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Ferrao PNF, Saragas NP, Naude JJ. Outcomes of Total Ankle Arthroplasty After Periprosthetic Cyst Curettage and Bone Grafting. Foot Ankle Clin 2024; 29:123-143. [PMID: 38309797 DOI: 10.1016/j.fcl.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Total ankle arthroplasty (TAA) has become a popular management option for ankle arthritis. Periprosthetic osteolysis is one of the most common causes for reoperation in TAA. A CT scan should be done in all suspected osteolysis cases to confirm location, quantify size and aid in surgical planning. These patients are often asymptomatic with limited evidence regarding appropriate management. Smaller lesions should be monitored for progression in size. Periprosthetic cysts measuring 10-15mm in all three axes should be considered for debridment and curettage with autogenous bone grafting. The authors believe that bone grafting of large asymptomatic periprosthetic cysts could prevent implant failure.
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Affiliation(s)
- Paulo N F Ferrao
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Department of Orthopaedic Surgery, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Nikiforos P Saragas
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Department of Orthopaedic Surgery, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Jaco J Naude
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Life Wilgers Hospital, Denneboom road, Wilgers ext 14, Pretoria, 0040, South Africa
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2
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van der Plaat LW, Hoornenborg D, Sierevelt IN, van Dijk CN, Haverkamp D. Ten-year revision rates of contemporary total ankle arthroplasties equal 22%. A meta-analysis. Foot Ankle Surg 2022; 28:543-549. [PMID: 34116950 DOI: 10.1016/j.fas.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 04/30/2021] [Accepted: 05/31/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The National Institute for Health and Care Excellence criterion for hip replacements is a (projected) revision rate of less than 5% after 10 years. No such criterion is available for ankle prostheses. The objective of the current study is to compare survival rates of contemporary primary ankle prostheses to the hip-benchmark. METHODS The PRISMA methodology was used. Eligible for inclusion were clinical studies reporting revision rates of currently available primary total ankle prostheses. Data was extracted using preconstructed forms. The total and prosthesis-specific annual revision rate was calculated. RESULTS Fifty-seven articles of eight different ankle prostheses were included (n = 5371), totaling 513 revisions at an average 4.6 years of follow-up. An annual revision rate of 2.2 was found (i.e. an expected revision rate of 22% at 10 years). CONCLUSIONS The expected 10-year revision rate of contemporary ankle prostheses is lower than the current benchmark for hip prostheses.
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Affiliation(s)
- Laurens W van der Plaat
- Department of Orthopedics and Traumatology, St.-Antonius-Hospital Kleve, Albersallee 5-7, 47533 Kleve, Germany.
| | - Daniël Hoornenborg
- Department of Orthopedics, Xpert Orthopedics and Specialized Centre of Orthopedic Research and Education (SCORE), Laarderhoogtweg 12, 1101 EA Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopedics, Xpert Orthopedics and Specialized Centre of Orthopedic Research and Education (SCORE), Laarderhoogtweg 12, 1101 EA Amsterdam, The Netherlands
| | - C Niek van Dijk
- Department of Orthopedics, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Daniël Haverkamp
- Department of Orthopedics, Xpert Orthopedics and Specialized Centre of Orthopedic Research and Education (SCORE), Laarderhoogtweg 12, 1101 EA Amsterdam, The Netherlands
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3
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Naude JJ, Saragas NP, Ferrao PNF. CT Scan Assessment and Functional Outcome of Periprosthetic Bone Grafting After Total Ankle Arthroplasty at Medium-term Follow-up. Foot Ankle Int 2022; 43:609-619. [PMID: 35073771 DOI: 10.1177/10711007211064612] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic cysts can occur in up to 95% of total ankle arthroplasties (TAA) and have been correlated with implant failure. The aim of this study was to determine the clinical and radiologic outcomes, using computed tomographic (CT) scan, after periprosthetic cyst bone grafting and assess for the minimum cyst size that should be grafted. METHODS A retrospective review was performed of all TAA procedures performed between 2007 and 2014 (n=93). A CT scan was done to assess cyst size and operative planning. Eight patients with 9 periprosthetic cysts larger than 1.75 cm3 were grafted and specimens sent for histology. The mean time to bone grafting was 7.3 (3.8-9.5) years. Functional outcome was assessed using the American Orthopaedic Foot & Ankle Society ankle score, visual analog scale, and Self-reported Foot and Ankle Score. A CT scan was performed at follow-up to assess graft incorporation and cyst size progression. The mean time to CT scan post grafting was 3.0 (0.7-4.7) years. RESULTS There was no implant malalignment identified and no differences in the pre- and postoperative functional scores. Preoperatively cysts had a mean volume of 8.16 (2.04-14.03) cm3. The mean percentage incorporation was 89% (69%-100%). Eight of the grafted cysts were considered successful on CT, with the ninth having 69% incorporation. Five cysts were not grafted, as they were below 1.75 cm3, and remained the same size or had minimal enlargement. CONCLUSION The satisfactory results in this small cohort suggests that prophylactic bone grafting may extend implant survival. We recommend that periprosthetic cysts greater than 1.75 cm3 be prophylactically bone grafted, and that cysts smaller than 1.75 cm3 be monitored for progression in size. LEVEL OF EVIDENCE Level IV, Case Series.
