prosthetic survival by Kaplan-Meier analysis. We evaluated the patient-reported outcome measures (PROMs) SEFAS, EQ-5D, EQ-VAS, SF-36, and patient satisfaction by direct questions. RESULTS 69 patients underwent revision TAR median 22 (0-110) months after the primary procedure. 24 of these failed again after median 26 (1-110) months. Survival analysis of revision TAR showed a 5-year survival rate of 76% and a 10-year survival of 55%. 29 patients with first revision TAR in situ answered the PROMs at mean 8 (1-17) years after revision and had the following mean scores: SEFAS 22, SF-36 physical 37 and mental 49, EQ-5D index 0.6, and EQ-VAS 64. 15 of the patients were satisfied, 5 were neither satisfied nor dissatisfied, and 9 were dissatisfied. INTERPRETATION Revision TAR had a 10-year survival of 55%, which is lower than the 10-year survival of 74% for primary TAR reported from the same registry. Only half of the patients were satisfied. Future studies should show which, if any, patients benefit from revision TAR and which patients should rather be fused directly.
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Affiliation(s)
- Ilka Kamrad
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
| | - Anders Henricsson
- Department of Orthopedics, Falun Central Hospital and Centre for Clinical Research Dalarna, Falun, Sweden
| | - Magnus K Karlsson
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
| | - Håkan Magnusson
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
| | - Jan-Åke Nilsson
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
| | - Åke Carlsson
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
| | - Björn E Rosengren
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
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Horisberger M, Henninger HB, Valderrabano V, Barg A. Bone augmentation for revision total ankle arthroplasty with large bone defects. Acta Orthop 2015; 86:412-4. [PMID: 25619728 PMCID: PMC4513594 DOI: 10.3109/17453674.2015.1009673] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Monika Horisberger
- Department of Orthopedic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Heath B Henninger
- Department of Orthopedics, Harold K Dunn Orthopedic Research Laboratory, University of Utah, Salt Lake City, UT, USA
| | - Victor Valderrabano
- Department of Orthopedic Surgery, University Hospital of Basel, Basel, Switzerland
| | - Alexej Barg
- Department of Orthopedics, University of Utah, Salt Lake City, UT, USA
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Gross C, Erickson BJ, Adams SB, Parekh SG. Ankle arthrodesis after failed total ankle replacement: a systematic review of the literature. Foot Ankle Spec 2015; 8:143-51. [PMID: 25561701 DOI: 10.1177/1938640014565046] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE As the number of total ankle replacements (TARs) performed has risen, so has the need for revision. The purpose of this investigation was to perform a systematic review of clinical outcomes following a salvage ankle arthrodesis from a failed TAR to identify patient- and technique-specific prognostic factors and to determine the clinical outcomes and complications following an ankle arthrodesis for a failed TAR. METHODS We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for studies that analyzed ankle fusion after failed TAR with a minimum follow-up of 1 year. RESULTS We included 16 studies (193 patients). The majority of patients (41%) underwent the index TAR for rheumatoid arthritis. The majority of these revision surgeries were secondary to component loosening, frequently of the talar component (38%). In the cases that were revised to an ankle arthrodesis, 81% fused after their first arthrodesis procedure. The intercalary bone graft group and the blade plate group had the highest rate of fusion after the first attempt at fusion at 100%, whereas the tibiotalocalcaneal fusion with cage group had the lowest fusion rate at 50%. The overall complication rate was 18.2%, whereas the overall nonunion rate was 10.6%. CONCLUSION A salvage ankle arthrodesis for a failed TAR results in favorable clinical end points and overall satisfaction at short-term follow-up if the patients achieve fusion. The bone graft fusion and blade plate group resulted in the highest first-attempt fusion rate, with a low complication rate. Future studies should include prospective, comparative control or surgical groups and use standardized outcome measurements that will make direct comparisons easier. LEVELS Level IV: Systematic Review of Level IV Studies.
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Affiliation(s)
- Christopher Gross
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP)
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Abstract
BACKGROUND Although newer generations of total ankle arthroplasty designs have better clinical outcomes, failure due to aseptic loosening remains a frequent major complication. Arthrodesis is the most common salvage procedure for a failed total ankle replacement. There are several arthrodesis techniques each with its advantages and disadvantages. We present a technique of ankle arthrodesis for failed total ankle replacements using tantalum Trabecular Metal™ (Zimmer, Warsaw, IN) with internal fixation, thus sparing the subtalar joint. METHODS Three patients who had undergone arthrodesis for a failed total ankle replacement using tantalum Trabecular Metal were retrospectively reviewed. The mean follow-up period was 57 (range, 31-86) months. The mean age at ankle arthroplasty was 57 (range, 33-72) years and at ankle arthrodesis was 63 (range, 44-74) years. The mean time from arthroplasty to arthrodesis was 7 (range, 2-11) years. RESULTS The American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 30.7 (range, 20-39) preoperatively to 72.7 (range, 65-77) postoperatively at the time of last follow-up. Arthrodesis was achieved at a mean of 3 months, and there were no complications. CONCLUSION The technique described has several advantages when compared to other methods of salvage ankle arthrodesis. The subtalar joint is not included in the fusion unless it is degenerative and symptomatic. Height of the ankle is maintained throughout the fusion process. Furthermore, Trabecular Metal is abundantly available; it avoids donor site morbidity and eliminates the risk of transmissible diseases.
