1
|
Teehan E, Demetracopoulos C. Outcomes of Total Ankle Replacement. Orthop Clin North Am 2024; 55:503-512. [PMID: 39216955 DOI: 10.1016/j.ocl.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Total ankle replacement (TAR) is an effective operative treatment of end-stage ankle osteoarthritis (OA) in the appropriate patient, conferring improved kinematic function, decreased stress across adjacent joints, and offering equivalent pain relief in comparison to ankle arthrodesis (AA). It is important to consider patient age, weight, coronal tibiotalar deformity, joint line height, and adjacent joint OA to maximize clinical and patient outcomes. Both mobile-bearing and fixed-bearing implants have demonstrated favorable clinical outcomes, marked improvement in patient-reported outcomes, and good survivorship; however, implant survivorship decreases with longer term follow-up, necessitating constant improvement of primary and revision TAR options.
Collapse
Affiliation(s)
- Emily Teehan
- Foot & Ankle Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | | |
Collapse
|
2
|
Gray T, Harris AB, Patel R, Oni J, Aiyer A. Open Access Publication in Total Ankle Arthroplasty Literature Is Associated With Increased Social Media Attention, but Not Increased Citations. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241247817. [PMID: 38726322 PMCID: PMC11080731 DOI: 10.1177/24730114241247817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Open access (OA) publications are increasingly common in orthopaedic literature. However, whether OA publications are associated with increased readership or citations among total ankle arthroplasty (TAA) literature is unclear. We hypothesize that compared with non-OA status, OA status is associated with increased social media dissemination, and readership, but not with citation count. This study aimed to analyze social media attention, citations, readership, and cost of TAA OA and non-OA publications. Methods Using a PubMed query search, there were 368 publications from 81 journals, with 25% (91/368) being OA articles and 75% (277/368) non-OA articles from 2016 to 2023. We analyzed the Altmetric Attention Score (AAS), Mendeley readership score, and citations between OA vs non-OA articles. Citations and cost of OA articles were determined using an altered timeline and publisher's website, respectively. Subgroup analysis was performed among articles published in the top 5 TAA journals (Tables 2 and 3). Negative binomial regression was used while adjusting for days since publication. Significance was considered at P <.05. Results OA publication was associated with a larger mean AAS score (8.7 ± 37.0 vs 4.8 ± 26.3), Mendeley readership (42.4 ± 41.6 vs 34.9 ± 25.7), and Twitter mentions (4.6 ± 7.4 vs 3.3 ± 8.1), but not citations (19.7 ± 24.8 vs 20.3 ± 23.5) (Table 1). Conclusion TAA OA publications and top 5 journals were associated with significantly increased social media attention but not Mendeley readership or citation counts.
Collapse
Affiliation(s)
- Trayce Gray
- University of Houston Tilman J Fertitta Family College of Medicine, Houston, TX, USA
| | - Andrew B. Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Rahi Patel
- University of California Los Angeles, Los Angeles, CA, USA
| | - Julius Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Amiethab Aiyer
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
3
|
Palma J, Shaffrey I, Kim J, Cororaton A, Henry J, Ellis SJ, Demetracopoulos CA. Influence of Joint Line Level on Clinical Outcomes and Range of Motion in Total Ankle Arthroplasty. Foot Ankle Int 2024; 45:10-19. [PMID: 37885224 DOI: 10.1177/10711007231198515] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Ankle arthritis leads to an elevated joint line compared to the nonarthritic ankle, as measured by the "joint line height ratio" (JLHR). Previous work has shown that the JLHR may remain elevated after total ankle arthroplasty (TAA). However, the clinical impact of this has yet to be determined. This study assessed the correlation between postoperative JLHR, post-TAA range of motion (ROM), and 1-year Patient-Reported Outcome Measurement Information System (PROMIS) scores. METHODS A retrospective review of 150 patients who underwent primary TAA was performed. Preoperative and postoperative JLHR, as well as postoperative dorsiflexion, plantarflexion, and total ROM, was calculated on weightbearing radiographs at a minimum of 1-year follow-up. Correlation between JLHR, post-TAA ROM, and 1-year PROMIS scores was investigated using Pearson correlation and multiple linear regression models. Interobserver reliability for the JLHR was also calculated. RESULTS Interobserver reliability for the JLHR was excellent (r = 0.98). Mean (SD) JLHR changed from 1.66 (0.45) to 1.55 (0.26) after TAA (P < .001), indicating that the joint line was lowered after TAA. An elevated joint line was correlated with decreased post-TAA dorsiflexion (r = -0.26, P < .001), total ROM (r = -0.18, P = .025), and worse 1-year PROMIS physical function (r = -0.22, P = .046), pain intensity (r = 0.22, P = .042), and pain interference (r = 0.29, P = .007). There was no correlation between the JLHR and post-TAA plantarflexion (r = -0.025, P = .76). Regression analysis identified a 0.5-degree reduction in post-TAA dorsiflexion with each 0.1-unit increase in JLHR (Coeff. = -5.13, P = .005). CONCLUSION In this patient cohort, we found that an elevated joint line modestly correlated with decreased postoperative dorsiflexion, total ROM, and worse 1-year PROMIS scores. These data suggest that effort likely should be made toward restoring the native joint line at the time of TAA. In addition, future studies investigating the clinical outcomes after TAA may consider including a measure of joint line height, such as the JLHR, because we found it was associated with patient-reported outcomes. LEVEL OF EVIDENCE Level III, retrospective review of prospectively collected data.
