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Mazzotti A, Zielli SO, Artioli E, Astolfi M, Langone L, Faldini C. The Forgotten Joint Score Is a Valid Outcome Measure for Total Ankle Arthroplasty: A Prospective Study. Clin Orthop Relat Res 2024; 482:1813-1821. [PMID: 38686993 PMCID: PMC11419501 DOI: 10.1097/corr.0000000000003083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The success of total ankle arthroplasty (TAA) involves objective and subjective parameters such as joint motion and implant survival. Patient-reported outcome measures provide key context from the patient's perspective so that we can evaluate the results of these procedures. The Forgotten Joint Score (FJS) has demonstrated validity and reliability in other arthroplasties, but the existing evidence on the FJS in TAA is very limited. QUESTION/PURPOSES We aimed to assess the reliability, validity, responsiveness to change, and floor and ceiling effects, as well as to perform a gender analysis, of the FJS in patients who had undergone TAA. METHODS A prospective, observational study enrolled patients who underwent TAA at our institution between June 2021 and May 2023. The three-component TAA was performed through an anterior approach. A total of 120 patients (mean age 62 ± 10 years) participated, which was 83% (120 of 145) of those eligible, and 77% (92 of 120) of those patients underwent follow-up assessments at 12 ± 1 months after surgery. A cross-culturally adapted and validated version of the FJS in our language (Italian) was used. Additionally, three other commonly used patient-reported outcome measures for TAA were administered: the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the Manchester-Oxford Foot Questionnaire (MOXFQ), and the VAS. RESULTS Reliability was demonstrated by excellent internal consistency (Cronbach α coefficient = 0.95) and excellent test-retest reliability (intraclass correlation coefficient = 0.99; standard error of measurement = 2.7). Robust validity was observed, in that the FJS had a strong correlation with the AOFAS ankle-hindfoot score, the MOXFQ, and the VAS (Pearson and Spearman values consistently above 0.7 or below -0.7). Responsiveness to change was observed between 6 and 12 months (Cohen d = 0.37). Low ceiling and floor effects at both 6 months (4% and 3% reached top and bottom scores, respectively) and 12 months (10% and 0% reached top and bottom scores, respectively) were demonstrated, below the recommended 15% interpretability threshold. No association between outcomes and patient gender was observed. CONCLUSION Test properties and validity of the FJS were strong in patients who underwent TAA. It seems suitable for clinical use, although future studies should seek to replicate or refute our findings in other patient populations. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simone Ottavio Zielli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Michele Astolfi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Laura Langone
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli, 1st Orthopaedics and Traumatologic Clinic, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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McCahon JAS, Massaglia J, Moncman TG, Riebesell S, Parekh SG, Pedowitz DI, Daniel JN. The Influence of Resilience on Outcomes After Total Ankle Arthroplasty. Foot Ankle Spec 2024:19386400241274601. [PMID: 39292209 DOI: 10.1177/19386400241274601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND Resiliency is the ability to recover from stressful events and has been shown to correlate with patient outcomes following certain orthopaedic procedures. The purpose of this study was to determine the relationship between resiliency and outcomes following TAA. METHODS A retrospective analysis of patients undergoing primary TAA between April 2015 and September 2022 was performed (N = 83). Data included demographics, comorbidities, complications, preoperative and postoperative visual analog scale (VAS) pain and Foot and Ankle Ability Measure (FAAM) functional scores, Brief Resilience Scale (BRS) scores, and surgical satisfaction. Patients were defined as having low resilience (LR), normal resilience (NR), or high resilience (HR) based on a BRS score of <3, 3-4.30, and >4.3, respectively. RESULTS High resilience patients had significantly higher postoperative FAAM ADL, Sports, and Overall scores as well as a significantly greater increase from preoperative scores compared with LR and NR patients. Low resilience patients had significantly lower FAAM Sports and Overall scores compared with normal and high resilience patients. BRS scores positively correlated with postoperative FAAM scores. We found no difference in satisfaction or VAS between the 3 cohorts. Multivariate regression analysis identified BRS scores to be an independent predictor for greater changes in FAAM scores following TAA. CONCLUSION Although functional improvements following TAA are expected, patients with higher resilience at baseline are more likely to experience greater improvements in functional outcomes following surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | - Tara G Moncman
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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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; 30:493-498. [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] [MESH Headings] [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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Kostuj T, Hönning A, Mittelmeier W, Malzahn J, H Baums M, Osmanski-Zenk K. Outcome after total ankle replacement or ankle arthrodesis in end-stage ankle osteoarthritis on the basis of german-wide data: a retrospective comparative study over 10 years. BMC Musculoskelet Disord 2024; 25:492. [PMID: 38918769 PMCID: PMC11197266 DOI: 10.1186/s12891-024-07612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND In symptomatic end-stage osteoarthritis of the ankle joint, total ankle replacement and ankle arthrodesis are the two primary surgical options for patients for whom conservative treatment fails. Published revision rates are often biased and difficult to compare. In this study, unplanned reoperation rates and revision rates were determined for both surgical interventions based on a large dataset, and risk factors for unplanned reoperations were identified. METHODS German-wide health data of the largest German health-care insurance carrier between 2001 and 2012 were retrospectively analyzed, and unplanned reoperation rates within 10 years were determined for index surgeries conducted in 2001 and 2002. Unplanned reoperation rates within 5 years for index surgeries conducted in 2001/2002 were compared to index surgeries conducted in 2006/2007. Multivariate logistic regression was used to identify risk factors for unplanned reoperations. RESULTS After ankle arthrodesis, 19% (95% confidence interval [CI], 16-22%) of 741 patients needed to undergo an unplanned reoperation within ten years. After total ankle replacement, the unplanned reoperation rate was 38% [95% CI, 29-48%] among 172 patients. For initial surgeries conducted at a later date, unplanned reoperation rates within five years were 21% [95% CI, 19-24%] for 1,168 ankle arthrodesis patients and 23% [95% CI, 19-28%] for 561 total ankle replacement patients. Significant risk factors for unplanned reoperations after ankle arthrodesis in the initial cohort were age < 50 years (odds ratio [OR] = 4.65 [95% CI 1.10;19.56]) and osteoporosis (OR = 3.72 [95% CI, 1.06;13.11]); after total ankle replacement, they were osteoporosis (OR = 2.96 [95% CI, 1.65;5.31]), Patient Clinical Complexity Level (PCCL) grade 3 (OR = 2.19 [95% CI, 1.19;4.03]), PCCL grade 4 (OR = 2.51 [95% CI, 1.22;5.17]) and diabetes mellitus (OR = 2.48 [95% CI, 1.33;4.66]). Kaplan-Meier analyses including 1,525 ankle arthrodesis patients and 644 total ankle replacement patients revealed an average unplanned reoperation-free time of approximately 17 years for both procedures. CONCLUSIONS Similar revision rates and unplanned reoperation rates for both procedures in the later-date cohort can likely be attributed to a learning curve for surgeons as well as advances in implant design. This analysis of billing health insurance data supports an increase in total ankle replacement surgeries.
