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Mazzotti A, Zielli SO, Arceri A, Artioli E, Langone L, Sgubbi F, Geraci G, Faldini C. Accuracy of patient-specific instrumentation for implant positioning in custom-made total ankle arthroplasty. J Exp Orthop 2024; 11:e12026. [PMID: 39072244 PMCID: PMC11272990 DOI: 10.1002/jeo2.12026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose This retrospective radiological analysis aimed to assess the accuracy of implant positioning in patients with ankle arthritis undergoing custom-made total ankle arthroplasty (TAA) with patient-specific instrumentation (PSI) compared with preoperative planning. Methods Patients who underwent custom-made TAA with PSI from January 2018 to March 2023 were retrospectively evaluated, focusing on the tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle and tibiotalar ratio (TTR). Additionally, data regarding the time from the preoperative computed tomography (CT) scan to surgery, associated procedures and complications were recorded. Results No associated procedures were performed, and only one intraoperative complication, an iatrogenic lateral malleolar fracture, was recorded. In the coronal plane, custom-made TAA with PSI consistently achieved precise positioning of prosthetic components, even in cases with significant preoperative deformities or bone deficits. However, a statistically significant deviation from the planned values was observed in the sagittal plane (p = 0.007). A notable correlation was identified between the time elapsed from the preoperative CT scan to surgery and the deviation from the planned to the actual postoperative TAS angle (p < 0.001). Conclusion This study underscores the efficacy of PSI systems in achieving precise positioning in the coronal plane, in accordance with preoperative planning. In contrast, sagittal plane positioning did not demonstrate the same level of accuracy, as evidenced by a statistically significant difference between the planned and postoperative TLS values. Nevertheless, all measurements remained within the recommended range according to the existing literature. Level of Evidence Level IV.
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Affiliation(s)
- Antonio Mazzotti
- IRCCS Istituto Ortopedico Rizzoli1st Orthopaedics and Traumatologic ClinicBolognaItaly
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Simone Ottavio Zielli
- IRCCS Istituto Ortopedico Rizzoli1st Orthopaedics and Traumatologic ClinicBolognaItaly
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Alberto Arceri
- IRCCS Istituto Ortopedico Rizzoli1st Orthopaedics and Traumatologic ClinicBolognaItaly
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Elena Artioli
- IRCCS Istituto Ortopedico Rizzoli1st Orthopaedics and Traumatologic ClinicBolognaItaly
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Laura Langone
- IRCCS Istituto Ortopedico Rizzoli1st Orthopaedics and Traumatologic ClinicBolognaItaly
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Federico Sgubbi
- IRCCS Istituto Ortopedico Rizzoli1st Orthopaedics and Traumatologic ClinicBolognaItaly
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Giuseppe Geraci
- IRCCS Istituto Ortopedico Rizzoli1st Orthopaedics and Traumatologic ClinicBolognaItaly
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Cesare Faldini
- IRCCS Istituto Ortopedico Rizzoli1st Orthopaedics and Traumatologic ClinicBolognaItaly
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
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Strydom A, Saragas NP, Ferrao PN. The use of a 3D printed titanium implant for arthrodesis in the management of large osseous defects in the ankle. Foot Ankle Surg 2023; 29:576-583. [PMID: 37833130 DOI: 10.1016/j.fas.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 05/01/2023] [Accepted: 05/13/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Large osseous defects (LOD) in the ankle occur because of multiple aetiologies. Advancement in 3-dimensional (3D) printing technologies has led to the use of custom implants and instrumentation their management. A 3D printed patient-specific porous titanium cage which allows for peripheral osteo-integration and autogenous bone-grafting could be an ideal implant in these cases. METHODS Retrospective review of a multi-centre, multi-surgeon consecutive cohort of patients requiring either TTC or AA for a large osseous defect between June 2019 - August 2020. A custom titanium prosthesis was 3D-printed according to CT measurements for implantation. RESULTS Mean follow up was 19.5 months (range 12-24 months). Plain radiographs and CT scans at 12 months confirmed osseointegration (stability) in 11of 13 patients (84%). Two patients developed late infection, one requiring revision surgery. CONCLUSIONS 3D-Printed titanium implants in the management of LODs in the ankle offer a comparable success rate to other reported procedures, with unlimited geometric possibilities in the design allowing for accurate length correction. Their structural stability may offer an advantage over conventional bone graft techniques and limits the amount of bone-graft required. LEVELS OF EVIDENCE LOE III.