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Affiliation(s)
- Jaco J Naude
- The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, Gauteng, South Africa.,Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Nikiforos P Saragas
- The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, Gauteng, South Africa.,Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Paulo N F Ferrao
- The Orthopaedic Foot and Ankle Unit, Netcare Linksfield Hospital, Johannesburg, Gauteng, South Africa.,Department of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Kormi S, Kohonen I, Koivu H, Tiusanen H. Low Rate of Peri-implant Osteolysis in Trabecular Metal Total Ankle Replacement on Short- to Midterm Follow-up. Foot Ankle Int 2021; 42:1431-1438. [PMID: 34142574 DOI: 10.1177/10711007211017468] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peri-implant osteolysis is one of the major complications related to total ankle replacement. The aim of this study was to investigate the short- to midterm incidence of peri-implant osteolysis using computed tomography (CT) as imaging method for the Trabecular Metal Total Ankle (TMTA) implant representing a novel total ankle replacement (TAR) implant design regarding material and surgical technique. METHODS In total, 104 consecutive patients who had a primary TMTA replacement between March 2013 and October 2017 were included in the study. The radiographic evaluation included weightbearing anteroposterior and lateral views at baseline and after 3, 6, and every 12 months postoperatively. A helical CT was undertaken preoperatively and of the 80 patients available to follow up at least 12 months postoperatively, with average time interval between the TAR operation and the latest CT of 39 (range, 12-85) months. RESULTS Eight of 80 patients had altogether 11 osteolytic lesions around the components on CT images. Seven lesions were found in tibia, 3 in talus, and 1 in distal fibula. Four of the tibial lesions were situated in the medial malleolus and were not in contact with the prosthesis component. The sizes of the osteolytic lesions ranged between 7 and 20 mm, and the average volume of the lesions was 689 mm3. CONCLUSION We conclude that the risk of peri-implant osteolysis with the TMTA implant is minimal in short to midterm. The anatomic configuration, unique material, and surgical technique may all contribute to the TMTA implant having a low rate of peri-implant osteolysis. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Sami Kormi
- Turku University Hospital, Turku, Finland
| | - Ia Kohonen
- Turku University Hospital, Turku, Finland
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Lundeen GA, Barousse PS, Moles LH, Whitlow SR, Cassinelli S. Technique Tip: Endoscopic-Assisted Curettage and Bone Grafting of Periprosthetic Total Ankle Arthroplasty Bone Cysts. Foot Ankle Int 2021; 42:224-229. [PMID: 33016116 DOI: 10.1177/1071100720961090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | | | - Laura H Moles
- University of Nevada Reno School of Medicine, Reno, NV, USA
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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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Lintz F, Mast J, Bernasconi A, Mehdi N, de Cesar Netto C, Fernando C, Buedts K. 3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement. Foot Ankle Int 2020; 41:1-9. [PMID: 31779466 DOI: 10.1177/1071100719891411] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration. METHODS Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (<95% CI) and valgus (>95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC. RESULTS Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, -1.12 to 1.36). Patients with greater residual malalignment (P < .001) and those with longer follow-up (P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV (P = .042), with a threshold FAO value of -2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV (P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV. CONCLUSION In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- François Lintz
- Ramsay Générale de Santé Clinique de l'Union, Foot and Ankle Department, Saint-Jean, Toulouse Metropole, France
| | - Jef Mast
- Foot and Ankle Unit, ZNA Middelheim, Antwerpen, Belgium
| | - Alessio Bernasconi
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK.,Orthopaedic and Traumatology Unit, University "Federico II," Naples, Italy
| | - Nazim Mehdi
- Ramsay Générale de Santé Clinique de l'Union, Foot and Ankle Department, Saint-Jean, Toulouse Metropole, France
| | - Cesar de Cesar Netto
- Carver College of Medicine, Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Céline Fernando
- Ramsay Générale de Santé Clinique de l'Union, Foot and Ankle Department, Saint-Jean, Toulouse Metropole, France
