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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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Doty J, Murphy GA, Bohay D, Fortin P, Vora A, Strasser N, Friscia D, Newton W, Gross CE. Two-Year Survivorship and Patient-Reported Outcomes of a Prospectively Enrolled Cohort of INFINITY Total Ankle Arthroplasties. Foot Ankle Int 2024; 45:150-157. [PMID: 38140701 DOI: 10.1177/10711007231212484] [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: 12/24/2023]
Abstract
BACKGROUND The INFINITY total ankle implant is a widely and successfully used option for total ankle arthroplasty. The purpose of this study is to assess the 2-year survivorship, complication rates, patient-reported outcomes, and radiologic findings of prospectively enrolled patients undergoing a fixed-bearing total ankle arthroplasty (TAA). This study sought to determine if factors such as traditional vs patient-specific instrumentation, preoperative degree of arthritis, deformity, or etiology of arthritis impact surgical or clinical outcomes. METHODS A total of 143 prospectively enrolled patients (148 ankles) underwent TAA with a fixed-bearing total ankle implant between 2017 and 2019 at 9 different institutions by 9 different surgeons. A total of 116 completed 2-year follow-up. Patients were stratified by instrumentation used, degree of preoperative deformity, the Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system, and etiology of arthritis. Outcomes used included implant survivorship and adverse events within 2 years of surgery. Additionally, patient-reported outcomes and radiographs were collected at 6-month, 1-year, and 2-year postoperatively. PROMs used included Ankle Osteoarthritis Score (AOS), Patient-Reported Outcomes Measurement Information System (PROMIS) global health score, the Foot and Ankle Outcome Score (FAOS), and patient satisfaction (rated from excellent to poor). RESULTS Implant survivorship at 2 years was 97.79%. There were 17 reoperations (11.5%), with 4 of the implants requiring revision (2.7%). Significant improvements in all PROMs were observed among all subgroups at all postoperative time points without significant variation between subgroups. Patients classified as COFAS type 2 arthritis preoperatively demonstrated significantly more improvement in FAOS Total Symptom Score at the 1- and 2-year measurements than COFAS type 3 patients at both time points. CONCLUSION Total ankle arthroplasty with a fixed-bearing implant system is a safe and reliable treatment option for patients with end-stage arthritis regardless of degree of deformity or COFAS grading. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Jesse Doty
- University of Tennessee/Erlanger Orthopaedics, Chattanooga, TN, USA
| | | | - Donald Bohay
- Orthopaedics Associates of Michigan, Grand Rapids, MI, USA
| | - Paul Fortin
- Michigan Orthopaedic Surgeons, Beaumont Hospital Royal Oak, MI, USA
| | - Anand Vora
- Illinois Bone & Joint Institute, Chicago, IL, USA
| | | | - David Friscia
- Eisenhower Desert Orthopaedic Center, Rancho Mirage, CA, USA
| | - William Newton
- Medical University of South Carolina, Charleston, SC, USA
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Ha J, Jones G, Staub J, Aynardi M, French C, Petscavage-Thomas J. Current Trends in Total Ankle Replacement. Radiographics 2024; 44:e230111. [PMID: 38096110 DOI: 10.1148/rg.230111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Ankle arthritis can result in significant pain and restriction in range of motion. Total ankle replacement (TAR) is a motion-preserving surgical option used as an alternative to total ankle arthrodesis to treat end-stage ankle arthritis. There are several generations of TAR techniques based on component design, implant material, and surgical technique. With more recent TAR implants, an attempt is made to minimize bone resection and mirror the native anatomy. There are more than 20 implant devices currently available. Implant survivorship varies among prosthesis types and generations, with improved outcomes reported with use of the more recent third- and fourth-generation ankle implants. Pre- and postoperative assessments of TAR are primarily performed by using weight-bearing radiography, with weight-bearing CT emerging as an additional imaging tool. Preoperative assessments include those of the tibiotalar angle, offset, and adjacent areas of arthritis requiring additional surgical procedures. US, nuclear medicine studies, and MRI can be used to troubleshoot complications. Effective radiologic assessment requires an understanding of the component design and corresponding normal perioperative imaging features of ankle implants, as well as recognition of common and device-specific complications. General complications seen at radiography include aseptic loosening, osteolysis, hardware subsidence, periprosthetic fracture, infection, gutter impingement, heterotopic ossification, and syndesmotic nonunion. The authors review several recent generations of TAR implants commonly used in the United States, normal pre- and postoperative imaging assessment, and imaging complications of TAR. Indications for advanced imaging of TAR are also reviewed. ©RSNA, 2023 Supplemental material is available for this article. Test Your Knowledge questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Jason Ha
- From the Penn State College of Medicine, Hershey, PA (J.H., G.J., J.S.); Departments of Orthopaedics (M.A.) and Radiology (C.F., J.P.T.), Penn State Hershey Medical Center, 500 University Dr, HG300B, Hershey, PA 17033; and Geisinger Commonwealth School of Medicine, Scranton, PA (J.P.T.)
| | - Gavin Jones
- From the Penn State College of Medicine, Hershey, PA (J.H., G.J., J.S.); Departments of Orthopaedics (M.A.) and Radiology (C.F., J.P.T.), Penn State Hershey Medical Center, 500 University Dr, HG300B, Hershey, PA 17033; and Geisinger Commonwealth School of Medicine, Scranton, PA (J.P.T.)
| | - Jacob Staub
- From the Penn State College of Medicine, Hershey, PA (J.H., G.J., J.S.); Departments of Orthopaedics (M.A.) and Radiology (C.F., J.P.T.), Penn State Hershey Medical Center, 500 University Dr, HG300B, Hershey, PA 17033; and Geisinger Commonwealth School of Medicine, Scranton, PA (J.P.T.)
| | - Michael Aynardi
- From the Penn State College of Medicine, Hershey, PA (J.H., G.J., J.S.); Departments of Orthopaedics (M.A.) and Radiology (C.F., J.P.T.), Penn State Hershey Medical Center, 500 University Dr, HG300B, Hershey, PA 17033; and Geisinger Commonwealth School of Medicine, Scranton, PA (J.P.T.)
| | - Cristy French
- From the Penn State College of Medicine, Hershey, PA (J.H., G.J., J.S.); Departments of Orthopaedics (M.A.) and Radiology (C.F., J.P.T.), Penn State Hershey Medical Center, 500 University Dr, HG300B, Hershey, PA 17033; and Geisinger Commonwealth School of Medicine, Scranton, PA (J.P.T.)
| | - Jonelle Petscavage-Thomas
- From the Penn State College of Medicine, Hershey, PA (J.H., G.J., J.S.); Departments of Orthopaedics (M.A.) and Radiology (C.F., J.P.T.), Penn State Hershey Medical Center, 500 University Dr, HG300B, Hershey, PA 17033; and Geisinger Commonwealth School of Medicine, Scranton, PA (J.P.T.)
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Kihara S, Kanzaki N, Yamashita T, Yamamoto T, Nishida K, Nagai K, Araki D, Hoshino Y, Matsushita T, Kuroda R. Talar component subsidence correlates with periprosthetic osteolysis after total ankle arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2987-2993. [PMID: 36930269 PMCID: PMC10504111 DOI: 10.1007/s00590-023-03519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE This study aimed to investigate the relationship between periprosthetic osteolysis around the talar component and the amount of talar component subsidence after total ankle arthroplasty (TAA). METHODS This study included forty patients who underwent TAA with a mean follow-up of 67.5 ± 17.0 months. The patients were divided into two groups based on the amount of osteolysis around the talar component, as measured by computed tomography at the latest clinic visit: none to 2 mm (N group, n = 20) and greater than or equal to 2 mm (O group, n = 20). The average amount of talar component subsidence, clinical outcomes, and complications were compared between the two groups. In the O group, the correlation between osteolysis and talar component subsidence was evaluated. RESULTS The average talar component subsidence was significantly different between the N (0.22 ± 0.94 mm) and O groups (2.12 ± 2.28 mm). Five out of 20 ankles in the O group required revision surgery owing to talar component subsidence. The Japanese Society for Surgery of the Foot scores in the N and O groups were significantly different: 93.5 ± 7.7 and 85.3 ± 15.4, respectively. In the O group, we found that osteolysis tended to develop on the lateral side, and the amount of osteolysis was positively correlated with the talar component subsidence (r = 0.59, P = .007). CONCLUSION In the O group, a positive correlation between osteolysis and talar component subsidence was found, and five patients required revision surgery.
