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Duff J, Dunson J, Doty JF. Early experience with a 3-D printed porous surface, fixed-bearing, total ankle arthroplasty: A minimum of 2-year follow-up. Foot Ankle Surg 2024; 30:382-388. [PMID: 38453589 DOI: 10.1016/j.fas.2024.02.008] [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: 10/03/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND This is a pilot study reviewing patients undergoing ankle replacement with the 3-D printed INFINITY™ with ADAPTIS™ total ankle arthroplasty (TAA) system. METHODS A retrospective review was conducted of patients with a minimum two-year follow-up who underwent TAA with the INFINITY™ with ADAPTIS™ implant system. Outcome measures include implant survivorship, complications with subsequent reoperations, patient reported outcomes, and radiologic subsidence or radiolucency. RESULTS Thirty patients were included with median follow-up of 26 months (range, 24-36). Implant survival rate was 90% (27/30). Two patients experienced linear radiolucency > 2 mm: one required a revision TAA secondary to tibial subsidence; the other patient was asymptomatic and nonprogressive on serial radiographs. No cystic radiolucencies > 5 mm were identified. VAS, PROMIS PF, and FADI scores improved significantly. CONCLUSION TAA performed with the 3-D printed INFINITY™ with ADAPTIS™ implant technology led to ninety percent short term implant survivorship and improvement in patient reported outcomes with comparable results to other 4th generation arthroplasty systems as a treatment modality for end-stage ankle arthritis. LEVEL OF EVIDENCE Level III, Retrospective cohort study, Prognostic.
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Affiliation(s)
- Joseph Duff
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, 975 East Third Street, Hospital Box 260, Chattanooga, TN 37403, USA.
| | - Jordan Dunson
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, 975 East Third Street, Hospital Box 260, Chattanooga, TN 37403, USA
| | - Jesse F Doty
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, 975 East Third Street, Hospital Box 260, Chattanooga, TN 37403, USA
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Henry JK, Shaffrey I, Cororaton AD, Munita JP, Cody E, O'Malley M, Deland J, Ellis S, Demetracopoulos C. Implant Choice May Reduce the Risk of Early Mechanical Failure in Total Ankle Replacement. J Bone Joint Surg Am 2024; 106:767-775. [PMID: 38442190 DOI: 10.2106/jbjs.23.00933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Total ankle replacements (TARs) have rapidly advanced in terms of volume, technique, design, and indications. However, TARs are still at risk for early mechanical failure and revision. Prior studies have investigated potential risk factors for failure, but have been limited to smaller series or older implants. This study sought to identify risk factors for early mechanical failure in modern TAR. METHODS This is a retrospective study of a single-institution registry. Five surgeons contributed cases involving patients who underwent a primary TAR with any implant. Implants were grouped on the basis of the type of fixation. The primary outcome was early mechanical failure (revision with component removal for a non-infectious etiology, that is, subsidence, aseptic loosening, and/or malalignment). Logistic regression determined the effects of age, weight, hindfoot arthrodesis, implant type, and radiographic deformity on failure. RESULTS The 731 included patients had a mean follow-up of 2.7 years. Ten percent (71 patients) had hindfoot arthrodesis. There were 33 mechanical failures (4.5%) at a mean of 1.7 years after the index surgical procedure. Our model demonstrated that hindfoot arthrodesis was associated with 2.7 times greater odds of failure (p = 0.045), every 10 kg of body weight increased the odds of tibial-sided failure by 1.29 times (p = 0.039), and implants with more extensive tibial fixation (stems or keels) lowered the odds of tibial failure by 95% (p = 0.031). CONCLUSIONS In patients with uncontrollable risk factors (hindfoot arthrodesis) or risk factors that may or may not be modifiable by the patient (weight), implants with more robust tibial fixation may be able to reduce the risk of early mechanical failure. Further research is warranted to support efforts to decrease early failure in TAR. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jensen K Henry
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
| | | | - Agnes D Cororaton
- Biostatistics Department, Hospital for Special Surgery, New York, NY
| | | | - Elizabeth Cody
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
| | - Martin O'Malley
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
| | - Jonathan Deland
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
| | - Scott Ellis
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY
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3
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Cottom JM, Badell JS, Wolf J. Two-Year Outcomes After Total Ankle Replacement With a Novel Fixed-Bearing Implant By a Single Surgeon Non-Inventor. J Foot Ankle Surg 2024; 63:337-344. [PMID: 38190880 DOI: 10.1053/j.jfas.2024.01.001] [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: 07/04/2023] [Revised: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Abstract
Total ankle arthroplasty continues to gain popularity amongst surgeons and patients as an alternative to arthrodesis. Historically the designs of early implants were plagued with complications and frequently abandoned. Since that time the procedure and materials have undergone significant advancements in both surgical approach as well as design and function of the available implants. In this study, 40 consecutive patients who received a semiconstrained prosthesis with a unique fixed-bearing polyethylene insert were identified. Minimum follow-up was 2 y. Demographic, social, and past medical data was retrospectively reviewed. Concomitant procedures were also recorded. Radiographic analysis included lateral ankle radiograph postoperative range of motion (ROM) with maximum dorsiflexion and maximum plantarflexion weight bearing at the most recent clinic visit. Clinical outcomes included VAS, FFI, and AOFAS scores. Lateral radiographs taken in the office at a minimum 2-y follow-up showed mean maximum dorsiflexion of 11.8 degrees and plantarflexion of 13.9 degrees. VAS, FFI, and AOFAS scores improved from 8.1, 92.9, and 44.8 to 1.4, 15.3, and 90.1 postoperatively, respectively. A total of 2.5% (n = 1) required revision surgery for poly failure, and 5.0% (n = 2) underwent local wound care in the office setting postoperatively and healed without complications. Overall survivorship was 97.5% at the minimum follow-up of 2 y. In conclusion, similar studies have reported survivorship from 90% to 100% with modern ankle implants in short to mid-term follow-up. Although this is a small sample size, our data shows a 97.5% survivorship at 2 y postoperatively with favorable patient-reported statistically significant functional outcome scores, and ankle range of motion consistent with existing literature.
