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van Es LJM, Sierevelt IN, Kerkhoffs GMMJ, Haverkamp D. Analyzing Learning Curve Effects: Total Ankle Replacement Design Switch and Long-Term Survival. J Foot Ankle Surg 2024:S1067-2516(24)00139-X. [PMID: 38909964 DOI: 10.1053/j.jfas.2024.06.002] [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: 01/24/2024] [Revised: 06/05/2024] [Accepted: 06/08/2024] [Indexed: 06/25/2024]
Abstract
Different aspects of the learning curve in Total Ankle Replacement (TAR) have been studied in the short to mid-term, with 30 cases often considered critical. However, its impact on long-term (10 and 15-year) survival remains unclear. Therefore, we retrospectively analyzed 77 consecutive TARs performed by one orthopedic surgeon. The main outcome was long-term survival between cases 1-30 and 31-77 using the Kaplan-Meier with Competing Risk Analyses. Secondarily, we used Moving Average Method with LOESS regression to confirm the learning curve based on the perioperative complications. Thirdly, associations between perioperative complications and operation time on long-term survival were assessed using Cox proportional hazard models. The 10-year survival of cases 1-30 was 89.9% (95% CI 70.4-96.5), and of 31-77, 92.4% (95% CI 7745- 97.5) (p = 0.58). The 15-year survival was 81.8% (95% CI 59.5-91.8) and 74.8% (95% CI 52.4-86.6), respectively (p = 0.97). The long-term survival rate for the TAR that endured perioperative complication was 96.70% (95% CI 90.28-103.12), and for the uncomplicated TAR 87.50% (95% CI 77.12-97.88%) (p=0.24). Operating time nor occurrence of perioperative fractures were significantly associated with long-term survival (p= 0.11 and 0.26, respectively). However, moving average method revealed a significant decreasing trend with a cut-off value of 33 procedures regarding the marginal probability of perioperative osseous complications (p<0.01). In conclusion, surgeons should note a learning curve when adapting arthroplasty procedures. After the prosthesis design switch, the learning curve regarding perioperative osseous complications was confirmed at 33 TAR. The switch did not affect long-term survival.
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Affiliation(s)
- Laurian J M van Es
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands; Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Inger N Sierevelt
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Program Sports and Musculoskeletal Health, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Academic Center for Evidence-Based Sports Medicine, Amsterdam, The Netherlands; Amsterdam Collaboration on Health & Safety in Sports, International Olympic Committee Research Centers, Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Department of Orthopedic Surgery, Xpert Clinics, Amsterdam, The Netherlands
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Zhao Y, Wang H, Zhao B, Diao S, Gao Y, Zhou J, Liu Y. The learning curve for minimally invasive Achilles repair using the "lumbar puncture needle and oval forceps" technique. BMC Musculoskelet Disord 2024; 25:373. [PMID: 38730376 PMCID: PMC11088138 DOI: 10.1186/s12891-024-07489-9] [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: 01/03/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION An acute Achilles tendon rupture represents a common tendon injury, and its operative methods have been developed over the years. This study aimed to quantify the learning curve for the minimally invasive acute Achilles tendon rupture repair. METHODS From May 2020 to June 2022, sixty-seven patient cases who received minimally invasive tendon repair were reviewed. Baseline data and operative details were collected. The cumulative summation (CUSUM) control chart was used for the learning curve analyses. Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, and visual analog scale (VAS) at 3/6/9/12 months were calculated to assess the clinical outcomes. RESULTS Thirty-six cases underwent at least a year of follow up and were enrolled in this study. The gender ratio and average age were 80.5% and 32.5 years. The linear equation fitted well (R2 = 0.95), and CUSUM for operative time peaked in the 12th case, which was divided into the learning phase (n = 12) and master phase (n = 24). No significant difference was detected between the two groups in clinical variables, except for the operative time (71.1 ± 13.2 min vs 45.8 ± 7.2 min, p = 0.004). Moreover, we detected one case with a suture reaction and treated it properly. CONCLUSION Minimally invasive Achilles repair provides an opportunity for early rehabilitation. Notably, the learning curve showed that the "lumbar puncture needle and oval forceps" technique was accessible to surgeons.
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Affiliation(s)
- Yanrui Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Hanzhou Wang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Binzhi Zhao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Shuo Diao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Yuling Gao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China
| | - Junlin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China.
| | - Yang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, P.R. China.
