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Lewis TL, Walker R, Alkhalfan Y, Latif A, Abbasian A. Custom Patient-Specific 3D-Printed Titanium Truss Tibiotalocalcaneal Arthrodesis Implants for Failed Total Ankle Replacements: Classification, Technical Tips, and Treatment Algorithm. Foot Ankle Int 2024:10711007241255381. [PMID: 38872312 DOI: 10.1177/10711007241255381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants, which offer an alternative salvage option for failed total ankle replacements. METHODS A prospective observational study was performed of 6 cases of failed total ankle replacements that were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification, and a treatment algorithm were developed based on our initial experience. RESULTS Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow-up was available for all cases. The mean follow-up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 (P < .05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 (P < .05) and the EQ-VAS also improved from 53.0 to 63.3 (P = .36). The mean VAS-Pain score at final follow-up was 27.5. There were no cases of nonunion. None of the patients were smokers. The overall complication rate was 50%. Two patients returned to surgery: one for wound washout following TAR explantation and a second for removal of metalwork 2 years following surgery for a prosthetic joint infection secondary to hematogenous spread. No patients underwent revision fixation or amputation. CONCLUSION Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable treatment option for failed total ankle replacements.
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Affiliation(s)
- Thomas L Lewis
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Roland Walker
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Yousif Alkhalfan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ahmed Latif
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ali Abbasian
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Wang JEH, Day J, McCann J, Cooper P. Early results of combined total ankle total talus replacement in the revision setting. Foot Ankle Surg 2024:S1268-7731(24)00071-7. [PMID: 38584061 DOI: 10.1016/j.fas.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/25/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Revision of failed total ankle replacement (TAR) is challenging and associated with increased morbidity. Given the increased popularity of TAR in treating end-stage ankle arthritis (ESAA), viable revision options are needed. The objective of this case series is to present a minimum 2-year clinical and radiographic outcomes of patient-specific custom 3D-printed total ankle total talus (TATR) prostheses in this unique subset of patients. METHODS 19 participants with ESAA and failed primary TAR who underwent TATR by a single surgeon at our institution from 2019 to 2021 were retrospectively identified. All participants were indicated for revision of primary STAR implant (Stryker, Kalamazoo, MI) and underwent replacement with 3D-printed titanium implants based on preoperative CT analysis (Additive Orthopaedics, Little Silver, NJ). Custom components included a mobile-bearing total talus and stemmed tibial system, performed through an anterior approach. Pre- and postoperative patient-reported outcomes were assessed using the Patient Reported Outcomes Measurement Information System (PROMIS). Pre- and postoperative implant alignment was assessed using medial distal tibial angle (MDTA) and tibiotalar angle (TTA) on anteroposterior, and sagittal tibial angle (STA) on lateral weight-bearing plain films. RESULTS The average patient age was 60.6 (range, 39-77) years, with an average follow-up of 37.9 (range, 25.3-57.5) months. There was statistically significant improvement in all PROMIS domains. Short-term survivorship was 100%, with two participants (11.0%) requiring reoperation for postoperative complications: one underwent open reduction internal fixation of the tibia for a periprosthetic fracture, and another underwent medial gutter debridement and tarsal tunnel release for recurrent pain. There were no significant differences in pre- versus postoperative radiographic alignment measured by MDTA (89.9 vs 86.4), TTA (89.7 vs 88.1), or STA (85.2 vs 85.3). CONCLUSION Custom 3D-printed TATR is a promising option for revision TAR. There was significant short-term improvement in pain and physical function, with excellent short-term survivorship and an acceptable postoperative complication rate.