Collapse
Affiliation(s)
- Joaquin Palma
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, RM, Chile
| | - Isabel Shaffrey
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jaeyoung Kim
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Agnes Cororaton
- Biostatistics Core, Hospital for Special Surgery, New York, NY, USA
| | - Jensen Henry
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | |
Collapse
|
4
|
Lima DJL, Sabesan VJ, Petersen-Fitts GR, Winkler ML, Sweet MC, Echeverry NB, Whaley JD. The Impact of Hospital Size and Teaching Status on Outcomes Following Total Ankle Arthroplasty. J Foot Ankle Surg 2022:S1067-2516(22)00330-1. [PMID: 36585326 DOI: 10.1053/j.jfas.2022.11.006] [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: 10/01/2018] [Revised: 10/21/2019] [Accepted: 11/13/2022] [Indexed: 11/29/2022]
Abstract
The popularity and utilization of total ankle arthroplasty (TAA) as treatment for ankle arthritis has increased exponentially from 1998 to 2012. Overall the outcomes have improved for TAA with the introduction of new-generation implants and this has increased the focus on optimizing other variables affecting outcomes for TAA. The purpose of this study was to examine the effects of hospital characteristics and teaching status on outcomes for TAA. The Nationwide Inpatient Sample database was queried from 2002 to 2012 using the ICD-9 procedure code for TAA. The primary outcomes evaluated included: in-hospital mortality, length of stay, total hospital charges, discharge disposition, perioperative complications, and patient demographics. Analyses were carried out based on hospital size: small, medium, and large; and teaching status: rural nonteaching, urban nonteaching, and urban teaching. A total weighted national estimate of 16,621 discharges for patients undergoing TAA was reported over the 10-year period. There were significant differences in length of stay and total charges between all hospitals when comparing location and teaching status; however, no significant differences were noted for in-hospital mortality. Rural, nonteaching hospitals had higher odds of perioperative complications. There were also significant differences in length of stay and total charges when comparing hospital sizes. Overall, there is no increased risk of mortality after TAA regardless of hospital size or setting. However, rural hospitals had increased rates of perioperative complications compared to urban hospitals. Our analyses demonstrated important factors affecting cost and resource utilization for TAA, clearly additional work is needed to optimize this relationship, especially in the upcoming bundled payment models.
Collapse
Affiliation(s)
| | - Vani J Sabesan
- Cleveland Clinic Florida, Weston, FL; Wayne State University School of Medicine, Detroit, MI.
| | | | | | | | | | | |
Collapse
|
5
|
So E, Rushing CJ, Prissel MA, Berlet GC. Bone Mineral Density Testing in Patients Undergoing Total Ankle Arthroplasty: Should We Pay More Attention to the Bone Quality? J Foot Ankle Surg 2021; 60:224-227. [PMID: 33187901 DOI: 10.1053/j.jfas.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/15/2020] [Accepted: 10/03/2020] [Indexed: 02/03/2023]
Abstract
Total ankle arthroplasty (TAA) has become one of the standard treatments for end-stage ankle arthritis. Long-term TAA survivorship is reported from 63% to 95%, with aseptic loosening being the most common mode of failure. Several studies have shown that low bone mineral density (BMD) of the hip affects the longevity of prosthetic implants. The role of Dual energy X-ray absorptiometry for TAA has not been established. The purpose of this review was to define the role of BMD in TAA outcomes and the role of Dual energy X-ray absorptiometry in measuring periprosthetic BMD. There is a paucity of information and published literature regarding the relationship between BMD and TAA. From attempting this systematic review, we hope to highlight that much of the focus in total ankle arthroplasty has emphasized implants and relatively little has focused on the quality of bone into which the prostheses are implanted.
Collapse
Affiliation(s)
- Eric So
- Foot and Ankle Surgeon, Bryan Health, Lincoln, NE.
