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Jyoti, Ghosh R. Design modification and selection of improved stem design of the conical stem tibial implant for TAR using FE analysis and different MCDM methods. Proc Inst Mech Eng H 2024; 238:874-885. [PMID: 39164955 DOI: 10.1177/09544119241272839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
The conical stem tibial design of total ankle replacement (TAR) has high implant-bone micromotion. This may lead to aseptic loosening which can be avoided by improving the tibial design. The objective was to propose the best stem design parameters to reduce implant-bone micromotion along with minimizing stress shielding using an integrated Finite Element-Multi Criteria Decision Making (FE-MCDM) approach. FE models of implanted tibia bones were prepared by changing the height of the stem, the diameter of the stem, and the slant of the stem. Weighted Aggregated Sum Product Assessment (WASPAS), Technique for Order of Preference by Similarities to Ideal Solution (TOPSIS), Evaluation based on Distance from Average Solution (EDAS), and VIseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) MCDM techniques with equal weights for micromotion and stress shielding were considered. The micromotion and stress shielding were greater when the height of the stem was increased. Whereas, the increase in diameter and slant affected them marginally. The best-performing design was the Model with stem height 6 mm (diameter 6.4 mm and slant 4°) and after that was the Model with stem height 8 mm (diameter 6.4 mm and slant 4°), and then the Model with stem height 10 mm (diameter 6.4 mm and slant 4°). The height of the stem is the most important stem design parameter. Shorter height, moderate thickness, and moderate slanting stem designs are recommended.
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Affiliation(s)
- Jyoti
- Biomechanics Research Laboratory, School of Mechanical and Materials Engineering, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, India
| | - Rajesh Ghosh
- Biomechanics Research Laboratory, School of Mechanical and Materials Engineering, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh, India
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Krishnapillai S, Joling B, Sierevelt IN, Kerkhoffs GMMJ, Haverkamp D, Hoornenborg D. Long-term Follow-up Results of Buechel-Pappas Ankle Arthroplasty. Foot Ankle Int 2019; 40:553-561. [PMID: 30700155 DOI: 10.1177/1071100719828379] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle replacement (TAR) is gaining popularity as a treatment option for ankle osteoarthritis. Long-term implant survival is a critical outcome to determine the success of the TAR implant. The Buechel-Pappas (BP) implant is a second-generation mobile bearing implant. The aim of this study was to analyze the BP implant survivorship at 10-year follow-up, make a subanalysis between patient groups, and evaluate long-term functional outcomes. METHODS Data of 86 patients who received 101 BP implants between 1993 and 2010 were obtained from a prospectively documented database. Subanalyses were done for patients diagnosed with inflammatory joint disease and noninflammatory joint disease, and patients with preoperative tibiotalar neutral and nonneutral alignment. A Kaplan-Meier curve was used for survival analysis. Long-term functional outcomes were assessed with the following patient-reported outcome measures: Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), Short Form-36 (SF-36) Stand Version 2.0 Health Survey and 3 anchor questions. RESULTS The survival rate of the BP implant at 10 years was 86% (95% confidence interval, 78%-93%). A total of 31 patients (36%) required 55 reoperations, and in 13 patients (15%) a revision procedure was performed. In this series, no significant difference in 10-year survival rate was found between neither the inflammatory joint disease and noninflammatory joint disease group ( P = .47), nor the tibiotalar neutral and nonneutral alignment group ( P = .16). At a mean follow-up of 16.8 years for 21 patients, the mean FAOS activities of daily living (ADL) and FAAM ADL subscale scores were 75/100 and 56/100 points. The mean physical component summary (PCS) and mental component summary (MCS) of the SF-36 were 34/100 and 51/100 points, respectively. CONCLUSION A survival rate of 86% was found at 10-year follow-up for the Buechel-Pappas implant. Our series demonstrated no significant difference in 10-year survival rates between the 2 patient subgroups. Long-term results of the various functional outcomes varied between poor and moderate. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Sajeeban Krishnapillai
