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Henry JK, Teehan E, Deland J, Ellis SJ, Demetracopoulos C. Lessons From Revision Total Ankle Replacement: Tibias Fail Earlier, and Taluses Fail Later (and Fail Again). Foot Ankle Int 2024; 45:993-999. [PMID: 38798096 DOI: 10.1177/10711007241255112] [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: 05/29/2024]
Abstract
BACKGROUND The literature on survivorship and outcomes after revision total ankle replacement (TAR) in the modern era is limited. This study aimed to describe the timing to revision and survivorship after revision TAR. We hypothesized that tibial-sided failures would occur earlier after the primary TAR, and secondary revisions after failure of revision TAR would occur more due to talar-sided failures than tibial-sided failures. METHODS This is a single-institution retrospective study of TAR patients with minimum 2-year follow-up. Revision TARs (defined as exchange of tibial and/or talar components) for aseptic causes with any implant were included. Etiology of failure necessitating revision and ultimate outcomes after revision (survival of TAR revision, additional revision, conversion to fusion, and below-knee amputation [BKA]) were recorded. RESULTS There were 46 revision TARs, with mean age of 60.6 (range: 31-77) years and mean 3.5 years' follow-up postrevision. Revisions for tibial failure occurred significantly earlier (n = 22, 1.3 ± 0.5 years after index procedure) than those for talar failure (n = 19, 2.3 ± 1.7 years after index procedure) or combined tibial-talar failure (n = 5, 3.4 ± 3.4 years after index procedure) (P = .015). Revisions for tibial-only failure had better survival (95.5%) than revisions for talar or combined tibial-talar failures: 26% of talar failures and 20% of combined tibial-talar failures underwent ≥1 revisions. Of the 6 additional revisions after failure of the talar component, 1 ultimately underwent BKA, 2 were converted to total talus replacement, 2 were revised to modular augmented talar components, and 1 was treated with explant and cement spacer for PJI after the revision. CONCLUSION TAR tibial failures occurred earlier than talar failures or combined tibial-talar failures. Revisions for talar failures and combined tibial-talar failures were more likely to require additional revision or ultimately fail revision treatment. This is important given the consequences of talar implant subsidence, bone necrosis, loss of bone stock, and limited salvage options.
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Affiliation(s)
- Jensen K Henry
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Emily Teehan
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Deland
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
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Valan B, Anastasio AT, Kim B, Krez A, Wu KA, Talaski GM, Nunley J, DeOrio JK, Easley ME, Adams SB. The INVISION Talar Component in Revision Total Ankle Arthroplasty: Analysis of Early Outcomes. Diagnostics (Basel) 2024; 14:1612. [PMID: 39125488 PMCID: PMC11311589 DOI: 10.3390/diagnostics14151612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Launched in 2018 for revision total ankle arthroplasty (rTAA), the INVISION talar component addresses subsidence when poor talar bone stock is present. Due to the recency of the market-availability of the INVISION, studies evaluating its efficacy are lacking. This study presents the first analysis of early-term outcomes of patients undergoing rTAA with the INVISION talar component. METHODS This was a single-center, retrospective review of 28 patients undergoing rTAA with the INVISION talar component and INBONE II tibial component performed between 2018 and 2022. Data on preoperative characteristics, postoperative complications, secondary procedures, and survivorship were collected. The primary outcome measures were rates of major complications, re-operation, and implant failure. Secondary outcomes included post-operative changes in varus and valgus alignment of the tibia and talus. RESULTS The most common secondary procedures performed with rTAA were medial malleolus fixation (n = 22, 78.6%) and gastrocnemius recession (n = 14, 50%). Overall, 10.7% (n = 3) of patients underwent reoperation and 14.3% (n = 4) suffered major complications. Incidence of implant failure was 10.7% (n = 3). All reoperations were caused by infection. Mean varus alignment of the tibia and talus improved from 4.07 degrees and 4.83 degrees to 1.67 degrees and 1.23 degrees, respectively. Mean valgus alignment of the tibia and talus improved from 3.67 degrees and 4.22 degrees to 2.00 degrees and 2.32 degrees, respectively. CONCLUSIONS In a series of 28 patients undergoing rTAA with the INVISION talar component, we discovered comparatively low rates of reoperation, major complication, and implant failure (10.7%, 14.3%, and 10.7%). The INVISION system appears to have a reasonable safety profile, but further studies evaluating long-term outcomes are required to assess the efficacy of the INVISION system.