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Silvestre J, Reid JJ, Scott DJ, Aiyer AA, Gross CE. Variability in Surgical Case Volume Performed During ACGME-Accredited Orthopaedic Foot and Ankle Fellowship Training. Foot Ankle Spec 2024:19386400241247256. [PMID: 38676630 DOI: 10.1177/19386400241247256] [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: 04/29/2024]
Abstract
INTRODUCTION Previous studies have demonstrated a positive correlation between case volume and outcomes in foot and ankle surgery. This study elucidates surgical case volume benchmarks for Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic foot and ankle fellowship training in the United States. METHODS The ACGME provided case logs for orthopaedic residents and foot and ankle fellows (2018-2021). Variabilities in reported fellowship case volumes were defined as the fold-difference between 90th and 10th percentiles. Reported case volumes were compared between training cohorts with parametric tests. RESULTS Case logs from 65 orthopaedic foot and ankle fellows and 3146 orthopaedic residents were included. Fellows reported 1.3- to 1.5-fold more foot and ankle cases during fellowship training than during residency training (P < .001). On average, orthopaedic foot and ankle fellows reported 405.4 cases and most were arthrodesis (17%), forefoot reconstruction (17%), mid/hindfoot reconstruction (13%), tendon repair/transfer (12%), and trauma ankle hindfoot (11%). Case categories with the highest variabilities were amputation (14.8-fold difference), infection/tumor (11.6-fold difference), arthroscopy (9.2-fold difference), and calcaneus (8.7-fold difference). DISCUSSION Case volume benchmarks can assist trainees and faculty during orthopaedic foot and ankle training. More research is needed to determine case minimum requirements needed for autonomous practice in foot and ankle surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, South Carolina
| | - Jared J Reid
- Medical University of South Carolina, Charleston, South Carolina
| | - Daniel J Scott
- Medical University of South Carolina, Charleston, South Carolina
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Usuelli FG, Maccario C, Indino C. Outcomes of Lateral Transfibular Approach for Total Ankle Replacement. Foot Ankle Clin 2024; 29:69-80. [PMID: 38309804 DOI: 10.1016/j.fcl.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Total ankle replacement through a lateral transfibular approach with trabecular metal implants was introduced in 2012 and originally was advertised as a safer approach in terms of wound healing issues. Further studies showed no significant difference comparing anterior and lateral approach for infections and would healing issues, whereas the main advantage is deformity correction, acting on coronal, sagittal, and rotational deformities and on fibular length issues. It showed a survival rate of 97.7% at 5 years follow-up.
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Affiliation(s)
- Federico G Usuelli
- Ortopedia della Caviglia e del Piede, Humanitas San Pio X, Via Francesco Nava, 31, Milan 20159, Italy.
| | - Camilla Maccario
- Ortopedia della Caviglia e del Piede, Humanitas San Pio X, Via Francesco Nava, 31, Milan 20159, Italy
| | - Cristian Indino
- Ortopedia della Caviglia e del Piede, Humanitas San Pio X, Via Francesco Nava, 31, Milan 20159, Italy
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Arshad Z, Haq II, Bhatia M. Learning curve of total ankle arthroplasty: a systematic review. Arch Orthop Trauma Surg 2024; 144:591-600. [PMID: 37917408 DOI: 10.1007/s00402-023-05064-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: 06/03/2023] [Accepted: 09/03/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION Together with ankle arthrodesis, total ankle arthroplasty is now accepted as a first-line intervention in the management of end-stage arthritis of the ankle. The evidence regarding how outcomes are affected by surgeon experience is inconsistent; we performed a systematic review to evaluate the effect of a learning curve in total ankle arthroplasty outcomes. METHODS An electronic database search was performed in PubMed, Embase, ISI Web of Science and Cochrane trials. Two reviewers independently conducted a two-stage title/abstract and full text screening. English-language original research studies comparing patient-reported outcome measures (PROMs), complication/revision rates, operative time, length of stay or radiation exposure according to surgeon experience were included. Quality assessment was performed using the methodological index for non-randomised studies. RESULTS All but one included study report either improved PROMs, reduced complication/revision rate, reduced hospital stay length/operative time or reduced radiation exposure with increasing surgeon experience. However, the majority of these findings lack statistical significance. Two studies assessing the plateau of the learning curve report a wide range of plateau thresholds between 9 and 39 cases. CONCLUSION This review finds a largely non-significant trend towards improvements in PROMs, complication, and revision rates with improved surgeon experience. The lack of statistical significance in a number of studies may be partially explained by methodological flaws, with more suitably designed studies reporting significant improvements. Future research into the effect of advancements in implant design and insertion guides is required to further characterise the magnitude of the learning curve and guide both mitigation and learning strategies.