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Affiliation(s)
- Shinsuke Kihara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
- Department of Orthopaedic Surgery, Konan Medical Center, 1-5-16, Kamokogahara, Higashi Nada-Ku, Kobe, 658-0064, Japan.
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Takahiro Yamashita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Tetsuya Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
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Allport J, Ramaskandhan J, Alkhreisat M, Siddique MS. Ankle Arthroplasty-Does Preoperative Fixed Equinus Affect Patient-Reported Outcomes. J Foot Ankle Surg 2023; 62:893-898. [PMID: 37380121 DOI: 10.1053/j.jfas.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 06/30/2023]
Abstract
Postoperative sagittal range of motion, in particular degree of dorsiflexion, is critical for satisfactory outcomes in total ankle arthroplasty (TAA). Although there is literature discussing techniques to treat a preoperative fixed equinus we are not aware of any papers presenting patient outcomes. We present patient-reported outcomes for our cohort of patients undergoing TAA with preoperative fixed equinus compared to plantigrade ankles. This is a single surgeon, cohort study of consecutive cases. Cases of primary TAA were identified from a local joint registry which prospectively records Foot and Ankle Outcome Scores (FAOS), Short Form-36 (SF-36), and patient satisfaction. Revision cases or those with inadequate data were excluded. Patients were classified as fixed equinus or neutral based on both preoperative weightbearing lateral radiographs and clinical records. Overall 259 cases were identified, 92 were excluded leaving 167 cases for analysis (mean follow-up 81.7 months), 147 were classified as neutral and 20 fixed equinus. The fixed equinus group were significantly younger (neutral 63.9 vs equinus 52.9, p < .001). Stiffness was the only FAOS domain that was detectibly different at baseline (neutral 36.6 vs equinus 25.6, p = .044). Final FAOS scores, change from baseline and patient satisfaction was the same in all domains for both groups. There was no difference in revision rates. With the numbers available we did not demonstrate a postoperative difference in outcomes for patients with preoperative fixed equinus.
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Affiliation(s)
- Jack Allport
- Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK.
| | | | | | - Malik S Siddique
- Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK
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Kormi S, Koivu H, Kohonen I, Mäkelä K, Tiusanen H, Saltychev M. The ceramic coated implant (CCI). Evolution total ankle replacements: a retrospective analysis of 40 ankles with 8 years follow-up. Acta Orthop Belg 2023; 89:515-524. [PMID: 37935237 DOI: 10.52628/89.3.11585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Diminutive data is available on the outcome of several previously used total ankle replacement implants. The purpose of this study was to investigate the medium-term functional and radiological outcome and implant survival of the CCI Evolution implant. Consecutive series of 40 ankles operated in our hospital with primary TAR using the CCI Evolution implant in 2010-2013 were available for follow-up. The prospective clinical and radiographic data including the Kofoed score, subjective satisfaction and standard radiographs were collected preoperatively and at fixed time-points postoperatively. A CT was obtained in cases where osteolysis or loosening were suspected. The improvement of the Kofoed score and subjective satisfaction were statistically significant (p<0.0001). The implant survival was 97% (95% confidence interval (CI) 81%-100 %) at 5 years, and 81 % (95% confidence interval (CI) 60 %-92%) at 8 years. There were altogether 25 (64%) complications. Overall revision rate was 28% and failure rate 13%. The CCI implant outcome was not acceptable. The malposition of prosthetic components, subsidence, and peri-implant osteolysis were recorded often. Although the patient reported outcome measures improved, mostly due to positive changes in pain severity, overall revision and failure rates were high and comparable with previous findings of the CCI implant.
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Hybrid-Total Ankle Arthroplasty (H-TAA) for Failed Talar Component in Mobile-Bearing Total Ankle Arthroplasty. J Clin Med 2023; 12:jcm12051764. [PMID: 36902551 PMCID: PMC10003300 DOI: 10.3390/jcm12051764] [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: 01/16/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION Revision Total Ankle Arthroplasty (TAA) surgery due to TAA aseptic loosening is increasing. It is possible to exchange the talar component and inlay to another system for isolated talar component loosening in a primary mobile-bearing TAA: Hybrid-Total Ankle Arthroplasty (H-TAA). The purpose of this study was to analyze the results of the revision surgery of an isolated aseptic talar component loosening in a mobile-bearing three-component TAA with a H-TAA solution. METHODS In this prospective case study, nine patients (six women, three men; mean age 59.8 years; range 41-80 years) with symptomatic isolated aseptic loosening of the talar component of a mobile-bearing TAA were treated with an isolated talar component and inlay substitution. In all nine cases, a hybrid TAA revision surgery was performed by implanting a VANTAGE TAA talar and insert component (Flatcut talar component: six cases, standard talar component: three cases). The patients were reviewed with the pain score (VAS Pain Score 0-10), Dorsiflexion/Plantarflexion (DF/PF) Range of Motion (ROM; degrees), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0-100 points), Sports Frequency Score (Level 0-4), and subjective Patients' Satisfaction Score (0-10 points). RESULTS The average Pain score improved significantly from preoperative 6.7 points to postoperative 1.1 points (p < 0.001). Average Dorsiflexion/Plantarflexion ROM values increased significantly post-surgery: 21.7° preoperative to 45.6° postoperative (p < 0.001). The postoperative AOFAS scores were significantly greater than the preoperative values: 47.7 points preoperative, 92.3 points postoperative (p < 0.001). The sports activity improved from preoperative to postoperative where, preoperative, none of the patients were able to perform sports. Postoperative, eight patients were able to be sports-active again. The overall average postoperative level of sports activity was 1.4. The postoperative average patient's satisfaction was 9.3 points. CONCLUSIONS In painful talar component aseptic loosening of a three-component mobile-bearing TAA, H-TAA is a good surgical solution for reducing pain, restoring ankle function, and improving patients' life quality.
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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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Kim J, Rajan L, Bitar R, Caolo K, Fuller R, Henry J, Deland J, Ellis SJ, Demetracopoulos C. Early Radiographic and Clinical Outcomes of a Novel, Fixed-Bearing Fourth-Generation Total Ankle Replacement System. Foot Ankle Int 2022; 43:1424-1433. [PMID: 35919955 DOI: 10.1177/10711007221115185] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Cadence Total Ankle System is a 2-component, fixed-bearing fourth-generation total ankle arthroplasty (TAA) system that was introduced for clinical use in 2016. The purpose of this study was to report non-inventor, non-industry funded survivorship, radiographic and clinical outcomes, and early complications following use of this implant at a minimum of 2 years. METHODS This single-center retrospective study included patients who underwent TAA by 2 surgeons with this novel fixed-bearing system between January 2017 and September 2018. Forty-eight patients were evaluated at an average of 33.6 months. Radiographic outcomes included preoperative and postoperative tibiotalar angle on anteroposterior radiographs of the ankle, sagittal tibial angle (STA) on lateral radiographs of the ankle, and periprosthetic lucency formation and location. Revision and reoperation data were collected, and patient-reported outcomes were assessed using Patient Reported Outcomes Measurement Information System (PROMIS). Subgroup analysis assessed associations between preoperative deformity, postoperative implant alignment, PROMIS scores, and periprosthetic lucency formation. RESULTS Survivorship of implant was 93.7%, with 3 revisions, 1 due to infection and 2 due to loosening of the implant (1 tibial and 1 talar component). Three patients had reoperations (6.3%): 2 for superficial infection and 1 for gutter debridement due to medial gutter impingement. Fifteen patients (35.8%) developed periprosthetic lucencies, all on the tibial side. PROMIS scores improved after surgery in all domains except Depression. Patients with significant postoperative periprosthetic lucency had worse postoperative PROMIS Physical function scores than patients without lucency (P < .05). CONCLUSION This study demonstrated excellent minimum 2-year clinical and radiographic outcomes and low revision and reoperation rates of this new fourth-generation TAA system. Future studies with longer follow-up, especially on patients with periprosthetic lucency, are necessary to investigate the long-term complications and understand the long-term functional and radiographic outcomes of this implant.
