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Wu S, Liu S, Huang M, Liu Z, Shi J, Ling M. Different radius of curvature at the talus trochlea from northern Chinese population measured using 3D model. J Orthop Surg Res 2024; 19:266. [PMID: 38671519 PMCID: PMC11055296 DOI: 10.1186/s13018-024-04751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND To analyze the curvature characteristics of the talus trochlea in people from northern China in different sex and age groups. METHODS Computed tomography scanning data of talus from 61 specimens were collected and constructed as a three-dimensional model by Materialise's Interactive Medical Image Control System(MIMICS) software, anteromedial(AM), posteromedial(PM), anterolateral(AL), and posterolateral(PL) edge, anterior edge of medial trochlea, posterior edge of medial trochlea and anterior edge of lateral trochlea were defined according to the anatomical landmarks on trochlear surface. The curvature radii for different areas were measured using the fitting radius and measure module. RESULTS There were significant differences among the talus curvatures in the six areas (F = 54.905, P = 0.000), and more trends in the analytical results were as follows: PM > PL > MP > AL > MA > AM. The average PL radius from specimens aged > 38 years old was larger than that from specimens aged < = 38 years (t=-2.303, P = 0.038). The talus curvature of the AM for males was significantly larger than that for females (t = 4.25, P = 0.000), and the curvature of the AL for males was larger than that for females (t = 2.629, P = 0.010). For observers aged < = 38 years, the AM curvature of the right talus in the male group was significantly larger than that in the female group (P < 0.01). In age < = 38years group, the MA curvature of right talus in male was significantly larger than in female group(P < 0.01), fitting radius of talus for male (21.90 ± 1.97 mm) was significantly greater than female of this(19.57 ± 1.26 mm)(t = 6.894, P = 000). The average radius of the talus in the male population was larger than that in the female population. CONCLUSION There was no significant relationship between age and talus curvature for males and females. The radius of curvature in the posterior area was significantly larger than that in the anterior area. We recommend that this characteristic of the talus trochlea should be considered when designing the talus component in total ankle replacement (TAR).
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Affiliation(s)
- Shixun Wu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China
| | - Shizhang Liu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China
| | - Minggang Huang
- Department of CT, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Zhe Liu
- Department of CT, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Jiyuan Shi
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China
| | - Ming Ling
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China.
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China.
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2
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Veale M, Endo A, Veale N, Swanson D, Mahendraraj K, Brzezinski A, Hofmann K, Slovenkai M. Salto Talaris Fixed-Bearing Total Ankle Arthroplasty: Long-Term Results at a Mean of 10.7 Years. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114231225458. [PMID: 38420290 PMCID: PMC10901057 DOI: 10.1177/24730114231225458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Background Total ankle arthroplasty (TAA) has become increasingly popular in the treatment for end-stage ankle arthritis in recent decades. However, there is limited evidence regarding the long-term clinical outcomes and complication rates of modern TAA implants. Methods This study presents a follow-up on a previous cohort involving 78 patients (81 ankles) who underwent Salto Talaris fixed-bearing TAA to treat end-stage arthritis, with a mean postoperative follow-up of 5.2 years. The aim of this follow-up study was to assess the radiographic (33 patients, 35 ankles) and clinical (48 patients, 50 ankles) results from the original cohort at a mean of 10.7 years (range, 7.8-14 years). Results At a mean of 10.7 years, the Kaplan-Meier estimated survivorship was 84.2% (95% CI, 71.9%-98.6%). For the patients reviewed, we did not find any change in patient-reported outcomes between an average 5- and 11-year follow-up. Measured total range of motion and plantarflexion did not change between 1 and 11 years, but dorsiflexion was measured as decreasing by an average of 4 degrees (P < .02). Conclusion In this longer-term follow-up of a limited cohort, we found that Salto Talaris fixed-bearing TAA demonstrated good long-term survival with relatively low rates of revision or other complications. Patient-reported outcome and range of motion measures revealed good stability. Level of Evidence Level III, therapeutic.