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Affiliation(s)
- Zaki Arshad
- Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | - Ibrahim Inzarul Haq
- Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
| | - Maneesh Bhatia
- Infirmary Square, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
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Ong CB, Ong JM, Grubel J, Chiu YF, Premkumar A, Lee GC, Della Valle AG. Defining the Learning Period of a Novel Imageless Navigation System for Posterior Approach Total Hip Arthroplasty: Analysis of Surgical Time and Accuracy. Indian J Orthop 2024; 58:121-126. [PMID: 38312909 PMCID: PMC10830994 DOI: 10.1007/s43465-023-01060-9] [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: 01/09/2023] [Accepted: 11/14/2023] [Indexed: 02/06/2024]
Abstract
Introduction The use of imageless navigation in total hip arthroplasty (THA) is frequently associated with prolonged surgical times, predominantly during the learning period. The purpose of the present study was to characterize the learning period of a novel imageless navigation system, specifically as it related to surgical time and acetabular navigation accuracy. Materials and Methods This was a retrospective observational study of a consecutive group of 158 patients who underwent primary unilateral THA for osteoarthritis by a team headed by a single surgeon. All procedures used an imageless navigation system to measure acetabular cup inclination and anteversion angles, referencing a generic sagittal and frontal plane. Navigation accuracy was determined by assessing differences between intraoperative inclination and anteversion values and those obtained from standardized 6-week follow-up radiographs. Operative time and navigation accuracy were assessed by plotting moving averages of 7 consecutive cases. The learning period was defined using Mann-Kendall trend analyses, student t-tests and nonlinear regression modeling based on surgical time and navigation accuracy. Alpha error was 0.05. Results The average surgical time was 67.3 min (SD:9.2) (range 45-95). The average navigation accuracy for inclination was 0.01° (SD:4.2) (range - 10 to 10), and that for anteversion was - 4.9° (SD:3.8) (range - 14 to 5). Average surgical time and navigation accuracy were similar between the first and final cases in the series with no learning period detected. Conclusions There was no discernible learning period effect on surgical time or system measurement accuracy during the early phases of adoption for this imageless navigation system.
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Affiliation(s)
- Christian B. Ong
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Justin M. Ong
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jacqueline Grubel
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Yu-Fen Chiu
- The Department of Biostatistics, Hospital for Special Surgery, New York, NY USA
| | - Ajay Premkumar
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Gwo-Chin Lee
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 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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Sen RK, Tripathy SK, Shetty N. Ethics in Clinical Orthopedic Surgery. Indian J Orthop 2023; 57:1714-1721. [PMID: 37881283 PMCID: PMC10593651 DOI: 10.1007/s43465-023-01003-4] [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: 07/25/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023]
Abstract
Introduction Orthopedic surgeons, owing to their specialized role, have a set of medical and moral responsibilities that span beyond the confines of the operating room. The primary objective of this exploration is to emphasize the pivotal ethical and professional standards that these surgeons should uphold. Methodology We derived key ethical and professional aspects by reviewing standard medical practices, professional guidelines, and through consultations with senior orthopedic professionals. These aspects covered both the conduct inside the surgery room and the interpersonal relations outside. Results Several core areas of conduct were identified.Patient-Centered Care: Prioritizing the holistic well-being of the patient.Communication: Ensuring that all communications are both transparent and respectful.Informed Consent: Properly securing consent after ensuring the patient is adequately informed.Confidentiality: Taking measures to safeguard patient information.Professional Behavior: Upholding the highest standards of professional conduct.Continuous Learning: Remaining committed to updating skills and enhancing competence.Interpersonal Relations: Building healthy and constructive relationships with industry representatives, professional peers, and hospital staff.Personal Life Balance: Recognizing the importance of a balanced personal and professional life for holistic well-being. Conclusion For Orthopedic surgeons, strict adherence to the outlined ethical and professional principles is essential. Such commitment not only ensures the trust and safety of patients but also serves to maintain and elevate the prestigious standing of the orthopedic community in the broader medical landscape.