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Affiliation(s)
- Jaeyoung Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Lavan Rajan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Rogerio Bitar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kristin Caolo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Robert Fuller
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jensen Henry
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan Deland
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Yoon YK, Park KH, Park JH, Lee W, Han SH, Lee JW. Long-Term Clinical Outcomes and Implant Survivorship of 151 Total Ankle Arthroplasties Using the HINTEGRA Prosthesis: A Minimum 10-Year Follow-up. J Bone Joint Surg Am 2022; 104:1483-1491. [PMID: 35726878 DOI: 10.2106/jbjs.22.00060] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have investigated long-term clinical outcomes of a mobile-bearing total ankle arthroplasty (TAA) system. This study analyzed long-term outcomes of TAA using the HINTEGRA prosthesis at a single, non-developer center. METHODS Primary TAAs were performed on 213 ankles in 194 patients, and 151 consecutive ankles [71%] in 136 patients with a minimum follow-up of 10 years after the primary TAA were included in this study. Clinical results were assessed using a visual analog scale (VAS) pain score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale score, the Ankle Osteoarthritis Scale (AOS) pain and disability subscores, and ankle range of motion. Prosthesis survivorship, reoperations, and risk factors were also evaluated. RESULTS The mean follow-up was 135.5 months (range, 120.0 to 204.0 months). All clinical scores and ankle range of motion improved significantly from preoperatively to 2 years, 4 to 6 years, and ≥10 years after TAA (p < 0.001). A total of 43 ankles (28.5%) required revision procedures, with the most common reason being periprosthetic osteolysis (32 ankles [21.2%]). The overall implant survivorship was 93.5% in Kaplan-Meier survival analysis at the mean follow-up of 11.3 years after the TAA. CONCLUSIONS TAA using the HINTEGRA prosthesis with careful follow-up observation and appropriate adjunct procedures for the treatment of end-stage ankle arthritis produced satisfactory clinical results, which were maintained at a follow-up of ≥10 years, and resulted in 93.5% of implant survivorship. LEVEL OF EVIDENCE Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yeo Kwon Yoon
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang Hwan Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Han Park
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Wonwoo Lee
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Lee GW, Lee KB. Periprosthetic Osteolysis as a Risk Factor for Revision After Total Ankle Arthroplasty: A Single-Center Experience of 250 Consecutive Cases. J Bone Joint Surg Am 2022; 104:1334-1340. [PMID: 35930380 DOI: 10.2106/jbjs.21.01093] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic osteolysis after total ankle arthroplasty (TAA) is a challenging problem. This study aimed to evaluate the prevalence of and predisposing factors for osteolysis and its effects on clinical outcomes. METHODS We enrolled 236 patients (250 ankles) who underwent primary TAA using a mobile-bearing HINTEGRA prosthesis, with a mean follow-up of 83.5 months (range, 36 to 182 months), and subsequently divided them into 2 groups: the osteolysis group (79 ankles) and non-osteolysis group (171 ankles). Clinical and radiographic outcomes were compared between the 2 groups, and a bivariable logistic regression analysis was performed to identify predisposing factors for the development of osteolysis. RESULTS In the osteolysis group (31.6% of the 250 ankles), the mean time of detection was 28.8 months postoperatively. Forty of these ankles were closely monitored without surgical treatment. Another 29 ankles underwent bone grafting and exchange of the polyethylene inlay, and the remaining 10 ankles underwent revision TAA or arthrodesis. All clinical outcome variables were significantly lower in patients with osteolysis, compared with those without osteolysis, at the final follow-up (p < 0.05). In the investigation of predisposing factors, only rheumatoid arthritis was identified as having a significant association with an increased prevalence of osteolysis (p = 0.030). CONCLUSIONS This study demonstrated that the prevalence of periprosthetic osteolysis after TAA was considerable and that the development of osteolysis negatively affected the clinical outcome. Therefore, the prevention and appropriate treatment of osteolysis are crucial for the satisfactory long-term survival of TAA. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Gun-Woo Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
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12
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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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13
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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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14
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Cercone M, Chevalier J, Kennedy JG, Miller AD, Fortier LA. Early Failure of a Polyvinyl Alcohol Hydrogel Implant With Osteolysis and Foreign Body Reactions in an Ovine Model of Cartilage Repair. Am J Sports Med 2021; 49:3395-3403. [PMID: 34424105 DOI: 10.1177/03635465211033601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hemiarthroplasty using a polyvinyl alcohol (PVA) hydrogel synthetic implant has been suggested as a good alternative to arthrodesis for the treatment of hallux rigidus. However, failure rates as high as 20% have been recorded. PURPOSE To characterize the pathological processes in bone, cartilage, and the synovial membrane after PVA hemiarthroplasty in an ovine model with 6 months of follow-up. STUDY DESIGN Controlled laboratory study. METHODS A unilateral osteochondral defect (8-mm diameter × 10-mm depth) was made in the medial femoral condyle in 6 sheep. Animals were randomized to receive a PVA implant (n = 4) or to have an empty defect (n = 2) and were monitored for 6 months. Patellofemoral radiographs were obtained at monthly intervals, and quantitative computed tomography was performed at the end of the study. After death, the joints were macroscopically evaluated and scored. Osteochondral and synovial membrane histological findings were assessed using modified Osteoarthritis Research Society International (OARSI) and aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) scoring systems. Immunohistochemistry using Iba1 was performed to evaluate activated macrophage infiltration. RESULTS Overall, 2 sheep with PVA implants were euthanized at 1 and 5 months because of uncontrollable pain and lameness (failed implants). Quantitative computed tomography showed that sheep with failed implants had 2.1-fold more osteolysis than those with successful implants. The sheep with failed implants had osteoarthritis with extensive glycosaminoglycan loss and cartilage fibrillation of the condyle and opposing tibial surface on histological examination. A foreign body reaction with severe chronic lymphoplasmacytic and granulomatous inflammation with giant cells was detected surrounding the implant. The synovial membrane ALVAL score was 9 of 19 and 14 of 19 in failed implants with synovial hyperplasia and lymphoplasmacytic and macrophage infiltration. In contrast, the synovial membrane in successful implants and empty defects was normal (ALVAL score = 0/19). Immunolabeling for Iba1 in failed implants confirmed extensive and dense macrophage infiltration within the condyle and synovial membrane, with the highest immunoreactive score (9/9). CONCLUSION PVA hydrogel implants had a 50% failure rate with uncontrollable pain, severe osteolysis, inflammation, and foreign body reactions. CLINICAL RELEVANCE The failure rate and pathological characteristics of the PVA implants suggest that their use should not be continued in human patients without further in vivo safety studies.
