Functional and clinical outcomes of total ankle arthroplasty in elderly compared to younger patients

Outcomes After Total Ankle Arthroplasty in Patients Aged ≤50 Years at Midterm Follow-up

BACKGROUND

Ankle arthritis differs from arthritis of the hip and knee in that 80% is posttraumatic and thus often occurs in a younger patient population. The literature supporting total ankle arthroplasty (TAA) in younger patients has increased over recent years and has bolstered the argument that in the short term, TAA in younger patients has successful outcomes that are comparable to older, lower-demand patients.The purpose of our study was to evaluate patient-reported outcomes (PROs) and implant survivorship at midterm after primary TAA in patients ≤ 50 years of age at the time of surgery.

METHODS

A retrospective chart review was conducted of patients ≤ 50 years of age who underwent primary TAA at a single institution from 2000 to 2017. Patient demographics, outcome measures, and complications were recorded. All patients had a minimum clinical follow-up of 5 years. PRO measures were evaluated at preoperative, 1-year postoperative, and final follow-up visits. Paired t tests were performed to compare individual patient changes in PROs from preoperative. Implant survivorship was evaluated based on need for revision of either the tibial or talar component. The need for additional surgery related to the TAA was also evaluated.

RESULTS

A total of 58 patients were included. The average age at the time of the index surgery was 43.3 years (range 22-50 years). All patients had a minimum follow-up of 5 years with a mean follow-up of 8.8 years. A total of 11 patients required additional surgery related to their TAA. Six patients (10.3%) required bone grafting of peri-implant cysts, 3 patients (5.2 %) required gutter debridement, and 1 patient underwent complete revision of metal components. Mean visual analog scale, 36-item Short Form Health Survey, Short Musculoskeletal Function Assessment, and American Orthopaedic Foot & Ankle Society hindfoot scores significantly improved from preoperative to 1-year postoperative and final postoperative follow-up.

CONCLUSION

The patients aged ≤50 years treated with a TAA whom we have been able to observe for a minimum of 5 years showed generally maintained improvement in functional scores and thus far have had a relatively low rate of secondary surgeries.Level of Evidence:Level III, retrospective cohort study.

Total Ankle Arthroplasty in Young Patients

With continuing advancements in total ankle arthroplasty (TAA), it is quickly becoming the procedure of choice for older patients with end-stage ankle arthritis. Multiple studies have been conducted on younger patients who have undergone TAA with promising results, but is it the procedure of choice? Considerations of TAA versus ankle arthrodesis, TAA implant longevity, outcomes of revision TAA, and whether patients should be offered an arthrodesis with plans for conversion to arthroplasty may help elucidate whether pursuing ankle arthroplasty in a younger, more active population is the correct approach for surgeons.

Clinical Outcomes and Registry Data in Total Ankle Arthroplasty

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.

Long-Term Survival Analysis of 5619 Total Ankle Arthroplasty and Patient Risk Factors for Failure

BACKGROUND

Total ankle arthroplasty (TAA) has higher complication and failure rates compared to other surgical joint replacement procedures despite technological advances. This study aimed to find the long-term survivability of the TAA procedure and identify the patient risk factors for failure with one of the largest cohorts of patients in the literature.

METHODS

This retrospective cohort study involving cases between 2007 and 2018 analyzed patients who received an index primary TAA procedure in Korea. A total of 5619 cases were included in the final analysis. The TAA failure was defined as either a case with revision arthroplasty or a case with TAA implant removal and arthrodesis performed after primary TAA.

RESULTS

During the study period, the 5-year survival rate was 95.4% (95% CI, 94.7-96.1%), and the 10-year survival rate was 91.1% (95% CI, 89.1-93.1%). A younger age (<55 years, adjusted hazard ratio [AHR], 1.725; 55-64 years, AHR, 1.812; p < 0.001 for both), chronic pulmonary disease (AHR, 1.476; p = 0.013), diabetes (AHR, 1.443; p = 0.014), and alcohol abuse (AHR, 1.524; p = 0.032) showed a significantly high odds ratio for primary TAA failure in Cox regression analysis.