- 1 Slotervaart Center of Orthopaedic Research & Education (SCORE), Department of Orthopaedic Surgery, MC Slotervaart, Amsterdam, the Netherlands
| | - Boudijn Joling
- 1 Slotervaart Center of Orthopaedic Research & Education (SCORE), Department of Orthopaedic Surgery, MC Slotervaart, Amsterdam, the Netherlands
| | - Inger N Sierevelt
- 1 Slotervaart Center of Orthopaedic Research & Education (SCORE), Department of Orthopaedic Surgery, MC Slotervaart, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- 2 Orthopaedic Research Centre Amsterdam, Department of Orthopaedic Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Daniël Haverkamp
- 1 Slotervaart Center of Orthopaedic Research & Education (SCORE), Department of Orthopaedic Surgery, MC Slotervaart, Amsterdam, the Netherlands
| | - Daniël Hoornenborg
- 1 Slotervaart Center of Orthopaedic Research & Education (SCORE), Department of Orthopaedic Surgery, MC Slotervaart, Amsterdam, the Netherlands
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Koivu H, Kohonen I, Mattila K, Loyttyniemi E, Tiusanen H. Medium to long-term results of 130 Ankle Evolutive System total ankle replacements-Inferior survival due to peri-implant osteolysis. Foot Ankle Surg 2017; 23:108-115. [PMID: 28578793 DOI: 10.1016/j.fas.2017.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 03/16/2017] [Accepted: 03/30/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The study reports the medium to long-term results of 130 Ankle Evolutive System total ankle replacements operated at a single-centre. Previously high amount of peri-implant osteolysis was reported from the same material. METHODS Between 2002 and 2008 one hundred and thirty consecutive ankles replaced with AES ankle prosthesis were followed both radiologically and clinically. RESULTS The five-year survival was 87.3% (95% confidence interval (CI) 80.0-92.0%), and ten-year survival 74.9% (95% confidence interval (CI) 65.4-82.2%) at a median follow-up time of 96 months (range 2-161; 8 years). Peri-implant osteolysis was found in 91 (70%) ankles, marked in 78 (60%). 44 ankles (34%) have been revised by filling of the cavities, 24 (18%) by fusion, and 6 by further replacement, resulting in the revision rate of 58%. Osteolysis was the main reason for all revisions. The improvement of the Kofoed Score and pain points was significant (all p<0.0001), and the subjective patient satisfaction was good. CONCLUSIONS Outcome of the current study was seriously affected by osteolysis and is inferior compared to previous reports.
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Affiliation(s)
- Helka Koivu
- Hospital Terveystalo Pulssi and University of Turku, Turku University Hospital, University of Turku, Turku, Finland.
| | - Ia Kohonen
- The Medical Imaging Centre of Southwest Finland, Turku University Hospital, University of Turku, Turku, Finland
| | - Kimmo Mattila
- The Medical Imaging Centre of Southwest Finland, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Hannu Tiusanen
- Department of Orthopaedics, Turku University Hospital,University of Turku, Turku, Finland
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Giannini S, Romagnoli M, Barbadoro P, Marcheggiani Muccioli GM, Cadossi M, Grassi A, Zaffagnini S. Results at a minimum follow-up of 5 years of a ligaments-compatible total ankle replacement design. Foot Ankle Surg 2017; 23:116-121. [PMID: 28578794 DOI: 10.1016/j.fas.2017.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/19/2017] [Accepted: 03/21/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND A new design of 3-part ankle replacement was developed to achieve compatibility with the natural ligaments by allowing certain fibers to remain isometric during passive motion. METHODS We evaluate 75 ankle prostheses implanted from July 2003 to December 2008, at a mean follow-up 6.5±1.1years (range 5-9 years). The mean age at surgery was 62±13years (range 29-82). RESULTS The mean AOFAS scores achieved at pre-op and at last follow-up were respectively 37±5 (23-45) and 78±8 (64-98). (p<0.001). Clinical range of motion of the ankle measured by goniometer pre op was 1°±2 of dorsiflexion and 12°±4° of plantarflexion; at last follow-up range of motion increased to 6°±5° in dorsiflexion (p<0.01) and 18°±7° in plantarflexion (p<0.05). Radiographs showed no loosening and little signs of radiolucency. Two revisions necessitated component removal, neither for implant loosening. The overall survival rate was 97.3%. CONCLUSIONS Function and Range-of-motion showed significant improvements. These results demonstrate that ligaments-compatible shaped talar and tibial components, with a fully conforming interposed meniscal bearing, can provide satisfactory survival rates and clinical outcomes in the middle term.