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Affiliation(s)
- Joyce En-Hua Wang
- Department of Orthopedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Jonathan Day
- Department of Orthopedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.
| | - Julia McCann
- Department of Orthopedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Paul Cooper
- Department of Orthopedic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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Hunt KJ, Ross D, Fontan F. Clinical Outcomes and Registry Data in Total Ankle Arthroplasty. Foot Ankle Clin 2024; 29:11-26. [PMID: 38309795 DOI: 10.1016/j.fcl.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] [Indexed: 02/05/2024]
Abstract
Total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle arthritis consistently demonstrating good to excellent outcomes, even when considering factors such as deformity, patient age, bilaterality, and arthritis etiology. There is little consensus in the literature with regard to preferred patient-reported outcome metrics (PROMs) for assessing outcomes, although all metrics generally improve following TAA. Several countries have successful registries to track longevity of TAA in populations; however, PROMs are generally not successfully tracked in registries. A trend toward consensus on outcome metrics and collaborative registries is warranted to optimize patient selection and outcomes in TAA.
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Affiliation(s)
- Kenneth J Hunt
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA.
| | - Daniel Ross
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA
| | - Francisco Fontan
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA
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Goldberg AJ, Bordea E, Chowdhury K, Hauptmannova I, Blackstone J, Brooking D, Deane EL, Bendall S, Bing A, Blundell C, Dhar S, Molloy A, Milner S, Karski M, Hepple S, Siddique M, Loveday DT, Mishra V, Cooke P, Halliwell P, Townshend D, Skene SS, Doré CJ. Cost-Utility Analysis of Total Ankle Replacement Compared with Ankle Arthrodesis for Patients Aged 50-85 Years with End-Stage Ankle Osteoarthritis: The TARVA Study. PHARMACOECONOMICS - OPEN 2024; 8:235-249. [PMID: 38189868 PMCID: PMC10884388 DOI: 10.1007/s41669-023-00449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Patients with end-stage ankle osteoarthritis suffer from reduced mobility and quality of life and the main surgical treatments are total ankle replacement (TAR) and ankle fusion (AF). OBJECTIVES Our aim was to calculate the mean incremental cost per quality-adjusted life-year (QALY) of TAR compared with AF in patients with end-stage ankle osteoarthritis, over 52 weeks and over the patients' lifetime. METHOD We conducted a cost-utility analysis of 282 participants from 17 UK centres recruited to a randomised controlled trial (TARVA). QALYs were calculated using index values from EQ-5D-5L. Resource use information was collected from case report forms and self-completed questionnaires. Primary analysis was within-trial analysis from the National Health Service (NHS) and Personal Social Services (PSS) perspective, while secondary analyses were within-trial analysis from wider perspective and long-term economic modelling. Adjustments were made for baseline resource use and index values. RESULTS Total cost at 52 weeks was higher in the TAR group compared with the AF group, from the NHS and PSS perspective (mean adjusted difference £2539, 95% confidence interval [CI] £1142, £3897). The difference became very small from the wider perspective (£155, 95% CI - £1947, £2331). There was no significant difference between TAR and AF in terms of QALYs (mean adjusted difference 0.02, 95% CI - 0.015, 0.05) at 52 weeks post-operation. The incremental cost-effectiveness ratio (ICER) was £131,999 per QALY gained 52 weeks post-operation. Long-term economic modelling resulted in an ICER of £4200 per QALY gained, and there is a 69% probability of TAR being cost effective at a cost-effectiveness threshold of £20,000 per QALY gained. CONCLUSION TAR does not appear to be cost effective over AF 52 weeks post-operation. A decision model suggests that TAR can be cost effective over the patients' lifetime but there is a need for longer-term prospectively collected data. Clinical trial registration ISRCTN60672307 and ClinicalTrials.gov NCT02128555.
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Affiliation(s)
- Andrew J Goldberg
- Division of Surgery, UCL Institute of Orthopaedics and Musculoskeletal Science, Royal Free Hospital, 9th Floor (East), 2QG, 10 Pond St, London, NW3 2PS, UK
- Department of Research and Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, UK
- MSK Lab, Imperial College London, Sir Michael Uren Hub Imperial College London White City Campus, 86 Wood Lane, London, W12 0BZ, UK
| | - Ekaterina Bordea
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK.