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Affiliation(s)
- Andrew Strydom
- Consultant Foot and Ankle Surgeon, Suite 3A, -2 Level, Westwing, Netcare Sunninghill Hospital, Cnr Nanyuki & Witkoppen Road, Sunninghill, 2157, South Africa.
| | - Nikiforos P Saragas
- The Orthopaedic Foot and Ankle Unit, Suite 303 Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, 2192, Johannesburg, South Africa; Honorary Adjunct Professor and Head, Foot and Ankle Unit, Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Paulo Nf Ferrao
- The Orthopaedic Foot and Ankle Unit, Suite 303 Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, 2192, Johannesburg, South Africa; Foot and Ankle Unit, Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Santini S, Alharbi W, Teoh KH, Herrera-Perez M, Valderrabano V. Hybrid-Total Ankle Arthroplasty (H-TAA) for Failed Talar Component in Mobile-Bearing Total Ankle Arthroplasty. J Clin Med 2023; 12:1764. [PMID: 36902551 PMCID: PMC10003300 DOI: 10.3390/jcm12051764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Revision Total Ankle Arthroplasty (TAA) surgery due to TAA aseptic loosening is increasing. It is possible to exchange the talar component and inlay to another system for isolated talar component loosening in a primary mobile-bearing TAA: Hybrid-Total Ankle Arthroplasty (H-TAA). The purpose of this study was to analyze the results of the revision surgery of an isolated aseptic talar component loosening in a mobile-bearing three-component TAA with a H-TAA solution. METHODS In this prospective case study, nine patients (six women, three men; mean age 59.8 years; range 41-80 years) with symptomatic isolated aseptic loosening of the talar component of a mobile-bearing TAA were treated with an isolated talar component and inlay substitution. In all nine cases, a hybrid TAA revision surgery was performed by implanting a VANTAGE TAA talar and insert component (Flatcut talar component: six cases, standard talar component: three cases). The patients were reviewed with the pain score (VAS Pain Score 0-10), Dorsiflexion/Plantarflexion (DF/PF) Range of Motion (ROM; degrees), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0-100 points), Sports Frequency Score (Level 0-4), and subjective Patients' Satisfaction Score (0-10 points). RESULTS The average Pain score improved significantly from preoperative 6.7 points to postoperative 1.1 points (p < 0.001). Average Dorsiflexion/Plantarflexion ROM values increased significantly post-surgery: 21.7° preoperative to 45.6° postoperative (p < 0.001). The postoperative AOFAS scores were significantly greater than the preoperative values: 47.7 points preoperative, 92.3 points postoperative (p < 0.001). The sports activity improved from preoperative to postoperative where, preoperative, none of the patients were able to perform sports. Postoperative, eight patients were able to be sports-active again. The overall average postoperative level of sports activity was 1.4. The postoperative average patient's satisfaction was 9.3 points. CONCLUSIONS In painful talar component aseptic loosening of a three-component mobile-bearing TAA, H-TAA is a good surgical solution for reducing pain, restoring ankle function, and improving patients' life quality.
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Affiliation(s)
- Simone Santini
- Department of Orthopaedic and Trauma Surgery, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Waheeb Alharbi
- King Fahad Armed Forces Hospital, Al Kurnaysh Rd, Al Andalus, Jeddah 23311, Saudi Arabia
| | - Kar Hao Teoh
- Princess Alexandra Hospital NHS Trust, Harlow CM20 1QX, UK
| | - Mario Herrera-Perez
- Head Foot and Ankle Unit, Orthopaedic Department, Universidad de La Laguna, 38200 San Cristóbal de La Laguna, Spain
| | - Victor Valderrabano
- Swiss Ortho Center, Swiss Medical Network, Schmerzklinik Basel, Hirschgässlein 15, 4010 Basel, Switzerland
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Hur ES, Mehta N, Lee S, Bohl DD. Management of Periprosthetic Bone Cysts After Total Ankle Arthroplasty. Orthop Clin North Am 2023; 54:109-119. [PMID: 36402507 DOI: 10.1016/j.ocl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Modern improvements in total ankle arthroplasty (TAA) have increased the performance of this procedure for treatment of end-stage ankle arthritis. A common finding after TAA is the formation of periprosthetic bone cysts, which can be clinically silent or result in TAA failure. The exact cause of periprosthetic bones cysts has not been established, but major theories are related to osteolysis secondary to implant wear, micromotion, and stress shielding. Treatment can be nonoperative with clinical observation for small, asymptomatic cysts. Large, progressive, and symptomatic cysts often merit surgical treatment with debridement and grafting, revision TAA, or salvage arthrodesis.
