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Fa-Binefa M, López-Hervás S, López-Capdevila L, Fernández de Retana P, Schon L. Survival and complications of transfibular trabecular metal total ankle replacement - A systematic review. Foot Ankle Surg 2024:S1268-7731(24)00108-5. [PMID: 38821820 DOI: 10.1016/j.fas.2024.05.007] [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: 02/06/2024] [Revised: 03/06/2024] [Accepted: 05/13/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND In the past decade, the transfibular approach to Total Ankle Replacement (TAR) has emerged as an alternative to anterior approach with reduced bone resection. The purpose of this systematic review is to report survival, complications, and reoperation rates of transfibular TAR. METHODS We conducted a systematic search of studies that evaluated complications, reoperations, and survival of transfibular TAR following PRISMA guidelines across PubMed, Scopus and Web of Science. RESULTS Our review included data from 12 cohorts, comprising 919 patients across 7 countries, with an average age of 62 years (59% posttraumatic). Over an average follow-up period of 3 years, adverse events occurred in 23% of cases, with 18% requiring surgical reintervention, mostly due to hardware removal. The survival rate of the transfibular TAR metal components was 97% at the final follow-up. CONCLUSION Transfibular TAR demonstrates a 97% survival rate at a 3-year follow-up. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Manel Fa-Binefa
- Hospital de la Santa Creu i Sant Pau. Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; Universitat Autònoma de Barcelona, Spain
| | - Sergio López-Hervás
- Hospital de la Santa Creu i Sant Pau. Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Laia López-Capdevila
- Hospital de la Santa Creu i Sant Pau. Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Pablo Fernández de Retana
- Hospital de la Santa Creu i Sant Pau. Barcelona, Spain; Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Lew Schon
- Institute for Foot and Ankle Reconstruction, Baltimore, MD, USA
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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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Pfahl K, Röser A, Eder J, Gottschalk O, Hörterer H, Mehlhorn A, Walther M. Failure rates and patient-reported outcomes of revision of total ankle arthroplasty. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04657-1. [PMID: 36271162 DOI: 10.1007/s00402-022-04657-1] [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: 04/19/2022] [Accepted: 10/09/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite the increasing number of revision total ankle arthroplasty (TAA), the literature on indications, surgical options, and outcomes is limited. This study reports on failure rates and patient-reported outcomes (PROM) for a cohort of 122 patients who underwent revision of TAA. MATERIALS AND METHODS A retrospective review of revision TAA between 2006 and 2020 was performed at one institution. Patient's demographics and different surgical procedures were analyzed with particular attention to comparing polyethylene exchange with revision of both metallic components and to additional interventions for axis correction. Failure rates and the European Foot and Ankle Society (EFAS) score were collected. The average follow-up period was 70.37 ± 46.76 months. RESULTS 122 patients were treated with an exchange procedure. The surgery included 69 polyethylene exchanges, 12 revisions of one metallic component, and 41 revisions of both metallic components. The overall failure rate was 14.75%. The EFAS score, completed by 94 of the 122 patients, was used to evaluate clinical outcomes. Median EFAS score was 12.51 ± 5.53, and median EFAS sports score was 2.97 ± 3.04. Revision rates after polyethylene exchange were significantly higher than after exchanging both metallic components (p value = 0.03), while the EFAS score showed slightly better results in patients treated with polyethylene exchange. Adding procedures to induce axis correction led to significantly lower revision rates (p value = 0.03), and the EFAS score was also improved but without statistical significance. CONCLUSIONS The high failure rate of polyethylene exchange indicates that the intervention does not address the actual cause of failed TAA in many cases. Additional axis correction should be considered more frequently. If the underlying issues of prosthesis failure can be identified and sufficiently addressed, the results of revision surgery are likely to improve.