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Affiliation(s)
- Tanja Kostuj
- Orthopädisch-Traumatologisches Zentrum, St. Marien-Hospital Hamm, Nassauerstraße 13-19, 59065, Hamm, Germany.
| | - Alexander Hönning
- Zentrum für Klinische Forschung, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Wolfram Mittelmeier
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
| | | | - Mike H Baums
- Fachbereich Orthopädie, Katholisches Klinikum Ruhrgebiet Nord (KKRN), Unfallchirurgie und Sporttraumatologie, Dorsten, Germany
| | - Katrin Osmanski-Zenk
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
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De Rito G, Biscione R, Volpe A, Liverani L, Zanoli GA, Maritati M. Partial revision of a dislocated periprosthetic tibial fracture after total ankle replacement with a stemmed implant and plate fixation: A case report. Int J Surg Case Rep 2024; 116:109336. [PMID: 38325111 PMCID: PMC10859300 DOI: 10.1016/j.ijscr.2024.109336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Total ankle arthroplasty (TAR) procedures have become more reliable and incidence is increasing. A growing number of postoperative complications can be expected and should be correctly addressed. PRESENTATION OF CASE A 43-year-old woman suffering from severe ankle osteoarthritis underwent TAR (Stryker's Infinity with Prophecy alignment guides, uncemented tibial component and cemented talus component). After a fall, one month after the surgery, she presented with a fracture of the medial malleolus and an anterior periprosthetic fracture of the tibia, with anterior dislocation of the tibial prosthetic component. Fracture fixation and partial revision surgery was planned using the same anterior surgical access. To restore length, rotation and joint articulation, the medial malleolus was first reduced and synthesized with a plate and 6 screws through additional minimally invasive medial ankle incisions. Once the medial malleolus was stabilized, the already mobilized tibial component was removed. Freehand cuts under fluoroscopic guidance on the anterior surface of the tibia were performed. After a final check with a trial component, a Stryker's Inbone II stem, which matched the previously inserted talar component, was implanted and partially cemented to fill the remaining bone gaps. DISCUSSION Only few case reports of periprosthetic ankle fractures exist, and none of them were similar to ours. There are no published precedents for this revision approach from a stemless to a stemmed tibial implant without changing the talar implant. CONCLUSION Partial revision after a complex periprosthetic fracture results in a satisfactory outcome if surgery is performed in specialized centers.
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Affiliation(s)
- Giuseppe De Rito
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Via Gorizia, Occhiobello, Rovigo, Italy
| | - Roberto Biscione
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Via Gorizia, Occhiobello, Rovigo, Italy
| | - Antonio Volpe
- Policlinico Abano, Piazza Cristoforo 1, Abano Terme, Padova, Italy
| | - Luca Liverani
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Via Gorizia, Occhiobello, Rovigo, Italy
| | - Gustavo Alberto Zanoli
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Via Gorizia, Occhiobello, Rovigo, Italy
| | - Martina Maritati
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Via Gorizia, Occhiobello, Rovigo, Italy; Department of Translational Medicine, University of Ferrara, Via Aldo Moro, Ferrara, Italy.
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van Es LJM, Haverkamp D, van Dijk NC, van der Plaat LW. Outcomes of Total Ankle Replacement with Preoperative Varus Deformity. Foot Ankle Clin 2024; 29:81-96. [PMID: 38309805 DOI: 10.1016/j.fcl.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Historically, coronal plane deformities of greater than 10° to 15° have been deemed contraindications for total ankle replacement (TAR). However, recent studies show satisfactory results in TAR with severe preoperative varus deformity. When correctly applying ancillary procedures, preoperative varus deformity can be structurally corrected, resulting in similar clinical scores to those obtained with "regular TAR." However, complications and revisions appear to increase with increasing deformity. Unfortunately, results of TAR in varus ankles consist of heterogeneous data (eg, with regards to prosthetic brands, bearing-types, duration of follow-up, and ancillary procedures) precluding strict conclusions. This could be solved by an international consensus group.
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Affiliation(s)
- Laurian J M van Es
- Department of Orthopedic Surgery, Tergooi MC, Van Riebeeckweg 212, 1213 XZ Hilversum, the Netherlands; Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE, Amsterdam, the Netherlands
| | - Daniel Haverkamp
- Department of Orthopedic Surgery, Xpert Clinics, SCORE Foundation, Specialized Center of Orthopedic Research and Education, Laarderhoogtweg 12, 1101AE, Amsterdam, the Netherlands
| | - Niek C van Dijk
- Department of Orthopedic Surgery, Amsterdam UMC location AMC, Postbus 22660, 1100 DD Amsterdam Zuidoost, the Netherlands; Head of Ankle Unit, FIFA Medical Centre of Excellence Ripoll-DePrado Sport Clinic Madrid, Spain; Head of Ankle Unit, FIFA Medical Centre of Excellence Clínica do Dragão Porto, Portugal; Casa di Cura San Rossore, Viale delle Cascine, 152/f, 56122 Pisa Italy
| | - Laurens W van der Plaat
- Department of Traumatology and Orthopedic Surgery, St.-Antonius-Hospital Kleve, Klinik für Unfallchirurgie und Orthopädie, Albersallee 5-7, Kleve 47533, Germany.
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7
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Jamjoom BA, Dhar S. Outcomes of Revision Total Ankle Replacement. Foot Ankle Clin 2024; 29:171-184. [PMID: 38309801 DOI: 10.1016/j.fcl.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
The objective of this study is to provide an up-to-date review of the outcomes of revision total ankle arthroplasty (TAA). Relevant studies published over the last decade were reviewed. Twelve studies were included. At a median follow-up of 4 years, the median survival and reoperation rates were 86% and 16%, respectively. Significant postoperative improvements in patient-reported outcome measures were recorded in 6 studies. Significant improvement in alignment was documented in 1 study only. Revision TAA is a safe procedure that can produce good outcomes. Nevertheless, data relating to long-term outcome are still limited in quantity and duration.
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Affiliation(s)
- Bakur A Jamjoom
- Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
| | - Sunil Dhar
- Foot and Ankle Unit, Nottingham Elective Orthopaedics, Nottingham University Hospitals City Campus, Nottingham NG5 1PB, UK
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Garcia AR, Ling K, Olsen E, Komatsu DE, Paulus M. Chronic Steroid Use Does Not Increase the Risk of Superficial Surgical Site Infection or Wound Dehiscence Following Total Ankle Arthroplasty. Cureus 2024; 16:e52569. [PMID: 38371139 PMCID: PMC10874611 DOI: 10.7759/cureus.52569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle arthritis. Recent surgical and technological advances have led to a significant increase in the surgical volume of TAA. While a majority of ankle arthritis is post-traumatic in nature, other causes include autoimmune or inflammatory conditions. Medical management of these conditions frequently requires chronic corticosteroid administration, which is a well-established risk factor for complications following surgery. The purpose of this study was to investigate the association between chronic preoperative steroid use and postoperative complications following TAA. Methods The American College of Surgeons National Surgical Quality Improvement (NSQIP) database was analyzed to identify all patients who underwent TAA between 2015 and 2020. Patient characteristics including demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data were collected. The data was analyzed using bivariate and multivariate logistic regression to identify all postoperative complications associated with chronic preoperative steroid use. Results A total of 1,606 patients were included in this study: 1,533 (95.5%) were included in the non-steroid cohort, and 73 (4.5%) were included in the chronic steroid cohort. Chronic steroid use was significantly associated with female sex (p < 0.001) and American Society of Anesthesiologists (ASA) ≥3 (p < 0.001). Chronic steroid use was not associated with superficial surgical site infection (SSI) (p = 0.634) or wound dehiscence (p = 0.999). The postoperative complication that was significantly associated with chronic steroid use was sepsis (p = 0.031). After adjusting for female sex and the ASA grade, chronic steroid use was found to be independently associated with sepsis (p = 0.013). Conclusion Preoperative chronic steroid use is not associated with superficial SSI or wound dehiscence within 30 days following TAA. As TAA becomes a more attractive alternative to ankle arthrodesis, a better understanding of preoperative risk factors can aid in widening indications and knowing what patients are at risk for complications.