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Affiliation(s)
- James M Cottom
- Fellowship Trained Foot and Ankle Surgeon, Director, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL.
| | - Jay S Badell
- Fellowship Trained Foot and Ankle Surgeon, Florida Orthopedic Foot & Ankle Center, Sarasota, FL
| | - Joseph Wolf
- Fellowship Trained Foot and Ankle Surgeon, Florida Orthopedic Foot & Ankle Center, Sarasota, FL
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Millstein ID, Koneru M, Dibato JE, Gentile P, Mahjoub A, Freeland E. Comparing Rates of Radiographic Baseplate Loosening Between Cement and Cementless INFINITY Total Ankle Prostheses. Foot Ankle Spec 2024:19386400241247456. [PMID: 38676637 DOI: 10.1177/19386400241247456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Total ankle replacement is indicated for end-stage ankle osteoarthritis. Periprosthetic radiolucency, from separation between the bone and implant, is suggested to be indicative of potential prosthesis failure risk. Anchoring implants with cement may mitigate this. This study aimed to compare rates of periprosthetic radiolucency between patients with cement-affixed and cementless implants. METHODS A retrospective analysis was performed on 28 patients who underwent total ankle replacement with the INFINITY Total Ankle System (Wright Medical, Memphis, Tennessee) implant between January 2016 and May 2022. Anteroposterior, mortise, and lateral ankle X-rays were reviewed by 2 independent reviewers for tibiotalar angle, talar tilt, and periprosthetic radiolucency. The Wilcoxon rank-sum test and chi-square test were performed. RESULTS The incidence of periprosthetic radiolucency at the most recent follow-up did not significantly differ between cement and cementless groups (57.1% in both groups, P = 1.0). Follow-up tibiotalar and talar tilt angles were not significantly different (P > .51 for all comparisons). CONCLUSIONS Patients with cemented implants had a similar incidence of periprosthetic radiolucency compared with patients with cementless prostheses. Understanding of long-term clinical outcomes will help inform optimal operative approaches for ankle prostheses. LEVELS OF EVIDENCE Therapeutic, Level III, Retrospective cohort study.
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Affiliation(s)
| | - Manisha Koneru
- Cooper Medical School, Rowan University, Camden, New Jersey
| | | | | | - Adel Mahjoub
- Cooper University Health Care, Camden, New Jersey
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5
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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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Anastasio AT, Adams SB, DeOrio JK, Easley ME, Nunley JA, Lee DO. Comparison of Radiographic Talar Loosening Rates Between Salto-Talaris and INBONE II. Foot Ankle Int 2024; 45:60-66. [PMID: 37994659 DOI: 10.1177/10711007231209763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Despite substantial increase in total ankle arthroplasty (TAA) nationwide, there are few studies comparing flat-cut vs chamfer-cut talar systems in TAA with regard to radiographic aseptic loosening rates of the implant. METHODS This retrospective study included 189 Salto-Talaris TAA and 132 INBONE II primary TAA with a minimum 1-year follow-up. Patient characteristics were obtained including gender, age at surgery, body mass index (BMI), smoking status, primary diagnosis, surgical time, and the presence of diabetes. Radiographic evidence for aseptic loosening was assessed. Statistical analysis was performed for comparison in outcomes between Salto-Talaris and INBONE II. RESULTS The mean age of the study population was 63.5 ± 9.8 years at surgery. Mean follow-up was 4.9 ± 3.0 years. Radiographic aseptic loosening of the tibial implant showed no significant difference between the 2 groups: Salto-Talaris, 18%, and INBONE II, 18.9% (P = .829). Aseptic loosening of the talar implant also showed no significant difference between the 2 groups: Salto-Talaris, 1.6%, and INBONE II, 1.5% (P = .959). No variables, including the implant type, were found to contribute to the aseptic loosening rate of either the tibia or talus. CONCLUSION In our cohort, we observed no difference in radiographic implant aseptic loosening between Salto-Talaris and INBONE II systems. LEVEL OF EVIDENCE Level IV, retrospective case series study.