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Affiliation(s)
- Marta Cercone
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Jacqueline Chevalier
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - John G Kennedy
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Andrew D Miller
- Section of Anatomic Pathology, Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Lisa A Fortier
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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15
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Clifton LJ, Kingman A, Rushton PRP, Murty A, Kakwani R, Coorsh J, Townshend DN. The Hintegra total ankle replacement: survivorship, failure modes and patient reported outcomes in seventy consecutive cases with a minimum five year follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:2331-2336. [PMID: 34143253 DOI: 10.1007/s00264-021-05071-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The Hintegra total ankle replacement (TAR) has been widely used worldwide for ankle arthroplasty since its introduction in 2000. The implant survivorship, patient reported outcomes, rate of periprosthetic cyst formation and reoperation rates are variably reported. The purpose of this study is to determine the functional outcomes and survivorship of the Hintegra TAR, in consecutive cases by multiple surgeons in a single UK institution, with a minimum of five year follow-up. METHODS A retrospective review of prospectively collected data for 70 consecutive Hintegra TAR cases performed between 2010 and 2014. Data collected included patient demographics, complications, reoperations, revisions and patient reported outcome measures (PROMS: AOS, MOX-FQ, pain VAS and EQ-5D 3L). RESULTS Seventy patients underwent Hintegra TAR (54 male/16 female) with an average age of 69 (range 48-84 years). Mean follow up was 76 months (range 60-104), 10 patients died during the follow-up. Implant survivorship was 81.7% at most recent follow-up. The commonest radiographic finding was periprosthetic cysts (n = 28, 40%): size range (7-40 mm). Nine patients required re-operation: six periprosthetic cyst debridement and grafting at a mean of 61 months (range 27-91), one lateral gutter debridement, one periprosthetic fracture and one debridement for deep infection. PROMS data was available for the majority of patients. Mean final follow-up scores were total AOS 35 (range: 0-97), MOX-FQ 36 (range: 2-93), pain VAS 34.6 (range: 0-100) and EQ-5D 3L Index 0.69 (range: 0.08-1.00). CONCLUSION Our experience demonstrates implant survivorship similar to other TAR studies. We have identified a high incidence of periprosthetic cysts and would recommend ongoing surveillance of these patients.
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Affiliation(s)
- Laura J Clifton
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK.
| | - Anji Kingman
- Hexham General Hospital, Corbridge Road, Hexham, NE46 1QJ, UK
| | - Paul R P Rushton
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - An Murty
- Wansbeck General Hospital, Woodhorn Lane, Ashington, NE63 9JJ, UK
| | - Rajesh Kakwani
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - Jonathan Coorsh
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
| | - David N Townshend
- North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK
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16
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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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17
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Allport J, Ramaskandhan J, Alkhreisat M, Siddique MS. Patient-Reported Outcome Measures and Radiological Outcomes in Mobile-Bearing Total Ankle Arthroplasty With Varus or Valgus Deformity. Foot Ankle Int 2021; 42:176-182. [PMID: 32830589 DOI: 10.1177/1071100720949852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is increasing evidence that varus deformity does not negatively affect total ankle arthroplasty (TAA) outcomes, but there is a sparsity of evidence for valgus deformity. We present our outcomes using a mobile-bearing prosthesis for neutral, varus, and valgus ankles. METHODS This is a retrospective cohort study of consecutive cases identified from a local joint registry. In total, 230 cases were classified based on preoperative radiographs as neutral (152 cases), varus greater than 10 degrees (60 cases), or valgus greater than 10 degrees (18 cases). Tibiotalar angle was again measured postoperatively and at final follow-up (mean follow-up of 55.9 months). A total of 164 cases had adequate patient-reported outcome measures data (Foot and Ankle Outcome Score, Short Form-36 [SF-36] scores, and patient satisfaction) for analysis (mean follow-up of 61.6 months). The groups were similar for body mass index and length of follow-up, but neutral ankles were younger (P = .021). RESULTS Baseline scores were equal except SF-36 physical health, with valgus ankles scoring lowest (P = .045). Valgus ankles had better postoperative pain (P = .025) and function (P = .012) than neutral. Pre- to postoperative change did not reach statistical significance except physical health, in which valgus performed best (P = .039). Mean final angle for all groups was less than 5 degrees. There was no significant difference in revision rates. CONCLUSION Our study is consistent with previous evidence that varus deformity does not affect outcome in TAA. In addition, in our cohort, outcomes were satisfactory with valgus alignment. Postoperative coronal radiological alignment was affected by preoperative deformity but within acceptable limits. Coronal plane deformity did not negatively affect radiological or clinical outcomes in TAA. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Jack Allport
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | | | - Malik S Siddique
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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18
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Behrens SB, Irwin TA, Bemenderfer TB, Schipper ON, Odum SM, Anderson RB, Davis WH. Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary-Referencing Implant. Foot Ankle Int 2020; 41:1510-1518. [PMID: 32795097 DOI: 10.1177/1071100720947036] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of failed total ankle arthroplasty (TAA) is challenging. Limited literature is available on options and outcomes of revision arthroplasty despite failure rates ranging from 10% to 23% within 10 years after primary TAA. This study reports the clinical and radiographic outcomes of revision TAA using a fixed-bearing, intramedullary-referencing implant. METHODS A retrospective review was performed of 18 consecutive revision TAA cases between 2008-2015 using an intramedullary-referencing, fixed-bearing, 2-component total ankle system. Demographic and radiographic data were collected preoperatively, immediately postoperatively, and at the most recent follow-up. Functional outcome data were collected immediately postoperatively and at mean follow-up 47.5 months. RESULTS Eighteen patients underwent revision TAA, with 77.8% (14/18) implant survival. Index revision was performed most commonly for aseptic talar subsidence (55.6%) or implant loosening (tibia, 29.4%; talus, 58.9%). Following revision, 22.2% (4/18) patients required reoperation at a mean 57.3 (39-86) months. Osteolysis of the tibia, talus, and fibula was present preoperatively in 66.7% (12/18), 38.9% (7/18), and 38.9% (7/18) of patients, respectively, with progression of osteolysis in 27.8% (5/18), 11.1% (2/18) and 11.1% (2/18) of patients, respectively. Subsidence of the tibial and talar revision components was observed in 38.9% (7/18) and 55.6% (10/18) of patients, respectively. The median American Orthopaedic Foot & Ankle Society (AOFAS) score was 74.5 (26-100) and Foot Function Index (FFI) score 10.2 (0-50.4). CONCLUSION Early results of intramedullary-referencing revision TAA demonstrated good patient-reported outcomes with maintenance of radiographic parameters at mean follow-up of 47.5 months. Aseptic talar subsidence or loosening were the main postoperative causes of reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant was a viable option for the failed TAA. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Todd A Irwin
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
| | | | | | - Susan M Odum
- Atrium Health, Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Robert B Anderson
- Bellin Health, Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin
| | - W Hodges Davis
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
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19
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Gurbani A, Demetracopoulos C, O'Malley M, Deland J, Cody E, Sofka C, Scharf S, Ellis S. Correlation of Single-Photon Emission Computed Tomography Results With Clinical and Intraoperative Findings in Painful Total Ankle Replacement. Foot Ankle Int 2020; 41:639-646. [PMID: 32156161 DOI: 10.1177/1071100720909357] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Evaluating pain after total ankle replacement (TAR) is often difficult, and traditional imaging modalities do not always adequately assess potential etiologies of failure. Our study adds to the current understanding of single-photon emission computed tomography combined with conventional computed tomography (SPECT-CT) as a diagnostic tool for painful TAR. We hypothesized that SPECT-CT would be predictive of clinical and intraoperative findings and would be more useful than magnetic resonance imaging (MRI) in our cohort. METHODS A retrospective review of SPECT-CT imaging performed at our institution in patients with painful TAR from January 2014 to November 2018 was conducted. A total of 37 patients were identified, and 28 of them underwent revision surgery. Additionally, 19 patients had an MRI during the same time frame. Imaging results were compared to the documented clinical findings and intraoperative findings during revision surgery. RESULTS Of the 37 patients included, 89.2% (33/37) had SPECT-CT results that were consistent with the ultimate diagnosis documented in the medical record. Aseptic loosening (12/33) and impingement (11/33) were the most common diagnoses. Among patients who underwent revision surgery, SPECT-CT results were consistent with intraoperative findings in 26 of the 28 (92.9%) cases. In the 19 patients who also underwent MRI, the findings were consistent with clinical findings 36.8% (7/19) of the time. CONCLUSION In our cohort, there was high consistency between SPECT-CT results and documented clinical diagnoses. SPECT-CT also demonstrated high consistency with intraoperative findings during revision surgery. Compared with MRI, SPECT-CT proved more useful in establishing a diagnosis of pain after TAR. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