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Affiliation(s)
| | - Atsushi Endo
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | | | | | | | - Andrzej Brzezinski
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Kurt Hofmann
- Boston Sports and Shoulder Center, Waltham, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
| | - Mark Slovenkai
- Boston Sports and Shoulder Center, Waltham, MA, USA
- Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, MA, USA
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3
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Anastasio AT, Adams SB, DeOrio JK, Easley ME, Nunley JA, Lee DO. Comparison of Radiographic Talar Loosening Rates Between Salto-Talaris and INBONE II. Foot Ankle Int 2024; 45:60-66. [PMID: 37994659 DOI: 10.1177/10711007231209763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Despite substantial increase in total ankle arthroplasty (TAA) nationwide, there are few studies comparing flat-cut vs chamfer-cut talar systems in TAA with regard to radiographic aseptic loosening rates of the implant. METHODS This retrospective study included 189 Salto-Talaris TAA and 132 INBONE II primary TAA with a minimum 1-year follow-up. Patient characteristics were obtained including gender, age at surgery, body mass index (BMI), smoking status, primary diagnosis, surgical time, and the presence of diabetes. Radiographic evidence for aseptic loosening was assessed. Statistical analysis was performed for comparison in outcomes between Salto-Talaris and INBONE II. RESULTS The mean age of the study population was 63.5 ± 9.8 years at surgery. Mean follow-up was 4.9 ± 3.0 years. Radiographic aseptic loosening of the tibial implant showed no significant difference between the 2 groups: Salto-Talaris, 18%, and INBONE II, 18.9% (P = .829). Aseptic loosening of the talar implant also showed no significant difference between the 2 groups: Salto-Talaris, 1.6%, and INBONE II, 1.5% (P = .959). No variables, including the implant type, were found to contribute to the aseptic loosening rate of either the tibia or talus. CONCLUSION In our cohort, we observed no difference in radiographic implant aseptic loosening between Salto-Talaris and INBONE II systems. LEVEL OF EVIDENCE Level IV, retrospective case series study.
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4
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Vacketta VG, Perkins JM, Hyer CF. Updates of Total Ankle Replacement Revision Options: New Generation Total Ankle Replacement Revision Options, Stemmed Implants, Peri-Articular Osteotomies. Clin Podiatr Med Surg 2023; 40:749-767. [PMID: 37716750 DOI: 10.1016/j.cpm.2023.05.015] [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: 09/18/2023]
Abstract
Ankle arthritis is a disabling disease pattern resulting in pain and dysfunction ultimately leading to a reduction in quality of life. Unlike more common arthritides of the knee and hip, ankle arthritis is unique in its presentation with an earlier onset of end-stage disease and an etiology, which is most-commonly posttraumatic in nature. Through continued research and design, improvements have continued to be made as newer generation implants are developed. This article discusses the considerations for revision total ankle replacement based on the current revision options and a treatment algorithm developed by the lead author.
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Affiliation(s)
- Vincent G Vacketta
- Orthopedic Foot and Ankle Center, 350 West Wilson Bridge Road, Suite 200, Worthington, OH 43085, USA.
| | - Jacob M Perkins
- Orthopedic Foot and Ankle Center, 350 West Wilson Bridge Road, Suite 200, Worthington, OH 43085, USA
| | - Christoper F Hyer
- Orthopedic Foot and Ankle Center, 350 West Wilson Bridge Road, Suite 200, Worthington, OH 43085, USA
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5
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Fijany AJ, Olsson SE, Givechian BK, Zago I, Bishay AE, Troia T, Page TS, Barnett A, Downey MW, Pekarev M. A Novel Orthoplastic Reconstruction of Relapsed Clubfoot With Total Ankle Arthroplasty. Cureus 2023; 15:e44796. [PMID: 37809200 PMCID: PMC10558358 DOI: 10.7759/cureus.44796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Congenital clubfoot is addressed in infancy and rarely persists into adulthood. Ankle arthroplasty is an increasingly popular surgical intervention for patients with ankle arthritis since it allows a natural ankle range of motion and completely replaces a degenerative hindfoot. Here, we describe the first successful total ankle arthroplasty (TAA) for a patient with previously treated congenital clubfoot that reverted later in life. To address the patient's poor soft-tissue integument and reduce the likelihood of post-surgical complications, a perioperative latissimus muscle-free flap was performed. This two-staged, novel orthoplastic intervention addressed our patient's ankle issues and appears to be a viable option for clubfoot patients.