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Zunarelli R, Fiore M, Lonardo G, Pace A, Persiani V, De Paolis M, Sambri A. Total Ankle Replacement Infections: A Systematic Review of the Literature. J Clin Med 2023; 12:7711. [PMID: 38137779 PMCID: PMC10743530 DOI: 10.3390/jcm12247711] [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: 11/06/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Periprosthetic infection (PJI) after TAR is a serious complication, often requiring further surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. This systematic review aims to summarize the current evidence on the management of TAR PJI and provide a comprehensive overview of this topic, especially from an epidemiologic point of view. Three different databases (PubMed, Scopus, and Web of Science) were searched for relevant articles, and further references were obtained by cross-referencing. Seventy-one studies met the inclusion criteria, reporting on cases of TAR PJI. A total of 298 PJIs were retrieved. The mean incidence of PJI was 3.8% (range 0.2-26.1%). Furthermore, 53 (17.8%) were acute PJIs, whereas most of them (156, 52.3%) were late PJIs. Most of the studies were heterogeneous regarding the treatment protocols used, with a two-stage approach performed in most of the cases (107, 35.9%). While the prevalence of ankle PJI remains low, it is potentially one of the most devastating complications of TAR. This review highlights the lack of strong literature regarding TAR infections, thus highlighting a need for multicentric studies with homogeneous data regarding the treatment of ankle PJI to better understand outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.Z.); (M.F.); (G.L.); (A.P.); (V.P.); (M.D.P.)
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8
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Townshend D, Bing A, Blundell C, Clough T, Davenport J, Davies H, Davis J, Dhar S, Hepple S, Kakwani R, Karski M, Makwana N, McKinley J, Murty A, Raglan M, Shalaby H, Sharpe I, Smith R, Taylor H, Goldberg A. Two to Five-Year Outcomes of Total Ankle Arthroplasty with the Infinity Fixed-Bearing Implant: A Concise Follow-up of a Previous Report. J Bone Joint Surg Am 2023; 105:1846-1856. [PMID: 38063779 PMCID: PMC10695343 DOI: 10.2106/jbjs.22.01294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- David Townshend
- Northumbria NHS Healthcare Trust, North Shields, England, United Kingdom
| | - Andrew Bing
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, England, United Kingdom
| | | | - Tim Clough
- Wrightington Hospital, Wrightington, United Kingdom
| | | | - Howard Davies
- Northern General Hospital, Sheffield, United Kingdom
| | | | - Sunil Dhar
- Nottingham University Hospitals Trust, Nottingham, United Kingdom
| | - Steve Hepple
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom
| | - Rajesh Kakwani
- Northumbria NHS Healthcare Trust, North Shields, England, United Kingdom
| | - Mike Karski
- Wrightington Hospital, Wrightington, United Kingdom
| | - Nilesh Makwana
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Trust, Oswestry, England, United Kingdom
| | | | - Aradhyula Murty
- Northumbria NHS Healthcare Trust, North Shields, England, United Kingdom
| | - Martin Raglan
- Nottingham University Hospitals Trust, Nottingham, United Kingdom
| | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Robert Smith
- Wrightington Hospital, Wrightington, United Kingdom
| | - Heath Taylor
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
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9
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Shaffrey I, O'Malley E, Henry JK, Rajan L, Deland JT, O'Malley M, Ellis SJ, Demetracopoulos CA. Midterm Clinical Outcomes, Radiographic Outcomes, and Survivorship of the Infinity Total Ankle Arthroplasty. Foot Ankle Int 2023; 44:1247-1255. [PMID: 37964445 DOI: 10.1177/10711007231201136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND The Infinity Total Ankle Arthroplasty (Stryker, Mahwah, NJ) is a low-profile fixed-bearing implant first introduced in 2014. Although the short-term survivorship (2-4 years follow-up) and complication rates of the Infinity TAA have been reported, there are limited midterm outcome reports. The aim of this study was to describe the survivorship and clinical outcomes of a single-center experience with the Infinity implant at minimum 5-year follow-up. METHODS Retrospective review of 65 ankles that underwent primary total ankle arthroplasty (TAA) with the Infinity implant was conducted. Mean clinical follow-up was 6.5 years (range, 5.0-8.0). Preoperative and postoperative radiographs were measured to assess tibiotalar alignment, periprosthetic lucencies, and cysts. Preoperative, 2-year, and 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscores were compared to assess midterm clinical outcomes. Survivorship assessment was determined by removal of 1 or both metallic implant components. RESULTS Survivorship of the implant was 93.8% at final follow-up. There were 4 revisions: 2 for tibial implant loosening, 1 for talar loosening, and 1 for loosening of both components. Three of