- Ajay Gurbani
- University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | | | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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20
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Serino J, Kunze KN, Jacobsen SK, Morash JG, Holmes GB, Lin J, Lee S, Hamid KS, Bohl DD. Nuclear Medicine for the Orthopedic Foot and Ankle Surgeon. Foot Ankle Int 2020; 41:612-623. [PMID: 32141327 DOI: 10.1177/1071100720910422] [Citation(s) in RCA: 9] [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
Nuclear medicine has been widely applied as a diagnostic tool for orthopedic foot and ankle pathology. Although its indications have diminished with improvements in and the availability of magnetic resonance imaging, nuclear medicine still has a significant and valuable role. The present article offers a comprehensive and current review of the most common nuclear imaging modalities for the orthopedic foot and ankle surgeon. Methods discussed include bone scintigraphy, gallium citrate scintigraphy, labeled-leukocyte scintigraphy, and single-photon emission computed tomography (SPECT). We review the indications and utility of these techniques as they pertain to specific foot and ankle conditions, including osteomyelitis, stress fractures, talar osteochondral lesions, complex regional pain syndrome, oncology, plantar fasciitis, and the painful total ankle arthroplasty. We conclude with a discussion of our approach to nuclear medicine with illustrative cases. Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kyle N Kunze
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Stephen K Jacobsen
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joel G Morash
- Department of Orthopaedic Surgery, Dalhouse University, Halifax, Nova Scotia, Canada
| | - George B Holmes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Johnny Lin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- 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
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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21
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Tiusanen H, Kormi S, Kohonen I, Saltychev M. Results of Trabecular-Metal Total Ankle Arthroplasties With Transfibular Approach. Foot Ankle Int 2020; 41:411-418. [PMID: 31868017 DOI: 10.1177/1071100719894929] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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 is an alternative for arthrodesis. The objective of this study was to investigate the safety of trabecular-metal ankle prosthetic system with transfibular approach and external frame and its association with changes in clinical and functional scores. METHODS Between May 2013 and June 2017, a total of 104 consecutive patients underwent primary total ankle arthroplasty with a trabecular metal implant. The prospective clinical and radiographic data were collected. The mean follow-up time was 43.6 (14.6) months. RESULTS Of 104 patients, 88 (89%) reported improved functioning and 65 (66%) were very satisfied with the surgery. Of the patients, 51 (50%) did not report any pain at the end of follow-up at all. The average Kofoed score was 37.6 (SD 17.4) points at baseline and 74.8 (SD 20.6) points at the end of follow-up. There were 37 additional procedures, and the complication rate was nearly 20%. CONCLUSION Trabecular-metal total ankle prosthesis showed promising clinical results concerning pain and function. At 5-year follow-up, osteolysis and component loosening were rare. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Sami Kormi
- Tyks Orto, Turku University Hospital, Turku, Finland
| | - Ia Kohonen
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
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22
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Escudero MI, Symes M, Bemenderfer TB, Barahona M, Anderson R, Davis H, Wing KJ, Penner MJ. Does Patient-Specific Instrumentation Have a Higher Rate of Early Osteolysis Than Standard Referencing Techniques in Total Ankle Arthroplasty? A Radiographic Analysis. Foot Ankle Spec 2020; 13:32-42. [PMID: 30757922 DOI: 10.1177/1938640019828069] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Patient-specific instrumentation (PSI) has been developed for total ankle arthroplasty (TAA), with proven benefits. One concern regarding PSI is the need for more soft tissue dissection in order to accurately position the PSI guides, which has the theoretical disadvantage of increased osteolysis. The purpose of our study is to compare the incidence and magnitude of osteolysis for the INFINITY Total Ankle System between PSI and standard referencing (SR) techniques. Methods: Sixty-seven patients who underwent primary TAA using Prophecy (PSI) or SR technique between 2013 and 2015 were reviewed in a retrospective observational study. Osteolysis was assessed on radiographs at 2 years. The incidence was calculated by binomial distribution. The number of zones compromised and the magnitude of osteolysis was calculated using the median as a summary statistic and interquartile range as dispersion statistic. Fisher exact test was used to compare both groups, then a regression model was estimated to calculate the odds ratio for osteolysis. Results: Of the 67 TAAs, 51 were in the PSI group and 16 in the SR group. In the PSI group the incidence, number of compromised zones (CZ), and magnitude was 41% (25%-59%), 1 [1-2], and 2 [2-3], respectively. In the SR group these were 36% (13%-65%), 3 [2-3], and 3 [2-4], respectively. No significant differences were found (P = .46, P = .12, P = .33). A slightly higher risk of osteolysis was found in the PSI group (odds ratio = 1.33 [0.36-4.83]) (P = .46). The majority of lesions were in 1 zone with size of 2 to 5 mm (63% for all cohort, 64% PSI, 60% SR). Two cases underwent revision for aseptic loosening, 1 in the SR group and 1 in the PSI group. Conclusion: According to our data, there is no significant difference between PSI and SR in terms of risk, incidence, size and magnitude of osteolysis in the INFINITY Total Ankle System at 2 years. Levels of Evidence: Therapeutic, Level III, Retrospective cohort study.
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Affiliation(s)
- Mario I Escudero
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (MIE, MS, KJW, MJP).,Orthocarolina Foot and Ankle Institute, Charlotte, North Carolina (TBB, RA, HD).,Department of Orthopaedics, University of Chile, Santiago, Chile (MIE, MB)
| | - Michael Symes
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (MIE, MS, KJW, MJP).,Orthocarolina Foot and Ankle Institute, Charlotte, North Carolina (TBB, RA, HD).,Department of Orthopaedics, University of Chile, Santiago, Chile (MIE, MB)
| | - Thomas Bradford Bemenderfer
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (MIE, MS, KJW, MJP).,Orthocarolina Foot and Ankle Institute, Charlotte, North Carolina (TBB, RA, HD).,Department of Orthopaedics, University of Chile, Santiago, Chile (MIE, MB)
| | - Maximiliano Barahona
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (MIE, MS, KJW, MJP).,Orthocarolina Foot and Ankle Institute, Charlotte, North Carolina (TBB, RA, HD).,Department of Orthopaedics, University of Chile, Santiago, Chile (MIE, MB)
| | - Robert Anderson
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (MIE, MS, KJW, MJP).,Orthocarolina Foot and Ankle Institute, Charlotte, North Carolina (TBB, RA, HD).,Department of Orthopaedics, University of Chile, Santiago, Chile (MIE, MB)
| | - Hodges Davis
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (MIE, MS, KJW, MJP).,Orthocarolina Foot and Ankle Institute, Charlotte, North Carolina (TBB, RA, HD).,Department of Orthopaedics, University of Chile, Santiago, Chile (MIE, MB)
| | - Kevin J Wing
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (MIE, MS, KJW, MJP).,Orthocarolina Foot and Ankle Institute, Charlotte, North Carolina (TBB, RA, HD).,Department of Orthopaedics, University of Chile, Santiago, Chile (MIE, MB)
| | - Murray J Penner
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (MIE, MS, KJW, MJP).,Orthocarolina Foot and Ankle Institute, Charlotte, North Carolina (TBB, RA, HD).,Department of Orthopaedics, University of Chile, Santiago, Chile (MIE, MB)
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23
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Metal artifact reduction MRI for total ankle replacement sagittal balance evaluation. Foot Ankle Surg 2019; 25:739-747. [PMID: 30385108 DOI: 10.1016/j.fas.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 08/23/2018] [Accepted: 09/26/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Restoration of anatomical relationship between talus and tibia is crucial for longevity of total ankle replacement (TAR). Weight-bearing (WB) radiographs are the standard for evaluating the sagittal balance alignment, but are prone to rotational misalignment and altered measurements. Metal artifact reduction sequence (MARS) MRI allows visualization of periprosthetic landmarks and alignment of the image plane to the true sagittal axis of the implant. The purpose of this study was to compare TAR sagittal balance measurements on MARS MRI and WB radiographs. METHODS Twenty-three subjects with TAR [10 men/13 women, age 60 (41-73) years; 13 (3-24) months post-op] underwent MARS MRI and standard lateral WB radiographs. Standardized MARS MR images were aligned to the sagittal talar component axis. Three observers performed sagittal balance alignment measurements twice in an independent, random and blinded fashion. Lateral Talar Station (LTS), tibial axis-to-talus (T-T) ratio and normalized tibial axis-to-lateral-process (T-L) distance were measured. Concordance correlation coefficients (CCC) and intraclass correlation coefficients (ICC) were used for statistical analysis. In addition, mixed effects linear models were employed to assess overall concordance of the two image types. RESULTS The intraobserver agreement was excellent for radiographic (CCC=0.96) and MRI (CCC=0.90-0.97) measurements. Interobserver agreements were good-to-excellent with overall slightly higher agreements for MRI (ICC=0.78-0.94) than radiography (ICC=0.78-0.90) measurements. The T-T ratios of radiographs and MRI showed a high degree of concordance, whereas LTS was significantly lower on MRI when compared with radiographs, and T-L distance showed notable disagreement between the two imaging types. CONCLUSION Sagittal balance measurements performed on standardized weight-bearing radiographs and standardized MARS MRI demonstrate substantial correlation and similarity. Given its high intra and interobserver agreement, MARS MRI may be helpful for the evaluation of TAR sagittal balance. LEVEL OF EVIDENCE Level II - Prospective Comparative Study.