CONCLUSION

The 10-year TAA survivorship rate was 91.1%. A younger age, chronic pulmonary disease, diabetes, and heavy alcohol consumption are risk factors for TAA.

Elective Foot and Ankle Procedures in the Patients Greater than 65 Years of Age: Worth the Mobility Gains

Chronic, non-traumatic pathologies of the foot and ankle can be mobility-limiting for patients of all ages. The objective of this study was to compare postoperative changes in LifeSpace Mobility Assessment (LSA) scores of adult and elderly patients following elective foot and ankle surgery. A prospective study of 184 patients undergoing elective ankle, hindfoot, and midfoot procedures conducted by one surgeon between 2015 and 2019 was undertaken. Patient-reported LSA scores were collected at preoperative, 6-month, and 12-month follow-up. Patient data was compared using an independent sample t-test for continuous, normally distributed data and a chi-squared or Fischer's exact test for categorical data. Alpha and beta were .05 and .8. Patients were divided based on age. 140 patients were observed in the younger (<65) group, 44 patients were observed in the elderly (≥65) group. The average LSA score of elderly patients at the preoperative visit was 58.3 (SD 38.0) vs 79.3 (SD 38.8) in the younger cohort (P = .041). Both patient cohorts saw decreased mobility at 3-month postoperative visits but surpassed preoperative mobility scores by 6 months and 1 year postop. No difference in average mobility score was observed between young (85.6, SD 36.1) and elderly (90.1, SD 34.3) cohorts at 1-year follow up. Given the increased rates of perioperative comorbidities and the heightened risks of intraoperative complications, physicians may be more inclined to manage elderly patients with longer periods of conservative treatment for similar pathologies. However, these results imply that elderly patients experience similar improvements after surgery to younger cohorts and should not be excluded from surgical consideration. Our results, in tandem with literature showing the deleterious effects of decreased mobility in the elderly, suggest that the discussion to pursue or hold surgical correction of chronic foot and ankle disease in patients over age 65 must consider the mobility benefits of surgery.

Risk Factors for Failure of Total Ankle Replacements: A Data Linkage Study Using the National Joint Registry and NHS Digital

BACKGROUND

Despite the increasing numbers of ankle replacements, there remains debate about which patients should undergo an ankle replacement, and there are limited studies analyzing risk factors for failure of an ankle replacement. The primary aim of this study is to analyze the risk factors for failure of total ankle replacements.

METHODS

A data linkage study combining the National Joint Registry (NJR) Data and NHS (National Health Service) Digital data was performed. The primary outcome of failure is defined as the removal or exchange of any components of the implanted device. Kaplan-Meier survival charts were used to illustrate survivorship. Multivariable Cox proportional hazards regression models were fitted to analyze potential risk factors for failures or ankle replacements.

RESULTS

The overall 5-year survival was 90.2% (95% CI 89.2%-91.1%). In multivariable (adjusted) Cox regression models, only age (hazard ratio [HR] 0.96, 95% CI 0.94-0.97), body mass index (BMI; HR 1.03, 95% CI 1.01-1.06), and underlying etiology (HR 0.88, 95% CI 0.80-0.97) were associated with an increased risk of failure.

CONCLUSION

This study demonstrates that younger patients and those with an increased BMI have an increased risk of failure of a primary ankle replacement. We also show that rheumatoid patients have higher survivorship than those with osteoarthritis.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years: a multicenter, retrospective study

BACKGROUND

This study aimed to clarify the clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years and compare these outcomes with those of patients aged < 75 years.

METHODS

A total of 148 patients, including 65 who underwent total ankle arthroplasty and 83 who underwent ankle arthrodesis, were retrospectively surveyed. Clinical outcomes were assessed preoperatively and at the last follow-up using the Japanese Society for Surgery of the Foot Hindfoot Scale and a self-administered foot evaluation questionnaire (SAFE-Q). Patient characteristics, including age, sex, body mass index, radiographic severity, and follow-up period, were also assessed. The patients were divided into older (≥ 75 years) and younger (< 75 years) age groups. Improvements in outcomes were then compared between age groups using univariate analysis and analysis of covariance adjusted for patient characteristics. Total ankle arthroplasty and ankle arthrodesis were analyzed separately.