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Affiliation(s)
- Bruno Valan
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Albert T. Anastasio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Billy Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY 10021, USA;
| | - Alexandra Krez
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Kevin A. Wu
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Grayson M. Talaski
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - James Nunley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - James K. DeOrio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Mark E. Easley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Samuel B. Adams
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
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Jamjoom BA, Dhar S. Outcomes of Revision Total Ankle Replacement. Foot Ankle Clin 2024; 29:171-184. [PMID: 38309801 DOI: 10.1016/j.fcl.2023.08.012] [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
The objective of this study is to provide an up-to-date review of the outcomes of revision total ankle arthroplasty (TAA). Relevant studies published over the last decade were reviewed. Twelve studies were included. At a median follow-up of 4 years, the median survival and reoperation rates were 86% and 16%, respectively. Significant postoperative improvements in patient-reported outcome measures were recorded in 6 studies. Significant improvement in alignment was documented in 1 study only. Revision TAA is a safe procedure that can produce good outcomes. Nevertheless, data relating to long-term outcome are still limited in quantity and duration.
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Affiliation(s)
- Bakur A Jamjoom
- Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
| | - Sunil Dhar
- Foot and Ankle Unit, Nottingham Elective Orthopaedics, Nottingham University Hospitals City Campus, Nottingham NG5 1PB, UK
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Jennison T, Spolton-Dean C, Rottenburg H, Ukoumunne O, Sharpe I, Goldberg A. The outcomes of revision surgery for a failed ankle arthroplasty. Bone Jt Open 2022; 3:596-606. [PMID: 35880516 PMCID: PMC9350690 DOI: 10.1302/2633-1462.37.bjo-2022-0038.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed. Results Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed. Conclusion Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques. Cite this article: Bone Jt Open 2022;3(7):596–606.
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Affiliation(s)
- Toby Jennison
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Bu P, Li C, Li J, Zhu M. [Development and clinical application of ankle prosthesis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1370-1373. [PMID: 31650750 PMCID: PMC8337445 DOI: 10.7507/1002-1892.201902014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To review the development and clinical application of ankle prosthesis. METHODS The recent literature on ankle prosthesis design and clinical application was reviewed and analyzed. RESULTS Compared with the hip and knee prostheses, the ankle prosthesis develops slowly and has been developed to the third generation. The ankle joint has a special structure of multi-axis movement. The design of the first and second generations of prostheses is not conformed to the biomechanics of the ankle. The third generation of prosthesis is more conform to the characteristics of ankle biomechanics, with high postoperative survival rate and satisfactory clinical outcome. CONCLUSION At present, the survival rate of ankle prosthesis is low, and there is still much room for improvement in biomechanics, materials, and other aspects.
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Affiliation(s)
- Pengfei Bu
- Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100,
| | - Chuan Li
- Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100, P.R.China
| | - Jun Li
- Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100, P.R.China
| | - Min Zhu
- Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100, P.R.China
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Revision Total Ankle Replacement in the Setting of Significant Bone Loss. TECHNIQUES IN FOOT AND ANKLE SURGERY 2018. [DOI: 10.1097/btf.0000000000000189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Total ankle arthroplasty is a viable surgical technique for the treatment of end-stage degenerative joint disease. With continued advancement in prosthetic design, refined surgical techniques, and improved outcomes, the indications for total ankle replacement have expanded to include cases of increasing complexity. With meticulous preoperative planning and exacting execution, many frontal plane deformities and cases of avascular necrosis can now be successfully addressed at the time of prosthesis implantation or in a staged procedure.
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Affiliation(s)
- Stephen A Brigido
- Foot and Ankle Reconstruction, Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA.
| | - Scott C Carrington
- Foot and Ankle Reconstruction, Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA
| | - Nicole M Protzman
- Clinical Integration Department, Coordinated Health, 3435 Winchester Road, Allentown, PA 18104, USA
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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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9
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Wagener J, Gross CE, Schweizer C, Lang TH, Hintermann B. Custom-made total ankle arthroplasty for the salvage of major talar bone loss. Bone Joint J 2017; 99-B:231-236. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0504.r2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/23/2016] [Indexed: 12/14/2022]
Abstract
Aims A failed total ankle arthroplasty (TAA) is often associated with much bone loss. As an alternative to arthrodesis, the surgeon may consider a custom-made talar component to compensate for the bone loss. Our aim in this study was to assess the functional and radiological outcome after the use of such a component at mid- to long-term follow-up. Patients and Methods A total of 12 patients (five women and seven men, mean age 53 years; 36 to77) with a failed TAA and a large talar defect underwent a revision procedure using a custom-made talar component. The design of the custom-made components was based on CT scans and standard radiographs, when compared with the contralateral ankle. After the anterior talocalcaneal joint was fused, the talar component was introduced and fixed to the body of the calcaneum. Results At a mean follow-up of 6.9 years (1 to 13), 11 ankles were stable with no radiological evidence of loosening. Only one was lost to follow-up. The mean arc of movement was 21° (10° to 35°). A total of nine patients (75%) were satisfied or very satisfied with the outcome, two (17%) were satisfied but with reservations and one (8%) was not satisfied. All but one patient had an improvement in the American Orthopaedic Foot and Ankle Society hindfoot score (p = 0.01). Just one patient developed deep infection, leading to arthrodesis. Conclusion A custom-made talar component yielded satisfactory results with regard to function, stability and satisfaction. This should encourage the use of such components as an alternative to arthrodesis of the ankle in patients with a failed TAA. Cite this article: Bone Joint J 2017;99-B:231–6.