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Affiliation(s)
- Kathrin Pfahl
- Schön Klinik München Harlaching - FIFA Medical Centre, Center for Foot and Ankle Surgery, Harlachinger Straße 51, 81547, Munich, Germany.
| | - Anke Röser
- Schön Klinik München Harlaching - FIFA Medical Centre, Center for Foot and Ankle Surgery, Harlachinger Straße 51, 81547, Munich, Germany
| | - Julia Eder
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - Oliver Gottschalk
- Schön Klinik München Harlaching - FIFA Medical Centre, Center for Foot and Ankle Surgery, Harlachinger Straße 51, 81547, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Hubert Hörterer
- Schön Klinik München Harlaching - FIFA Medical Centre, Center for Foot and Ankle Surgery, Harlachinger Straße 51, 81547, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Alexander Mehlhorn
- Schön Klinik München Harlaching - FIFA Medical Centre, Center for Foot and Ankle Surgery, Harlachinger Straße 51, 81547, Munich, Germany
| | - Markus Walther
- Schön Klinik München Harlaching - FIFA Medical Centre, Center for Foot and Ankle Surgery, Harlachinger Straße 51, 81547, Munich, Germany
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Caravelli S, Di Ponte M, Grassi A, Zaffagnini S, Mosca M. Associated Corrective Procedures of Extra-Articular Asymptomatic Foot Malalignments in Total Ankle Replacement: Are They Really Mandatory? J Clin Med 2022; 11:jcm11154544. [PMID: 35956158 PMCID: PMC9370014 DOI: 10.3390/jcm11154544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/02/2022] [Indexed: 02/01/2023] Open
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Wu SX, Liu SZ, Ling M, Che YH, Tian X, Duan XL, Yi Z. A Novel Method for Preoperative Positioning of Total Ankle Replacement Using 3D Digital Model. Orthop Surg 2022; 14:1378-1384. [PMID: 35656705 PMCID: PMC9251280 DOI: 10.1111/os.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To establish a digital model of the ankle joint through 3D imaging technology and explore the preoperative placement of ankle replacement prostheses. METHODS Computed tomography images of intact ankle joints from 54 cases in the outpatient and inpatient departments of our hospital were collected; according to the INBONE® total ankle system surgery process, the surgery model and surgical osteotomy were finished using MIMICS based on computer simulation method. The shortest distance was measured between the center point and the anterior, posterior, medial, and lateral, respectively, to ensure the precise position of the ankle replacement prosthesis by digital simulation surgery. The relationship between the two variables was analyzed by bivariate correlation analysis. RESULTS The dataset of this study included 48 cases of the sub-data set (26 males and 22 females) and included 27 cases of left ankle and 21 cases of right ankle. The average medial malleolar angle was 18.67°± 2.87°, the average amount of bone resection was 12.13 ± 1.86 cm3 , the mid-anterior distance was 1.72 ± 0.19 cm, the mid-posterior distance was 2.00 ± 0.19 cm, the ratio of mid-anterior to mid-posterior was 0.87, the mid-medial distance was 1.26 ± 0.17 cm, the mid-lateral distance was 1.19 ± 0.16 cm, and the ratio of mid-medial to mid-lateral was 1.06. After osteotomy, the anteroposterior diameter was 3.73 ± 0.32 cm, the transverse diameter was 2.46 ± 0.27 cm, and the ratio of anteroposterior diameter to transverse diameter was 1.53. In the bottom view, the shape after osteotomy is rectangular. The mid-anterior distance was strongly negatively correlated with age, the mid-anterior distance and the amount of bone resection, the mid-medial distance and the amount of bone resection, the mid-lateral distance and the amount of bone resection, the mid-lateral distance and the anteroposterior diameter, the anteroposterior diameter and the transverse diameter were all strongly positively correlated. CONCLUSION The projection point of the lower tibia centerline on the tibial horizontal osteotomy surface is located at a position slightly anterior to the midpoint of the transverse diameter after ankle arthroplasty. The rational positioning of the total ankle replacement is located at both a position slightly anterior to the midpoint of the transverse diameter and midpoint of the anteroposterior diameter, which can be used as a reference method before total ankle arthroplasty surgery.
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Affiliation(s)
- Shi-Xun Wu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China.,The College of Life Sciences and Medicine, Northwest University, xi'an, China
| | - Shi-Zhang Liu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ming Ling
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yan-Hui Che
- First Middle School of Xi'an City, Xi'an, China
| | - Xin Tian
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiang-Long Duan
- The College of Life Sciences and Medicine, Northwest University, xi'an, China.,Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhi Yi
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
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Lin J, Sofka CM, Demetracopoulos CA, Potter HG. The Utility of Isotropic 3D Magnetic Resonance Imaging in Assessing Painful Total Ankle Replacements. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221094840. [PMID: 35520474 PMCID: PMC9067051 DOI: 10.1177/24730114221094840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ji Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | | | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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