RESULTS

All clinical outcome scores improved postoperatively in the older age groups for both procedures. Scores for the pain and pain-related subscale of the SAFE-Q improved by 37 points (p < 0.001) in post-total ankle arthroplasty patients and by 35 points in post-ankle arthrodesis patients (p < 0.001). Furthermore, multivariate analysis showed that the improvements observed in all scores were not different between the older and younger age groups for both post-total ankle arthroplasty and post-ankle arthrodesis patients, except for the SAFE-Q physical functioning subscale score for post-ankle arthrodesis patients. The clinical outcomes improved significantly in post-total ankle arthroplasty and post-ankle arthrodesis patients aged ≥ 75 years. Moreover, these improvements were similar to those observed in patients aged < 75 years.

CONCLUSIONS

Surgical treatment of end-stage ankle osteoarthritis can be a viable treatment option, even in elderly patients, and can be expected to improve similarly to younger patients.

Short-Term Outcomes of Primary Total Ankle Arthroplasty in Octogenarians: A National Database Analysis

BACKGROUND

Total ankle arthroplasty (TAA) is an increasingly popular option for end-stage ankle arthritis. Americans over the age of 80 years grew to 16.7 million in 2010, but there are scarce data assessing the outcomes of octogenarians undergoing TAA. This study evaluated (1) perioperative factors, (2) 30-day postoperative complications compared to a nonoctogenarian cohort, and (3) independent risk factors for adverse outcomes.

METHODS

A national database registry was queried for patients who had undergone primary TAA. This yielded 1113 patients, under (n = 1059) and over (n = 54) age 80 years. Demographics and perioperative data were compared using Fisher's exact, χ², and independent-samples t tests. Logistic and Poisson regressions were used to calculate odds ratio (OR) of complications and independent risk factors.

RESULTS

The octogenarian cohort had longer in-hospital length of stay (1.9 vs 2.5 days, P < .0001). Octogenarians were not significantly more likely to develop any complication (OR = 1.32; 95% confidence interval = 0.29-6.04; P = .722), or increased number of complications (OR = 1.18; 95% CI = 0.27-5.18; P = .820). Octogenarians had significantly increased risk of being discharged to rehab/skilled nursing (OR = 6.60; 95% CI = 2.16-20.15; P < .001) instead of home.

CONCLUSION

Although the elderly population may carry inherent risk factors, octogenarians do not present an increased risk of short-term complications following TAA.

LEVELS OF EVIDENCE

Therapeutic, Level III: Retrospective cohort study.

Long-Term Survival of HINTEGRA Total Ankle Replacement in 683 Patients: A Concise 20-Year Follow-up of a Previous Report

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

High Reoperation Rate in Mobile-Bearing Total Ankle Arthroplasty in Young Patients

Background and Objectives: Due to inferior survival rates compared to hip and knee arthroplasty, total ankle arthroplasty (TAA) was previously mainly recommended for older and less active patients. However, given the encouraging survival rates and clinical outcomes of modern generations of TAA, some authors have also advocated TAA in young patients. Thus, the aim of this study was to evaluate age related reoperation, revision and survival rates of third-generation mobile-bearing TAAs. Materials andMethods: In this retrospective study, 224 consecutive TAA patients with a minimum follow up (FU) of 2 years were analyzed. Patients were retrospectively assigned to two study groups (Group A: age < 50 years; Group B: age ≥ 50 years). Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. Results: After a mean FU of 7.1 ± 3.2 years, the reoperation rate (Group A: 22.2%; Group B: 5.3%; p = 0.003) and revision rate (Group A: 36.1%; Group B: 13.8%; p = 0.003) were higher within Group A. An age of under 50 years at time of surgery was associated with higher reoperation (odds ratio (OR): 6.54 (95% CI: 1.96–21.8); p = 0.002) and revision rates (OR: 3.13 (95% CI: 1.22–8.04); p = 0.018). Overall, lower patient age was associated with higher reoperation (p = 0.009) and revision rates (p = 0.001). Conclusions: The ideal indication for TAA remains controversial, especially regarding patient age. The findings of this study show high reoperation and revision rates in patients aged under 50 years at time of surgery. Therefore, the outcomes of this study suggest that the indication for TAA in young patients should be considered very carefully and that the association between low patient age and high reoperation rate should be disclosed to all eligible patients.