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Affiliation(s)
- Edward S Hur
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Simon Lee
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Daniel D Bohl
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA.
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5
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Doyle MD, Ishibashi MA, Sherick RM, Mitchell LH, Castellucci-Garza FM, Rao NM. Outcomes and Complications of the INFINITY Total Ankle: A Systematic Review. Foot Ankle Spec 2022:19386400221079491. [PMID: 35189714 DOI: 10.1177/19386400221079491] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, California
| | - Megan A Ishibashi
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Foundation Hospitals, Oakland, California
| | - Ryan M Sherick
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, California
| | - Logan H Mitchell
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Foundation Hospitals, Oakland, California
| | - Francesca M Castellucci-Garza
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospitals, Antioch, California
| | - Nilin M Rao
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, California
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Henry JK, Rider C, Cody E, Ellis SJ, Demetracopoulos C. Evaluating and Managing the Painful Total Ankle Replacement. Foot Ankle Int 2021; 42:1347-1361. [PMID: 34315246 DOI: 10.1177/10711007211027273] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation.Level of Evidence: Level V, expert opinion or review.
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Mehta N, Serino J, Hur ES, Smith S, Hamid KS, Lee S, Bohl DD. Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty. Foot Ankle Int 2021; 42:230-242. [PMID: 33345610 DOI: 10.1177/1071100720978426] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Periprosthetic osteolysis is a common occurrence after total ankle arthroplasty (TAA) and poses many challenges for the foot and ankle surgeon. Osteolysis may be asymptomatic and remain benign, or it may lead to component instability and require revision or arthrodesis. In this article, we present a current and comprehensive review of osteolysis in TAA with illustrative cases. We examine the basic science principles behind the etiology of osteolysis, discuss the workup of a patient with suspected osteolysis, and present a review of the evidence of various management strategies, including grafting of cysts, revision TAA, and arthrodesis.Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Nabil Mehta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Edward S Hur
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shelby Smith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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8
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Zhao D, Huang D, Zhang G, Wang X, Zhang T, Ma X. Positive and negative factors for the treatment outcomes following total ankle arthroplasty? A systematic review. Foot Ankle Surg 2020; 26:1-13. [PMID: 30598423 DOI: 10.1016/j.fas.2018.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/22/2018] [Accepted: 12/11/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patient selection, surgeon's experience and implant design play an integral role and affect the treatment outcomes of total ankle arthroplasty (TAA). The aims of this study were to investigate the positive and negative attributes that correlate with different clinical and radiographic outcomes. METHODS Eight-nine studies matched the inclusion criteria: (1) studies of primary TAA with uncemented prosthesis; (2) mean follow-up of no less than 2-year; (3) reports of clinical and radiographic outcomes, and exclusion criteria: (1) non-English study; (2) more than one type of prosthesis without separated data; (3) kin studies with shorter follow-up or smaller cohort. Age, etiology, preoperative deformity, surgeon's experience, follow-up duration and prosthetic type were studied with respect to different outcomes by mixed-effects logistic regression analysis. RESULTS Patients factor: older patients reported less pain or stiffness and demonstrated less radiographic loosening which did not require additional surgical intervention. More traumatic arthritis experienced adjacent joints degeneration after TAA. Surgeon factor: less experienced surgeons had more intraoperative complications. Lack of experience for complications management without implant retrieval during early period might result in more revisions or fusion was done. Prosthetic factor: updated instrumentation decreased malalignment. If the polyethylene (PE) insert was significantly narrower than the metal components more implant instability and subsequent severe particulate wear was seen. Designs with flat-on-flat articulation and ridge at the center of the talar component associated with more PE fracture. Minimal bone resection reduced postoperative fractures. A flat cut of the tibial component and a flat undersurface with press-fit by two screws or pegs of the talar component demonstrated less postoperative fractures, whereas a syndesmosis fusion and a small triangular shape with one central fin of the talar component experienced more loosening which did not require additional surgery. Anatomic conical shape of the talar component seemed to reduce adjacent joint degeneration. Finally, fewer failures were found in patients who received HINTEGRA and Salto Talaris. CONCLUSIONS Based on our investigation, some positive and negative factors for different clinical and radiographic outcomes were found, which should be taken into consideration in clinical practice and ankle implant design.
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Affiliation(s)
- Dahang Zhao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
| | - Dichao Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China; Department of Traumatic Orthopaedics, Ningbo No.6 Hospital, Zhengjiang, China.
| | - Gonghao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
| | - Tiansong Zhang
- Department of TCM, Jing'an District Center Hospital, Shanghai, China.