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Affiliation(s)
| | - Sujit Kumar Tripathy
- Department of Orthopedics, All India Institute of Medical Sciences, Bhubanewar, 751019 India
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Ueyama H, Nakagawa S, Kishimura Y, Minoda Y, Nakamura S, Koyanagi J, Yamamura M, Kadoya Y. Long-term clinical results of alumina ceramic medial pivot total knee arthroplasty: a 10-year follow-up study. ARTHROPLASTY 2023; 5:27. [PMID: 37202793 DOI: 10.1186/s42836-023-00180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/08/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The newly-designed alumina ceramic medial pivot total knee prosthesis was introduced to reduce polyethylene wear and better fit the anatomical morphology of the Asian population. This study aimed to clarify the long-term clinical results of alumina medial pivot total knee arthroplasty over a minimum follow-up period of 10 years. METHODS The data of 135 consecutive patients who underwent primary alumina medial pivot total knee arthroplasty were analyzed in this retrospective cohort study. Patients were examined over a minimum 10-year follow-up period. The knee range of motion, Knee Society Score (KSS) knee score, Knee Society Score function score, and radiological parameters were assessed. The survival rate was also evaluated by using reoperation and revision as endpoints. RESULTS The mean follow-up period lasted 11.8 ± 1.4 years. Patients who were not followed accounted for 7.4% of the total cohort. Knee and function scores of KSS improved significantly following total knee arthroplasty (P < 0.001). In 27 individuals (28.1%), a radiolucent line was observed. Aseptic loosening occurred in three cases (3.1%). The survival rates for reoperation and revision were 94.8% and 95.8% 10 years after the operation, respectively. CONCLUSIONS During a minimum 10-year follow-up period, the present model of alumina medial pivot total knee arthroplasty showed good clinical outcomes and survival rates.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan.
| | - Shigeru Nakagawa
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Yuichi Kishimura
- Department of Orthopedic Surgery, Hanwa Joint Reconstruction Center, 3176 Hukaikitamachi Naka Ward, Sakai, Osaka, 599-8271, Japan
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka, 545-8585, Japan
| | - Suguru Nakamura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Junichiro Koyanagi
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Mitsuyoshi Yamamura
- Department of Orthopedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasonecho, Kita Ward, Sakai, Osaka, 591-8025, Japan
| | - Yoshinori Kadoya
- Department of Orthopedic Surgery, Hanwa Joint Reconstruction Center, 3176 Hukaikitamachi Naka Ward, Sakai, Osaka, 599-8271, Japan
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Leardini A, Belvedere C, de Cesar Netto C. Total Ankle Replacement: Biomechanics of the Designs, Clinical Outcomes, and Remaining Issues. Foot Ankle Clin 2023; 28:e1-e14. [PMID: 36935170 DOI: 10.1016/j.fcl.2023.01.001] [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: 03/21/2023]
Abstract
The present review paper aimed at discussing the current major issues in total ankle replacement, both the technical and biomechanical concepts, and the surgical and clinical concerns. Designers shall target at the same time restoration of natural ankle kinematics and congruity of the artificial surfaces throughout the range of motion. Surgeons are recommended to expand biomechanical knowledge on ankle joint replacement, and provide appropriate training and key factors to make arthroplasty a good alternative to arthrodesis. Moreover, adequate selection of patients and careful rehabilitation are critical. In the future, custom-made prosthesis components and patient-specific instrumentation are major developments for more complex cases.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy.
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA; Orthopedic Functional Imaging Research Laboratory, University of Iowa, Iowa City, IA, USA; Department of Orthopedics, Duke University, Durham, NC, USA
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Abarquero-Diezhandino A, Vacas Sánchez E, Diaz Fernandez R, Vilá Y Rico J. Results of Transfibular Total Ankle Arthroplasty. A Series of 50 Implants. J Foot Ankle Surg 2023:S1067-2516(23)00029-7. [PMID: 36941143 DOI: 10.1053/j.jfas.2023.02.005] [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: 08/25/2022] [Revised: 12/23/2022] [Accepted: 02/02/2023] [Indexed: 03/23/2023]
Abstract
Total ankle arthroplasty has become popular in the last few years. The lateral transfibular approach is an alternative to the traditional anterior approach. The purpose of this study was to evaluate our 50 first and consecutive clinical and radiological outcomes of transfibular total ankle replacements (Trabecular Metal Total AnkleR Zimmer Biomet, Warsaw, IN) with a follow-up of at least 3 years. This retrospective study included 50 patients. The main indication was post-traumatic osteoarthritis (n = 41). The mean age was 59 (range = 39-81). All patients were followed for at least 36 months postoperatively. Patients were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score and Visual analog scale (VAS) preoperatively and postoperatively. Range of motion and radiological measures were assessed as well. Postoperatively, patients demonstrated statistically significant improvement in the AOFAS score from 32 (range = 14-46) to 80 (range = 60-100) (p < .01) and VAS from 7.8 (range = 6.1-9.7) to 1.3 (range = 0-6) (p < .01). The average total range of motion increased significantly from 19.8° to 29.2° of plantarflexion and 6.8° to 13.5° of dorsiflexion. Alignment measured by alpha, beta, and gamma angles was satisfactorily achieved. No patient demonstrated any radiographic evidence of tibial or talar lucency at the final follow-up. Five patients (10%) experienced delayed wound healing. One patient (2%) developed a postoperative prosthetic infection. One patient (2%) developed fibular pseudoarthrosis and 2 patients (4%) suffered impingement. Two patients (4%) needed surgery for symptomatic fibular hardware. This study found excellent clinical and radiological results of transfibular total ankle replacement. This is a safe and effective option that allows the correction of sagittal and coronal malalignment.