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Affiliation(s)
| | - Kenny Ling
- Orthopaedic Surgery, Stony Brook University, New York, USA
| | - Evan Olsen
- Orthopaedic Surgery, Stony Brook University, New York, USA
| | | | - Megan Paulus
- Orthopaedic Surgery, Stony Brook University, New York, USA
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Bagheri K, Anastasio AT, Poehlein E, Green CL, Aitchison AH, Cantor N, Hendren S, Adams SB. Outcomes after total ankle arthroplasty with an average follow-up of 10 years: A systematic review and meta-analysis. Foot Ankle Surg 2024; 30:64-73. [PMID: 37775362 DOI: 10.1016/j.fas.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The literature demonstrating positive outcomes after total ankle arthroplasty (TAA) is mounting. However, the long-term outcomes of TAA (≥ 10 years) remain minimally reported. The purpose of this systematic review and meta-analysis was to evaluate outcome metrics over multiple TAA studies with greater than 10 years of average follow-up. METHODS TAA studies were searched in Medline, Embase, and Scopus from the date of inception to September 12, 2022. Inclusion criteria included 1) studies of patients that underwent uncemented TAA, and 2) studies with an average follow-up time of at least ten years. Manuscripts in non-English languages and isolated abstracts were excluded. We collected American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) scores from the included studies for pooled meta-analysis. Due to the varying definition of survivability between studies, this metric was not assessed in our final evaluation. RESULTS Our data included approximately 3651 patients (3782 ankles). Of the 25 studies with an average follow-up of 10 years included in the systematic review, 5 provided pre- and post-operative AOFAS means and 5 provided pre- and post-operative VAS means with associated measures of variability and were included in our meta-analysis. The weighted mean difference between pre-and post-operative AOFAS and VAS scores was -40.36 (95% CI -47.24 to -33.47) and 4.52 (95% CI: 2.26-6.43), respectively. The risk of bias was low to moderate for the included studies. CONCLUSION Outcomes following TAA are favorable and indicate patient-reported outcome improvement over long-term follow-up. However, a significant amount of heterogeneity exists between studies. Future, prospective, randomized research should focus on standardizing outcome measures, survivorship, and complication reporting methodologies to allow for pooled meta-analyses of these important outcome metrics.
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Affiliation(s)
- Kian Bagheri
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA; Campbell University School of Osteopathic Medicine, Lillington, NC, USA.
| | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Nicole Cantor
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | | | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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10
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Rougereau G, Stiglitz Y, Franqueville C, Bauer T, Hardy A, Gaudot F. Revision of total ankle arthroplasty: Survival and medium-term functional results. Foot Ankle Surg 2024; 30:57-63. [PMID: 37827896 DOI: 10.1016/j.fas.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 06/20/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The objective of this study was to analyze the results and survivorship of total ankle arthroplasty (TAA) revision surgery with standard (Salto Talaris®) or revision (Salto Talaris XT®) implants. METHODS Between January 2005 and December 2017, all patients undergoing TAA revision at our hospital were included. Indications for revision, type of surgery performed, improvement in function assessed with the AOFAS score, occurrence of complications and implant survival at last follow-up were analyzed. RESULTS In the end, 25 TAA patients who had undergone revision (11 unipolar, 14 bipolar) were included. The mean follow-up time was 5.1 ± 1.9 years. At the last follow-up, function was improved compared to the preoperative AOFAS score (51.3 ± 17.5 vs. 83.5 ± 10.1; p < .001), but not plantar flexion (17.5 ± 5.7 vs. 15.4 ± 7.1; p = 0.28) or dorsal flexion (7 ± 5.6 vs. 8.3 ± 4.9; p = 0.3). Complications occurred in six patients (24 %) that led to reoperation: three infections, one lateral impingement, one implant malposition, and one hindfoot alignment disorder. At the last follow-up, implant survival was 96 %, but the probability of survival without reoperation was 78.7 ± 8.5 % at 4 years. CONCLUSION TAA revision by arthroplasty is feasible, produces good functional results in the medium term, but has a high risk of complications. The challenge of revision TAA is managing the loss of bone stock and anchoring the new implants.
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Affiliation(s)
- Grégoire Rougereau
- Department of Orthopedic Surgery, Hospital Ambroise Paré, University UVSQ, Boulogne-Billancourt, France; Department of Orthopedic Surgery, Hospital Raymond Poincaré, University UVSQ, Garches, France.
| | - Yves Stiglitz
- Department of Orthopedic Surgery, Clinique Victor Hugo, Paris, France
| | - Charles Franqueville
- Department of Orthopedic Surgery, Private Hospital of Vitry, Vitry-sur-Seine, France
| | - Thomas Bauer
- Department of Orthopedic Surgery, Hospital Ambroise Paré, University UVSQ, Boulogne-Billancourt, France
| | - Alexandre Hardy
- Department of Orthopedic Surgery, Clinique du Sport, Paris, France
| | - Fabrice Gaudot
- Department of Orthopedic Surgery, Ramsay Santé, Clinique Jouvenet, Paris, France
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11
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Kotlier JL, Fathi A, Ong MY, Yazditabar JM, Panoussi EE, Mayfield CK, Petrigliano FA, Liu JN, Peterson AB, Tan EW. Evidence Guiding Commercial Payer Coverage Criteria for Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241239310. [PMID: 38529013 PMCID: PMC10962051 DOI: 10.1177/24730114241239310] [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: 03/27/2024] Open
Abstract
Background Total ankle arthroplasty (TAA), first developed as an alternative to ankle arthrodesis, has become an increasingly popular management option for end-stage ankle arthritis. Prior studies have shown commercial insurance payers base their coverage criteria on limited and low level of evidence research. This study aims to quantify and describe the evidence insurance companies use to support TAA coverage policies. Methods The top 11 national commercial health insurance payers for TAA were identified. A google search was performed to identify payer coverage policies. Policy documents were examined and cited references were classified by type of reference as well as reviewed for level of evidence (LOE). Specific coverage criteria for each individual payer were then extracted. Criteria were compared to assess for similarities among commercial payers. Finally, all references cited by each payer were examined to determine whether they mentioned the specific payer criteria. Results Six of the 11 payers had accessible coverage policies. The majority of cited references were primary journal articles (145, 60.9%) and the majority of references cited (179, 75.2%) were level III or level IV evidence. We found significant homogeneity in coverage criteria among payers. In addition, cited sources inconsistently mentioned specific payer coverage criteria. Conclusion This study demonstrates that commercial insurance payers rely on the relatively low level of currently available scientific evidence when formulating coverage policies for TAA use and adopt criteria that have not been thoroughly analyzed in the literature. More high level of evidence research is needed to help clinicians and insurance companies further refine indications for TAA so that patients who might benefit from the procedure are adequately covered. Level of Evidence Level IV, review.