| | - Kashfia Chowdhury
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK
| | - Iva Hauptmannova
- Department of Research and Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, UK
| | - James Blackstone
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK
| | - Deirdre Brooking
- Department of Research and Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, UK
| | - Elizabeth L Deane
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK
| | - Stephen Bendall
- University Hospitals Sussex NHS Foundation Trust, Lewes Road, Haywards Heath, RH16 4EX, UK
| | - Andrew Bing
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, Shropshire, UK
| | - Chris Blundell
- Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, S5 7AU, UK
| | - Sunil Dhar
- Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Andrew Molloy
- Liverpool University Hospitals NHS Foundation Trust, Fazakerley, L9 7AL, Liverpool, UK
| | - Steve Milner
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE22 3NE, UK
| | - Mike Karski
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, WN6 9EP, Lancashire, UK
| | - Steve Hepple
- North Bristol NHS Trust, Southmead Rd, Bristol, BS10 5NB, UK
| | - Malik Siddique
- Newcastle Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK
| | - David T Loveday
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk and Norwich University Hospital Colney Lane, Norwich, NR4 7UY, UK
| | - Viren Mishra
- Hull University Teaching Hospitals NHS Trust, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Paul Cooke
- Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Paul Halliwell
- Royal Surrey NHS Foundation Trust, Guildford, GU2 7XX, Surrey, UK
| | - David Townshend
- Northumbria Healthcare NHS Foundation Trust, Tyne and Wear, North Shields, NE29 8NH, UK
| | - Simon S Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, Surrey, UK
| | - Caroline J Doré
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK
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Jamjoom BA, Dhar S. Outcomes of Revision Total Ankle Replacement. Foot Ankle Clin 2024; 29:171-184. [PMID: 38309801 DOI: 10.1016/j.fcl.2023.08.012] [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] [Indexed: 02/05/2024]
Abstract
The objective of this study is to provide an up-to-date review of the outcomes of revision total ankle arthroplasty (TAA). Relevant studies published over the last decade were reviewed. Twelve studies were included. At a median follow-up of 4 years, the median survival and reoperation rates were 86% and 16%, respectively. Significant postoperative improvements in patient-reported outcome measures were recorded in 6 studies. Significant improvement in alignment was documented in 1 study only. Revision TAA is a safe procedure that can produce good outcomes. Nevertheless, data relating to long-term outcome are still limited in quantity and duration.
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Affiliation(s)
- Bakur A Jamjoom
- Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
| | - Sunil Dhar
- Foot and Ankle Unit, Nottingham Elective Orthopaedics, Nottingham University Hospitals City Campus, Nottingham NG5 1PB, UK
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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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7
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Hintermann B, Peterhans US, Susdorf R, Horn Lang T, Ruiz R, Kvarda P. Survival and risk assessment in revision arthroplasty of the ankle. Bone Joint J 2024; 106-B:46-52. [PMID: 38160692 DOI: 10.1302/0301-620x.106b1.bjj-2023-0716.r2] [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] [Indexed: 01/03/2024]
Abstract
Aims Implant failure has become more common as the number of primary total ankle arthroplasties (TAAs) performed has increased. Although revision arthroplasty has gained attention for functional preservation, the long-term results remain unclear. This study aimed to assess the long-term outcomes of revision TAA using a mobile-bearing prosthesis in a considerably large cohort; the risk factors for failure were also determined. Methods This single-centre retrospective cohort study included 116 patients (117 ankles) who underwent revision TAA for failed primary TAA between July 2000 and March 2010. Survival analysis and risk factor assessment were performed, and clinical performance and patient satisfaction were evaluated preoperatively and at last follow-up. Results The mean duration from initial revision TAA to last follow-up was 15.0 years (SD 3.0; 11.2 to 20.5). The cumulative survival rates of the revised ankles were 81% (95% confidence interval (CI) 74% to 88%), 74% (65% to 82%), and 70% (61% to 79%) at five, ten, and 15 years, respectively. Comorbidities prior to primary TAA, aseptic loosening, instability, or grafting of cysts were found to be the most common risk factors for secondary revision. The median value for preoperative pain, as assessed using the visual analogue scale, declined from 6 (interquartile range (IQR) 5 to 8) to 2 (IQR 0 to 5) (p < 0.001) and the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from 43 (SD 17) preoperatively to 70 (SD 20) (p < 0.001) at last follow-up. Conclusion Revision TAA offers acceptable survival rates after 15 years; it therefore offers a valuable option for treatment of implant failure in carefully selected cases. Although patient-reported outcomes improve substantially, the degree of improvement reported following primary TAA is not achieved.