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Arcângelo J, Guerra-Pinto F, Pinto A, Grenho A, Navarro A, Martin Oliva X. Peri-prosthetic bone cysts after total ankle replacement. A systematic review and meta-analysis. Foot Ankle Surg 2019; 25:96-105. [PMID: 29409184 DOI: 10.1016/j.fas.2017.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/01/2017] [Accepted: 11/15/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Periprosthetic cystic osteolysis is a well-known complication of total ankle replacement. Several theories have been proposed for its aetiology, based on individual biomechanical, radiological, histopathology and outcome studies. METHODS Studies that met predefined inclusion/exclusion criteria were analysed to identify literature describing the presence of peri-prosthetic ankle cystic osteolysis. Quantitative data from the selected articles were combined and statistically tested in order to analyse possible relations between ankle peri-prosthetic bone cysts and specific implant characteristics. RESULTS Twenty-one articles were elected, totalizing 2430 total ankle replacements, where 430 developed peri-prosthetic cystic osteolysis. A statistically significant association (P<.001) was found between the presence of bone cysts and non-anatomic implant configuration, hydroxyapatite-coating, mobile-bearing and non tibial-stemmed implants. No significant association existed between the type of constraining and the presence of cysts (P>.05). CONCLUSIONS Non-anatomic, mobile-bearing, hydroxyapatite-coated and non tibial-stemmed total ankle replacements are positively associated with more periprosthetic bone cysts.
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Affiliation(s)
- Joana Arcângelo
- Orthopedic Surgery Department, Hospital Curry Cabral - Centro Hospitalar Lisboa Central, Lisboa, Portugal.
| | | | - André Pinto
- Orthopedic Surgery Department, Centro Hospitalar de Coimbra, Coimbra, Portugal.
| | - André Grenho
- Orthopedic Surgery Department, Hospital Curry Cabral - Centro Hospitalar Lisboa Central, Lisboa, Portugal.
| | - Alfons Navarro
- Human Anatomy and Embryology Unit, School of Medicine, University of Barcelona, Spain.
| | - Xavier Martin Oliva
- Human anatomy Unit, School of Medicine, University of Barcelona, Foot and Ankle Unit, Clinica del Remei, Barcelona, Spain.
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Comparison of 25 ankle arthrodeses and 25 replacements at 67 months' follow-up. Orthop Traumatol Surg Res 2019; 105:139-144. [PMID: 30573399 DOI: 10.1016/j.otsr.2018.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 09/25/2018] [Accepted: 10/18/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In the treatment of osteoarthritis of the ankle, controversy persists between advocates of arthrodesis and of joint replacement. HYPOTHESIS Results of total ankle replacement (TAR) are equivalent to those of ankle arthrodesis (AA). MATERIAL AND METHODS A single-center continuous retrospective series included 50 patients (25 TAR, 25 AA) operated on by a single surgeon. TAR used the standard Salto® mobile-bearing prosthesis, and arthrodesis used screws or plates. Results were assessed clinically on AOFAS score, visual analog scale (VAS) and satisfaction questionnaire, and radiologically on X-ray and CT. Survivorship in the 2 procedures was estimated on the Kaplan Meier method. RESULTS At a mean 67 months' follow-up (range, 40-105 months), mean AOFAS and VAS scores were significantly better in the AA group (74.1 and 1.9, respectively) than in the TAR group (67 and 3.5, respectively) (p<0.001). In the AA group, 80% of patients were satisfied or very satisfied, compared to 64% after TAR. Five-year survival without revision for non-union (AA) or implant removal (TAR) was similar between groups: AA, 96%; TAR, 90% (p=0.72). In contrast, survival with no revision procedures was significantly better with AA (96%) than TAR (75%) (p=0.03). DISCUSSION At 5 years, surgical revision rates were significantly greater than after standard Salto® mobile-bearing TAR than for arthrodesis, notably due to onset of cysts; we therefore decided to abandon this implant. LEVEL OF EVIDENCE IV, comparative retrospective study.
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Koivu H, Kohonen I, Mattila K, Loyttyniemi E, Tiusanen H. Long-term Results of Scandinavian Total Ankle Replacement. Foot Ankle Int 2017; 38:723-731. [PMID: 28535724 DOI: 10.1177/1071100717698695] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the long-term results of the Scandinavian Total Ankle Replacement (STAR) implant in a single center. METHODS Between 1997 and 2002, 34 consecutive ankles were replaced with the STAR ankle prosthesis and reviewed in 2016. Patients were followed both radiologically and clinically; clinical outcomes were measured with the Kofoed ankle score and subjective measurements. The median follow-up period was 159 months (13.3 years; range, 13-202 months). RESULTS The implant survival rate was 93.9% (95% confidence interval [CI], 92.2%-86.7%) at 5 years, 86.7% (95% CI, 69.3%-96.2%) at 10 years, and 63.6% (95% CI, 30.8%-89.0%) at 15 years. A total of 15 ankles (44%) had been revised: 2 by fusion, 3 by further replacement, 5 by insert exchange, and 5 by bone grafting for marked osteolysis. The improvements in the Kofoed ankle score and Kofoed ankle score for pain were statistically significant at every postoperative evaluation point compared to the preoperative values (all P < .0001), and subjective patient satisfaction was high. CONCLUSION Our results were satisfactory and in agreement with previously reported findings of STAR implants. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Helka Koivu
- 1 Hospital Terveystalo Pulssi, Turku, Finland
| | - Ia Kohonen
- 2 Medical Imaging Centre of Southwest Finland, Turku, Finland
| | - Kimmo Mattila
- 2 Medical Imaging Centre of Southwest Finland, Turku, Finland
| | | | - Hannu Tiusanen
- 4 Department of Orthopaedics, Turku University Hospital, Turku, Finland
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Abstract
Aseptic loosening of implants remains the most common reason for revision surgery for hip, knee, or ankle prostheses. Although a great scientific effort has been made to explain the underlying mechanisms it remains poorly understood, complex, and multifactorial. Many factors, including age, body weight, activity lesions, implant design, fixation methods, material proprieties, immunologic responses, and biomechanical adaptations to total ankle replacement all contribute to the development of periprosthetic osteolysis.