| | - Calvin J Rushing
- Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Mark A Prissel
- Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Gregory C Berlet
- Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
| |
Collapse
|
6
|
Li Y, He J, Hu Y. Comparison of the Efficiency and Safety of Total Ankle Replacement and Ankle Arthrodesis in the Treatment of Osteoarthritis: An Updated Systematic Review and Meta-analysis. Orthop Surg 2020; 12:372-377. [PMID: 32227465 PMCID: PMC7189039 DOI: 10.1111/os.12635] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 11/27/2022] Open
Abstract
While osteoarthritis is a common degenerative disease, ankle osteoarthritis is a subdivision that has received little attention. Two effective ways to treat osteoarthritis of the ankle are total ankle replacement (TAR) and ankle arthrodesis (AAD). Whether TAR or AAD is more beneficial for treatment is controversial. The purpose of this meta‐analysis was to compare the efficiency (clinical outcome and patient satisfaction) and safety (complications and survival) of these two procedures. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement was performed as a guideline for this study. Three electronic databases, PubMed, Web of Science, and Cochrane Library, were searched up to May 2019, with no language restrictions. Prospective or retrospective comparative studies were identified. The outcomes included clinical outcome, patient satisfaction, complications, and survival. Review Manager (Revman) 5.3 software was used to conduct the data analysis. We only selected literature from the past 5 years (no earlier than 2015). Seven comparative studies were included. There were six cohort studies and one cross‐sectional study. The Newcastle–Ottawa Scale (NOS) was used to assess the quality of cohort studies, and The Agency for Healthcare Research and Quality (AHRQ) checklist was chosen to assess the quality of cross‐sectional studies. No significant difference was observed for efficiency and safety. Clinical outcome was included in five studies with four different scoring systems. Two of them used the American Orthopaedic Foot & Ankle Society (AOFAS) questionnaire scores to assess the two procedures (mean difference, −4.26; 95% confidence interval [CI], −11.37–2.85; P = 0.24; I2 = 1%). Patient satisfaction (risk ratio [RR], 0.96; 95% CI, 0.65–1.40; P = 0.82; I2 = 54%), complications (RR, 1.15; 95% CI, 0.16–8.21; P = 0.89; I2 = 84%), and survival (RR, 1.91; 95% CI, 0.33–11.08; P = 0.47; I2 = 90%) showed no significant difference between the TAR group and the AAD group. This meta‐analysis showed no statistically significant difference between TAR and AAD in clinical outcome, patient satisfaction, complications, and survival. This revealed that TAR and AAD could appear to have similar results in these aspects. Therefore, the present results are not sufficient to conclude which of these two methods is better. Further studies are needed to obtain more clues.
Collapse
Affiliation(s)
- Yuhan Li
- Department of Biological Sciences, Auburn University, Auburn, Alabama, USA
| | - Jinquan He
- The First Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, China
| | - Yongcheng Hu
- Department of Orthopaedic Oncology, Tianjin Hospital, Tianjin, China
| |
Collapse
|
7
|
Harnroongroj T, Volpert LG, Ellis SJ, Sofka CM, Deland JT, Demetracopoulos CA. Comparison of Tibial and Talar Bone Density in Patients Undergoing Total Ankle Replacement vs Non-Ankle Arthritis Matched Controls. Foot Ankle Int 2019; 40:1408-1415. [PMID: 31423826 DOI: 10.1177/1071100719868496] [Citation(s) in RCA: 5] [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
BACKGROUND Bone quality in the distal tibia and talus is an important factor contributing to initial component stability in total ankle replacement (TAR). However, the effect of ankle arthritis on bone density in the tibia and talus remains unclear. The objective of this study was to compare bone density of tibia and talus in arthritic and nonarthritic ankles as a function of distance from ankle joint. METHODS We retrospectively reviewed 93 end-stage ankle arthritis patients who had preoperative nonweightbearing ankle computed tomography (CT) and identified a cohort of 83 nonarthritic ankle patients as a demographic-matched control group. A region of interest tool was used to calculate Hounsfield unit (HU) values in the cancellous region of the tibia and talus. Measurements were obtained on axial cut CTs from 6 to 12 mm above the tibial plafond, and 1 to 4 mm below the talar dome. HU measurements between groups and the decrease of HU at the relative level in each group were compared. RESULTS Arthritic ankles demonstrated significantly greater mean bone density than nonarthritic ankles at between 6 and 10 mm above the joint in the tibia (P < .05). No significant difference in bone density between 10 and 12 mm from the joint in the tibia nor at any level of the talus was found between groups. In both groups, bone density decreased significantly at each successive level away from the ankle joint. CONCLUSION Ankle arthritis patients demonstrated greater or equal bone density in both the tibia and talus compared to demographic-matched controls. In both groups, bone density decreased with increasing distance away from the articular surface. In TAR, tibial bone resection between 6 and 8 mm may provide improved initial implant stability. LEVEL OF EVIDENCE Level III, comparative study.