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Affiliation(s)
| | - Amir Fathi
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Meng-Yung Ong
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | | | | | | | - Joseph N. Liu
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Eric W. Tan
- Keck School of Medicine of USC, Los Angeles, CA, USA
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Kim J, Radkievich R, Mizher R, Shaffrey I, O'Malley M, Deland J, Demetracopoulos C, Ellis S. Outcomes of Total Ankle Arthroplasty in Postfracture Ankle Arthritis. Foot Ankle Int 2023; 44:1075-1084. [PMID: 37772404 DOI: 10.1177/10711007231194050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Ankle arthritis that develops after fracture accounts for a significant portion of ankle arthritis necessitating total ankle arthroplasty (TAA). It remains unknown whether TAA in postfracture patients produces equivalent outcomes to those without fracture history. The purpose of this study was to evaluate the medium-term outcomes of TAA in postfracture ankle arthritis compared to those without fracture history. METHODS This study reviewed 178 ankles from 171 consecutive patients who underwent TAA in our institution between 2007 and 2017 and completed a minimum 5-year follow-up. Four different TAA systems were utilized by 6 surgeons. Based on fracture history, patients were divided into 2 groups: the postfracture group (n = 63; median age 65.7 years; median follow-up 5.9 years) and the nonfracture group (n = 115; median age 64.4 years; median follow-up 6.2 years). Types and rates of complications including revision and reoperation were compared. Minimum 5-year Foot and Ankle Outcome Score (FAOS) and postoperative improvement were investigated. A subgroup analysis was performed to determine whether outcomes differ between intraarticular fracture patients (n = 43) and extraarticular fracture patients (n = 20). RESULTS Both groups exhibited comparable postoperative improvement and final FAOS scores. The postfracture group had a significantly higher reoperation rate than the nonfracture group (20 of 63, 31.7%, vs 17 of 115, 14.8%; P = .011), with gutter impingement being the most common cause. There were 3 revisions in each group. In the subgroup analysis, we found no evidence of statistical difference between the intraarticular fracture group and the extraarticular fracture group in terms of FAOS scores, revision, and reoperation rates. CONCLUSION In this single-center, retrospective comparative study, we found total ankle arthroplasty in patients with a history of fractures around the ankle joint had no evidence of statistical difference in patient-reported outcomes and implant survivorship but led to a higher rate of nonrevision reoperation following surgery. In the much smaller subset of patients with previous fracture, we did not find that those with a history of intraarticular fracture had inferior outcomes after TAA when compared to those with a history of extraarticular fracture. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Jaeyoung Kim
- Baylor University Medical Center, Dallas, TX, USA
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Ruben Radkievich
- Department of Orthopaedic Surgery, Clinica Alemana de Santiago-Universidad del Desarrollo, Santiago, Chile
| | - Rami Mizher
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Isabel Shaffrey
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Martin O'Malley
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Deland
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
| | | | - Scott Ellis
- Foot and Ankle Service, Hospital for Special Surgery, New York, NY, USA
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13
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Endstrasser F, Lindtner RA, Landegger A, Wagner M, Eichinger M, Schönthaler H, Kaufmann G, Brunner A. Midterm Results of AAA Ankle Arthroplasty. Foot Ankle Int 2023; 44:983-991. [PMID: 37655685 DOI: 10.1177/10711007231186375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Outcome reports for Alpha Ankle Arthroplasty (AAA), a third-generation implant relying on a mobile bearing design for total ankle replacement, are sparse. This retrospective study evaluated the midterm survivorship, clinical, and radiologic outcomes after implantation of this implant. METHODS For 64 patients who received 65 Triple A ankle implants between 2009 and 2020, implant survival was calculated using the Kaplan-Meier curve. Clinical outcomes were evaluated by measuring the range of motion, stability, Western Ontario and McMaster Universities Osteoarthritis Questionnaire score (WOMAC), and American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS). The average pain level and satisfaction with the postoperative result were rated on a numeric rating scale (0-10). Additionally, radiologic analysis was performed using anteroposterior and lateral radiographs and tibiotalar alignment was assessed. RESULTS The implant-survival rate was 61.5% at a mean follow-up of 8.2 years. Twenty-five patients (38.5%) required revision surgery (average time to revision, 3.1 years, 95% CI 2.1-4.1 years). For patients without revisions, the average range of motion in dorsiflexion and plantarflexion were 3.6 ± 4.2 degrees and 21.9 ± 7.8 degrees, respectively. The mean WOMAC and AOFAS scores were 44.7 ± 47.5 and 75.1 ± 14.0, respectively. The average pain and subjective satisfaction scores were 2.0 ± 1.7 and 8.5 ± 1.9, respectively. Mean alignment values did not differ significantly for patients who required revision surgery. CONCLUSION We found a high revision rate with use of the AAA. However, patients who did not require revision surgery had, on average, high satisfaction and good functional outcomes. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Franz Endstrasser
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Austria
| | - Richard A Lindtner
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
| | | | - Moritz Wagner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Austria
| | - Martin Eichinger
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Austria
| | - Hannes Schönthaler
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Austria
| | - Gerhard Kaufmann
- Orthopaedic and Foot Center Innsbruck (OFZ Innsbruck), Innsbruck, Tirol, Austria
| | - Alexander Brunner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Austria
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14
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Ratnasamy PP, Maloy GC, Oghenesume OP, Peden SC, Grauer JN, Oh I. The Burden of Revision Total Ankle Replacement Has Increased From 2010 to 2020. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231198234. [PMID: 37767009 PMCID: PMC10521287 DOI: 10.1177/24730114231198234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Background Total ankle replacement (TAR) surgery has increased in recent decades. The aim of this study was to investigate the evolving burden of revision surgery and risk factors and timing of revision or explant. Methods Using the 2010 to 2020 PearlDiver M151Ortho data set, this retrospective cohort study identified primary TAR, TAR revision, and TAR explant patients via Current Procedural Terminology (CPT) and International Classification of Disease Procedural (ICD-P) codes. This database contains billing claims information across all payers and sites of care in the United States. Patient factors investigated included age, sex, and Elixhauser Comorbidity Index (ECI). Annual incidence for primary TAR was normalized per 100 000 covered lives in the data set for each year of study and recorded. Annual incidence of revision TAR and explant were normalized per 100 TARs performed for each year of study. Multivariate logistic regression analyses were performed to determine independent risk factors for revision TAR or explant. For explants, the eventual intervention by 2 years was analyzed. Ten-year timing and survival to revision or explant surgery following unilateral TAR were characterized. Results A total of 10 531 primary, 1218 revision, and 1735 explant TARs were identified. After normalization, TAR utilization increased by 284% from 2010 to 2020, annual TAR revisions rose 28%, and annual TAR explants decreased 65%. Independent predictors of revision TAR were younger age (odds ratio [OR] 1.29 per decade decrease) and higher ECI (OR 1.23 per 2-point increase). Independent predictors of explant included younger age (OR 1.80 per decade decrease), female sex (OR 1.17), and higher ECI (OR 1.35 per 2-point increase). The 10-year implant survival rate was 91.8%, of which 73% of revisions and 83% of explants occurred in the first 3 years following index TAR. Conclusion TAR utilization has grown substantially over the past decade, with minimal increases in the annual rate of revision surgery with respect to index procedures performed. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Philip P. Ratnasamy
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Gwyneth C. Maloy
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | | | - Sean C. Peden
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N. Grauer
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Irvin Oh
- Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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15
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Stratton-Powell AA, Williams S, Tipper JL, Redmond AC, Brockett CL. Isolation and characterisation of wear debris surrounding failed total ankle replacements. Acta Biomater 2023; 159:410-422. [PMID: 36736850 DOI: 10.1016/j.actbio.2023.01.051] [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] [Received: 09/24/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
Aseptic loosening and osteolysis continue to be a short- to mid-term problem for total ankle replacement (TAR) devices. The production of wear particles may contribute to poor performance, but their characteristics are not well understood. This study aimed to determine the chemical composition, size and morphology of wear particles surrounding failed TARs. A recently developed wear particle isolation method capable of isolating both high- and low-density materials was applied to 20 retrieved periprosthetic tissue samples from 15 failed TARs of three different brands. Isolated particles were imaged using ultra-high-resolution imaging and characterised manually to determine their chemical composition, size, and morphology. Six different materials were identified, which included: UHMWPE, calcium phosphate (CaP), cobalt chromium alloy (CoCr), commercially pure titanium, titanium alloy and stainless steel. Eighteen of the 20 samples contained three or more different wear particle material types. In addition to sub-micron UHMWPE particles, which were present in all samples, elongated micron-sized shards of CaP and flakes of CoCr were commonly isolated from tissues surrounding AES TARs. The mixed particles identified in this study demonstrate the existence of a complex periprosthetic environment surrounding TAR devices. The presence of such particles suggests that early failure of devices may be due in part to the multifaceted biological cascade that ensues after particle release. This study could be used to support the validation of clinically-relevant wear simulator testing, pre-clinical assessment of fixation wear and biological response studies to improve the performance of next generation ankle replacement devices. STATEMENT OF SIGNIFICANCE: Total ankle replacement devices do not perform as well as total hip and knee replacements, which is in part due to the relatively poor scientific understanding of how they fail. The excessive production of certain types of wear debris is known to contribute to joint replacement failure. This is the first study to successfully isolate and characterise high- and low-density wear particles from tissues collected from patients with a failed total ankle replacement. This article includes the chemical composition and characteristics of the wear debris generated by ankle devices, all of which may affect their performance. This research provides clinically relevant reference values and images to support the development of pre-clinical testing for future total ankle replacement designs.