Patient-Reported Outcomes of Primary Total Ankle Arthroplasty in Patients Aged <50 Years

Background:

Compared to more prevalent arthritic conditions, ankle arthritis is complicated by an earlier age of onset. Recently published data demonstrates excellent survivorship and complication rates in short-/midterm follow-up of younger patients who received a primary total ankle arthroplasty (TAA). Additionally, older TAA patients display comparable reported outcomes relative to hip/knee arthroplasty. However, there remains a paucity of literature surrounding the reported outcomes of younger patients undergoing TAA. Thus, our aim was to assess the reported outcomes of individuals aged <50 years receiving a primary TAA.

Methods:

A retrospective cohort analysis of adult patients <50 years who received a primary total ankle replacement was conducted. Patient demographics, diagnosis, treatment, and outcome characteristics were recorded from a chart review of 41 patients with at least 1 year of postoperative clinical follow-up. Postoperative reported outcomes were obtained via telephone interviews. Primary outcomes that were measured included emotional and physical health, activity limitation, ambulation, and global health. Measures used included the 36-Item Short Form Health Survey (SF-36), Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, and Sickness Impact Profile Ambulation. The functional outcomes in our study sample were compared with age- and gender-matched norms from a general US population, and 95% CIs were calculated for each functional outcome mean. Student t test was used for continuous variables, and χ² analysis was used for categorical variables.

Results:

Thirty-one of 41 eligible patients were reached for interview. The average age at surgery was 39.7 years. Clinical and radiographic follow-up was a mean of 51.6 months and 31.2 months following TAA, respectively. General health as measured with the SF-36 was not significantly different from age-/gender-matched norms. Eighty-seven percent of patients would choose to have a TAA again. Although 58% reported being limited in vigorous activities, 61% were able to ambulate frequently for long periods of time. On average, the patients did not report ongoing pain, and only 16% reported fatigue that hindered activities. Eighty-one percent reported returning to full employment and performing their duties without difficulty, and 84% reported they resumed all normal social activities. Primary implant survivorship was 93%.

Conclusion:

Despite a younger age and potentially increased demands, patients aged <50 years undergoing primary TAA are generally satisfied with their index procedure at a mean follow-up of nearly 5 years. Our findings of positive outcomes on their health and well-being may improve surgeon insight for TAA as an alternative treatment for younger individuals with end-stage ankle arthritis.

Level of Evidence: Level IV, case series.

Effect of Age on Clinical and Radiological Outcomes of Hallux Valgus Surgery

BACKGROUND

The prevalence of hallux valgus increases with age. However, no studies have compared the effectiveness of surgical correction among different age groups. This study investigated the influence of age on clinical and radiological outcomes following hallux valgus surgery.

METHODS

Patients who underwent correction for hallux valgus at an academic hospital were stratified into 3 age groups: younger (<50 years), middle-aged (50-59 years), and older (≥60 years). Functional outcomes and satisfaction questionnaires were collected preoperatively and at 6 months and 2 years postoperatively. Radiological recurrence and reoperations were recorded at follow-up. There were 193 patients (93% female): 34 younger, 74 middle-aged, and 85 older.

RESULTS

The preoperative hallux valgus angle was significantly greater in older patients (P < .001). The older group had 3 perioperative complications (P = .144) and showed a trend toward a longer hospital stay (P = .083). There was no difference in visual analog scale, American Orthopaedic Foot & Ankle Society score, or SF-36 among the groups at 6 months or 2 years. Using multiple regression, age was not associated with any outcome score. The satisfaction rates were 82%, 78%, and 83% in the young, middle-aged, and older groups, respectively (P = .698). There was no difference in the number of reoperations at a mean follow-up of 9.2 ± 2.2 years (P = .778), and no patients underwent reoperation for recurrent hallux valgus. The risk of recurrence was 5 times higher in older patients compared with younger patients (OR, 5.15; 95% CI, 1.10-24.03; P = .037).