the 4 revisions occurred within the first 2 years following implantation, and the last failure occurred at 7 years postoperatively. There were 11 reoperations in 10 (15%) ankles and 3 wound complications. There were 17 ankles (26.2%) with radiographic abnormalities around the implants, including 14 cases with tibial component lucencies and 4 cases of periimplant cysts. FAOS outcome measurement showed general stability between 2 and 5 years and substantial improvement from preoperative status. CONCLUSION To date this study is the largest midterm report on the Infinity total ankle prosthesis, with 65 implants at a mean follow-up of 6.5 years. We found good midterm implant survivorship, and patients experienced significant improvements in FAOS outcome scores and radiographic alignment at final follow-up. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Isabel Shaffrey
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Emmett O'Malley
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Jensen K Henry
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Lavan Rajan
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan T Deland
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Martin O'Malley
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Scott J Ellis
- Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA
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10
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April PM, Locke E, Champagne PH, Angers M, Martinez-Gomez AP, Seidel A, Jibri Z, Lalonde KA, Meulenkamp B. Accuracy of a Patient-Specific Total Ankle Arthroplasty Instrumentation. Foot Ankle Int 2023; 44:1150-1157. [PMID: 37727986 DOI: 10.1177/10711007231194049] [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: 09/21/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is a preferred surgical option for end-stage ankle osteoarthritis; however, it is a demanding procedure with a higher historical rate of revision compared with ankle fusion. Patient-specific instrumentation (PSI) has been introduced to optimize prosthesis alignment and theoretically overall improve TAA outcomes. The goal of this study is to report on the experience and surgical outcomes of one implant with specific evaluation of the accuracy and reproducibility of the system with respect to prosthesis alignment and prediction of implant size. METHODS A retrospective, multicentered study involving 4 foot and ankle fellowship-trained orthopaedic surgeon's patients undergoing TAA between January 1, 2015, and December 31, 2018, using the PROPHECY PSI system. RESULTS 80 TAA procedures were performed. On average the postoperative tibial component alignment was 89.9 (range, 86.1-96.5) degrees in the coronal plane, with a mean sagittal alignment of 88.1 (range, 81.3-96.7) degrees. The mean deviation from neutral sagittal alignment improved from 4.9 ± 3.9 degrees preoperatively to 2.7 ± 1.7 degrees postoperatively, whereas the mean coronal alignment improved from 3.3 ± 2.5 degrees to 1.3 ± 1.1 degrees. The PSI software correctly determined the tibial implant size in 70 patients (89%). Prediction of talar implant sizing was less accurate than the tibial component, with 56 patients (71%) using the predicted sized implant. The overall implant survival at a mean follow-up of 45 months (range, 27-76) was 97.5%. CONCLUSION We found that this PSI system accurately and reliably assisted in implant total ankle prosthesis positioning within a clinically acceptable margin and without significant outliers. Prediction of implant size was not as accurate as component orientation. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
| | - Eric Locke
- Department of Orthopaedics, Civic Hospital, Ottawa, Canada
| | | | | | | | - Angela Seidel
- Department of Orthopaedics, Civic Hospital, Ottawa, Canada
| | - Zaid Jibri
- Department of Orthopaedics, Civic Hospital, Ottawa, Canada
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11
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Vacketta VG, Perkins JM, Hyer CF. Updates of Total Ankle Replacement Revision Options: New Generation Total Ankle Replacement Revision Options, Stemmed Implants, Peri-Articular Osteotomies. Clin Podiatr Med Surg 2023; 40:749-767. [PMID: 37716750 DOI: 10.1016/j.cpm.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Ankle arthritis is a disabling disease pattern resulting in pain and dysfunction ultimately leading to a reduction in quality of life. Unlike more common arthritides of the knee and hip, ankle arthritis is unique in its presentation with an earlier onset of end-stage disease and an etiology, which is most-commonly posttraumatic in nature. Through continued research and design, improvements have continued to be made as newer generation implants are developed. This article discusses the considerations for revision total ankle replacement based on the current revision options and a treatment algorithm developed by the lead author.
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Affiliation(s)
- Vincent G Vacketta
- Orthopedic Foot and Ankle Center, 350 West Wilson Bridge Road, Suite 200, Worthington, OH 43085, USA.