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Affiliation(s)
- Sandro Giannini
- Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matteo Romagnoli
- Department of Orthopaedic Surgery, Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria, Italy.
| | - Paolo Barbadoro
- Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Matteo Cadossi
- Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Department of Orthopaedic Surgery, Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria, Italy
| | - Stefano Zaffagnini
- Department of Orthopaedic Surgery, Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria, Italy
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Sopher RS, Amis AA, Calder JD, Jeffers JRT. Total ankle replacement design and positioning affect implant-bone micromotion and bone strains. Med Eng Phys 2017; 42:80-90. [PMID: 28233732 PMCID: PMC5360194 DOI: 10.1016/j.medengphy.2017.01.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 01/12/2017] [Accepted: 01/31/2017] [Indexed: 11/20/2022]
Abstract
A finite element model was developed to calculate micromotion of ankle implants. Both optimally-positioned and malpositioned cases were considered. Fixation nearer to the joint line relying on plural pegs improved implant stability. Gaps between the implant and bone greatly increased micromotion and bone strains.
Implant loosening – commonly linked with elevated initial micromotion – is the primary indication for total ankle replacement (TAR) revision. Finite element modelling has not been used to assess micromotion of TAR implants; additionally, the biomechanical consequences of TAR malpositioning – previously linked with higher failure rates – remain unexplored. The aim of this study was to estimate implant-bone micromotion and peri-implant bone strains for optimally positioned and malpositioned TAR prostheses, and thereby identify fixation features and malpositioning scenarios increasing the risk of loosening. Finite element models simulating three of the most commonly used TAR devices (BOX®, Mobility® and Salto®) implanted into the tibia/talus and subjected to physiological loads were developed. Mobility and Salto demonstrated the largest micromotion of all tibial and talar components, respectively. Any malpositioning of the implant creating a gap between it and the bone resulted in a considerable increase in micromotion and bone strains. It was concluded that better primary stability can be achieved through fixation nearer to the joint line and/or while relying on more than a single peg. Incomplete seating on the bone may result in considerably elevated implant-bone micromotion and bone strains, thereby increasing the risk for TAR failure.
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Affiliation(s)
- Ran S Sopher
- Department of Mechanical Engineering, Imperial College London, 715 City & Guilds Building, South Kensington, London SW7 2AZ, UK
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, 715 City & Guilds Building, South Kensington, London SW7 2AZ, UK ; Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RP, UK
| | - James D Calder
- Department of Surgery & Cancer, Imperial College London, Charing Cross Hospital, London, W6 8RP, UK; Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ , UK
| | - Jonathan R T Jeffers
- Department of Mechanical Engineering, Imperial College London, 715 City & Guilds Building, South Kensington, London SW7 2AZ, UK .
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Kraal T, van der Heide HJL, van Poppel BJ, Fiocco M, Nelissen RGHH, Doets HC. Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease. Bone Joint J 2014; 95-B:1656-61. [PMID: 24293596 DOI: 10.1302/0301-620x.95b12.32146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Little is known about the long-term outcome of mobile-bearing total ankle replacement (TAR) in the treatment of end-stage arthritis of the ankle, and in particular for patients with inflammatory joint disease. The aim of this study was to assess the minimum ten-year outcome of TAR in this group of patients. We prospectively followed 76 patients (93 TARs) who underwent surgery between 1988 and 1999. No patients were lost to follow-up. At latest follow-up at a mean of 14.8 years (10.7 to 22.8), 30 patients (39 TARs) had died and the original TAR remained in situ in 28 patients (31 TARs). The cumulative incidence of failure at 15 years was 20% (95% confidence interval (CI) 11 to 28). The mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of the surviving patients at latest follow-up was 80.4 (95% CI 72 to 88). In total, 21 patients (23 TARs) underwent subsequent surgery: three implant exchanges, three bearing exchanges and 17 arthrodeses. Neither design of TAR described in this study, the LCS and the Buechel-Pappas, remains currently available. However, based both on this study and on other reports, we believe that TAR using current mobile-bearing designs for patients with end-stage arthritis of the ankle due to inflammatory joint disease remains justified.