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Affiliation(s)
- Ashley A Stratton-Powell
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Joanne L Tipper
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK; School of Biomedical Engineering, University of Technology Sydney, Ultimo 2007, Australia
| | - Anthony C Redmond
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK; Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, UK
| | - Claire L Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK
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16
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Abstract
Despite the increasing numbers of ankle arthroplasties, there are limited studies on their survival and comparisons between different implants. The primary aim of this study was to determine the failure rates of primary ankle arthroplasties commonly used in the UK. A data linkage study combined National Joint Registry (NJR) data and NHS Digital data. The primary outcome of failure was defined as the removal or exchange of any components of the implanted device. Life tables and Kaplan-Meier survival charts were used to illustrate survivorship. Cox proportional hazards regression models were fitted to compare failure rates between 1 April 2010 and 31 December 2018. Overall, 5,562 primary ankle arthroplasties were recorded in the NJR. Linked data show a one-year survivorship of 98.8% (95% confidence interval (CI) 98.4% to 99.0%), five-year survival in 2,725 patients of 90.2% (95% CI 89.2% to 91.1%), and ten-year survival in 199 patients of 86.2% (95% CI 84.6% to 87.6%). The five-year survival for fixed-bearing implants was 94.3% (95% CI 91.3% to 96.3%) compared to 89.4% (95% CI 88.3% to 90.4%) for mobile-bearing implants. A Cox regression model for all implants with over 100 implantations using the implant with the best survivorship (Infinity) as the reference, only the STAR (hazard ratio (HR) 1.60 (95% CI 0.87 to 2.96)) and INBONE (HR 0.38 (95% CI 0.05 to 2.84)) did not demonstrate worse survival at three and five years. Ankle arthroplasties in the UK have a five-year survival rate of 90.2%, which is lower than recorded on the NJR, because we have shown that approximately one-third of ankle arthroplasty failures are not reported to the NJR. There are statistically significant differences in survival between different implants. Fixed-bearing implants appear to demonstrate higher survivorship than mobile-bearing implants.
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Affiliation(s)
- Toby Jennison
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.,University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew J Goldberg
- Wellington Hospital, London, UK.,UCL Division of Surgery, Royal Free Hospital, London, UK.,Imperial College London, London, UK
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17
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Tapaninaho K, Ponkilainen VT, Haapasalo H, Mattila VM, Huttunen TT, Repo JP. Incidence of ankle arthrodesis and total ankle replacement between 1997 and 2018: A nationwide registry study in Finland. Foot Ankle Surg 2023; 29:288-292. [PMID: 36878765 DOI: 10.1016/j.fas.2023.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Surgical treatment options for end-stage ankle osteoarthritis (OA) include ankle arthrodesis (AA) and total ankle replacement (TAR). We investigated the national incidence of AA and TAR and assessed trends in the surgical management of ankle OA in Finland between 1997 and 2018. METHODS The Finnish Care Register for Health Care was used to calculate the incidence of AA and TAR based on sex and different age groups. RESULTS The mean age (SD) of patients was similar, 57.8 (14.3) years for AA and 58.1 (14.0) for TAR. TAR showed a 3-fold increase from 0.3 per 100 000 person-years in 1997 to 0.9 per 100 000 person-years in 2018. The incidence of AA operations decreased during the study period from 4.4 per 100 000 person-years in 1997 to 3.8 per 100 000 person-years in 2018. TAR utilization increased notably at the expense of AA between 2001 and 2004. CONCLUSION TAR and AA are both widely used procedures in the treatment of ankle OA, with AA being the favored option for most patients. The incidence of TAR has remained constant for the past 10 years, indicating appropriate treatment indications and utilization.
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Affiliation(s)
- Krista Tapaninaho
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland.
| | | | - Heidi Haapasalo
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and University of Tampere, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and University of Tampere, Finland
| | - Tuomas T Huttunen
- Tampere University Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and University of Tampere, Finland
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18
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Schwarz T, Greimel F, Grifka J, Leiß F. [Update: endoprosthetics on the ankle joint]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:165-176. [PMID: 36745219 DOI: 10.1007/s00132-022-04344-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 02/07/2023]
Abstract
The ankle joint has to bear the entire body weight on a relatively small joint surface. Incongruities, instabilities and deformities lead to painful arthrosis and considerable restrictions in everyday life. For many years, arthrodesis has proven to be the gold standard for end stage arthrosis; however, considering modern endoprostheses for the ankle joint it is no longer appropriate to offer only arthrodesis. The very good results of the 3rd generation 3‑component prostheses and the 4th generation 2‑component prostheses show how much the surgical treatment options for the ankle joint are currently changing. The simplified implantation techniques enable access to arthroplasty of the ankle joint for a broader spectrum of surgeons and explain the increasing implantation rates in recent years. Decisive for postoperative success are correct planning with knowledge of the leg axes and foot position, correct patient selection and exact surgical placement of the components.
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Affiliation(s)
- T Schwarz
- Orthopädische Universitätsklinik Regensburg, Am Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - F Greimel
- Orthopädische Universitätsklinik Regensburg, Am Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Universitätsklinik Regensburg, Am Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - F Leiß
- Orthopädische Universitätsklinik Regensburg, Am Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
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19
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Querci L, Caravelli S, Di Ponte M, Fuiano M, De Blasiis P, Sirico F, Baiardi A, Zannoni F, Mosca M. Enhanced recovery (fast-track surgery) after total ankle replacement: The state of the art. Foot Ankle Surg 2022; 28:1163-1169. [PMID: 35882574 DOI: 10.1016/j.fas.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/02/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
The post-operative results of a total ankle replacement are not determined solely by an optimal surgical technique, but by an appropriate anesthesiological and rehabilitative post-operative approach. Enhanced functional recovery often depends on a multidisciplinary approach based on a correct framework of the patient and his needs, requests, and characteristics. Extensive bibliographical research has been performed on Pubmed, Google Scholar, Scopus. This comprehensive and inclusive review of the literature aims to examine the state of the art of "fast-track" protocols employed in total ankle replacement (TAR), considering pre-operative preparation, anesthetic management, intraoperative and surgical factors, post-operative rehabilitative care and reduction of hospitalization time.