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Affiliation(s)
- Arman J Fijany
- Plastic Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Sofia E Olsson
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | | | - Ilana Zago
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | - Anthony E Bishay
- Neurosurgery, Vanderbilt University School of Medicine, Nashville, USA
| | - Thomas Troia
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | - Trevor S Page
- Plastic Surgery, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | | | - Michael W Downey
- Trauma and Reconstructive Surgery, Precision Orthopedics and Sports Medicine, Fort Worth, USA
| | - Maxim Pekarev
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
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6
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O'Connor K, Klein S, Ebeling P, Flemister AS, Phisitkul P. Republication of "Total Ankle Arthroplasty: Summary of Current Status". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231195063. [PMID: 37655936 PMCID: PMC10467185 DOI: 10.1177/24730114231195063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
| | - Sandra Klein
- Washington University in St Louis, Chesterfield, MO, USA
| | - Patrick Ebeling
- Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA
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7
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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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8
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Miner SA, Basile P, Cook J, Cook E, Constantino J. Tibial Component Subsidence in a Total Ankle System Comparing Standard Technique Versus a Hybrid Technique. J Foot Ankle Surg 2022; 62:472-478. [PMID: 36550003 DOI: 10.1053/j.jfas.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 10/04/2022] [Accepted: 11/20/2022] [Indexed: 11/26/2022]
Abstract
Total ankle arthroplasty (TAA) is a viable treatment option for end-stage ankle arthritis. However, implant survivorship remains an important consideration. Concerns regarding early component loosening with the low-profile tibial tray utilized by fourth-generation TAA systems have been raised in the literature. We have previously described our preliminary outcomes of a hybrid technique combining a stemmed intramedullary tibial component with a chamfer-cut talar component for TAA. A retrospective study comparing short-term outcomes of the tibial component between a standard fourth-generation TAA system versus our hybrid technique was performed. 46 patients with a minimum of 1-year follow up were included in the analyses. There were 25 subjects in the standard implant cohort utilizing a low-profile tibial tray, and 21 subjects in the hybrid group utilizing a stemmed intramedullary tibial component. No statistically significant difference between the demographics of each group was found. The rate of tibial component subsidence was 8% (n = 2) in the standard implant group, and 0% (n = 0) in the hybrid group, though this did not meet statistical significance (p = .49). Mean time to subsidence was 6 months, and revision rate due to tibial component subsidence was 2.1% (n = 1). Periprosthetic lucency was present on most recent follow-up radiographs in 32% and 9.5% of ankles in the standard and hybrid groups, respectively (p = .08). Despite prior concerns for tibial component subsidence with the standard fourth-generation system, we demonstrated low rates in both implant groups. Additional studies are needed to further explore factors that may predispose patients to early tibial component subsidence and resulting implant failure.
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Affiliation(s)
- Samantha A Miner
- Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow in Surgery, Harvard Medical School, Boston, MA.
| | - Philip Basile
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Chief, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge MA
| | - Jeremy Cook
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Director of Research and Quality Assurance, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Emily Cook
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Director of Resident Training, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - John Constantino
- Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow in Surgery, Harvard Medical School, Boston, MA
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9
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Madi NS, Fletcher AN, Pereira GF, Balu A, DeOrio JK, Parekh SG. Early Outcomes of Combined Total Ankle Total Talus Replacement Using a 3D-Printed Talus Component With Hindfoot Arthrodesis. Foot Ankle Spec 2022:19386400221120567. [PMID: 36039497 DOI: 10.1177/19386400221120567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Late-stage talar avascular necrosis (AVN) results in devascularization of the talus with osteonecrosis and subchondral collapse. A combined total ankle and total talus replacement (TATTR) with hindfoot arthrodesis may be utilized for end-stage talar AVN with tibiotalar and hindfoot joint arthritis. The purpose of this study is to evaluate the short-term outcomes of combined TATTR with hindfoot arthrodesis. Patients who underwent a combined TATTR or TTR with a hindfoot arthrodesis (subtalar with or without talonavicular arthrodesis) from 2016 to 2020 were retrospectively reviewed. Patient demographics, comorbidities, and surgical data were collected. Outcomes included the Visual Analog Scale (VAS) scores, range of motion, radiographic parameters, union rates, and complications. A total of 18 patients were reviewed. Nine patients were included with an average of 19.4 months follow-up. Significant postoperative improvements were observed in VAS scores (P < .001), ankle plantarflexion (P = .04), talocalcaneal height (P = .03), and tibiotalar alignment (P = .02). All patients achieved a successful union of their subtalar and talonavicular joints arthrodesis. There was one reoperation for a persistent varus ankle deformity. This is the first study to evaluate the clinical outcomes, radiographic outcomes, and union rate in combined TATTR with hindfoot arthrodesis. The early results demonstrated significant clinical improvement with 100% hindfoot union rate and no prosthetic failure.Level of Evidence: IV.