| | - Jacob M Perkins
- Orthopedic Foot and Ankle Center, 350 West Wilson Bridge Road, Suite 200, Worthington, OH 43085, USA
| | - Christoper F Hyer
- Orthopedic Foot and Ankle Center, 350 West Wilson Bridge Road, Suite 200, Worthington, OH 43085, USA
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12
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Henry JK, Shaffrey I, Wishman M, Palma Munita J, Zhu J, Cody E, Ellis S, Deland J, Demetracopoulos C. Early outcomes of the Exactech Vantage fixed-bearing total ankle replacement. Bone Joint J 2023; 105-B:1099-1107. [PMID: 37777206 DOI: 10.1302/0301-620x.105b10.bjj-2023-0173.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Aims The Vantage Total Ankle System is a fourth-generation low-profile fixed-bearing implant that has been available since 2016. We aimed to describe our early experience with this implant. Methods This is a single-centre retrospective review of patients who underwent primary total ankle arthroplasty (TAA) with a Vantage implant between November 2017 and February 2020, with a minimum of two years' follow-up. Four surgeons contributed patients. The primary outcome was reoperation and revision rate of the Vantage implant at two years. Secondary outcomes included radiological alignment, peri-implant complications, and pre- and postoperative patient-reported outcomes. Results There were 168 patients (171 ankles) included with a mean follow-up of 2.81 years (2 to 4.6) and mean age of 63.0 years (SD 9.4). Of the ten ankles with implant failure (5.8%), six had loosening of the tibial component. In the remaining four failed implants, one was due to periprosthetic joint infection (PJI), one was due to loosening of the talar component, and two were due to loosening of both the tibial and talar components. Seven patients underwent reoperation: irrigation and debridement for superficial infection (n = 4); bone grafting for cysts (n = 2); and open reduction internal fixation (n = 1). Asymptomatic peri-implant lucency/subsidence occurred in 20.1% of ankles, with the majority involving the tibial component (n = 25). There were statistically significant improvements in PROMs in all domains. Conclusion Short-term results of this implant demonstrate early survival comparable to the reported survivorship of similar low-profile, non-stemmed implants. Radiological lucency occurred more commonly at the tibial component, and revisions occurred primarily due to loosening of the tibial component. Further research is needed to evaluate longer-term survivorship.
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Affiliation(s)
- Jensen K Henry
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Isabel Shaffrey
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Mark Wishman
- Weill Cornell Medical College, New York, New York, USA
| | - Joaquín Palma Munita
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Hospital Sótero del Río, Santiago, Brazil
| | - Jiaqi Zhu
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Elizabeth Cody
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Scott Ellis
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan Deland
- Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York, USA
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13
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Hinh CM, Chong ACM, Bierman BR, Uglem TP. Computed Tomography Derived Patient-specific Instrumentation Total Ankle Arthroplasty Survivorship Outcomes. J Foot Ankle Surg 2023; 62:338-346. [PMID: 36180364 DOI: 10.1053/j.jfas.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/19/2022] [Accepted: 08/27/2022] [Indexed: 02/03/2023]
Abstract
Computed tomography (CT) derived patient-specific total ankle arthroplasty (TAA) systems have been utilized for improved accuracy and reproducible implant alignment. The purpose of the present study was to report the overall implant survivorship as well as radiographic analysis of patients who underwent primary TAA utilizing CT-derived patient-specific instrumentation. A retrospective review of medical charts and radiographs were performed on patients who had undergone primary TAA at a single institution in the Midwest region from March 2013 to October 2020. Radiographic analysis included preoperative, initial postoperative, and final follow-up coronal and sagittal tibiotalar alignment as well as periprosthetic radiolucency. A total of 96 patients with a mean follow-up of 3 years (range, 0.3-7.3 years) were included. Implant survivorship was found to be 92% at median follow-up of 3 years. A total of 8 cases (8.3%) required revision/reoperation, with 6 (6.3%) of these reoperations directly related for failure of one of the metallic implant components. There was significant improvement in both coronal and sagittal tibiotalar alignment from preoperative to initial postoperative follow-up (p < .001). At latest postoperative follow-up, there were 88% of TAAs that remained in a neutral alignment following surgery. A total of 10 cases were found to have radiolucency at latest follow-up. In conclusion, the use of CT derived patient-specific TAA showed high implant survivorship with significant improvement of sagittal and coronal tibiotalar alignment. With better implant alignment and position, it potentially reduces the risk of early implant failure or implant loosening in long-term follow-up.
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Affiliation(s)
- Christopher M Hinh
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND
| | - Alexander C M Chong
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND; Department of Graduate Medical Education - Sanford Health, Fargo, ND.
| | - Bennen R Bierman
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND
| | - Timothy P Uglem
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND
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14
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Miner SA, Basile P, Cook J, Cook E, Constantino J. Tibial Component Subsidence in a Total Ankle System Comparing Standard Technique Versus a Hybrid Technique. J Foot Ankle Surg 2022; 62:472-478. [PMID: 36550003 DOI: 10.1053/j.jfas.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 10/04/2022] [Accepted: 11/20/2022] [Indexed: 11/26/2022]
Abstract
Total ankle arthroplasty (TAA) is a viable treatment option for end-stage ankle arthritis. However, implant survivorship remains an important consideration. Concerns regarding early component loosening with the low-profile tibial tray utilized by fourth-generation TAA systems have been raised in the literature. We have previously described our preliminary outcomes of a hybrid technique combining a stemmed intramedullary tibial component with a chamfer-cut talar component for TAA. A retrospective study comparing short-term outcomes of the tibial component between a standard fourth-generation TAA system versus our hybrid technique was performed. 46 patients with a minimum of 1-year follow up were included in the analyses. There were 25 subjects in the standard implant cohort utilizing a low-profile tibial tray, and 21 subjects in the hybrid group utilizing a stemmed intramedullary tibial component. No statistically significant difference between the demographics of each group was found. The rate of tibial component subsidence was 8% (n = 2) in the standard implant group, and 0% (n = 0) in the hybrid group, though this did not meet statistical significance (p = .49). Mean time to subsidence was 6 months, and revision rate due to tibial component subsidence was 2.1% (n = 1). Periprosthetic lucency was present on most recent follow-up radiographs in 32% and 9.5% of ankles in the standard and hybrid groups, respectively (p = .08). Despite prior concerns for tibial component subsidence with the standard fourth-generation system, we demonstrated low rates in both implant groups. Additional studies are needed to further explore factors that may predispose patients to early tibial component subsidence and resulting implant failure.