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Affiliation(s)
- T Kraal
- Slotervaart Hospital, P.O. Box 90440, 1006 BK Amsterdam, the Netherlands
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The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review. BMC Musculoskelet Disord 2013; 14:306. [PMID: 24161014 PMCID: PMC4231459 DOI: 10.1186/1471-2474-14-306] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 09/19/2013] [Indexed: 12/02/2022] Open
Abstract
Background While arthrodesis is the standard treatment of a severely arthritic ankle joint, total ankle arthroplasty has become a popular alternative. This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis. Methods Studies were obtained from Pubmed, Embase and Web of Science (January 1980 – June 2011) and additional manual search. Inclusion criteria: original clinical study, > 5 rheumatoid arthritis (population), internal fixation arthrodesis or three-component mobile bearing prosthesis (intervention), ankle scoring system (outcome). The clinical outcome score, complication- and failure rates were extracted and the methodological quality of the studies was analysed. Results 17 observational studies of 868 citations were included. The effect size concerning total ankle arthroplasty ranged between 1.9 and 6.0, for arthrodesis the effect sizes were 4.0 and 4.7. Reoperation due to implant failure or reoperation due to non-union, was 11% and 12% for respectively total ankle arthroplasty and arthrodesis. The methodological quality of the studies was low (mean 6.4 out of a maximum of 14 points) and was lower for arthrodesis (mean 4.8) as compared to arthroplasty (mean 7.8) (p = 0.04). Conclusions 17 observational and no (randomized) controlled clinical trials are published on the effectiveness of arthroplasty or arthrodesis of the ankle in rheumatoid arthritis. Regardless of the methodological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other.
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8
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[Arthrodesis and endoprostheses of the ankle joint: indications, techniques and pitfalls]. Unfallchirurg 2013; 116:797-805. [PMID: 23979169 DOI: 10.1007/s00113-013-2386-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
If adequate conservative measures for the treatment of end-stage ankle osteoarthritis have failed, surgery may be taken into consideration. After exorbitant failure rates in the beginning of total ankle replacement, nowadays this kind of treatment has regained lot of interest and has become a viable alternative to ankle fusion. The correct indication and a precise explanation of the surgical procedure, outcomes and potential complications provide a solid base for future success.Currently, there is no doubt that total ankle replacement has become an important player in the treatment of symptomatic and debilitating end-stage ankle arthritis. With increasing number of patients who undergo total ankle replacement the experience with this kind of procedure increases too. As a consequence several surgeons have started to stretch indications favoring total ankle replacement. However, it must be mentioned here, despite progress in terms of improved anatomical and biomechanical understanding of the hindfoot and improved surgical techniques and instruments, total ankle replacement and ankle fusion remain challenging and difficult procedures. We provide a review article including an overview of the relevant techniques. This article should serve as rough guide for surgeons and help in decision-making regarding total ankle replacement and ankle fusion.
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Valderrabano V, Pagenstert GI, Müller AM, Paul J, Henninger HB, Barg A. Mobile- and fixed-bearing total ankle prostheses: is there really a difference? Foot Ankle Clin 2012; 17:565-85. [PMID: 23158371 DOI: 10.1016/j.fcl.2012.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Approximately 1% of the world's adult population is affected by ankle osteoarthritis (OA). Therapeutic options include conservative and surgical measures. Because of substantial progress in total ankle replacement, ankle fusion is no longer the "gold standard" therapy for end-stage ankle OA. Various ankle prostheses have been designed and are currently available. This article reviews the in vitro studies addressing the biomechanics and kinematics of the replaced ankle. Furthermore, a systematic literature review was conducted to assess possible differences in clinical outcomes, including prosthesis survivorship and postoperative range of motion between mobile- and fixed-bearing total ankle prostheses.
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Affiliation(s)
- Victor Valderrabano
- Orthopaedic Department, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel CH-4031, Switzerland.