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Affiliation(s)
- Lorenzo Querci
- Anesthesiology and Critical Care Residency Program, University of Bologna, Via Massarenti, 9, 40138 Bologna
| | - Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo De Blasiis
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania"Luigi Vanvitelli", Naples, Italy
| | - Felice Sirico
- Department of Public Health - Physical Medicine & Rehabilitation Unit, Univeristy of Naples "Federico II", 80131 Naples, Italy
| | - Annalisa Baiardi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Zannoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Stadler C, Stöbich M, Ruhs B, Kaufmann C, Pisecky L, Stevoska S, Gotterbarm T, Klotz MC. Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis. Arch Orthop Trauma Surg 2022; 142:3697-3704. [PMID: 34086075 PMCID: PMC9596531 DOI: 10.1007/s00402-021-03946-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Osteoarthritis of the ankle is a major burden to affected patients. While tibio-talar arthrodesis has been the gold-standard regarding the treatment of osteoarthritis of the ankle joint for many years, at present total ankle arthroplasty (TAA) provides appealing clinical outcomes and is continually gaining popularity. The aim of this study was to evaluate the intermediate- to long-term clinical outcome including the survival rate of Salto Mobile Bearing TAA (Tonier SA, Saint Ismier, France). MATERIAL AND METHODS In this retrospective study intermediate- to long-term outcomes measures [Ankle Range of Motion (ROM), American Orthopaedic Foot and Ankle Score (AOFAS score) and survival rate] of 171 consecutive TAA were analysed and compared before and after surgery. Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. RESULTS At a mean follow-up (FU) period of 7.2 ± 2.7 years (range 2.0 to 14.1 years) there was a significant improvement in ankle ROM (total ROM improved from 25.0° ± 15.0° to 28.7° ± 11.3°, p = 0.015; plantarflexion improved from 18.4° ± 11.7° to 20.6° ± 8.2°, p = 0.044; dorsiflexion improved from 6.6° ± 5.7° to 8.1° ± 4.9°, p = 0.011). AOFAS score increased significantly by 41 ± 15 points after surgery (43.3 ± 11.1 before and 84.3 ± 12.0 after surgery, p < 0.001). Overall survival rate within the FU was 81.3% (95% CI 75.3% to 87.3%) with any secondary surgery, 89.9% (95% CI 84.1% to 93.6%) with revision and 93.6% (95% CI 89.8% to 97.3%) with reoperation as endpoint. CONCLUSION This study endorses the previously reported appealing intermediate- to long-term outcomes of the Salto Mobile Bearing TAA. There was a significant increase in ROM and AOFAS score as well as decent implant survival at final FU.
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Affiliation(s)
- C Stadler
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria.
| | - M Stöbich
- Orthopaedics and Traumatology, Klinik Diakonissen, Weißenwolffstrasse 13, 4020, Linz, Austria
| | - B Ruhs
- Orthopaedics, Klinik Diakonissen, Weißenwolffstrasse 13, 4020, Linz, Austria
| | - C Kaufmann
- Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
| | - L Pisecky
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
| | - S Stevoska
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
| | - T Gotterbarm
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
| | - M C Klotz
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
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Renner K, Delaney C, Hill C, Sands L, Queen R. Predicting post-total ankle arthroplasty walking speed based on preoperative gait mechanics. J Orthop Res 2022; 41:1070-1075. [PMID: 36116022 DOI: 10.1002/jor.25444] [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: 03/08/2022] [Revised: 08/01/2022] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
Decreased walking speed is associated with impaired physical performance and function in older adults. Following total ankle arthroplasty (TAA), walking speed continues to be slower than age matched controls. The purpose of this study was to determine if patients 1 year post-TAA can achieve walking speed benchmarks and investigate if gait metrics are predictive of achieved benchmarks. 191 TAA patients were recruited and assessed pre-TAA and 1 year post-TAA. Kinetic and kinematic data were collected during seven self-selected speed barefoot walking trials along a 30-m walkway. Receiver operator curves were generated for each variable to determine threshold values needed to achieve walking speeds of 0.8, 0.9, 1.1, and 1.3 m/s. Each variable's predictive ability was classified according to the area under the curve. Ninety one percent of participants achieved a walking speed > 0.8 m/s, 85.3% achieved ≥0.9 m/s, 64.9% walked at ≥1.1 m/s, and 24.1% achieved a walking speed of 1.3 m/s by 1 year post-TAA. Walking speed pre-TAA was the strongest predictor with ankle moment, power and GRF data showing mixed results. Clinical Significance: 75.9% of participants were unable to walk at 1.3 m/s-a speed indicative of safely crossing a street. Variables predictive of postoperative walking speed benchmarks could be useful in developing interventions for the TAA population. The strongest predictor across all walking speed benchmarks was preoperative walking speed. A walking speed > 0.71 m/s was predictive of achieving 0.8 m/s 1 year post-TAA, while >1.09 m/s predicted 1.3 m/s 1 year post-TAA.
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Affiliation(s)
- Kristen Renner
- Department of Orthopaedic Surgery, University of Arizona College of Medicine-Tucson, Tucson, Arizona, USA
| | - Caitlyn Delaney
- Department of Physical Therapy, Radford University Carilion, Roanoke, Virginia, USA
| | - Cherice Hill
- Clemson University-Medical University of South Carolina Joint Bioengineering Program, Charleston, South Carolina, USA
| | - Laura Sands
- Center for Gerontology, Virginia Tech, Blacksburg, Virginia, USA
| | - Robin Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
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22
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van der Plaat LW, Doets HC, van Dijk CN, Haverkamp D. Medial malleolar osteotomy for the correction of tibiotalar varus deformity during total ankle arthroplasty: Results in 95 ankles. Foot (Edinb) 2022; 52:101905. [PMID: 35598437 DOI: 10.1016/j.foot.2022.101905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 01/01/2022] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The importance of deformity correction before or during total ankle replacement (TAR) has been recognized for a long time. Our results of TAR, combined with medial malleolar lengthening osteotomy, for the reconstruction of osteoarthritic ankles with varus deformity are hereby reported. METHODS All ankles in which a medial malleolar osteotomy was performed during implantation of an ankle prosthesis during the period 1998-2018 were filtered out of our database. Preoperative coronal talar alignment was evaluated by measuring the angle between the tibial shaft and talar dome on the weightbearing mortise ankle radiograph. Patient-reported outcomes were measured with the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM). A Kaplan-Meier survival curve was constructed and the number of revisions per 100 observed component years was calculated for interprosthetic comparison. RESULTS A total of 95 TARs were included, consisting of the Alpha Ankle Arthroplasty (n = 22); Buechel-Pappas (n = 14) and the Ceramic Coated Implant Evolution (n = 59) prostheses. The preoperative average talar angle in these ankles was 12.4 degrees varus. In 33% (31/95) corrective procedures, in addition to the medial malleolar osteotomy, were performed. A reoperation rate of 44% (42/95) was found, including 28 revisions (revision rate 29% (4% septic; 25% aseptic) at an average follow-up of 5.9 years, resulting in a survival of 0.69 for the total cohort at 10 years of follow-up. At an average follow-up of 6.6 years the average FAOS scores were: FAOSsymptoms 66, FAOSpain 73, FAOSfunction 78, FAOSsport 45 and FAOSquality of life 56 respectively. The FAAMadl score averaged 64. CONCLUSION This is the largest cohort of TAR combined with medial malleolar osteotomy to date. A 29% revision rate at 5.9 years of average follow-up compares unfavorably with regular cohort studies and with most other results in varus-deformed ankles. Scores on the FAOS and FAAM are comparable to those obtained in regular cohorts with similar length of follow-up. TAR in varus-deformed ankles necessitating medial malleolar osteotomy has an even higher failure rate than regular TAR. Obtaining a stable prosthesis with a neutrally-aligned hindfoot at the end of the procedure is of paramount importance. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - H Cornelis Doets
- Department of Orthopedics, Former Slotervaart Hospital, Amsterdam, The Netherlands
| | - C Niek van Dijk
- Department of Orthopedics, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Daniël Haverkamp
- Department of Orthopedics, Xpert Orthopedics and Specialized Centre of Orthopedic Research and Education (SCORE), Amsterdam, The Netherlands
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23
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Mercurio M, Castioni D, Porco E, Familiari F, Gasparini G, Galasso O. Periprosthetic ankle infection: eradication rate, complications, and limb salvage. A systematic review. Foot Ankle Surg 2022; 28:550-556. [PMID: 34321185 DOI: 10.1016/j.fas.2021.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This systematic review investigated the outcomes of revision surgery after periprosthetic ankle infection (PAI). METHODS According to the PRISMA statement, 9 studies with 131 PAIs surgically treated and analyzed were included. Demographics and surgical techniques with eradication rates and complications were reported. RESULTS Methicillin-sensitive Staphylococcus aureus (MSSA) (30.4%) and coagulase-negative Staphylococcus (CNS) (26.5%) were the most common microorganisms. The eradication rate was 91.7% with permanent antibiotic spacers (SPC), 84.4% with 2-stage, 79.4% with arthrodesis (AA), and 58.8% with debridement and implant retention (DAIR). DAIR showed a significantly lower eradication rate than 2-stage (p = 0.016) and SPC (p = 0.043). Amputations occurred in 25% of patients after SPC, 8.8% after AA and 3.9% after DAIR. SPC showed a significantly higher amputation rate than DAIR and 2-stage (p = 0.044, and p = 0.017, respectively). CONCLUSIONS SPC and 2-stage revision show the highest eradication rates, but 2-stage has a lower risk of amputation.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, loc. Germaneto, 88100, Catanzaro, Italy
| | - Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, loc. Germaneto, 88100, Catanzaro, Italy.