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Affiliation(s)
- J. Wagener
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - C. E. Gross
- Medical University of South Carolina, Department
of Orthopaedic Surgery, Charleston, South
Carolina, USA
| | - C. Schweizer
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - T. Horn Lang
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - B. Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
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Goetz JE, Rungprai C, Tennant JN, Huber E, Uribe B, Femino J, Phisitkul P, Amendola A. Variable Volumes of Resected Bone Resulting From Different Total Ankle Arthroplasty Systems. Foot Ankle Int 2016; 37:898-904. [PMID: 27113607 DOI: 10.1177/1071100716645404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The increased popularity and success of total ankle arthroplasty (TAA) has resulted in the development of varying TAA hardware designs, many of which include specific bone-sparing or bone-sacrificing features. The goal of this work was to determine differences in the volume of bone removed for implantation of different total ankle arthroplasty hardware systems. METHODS Sixteen cadaveric specimens were computed tomography-scanned preoperatively and after total ankle arthroplasty using either an INBONE II, Salto Talaris, STAR, or Zimmer TMTA implant. Geometries of the talus and the distal tibia were manually segmented and converted to 3D bony surface models. The volume of bone removed for each implant was calculated as the difference in volume between the preoperative and postoperative bone models. To account for differences in specimen size, volume was expressed as a percentage of the intact bone. RESULTS There was a significant difference (P = .049) in the average percent of talar bone removed, with the STAR and INBONE II systems requiring removal of greater volumes of bone. The INBONE II system required significantly (P < .004) more tibial bone resection than the other 3 implants when evaluating a long span of the distal tibia. However, most of this increased bone resection was medullary bone. Close to the articular surface, bone volumes removed for the various tibial components were not significantly different (P = .056). CONCLUSION Volume and location of bone removed for different implant systems varied with implant design. CLINICAL RELEVANCE Primary bone resection associated with different implant hardware systems varied more on the talar side of the articulation, and the stemmed prosthesis did not result in dramatic increases in periarticular bone resection. Clinicians should weigh the effects of greater or lesser bone resection associated with various implant designs against other factors used for hardware selection.
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Affiliation(s)
- Jessica E Goetz
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | | | - Joshua N Tennant
- Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, USA
| | - Emmalei Huber
- Department of Engineering, University of Rochester, Rochester, NY, USA
| | - Bastian Uribe
- Department of Orthopaedic Surgery, Clinical Las Condes, Santiago, Chile
| | - John Femino
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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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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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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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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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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Krause M, Rupprecht M, Mumme M, Püschel K, Amling M, Barvencik F. Bone microarchitecture of the talus changes with aging. Clin Orthop Relat Res 2013; 471:3663-71. [PMID: 23893363 PMCID: PMC3792264 DOI: 10.1007/s11999-013-3195-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/17/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fractures of the talus in the elderly are rare and usually result from high-impact injuries, suggesting only minor age-related bone structure changes. However, total ankle replacement failures with age often result from talar subsidence, suggesting age-related bone loss in the talus. Despite a number of histological analyses of talar microarchitecture, the effects of age and sex on talar microarchitecture changes remain poorly defined. QUESTIONS/PURPOSES The aim of this study was to analyze changes or differences in the trabecular microarchitecture of the talus with regard to (1) age and (2) sex. METHODS Sixty human tali were harvested from 30 patients at autopsy of three different age groups (20-40, 41-60, 61-80 years). The specimens were analyzed by radiography, micro-CT, and histological analysis. Given that there was no difference between the left and right talus, static histomorphometric parameters were assessed in three regions of interest of the right talus only (body, neck, head; n = 30). RESULTS The talar body, neck, and head were affected differently by age-related changes. The greatest loss of bone volume with age was seen in the talar body (estimate: -0.239; 95% confidence interval [CI], -0.365 to -0.114; p < 0.001). In the talar neck (estimate: -0.165; 95% CI, -0.307 to -0.023; p = 0.025), bone loss was only moderate and primarily was the result of reduction in trabecular thickness (estimate: -1.288; 95% CI, -2.449 to -0.127; p = 0.031) instead of number (estimate: -0.001; 95% CI, -0.005 to -0.003; p = 0.593). Bone structure changes were independent of sex. CONCLUSIONS Age-related bone structure changes predominantly occur in the talar body, which poses a potential risk factor for total ankle replacement loosening. The moderate changes in the talar neck might explain the persistent low incidence of talar neck fractures with age. CLINICAL RELEVANCE Our findings suggest that before total ankle replacement implantation, careful patient selection with dual-energy xray absorptiometry evaluation may be necessary to reduce the risk of talar implant subsidence.