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The AES total ankle arthroplasty analysis of failures and survivorship at ten years. INTERNATIONAL ORTHOPAEDICS 2017; 41:2525-2533. [PMID: 28871360 DOI: 10.1007/s00264-017-3605-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AES mobile-bearing total ankle replacement was developed from the Buechel Pappas model. It was withdrawn in 2009, after identification of a higher than expected complication rate. The purpose of the current study was to analyse clinical outcomes, failures and survival of the initial series of 50 AES published in 2009. METHODS In this single-centre continuous prospective study (2003-2006), 50 AES prostheses were included. Pre-operative osteoarthritis was mainly post-traumatic (50%) and secondary to instability (36%). All patients were assessed with clinical and radiographic follow-up at six months, one year, two years and every two to three years thereafter. A CT-scan was systematically performed before procedure, and at two years, five years and ten years. At last follow-up, all patients with TAR had a functional (SF 36, AOFAS) and clinical assessment. All complications or surgical events were analysed. RESULTS The mean follow-up was ten ± two years (range, 9-13). The mean AOFAS score was 75 points (range, 26-100). The mean SF 36 score was 69 points (range, 35-97). There was a significant deterioration in AOFAS score at five years and at last follow-up (p < 0.05). Fifteen TARs underwent reoperation for cyst curettage-graft because of development of periprosthetic lesions. Six of them ended up with prosthesis removal-arthrodesis. At the last follow-up, 14 TARs were removed for arthrodesis. Of the 30 prostheses seen at last follow-up, four are awaiting prosthesis removal-arthrodesis and one for cyst curettage-graft. The ten year survivorships free of any prosthesis removal or arthrodesis and free of any reoperation were 68% (95% CI, 55-85) and 57% (95% CI, 44-74), respectively. CONCLUSION Our data suggested a high rate of reoperation. Overall ten year survival was lower than with other designs, particularly due to cyst lesions. LEVEL OF EVIDENCE Level IV, prospective case series.
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Ruatti S, Corbet C, Boudissa M, Kerschbaumer G, Milaire M, Merloz P, Tonetti J. Total Talar Prosthesis Replacement after Talar Extrusion. J Foot Ankle Surg 2017. [PMID: 28633801 DOI: 10.1053/j.jfas.2017.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Dislocation of the talus is a serious and extremely rare injury, with 86 cases reported in the published data in 20 years. The reference standard for case management involves replacement of the dislocated talus to restore the height and function of the tibiotalar joint. The risk of avascular necrosis remains very high, and the standard treatment in such cases is tibiotalar arthrodesis. We report the case of total dislocation of the talus, which was treated with the insertion of a custom total talar prosthesis affixed directly to the tibial cartilage at 6 months after injury. At the 2-year follow-up point, the preliminary results were rather encouraging, with well-functioning activity and an improved American Orthopaedic Foot and Ankle Society foot function scale score increasing from 11 to 77 of 100 and a Short-Form 36-item Health Survey score increasing from 17 to 82. Much longer follow-up periods are necessary to evaluate longer term trends.
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Affiliation(s)
- Sébastien Ruatti
- Orthopaedic Surgeon, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France.
| | - Clémentine Corbet
- Resident, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Mehdi Boudissa
- Assistant Professor, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Gael Kerschbaumer
- Orthopaedic Surgeon, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Michel Milaire
- Orthopaedic Surgeon, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Philippe Merloz
- Professor, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
| | - Jérôme Tonetti
- Professor, Department of Orthopaedic and Traumatologic Surgery, Michallon Hospital, Grenoble University Hospital, Grenoble, France
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Koivu H, Kohonen I, Mattila K, Loyttyniemi E, Tiusanen H. Medium to long-term results of 130 Ankle Evolutive System total ankle replacements-Inferior survival due to peri-implant osteolysis. Foot Ankle Surg 2017; 23:108-115. [PMID: 28578793 DOI: 10.1016/j.fas.2017.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 03/16/2017] [Accepted: 03/30/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The study reports the medium to long-term results of 130 Ankle Evolutive System total ankle replacements operated at a single-centre. Previously high amount of peri-implant osteolysis was reported from the same material. METHODS Between 2002 and 2008 one hundred and thirty consecutive ankles replaced with AES ankle prosthesis were followed both radiologically and clinically. RESULTS The five-year survival was 87.3% (95% confidence interval (CI) 80.0-92.0%), and ten-year survival 74.9% (95% confidence interval (CI) 65.4-82.2%) at a median follow-up time of 96 months (range 2-161; 8 years). Peri-implant osteolysis was found in 91 (70%) ankles, marked in 78 (60%). 44 ankles (34%) have been revised by filling of the cavities, 24 (18%) by fusion, and 6 by further replacement, resulting in the revision rate of 58%. Osteolysis was the main reason for all revisions. The improvement of the Kofoed Score and pain points was significant (all p<0.0001), and the subjective patient satisfaction was good. CONCLUSIONS Outcome of the current study was seriously affected by osteolysis and is inferior compared to previous reports.