Collapse
Affiliation(s)
- Thos Harnroongroj
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.,Department of Orthopaedics and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lauren G Volpert
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Carolyn M Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | |
Collapse
|
8
|
Harnroongroj T, Hummel A, Ellis SJ, Sofka CM, Caolo KC, Deland JT, Demetracopoulos CA. Assessing the Ankle Joint Line Level Before and After Total Ankle Arthroplasty With the "Joint Line Height Ratio". FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419884359. [PMID: 35097348 PMCID: PMC8697171 DOI: 10.1177/2473011419884359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Restoring the joint line is an important principle in total knee arthroplasty. However, the effect of joint line level on patient outcomes after total ankle arthroplasty (TAA) remains unclear, as there is no established method for measuring ankle joint level in TAA. The objective of this study was to develop a reliable radiographic ankle joint line measurement method and to compare ankle joint line level measured pre-TAA, post-TAA, and in nonarthritic ankles. METHODS A total of 112 radiographic sets were analyzed. Each set included weightbearing anteroposterior radiographs of the operative ankle taken preoperatively, 1-year postoperatively, and of the contralateral ankle. Measurements of vertical intermalleolar distance (VIMD) and vertical joint line distance (VJLD) at pre-TAA, post-TAA, and of the contralateral ankle were recorded by 2 authors on 2 separate occasions. The ratio of VJLD to VIMD was defined as the joint line height ratio (JLHR). Reliability of measurements and correlation between VIMD and VJLD were assessed. Pre-TAA, nonarthritic contralateral ankle, and post-TAA JLHR were compared and considered significantly different if P <.05. RESULTS The inter- and intrarater reliability of radiographic measurements was excellent (r > 0.9). There were strong positive correlations of VIMD and VJLD, r = 0.809 (pre-TAA)/0.756 (post-TAA), P < .001. Mean (SD) pre-TAA, nonarthritic contralateral ankle, and post-TAA JLHRs were 1.54 (0.31), 1.39 (0.26), and 1.62 (0.49), respectively. Pre- and post-TAA JLHRs were significantly higher compared to the nonarthritic contralateral ankle (P < .05). JHLR was not significantly different between pre- and post-TAA (P = .15). CONCLUSION The JLHR was reliable and could be a clinically applicable method for assessing ankle joint line level in patients undergoing TAA. End-stage ankle arthritis demonstrated elevated joint line level compared with nonarthritic ankles, and the joint line level post-TAA remained elevated compared with nonarthritic ankles. Further studies are needed to understand the effect of joint line elevation on clinical outcomes after TAA. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Thos Harnroongroj
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopaedics and Rehabilitation, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Amelia Hummel
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J. Ellis
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Kristin C. Caolo
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T. Deland
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | |
Collapse
|
9
|
Koo K, Liddle AD, Pastides PS, Rosenfeld PF. The Salto total ankle arthroplasty - Clinical and radiological outcomes at five years. Foot Ankle Surg 2019; 25:523-528. [PMID: 30321952 DOI: 10.1016/j.fas.2018.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Modern designs of total ankle arthroplasty (TAA) have the potential to treat symptomatic ankle OA without adversely affecting ankle biomechanics. We present the mid-term results of a modern, mobile-bearing TAA design. METHODS TAA was performed in 50 consecutive patients (55 ankles) in an independent, prospective, single-centre series. Implant survival, patient-reported outcome measures (PROMs) and radiographic outcomes are presented at a mean of five years (range 2-10.5years). RESULTS A total of three patients (four ankles) died and two (two ankles) were lost to follow-up. Three TAAs were revised for aseptic loosening (in two cases) or infection. Two further patients underwent reoperations, one for arthroscopic debridement of anterolateral synovitis and one for grafting of an asymptomatic tibial cyst. With all-cause revision as an endpoint, implant survival was 93.3% at five to ten years (95% CI 80.5%-97.8%). If reoperations are included this falls to 90.2% (95% CI 75.6%-96.3%) at five years. No other patient demonstrated radiographic evidence of loosening or subsidence. PROMs and satisfaction were excellent at latest follow-up. CONCLUSION At five years, the outcomes for this design of TAA in this series were excellent, and were similar to those of previously published series from the designer centre.
Collapse
Affiliation(s)
- K Koo
- Singapore General Hospital, Outram Road, 169608, Singapore; Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom; Fortius Clinic, 17 Fitzhardinge Street, London W1H 6EQ, United Kingdom.
| | - A D Liddle
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom.
| | - P S Pastides
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom.
| | - P F Rosenfeld
- Imperial College Healthcare NHS Trust, The Bays, South Wharf Road, St Mary's Hospital, London W2 1NY, United Kingdom; Fortius Clinic, 17 Fitzhardinge Street, London W1H 6EQ, United Kingdom.
| |
Collapse
|
10
|
Cottom JM, Douthett SM, McConnell KK, Plemmons BS. The Relationship Between Polyethylene Insert Size and Complications in Total Ankle Replacement. Foot Ankle Spec 2019; 12:253-257. [PMID: 30051731 DOI: 10.1177/1938640018787044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to compare complication rates after total ankle replacement in 2 groups of patients based on polyethylene insert size. The total cohort was divided into 2 groups based on insert size. Group 1 included patients with polyethylene insert size less than 10 mm in thickness. Group 2 included patients with polyethylene insert sizes 10 mm and larger. Available charts were reviewed for patients who underwent primary total ankle arthroplasty by one surgeon. Patient demographics, polyethylene insert size, implant used, concomitant procedures, postoperative complications, and patient-reported outcome scores were recorded. One hundred patients were available for follow-up and were included in this study, which ranged from March 2012 to July 2017. The average follow-up was 31.3 months (range = 10-60 months). Forty-eight females and 52 males were included in this study. There were a total of 63 patients in group 1 and 47 patients in group 2. The total complication rate for patients in group 1 was 11.1% (7/63), and in group 2 it was 16.2% (6/32). There was no statistical significance in complication rates when comparing the 2 groups (P = 0.5427). All patients underwent at least one concomitant procedure at the time of initial ankle replacement. Our findings show that total ankle replacement complication rates are equal when comparing large polyethylene inserts commonly utilized to correct deformities, versus small polyethylene inserts commonly utilized in primary resurfacing. Levels of Evidence: Level IV, Retrospective comparative study.