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Affiliation(s)
- Naji S Madi
- Foot and Ankle Surgery, Duke University Medical Center, Durham, North Carolina.,Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Amanda N Fletcher
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Gregory F Pereira
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | | | - James K DeOrio
- Foot and Ankle Surgery, Duke University Medical Center, Durham, North Carolina.,Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Selene G Parekh
- Foot and Ankle Surgery, Duke University Medical Center, Durham, North Carolina.,Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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10
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Lin J, Sofka CM, Demetracopoulos CA, Potter HG. The Utility of Isotropic 3D Magnetic Resonance Imaging in Assessing Painful Total Ankle Replacements. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221094840. [PMID: 35520474 PMCID: PMC9067051 DOI: 10.1177/24730114221094840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ji Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | | | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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11
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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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12
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Yamamoto T, Nagai K, Kanzaki N, Nukuto K, Yamashita T, Ibaraki K, Araki D, Hoshino Y, Matsushita T, Kuroda R. Anterior placement of the talar component in total ankle arthroplasty: A risk factor for talar component subsidence. Foot Ankle Surg 2021; 27:311-315. [PMID: 32591174 DOI: 10.1016/j.fas.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/03/2020] [Accepted: 05/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Component subsidence is considered as a cause of revision surgery. The talar component subsidence may be a risk factor for revision surgery; however, there are no reports regarding talar component placement and subsidence amount following total ankle arthroplasty (TAA). We therefore investigated the relationship between talar component placement and subsidence amount. METHODS Fifty-two ankles from 49 patients (age: 71 years [range 62-83], 13 male/ 36 female), who underwent TAA with mean follow-up of 36 months (range 12-83), were included. The subjects were divided into two groups based on talar component placement: anterior placement (n = 20, group A) and posterior placement (n = 32, group P) using weight-bearing lateral plain radiographs. The amount of the talar component subsidence and clinical outcomes, which included the Japanese Society for Surgery of the Foot (JSSF) scale, range of the motion (ROM) and the revision rate, were compared between the groups. RESULTS Talar component subsidence was significantly higher in group A (2.1 ± 2.0 mm) than in group P (0.6 ± 1.4 mm, P = .017). There was no significant difference in the JSSF scale and ROM between group A and group P. The revision rate was 10.0% in group A and 6.3% in group P, albeit not statistically significant. CONCLUSION Greater talar component subsidence was observed when the talar component was placed more anteriorly, suggesting that anterior placement of the talar component may need to be avoided during the surgery in order to minimize the postoperative talar component subsidence.
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Affiliation(s)
- Tetsuya Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Koji Nukuto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Yamashita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuyuki Ibaraki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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13
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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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14
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Morita S, Taniguchi A, Miyamoto T, Kurokawa H, Tanaka Y. Application of a Customized Total Talar Prosthesis for Revision Total Ankle Arthroplasty. JB JS Open Access 2020; 5:e20.00034. [PMID: 33283130 PMCID: PMC7593043 DOI: 10.2106/jbjs.oa.20.00034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The rate of revision surgery for total ankle arthroplasty (TAA) is higher than for hip and knee arthroplasties. Tibiotalocalcaneal arthrodesis is widely used; however, it requires a large allograft. Thus, the use of a customized total talar prosthesis in combination with the tibial component of TAA (combined TAA) may be an effective strategy for talar component subsidence. This study aimed to evaluate the clinical and radiographic effectiveness of the combined TAA in such revision cases. METHODS Between 2000 and 2015, 10 patients (10 women; 10 ankles) were treated using the combined TAA for revision after standard TAA or combined procedures that included the use of a talar body prosthesis. In 6 patients, the tibial component was concurrently replaced. The median follow-up period was 49 months (interquartile range [IQR], 24.5 to 90 months). The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score, a numerical rating scale (NRS) pain score, passive range of motion of the ankle, and the presence of osteophytes and degenerative changes in the adjacent joints were assessed preoperatively and at final postoperative follow-up. RESULTS The median NRS pain score improved significantly, from 7 (IQR, 6.25 to 8.75) to 2 (IQR, 1 to 3). The median JSSF