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Affiliation(s)
- Matthias Krause
- />Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529 Hamburg, Germany
| | - Martin Rupprecht
- />Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, Hamburg, Germany
| | - Marcus Mumme
- />Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529 Hamburg, Germany
| | - Klaus Püschel
- />Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- />Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529 Hamburg, Germany
| | - Florian Barvencik
- />Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 52, 22529 Hamburg, Germany
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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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18
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Abstract
Total ankle arthroplasty can be technically demanding in patients with poor bone quality. In bone fragile patients, the use of a temporary cementation technique ("biocementation") can assist in providing a stable, secure implant interface with native bone that is of poor quality. I report the short-term results of 9 ankles (7 consecutive patients) undergoing total ankle replacement with temporary cementation using a slowly resorbable injectable bone graft substitute composed of 75% calcium sulfate and 25% calcium phosphate.
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Affiliation(s)
- Christopher Bibbo
- Foot and Ankle and Lower Extremity Preservation and Restoration Services, Department of Orthopaedics, Marshfield Clinic, Marshfield, WI 54449, USA.
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19
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Abstract
The INBONE total ankle replacement is a unique modular ankle replacement that has the ability to serve as both a primary and a revision total ankle replacement. Despite its versatility, it may need to be revised, either because of poor patient selection, technical error, or infection. This article may be of value to those surgeons embarking on the primary placement or revision of an INBONE total ankle replacement.
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Wünschel M, Leichtle UG, Leichtle CI, Walter C, Mittag F, Arlt E, Suckel A. Fusion following failed total ankle replacement. Clin Podiatr Med Surg 2013; 30:187-98. [PMID: 23465808 DOI: 10.1016/j.cpm.2012.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although mid- to long-term results after total ankle replacement have improved because of available second- and third-generation devices, failure of total ankle replacement is still more common compared with total hip replacement and total knee replacement. The portfolio of available total ankle replacement revision component options is small. Furthermore, the bone stock of the tibiotalar region is scarce making it difficult and in some situations impossible to perform revision total ankle replacement. In these cases tibiotalar and tibiotalocalcaneal fusions are valuable options. This article describes which surgical procedures should be performed depending on the initial situation and gives detailed advice on surgical technique, postoperative care, and clinical results.
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Affiliation(s)
- Markus Wünschel
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Street 3, Tübingen 72076, Germany.
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21
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Abstract
The INBONE II Total Ankle System consists of modular intramedullary stem pieces that are supported by a tibial tray spanning the anterior and posterior tibial cortices. The original INBONE talar component was broad and saddle-shaped whereas the INBONE II design is sulcus-shaped. Both talar components have a modular stem; the INBONE II design also has 2 anterior pegs. This article provides a detailed review of the surgical technique for implantation of the INBONE II and perioperative insight into patient care.
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Affiliation(s)
- Bradley P Abicht
- Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Lutheran Healthcare System, 2nd Floor Founders Building, 1900 South Avenue, La Crosse, WI 54601, USA
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22
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Roukis TS. Salvage of a failed DePuy Alvine Total Ankle Prosthesis with Agility LP custom stemmed tibia and talar components. Clin Podiatr Med Surg 2013; 30:101-9. [PMID: 23164443 DOI: 10.1016/j.cpm.2012.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article presents a procedure whereby a second-phase design DePuy Alvine Total Ankle Prosthesis underwent revision to an Agility LP custom-designed stemmed tibial and talar component total ankle replacement system. The rationale for this procedure, the process of developing the custom components, 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
- Department of Orthopaedics, Podiatry and Sports Medicine, Gundersen Lutheran Healthcare System, second Floor Founders Building, Mail Stop FB2-009, 1900 South Avenue, La Crosse, WI 54601, USA.
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23
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Abstract
Total ankle joint replacement (TAR) has been offered as an alternative to ankle joint arthrodesis since the 1970s. TAR offers the benefit of perseveration of joint motion, with potential decreased occurrence of adjacent joint degeneration, and a more expedient path to weight bearing. Since their introduction, TAR devices have undergone a variety of modifications, specifically in regards to the number and type of components used.
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Affiliation(s)
- Lawrence A DiDomenico
- Department of Podiatry, Department of Surgery, St. Elizabeth Health Center, Youngstown, OH, USA.
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