Collapse
Affiliation(s)
- James M Cottom
- Florida Orthopedic Foot and Ankle Center, Sarasota, Florida (JMC, SMD, KKM).,Longview Orthopedic Clinic Association, Longview, Texas (BSP)
| | - Steven M Douthett
- Florida Orthopedic Foot and Ankle Center, Sarasota, Florida (JMC, SMD, KKM).,Longview Orthopedic Clinic Association, Longview, Texas (BSP)
| | - Kelly K McConnell
- Florida Orthopedic Foot and Ankle Center, Sarasota, Florida (JMC, SMD, KKM).,Longview Orthopedic Clinic Association, Longview, Texas (BSP)
| | - Britton S Plemmons
- Florida Orthopedic Foot and Ankle Center, Sarasota, Florida (JMC, SMD, KKM).,Longview Orthopedic Clinic Association, Longview, Texas (BSP)
| |
Collapse
|
11
|
Usuelli FG, Maccario C, Granata F, Indino C, Vakhshori V, Tan EW. Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty. Foot Ankle Int 2019; 40:24-33. [PMID: 30203667 DOI: 10.1177/1071100718798851] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proven to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with follow-up of at least 2 years. METHODS: This prospective study included 89 patients who underwent transfibular total ankle arthroplasty from May 2013 to February 2016. The mean age was 53.2 ± 13.5 years. All patients were followed for at least 24 months postoperatively with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiographically preoperatively and at 6, 12, and 24 months postoperatively. RESULTS: At 24 months postoperatively, patients demonstrated statistically significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score from 33.8 ± 14.3 to 88.5 ± 6.6 ( P < .001), visual analog scale (VAS) from 80.5 ± 17.0 to 14.1 ± 9.2 ( P < .001), and Short Form-12 Physical and Mental Composite Scores from 29.9 ± 6.7 and 43.3 ± 8.6 to 47.0 ± 7.6 and 53.3 ± 8.1, respectively ( P < .001). In addition, ankle dorsiflexion and plantarflexion improved from 6.2 ± 5.5 and 9.6 ± 5.8 degrees to 24.2 ± 7.9 and 18.1 ± 7.6 degrees, respectively ( P < .001). Radiographically, patients demonstrated maintained neutral alignment of the ankle at 24 months. No patient demonstrated any radiographic evidence of tibial or talar lucency at final follow-up. Seven patients underwent reoperation for removal of symptomatic hardware (6 fibular plates, 1 syndesmotic screw); 2 patients experienced delayed wound healing. The first one was treated with plate removal and flap coverage. The second one required fibular plate removal. One patient developed a postoperative prosthetic infection requiring operative debridement, removal of implants, and placement of an antibiotic spacer. CONCLUSION: This study found that transfibular total ankle replacement was a safe and effective option for patients with ankle arthritis resulting in improvements in patient-reported outcomes, range of motion, and radiographic parameters. However, further studies are required to determine the mid- and long-term performance of these implants. LEVEL OF EVIDENCE: Level IV, case series.
Collapse
Affiliation(s)
- Federico G Usuelli
- 1 CASCO Piede e Caviglia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Camilla Maccario
- 1 CASCO Piede e Caviglia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesco Granata
- 2 Universita' di Napoli Federico II, Dipartimento di Sanita' Pubblica, Naples, Italy
| | - Cristian Indino
- 1 CASCO Piede e Caviglia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Venus Vakhshori
- 3 University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Eric W Tan
- 3 University of Southern California, Keck School of Medicine, Los Angeles, CA
| |
Collapse
|
12
|
Kieser DC, Cawley DT, Fujishiro T, Tavolaro C, Mazas S, Boissiere L, Obeid I, Pointillart V, Vital JM, Gille O. Anterior Bone Loss in Cervical Disc Arthroplasty. Asian Spine J 2018; 13:13-21. [PMID: 30326692 PMCID: PMC6365779 DOI: 10.31616/asj.2018.0008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/03/2018] [Indexed: 12/18/2022] Open
Abstract
Study Design Retrospective, longitudinal observational study. Purpose To describe the natural history of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and introduce a classification system for its assessment. Overview of Literature ABL has recently been recognized as a complication of CDA, but its cause and clinical effects remain unknown. Methods Patients with non-keeled CDA (146) were retrospectively reviewed. X-rays were examined at 6 weeks, 3, 6, 9, 12, 18, and 24 months, and annually thereafter for a minimum of 5 years. These were compared with the initial postoperative X-rays to determine the ABL. Visual Analog Scale pain scores were recorded at 3 months and 5 years. Neck Disability Index was recorded at postoperative 5 years. The natural history was determined and a classification system was introduced. Results Complete radiological assessment was available for 114 patients with 156 cervical disc replacements (CDRs) and 309 endplates (average age, 45.3 years; minimum, 28 years; maximum, 65 years; 57% females). ABL occurred in 57.1% of CDRs (45.5% mild, 8.3% moderate, and 3.2% severe) and commenced within 3 months of the operation and followed a benign course, with improvement in the bone stock after initial bone resorption. There was no relationship between ABL degree and pain or functional outcome, and no implants were revised. Conclusions ABL is common (57.1%). It occurs at an early stage (within 3 months) and typically follows a non-progressive natural history with stable radiographic features after the first year. Most ABL cases are mild, but severe ABL occurs in approximately 3% of CDAs. ABL does not affect the patients’ clinical outcome or the requirement for revision surgery. Surgeons should thus treat patients undergoing CDA considering ABL.