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Affiliation(s)
- Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Tamara Horn Lang
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Roxa Ruiz
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Peter Kvarda
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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8
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Hybrid-Total Ankle Arthroplasty (H-TAA) for Failed Talar Component in Mobile-Bearing Total Ankle Arthroplasty. J Clin Med 2023; 12:jcm12051764. [PMID: 36902551 PMCID: PMC10003300 DOI: 10.3390/jcm12051764] [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: 01/16/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Revision Total Ankle Arthroplasty (TAA) surgery due to TAA aseptic loosening is increasing. It is possible to exchange the talar component and inlay to another system for isolated talar component loosening in a primary mobile-bearing TAA: Hybrid-Total Ankle Arthroplasty (H-TAA). The purpose of this study was to analyze the results of the revision surgery of an isolated aseptic talar component loosening in a mobile-bearing three-component TAA with a H-TAA solution. METHODS In this prospective case study, nine patients (six women, three men; mean age 59.8 years; range 41-80 years) with symptomatic isolated aseptic loosening of the talar component of a mobile-bearing TAA were treated with an isolated talar component and inlay substitution. In all nine cases, a hybrid TAA revision surgery was performed by implanting a VANTAGE TAA talar and insert component (Flatcut talar component: six cases, standard talar component: three cases). The patients were reviewed with the pain score (VAS Pain Score 0-10), Dorsiflexion/Plantarflexion (DF/PF) Range of Motion (ROM; degrees), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0-100 points), Sports Frequency Score (Level 0-4), and subjective Patients' Satisfaction Score (0-10 points). RESULTS The average Pain score improved significantly from preoperative 6.7 points to postoperative 1.1 points (p < 0.001). Average Dorsiflexion/Plantarflexion ROM values increased significantly post-surgery: 21.7° preoperative to 45.6° postoperative (p < 0.001). The postoperative AOFAS scores were significantly greater than the preoperative values: 47.7 points preoperative, 92.3 points postoperative (p < 0.001). The sports activity improved from preoperative to postoperative where, preoperative, none of the patients were able to perform sports. Postoperative, eight patients were able to be sports-active again. The overall average postoperative level of sports activity was 1.4. The postoperative average patient's satisfaction was 9.3 points. CONCLUSIONS In painful talar component aseptic loosening of a three-component mobile-bearing TAA, H-TAA is a good surgical solution for reducing pain, restoring ankle function, and improving patients' life quality.
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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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10
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Querci L, Caravelli S, Di Ponte M, Fuiano M, De Blasiis P, Sirico F, Baiardi A, Zannoni F, Mosca M. Enhanced recovery (fast-track surgery) after total ankle replacement: The state of the art. Foot Ankle Surg 2022; 28:1163-1169. [PMID: 35882574 DOI: 10.1016/j.fas.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/02/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
The post-operative results of a total ankle replacement are not determined solely by an optimal surgical technique, but by an appropriate anesthesiological and rehabilitative post-operative approach. Enhanced functional recovery often depends on a multidisciplinary approach based on a correct framework of the patient and his needs, requests, and characteristics. Extensive bibliographical research has been performed on Pubmed, Google Scholar, Scopus. This comprehensive and inclusive review of the literature aims to examine the state of the art of "fast-track" protocols employed in total ankle replacement (TAR), considering pre-operative preparation, anesthetic management, intraoperative and surgical factors, post-operative rehabilitative care and reduction of hospitalization time.