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Affiliation(s)
- Norman Espinosa
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
| | - Georg Klammer
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland
| | - Stephan H Wirth
- Department of Orthopaedics, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
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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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Alrashidi Y, Galhoum AE, Wiewiorski M, Herrera-Pérez M, Hsu RY, Barg A, Valderrabano V. How To Diagnose and Treat Infection in Total Ankle Arthroplasty. Foot Ankle Clin 2017; 22:405-423. [PMID: 28502355 DOI: 10.1016/j.fcl.2017.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Periprosthetic infection after total ankle arthroplasty (TAA) is a serious complication, often requiring revision surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. Risk factors for periprosthetic ankle infection include prior surgery at the site of infection, low functional preoperative score, diabetes, and wound healing problems. The clinical presentation of patients with periprosthetic ankle joint infection can be variable and dependent on infection manifestation: acute versus chronic. The initial evaluation in patients with suspected periprosthetic joint infections should include blood tests: C-reactive protein and erythrocyte sedimentation rate. Joint aspiration and synovial fluid analysis can help confirm suspected periprosthetic ankle infection.
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Affiliation(s)
- Yousef Alrashidi
- Orthopaedic Department, College of Medicine, Taibah University, P.O. Box 30001, Almadinah Almunawwarah 41411, Kingdom of Saudi Arabia
| | - Ahmed E Galhoum
- Nasser Institute for Research and Treatment, Cairo, Egypt; Department of Orthopaedics and Traumatology, Swiss Ortho Center, Schmerzklinik Basel, Hirschgässlein 15, Basel 4010, Switzerland
| | - Martin Wiewiorski
- Orthopaedic and Trauma Department, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Mario Herrera-Pérez
- Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Calle El Pilar 50 4 piso, 38002 Tenerife, Spain
| | - Raymond Y Hsu
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Victor Valderrabano
- Orthopaedic Department, Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, Basel 4010, Switzerland.
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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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31
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Kerkhoff YRA, Kosse NM, Metsaars WP, Louwerens JWK. Long-term Functional and Radiographic Outcome of a Mobile Bearing Ankle Prosthesis. Foot Ankle Int 2016; 37:1292-1302. [PMID: 27540011 DOI: 10.1177/1071100716661477] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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 is an accepted alternative to arthrodesis of the ankle. However, complication and failure rates remain high. Long-term results of the Scandinavian Total Ankle Replacement (STAR) are limited, with variable complication and failure rates observed. This prospective study presents the long-term survivorship and postoperative complications of the STAR prosthesis. METHODS Between May 1999 and June 2008, 134 primary total ankle arthroplasties were performed using the STAR prosthesis in 124 patients. The survivorship, postoperative complications, and reoperations were recorded, with a minimum follow-up period of 7.5 years. Clinical results were assessed using the Foot Function Index and the Kofoed score. The presence of component migration, cysts, and radiolucency surrounding the prosthesis components, heterotopic ossification, and progression of osteoarthritis in adjacent joints were determined. RESULTS The cumulative survival was 78% after the 10-year follow-up period. An ankle arthrodesis was performed in 20 ankles (14.9%) that failed. Fourteen polyethylene insert fractures occurred (10.4%). Other complications occurred in 29 ankles (21.6%), requiring secondary procedures in 21 ankles (15.7%). Nevertheless, the postoperative clinical results improved significantly. Osteolytic cysts were observed in 61 ankles (59.8%) and the surface area of these cysts increased during follow-up, without any association with the prosthesis alignment or clinical outcome. Heterotopic ossification at the medial malleolus was present in 58 cases (56.8%) and at the posterior tibia in 73 cases (71.6%), with no effect on clinical outcome. Osteoarthritis of the subtalar and talonavicular joint developed in 9 (8.8%) and 11 cases (10.8%), respectively. CONCLUSION The long-term clinical outcomes for the STAR were found to be satisfactory. Although these results are consistent with previous studies, the survival and complication rates are disappointing compared to knee and hip arthroplasty. Higher rates of successful outcomes following ankle arthroplasty are important, and these results highlight the need for further research to clarify the origin and significance of the reported complications. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Yvonne R A Kerkhoff
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Nienke M Kosse
- Sint Maartenskliniek Research, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Wieneke P Metsaars
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands
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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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Koivu H, Kohonen I. Letter to the editor on "Periprosthetic osteolysis after AES total ankle replacement: Conventional radiography versus CT scan". Foot Ankle Surg 2016; 22:142. [PMID: 27301736 DOI: 10.1016/j.fas.2016.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 01/27/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Helka Koivu
- Hospital Terveystalo Pulssi Turku, Humalistonkatu 9-11, Turku, Finland.
| | - Ia Kohonen
- Medical Imaging Center of Southwest Finland, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
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Reply to the letter to the editor: Periprosthetic osteolysis after AES total ankle replacement: Conventional radiography versus CT scan. Foot Ankle Surg 2016; 22:143. [PMID: 27301737 DOI: 10.1016/j.fas.2016.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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35
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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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36
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Periprosthetic osteolysis after AES total ankle replacement: Conventional radiography versus CT-scan. Foot Ankle Surg 2015; 21:164-70. [PMID: 26235854 DOI: 10.1016/j.fas.2014.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/01/2014] [Accepted: 11/12/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to compare conventional X-rays and CT-scan in detecting peri-prosthetic osteolytic lesions, a major concern after total ankle replacement (TAR). METHODS We prospectively assessed 50 patients (mean age 56 years), consecutively operated on by the same senior surgeon, between 2003 and 2006 and with a mean follow-up period of 4 years (range, 2-6.2). The component used was AES total ankle replacement. The etiologies for total ankle arthroplasty were: posttraumatic in 50%, osteoarthritis secondary to instability in 36%. Plain radiographs were analyzed by 4 independent observers, using a 10-zone protocol (location) and 5 size categories. RESULTS At 4-year follow-up, all patients had been CT-scan assessed with the same protocol by 2 independent observers. Plain radiographs showed dramatic progression of severe periprosthetic lyses (>10mm): from 14% to 36% of interface cysts for the tibial component respectively at 2 and 4-year follow-up and from 4% to 30% for the talar implant. The talar component was more accurately assessed by CT-scan (mean frontal and sagittal talar lesion: from 270 mm2 to 288 mm2 for CT-scan versus 133 mm2 to 174 mm2 for X-rays). For tibial cysts, axial views showed larger lesions (313 mm2 than frontal (194 mm2) or sagittal (213.5 mm2) views. At 4-year follow-up, 24% of patients had revision with curetage or arthrodesis, and at 7 years follow-up 38% were revised. CONCLUSION These results are similar to recent AES series, justifying withdrawal of this device. CT-scan was more accurate than X-rays for detecting and quantifying periprosthetic osteolysis. We recommend a yearly radiological control and CT-scan in case of lesion on X-rays.
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Braito M, Liebensteiner M, Dammerer D, Krismer M, Pfurner M, Biedermann R. Poor accuracy of plain radiographic measurements of prosthetic migration and alignment in total ankle replacement. J Orthop Surg Res 2015; 10:71. [PMID: 25986485 PMCID: PMC4490685 DOI: 10.1186/s13018-015-0220-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/10/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The rotational position of the leg substantially influences measurements in ankle radiographs after total ankle replacement (TAR). The aim of our study was to further specify the influence of different projections on radiographic parameters used to assess component position after TAR. METHODS The effect of varying degrees of internal rotation, flexion, and ab-/adduction on reference lines in anteroposterior and lateral ankle radiographs was investigated in a cadaveric TAR model. Observed variations were then compared with those found in 34 consecutive patients that received a HINTEGRA total ankle prosthesis in our department. RESULTS A change of rotation of 20° resulted in a variation of measured reference lines of more than 1.3 cm in anteroposterior radiographs and more than 1 cm in lateral radiographs in our experimental setting. Even higher intraindividual changes of up to 1.4 cm were observed in our in vivo series. CONCLUSIONS The findings suggest that rotational position of the leg highly influences measurements in ankle radiographs after TAR. It further raises the question, if previously described radiographic parameters do provide accurate information for the outcome after TAR in clinical routine as suggested in literature.