Collapse
Affiliation(s)
| | | | - Takashi Fujishiro
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Celeste Tavolaro
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Simon Mazas
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Louis Boissiere
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Ibrahim Obeid
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | | | - Jean Marc Vital
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| | - Olivier Gille
- L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, France
| |
Collapse
|
13
|
Usuelli FG, Di Silvestri CA, D’Ambrosi R, Orenti A, Randelli F. Total ankle replacement: is pre-operative varus deformity a predictor of poor survival rate and clinical and radiological outcomes? INTERNATIONAL ORTHOPAEDICS 2018; 43:243-249. [DOI: 10.1007/s00264-018-4189-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 09/26/2018] [Indexed: 12/14/2022]
|
14
|
Kieser DC, Cawley DT, Fujishiro T, Mazas S, Boissière L, Obeid I, Pointillart V, Vital JM, Gille O. Risk factors for anterior bone loss in cervical disc arthroplasty. J Neurosurg Spine 2018; 29:123-129. [PMID: 29799314 DOI: 10.3171/2018.1.spine171018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study was to identify the risk factors of anterior bone loss (ABL) in cervical disc arthroplasty (CDA) and the subsequent effect of this phenomenon. METHODS The authors performed a retrospective radiological review of 185 patients with a minimum 5-year follow-up after CDA (using Bryan, Discocerv, Mobi-C, or Baguera C). Postoperative radiographs were examined and compared to the initial postoperative films to determine the percentage of ABL. The relationship of ABL to potential risk factors was analyzed. RESULTS Complete radiological assessment was available in 145 patients with 193 CDRs and 383 endplates (average age 45 years, range 25-65 years, 54% women). ABL was identified in 63.7% of CDRs (48.7% mild, 11.9% moderate, 3.1% severe). Age (p = 0.770), sex (p = 0.200), postoperative alignment (p = 0.330), midflexion point (p = 0.509), maximal flexion (p = 0.080), and extension (p = 0.717) did not relate to ABL. There was no significant difference in the rate of severe ABL between implants. Multilevel surgery conferred an increased risk of any and severe ABL (p = 0.013 for both). The upper endplate, defined as superior to the CDA, was more commonly involved (p = 0.008), but there was no significant difference whether the endplate was between or not between implants (p = 0.226). The development of ABL did not affect the long-term range of movement (ROM) of the CDA, but did increase the overall risk of autofusion. ABL was not associated with pain or functional deficits. No patients required a reoperation or revision of their implant during the course of this study, and there were no cases of progressive ABL beyond the first year. CONCLUSIONS ABL is common in all implant types assessed, although most is mild. Age, sex, postoperative alignment, ROM, and midflexion point do not relate to this phenomenon. However, the greater the number of levels operated, the higher the risk of developing ABL. The development of ABL has no long-term effect on the mechanical functioning of the disc or necessity for revision surgery, although it may increase the rate of autofusion.
Collapse
Affiliation(s)
- David Christopher Kieser
- 1Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, Canterbury, New Zealand; and
| | - Derek Thomas Cawley
- 2L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, Aquitaine, France
| | - Takashi Fujishiro
- 2L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, Aquitaine, France
| | - Simon Mazas
- 2L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, Aquitaine, France
| | - Louis Boissière
- 2L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, Aquitaine, France
| | - Ibrahim Obeid
- 2L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, Aquitaine, France
| | - Vincent Pointillart
- 2L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, Aquitaine, France
| | - Jean-Marc Vital
- 2L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, Aquitaine, France
| | - Olivier Gille
- 2L'Institut de la Colonne Vertébrale, CHU Pellegrin, Bordeaux, Aquitaine, France
| |
Collapse
|
15
|
Affiliation(s)
- Anke Röser
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, D-81347, München, Deutschland.