CONCLUSION

Age did not influence the perioperative, functional, or subjective outcomes following hallux valgus surgery. However, older patients should be counseled on the higher risk of recurrence following surgical correction.

LEVEL OF EVIDENCE

Therapeutic, level III, retrospective comparative series.

Impact of foot modeling on the quantification of the effect of total ankle replacement: A pilot study

BACKGROUND

Kinematic and kinetic foot models showed that computing ankle joint angles, moments and power with a one-segment foot modeling approach alters kinematics and tends to overestimate ankle joint power. Nevertheless, gait studies continue to implement one-segment foot models to assess the effect of total ankle replacement.

RESEARCH QUESTION

The objective of this pilot study was to investigate the effect of the foot modeling approach (one-segment versus multi-segment) on how total ankle replacement is estimated to benefit or degrade the patient's biomechanical performance.

METHODS

Ten subjects with post-traumatic ankle osteoarthritis scheduled for total ankle replacement and 10 asymptomatic subjects were recruited. A one-segment and a multi-segment foot model were used to calculate intrinsic foot joints kinematics and kinetics during gait. A linear mixed model was used to investigate the effect of the foot model on ankle joint kinematic and kinetic analysis and the effect of total ankle replacement.

RESULTS

Differences in range of motion due to the foot model effect were significant for all the gait subphases of interest except for midstance. Peak power generation was significantly overestimated when computed with the one-segment foot model. Ankle and shank-calcaneus joint dorsi-/plantarflexion range of motion did not increase post-operatively except during the loading response phase. A significant 'group' effect was found for stance and pre-swing phase range of motion, with total ankle replacement patients showing lower range of motion values than controls for dorsi/plantarflexion.

SIGNIFICANCE

The outcome of this study showed that the 'foot model' had a significant effect on estimates of range of motion and power generation. The findings in our study therefore emphasize the clinical interest of multi-segment foot modeling when assessing the outcome of a therapeutic intervention.

Retrospective comparison between a two- and three-component ankle arthroplasty: clinical and functional evaluation via gait analysis

BACKGROUND

Total ankle arthroplasty is intended to restore physiological joint function in case of severe ankle arthritis. However, little is known about the functional outcome associated to different prosthesis designs. The aim of this retrospective study was to compare clinical and functional outcomes via gait analysis of two ankle prostheses designed to preserve ankle ligamentous isometry.

METHODS

Two groups of twenty patients who underwent ankle arthroplasty using either a three-component or a two-component prosthesis, were clinically evaluated, both pre-operatively and at minimal 2-year follow-up, by means of the AOFAS score. The spatio-temporal parameters, along with the kinetics and kinematics of the lower limb joints were also assessed at follow-up via gait analysis. The non-parametric Kruskal-Wallis test was used to assess differences in functional data between the two patient groups and with respect to those from a control group of 20 healthy subjects.

FINDINGS

All AOFAS scores significantly improved from pre-operative to post-operative assessment in both patient groups (P < 0.05). Most spatio-temporal and functional parameters in the patients were worse than those in the control group, but no significant differences were observed between the two arthroplasty groups.

INTERPRETATION

Both patient groups showed improved clinical outcome at follow-up, with a few differences in gait parameters. However, neither of the two groups achieved normal locomotion patterns. Since both prostheses were designed to preserve ligamentous isometry, the choice of one implant over the other should be due to preferences in the surgical approach and to other patient-specific factors.

Effect of age on outcome and revision in total ankle arthroplasty

Aims

To assess the effect of age on clinical outcome and revision rates in patients who underwent total ankle arthroplasty (TAA) for end-stage ankle osteoarthritis (OA).

Methods

A consecutive series of 811 ankles (789 patients) that underwent TAA between May 2003 and December 2013 were enrolled. The influence of age on clinical outcome, including the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and pain according to the visual analogue scale (VAS) was assessed. In addition, the risk for revision surgery that includes soft tissue procedures, periarticular arthrodeses/osteotomies, ankle joint debridement, and/or inlay exchange (defined as minor revision), as well as the risk for revision surgery necessitating the exchange of any of the metallic components or removal of implant followed by ankle/hindfoot fusion (defined as major revision) was calculated.