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Affiliation(s)
- Samantha A Miner
- Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow in Surgery, Harvard Medical School, Boston, MA.
| | - Philip Basile
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Chief, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge MA
| | - Jeremy Cook
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Director of Research and Quality Assurance, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Emily Cook
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Director of Resident Training, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - John Constantino
- Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow in Surgery, Harvard Medical School, Boston, MA
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15
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HENRICSON A, UNDÉN A, CARLSSON Å, JEHPSSON L, ROSENGREN B. Outcomes of trabecular metal total ankle replacement: a longitudinal observational cohort study of 239 consecutive cases from the Swedish Ankle Registry. Acta Orthop 2022; 93:689-695. [PMID: 35919022 PMCID: PMC9348131 DOI: 10.2340/17453674.2022.4387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Information on outcomes after some modern total ankle replacement (TAR) designs is scarce. We therefore examined outcomes after trabecular metal (TM) TAR in Sweden by use of data from the national registry. PATIENTS AND METHODS On December 31, 2020, 239 primary TM TARs had been reported to the Swedish Ankle Registry. We analyzed prosthesis survival probability, using exchange or permanent extraction of components as endpoint for 239 protheses with mean follow-up of 2.2 years (0.1-6.6), risk of revision, as well as patient-reported outcome measures (SEFAS/EQ-5D/EQ-VAS) and satisfaction with surgery. RESULTS 7/239 prostheses (3%) had been revised by December 31, 2020. We found an overall prosthesis survival probability of 95% (95% CI 89-98) after 3 years. 2 years after surgery 81% of the answering patients were satisfied or very satisfied with surgery and patients reported median SEFAS 36 (max 48), EQ-5D 0.90 (max 1), and EQ-VAS 80 (max 100). INTERPRETATION We found short- to mid-term outcomes after TM TAR to be at least as good as after other TAR designs regarding prosthesis survival and patient-reported satisfaction.
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Affiliation(s)
- Anders HENRICSON
- Department of Orthopedics, Falu Central Hospital and Center of Clinical Research Dalecarlia, Falun
| | - Alexandra UNDÉN
- Department of Radiology, Skåne University Hospital, Malmö,Department of Clinical Sciences Malmö (IKVM), Lund University
| | - Åke CARLSSON
- Department of Clinical Sciences Malmö (IKVM), Lund University,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Lars JEHPSSON
- Department of Clinical Sciences Malmö (IKVM), Lund University,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Björn ROSENGREN
- Department of Clinical Sciences Malmö (IKVM), Lund University,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
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16
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Mazzotti A, Viglione V, Gerardi S, Bonelli S, Zielli S, Geraci G, Faldini C. Post-operative management after total ankle arthroplasty: A systematic review of the literature. Foot Ankle Surg 2022; 28:535-542. [PMID: 34088605 DOI: 10.1016/j.fas.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Currently, there is no consensus on the most appropriate post-operative management for patients undergoing total ankle arthroplasty. The aim of this study is therefore to offer a systematic review of the pertaining literature to identify current post-operative protocols and describe possible differences. METHODS A systematic review to identify recent studies concerning the post-operative management after total ankle arthroplasty was conducted. Five topics were analyzed: length of hospital stay, type and duration of immobilization, weight-bearing management, post-operative pharmacological therapies, adopted rehabilitation scheme. RESULTS Eighty-four studies met the inclusion criteria and were included in the review process. Most of the papers appear to have conflicting opinions with no consensus and homogeneous protocols. CONCLUSION Due to various methodological limitations, it is not possible to provide sufficiently supported evidence-based recommendations, and it is therefore difficult to determine the superiority of one post-operative protocol over the others after total ankle arthroplasty.