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
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Abstract
RECOMMENDATION We recommend that intraoperative cultures be taken during revision total ankle arthroplasty (TAA). The result of intraoperative cultures should be interpreted together with clinical suspicion for infection and the results of the laboratory and imaging investigations. We also recommend that multiple tissue specimens be collected. Given a lack of evidence for routine intraoperative cultures for revision TAA literature, this recommendation is based on analogous evidence in the total hip and knee replacement literature. LEVEL OF EVIDENCE Consensus. DELEGATE VOTE Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).
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10
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Sun Z, Li N, Zhang T, Xin J, Ma X. [Progress of total ankle arthroplasty for end-stage ankle osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1313-1316. [PMID: 30215493 DOI: 10.7507/1002-1892.201803028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the progress of total ankle arthroplasty (TAA) in treatment of end-stage ankle osteoarthritis (AOA). Methods The domestic and foreign literatures about TAA in recent years were reviewed. The current status and progress of TAA were summarized from the results of traditional and computer-assisted TAA clinical outcomes. Results End-stage AOA often leads to severe pain and dysfunction, and arthrodesis is still the main selective treatment option. In recent years, with the advancement of surgical techniques and prosthesis design, TAA which can remain joint mobility has increased gradually, and the surgical results also have significant progress. Accurate prosthesis implant and mechanical alignment restoration are critical factors for TAA, and surgery-related malalignment is correlative to the prosthesis failure. Computer assisted patient-specific guide can simplify the TAA procedures and obtain the accuracy of tibia and talus osteotomy. Conclusion The clinical efficiency of preoperative CT based patient-specific guide technology for TAA needs further clinical follow-up. Meanwhile, it is necessary to further develop intraoperative navigation and robotic surgery system suitable for TAA.
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Affiliation(s)
- Zhenhui Sun
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
| | - Nan Li
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
| | - Tao Zhang
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
| | - Jingyi Xin
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
| | - Xinlong Ma
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China[]
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Law TY, Sabeh KG, Rosas S, Hubbard Z, Altajar S, Roche MW. Trends in total ankle arthroplasty and revisions in the Medicare database. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:112. [PMID: 29955572 DOI: 10.21037/atm.2018.02.06] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background High failure rates and unacceptable patient outcomes have kept total ankle arthroplasty (TAA) from becoming a favorable treatment option. Modern prosthetic designs and techniques have improved outcomes and decreased revision rates. Current literature has not adequately investigated the recent trends in TAA utilization and revision rate. The purpose of this study was to determine the trends in TAA utilization and the rate of revision TAA by analyzing a comprehensive Medicare database for procedures performed between 2005 and 2012. Methods A retrospective review of a comprehensive Medicare database within the PearlDiver Supercomputer application (Warsaw, IN) of the index procedures TAA and revision TAA was conducted. Patients who underwent TAA and revision TAA were identified by Current Procedural Terminology (CPT)-27702, 27703, and International Classification of Disease ninth revision (ICD) codes 81.56, 81.59 respectively. The primary outcomes of this study were annual revision incidence and TAA annual utilization. Demographic data such as age, gender, and geographical location of patients were also examined. Results Within our study period of 2005-2012 there was a reported total of 7,181 TAAs and 1,431 revision TAAs which is a revision incidence of 19.928% amongst the Medicare population. The compound annual growth rate (CAGR) was 16.37% for TAA, 7.74% for revision TAA, and a mean 7.41% annual revision incidence. Amongst females there were 3,568 TAA and 731 revision TAA compared with 3,336 TAA and 613 revision TAA amongst males. The greatest amount of TAA and revision TAA were found in the 65-69 age group followed by the 70-74 age group. Regionally, the highest number of TAA and revision TAA were found in the South and the lowest in the Northeast. Conclusions Our analysis of the Medicare database shows that there is a high rate of annual growth in TAA utilization (16.37%) and revision TAA (7.74%) indicating that there is an increased demand for TAA in the Unites States. However, failed TAA can have serious consequence and revision TAA remains to have suboptimal results. This study highlights the recent trends in ankle arthroplasty and serves to increase awareness of this increasingly popular procedure.