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Affiliation(s)
- Helka Koivu
- Hospital Terveystalo Pulssi and University of Turku, Turku University Hospital, University of Turku, Turku, Finland.
| | - Ia Kohonen
- The Medical Imaging Centre of Southwest Finland, Turku University Hospital, University of Turku, Turku, Finland
| | - Kimmo Mattila
- The Medical Imaging Centre of Southwest Finland, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Hannu Tiusanen
- Department of Orthopaedics, Turku University Hospital,University of Turku, Turku, Finland
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Are periprosthetic osteolytic lesions in ankle worth bone grafting? Foot Ankle Surg 2017; 23:128-133. [PMID: 28578796 DOI: 10.1016/j.fas.2017.01.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/23/2017] [Accepted: 01/30/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND We retrospectively evaluated the medium-term follow-up of bone grafting due to periprosthetic osteolytic lesions in ankles. METHODS 34 ankles (32 patients) with total ankle arthroplasty (TAA) underwent re operation. Indications were large periprosthetic osteolytic lesions or continuous growing of the lesions. The osteolytic lesions were imaged by CT before reoperation and once a year after that. The mean CT follow-up after re operation was 3.8 years (range, 2-6.2 years). Patient's clinical outcome was also monitored. RESULTS Osteolysis continued to progress in 44 bone grafted lesions (68%) in CT follow-up. Pain (p=0.04) and location of the lesion (p=0.03) were associated with progression of osteolysis. In 18 bone grafted osteolytic lesions (28%) the radiological survival remained excellent. 25 out of 34 ankles showed improvement of the function after bone grafting. CONCLUSIONS There is no established treatment protocol for osteolysis around TAA. Bone grafting is one alternative in the treatment of osteolytic lesions.
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12
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Singh G, Reichard T, Hameister R, Awiszus F, Schenk K, Feuerstein B, Roessner A, Lohmann C. Ballooning osteolysis in 71 failed total ankle arthroplasties. Acta Orthop 2016; 87:401-5. [PMID: 27196532 PMCID: PMC4967284 DOI: 10.1080/17453674.2016.1188346] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Aseptic loosening is a major cause of failure in total ankle arthroplasty (TAA). In contrast to other total joint replacements, large periarticular cysts (ballooning osteolysis) have frequently been observed in this context. We investigated periprosthetic tissue responses in failed TAA, and performed an element analysis of retrieved tissues in failed TAA. Patients and methods - The study cohort consisted of 71 patients undergoing revision surgery for failed TAA, all with hydroxyapatite-coated implants. In addition, 5 patients undergoing primary TAA served as a control group. Radiologically, patients were classified into those with ballooning osteolysis and those without, according to defined criteria. Histomorphometric, immunohistochemical, and elemental analysis of tissues was performed. Von Kossa staining and digital microscopy was performed on all tissue samples. Results - Patients without ballooning osteolysis showed a generally higher expression of lymphocytes, and CD3+, CD11c+, CD20+, and CD68+ cells in a perivascular distribution, compared to diffuse expression. The odds of having ballooning osteolysis was 300 times higher in patients with calcium content >0.5 mg/g in periprosthetic tissue than in patients with calcium content ≤0.5 mg/g (p < 0.001). Interpretation - There have been very few studies investigating the pathomechanisms of failed TAA and the cause-effect nature of ballooning osteolysis in this context. Our data suggest that the hydroxyapatite coating of the implant may be a contributory factor.
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Affiliation(s)
- Gurpal Singh
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany; ,National University Health System University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, Singapore;
| | - Theresa Reichard
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany;
| | - Rita Hameister
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany; ,Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;
| | - Friedemann Awiszus
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany;
| | - Katja Schenk
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany;
| | - Bernd Feuerstein
- Department of Mechanical Engineering, Magdeburg-Stendal University of Applied Sciences, Magdeburg;
| | - Albert Roessner
- Department of Pathology, Otto-von-Guericke University, Magdeburg, Germany
| | - Christoph Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany; ,Correspondence:
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