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Affiliation(s)
- Ana Abarquero-Diezhandino
- Foot and Ankle Unit, Department of Orthopaedics and Traumatology Surgery, Hospital Fundación Jiménez Diaz, Madrid, Spain.
| | - Elena Vacas Sánchez
- Foot and Ankle Unit, Department of Orthopaedics and Traumatology Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Orthopaedics and Traumatology Surgery, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain
| | - Rodrigo Diaz Fernandez
- Foot and Ankle Unit, Department of Orthopaedic Surgery, Hospital de Manises, Valencia, Spain; Foot and Ankle Unit, Department of Orthopaedic Surgery, Hospital Quironsalud, Valencia, Spain; Associate Professor, Faculty of Medicine, Catholic University of Valencia, Saint Vincent Martyr, Valencia, Spain
| | - Jesús Vilá Y Rico
- Foot and Ankle Unit, Department of Orthopaedics and Traumatology Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Orthopaedics and Traumatology Surgery, Complejo Hospitalario Ruber Juan Bravo, Madrid, Spain; Associate Professor, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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12
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Usuelli FG, Paoli T, Indino C, Maccario C, Di Silvestri CA. Fast-Track for Total Ankle Replacement: A Novel Enhanced Recovery Protocol for Select Patients. Foot Ankle Int 2023; 44:148-158. [PMID: 36576024 DOI: 10.1177/10711007221140841] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Enhanced recovery after surgery programs, also called fast-track protocols, were developed and successfully applied in the last decade for hip and knee reconstruction. Specific fast-track protocols have not yet been applied to ankle prostheses. The aim of the study was to develop and validate an enhanced recovery protocol for total ankle replacement (TAR) evaluating the clinical and radiographic results. We hypothesize that on the basis of well-defined pre- and postoperative characteristics, the current knowledge on ankle replacement, and referring to hip and knee reconstruction, it is possible to identify a "patient type" to be safely eligible to a Fast-Track Protocol with at least comparable results and without increasing the complications risk. METHODS We identified 8 predictive variables that might affect the outcome of TAR. Those variables were the body mass index, the state of anxiety or depression, the functional preoperative status, ankle equinus, the coronal malalignment, the surgical time, the surgical accessory procedures, and the bone quality. These characteristics were evaluated for each patient with almost validated outcome tools attributing a specific score. Based on the score obtained, the patients were divided into 2 groups: the Standard Protocol group (Control Group) and the Fast-Track Protocol group (Study Group). The main difference between treatment of the 2 groups relates to the use of postoperative plaster casts: in the Fast-Track group the cast was removed the first day after surgery and walking was allowed in sports shoes assisted with crutches, whereas in the Standard Protocol group, the cast was removed after 3 weeks. Clinical and radiographic evaluation was performed for all patients preoperatively and postoperatively every 6 months. RESULTS A total of 163 patients received a score between 1 and 5 and were included in the control group (Standard Protocol); 47 patients received a score of 0 and were allocated to the study group (Fast-Track Protocol). Clinically, except for the preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score, no statistically significant differences were recorded in the multiple comparisons between the 2 groups. No significant differences were found regarding complications. CONCLUSION In selected patients, it is possible to apply an enhanced recovery protocol of rehabilitation, focused on immediate weightbearing and mobilization without any plaster or boot. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Kim J, Gagne OJ, Rajan L, Caolo K, Sofka C, Ellis SJ, Demetracopoulos CA, Deland JT. Clinical Outcomes of the Lateral Trabecular Metal Total Ankle Replacement at a 5-Year Minimum Follow-up. Foot Ankle Spec 2022:19386400221139525. [PMID: 36482702 DOI: 10.1177/19386400221139525] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Trabecular Metal (Zimmer Biomet, Warsaw, IN) total ankle arthroplasty (TAA) system uses a lateral approach with a fibular osteotomy to gain access to the tibiotalar joint and a sagittally curved tibial component. This is the first TAA system to laterally approach the ankle, and few studies have explored outcomes associated with this implant. This study aimed to report the 5-year clinical and radiographic outcomes as well as the survivorship of the implant. METHODS Over a 3-year period, 2 fellowship-trained foot and ankle surgeons used this implant system to treat 38 end-stage arthritic ankles. Reoperation and revision data were collected from all patients (100%) as part of the local prospective database. Patients completed the Foot and Ankle Outcome Score (FAOS) questionnaire preoperatively and at each annual follow-up visit; scores for a minimum of 5 years were available for 28 (73.7%) patients. A radiographic analysis compared postoperative coronal and sagittal alignment in weightbearing radiographs at a minimum of 5 years with that at 3 months postoperatively, as well as cyst or lucency formation, which was available for 21 patients (55.3%). RESULTS At 5 years, there were 3 revisions (7.9%) and 9 reoperations (23.7%). Reoperations included 4 fibular hardware removal and 5 medial gutter debridement procedures. The FAOS significantly improved for all domains (P < .05). Implant positioning did not significantly change between 3 months and 5 years postoperatively. CONCLUSION Our 5-year results in this small series using this unique prosthesis showed good overall survivorship (92.1%) and a reoperation rate of 23.7%, along with clinically significant improvement in patient-reported outcomes. LEVELS OF EVIDENCE Level IV: Retrospective case series.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, New York City, New York