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Palmanovich E, Brin YS, Ben David D, Massarwe S, Stern A, Nyska M, Hetsroni I. Use of a spinal cage for creating stable constructs in ankle and subtalar fusion. J Foot Ankle Surg 2015; 54:254-7. [PMID: 25631194 DOI: 10.1053/j.jfas.2014.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Indexed: 02/03/2023]
Abstract
In complicated foot surgery with reconstruction of the hindfoot, a gap will sometimes be present between the bones that must be filled and stabilized. Bone grafting with structural bone graft is 1 alternative; however, it can collapse and must be stabilized with screws or a nail. A locking intramedullary nail can be used but could lead to nonunion owing to distraction. Newer nails include a compression device but that can result in shortening. We developed a technique that includes distraction of the fusion area with a spinal cage and then compression of the construct by inserting a compression screw through the cage. We present our experience with this technique.We reviewed the data from 7 patients who had undergone surgery using this technique. The technique included distraction of the fusion area and insertion of a titanium cylindrical spinal cage filled with autologous cancellous bone graft. A cannulated compression screw was then inserted through the cage, creating compression of the fusion area against the cage and achieving stabilization of the fusion area. Postoperatively, a non-weightbearing cast was applied for 3 months, followed by a full weightbearing cast until radiographic fusion was apparent. Complete radiographic union was observed in all 7 patients within 6 to 12 months postoperatively. At the latest follow-up visit, the mean American Orthopaedic Foot and Ankle Society scale score was 54 ± 16 (range 30 to 71) points. The use of a cylindrical titanium cage with a local bone graft and stabilization by distraction and compression provided a stable construct, avoided shortening, and led to good fusion. In addition, donor site complications and unpredictable strength loss and lysis of bone allograft were avoided.
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Affiliation(s)
- Ezequiel Palmanovich
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel.
| | - Yaron S Brin
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Dror Ben David
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Sabri Massarwe
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Abraham Stern
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Meir Nyska
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Iftach Hetsroni
- Orthopedic Surgeon, Department of Orthopaedic Surgery, Meir General Hospital, Kfar-Saba, Israel; Orthopedic Surgeon, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
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Santos ALG, Demange MK, Prado MP, Fernandes TD, Giglio PN, Hintermann B. Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm. Rev Bras Ortop 2014; 49:565-72. [PMID: 26229863 PMCID: PMC4487502 DOI: 10.1016/j.rboe.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022] Open
Abstract
The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest among young individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients' quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament stability and age. The treatment algorithm is divided into non-surgical therapeutic methods and options for surgical treatment. Joint preservation, joint replacement and arthrodesis surgical procedures have precise indications. This article presents a review on this topic and a proposal for a treatment algorithm for this disease.