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Affiliation(s)
- Tsun Yee Law
- Holy Cross Orthopedic Institute, 4595 North Dixie Highway, Fort Lauderdale, FL, USA
| | - Karim G Sabeh
- Department of Orthopaedic Surgery and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Samuel Rosas
- Holy Cross Orthopedic Institute, 4595 North Dixie Highway, Fort Lauderdale, FL, USA
| | - Zachary Hubbard
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sarah Altajar
- FIU Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Martin W Roche
- Holy Cross Orthopedic Institute, 4595 North Dixie Highway, Fort Lauderdale, FL, USA
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12
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Waly FJ, Yeo NE, Penner MJ. Computed Navigation Guidance for Ankle Replacement in the Setting of Ankle Deformity. Clin Podiatr Med Surg 2018; 35:85-94. [PMID: 29156170 DOI: 10.1016/j.cpm.2017.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Total ankle replacement (TAR) has evolved over the past decade as a treatment for end-stage ankle arthritis with improved survivorship. Despite the improving outcomes, ankle deformity represents a challenge to the foot and ankle surgeon with increased risk of implant failure. The use of preoperative computer-assisted guidance has led to better understanding the 3-dimensional ankle anatomy and associated deformities and allows for reproducible, anatomic placement of the TAR components.
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Affiliation(s)
- Feras J Waly
- Department of Orthopaedic Surgery, St Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; Department of Orthopedic Surgery, University of Tabuk, Tabuk 71491, Saudi Arabia.
| | - Nicholas E Yeo
- Department of Orthopaedic Surgery, St Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Murray J Penner
- Department of Orthopedic Surgery, University of British Columbia, 3114 - 910 West 10th Avenue, Vancouver, British Columbia V5Z 1M9, Canada
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13
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Abstract
With total ankle arthroplasty, documented complications can be categorized chronologically into intraoperative, postoperative, and late complications. Factors such as patient selection, surgeon experience, implant features, and prosthetic device selection can influence functional outcomes as well as incidence of complications. Even with impeccable surgical technique and optimal patient selection, complications that require revision may still arise and the most common complications with revision solutions are discussed in this article.
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Affiliation(s)
- Jerome K Steck
- Southern Arizona Orthopedics, 6567 East Carondolet Drive, Suite 415, Tucson, AZ 85710, USA.
| | - John M Schuberth
- Foot and Ankle Surgery, Department of Orthopedic Surgery, Kaiser San Francisco Medical Center, Kaiser Foundation Hospital, French Campus, 450, 6th Avenue, San Francisco, CA 94118, USA
| | - Jeffrey C Christensen
- Podiatric Section, Department of Orthopedics, Swedish Medical Center, Seattle, WA, USA; Ankle & Foot Clinics Northwest, 3131 Nassau Street, Suite 101, Everett, WA 98201, USA
| | - Cynthia A Luu
- Tucson Medical Center, Midwestern University, 5301 East Grant Road, Tucson, AZ 85712, USA
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14
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Terrier A, Fernandes CS, Guillemin M, Crevoisier X. Fixed and mobile-bearing total ankle prostheses: Effect on tibial bone strain. Clin Biomech (Bristol, Avon) 2017; 48:57-62. [PMID: 28755611 DOI: 10.1016/j.clinbiomech.2017.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total ankle replacement is associated to a high revision rate. To improve implant survival, the potential advantage of prostheses with fixed bearing compared to mobile bearing is unclear. The objective of this study was to test the hypothesis that fixed and mobile bearing prostheses are associated with different biomechanical quantities typically associated to implant failure. METHODS With a validated finite element model, we compared three cases: a prosthesis with a fixed bearing, a prosthesis with a mobile bearing in a centered position, and a prosthesis with mobile bearing in an eccentric position. Both prostheses were obtained from the same manufacturer. They were tested on seven tibias with maximum axial compression force during walking. We tested the hypothesis that there was a difference of bone strain, bone-implant interfacial stress, and bone support between the three cases. We also evaluated, for the three cases, the correlations between bone support, bone strain and bone-implant interfacial stress. FINDINGS There were no statistically significant differences between the three cases. Overall, bone support was mainly trabecular, and less effective in the posterior side. Bone strain and bone-implant interfacial stress were strongly correlated to bone support. INTERPRETATIONS Even if slight differences are observed between fixed and mobile bearing, it is not enough to put forward the superiority of one of these implants regarding their reaction to axial compression. When associated to the published clinical results, our study provides no argument to warn surgeons against the use of two-components fixed bearing implants.
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Affiliation(s)
- Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland.
| | - Caroline Sieger Fernandes
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland
| | - Maïka Guillemin
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 9, 1015 Lausanne, Switzerland
| | - Xavier Crevoisier
- Service of Orthopaedics and Traumatology, University Hospital Center and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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15
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Abstract
Component subsidence has been found to be the top complication that leads to failure of the total ankle arthroplasty (TAA). The cause of subsidence formation is unclear, and is multifactorial. Talar subsidence is more frequently met than tibial subsidence, and the subsequent big bone loss is demanding to handle. As a revision treatment option, neither a revision TAA nor a salvage ankle and/or hindfoot arthrodesis procedure is easy to perform or can obtain a definite outcome. The Salto XT can be used to treat most of the TAA systems available for use in the United States with acceptable short-term outcomes.