| | | | - Lavan Rajan
- Hospital for Special Surgery, New York City, New York
| | - Kristin Caolo
- Hospital for Special Surgery, New York City, New York
| | - Carolyn Sofka
- Hospital for Special Surgery, New York City, New York
| | - Scott J Ellis
- Hospital for Special Surgery, New York City, New York
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14
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Shah JA, Schwartz AM, Farley KX, Mahmoud K, Attia AK, Labib S, Kadakia RJ. Projections and Epidemiology of Total Ankle and Revision Total Ankle Arthroplasty in the United States to 2030. Foot Ankle Spec 2022:19386400221109420. [PMID: 35833386 DOI: 10.1177/19386400221109420] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Total ankle arthroplasty (TAA) utilization is increasing in the United States. As the incidence of this procedure grows, it is important for providers to understand the future projections for ankle arthroplasty and more importantly revision total ankle arthroplasty (rTAA). Methods: The National Inpatient Sample (USA) was queried from 2005 to 2017 for all TAA and rTAA. Poisson and linear regression analysis was performed to project annual incidence of TAA and rTAA to 2030, with subgroup analyses on septic rTAA. Results: There were 5315 TAAs performed in 2017, a 564% (P < .001) increase when compared with the TAAs performed in 2005. From 2017 to 2030, the incidence of TAAs is projected to increase from 110% to 796% (P < .001). There were 1170 rTAAs performed in 2017, a 155% (P < .001) increase when compared with rTAAs performed in 2005. There was a 256% increase in the incidence of septic rTAAs from 2005 to 2017 with a projected increase between 22% and 120% by 2030. Conclusions: The incidence of both TAAs and rTAAs is projected to significantly increase over the next decade. Given the known risk factors of TAA and rTAA, these findings reinforce the need for thoughtful consideration when selecting patients for TAA.
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Affiliation(s)
- Jason A Shah
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia (JAS, AMS, KM)
- Emory University School of Medicine, Atlanta, Georgia (KXF, SL, RJK)
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (AKA)
| | - Andrew M Schwartz
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia (JAS, AMS, KM)
- Emory University School of Medicine, Atlanta, Georgia (KXF, SL, RJK)
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (AKA)
| | - Kevin X Farley
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia (JAS, AMS, KM)
- Emory University School of Medicine, Atlanta, Georgia (KXF, SL, RJK)
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (AKA)
| | - Karim Mahmoud
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia (JAS, AMS, KM)
- Emory University School of Medicine, Atlanta, Georgia (KXF, SL, RJK)
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (AKA)
| | - Ahmed Khalil Attia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia (JAS, AMS, KM)
- Emory University School of Medicine, Atlanta, Georgia (KXF, SL, RJK)
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (AKA)
| | - Sameh Labib
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia (JAS, AMS, KM)
- Emory University School of Medicine, Atlanta, Georgia (KXF, SL, RJK)
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (AKA)
| | - Rishin J Kadakia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia (JAS, AMS, KM)
- Emory University School of Medicine, Atlanta, Georgia (KXF, SL, RJK)
- Department of Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania (AKA)
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Mazzotti A, Viglione V, Gerardi S, Bonelli S, Zielli S, Geraci G, Faldini C. Post-operative management after total ankle arthroplasty: A systematic review of the literature. Foot Ankle Surg 2022; 28:535-542. [PMID: 34088605 DOI: 10.1016/j.fas.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Currently, there is no consensus on the most appropriate post-operative management for patients undergoing total ankle arthroplasty. The aim of this study is therefore to offer a systematic review of the pertaining literature to identify current post-operative protocols and describe possible differences. METHODS A systematic review to identify recent studies concerning the post-operative management after total ankle arthroplasty was conducted. Five topics were analyzed: length of hospital stay, type and duration of immobilization, weight-bearing management, post-operative pharmacological therapies, adopted rehabilitation scheme. RESULTS Eighty-four studies met the inclusion criteria and were included in the review process. Most of the papers appear to have conflicting opinions with no consensus and homogeneous protocols. CONCLUSION Due to various methodological limitations, it is not possible to provide sufficiently supported evidence-based recommendations, and it is therefore difficult to determine the superiority of one post-operative protocol over the others after total ankle arthroplasty.