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Barg A, Knupp M, Henninger HB, Zwicky L, Hintermann B. Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls. Foot Ankle Clin 2012; 17:607-35. [PMID: 23158373 DOI: 10.1016/j.fcl.2012.08.006] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Total ankle replacement (TAR) has become a valuable treatment option in patients with end-stage ankle osteoarthritis. One popular 3-component system, the HINTEGRA TAR, is an unconstrained system that provides inversion-eversion stability. More natural biomechanics of the replaced ankle may be expected when anatomic considerations drive prosthesis design. The HINTEGRA prosthesis includes 2 anatomically contoured metal components and a polyethylene insert, providing axial rotation and physiologic flexion-extension mobility. This article describes the HINTEGRA TAR design and surgical technique. Use of the prosthesis for complex hindfoot reconstruction in patients with an osteoarthritic, varus, or valgus ankle deformity is described.
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Affiliation(s)
- Alexej Barg
- Clinic of Orthopaedic Surgery, Kantonsspital Liestal, Rheinstrasse 26, Liestal CH-4410, Switzerland,
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Barg A, Pagenstert GI, Leumann AG, Müller AM, Henninger HB, Valderrabano V. Treatment of the arthritic valgus ankle. Foot Ankle Clin 2012; 17:647-63. [PMID: 23158375 DOI: 10.1016/j.fcl.2012.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The ankle joint is part of a biomechanical hindfoot complex. Approximately 1% of the world's adult population is affected by ankle osteoarthritis (AO). Trauma is the primary cause of ankle OA, often resulting in varus or valgus deformities. Only 50% of patients with end-stage ankle OA have a normal hindfoot alignment. The biomechanics and morphology of the arthritic valgus ankle is reviewed in this article and therapeutic strategies, including joint preserving and nonpreserving modalities are presented. Pitfalls are discussed and the literature is reviewed regarding outcomes in patients with valgus deformity who underwent total ankle replacement.
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Affiliation(s)
- Alexej Barg
- Orthopaedic Department, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel CH-4031, Switzerland.
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Abstract
Rheumatoid arthritis is an autoimmune disease that may affect multiple joints, both small and large, and leads to numerous complications. The standard surgical treatment for a rheumatoid arthritic ankle has been an arthrodesis. The ideal candidate for an ankle replacement in a rheumatoid patient is one who is moderately active, has a well-aligned ankle and heel, and a fair range of motion in the ankle joint. Good surgical technique and correction of any hindfoot deformity will result in satisfactory alignment of the ankle with regard to the mechanical axis, and this will lead to increased prosthetic longevity.
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Affiliation(s)
- Sean Y C Ng
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital La Tour, Geneva, Switzerland
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Clement ND, Breusch SJ, Biant LC. Lower limb joint replacement in rheumatoid arthritis. J Orthop Surg Res 2012; 7:27. [PMID: 22697352 PMCID: PMC3411461 DOI: 10.1186/1749-799x-7-27] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 06/14/2012] [Indexed: 11/15/2022] Open
Abstract
Introduction There is limited literature regarding the peri-operative and surgical management of patients with rheumatoid disease undergoing lower limb arthroplasty. This review article summarises factors involved in the peri-operative management of major lower limb arthroplasty surgery for patients with rheumatoid arthritis. Methods We performed a search of the medical literature, using the PubMed search engine (http://www.pubmed.gov). We used the following terms: ‘rheumatoid’ ‘replacement’ ‘arthroplasty’ and ‘outcome’. Findings The patient should be optimised pre-operatively using a multidisciplinary approach. The continued use of methotrexate does not increase infection risk, and aids recovery. Biologic agents should be stopped pre-operatively due the increased infection rate. Patients should be made aware of the increased risk of infection and periprosthetic fracture rates associated with their disease. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR) and total knee replacement (TKR) have superior survival rates over uncemented components. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. Patella resurfacing as part of a TKR is associated with improved outcomes. The results of total ankle replacement remain inferior to THR and TKR. RA patients achieve equivalent pain relief, but their rehabilitation is slower and their functional outcome is not as good. However, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimise their outcome.
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Affiliation(s)
- Nicholas D Clement
- Orthopaedic Research Fellow, Royal Infirmary of Edinburgh, Little France EH16 4SA, UK.