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Affiliation(s)
- Shu-Yuan Li
- The Foot and Ankle Association, Inc., 1209 Harbor Island Walk, Baltimore, MD 21230, USA.
| | - Mark S Myerson
- The Foot and Ankle Association, Inc., 1209 Harbor Island Walk, Baltimore, MD 21230, USA
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16
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Abstract
UNLABELLED Gutter pain and impingement are recognized entities following total ankle arthroplasty (TAA). However, little concrete information is available in the existing literature regarding the etiology, potentiating factors, treatment and prevention of gutter disease. This comprehensive monograph discusses this problem in expansive detail and provides insight to surgeons who perform TAA, such that these complications can be minimized in the future. LEVELS OF EVIDENCE Level V: Expert opinion.
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Affiliation(s)
- John M Schuberth
- Kaiser Foundation Hospital, San Francisco, California (JMS)Mid-Atlantic Permanente Medical Group, Greater Baltimore Medical Center, Lutherville, Maryland (DAW)Department of Orthopedics, Swedish Medical Center, Seattle, Washington (JCC)
| | - David A Wood
- Kaiser Foundation Hospital, San Francisco, California (JMS)Mid-Atlantic Permanente Medical Group, Greater Baltimore Medical Center, Lutherville, Maryland (DAW)Department of Orthopedics, Swedish Medical Center, Seattle, Washington (JCC)
| | - Jeffrey C Christensen
- Kaiser Foundation Hospital, San Francisco, California (JMS)Mid-Atlantic Permanente Medical Group, Greater Baltimore Medical Center, Lutherville, Maryland (DAW)Department of Orthopedics, Swedish Medical Center, Seattle, Washington (JCC)
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17
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Roukis TS, Simonson DC. Incidence of Complications During Initial Experience with Revision of the Agility and Agility LP Total Ankle Replacement Systems: A Single Surgeon's Learning Curve Experience. Clin Podiatr Med Surg 2015; 32:569-93. [PMID: 26407742 DOI: 10.1016/j.cpm.2015.06.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As the frequency in which foot and ankle surgeons are performing primary total ankle replacement (TAR) continues to build, revision TAR will likely become more commonplace, creating a need for an established benchmark by which to evaluate the safety of revision TAR as determined by the incidence of complications. Currently, no published data exist on the incidence of intraoperative and early postoperative complications during revision of the Agility or Agility LP Total Ankle Replacement Systems during the surgeon learning curve period; therefore, the authors sought to determine this incidence during the senior author's learning curve period.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
| | - Devin C Simonson
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA
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18
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Abstract
There is great potential of managing the complications of total ankle replacement arthroscopically and endoscopically, and these procedures can be summarized into 3 groups. Group 1 includes procedures of the ankle joint proper with close proximity to the articular components of the total ankle replacement. Group 2 includes procedures of the tibia and talus with close proximity to the nonarticular parts of the total ankle replacement. Group 3 includes procedures that are away from the total ankle replacement. However, these remain master arthroscopist procedures and should be performed by foot and ankle surgeons who perform them with regularity.