Results

A significant improvement in the AOFAS hindfoot score and pain relief between the preoperative assessment and the last follow-up was evident. Age had a positive effect on pain relief. The risk for a minor or major revision was 28.7 % at the mean follow-up of 5.4 years and 11.0 % at a mean follow-up of 6.9 years respectively. The hazard of revision was not affected by age.

Conclusion

The clinical outcome, as well as the probability for revision surgery following TAA, is comparable between younger and older patients. The overall revision rate of the Hintegra total ankle is comparable with other three component designs. TAA should no longer be reserved for low demand elderly patients, but should also be recognized as a viable option for active patients of younger age. Cite this article: Bone Joint J 2020;102-B(7):925–932.

Quality measure of total ankle replacement outcomes in a non-designer centre

BACKGROUND

Total ankle replacement (TAR) is a high-risk procedure with significant revision rates, post-op complications and implant failures. Long term follow-up data is less available for TAR compared to other joint replacement surgeries. To identify optimal follow-up parameters for patients with TAR, we conducted a study on the clinical outcomes and patient-reported outcome measurements (PROMs) in patients who had TAR performed in a non-designer's centre belonging to one of the hospitals of East Lancashire Hospitals NHS Trust (ELHT).

METHODS

60 TAR procedures were identified. Clinical outcomes being studied include post-op ankle range of movement (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores, reoperation/revision rates, radiological parameters and general surgical outcomes. A Kaplan-Meier survival analysis was also conducted. PROMs data included the EQ-5D index and the Manchester-Oxford Foot Questionnaire (MOX-FQ).

RESULTS

Ankle range of movement and AOFAS scores improved from pre-op to post-op with statistical significance. The reoperation rate and revision rate were 3.3% and 8.3% respectively. 5-year survival of implant was 97.3% and 10-year survival was 84.2%. Overall PROMs data showed improvement from pre-op to post-op.

CONCLUSION

The clinical outcomes of TARs were comparable with conventional literature. Improvements in clinical, radiological and patient-reported outcomes were observed from pre-op to post-op. Further follow-up studies are required to assess the long-term survival of implants.

Change in gait biomechanics after total ankle replacement and ankle arthrodesis: a systematic review and meta-analysis

BACKGROUND

The aim of this systematic review with meta-analysis was to determine the change in gait biomechanics after total ankle replacement and ankle arthrodesis for end-stage osteoarthritis.

METHODS

Electronic databases were searched up until May 2019. Peer-reviewed journal studies including adult participants suffering from end-stage ankle osteoarthritis and reporting pre- and post-operative kinematics, kinetics and spatio-temporal effects of total ankle replacement and ankle arthrodesis during walking were included with a minimum of 12 months follow-up. Seventeen suitable studies were identified and assessed according to methodological and biomechanical qualities. Meta-analysis was performed by calculating the effect size using standard mean differences between pre- and post-operative gait status.

FINDINGS

Seventeen studies with a total of 883 patients were included. Meta-analysis revealed moderate evidence of an improvement in lower limb kinematics, kinetics and spatio-temporal parameters after total ankle replacement. Moderate evidence indicated an increase in ankle moment, hip range of motion and walking speed after ankle arthrodesis.

INTERPRETATION

The currently available evidence base of research papers evaluating changes in gait biomechanics after total ankle replacement and ankle arthrodesis is limited by a lack of prospective research, low sample sizes and heterogeneity in the patho-etiology of ankle osteoarthritis. Following total ankle replacement, improvements were demonstrated for spatio-temporal, kinematic and kinetic gait patterns compared to the pre-operative measures. Improvements in gait mechanics after ankle arthrodesis were limited to walking speed and ankle moment. Increased hip range of motion after ankle arthrodesis could represent a sign of compensation for the lack of ankle motion.