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Affiliation(s)
- Matthias Braito
- Department of Orthopedics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Michael Liebensteiner
- Department of Orthopedics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Dietmar Dammerer
- Department of Orthopedics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Martin Krismer
- Department of Orthopedics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Martin Pfurner
- Geometry and CAD Unit, University of Innsbruck, Innrain 52, 6020, Innsbruck, Austria.
| | - Rainer Biedermann
- Department of Orthopedics, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Lucas y Hernandez J, Laffenêtre O, Toullec E, Darcel V, Chauveaux D. AKILE™ total ankle arthroplasty: Clinical and CT scan analysis of periprosthetic cysts. Orthop Traumatol Surg Res 2014; 100:907-15. [PMID: 25453920 DOI: 10.1016/j.otsr.2014.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 07/22/2014] [Accepted: 09/09/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite good clinical results following total ankle replacement (TAR), the development of large periprosthetic cysts (>400 mm(2)) in the medium-term is a source of concern. OBJECTIVE The primary objective of this study was to detect any large periprosthetic cysts in a cohort of AKILE™ patients using radiographs and CT scans, and then to compare these findings to published ones. MATERIAL AND METHODS A total of 127 TAR procedures were performed between June 1995 and January 2012. We retrospectively reviewed 68 cases with the newest AKILE™ implant design that had a minimum follow-up of 36 months. The average follow-up was 81 ± 33 months; eight patients were lost to follow-up. The outcomes consisted of analyzing radiographs (A/P and lateral weight bearing views, Meary view and lateral views of flexion/extension) and helical CT scans, performing clinical evaluations (range of motion, AOFAS score, Foot Function Index, pain levels) and determining the survivorship of TAR implants. RESULTS TAR survival at 5 years was 79% for in situ implants and 62% for revision-free implants. The AOFAS score improved from 33.7 ± 14.7 to 77.1 ± 15.1 (out of 100) and the pain sub-score was 30.2 ± 9.7 (out of 40) at the last follow-up. The average ankle range of motion was 32.3° ± 12.7° on the radiographs. CT scan revealed Type A cysts (<200 mm(2)) under the talar implant in 52% of cases and in the tibia in 50% of cases; these cysts were smaller than 100 mm(2) in 80% of cases and had no effect on the implants. No periprosthetic cysts larger than 400 mm(2) in size were identified. DISCUSSION The medium-term functional results and survivorship are comparable to those reported for other TAR designs. The incidence of cysts was low overall and there were no large-diameter cysts, which should improve long-term survival. The implant's design and materials likely played a role in preserving the periprosthetic bone stock. The AKILE™ TAR has distinctive features related to the low rate of large periprosthetic cysts in the medium-term. LEVEL OF EVIDENCE IV (retrospective case series).
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Affiliation(s)
- J Lucas y Hernandez
- Orthopédie-traumatologie Pr. Chauveaux, groupe hospitalier Pellegrin, place Amélie Raba-Léon, 33000 Bordeaux, France.
| | - O Laffenêtre
- Orthopédie-traumatologie Pr. Chauveaux, groupe hospitalier Pellegrin, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - E Toullec
- Polyclinique de Bordeaux Tondu, 151, rue du Tondu, 33000 Bordeaux, France
| | - V Darcel
- HIA Robert-Picqué, 351, route de Toulouse, 33882 Villenave-d'Ornon, France
| | - D Chauveaux
- Orthopédie-traumatologie Pr. Chauveaux, groupe hospitalier Pellegrin, place Amélie Raba-Léon, 33000 Bordeaux, France
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Gaudot F, Colombier JA, Bonnin M, Judet T. A controlled, comparative study of a fixed-bearing versus mobile-bearing ankle arthroplasty. Foot Ankle Int 2014; 35:131-40. [PMID: 24351656 DOI: 10.1177/1071100713517094] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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 is available with fixed-bearing (FB) or mobile-bearing (MB) versions, and there is little consensus on the benefits and drawbacks of each type. This study aimed to compare clinical outcomes of statistically paired series of FB and MB versions of the same ankle prosthesis. METHODS The study was a multicenter retrospective comparison between 2 groups: the FB group of 33 consecutive Talaris cases and the MB group of 33 "paired" Salto cases, selected from a database of 313 consecutive cases to statistically match etiology, age, and preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score. All patients were operated upon with the same operative technique and received identical pre- and postoperative clinical and radiographic assessments. The mean follow-up was 24 months for the FB group and 23 months for the MB group. RESULTS There was no statistical difference between results of the 2 groups in terms of accuracy of positioning, clinical and radiographic mobility, and morbidity. The most recent postoperative AOFAS scores were higher for the FB group than for the MB group (P = .05). Radiolucent lines were observed in 4 FB patients versus 13 MB patients (P = .02). Subchondral cysts were noted in 1 FB patient and in 8 MB patients (P = .01). CONCLUSION There was no notable difference in clinical performance of the FB and MB implants with the numbers available. This short-term study demonstrated that FB ankle arthroplasty had results equivalent to, if not better than, MB ankle arthroplasty. Longer follow-up is necessary to determine the success of this new generation of ankle arthroplasty. LEVEL OF EVIDENCE Level III, retrospective case control study.
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Prissel MA, Roukis TS. Management of extensive tibial osteolysis with the Agility™ total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. J Foot Ankle Surg 2014; 53:101-7. [PMID: 24370485 DOI: 10.1053/j.jfas.2013.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Indexed: 02/03/2023]
Abstract
Although total ankle replacement has endured improvement in implant design since its conception, failure requiring revision remains a known endpoint. We describe a technique for management of extensive tibial osteolysis for failed Agility™ total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. This technique provides immediate component stability and is a cost-effective alternate to impaction bone grafting. With this technique, the complications we have experienced have been limited to minor delayed incisional healing, and all patients have resumed meaningful weightbearing activities with stable integration of the tibial component.
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Affiliation(s)
- Mark A Prissel
- Podiatric Medicine and Surgery Resident (Postgraduate Year III), Gundersen Health System Medical Foundation, La Crosse, WI
| | - Thomas S Roukis
- Attending Staff, Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, WI.
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Kohonen I, Koivu H, Vahlberg T, Larjava H, Mattila K. Total ankle arthroplasty: optimizing computed tomography imaging protocol. Skeletal Radiol 2013; 42:1507-13. [PMID: 23912198 DOI: 10.1007/s00256-013-1692-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/24/2013] [Accepted: 07/01/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate parameters and positioning when imaging total ankle prostheses on computed tomography (CT). MATERIALS AND METHODS An ankle prosthesis implanted into a pig's knee joint underwent 16 different CT imaging protocols. Four defects were drilled around prosthesis components simulating periprosthetic osteolytic lesions. The specimen with the implant was imaged in four different orientations with the tibial stem parallel to the table and at 25, 45, and 90° angles to it. The protocol consisted of scanning at 100, 120, and 140 kVp in every position with a pitch of 1.2. The scanning at 120 kVp in every position was repeated with a pitch of 1.0. RESULTS CT proved to be a reliable imaging modality when studying periprosthetic lesions adjacent to the ankle prosthesis when the tibial stem alignment was parallel to the table. When imaging at higher angles, metal artifacts distorted the image, making the analysis of periprosthetic bone structure unreliable. There were no statistically significant differences between different tube voltages or pitch in volume measurements of the osteolytic lesions. CONCLUSIONS CT is a reliable imaging method to evaluate periprosthetic bone structure around ankle prostheses when orientation of the prosthesis and acquisition parameters is optimized.
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Affiliation(s)
- Ia Kohonen
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland,
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Oppermann J, Franzen J, Spies C, Faymonville C, Knifka J, Stein G, Bredow J. The microvascular anatomy of the talus: a plastination study on the influence of total ankle replacement. Surg Radiol Anat 2013; 36:487-94. [DOI: 10.1007/s00276-013-1219-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/12/2013] [Indexed: 10/26/2022]
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