| | - Sebastian Altenberger
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, D-81347, München, Deutschland
| | - Markus Walther
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, D-81347, München, Deutschland
| |
Collapse
|
16
|
Pangrazzi GJ, Baker EA, Shaheen PJ, Okeagu CN, Fortin PT. Single-Surgeon Experience and Complications of a Fixed-Bearing Total Ankle Arthroplasty. Foot Ankle Int 2018; 39:46-58. [PMID: 29035609 DOI: 10.1177/1071100717735288] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) has historically resulted in inferior survivorship rates compared with total hip and knee arthroplasty, because of technical issues unique to ankle anatomy. In this study, a single-surgeon series of intra- and postoperative complications as well as resultant reoperations/revisions of the Tornier Salto Talaris, a fixed-bearing TAA prosthesis, were reviewed. METHODS Medical records from index procedure to latest follow-up of primary TAA were reviewed. Complications were categorized according to the Glazebrook classification; additional complications were documented. Concurrent procedures were recorded, and radiographs were analyzed for alignment, subsidence, and cyst formation. Time to complication onset and learning curve analyses were performed. One hundred four Salto Talaris TAA prostheses (96 patients), with an average follow-up of 46 months, were included. RESULTS Thirty-five complications were identified in 32 ankles with a 34% complication rate, resulting in 11 reoperations (5 TAA revisions). Technical error (n = 12), wound healing (n = 9), and aseptic loosening (n = 4) were the most common complications, and there were no statistically significant differences in demographics or follow-up duration between cases with versus without complications. In both the cohorts with and without complications, there were moderate, negative correlations between radiographically observed keel osteopenia and lucency (ρ = -0.548, P = .00125, and ρ = -0.416, P = .000303, respectively); also, in the complication cohort, a weak, positive correlation between subsidence and lucency (ρ = 0.357, P = .0450) was found. CONCLUSION Salto Talaris TAA survivorship and reoperation rates in our series were comparable with previous reports, using either the same or similar mobile-bearing prostheses; new information regarding complication, radiographic, and learning curve analyses was presented. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Garett J Pangrazzi
- 1 Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Erin A Baker
- 2 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Phillip J Shaheen
- 2 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Chikezie N Okeagu
- 2 Beaumont Health System, Department of Orthopaedic Research, Royal Oak, MI, USA
| | - Paul T Fortin
- 1 Beaumont Health System, Department of Orthopaedic Surgery, Royal Oak, MI, USA
| |
Collapse
|
17
|
Gross CE, Green CL, DeOrio JK, Easley M, Adams S, Nunley JA. Impact of Diabetes on Outcome of Total Ankle Replacement. Foot Ankle Int 2015; 36:1144-9. [PMID: 25948694 DOI: 10.1177/1071100715585575] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND As the incidence of diabetes mellitus (DM) grows, managing patients with diabetes and concomitant ankle arthritis poses a challenging clinical dilemma. While diabetes is known to be a risk factor for complications relating to open reduction and internal fixation of ankle fractures, it is unclear if DM is a risk factor for negative outcomes after total ankle replacement (TAR). METHODS We retrospectively identified a consecutive series of 813 primary TARs performed between 2002 and November 2013 that had a minimum follow-up of 1 year. Within that larger group, we identified 50 patients with DM and used a control group without DM for comparison (n = 55). Clinical outcomes including wound issues, infection rates, complications, and failure rates were then compared. Functional outcomes, including American Orthopaedic Foot & Ankle Society hindfoot score, Short Form-36 (SF-36), Short Musculoskeletal Function Assessment, Foot and Ankle Disability Index, and visual analog scale, were also compared. Median patient follow-up was 2.3 years in the DM group and 3.1 years in the control group (P = .239). RESULTS The body mass index, age, preoperative American Society of Anesthesiologists (ASA) grading, and smoking history in the DM were significantly higher than in the control group. While 5 patients (10%) in the DM group had secondary operations related to the TAR, no patients had a superficial or deep infection. Eight patients (14.5%) in the control group had secondary operations, including 1 patient who needed a flap. There was no statistical differences in secondary operations (P = .562), revisions (P = .604), or failure rates (P = .345). For both the diabetes and control groups, all functional outcome scores except SF-36 General Health significantly improved at 1 year postoperatively; these improvements were maintained at most recent follow-up. There was no statistically significant difference between the groups regarding functional outcomes except that at 1 year, the magnitude of improvement in SF-36 General Heath was significantly better in the control group. CONCLUSIONS Total ankle arthroplasty appears to be an effective and safe means for providing pain relief and improving function in patients with diabetes and ankle arthritis. While patients with DM were heavier and had worse ASA preoperative grades, they did not have a significantly different complication or infection rate. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Christopher E Gross
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Mark Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samuel Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
18
|
Gharehdaghi M, Rahimi H, Mousavian A. Anterior ankle arthrodesis with molded plate: technique and outcomes. THE ARCHIVES OF BONE AND JOINT SURGERY 2014; 2:203-209. [PMID: 25386583 PMCID: PMC4225027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 08/17/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND There is still controversy regarding the best technique for ankle arthrodesis to acheive stable rigid fixation along with reconstructing a functional plantigrade foot. Moreover, existing techniques have complictions related to stability, soft tissue covering, fusion rate, and exposure. METHODS With the anterior approach exactly on the tibialis anterior sheath, the joint was exposed and previous hardware, if any, was removed and with the safe direct approach, the ankle, hindfoot, and indirectly the subtalar joints were accessed. Then fresh cancellous bone was obtained and complete denudation was preformed. Lastly, a narrow 4.5 millimeter plate was carefully placed on what was determined to be the best final position.In this prospective study, 12 patients with severe ankle pain and arthritis enrolled from February 2010 to January 2012. Eight of them had posttraumatic arthritis and deformity with hardware, two had rheumatoid arthritis, one had poliomyelitis with severe deformity of the foot and knee, and another had chronic ulcerative synovitis of the ankle joint. The patients were assessed clinically and radiographically for an average of two years (range: 13 months to 4 years) for functional recovery, range of motion, stability of the ankle, and imaging evidence of union. RESULTS Ankle deformities and pain in all 12 cases were corrected. With a short healing time and rapid recovery period, after six weeks all of the patients could walk independently. Also, scores of the Manchester-Oxford Foot Questionnaire (MOXFQ) improved significantly from 69 preoperatively to 33 postoperatively). CONCLUSIONS Anterior ankle arthrodesis with molded plating can be an easy and safe way to manage deformities and it has excellent fusion rate and sufficient rigid fixation.