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Affiliation(s)
- A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - V Viglione
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Gerardi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Bonelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G Geraci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
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16
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Kurokawa H, Taniguchi A, Miyamoto T, Tanaka Y. What is the best way for an inexperienced surgeon to learn total ankle arthroplasty? J Orthop Sci 2022:S0949-2658(22)00128-2. [PMID: 35680494 DOI: 10.1016/j.jos.2022.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/25/2022] [Accepted: 05/17/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Previous reports on the learning curve of total ankle arthroplasty (TAA) revealed that inexperienced surgeons should be more careful about operative indications and procedures during the learning curve period. Patients who underwent surgery with inexperienced surgeons may be associated with inferior clinical outcomes, such as frequent complications. This study aimed to evaluate the effect of the participation of experienced surgeons as assistants on the results of TAA performed by inexperienced surgeons. METHODS Surgeons whose experience in performing TAA included less than 15 ankles were defined as inexperienced surgeons; on the other hand, those whose experience included more than 20 ankles were defined experienced surgeons in this study. Thirteen ankles operated by inexperienced surgeons, with an experienced surgeon who participated as an assistant, were assigned to the inexperienced group. Fifteen ankles operated on by an experienced surgeon were assigned to the experienced group. TNK Ankle (Kyocera, Kyoto, Japan) was used for all experiments. The coronal and sagittal alignments and the size of the tibial component relative to the tibial shaft were measured. Preoperative and postoperative Japanese Society for Surgery of the Foot (JSSF) and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were used for clinical assessment. RESULTS There were two malleolar fractures during the operation in both groups, and there were no cases of revision surgery. There were no significant differences in the coronal and sagittal tibial component alignment and size between the groups. The JSSF and SAFE-Q improved. There were no significant differences between groups, except for the preoperative JSSF score. CONCLUSIONS During the learning curve period, careful surgical indications and surgeries are desired. However, we found that when experienced surgeons participated as assistants, favorable results could be expected even when inexperienced surgeons performed the surgery. LEVEL OF EVIDENCE Ⅲ.
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Affiliation(s)
- Hiroaki Kurokawa
- Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Akira Taniguchi
- Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Takuma Miyamoto
- Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yasuhito Tanaka
- Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
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17
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van Hoogstraten SWG, Hermus J, Loenen ACY, Arts JJ, van Rietbergen B. Malalignment of the total ankle replacement increases peak contact stresses on the bone-implant interface: a finite element analysis. BMC Musculoskelet Disord 2022; 23:463. [PMID: 35581630 PMCID: PMC9112518 DOI: 10.1186/s12891-022-05428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Malalignment of the Total Ankle Replacement (TAR) has often been postulated as the main reason for the high incidence of TAR failure. As the ankle joint has a small contact area, stresses are typically high, and malalignment may lead to non-homogeneous stress distributions, including stress peaks that may initiate failure. This study aims to elucidate the effect of TAR malalignment on the contact stresses on the bone-implant interface, thereby gaining more understanding of the potential role of malalignment in TAR failure. Methods Finite Element (FE) models of the neutrally aligned as well as malaligned CCI (Ceramic Coated Implant) Evolution TAR implant (Van Straten Medical) were developed. The CCI components were virtually inserted in a generic three-dimensional (3D) reconstruction of the tibia and talus. The tibial and talar TAR components were placed in neutral alignment and in 5° and 10° varus, valgus, anterior and posterior malalignment. Loading conditions of the terminal stance phase of the gait cycle were applied. Peak contact pressure and shear stress at the bone-implant interface were simulated and stress distributions on the bone-implant interface were visualized. Results In the neutral position, a peak contact pressure and shear stress of respectively 98.4 MPa and 31.9 MPa were found on the tibial bone-implant interface. For the talar bone-implant interface, this was respectively 68.2 MPa and 39.0 MPa. TAR malalignment increases peak contact pressure and shear stress on the bone-implant interface. The highest peak contact pressure of 177 MPa was found for the 10° valgus malaligned tibial component, and the highest shear stress of 98.5 MPa was found for the 10° posterior malaligned talar model. High contact stresses were mainly located at the edges of the bone-implant interface and the fixation pegs of the talar component. Conclusions The current study demonstrates that TAR malalignment leads to increased peak stresses. High peak stresses could contribute to bone damage and subsequently reduced implant fixation, micromotion, and loosening. Further research is needed to investigate the relationship between increased contact stresses at the bone-implant interface and TAR failure.