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Affiliation(s)
- A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - V Viglione
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Gerardi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Bonelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G Geraci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
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17
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Basile P, Miner SA, Crafton JW, McKenna B. Preliminary Report of a Hybrid Total Ankle Arthroplasty Combining a Stemmed Intramedullary Tibial Component With Chamfer-Cut Talar Dome. J Foot Ankle Surg 2022; 61:e25-e33. [PMID: 35379534 DOI: 10.1053/j.jfas.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/10/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
Total ankle arthroplasty (TAA) is a viable treatment for end-stage ankle arthritis. In our experience, a stemmed intramedullary tibial component combined with a chamfer-cut talar component provides the most stable construct for TAA. We present our technique for placement of this hybrid prosthesis utilizing the INBONE tibial component in combination with the INFINITY talar component. This technique differs from the standard protocol by minimizing use of both patient-specific and standard intraoperative guides. The primary aim of this study is to report our preliminary outcomes with our novel technique. Secondarily, we aim to demonstrate that placement of this hybrid prosthesis is radiographically reproducible and accurate. The first 10 patients undergoing this technique with at least 1 year of follow-up were retrospectively reviewed. Average visual analog pain scale decreased from 7.4 preoperatively to 0.5 at 1 year postoperatively. The average time to weightbearing was 6.4 weeks. Complications were minimal, and no implant-related complications were encountered. First weightbearing ankle radiographs postoperatively were evaluated by 3 reviewers to determine accuracy of the tibial intramedullary stem in relation to the anatomical axis of the tibia. We found that the deviation of the tibial implant from the anatomic axis was on average 0.9°± 0.5° in the coronal plane, and 2.2°± 2.7° in the sagittal plane. Inter-rater reliability was 83%. We conclude that this hybrid technique utilizing a stemmed intramedullary tibial component in combination with a chamfer-cut talar component for TAA is reproducible, accurate, and safe.
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Affiliation(s)
- Philip Basile
- Chief of Foot & Ankle Surgery, Mount Auburn Hospital, Cambridge MA; Assistant Professor of Surgery, Harvard Medical School, Boston, MA
| | - Samantha A Miner
- Fellow, Foot and Ankle Reconstruction Fellowship, Coordinated Health-Lehigh Valley Health Network, Bethlehem, PA.
| | - Jordan W Crafton
- Fellowship-trained Foot & Ankle Surgeon, Arizona Orthopedics, Tucson, AZ; Attending Surgeon, Tucson Medical Center Foot and Ankle Surgery Residency Program, Tucson, AZ
| | - Bryon McKenna
- Fellowship-trained Foot & Ankle Surgeon, Thibodaux Regional Medical Center, Thibodaux, LA
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18
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Rushing CJ, Kibbler K, Hyer CF, Berlet GC. The INFINITY Total Ankle Prosthesis: Outcomes at Short-Term Follow-up. Foot Ankle Spec 2022; 15:119-126. [PMID: 32772552 DOI: 10.1177/1938640020946199] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The INFINITY total ankle prothesis remains the most widely used fourth-generation total ankle arthroplasty (TAA) system in the United States. The purpose of the present study was to assess radiographic outcomes for INFINITY at short-term follow-up. METHODS All patients who underwent primary TAA with INFINITY between August 2015 and June 2018 at a single institution and who were at least 1 year postoperative were included. A total of 55 ankles with a mean follow up 22 months (range, 12-43 months) met the criteria. Weightbearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 to 8 weeks postoperatively, and at the most recent follow-up. Medical records and charts were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook at el, respectively. RESULTS Overall, INFINITY survivorship was 98.2%. Coronal and sagittal tibiotalar alignment improved after surgery (P < .001, P = .09, respectively), and was maintained during the latest follow-up (P = .62, P = .47, respectively). Only 1 ankle (1.8%) required early revision; while 5 (9.1%) indicated non-implant-related revision; 85.5% required no reoperation. In nineteen ankles (34.5%), postoperative periprosthetic lucency was observed; most were not progressive (17 ankles, 89.5%). Twelve complications (3 high grade, 3 intermediate, and 6 low grade) in 11 ankles (20%) were recorded according to the Glazebrook classification system. CONCLUSION INFINITY survivorship was 98.2% at a mean of 1.8 years of follow-up, and only 1 ankle required prosthetic revision. Additional studies with longer follow-up are warranted for fourth-generation TAA prostheses. LEVELS OF EVIDENCE Level IV: Case series.