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14
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Hintermann B, Knupp M, Zwicky L, Barg A. Total ankle replacement for treatment of end-stage osteoarthritis in elderly patients. J Aging Res 2012; 2012:345237. [PMID: 22720158 PMCID: PMC3375014 DOI: 10.1155/2012/345237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/19/2012] [Indexed: 01/05/2023] Open
Abstract
End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands.
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Affiliation(s)
| | | | | | - Alexej Barg
- Clinic of Orthopaedic Surgery, Kantonsspital Liestal, 4410 Liestal, Switzerland
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16
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Henricson A, Carlsson A, Rydholm U. What is a revision of total ankle replacement? Foot Ankle Surg 2011; 17:99-102. [PMID: 21783065 DOI: 10.1016/j.fas.2010.02.007] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 02/12/2010] [Indexed: 02/04/2023]
Affiliation(s)
- Anders Henricson
- Dept Orthopedic Surg, Falu General Hospital, S-791 82 Falun, Sweden.
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17
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Giannini S, Romagnoli M, O'Connor JJ, Catani F, Nogarin L, Magnan B, Malerba F, Massari L, Guelfi M, Milano L, Volpe A, Rebeccato A, Leardini A. Early clinical results of the BOX ankle replacement are satisfactory: a multicenter feasibility study of 158 ankles. J Foot Ankle Surg 2011; 50:641-7. [PMID: 21840736 DOI: 10.1053/j.jfas.2011.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 05/06/2011] [Indexed: 02/03/2023]
Abstract
A new design for a 3-part ankle replacement was developed in an effort to achieve compatibility with the naturally occurring ligaments of the ankle by allowing certain fibers to remain isometric during passive motion. In order to test the design concept clinically, 158 prostheses were implanted in 156 patients within a 9-center trial and were followed up for a mean of 17 (range 6 to 48) months. The mean age at the time of surgery was 60.5 (range 29.7 to 82.5) years. Outcome measures included the American Orthopaedic Foot & Ankle Surgery hindfoot-ankle score and range of motion measured on lateral radiographs of the ankle. The preoperative American Orthopaedic Foot & Ankle Surgery score of 36.3 rose to 74.6, 78.6, 76.4, and 79.0, respectively, at 12, 24, 36, and 48 months. A significant correlation between meniscal bearing movement on the tibial component (mean 3.3 mm; range 2 to 11 mm) and range of flexion at the replaced ankle (mean 26.5°; range 14° to 53°) was observed in radiograms at extreme flexions. Two (1.3%) revisions in the second and third postoperative years necessitated component removal (neither were for implant failure), and 7 (4.4%) further secondary operations were required. The results of this investigation demonstrated that non-anatomic-shaped talar and tibial components, with a fully conforming interposed meniscal bearing, can provide safety and efficacy in the short term, although a longer follow-up period is required to more thoroughly evaluate this ankle implant.