| | - Elvira Porco
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, loc. Germaneto, 88100, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, loc. Germaneto, 88100, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, loc. Germaneto, 88100, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, V.le Europa, loc. Germaneto, 88100, Catanzaro, Italy
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24
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Kvarda P, Peterhans US, Susdorf R, Barg A, Ruiz R, Hintermann B. Long-Term Survival of HINTEGRA Total Ankle Replacement in 683 Patients: A Concise 20-Year Follow-up of a Previous Report. J Bone Joint Surg Am 2022; 104:881-888. [PMID: 35290251 DOI: 10.2106/jbjs.21.00899] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Peter Kvarda
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Roman Susdorf
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Alexej Barg
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, BG Hospital Hamburg, Hamburg, Germany.,Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Roxa Ruiz
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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25
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Pollock JR, Doan MK, Moore ML, Hassebrock JD, Makovicka JL, Deckey DG, Kile TA, Patel KA. 30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia. Foot Ankle Int 2021; 42:1463-1468. [PMID: 34109838 DOI: 10.1177/10711007211017512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. METHODS A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. RESULTS Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). CONCLUSION This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jordan R Pollock
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Matt K Doan
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - M Lane Moore
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - David G Deckey
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Todd A Kile
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Karan A Patel
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
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26
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Chen J, Akoh CC, Kadakia R, Somerson JS, Easley ME, Adams SB, DeOrio JK, Nunley JA. Analysis of 408 Total Ankle Arthroplasty Adverse Events Reported to the US Food and Drug Administration From 2015 to 2018. Foot Ankle Spec 2021; 14:393-400. [PMID: 32383635 DOI: 10.1177/1938640020919538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Total ankle arthroplasty (TAA) use has increased with newer generation implants. Current reports in the literature regarding complications use data extracted from high-volume centers. The types of complications experienced by lower-volume centers may not be reflected in these reports. The purpose of this study was to determine a comprehensive TAA adverse event profile from a mandatory-reporting regulatory database. Methods. The US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was reviewed from 2015 to 2018 to determine reported adverse events for approved implants. Results. Among 408 unique TAA device failures, the most common modes of failure were component loosening (17.9%), intraoperative guide or jig error (15.4%), infection (13.7%), and cyst formation (12.7%). In addition, the percentage distribution of adverse event failure types differed among implants. Conclusion. The MAUDE database is a publicly available method that requires mandatory reporting of approved device adverse events. Using this report, we found general agreement in types of complications reported in the literature, although there were some differences, as well as differences between implants. These data may more accurately reflect a comprehensive profile of TAA complications as data were taken from a database of all device users rather than only high-volume centers.Levels of Evidence: NA.
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Affiliation(s)
- Jie Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Craig C Akoh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
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27
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Patient-specific instrumentation (PSI) in total ankle arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2445-2452. [PMID: 34345975 DOI: 10.1007/s00264-021-05145-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient-specific instrument (PSI) may theoretically make total ankle arthroplasty (TAA) more accurate. Several studies have reported the outcomes of PSI TAA. The aim of this study is to systematically review the literature of PSI TAA. METHODS PubMed, Embase, Web of Science, and Cochrane Library databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for PSI TAA. The quality of the included studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). RESULT Nine articles were ultimately included in the systematic review. The implant position and function outcome of TAA was similar between PSI and SI. Prediction accuracy of implant size remained great difference. PSI can shorten the operative time and fluoroscopy time. The quality of current studies on PSI TAA is insufficient to produce high-level evidence. CONCLUSION PSI can get similar implant position and clinical outcome in TAA compared to SI, but current evidence is not strong enough to evaluate PSI TAA.
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28
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Huang G, Pan ST, Qiu JX. The Clinical Application of Porous Tantalum and Its New Development for Bone Tissue Engineering. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2647. [PMID: 34070153 PMCID: PMC8158527 DOI: 10.3390/ma14102647] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
Porous tantalum (Ta) is a promising biomaterial and has been applied in orthopedics and dentistry for nearly two decades. The high porosity and interconnected pore structure of porous Ta promise fine bone ingrowth and new bone formation within the inner space, which further guarantee rapid osteointegration and bone-implant stability in the long term. Porous Ta has high wettability and surface energy that can facilitate adherence, proliferation and mineralization of osteoblasts. Meanwhile, the low elastic modulus and high friction coefficient of porous Ta allow it to effectively avoid the stress shield effect, minimize marginal bone loss and ensure primary stability. Accordingly, the satisfactory clinical application of porous Ta-based implants or prostheses is mainly derived from its excellent biological and mechanical properties. With the advent of additive manufacturing, personalized porous Ta-based implants or prostheses have shown their clinical value in the treatment of individual patients who need specially designed implants or prosthesis. In addition, many modification methods have been introduced to enhance the bioactivity and antibacterial property of porous Ta with promising in vitro and in vivo research results. In any case, choosing suitable patients is of great importance to guarantee surgical success after porous Ta insertion.
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Affiliation(s)
| | | | - Jia-Xuan Qiu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China; (G.H.); (S.-T.P.)
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29
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Alsayel F, Alttahir M, Wiewiorski M, Barg A, Herrera M, Valderrabano V. Two-Staged Revision Total Ankle Arthroplasty Surgery with Primary Total Ankle Arthroplasty System: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00053. [PMID: 33914712 DOI: 10.2106/jbjs.cc.20.00339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Case of a 2-staged revision surgical technique for the treatment of an aseptic total ankle arthroplasty (TAA) loosening: first surgery: removal of the loosened and painful TAA Scandinavian Total Ankle Replacement, with exclusion of infection, and reconstruction of the large bone defect (bone-defect downsizing surgery); proof of successful ankle bone reconstruction by CT-scan imaging; second surgery: implantation of a primary VANTAGE TAA (ankle reconstruction with new primary TAA). CONCLUSION The present case shows the management of a failed TAA with bone defect by performing a 2-step surgical approach: removal of loosened TAA with simultaneous bone stock restoration and then implantation of a new primary TAA. This concept is a possible alternative to a post-TAA ankle arthrodesis or to the use of a TAA revision system.