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Affiliation(s)
- Sanne W G van Hoogstraten
- Department of Orthopedic Surgery, Laboratory for Experimental Orthopedics, Maastricht University Medical Center, Maastricht, the Netherlands. .,Department of Biomedical Engineering, Orthopedic Biomechanics, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Joris Hermus
- Department of Orthopedic Surgery, Laboratory for Experimental Orthopedics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Arjan C Y Loenen
- Department of Orthopedic Surgery, Laboratory for Experimental Orthopedics, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Biomedical Engineering, Orthopedic Biomechanics, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jacobus J Arts
- Department of Orthopedic Surgery, Laboratory for Experimental Orthopedics, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Biomedical Engineering, Orthopedic Biomechanics, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Bert van Rietbergen
- Department of Orthopedic Surgery, Laboratory for Experimental Orthopedics, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Biomedical Engineering, Orthopedic Biomechanics, Eindhoven University of Technology, Eindhoven, the Netherlands
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18
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Ishaque BA. Short Stem for Total Hip Arthroplasty (THA) - Overview, Patient Selection and Perspectives by Using the Metha ® Hip Stem System. Orthop Res Rev 2022; 14:77-89. [PMID: 35387255 PMCID: PMC8977779 DOI: 10.2147/orr.s233054] [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] [Received: 09/06/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
Short stem hip replacement has not only gained attention but also significance over the past decades. However, there still remains uncertainty regarding the correct indications for these stems. Even companies, producing implants, have varying recommendations that are more likely based on a well-meant advice than on statistically evaluated data. Thus, it is important to evaluate the advantages and disadvantages of a short stem prosthesis. The goal of this paper is to reveal some of the existing uncertainty in this field, by analyzing the Metha® short hip stem system. This paper does not only focus on general aspects but also discusses some more specific problems, such as avascular necrosis and post-rheumatic diseases, as well as hip dysplasia and coxarthrosis. The aim is also to convey the opportunity to indicate this type of implant for elderly and obese patients as well as for femoral misalignments following post-Perthes disease, post-traumatic deformities or other malpositions of the hip.
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Affiliation(s)
- Bernd Alexander Ishaque
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Giessen, 35392, Germany
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19
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D’Ambrosi R, Tiusanen HT, Ellington JK, Kraus F, Younger A, Usuelli FG. Fixed-Bearing Trabecular Metal Total Ankle Arthroplasty Using the Transfibular Approach for End-Stage Ankle Osteoarthritis. JB JS Open Access 2022; 7:JBJSOA-D-21-00143. [PMID: 36159081 PMCID: PMC9489156 DOI: 10.2106/jbjs.oa.21.00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This multicenter prospective cohort study assessed the safety and performance of the Trabecular Metal Total Ankle System (TM Ankle; Zimmer) for primary total ankle arthroplasty (TAA).
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Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Email for corresponding author:
| | | | | | | | - Alastair Younger
- University of British Columbia, Vancouver, British Columbia, Canada
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20
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Abstract
BACKGROUND A substantial coronal plane deformity is common in the context of end-stage ankle osteoarthritis. Recent literature shows a trend toward extending the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing promising results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity were similar to those with no major deformity at short-term follow-up. METHODS This retrospective cohort study included 228 LTTARs. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10 degrees of coronal deformity, 209 patients) and valgus (above 10 degrees of valgus, 19 patients). Clinical evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS), 12-Item Short Form Health Survey 12 (SF-12) regarding its Physical and Mental Component Summary items. The radiographic evaluation considered anteroposterior and lateral ankle radiographs. Complications were also registered and classified as major or minor. The minimum follow-up was 2 years. RESULTS The average AOFAS, VAS, and SF-12 scores improved significantly postoperatively (P < .001), without differences between groups. At final radiographic follow-up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle, or anterior distal tibial angle (P > .05). CONCLUSION LTTAR in cases with valgus deformity achieved and maintained correction at short-term follow-up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless of preoperative valgus deformity. LEVEL OF EVIDENCE Prognostic Level III, retrospective cohort study.
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Affiliation(s)
- Camilo Piga
- Equipo de Tobillo y Pie, Hospital del Trabajador, Santiago, Chile
| | - Camilla Maccario
- Ortopedia della Caviglia e del Piede, Humanitas S.Pio X, Milano, Italia
| | | | - Fausto Romano
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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