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Affiliation(s)
- Lorenzo Querci
- Anesthesiology and Critical Care Residency Program, University of Bologna, Via Massarenti, 9, 40138 Bologna
| | - Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo De Blasiis
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania"Luigi Vanvitelli", Naples, Italy
| | - Felice Sirico
- Department of Public Health - Physical Medicine & Rehabilitation Unit, Univeristy of Naples "Federico II", 80131 Naples, Italy
| | - Annalisa Baiardi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Zannoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Mehdi N, Lintz F, Alsafi M, Laborde J, Bernasconi A. Revision tibiotalar arthrodesis with posterior iliac autograft after failed arthroplasty: A matched comparative study with primary ankle arthrodeses. Orthop Traumatol Surg Res 2022; 108:103269. [PMID: 35288327 DOI: 10.1016/j.otsr.2022.103269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Tibiotalar arthrodeses performed after failed ankle arthroplasties are known to be complex procedures with often disappointing functional outcomes. This study reports the results of a revision technique using a posterior iliac crest autograft. HYPOTHESES We hypothesized that: (1) revision tibiotalar arthrodeses (RTTAs) had functional outcomes which were similar to those of a reference cohort of primary tibiotalar arthrodeses (TTAs) and that (2) the union rate was satisfactory. MATERIALS AND METHODS This retrospective study compared 16 RTTAs performed for failed arthroplasties that caused pain and a functional disability (4 aseptic loosening, 4 massive progressive periprosthetic cysts, 5 malpositioning of implants, and 3 cases of unexplained mechanical pain) with a series of 16 primary TTAs performed for painful ankle osteoarthritis. The groups were matched at a 1:1 ratio for age, sex, side and body mass index. The preoperative workup included a physical exam, the American Orthopaedic Foot and Ankle Society (AOFAS) score, weight bearing radiographs, CT and SPECT scans. Outcomes were assessed both clinically (AOFAS score) and radiographically (X-rays and scans). The mean duration of the procedure (DP), average length of stay (LOS), fusion and complication rates, and time to union were also compared. RESULTS At the mean follow-up of 30 months (range, 12-88) for the RTTA group and 59 months (range, 23-94) for the TTA group (p=.001), the AOFAS score increased from 27 to 70.8 points (p<.001) and from 29.8 to 76.2 points (p<.001), respectively; values were similar at the last follow-up (p=.442). Both groups had similar fusion (94%) and complication rates (12%). The DP was 196.9±33.6min (range, 179-213) vs. 130±28.4min (range, 118-141) (p<.001) and the LOS was 3.8 days (range, 2-6) vs. 3.9 days (range, 2-6) (p<.445) for both groups (RTTA vs. TTA). CONCLUSION This RTTA technique using a posterior iliac crest allograft for filling bone defects was validated by the quality of the functional outcomes obtained. LEVEL OF EVIDENCE IV; Comparative retrospective study.
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Affiliation(s)
- Nazim Mehdi
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France.
| | - François Lintz
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France
| | | | - Julien Laborde
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France
| | - Alessio Bernasconi
- University of Naples "Federico II", Department of Public Health, Orthopaedic and Traumatology Unit, Via S. Pansini 5, Napoli, 80131, Italy
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Benthien RA. Failed Total Ankle Arthroplasty and Our Expanding Shoreline of Peril: Commentary on an article by Bakur A. Jamjoom, BMBS, MCh, FRCS, et al.: "Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using the INBONE II Prosthesis". J Bone Joint Surg Am 2022; 104:e78. [PMID: 36069802 DOI: 10.2106/jbjs.22.00764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Ross A Benthien
- Orthopedic Associates of Hartford, The Bone and Joint Institute, Hartford Hospital, Hartford, Connecticut
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13
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Jamjoom BA, Siddiqui BM, Salem H, Raglan M, Dhar S. Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using the INBONE II Prosthesis. J Bone Joint Surg Am 2022; 104:1554-1562. [PMID: 35766416 DOI: 10.2106/jbjs.21.01240] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The literature on the outcome of revision total ankle arthroplasty (TAA) remains limited. In this study, we aimed to report the clinical and radiographic outcomes of revision TAA at a high-volume center in the United Kingdom. METHODS This study was a retrospective review of 28 patients who underwent 29 revision TAAs using the INBONE II Total Ankle System (Wright Medical Technology/Stryker). Demographic, radiographic, and patient-reported outcome measure data were analyzed. RESULTS The mean duration from primary TAA to revision was 87.5 months (range, 16 to 223 months). The main indication for the revision was aseptic loosening after the primary TAA (83%). Additional procedures were required in 76% of ankles. At a mean follow-up of 40 months (range, 24 to 60 months), the infection rate was 7%, the reoperation rate was 7%, and the implant survival rate was 97%. A significant postoperative improvement in the radiographic component alignment measures was observed. The subsidence, loosening, and heterotopic ossification rates in this study were comparable with those in other reports and did not influence the clinical outcome. A significant improvement was observed in the Manchester-Oxford Foot Questionnaire (MOXFQ) in all domains and the EuroQol-5 Dimensions (EQ-5D) in 3 domains at 24 months postoperatively. CONCLUSIONS Revision TAA using the INBONE II prosthesis was associated with good short-term survival and improvement in postoperative scores at 2 years. Maintenance of the postoperatively improved alignment was documented at the follow-up. The results of this study support the notion that revision TAA is a satisfactory option for failed primary TAA. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bakur A Jamjoom
- Foot and Ankle Unit, Nottingham Elective Orthopaedics, Nottingham University Hospitals, Nottingham, United Kingdom
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14
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Zhang Y, Chen Z, Zhao D, Yu J, Ma X, Jin Z. Anatomic ankle implant can provide better tibiotalar joint kinematics and loading. Med Eng Phys 2022; 103:103789. [DOI: 10.1016/j.medengphy.2022.103789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/17/2022] [Accepted: 03/13/2022] [Indexed: 11/28/2022]
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Henry JK, Rider C, Cody E, Ellis SJ, Demetracopoulos C. Evaluating and Managing the Painful Total Ankle Replacement. Foot Ankle Int 2021; 42:1347-1361. [PMID: 34315246 DOI: 10.1177/10711007211027273] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation.Level of Evidence: Level V, expert opinion or review.
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Clifton LJ, Kingman A, Rushton PRP, Murty A, Kakwani R, Coorsh J, Townshend DN. The Hintegra total ankle replacement: survivorship, failure modes and patient reported outcomes in seventy consecutive cases with a minimum five year follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:2331-2336. [PMID: 34143253 DOI: 10.1007/s00264-021-05071-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The Hintegra total ankle replacement (TAR) has been widely used worldwide for ankle arthroplasty since its introduction in 2000. The implant survivorship, patient reported outcomes, rate of periprosthetic cyst formation and reoperation rates are variably reported. The purpose of this study is to determine the functional outcomes and survivorship of the Hintegra TAR, in consecutive cases by multiple surgeons in a single UK institution, with a minimum of five year follow-up. METHODS A retrospective review of prospectively collected data for 70 consecutive Hintegra TAR cases performed between 2010 and 2014. Data collected included patient demographics, complications, reoperations, revisions and patient reported outcome measures (PROMS: AOS, MOX-FQ, pain VAS and EQ-5D 3L). RESULTS Seventy patients underwent Hintegra TAR (54 male/16 female) with an average age of 69 (range 48-84 years). Mean follow up was 76 months (range 60-104), 10 patients died during the follow-up. Implant survivorship was 81.7% at most recent follow-up. The commonest radiographic finding was periprosthetic cysts (n = 28, 40%): size range (7-40 mm). Nine patients required re-operation: six periprosthetic cyst debridement and grafting at a mean of 61 months (range 27-91), one lateral gutter debridement, one periprosthetic fracture and one debridement for deep infection. PROMS data was available for the majority of patients. Mean final follow-up scores were total AOS 35 (range: 0-97), MOX-FQ 36 (range: 2-93), pain VAS 34.6 (range: 0-100) and EQ-5D 3L Index 0.69 (range: 0.08-1.00). CONCLUSION Our experience demonstrates implant survivorship similar to other TAR studies. We have identified a high incidence of periprosthetic cysts and would recommend ongoing surveillance of these patients.
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Affiliation(s)
- Laura J Clifton
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK.
| | - Anji Kingman
- Hexham General Hospital, Corbridge Road, Hexham, NE46 1QJ, UK
| | - Paul R P Rushton
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - An Murty
- Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - Rajesh Kakwani
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - Jonathan Coorsh
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - David N Townshend
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
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