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19
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Roukis TS, Simonson DC. Management of Osseous and Soft-Tissue Ankle Equinus During Total Ankle Replacement. Clin Podiatr Med Surg 2015; 32:543-50. [PMID: 26407740 DOI: 10.1016/j.cpm.2015.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Obtaining functional alignment of a total ankle replacement, including physiologic sagittal plane range of motion, is paramount for a successful outcome. This article reviews the literature on techniques available for correction of osseous and soft-tissue equinus at the time of index total ankle replacement. These techniques include anterior tibiotalar joint cheilectomy, posterior superficial muscle compartment lengthening, posterior ankle capsule release, and release of the posterior portions of the medial and lateral collateral ligament complexes. The rationale for these procedures and the operative sequence of events for these procedures are presented.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
| | - Devin C Simonson
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA
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20
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Henricson A, Carlsson Å. Response to "Letter Regarding: Survival Analysis of the Single- and Double-Coated STAR Ankle up to 20 Years: Long-term Follow-up of 324 Cases From the Swedish Ankle Registry". Foot Ankle Int 2015; 36:1162. [PMID: 26429897 DOI: 10.1177/1071100715608778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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21
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Hsu AR, Davis WH, Cohen BE, Jones CP, Ellington JK, Anderson RB. Radiographic Outcomes of Preoperative CT Scan-Derived Patient-Specific Total Ankle Arthroplasty. Foot Ankle Int 2015; 36:1163-9. [PMID: 25941196 DOI: 10.1177/1071100715585561] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative computer navigation and patient-specific instrumentation have had promising results in total knee arthroplasty and in a previous cadaveric total ankle arthroplasty (TAA) study. Potential benefits of patient-specific guides include improved implant alignment and decreased surgical time. The purpose of this retrospective case series was to evaluate the accuracy, reproducibility, and limitations of TAA tibia and talar implant placement and radiographic alignment using preoperative computed tomography (CT) scan-derived instrumentation in a clinical setting. METHODS Between 2012 and 2014, 42 consecutive TAA cases in 42 patients using preoperative CT scan-derived patient-specific plans and guides (PROPHECY, Wright Medical Technology, Memphis TN) were reviewed from a single center of foot and ankle fellowship-trained orthopaedic surgeons. TAA implants used included 29 intramedullary referencing implants (INBONE II, Wright Medical Technology) and 13 low-profile tibia and talar resurfacing implants (Infinity, Wright Medical Technology). All patients had standardized preoperative CT scans before surgery that were used to create custom surgical plans and 3-dimensional solid cutting guides and models. All patients had a minimum 3-month follow-up with weightbearing postoperative radiographs. Patient demographics were recorded, and coronal and sagittal alignments were compared among weightbearing preoperative radiographs, CT scan-derived surgical plans, and weightbearing postoperative radiographs using a digital picture archiving and communication system. RESULTS Average age for all patients was 63 ± 9 years, with a body mass index of 29.8 ± 5.9. Average total surgical time for all TAAs was 100 ± 11 minutes, with Infinity TAAs taking less time than INBONE II TAAs (92 vs 104 minutes; P < .05). Average preoperative coronal alignment was 1.9 degrees varus ± 6.4 (range, 14 degrees valgus to 10 degrees varus). Postoperative weightbearing alignments for all TAA cases were within ±3° of the predicted coronal and sagittal alignments from the CT scan-derived surgical plans. There were no significant differences in pre- or postoperative weightbearing alignments between INBONE II and Infinity TAA cases. Neutral coronal and sagittal alignments were obtained for all TAA cases regardless of preoperative deformity. Patient-specific surgical plans were accurate to within 1 size for tibia and talar implants used. Surgical plans predicted the actual tibia implant size used in 100% of INBONE II cases and 92% of Infinity cases. Plans were less accurate for talar implants and predicted the actual talar implant size used in 76% of INBONE II cases and 46% of Infinity cases. In all cases of predicted tibia or talar size mismatch, surgical plans predicted 1 implant size larger than actually used. CONCLUSIONS Results from this study provide early clinical evidence that preoperative CT scan-derived patient-specific surgical plans and guides can help provide accurate and reproducible TAA radiographic alignments. Talar implant sizing was not as accurate due to individual surgeon preference regarding the extent of gutter debridement. Similar to other modern computer navigation and patient-specific instrumentation systems, final coronal and sagittal alignments were within 3 degrees of the predicted surgical plans, and sizing was accurate within 1 implant size. Future studies are warranted to investigate the clinical and functional implications of patient-specific TAA and the overall cost-effectiveness of this technique. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Andrew R Hsu
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
| | - W Hodges Davis
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
| | - Bruce E Cohen
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
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22
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Salvage of a Failed Agility Total Ankle Replacement System Associated with Acute Traumatic Periprosthetic Midfoot Fractures. Clin Podiatr Med Surg 2015; 32:609-16. [PMID: 26407744 DOI: 10.1016/j.cpm.2015.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article presents a rare case involving combined revision of a failed Agility Total Ankle Replacement System (DePuy Orthopaedics, Warsaw, Indiana) and open reduction with internal fixation of periprosthetic midfoot fractures secondary to acute traumatic injury. The rationale for these procedures, the operative sequence of events, and recovery course are presented in detail. Causes for concern regarding subsequent revision, should this be required, are raised.