Total Ankle Replacement Options

Total ankle arthroplasty has been in development for more than 40 years. Although early designs were experimental with high failure rates, current implants are significantly improved, showing promising functional results and clinical outcomes. Total ankle replacement designs are split into mobile-bearing and fixed-bearing designs. When deciding whether to perform ankle arthroplasty, many factors need to be considered to determine if the patient is suitable and which implant is the best fit for patient and surgeon. Many prostheses are available in the United States today and the purpose of this article is to outline options for foot and ankle surgeons.

Squat Lifting Imposes Higher Peak Joint and Muscle Loading Compared to Stoop Lifting

(1) Background: Yearly, more than 40% of the European employees suffer from work-related musculoskeletal disorders. Still, ergonomic guidelines defining optimal lifting techniques to decrease work-related musculoskeletal disorders (WMSDs) has not been unambiguously defined. Therefore, this study investigates if recommended squat lifting imposes lower musculoskeletal loading than stoop lifting while using a complex full body musculoskeletal OpenSim model. (2) Methods: Ten healthy participants lifted two different weights using both lifting techniques. 3D marker trajectories and ground reaction forces were used as input to calculate joint angles, moments and power using a full body musculoskeletal model with articulated lumbar spine. In addition, the muscle activity of nine different muscles was measured to investigate muscle effort when lifting. (3) Results: Peak moments and peak joint power in L5S1 were not different between the squat and the stoop, but higher peak moments and peak power in the hip, knee, elbow and shoulder were found during squat lifting. Moment impulses in L5S1 were higher during stoop lifting. This is reflected in higher peak electromyography (EMG) but lower muscle effort in prior described muscles during the squat. (4) Conclusions: Squat lifting imposes higher peak full body musculoskeletal loading but similar low back loading compared to stoop lifting, as reflected in peak moments, peak power, and peak EMG.

Comparison of Intermediate-Term Outcomes of Total Ankle Arthroplasty in Patients Younger and Older Than 55 Years

BACKGROUND

Total ankle arthroplasty is often not recommended to younger patients with ankle arthritis because of their high functional demands. The purpose of this study was to compare intermediate-term clinical and radiographic outcomes and survivorship rates of total ankle arthroplasty between patients younger and older than 55 years.

METHODS

A total of 117 consecutive patients (123 ankles) who underwent primary total ankle arthroplasty using Hintegra prosthesis with a mean follow-up of 78 months were enrolled and divided into 2 age groups: under 55 years (38 ankles; mean age 45 years) and over 55 years (85 ankles; mean age 65 years).

RESULTS

Clinical scores of Ankle Osteoarthritis Scale pain and disability, American Orthopaedic Foot & Ankle Society ankle-hindfoot, Short Form-36 Physical Component Summary and Mental Component Summary, and visual analog scale were not significantly different between the 2 age groups at the final follow-up (P > .05). There were no significant differences in complications and survivorship rates between the two at a mean follow-up of 78 months (P > .05).

CONCLUSIONS

Clinical and radiographic outcomes and survival rates of total ankle arthroplasty in patients under age of 55 years were satisfactory and comparable to those in patients older than 55 years in the intermediate-term follow-up. Therefore, total ankle arthroplasty may be considered as a viable treatment option in young patients with end-stage ankle arthritis.

LEVEL OF EVIDENCE

Level III, comparative series, therapeutic.

Outcome after 52 Salto Ankle Prostheses Implanted by a Single Surgeon

While ankle arthrodesis was traditionally the gold standard method of treatment for disabling end-stage ankle arthritis, total ankle replacement (TAR) has been an acceptable alternative. The satisfaction rate of patients with TAR however differs. The purpose of our study is to investigate whether implant survival and results with special emphasis on the satisfaction rate of patients treated with a TAR implanted by a single surgeon were comparable to the literature. This was a retrospective cohort study in a teaching hospital. Data was collected from 52 patients who received a total ankle replacement (TAR) between 05/2002 and 06/2014. The mean follow-up time was 4.2 years (95% CI 3.3 - 5.0). Results showed a high satisfaction rate of 94% and 94% survival of the TAR after 5 years. We conclude that TAR with the Salto prosthesis is, in our hands, a reliable solution for end-stage ankle arthritis, with results comparable to the literature.