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Affiliation(s)
- Sandro Giannini
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
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McKinley JC, Shortt N, Arthur C, Gunner C, MacDonald D, Breusch SJ. Outcomes following pantalar arthrodesis in rheumatoid arthritis. Foot Ankle Int 2011; 32:681-5. [PMID: 21972762 DOI: 10.3113/fai.2011.0681] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We report a consecutive series of pantalar arthrodeses in patients with rheumatoid arthritis, using a single laterally based incision and autologous bone graft. MATERIALS AND METHODS All operations were performed by a single surgeon and were assessed preoperatively and at 6 and 12 months postoperatively. The levels of patient satisfaction, functional improvement and pain scores of the foot following surgery were recorded along with radiological parameters. Seventeen patients (two male and 15 female) underwent 18 hindfoot surgeries and were assessed preoperatively using the SF-12 General Health survey questionnaire, Manchester-Oxford Foot Survey and pain scores. RESULTS We found a significant improvement in pain levels and SF-12 scores. In addition the patients reported a high level of satisfaction with the outcome of surgery and improvement in function. CONCLUSION The results show that pantalar arthrodesis is a very effective operative treatment for severe ankle and concomitant hindfoot disease. The treatment period is prolonged and patients should be counselled appropriately. LEVEL OF EVIDENCE IV, Retrospective Case Series
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Kokkonen A, Ikävalko M, Tiihonen R, Kautiainen H, Belt EA. High rate of osteolytic lesions in medium-term followup after the AES total ankle replacement. Foot Ankle Int 2011; 32:168-75. [PMID: 21288417 DOI: 10.3113/fai.2011.0168] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Some previous studies have shown a high percentage of early-onset and rapidly progressing osteolysis associated with total ankle arthroplasty (TAA) by the Ankle Evolutive System (AES). The purpose of our study was to analyze medium-term results at our institution. MATERIALS AND METHODS Altogether 38 TAAs using AES prostheses were carried out between 2003 and 2007. Diagnoses were rheumatoid arthritis (71%), post-traumatic and idiopathic osteoarthritis (29%). The mean age was 54 years, followup 28 months. Tibial and talar components had hydroxyapatite coating on metal (Co-Cr) components (HA-coated). Since 2005 the design was changed and components were porous coated with titanium and hydroxyapatite (dual-coated). RESULTS Two-year survival was 79% (95% CI: 56 to 98). At followup 34 (89%) primary tibial and talar components were preserved. In 19 (50%) TAAs osteolysis (more than or equal to 2 mm) occurred in the periprosthetic bone area and in nine (24%) comprised large "cyst-like osteolysis''. In HA-coated prostheses radiolucent lines (less than or equal to 2 mm) or osteolysis (more than or equal to 2 mm) were detected in 11 (100%) cases and in dual-coated prostheses in 19 (74%) (p = 0.08). On the other hand there was more large "cyst-like osteolysis'' around the dual-coated prosthesis and lesions were larger (p = 0.017). In rheumatoid arthritis osteolysis was detected in 14 (52%) and large "cyst-like osteolysis'' in seven (26%) prostheses and in the group of traumatic and idiopathic osteoarthritis in six (55%) and two (18%), respectively. CONCLUSION This study showed a high frequency of osteolysis in medium-term followup after the AES ankle replacement. The outcome was not sufficiently beneficial and we have discontinued use of this prosthesis.
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Affiliation(s)
- Ari Kokkonen
- Department of Orthopaedics, Rheumatism Foundation Hospital, FIN-18120 Heinola, Finland.
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Giannini S, Romagnoli M, O’Connor JJ, Malerba F, Leardini A. Total ankle replacement compatible with ligament function produces mobility, good clinical scores, and low complication rates: an early clinical assessment. Clin Orthop Relat Res 2010; 468:2746-53. [PMID: 20559763 PMCID: PMC3049631 DOI: 10.1007/s11999-010-1432-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 06/04/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND A three-part ankle replacement was developed to achieve compatibility with the natural ligaments by allowing fibers on the medial and lateral sides to remain isometric during passive motion. Unlike all current prostheses, the new design uses nonanatomically shaped components on the tibia and talus and a fully conforming interposed meniscal bearing. QUESTIONS/PURPOSES Does this new design restore ankle mobility, improve clinical score, and result in low complication and early revision rates? PATIENTS AND METHODS We reviewed 51 patients in whom 51 prostheses were implanted in a seven-center trial from July 2003 to July 2006. The mean age of the patients at surgery was 61.5 years (range, 35.1-82.5 years). We used the AOFAS score to assess clinical outcome. We used lateral radiographs to assess function. The minimum followup was 24 months (mean, 30 months; range, 24-48 months). RESULTS The mean preoperative AOFAS score of 38.5 increased to 76.9, 79.1, 76.4, and 79.0 at 12, 24, 36, and 48 months, respectively. We observed a correlation between meniscal bearing movement on the tibial component (mean, 3.4 mm; range, 2-12 mm) and range of flexion at the replaced ankle (mean, 27.4º; range, 16º-53º). We revised one arthroplasty in the second postoperative year for lateral impingement, providing a 3-year cumulative survival rate of 97% and performed one other secondary operation for hindfoot pain. CONCLUSIONS These data suggest the new prosthesis can provide short-term restoration of ankle mobility, a good clinical score, and low complication and failure rates. Longer followup with larger numbers is required. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sandro Giannini
- Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Matteo Romagnoli
- Department of Orthopaedic Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - John J. O’Connor
- Department of Engineering Science, University of Oxford, Oxford, UK
| | | | - Alberto Leardini
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
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The AES total ankle replacement: A mid-term analysis of 93 cases. Foot Ankle Surg 2010; 16:61-4. [PMID: 20483135 DOI: 10.1016/j.fas.2009.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 06/01/2009] [Accepted: 06/21/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are few studies concerning specific total ankle arthroplasties. This study reports mid-term survival data for the AES prosthesis. METHODS Ninety-three AES ankle arthroplasties were performed by the senior authors. The mean follow-up was 3.5 years. The 5-year survivorship and also the number of simultaneous procedures, reoperations, additional procedures and revisions are analyzed. RESULTS The 5-year survivorship with revision for any reason as end-point was 90%. Simultaneous procedures were performed in 25 patients, deltoid release and subtalar fusion being the most common. There were seven revisions, one due to loosening, and two due to infection, instability and fractures, respectively. Twenty-seven reoperations or additional procedures were performed in 23 patients with a procedure for malleolar impingement being the most common reoperation, and correction of hindfoot varus being the most common reason for an additional procedure. CONCLUSIONS The AES total ankle replacement seems to be a reasonably safe procedure in experienced hands.
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Abstract
Total ankle replacement in the rheumatoid patient is a feasible and effective treatment for ankle arthritis. The benefits of ankle prosthesis are good pain relief, acceptable function, and patient satisfaction. It is a joint-sparing procedure for restoring functionality. All investigators of total ankle replacement feel that, as clinicians gain experience with the procedure and related products, difficulties and risks associated with the procedure will decline. Following an early history of failure and poor patient satisfaction, more recent results have shown promise.
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Goldberg AJ, Sharp RJ, Cooke P. Ankle replacement: current practice of foot & ankle surgeons in the United kingdom. Foot Ankle Int 2009; 30:950-4. [PMID: 19796588 DOI: 10.3113/fai.2009.0950] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The main surgical treatments for end stage ankle arthritis are arthrodesis and total ankle replacement (TAR). In Europe, there are now more than 11 different prostheses, most with limited outcome data. This study aimed to determine the number and types of implants used in the United Kingdom. MATERIALS AND METHODS A questionnaire based survey was sent to all Consultant members of the British Orthopaedic Foot & Ankle Society (n = 180). RESULTS Sixty-eight percent completed the questionnaires. Thirty percent of respondents were not performing ankle joint replacements at the time of the survey. The mode number of ankle replacements carried out per year by Foot and Ankle Specialists was eight. CONCLUSION The UK has a population of 60 million and surgeons are implanting at least 800 ankle replacements per year. More surgeons are beginning to perform ankle replacements in small numbers and a UK National Joint Registry for Ankle Replacements is in development. Currently, none of the fixed bearing implants being used in the United States are being used in the United Kingdom and although the number of ankle replacements implanted in the United States is unknown, it is predicted that this type of surgery could have a significant impact on insurers and healthcare providers in the future.
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Affiliation(s)
- Andrew J Goldberg
- The Nuffield Orthopaedic Centre, Department of Foot & Ankle Surgery, Windmill Road, Oxford OX3 7LD, United Kingdom.
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Goldberg AJ, Sharp B, Cooke P. Early failure in total ankle replacements due to component malposition: a report of two cases. Foot Ankle Int 2009; 30:783-7. [PMID: 19735637 DOI: 10.3113/fai.2009.0783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Andrew J Goldberg
- The Nuffield Orthopaedic Centre, Department of Foot & Ankle Surgery, Windmill Road, Oxford, OX3 7LD, United Kingdom.
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Abstract
Treatment of the arthritic varus ankle presents a significant surgical challenge. The recognition of the causes and associated deformities directs the treatment of the individual patient and optimizes functional outcome. Arthrodesis and total ankle replacement often will need to be augmented by corrective hind- and midfoot procedures and by careful soft tissue balancing. Often multiple procedures are required to achieve the desired result, and patients need to be advised that surgery may need to be staged.
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