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23
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Abstract
The Salto Talaris XT Revision Ankle Prosthesis is an anatomically designed fixed-bearing prosthesis available in the United States based on the design of previous Salto systems. The Salto Talaris XT Revision Ankle Prosthesis design optimizes surface area, cortical contact, and ultrahigh-molecular-weight polyethylene conformity. Two tibial component designs, both with the same base plate dimensions, are available, the standard conical fixation plug affixed to a short keel and a long-stemmed version. The author presents an overview of the Salto Talaris XT Revision Ankle Prosthesis surgical technique and pearls for successful application.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
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24
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Roukis TS. Management of Massive Hindfoot Osteolysis Secondary to Failed INBONE I Total Ankle Replacement. Clin Podiatr Med Surg 2015; 32:595-607. [PMID: 26407743 DOI: 10.1016/j.cpm.2015.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article presents a procedure whereby a failed INBONE I saddle talar component and polyethylene insert associated with massive cystic changes within the talus and calcaneus secondary to aseptic osteolysis was treated with impaction cancellous allograft bone graft impregnated with autogenous proximal tibia bone marrow aspirate and conversion to an INBONE II sulcus talar component and polyethylene insert. Concomitantly, a percutaneous tendo-Achilles lengthening and posterior capsule release was performed to enhance ankle dorsiflexion. The rationale for these procedures, the operative sequence of events, and recovery course are presented in detail. Causes for concern regarding subsequent revision, should this be required, are raised.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
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25
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Evaluation and management of the painful total ankle arthroplasty. J Am Acad Orthop Surg 2015; 23:272-82. [PMID: 25829450 DOI: 10.5435/jaaos-d-14-00017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 08/25/2014] [Indexed: 02/01/2023] Open
Abstract
Total ankle arthroplasty (TAA) is an increasingly popular treatment option for patients with end-stage ankle arthritis. Although improved short- and long-term clinical and radiographic outcomes have been achieved with TAA, revision surgery may be necessary in the setting of aseptic loosening, subsidence, impingement, arthrofibrosis, or infection. Factors such as patient selection, implant design, and surgical technique can all contribute to TAA failure. Treatment of patients with a painful TAA is complex and requires careful consideration of symptom history, workup, and nonsurgical and surgical treatment options. Surgical management of failed TAA includes arthrodesis, revision surgery, or below-knee amputation.
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26
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Roukis TS, Prissel MA. Revision of agility total ankle™ replacements using agility™ components is the right choice, sometimes. J Foot Ankle Surg 2014; 53:391-3. [PMID: 24656766 DOI: 10.1053/j.jfas.2014.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Thomas S Roukis
- Department of Orthopedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, Wisconsin
| | - Mark A Prissel
- Department of Orthopedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, Wisconsin
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27
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Prissel MA, Roukis TS. Management of extensive tibial osteolysis with the Agility™ total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. J Foot Ankle Surg 2014; 53:101-7. [PMID: 24370485 DOI: 10.1053/j.jfas.2013.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Indexed: 02/03/2023]
Abstract
Although total ankle replacement has endured improvement in implant design since its conception, failure requiring revision remains a known endpoint. We describe a technique for management of extensive tibial osteolysis for failed Agility™ total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. This technique provides immediate component stability and is a cost-effective alternate to impaction bone grafting. With this technique, the complications we have experienced have been limited to minor delayed incisional healing, and all patients have resumed meaningful weightbearing activities with stable integration of the tibial component.
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Affiliation(s)
- Mark A Prissel
- Podiatric Medicine and Surgery Resident (Postgraduate Year III), Gundersen Health System Medical Foundation, La Crosse, WI
| | - Thomas S Roukis
- Attending Staff, Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, WI.
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28
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Roukis TS, Prissel MA. Management of extensive talar osteolysis with Agility™ total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. J Foot Ankle Surg 2013; 53:108-13. [PMID: 23954094 DOI: 10.1053/j.jfas.2013.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Indexed: 02/03/2023]
Abstract
The Agility™ Total Ankle Replacement System, almost exclusively without polymethylmethacrylate cement fixation, was the most commonly used implant in the United States from 1998 to 2007. Much attention has been given to the intraoperative complications and incision healing-related problems. However, it is the intermediate- and long-term complications, specifically, aseptic osteolysis, talar component loosening, subsidence, and progressive malalignment, that require careful consideration, because the revision options are limited. We describe a technique for management of extensive talar aseptic osteolysis for revision of Agility™ total ankle replacement systems with use of geometric metal-reinforced polymethylmethacrylate cement augmentation. This technique preserves the subtalar joint, provides immediate component stability and restoration of component alignment and height, and is a cost-effective alternative to other available options and still allows for additional revision should late failure occur.
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Affiliation(s)
- Thomas S Roukis
- Attending Staff, Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, WI.
| | - Mark A Prissel
- Postgraduate Year III Resident, Podiatric Medicine and Surgery, Gundersen Health System Medical Foundation, La Crosse, WI
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