ankle-hindfoot scale total score improved significantly, from 64 (IQR, 56.25 to 71.5) to 88.5 (IQR, 79.75 to 96). In the subcategories of this scale, the median pain score improved from 20 (IQR, 20 to 27.5) to 35 (IQR, 30 to 40), and the median function score improved from 34 (IQR, 26.5 to 37) to 43.5 (IQR, 39.75 to 46). The median range of motion improved from 29° (IQR, 25.5° to 35°) to 35° (IQR, 31.25° to 43.75°). No significant difference in osteophyte formation was found. Degenerative changes in the adjacent joint were found only in the talonavicular joint. CONCLUSIONS The combined TAA, used in revision for postoperative complications after standard TAA or combined procedures including the use of a talar body prosthesis, was associated with improved objective JSSF ankle-hindfoot scale scores, subjective pain assessment, and range of motion in the ankle. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shigeki Morita
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Akira Taniguchi
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Takuma Miyamoto
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Hiroaki Kurokawa
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
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Patel H, Kinmon K. Revision of Failed Total Ankle Replacement With a Custom 3-Dimensional Printed Talar Component With a Titanium Truss Cage: A Case Presentation. J Foot Ankle Surg 2019; 58:1006-1009. [PMID: 31345753 DOI: 10.1053/j.jfas.2018.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Indexed: 02/03/2023]
Abstract
An innovative technique is presented for salvage of a failed total ankle replacement resulting from talar subsidence with the use of a custom 3-dimensional printed articulating talar component with a titanium truss cage. This introduces a better alternative to an ankle arthrodesis with which ankle joint function and range of motion may be preserved.
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Affiliation(s)
- Harshil Patel
- Resident Physician, Department of Podiatry, Bethesda Hospital East, Boynton Beach, FL.
| | - Kyle Kinmon
- Residency Director and Attending Physician, Department of Podiatry, Bethesda Hospital East, Boynton Beach, FL
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Taylor MA, Green CL, Risoli TJ, DeOrio JK, Easley ME, Nunley JA, Adams SB. Hindfoot Arthrodesis Screw Position and Trajectory Effect on Talus Subsidence When Performed With Total Ankle Arthroplasty. Foot Ankle Int 2019; 40:307-317. [PMID: 30381958 DOI: 10.1177/1071100718806479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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 arthroplasty (TAA) is increasingly being recognized as an effective surgical option for end-stage ankle arthritis. Associated hindfoot arthrodesis procedures are at times needed to correct malalignment or to address adjacent joint arthritis. Results following TAA and associated hindfoot arthrodesis have at times been underwhelming and the devascularization of the talar blood supply has been postulated as a potential cause. This study explored the association between hindfoot arthrodesis fixation and talar component subsidence. METHODS: The study included 81 consecutive patients who underwent a TAA with either an isolated subtalar arthrodesis or combined subtalar and talonavicular arthrodesis with a minimum of 2 years of follow-up. Radiographic and clinical evaluations including patient-reported outcomes were performed at each postoperative visit. The primary outcome measure was the presence of talar component subsidence while patient-reported outcomes were the secondary outcome measure. RESULTS: 30.9% of patients had evidence of talar component subsidence. Subsidence was seen in 55.5% of patients with dorsal to plantar subtalar fixation compared to 11.1% of patients with plantar to dorsal screws ( P < .001) and in 44.4% of patients with screws violating the sinus tarsi compared to 3.7% of patients without screws in the sinus tarsi ( P < .001). Screws that were placed from dorsal to plantar were more likely to violate the sinus tarsi ( P < .001). Patients with evidence of talar subsidence reported higher pain scores and lower functional scores. There were 8 TAA failures, and the presence of dorsal to plantar screws was associated with failure ( P < .01). CONCLUSION: Screws that are placed across the subtalar joint from a dorsal to plantar approach are more likely to violate the sinus tarsi, contributing to a significantly higher rate of talar component subsidence when associated with TAA. LEVEL OF EVIDENCE: Level II, prospective comparative series.
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Affiliation(s)
- Michel A Taylor
- 1 Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Cynthia L Green
- 2 Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Thomas J Risoli
- 2 Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - James K DeOrio
- 1 Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Mark E Easley
- 1 Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - James A Nunley
- 1 Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Samuel B Adams
- 1 Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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O’Connor K, Klein S, Ebeling P, Flemister AS, Phisitkul P. Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418790003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Sandra Klein
- Washington University in St Louis, Chesterfield, MO, USA
| | - Patrick Ebeling
- Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA
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