Collapse
Affiliation(s)
- Mohammad Gharehdaghi
- Mohammad Gharehdaghi MD, Hasan Rahimi MD, Alireza Mousavian MD, Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hasan Rahimi
- Mohammad Gharehdaghi MD, Hasan Rahimi MD, Alireza Mousavian MD, Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Mousavian
- Mohammad Gharehdaghi MD, Hasan Rahimi MD, Alireza Mousavian MD, Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
19
|
Kessler B, Knupp M, Graber P, Zwicky L, Hintermann B, Zimmerli W, Sendi P. The treatment and outcome of peri-prosthetic infection of the ankle: a single cohort-centre experience of 34 cases. Bone Joint J 2014; 96-B:772-7. [PMID: 24891577 DOI: 10.1302/0301-620x.96b6.33298] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The treatment of peri-prosthetic joint infection (PJI) of the ankle is not standardised. It is not clear whether an algorithm developed for hip and knee PJI can be used in the management of PJI of the ankle. We evaluated the outcome, at two or more years post-operatively, in 34 patients with PJI of the ankle, identified from a cohort of 511 patients who had undergone total ankle replacement. Their median age was 62.1 years (53.3 to 68.2), and 20 patients were women. Infection was exogenous in 28 (82.4%) and haematogenous in six (17.6%); 19 (55.9%) were acute infections and 15 (44.1%) chronic. Staphylococci were the cause of 24 infections (70.6%). Surgery with retention of one or both components was undertaken in 21 patients (61.8%), both components were replaced in ten (29.4%), and arthrodesis was undertaken in three (8.8%). An infection-free outcome with satisfactory function of the ankle was obtained in 23 patients (67.6%). The best rate of cure followed the exchange of both components (9/10, 90%). In the 21 patients in whom one or both components were retained, four had a relapse of the same infecting organism and three had an infection with another organism. Hence the rate of cure was 66.7% (14 of 21). In these 21 patients, we compared the treatment given to an algorithm developed for the treatment of PJI of the knee and hip. In 17 (80.9%) patients, treatment was not according to the algorithm. Most (11 of 17) had only one criterion against retention of one or both components. In all, ten of 11 patients with severe soft-tissue compromise as a single criterion had a relapse-free survival. We propose that the treatment concept for PJI of the ankle requires adaptation of the grading of quality of the soft tissues.
Collapse
Affiliation(s)
- B Kessler
- Basel University Medical Clinic Liestal, Interdisciplinary Unit for Orthopaedic Infections, Kantonsspital Baselland, Liestal, Switzerland
| | - M Knupp
- Department of Orthopaedic Surgery & Traumatology, Interdisciplinary Unit for Orthopaedic Infections, Kantonsspital Baselland, Liestal, Switzerland
| | - P Graber
- Basel University Medical Clinic Liestal, Interdisciplinary Unit for Orthopaedic Infections, Kantonsspital Baselland, Liestal, Switzerland
| | - L Zwicky
- Department of Orthopaedic Surgery & Traumatology, Interdisciplinary Unit for Orthopaedic Infections, Kantonsspital Baselland, Liestal, Switzerland
| | - B Hintermann
- Department of Orthopaedic Surgery & Traumatology, Interdisciplinary Unit for Orthopaedic Infections, Kantonsspital Baselland, Liestal, Switzerland
| | - W Zimmerli
- Basel University Medical Clinic Liestal, Interdisciplinary Unit for Orthopaedic Infections, Kantonsspital Baselland, Liestal, Switzerland
| | - P Sendi
- Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
| |
Collapse
|
20
|
Barg A, Barg K, Schneider SW, Pagenstert G, Gloyer M, Henninger HB, Valderrabano V. Thrombembolic complications after total ankle replacement. Curr Rev Musculoskelet Med 2013; 6:328-335. [PMID: 24078351 PMCID: PMC4094097 DOI: 10.1007/s12178-013-9186-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The literature addressing functional outcome and survivorship of prosthesis components is constantly growing. However, the data on thromboprophylaxis and thrombembolic complications in patients who underwent TAR are scarce. A total of 31 studies were included in the systemic literature review. The incidence of thrombembolic complications varied between 0.0 % and 9.8 %. Most commonly, low molecular weight heparin was used as thromboprophylaxis for 6 weeks postoperatively. The incidence of thrombembolic complications was comparable with that of symptomatic deep vein thrombosis in patients with total knee or hip replacement.
Collapse
Affiliation(s)
- Alexej Barg
- Orthopaedic Department, University Hospital of Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland,
| | | | | | | | | | | | | |
Collapse
|