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Affiliation(s)
- Alexandre Leme Godoy Santos
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Marco Kawamura Demange
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Marcelo Pires Prado
- Orthopedics and Rehabilitation Center, Hospital do Coração, São Paulo, SP, Brazil
| | - Tulio Diniz Fernandes
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Pedro Nogueira Giglio
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Beat Hintermann
- Department of Orthopedics, Kantonsspital, Liestal, Switzerland
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Lesão de cartilagem e osteoartrose do tornozelo: revisão da literatura e algoritmo de tratamento. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.10.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Dalat F, Trouillet F, Fessy MH, Bourdin M, Besse JL. Comparison of quality of life following total ankle arthroplasty and ankle arthrodesis: Retrospective study of 54 cases. Orthop Traumatol Surg Res 2014; 100:761-6. [PMID: 25306302 DOI: 10.1016/j.otsr.2014.07.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/20/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The benefit of ankle arthroplasty compared to arthrodesis continues to be debated, but the quality of life after these two interventions has rarely been assessed. We conducted a case-control study to compare quality of life and functional and athletic ability. HYPOTHESIS Functional results, athletic ability, and quality of life after total ankle arthroplasty (TAA) are better than after ankle arthrodesis. MATERIAL AND METHODS Two continuous series of 59 TAAs and 46 arthrodeses (operated on between 1997 and 2009) were evaluated retrospectively using a questionnaire including the functional items of the AOFAS score, the Foot Function Index (FFI) score, the Foot Ankle Ability Measure (FAAM), and the SF-36. RESULTS Eighty-three responses (79% of the overall series) were matched in two groups: 32 TAAs [age at the intervention, 51.4years (range, 21-63years); follow-up, 52.2months (range, 30-146months); age at revision, 55.8years (range, 26-67years); BMI, 27.7 (range, 21.7-36.7)] and 22 arthrodeses [age at intervention, 50.1years (range, 24-72years); follow-up 57.9months (range, 12-147months); age at revision 54.9 years (range, 31-75years); BMI, 26.8 (range, 17.6-37)] (NS on all items between the two groups). The pain results were better after TAA, but with no statistically significant difference: AOFAS pain, (/40) 28.1±8.2 vs. 24.5±9.6; FFI pain, 16.6±18.8 vs. 24.3±21.5. The overall FFI score (/100) was better (P=0.048) after TAA (16.2±16.5 vs. 24.8±18.2). The overall mean athletic level compared to the state prior to the injury was relatively low in both groups, but significantly (p=0.007) higher in the TAA group: FAAM sports score (/100), 49.5±24.4 vs. 29.8±26.2. The quality-of-life scores, SF-36 physical health, mental health, and general health were not significantly different after TAA and arthrodesis: mental health score, 63.1±14.7 vs. 57.8±21.5; physical health score, 61.3±17.8 vs. 53.7±23.9, overall score, 63.2±16.4 vs. 55.9±23.5. DISCUSSION Very few publications describe activities and quality of life after TAA and arthrodesis. Despite weaknesses, this comparative study demonstrates a tendency toward better functional results after TAA than after ankle arthrodesis, without the difference between the two groups being very significant. On the other hand, there was no difference in terms of quality of life. After the doubts raised by publications on severe periprosthetic osteolysis at the intermediate term with certain TAA models, these results encourage pursuit of implantation and development of TAA. LEVEL OF PROOF Comparative retrospective. Level III study.
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Affiliation(s)
- F Dalat
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique, Traumatologique et de Médecine du Sport, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
| | - F Trouillet
- Hospices Civils de Lyon, Hôpital Renée-Sabran, Service de Chirurgie Orthopédique, 83400 Hyères, France
| | - M H Fessy
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique, Traumatologique et de Médecine du Sport, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69675 Bron cedex, France
| | - M Bourdin
- Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69675 Bron cedex, France
| | - J-L Besse
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique, Traumatologique et de Médecine du Sport, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, Laboratoire de Biomécanique et Mécanique des Chocs, 69675 Bron cedex, France.
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Nunag P, Vun SH, Atiya S, Pillai A, Kurdy N. Surgical tip: Titanium foam blocks can simplify fusion of failed total ankle replacements. Foot (Edinb) 2014; 24:111-5. [PMID: 24994679 DOI: 10.1016/j.foot.2014.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 05/19/2014] [Accepted: 06/09/2014] [Indexed: 02/04/2023]
Abstract
Ankle arthrodesis following failed ankle replacements is a technically challenging task because of the large defect left behind after the prosthesis is removed. The usual practice is to use bulk grafts which are either autografts or allografts to fill the defect. We report our experience with the use of a titanium foam block specifically designed for fusion of failed ankle replacements. This particular method was chosen to avoid the technical difficulties and morbidities associated with the use of bulk autografts and allografts. We describe the surgical technique and early results in the first two cases performed in our unit. The satisfactory clinical and radiologic results in the two cases demonstrate the ability of the titanium foam block to simplify an otherwise complex procedure without compromising the outcome.
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Affiliation(s)
- Perrico Nunag
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom.
| | - Shen Hwa Vun
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
| | - Sami Atiya
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
| | - Anand Pillai
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
| | - Nasser Kurdy
- University Hospital of South Manchester, UHSM, Department of Orthopaedics and Trauma, Foot and Ankle Surgery, Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
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Is end-stage ankle arthrosis best managed with total ankle replacement or arthrodesis? A systematic review. Adv Orthop 2014; 2014:986285. [PMID: 25215242 PMCID: PMC4158286 DOI: 10.1155/2014/986285] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/12/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes. Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure. Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn. Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.