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Affiliation(s)
- Faisal Alsayel
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mustafa Alttahir
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia
| | - Martin Wiewiorski
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Alexej Barg
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Mario Herrera
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Victor Valderrabano
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland
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30
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Dohle J, Stukenborg-Colsman C, Plaaß C. Endoprothetik am oberen Sprunggelenk. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 160:341-360. [PMID: 33733439 DOI: 10.1055/a-1284-6896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Arthrosis of the upper ankle is usually the long-term consequence of an ankle fracture. In the case of advanced osteoarthritis - after all conservative therapy options have been exhausted - the therapeutical options are reduced to the choice between arthrodesis and prosthesis, the technique and follow-up treatment of which this article presents. The mobility achieved after endoprosthetic treatment is usually less than the normal physiological level, but still functionally sufficient.
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31
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Mobile Anatomical Total Ankle Arthroplasty-Improvement of Talus Recentralization. J Clin Med 2021; 10:jcm10030554. [PMID: 33540943 PMCID: PMC7867334 DOI: 10.3390/jcm10030554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction: Total ankle arthroplasty (TAA) is becoming a more frequent treatment option for end-stage ankle osteoarthritis (OA) as outcomes measures are improving. However, there is concern that malalignment of TAA can result in premature failure of the implant. One of the malalignment issues is the talar sagittal malposition. However, a consensus on the significance of the sagittal translation of the talus in TAA is yet to be established. The aim of this study was, therefore, to clarify whether talus OA subluxation is normalized after the implantation of a mobile TAA. Methods: Forty-nine consecutive patients with symptomatic end-stage ankle OA underwent 50 cementless three-component mobile-bearing VANTAGE TAA with 21 right ankles (42%) and 29 left ankles (58%). Clinical and radiographic outcomes were assessed: Clinical variables: American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (0–100), visual analogue scale (VAS, 0–10), and ankle range of motion (ROM). Radiological variables: medial distal tibial articular angle (mDTAA), anterior distal tibial articular angle (aDTAA) and lateral talar station (LTS). Results: The clinical results showed the mean improvement in AOFAS hindfoot score from 42.12 ± SE 2.42 (Range: 9–72) preoperatively, to 96.02 ± SE 0.82 (Range: 78–100) at a mean follow-up of 12 months, with a highly statistically significant difference (p < 0.00001). Pain score (VAS) was 6.70 ± SE 0.28 (Range 0–10) preoperatively, and 0.26 ± SE 0.12 (Range: 0–3) at 12-month follow-up, with a highly statistically significant difference (p < 0.00001). ROM measurements preoperatively showed a mean of 22.55° ± SE 1.51° (Range: 0–50°), which showed a statistically significant improvement (p < 0.0001) to 45.43° ± SE 1.56° (Range: 25–60°) 12 months postoperatively. The radiological analyses revealed the following results: On the coronal view, the mDTAA preoperatively was 88.61 ± SE 0.70 (Range: 78.15–101.10), which improved to 89.46 ± SE 0.40 (Range: 81.95–95.80) at 12 months (not statistically significant—p = 0.94). On the sagittal view, the preoperative values of the aDTAA showed 82.66 ± SE 0.84 (Range: 70.35–107.47), which improved to 88.98 ± SE 0.47 (Range: 82.83–96.32) at 12 months postoperatively, with a highly statistically significant difference between preoperative and 12-months values (p < 0.00001). The mean LTS values for all patients were 3.95 mm ± SE 0.78 (Range: −11.52 to 13.89) preoperatively and 1.14 mm ± SE 0.63 (Range: −10.76 to 11.75) at 12 months, with a statistically significant difference between preoperative and 12-month follow-up (p = 0.01). The review of the radiological TAA osteointegration at 12 months showed no cases of loosening of the implanted TAAs. Two cases (4%) showed a radiolucency and one case (2%) a cyst on the tibial component; no cases had a change on the talar component. No TAA complication/revision surgeries were documented. Conclusion: In the present study, the lateral talar station of anteriorly subluxated ankles showed a significant improvement, i.e., physiological centralization of the talus, in the postoperative period when a mobile-bearing TAA was performed. The anterior/posterior congruency between the talar component and the mobile polyethylene insert of the mobile-bearing VANTAGE TAA allows the sagittal translation of the talus relative to the flat tibial component, reducing the prosthesis strain and failure.
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32
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Bernasconi A, Patel S, Malhotra K, Singh D, Welck M, Cullen N. Salvage Tibiotalocalcaneal Arthrodesis Augmented With Fibular Columns and Iliac Crest Autograft: A Technical Note. Foot Ankle Spec 2021; 14:79-88. [PMID: 33345604 DOI: 10.1177/1938640020980914] [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] [Indexed: 11/17/2022]
Abstract
Failure of ankle arthrodesis or total ankle replacement (TAR) results in a challenging clinical situation and may take the form of symptomatic nonunion following arthrodesis and aseptic or infective loosening following TAR. Revision in these scenarios is technically demanding, and if associated with subtalar degeneration, conversion to tibiotalocalcaneal (TTC) arthrodesis may be required, with use of bone grafting to maintain length and reduce disability. Fibular strut grafting in the form of pillars or columns, potentially supplemented by tricortical and iliac graft, may be used in association with intramedullary TTC nailing or lateral plating and has demonstrated encouraging fusion rates. In this technical note, we review the history of this technique and report indications and surgical approach. Furthermore, of 6 cases (mean age 69.8 years) treated at our institution and followed at 13 months (range, 8 to 20 months), 5 (83%) were clinically and radiologically united, and patients were satisfied with the outcome of surgery. One patient with a background of chronic kidney disease remained dissatisfied with no union achieved, persistent pain, and awaiting a below-the-knee amputation. No other complications were observed. TTC fusion augmented with fibular columns and iliac crest autograft is an option to treat combined ankle and subtalar joint pathologies with significant talar bone loss.Levels of Evidence: Level V (technical note).
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Affiliation(s)
- Alessio Bernasconi
- Department of Public Health, Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy.,Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Shelain Patel
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Karan Malhotra
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Dishan Singh
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Matthew Welck
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Nicholas Cullen
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
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Lee JW, Im WY, Song SY, Choi JY, Kim SJ. Analysis of early failure rate and its risk factor with 2157 total ankle replacements. Sci Rep 2021; 11:1901. [PMID: 33479348 PMCID: PMC7820457 DOI: 10.1038/s41598-021-81576-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/06/2021] [Indexed: 02/03/2023] Open
Abstract
The failure rate of TAA is still higher than that of other joint replacement procedures. This study aimed to calculate the early failure rate and identify associated patient factors. Data from the Korean Health Insurance Review and Assessment Service database from 2009 to 2017 were collected. We evaluated patients who had TAA as a primary surgical procedure. Early failure was defined as conversion to revision TAA or arthrodesis after primary TAA within five years. Patients with early failure after primary TAA were designated as the "Failure group". Patients without early failure and who were followed up unremarkably for at least five years after primary TAA were designated as the "No failure group". Overall, 2157 TAA participants were included. During the study period, 197 patients developed failure within five years postoperatively, for an overall failure rate of 9.1%. Significant risk factors for early failure were history of chronic pulmonary disease, diabetes, peripheral vascular disease, hyperlipidemia, dementia, and alcohol abuse. A significant increase of odds ratio was found in patients with a history of dementia, chronic pulmonary disease, and diabetes. Surgical indications and preoperative patient counseling should consider these factors.
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Affiliation(s)
- Jung Woo Lee
- Department of Orthopaedic Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, 20, Ilsan-ro, Wonju-si, Gangwon-do, 26426, Republic of Korea
| | - Woo-Young Im
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
| | - Si Young Song
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea
| | - Jae-Young Choi
- School of Advanced Materials Science and Engineering, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, Republic of Korea.,SKKU Advanced Institute of Nanotechnology (SAINT), Sungkyunkwan University, Suwon-si, Republic of Korea
| | - Sung Jae Kim
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, 18450, Republic of Korea.
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