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Deleu PA, Devos Bevernage B, Maldague P, Gombault V, Leemrijse T. Arthrodesis After Failed Total Ankle Replacement. Foot Ankle Int 2014; 35:549-557. [PMID: 24829375 DOI: 10.1177/1071100714536368] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature on salvage procedures for failed total ankle replacement (TAR) is sparse. We report a series of 17 patients who had a failed TAR converted to a tibiotalar or a tibiotalocalcaneal arthrodesis. METHODS Between 2003 and 2012, a total of 17 patients with a failed TAR underwent an arthrodesis. All patients were followed on a regular basis through chart review, clinical examination and radiological evaluation. The following variables were analyzed: pre- and postoperative Meary angle, cause of failure, method of fixation, type of graft, time to union, complications, and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score. The average follow-up was 30.1 months. The average period from the original arthroplasty to the arthrodesis was 49.8 months. RESULTS Thirteen of the 17 ankles were considered radiographically healed after the first attempt in an average time of 3.7 months and 3 after repeat arthrodesis. Bone grafts were used in 16 patients. The median postoperative AOFAS score was 74.5. The mean Meary angle of the hindfoot was 5 degrees of valgus. CONCLUSION Tibiotalar and tibiotalocalcaneal arthrodeses were effective salvage procedures for failed TAR. Massive cancellous allografts were a good alternative to compensate for the large bone defect after removal of the prosthesis and to preserve the leg length. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Paul-André Deleu
- 1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium.,2 Institut D'Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Bruxelles, Belgium
| | | | - Pierre Maldague
- 1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium
| | - Vincent Gombault
- 1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium
| | - Thibaut Leemrijse
- 1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium
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Kraal T, van der Heide HJL, van Poppel BJ, Fiocco M, Nelissen RGHH, Doets HC. Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease. Bone Joint J 2014; 95-B:1656-61. [PMID: 24293596 DOI: 10.1302/0301-620x.95b12.32146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Little is known about the long-term outcome of mobile-bearing total ankle replacement (TAR) in the treatment of end-stage arthritis of the ankle, and in particular for patients with inflammatory joint disease. The aim of this study was to assess the minimum ten-year outcome of TAR in this group of patients. We prospectively followed 76 patients (93 TARs) who underwent surgery between 1988 and 1999. No patients were lost to follow-up. At latest follow-up at a mean of 14.8 years (10.7 to 22.8), 30 patients (39 TARs) had died and the original TAR remained in situ in 28 patients (31 TARs). The cumulative incidence of failure at 15 years was 20% (95% confidence interval (CI) 11 to 28). The mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of the surviving patients at latest follow-up was 80.4 (95% CI 72 to 88). In total, 21 patients (23 TARs) underwent subsequent surgery: three implant exchanges, three bearing exchanges and 17 arthrodeses. Neither design of TAR described in this study, the LCS and the Buechel-Pappas, remains currently available. However, based both on this study and on other reports, we believe that TAR using current mobile-bearing designs for patients with end-stage arthritis of the ankle due to inflammatory joint disease remains justified.
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Affiliation(s)
- T Kraal
- Slotervaart Hospital, P.O. Box 90440, 1006 BK Amsterdam, the Netherlands
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Go A, Kim SE, Shim KM, Lee SM, Choi SH, Son JS, Kang SS. Osteogenic effect of low-temperature-heated porcine bone particles in a rat calvarial defect model. J Biomed Mater Res A 2013; 102:3609-17. [PMID: 24248774 DOI: 10.1002/jbm.a.35022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/04/2013] [Accepted: 10/30/2013] [Indexed: 11/05/2022]
Abstract
The current study was designed to investigate the chemical and physical properties of porcine-derived xenografts of different crystallinity (low and high) and to evaluate their osteogenic potential. Porcine femur bone underwent a heat treatment process at 400°C (P400) and 1200°C (P1200) and was then milled into particles of 1 mm or less. In X-ray diffraction, P400 exhibited a low crystallinity compared with that of P1200, as indicated by the relatively wide diffraction peaks. Brunauer-Emmett-Teller analysis revealed that P400 also had a wider surface area than P1200. In micro-CT scan analysis of specimens in a rat calvarial defect model, bone mineral density of the P400 group was significantly higher than that of the P1200 group (p < 0.01). New bone formation was also remarkably higher at 8 weeks in the P400 group, which showed more new osteocytes in the lacuna compared with the P1200 group. In this study, low crystalline bone particles were obtained at low processing temperature (at temperature of 400°C) and achieved superior new bone formation compared with the high crystalline bone particles created at a higher process temperature (1200°C). It can be concluded that lower process temperature bone particles might provide a more effective graft material for enhancing bone formation. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 102A: 3609-3617, 2014.
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Affiliation(s)
- Ara Go
- College of Veterinary Medicine, Chonnam National University, Gwangju, 500-757, Republic of Korea
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