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Affiliation(s)
- Calvin J Rushing
- Orthopedic Foot and Ankle Center, Worthington, Ohio (CJR, CFH, GCB) and Grant Medical Center, Columbus, Ohio (KK)
| | - Kurt Kibbler
- Orthopedic Foot and Ankle Center, Worthington, Ohio (CJR, CFH, GCB) and Grant Medical Center, Columbus, Ohio (KK)
| | - Christopher F Hyer
- Orthopedic Foot and Ankle Center, Worthington, Ohio (CJR, CFH, GCB) and Grant Medical Center, Columbus, Ohio (KK)
| | - Gregory C Berlet
- Orthopedic Foot and Ankle Center, Worthington, Ohio (CJR, CFH, GCB) and Grant Medical Center, Columbus, Ohio (KK)
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19
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Maccario C, Paoli T, Romano F, D'Ambrosi R, Indino C, Usuelli FG. Transfibular total ankle arthroplasty : a new reliable procedure at five-year follow-up. Bone Joint J 2022; 104-B:472-478. [PMID: 35360940 DOI: 10.1302/0301-620x.104b4.bjj-2021-0167.r5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. METHODS We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients' clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up. RESULTS A total of 86 patients were evaluated at a mean follow-up of 65.4 months (60 to 90). At five-year follow-up, statistically significant improvements (p < 0.001) were found in the mean American Orthopaedic Foot & Ankle Society Ankle Hindfoot Score (from 33.8 (SD 14.3) to 86.1 (SD 8.8)), visual analogue scale for pain (from 8.5 (SD 1.7) to 1.5 (SD 1.2)), Short Form-12 Physical and Mental Component Scores (from 29.9 (SD 6.7) and 43.3 (SD 8.6) to 47.3 (SD 7.5) and 52.2 (SD 8.0), respectively), and mean ankle dorsiflexion and plantarflexion (from 6.2° (SD 5.5°) and 9.6° (SD 5.8°) to 23.9° (SD 7.7°) and 16.9° (SD 7.2°), respectively). Radiologically, the implants maintained neutral alignment without subsidence. Tibial or talar radiolucency was found in eight patients, but none of these patients was symptomatic. At five-year follow up, 97.7% of implants (95% confidence interval 91.2 to 99.4) were free from revision or removal with 84 implants at risk. We recorded two cases (2.3%) of failure for septic loosening. CONCLUSION Transfibular TAA is safe and effective with a high survival rate at mid-term follow-up and satisfactory clinical and radiological results. Further studies are required to determine the long-term performance of these implants. Cite this article: Bone Joint J 2022;104-B(4):472-478.
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Affiliation(s)
| | | | - Fausto Romano
- Swiss Concussion Center, Schulthess Klinik, Zürich, Switzerland.,Department of Neurology, University of Zurich, Zurich, Switzerland
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20
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Doyle MD, Ishibashi MA, Sherick RM, Mitchell LH, Castellucci-Garza FM, Rao NM. Outcomes and Complications of the INFINITY Total Ankle: A Systematic Review. Foot Ankle Spec 2022:19386400221079491. [PMID: 35189714 DOI: 10.1177/19386400221079491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, California
| | - Megan A Ishibashi
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Foundation Hospitals, Oakland, California
| | - Ryan M Sherick
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, California
| | - Logan H Mitchell
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Foundation Hospitals, Oakland, California
| | - Francesca M Castellucci-Garza
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospitals, Antioch, California
| | - Nilin M Rao
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, California
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21
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The 15 year ankle arthroplasty experience in a university hospital. Foot Ankle Surg 2022; 28:217-221. [PMID: 33789795 DOI: 10.1016/j.fas.2021.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/17/2021] [Accepted: 03/19/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The study aim was to review the experience of ankle replacement surgery in a university teaching hospital. METHODS A retrospective review of primary ankle replacements performed between 2005 and 2019 was undertaken. Implant survival and reasons for revision surgery were assessed, along with patient reported outcomes and complications. RESULTS There were 157 ankle replacements implanted in 140 patients with a mean follow up 7.5 years (range 1.0-14.5). There were 108 Mobility™, 19 Zenith™ and 30 Infinity™ ankle replacements with an overall revision rate of 9.6% at a mean 4.0 years (range 0.1-11.0). Overall survivorship analysis for 5, 10 and 15 years was respectively 92.4%, 89.3% and 86.6%. DISCUSSION The revision rate was comparable to international registers and aseptic loosening was the commonest reason for revision. This study, in a teaching university hospital with an average of 10 primary ankle replacements each year, highlighted ankle arthroplasty provides good functional outcomes and medium term implant survivorship. This supports the use of ankle arthroplasty within foot and ankle specialist centres achieving appropriate outcomes.
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22
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Rushing CJ, Mckenna BJ, Berlet GC. Lateral Instability in Total Ankle Arthroplasty: A Comparison Between the Brostrom-Gould and Anatomic Lateral Ankle Stabilization (ATLAS). Foot Ankle Spec 2021:19386400211041897. [PMID: 34874206 DOI: 10.1177/19386400211041897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lateral ankle instability is not uncommon after osseous cuts and soft tissue releases are performed during Total Ankle Arthroplasty (TAA), particularly with varus malalignment. The purpose of the present study was to compare the outcomes of ankles that underwent TAA with concurrent Brostrom-Gould (BG) or Anatomic Lateral Ankle Stabilization (ATLAS) at a minimum of 1-year follow-up. METHODS Thirty-eight TAAs underwent BG (21 INFINITY, 4 CADENCE) or ATLAS (13 INBONE-2) between August 2015 and February 2019 at a single institution and were at least 1 year postoperative (mean 18.3 months, range: 12-40). Baseline patient demographics, characteristics, and operative factors were assessed via medical record and chart reviews. Radiographs parameters were measured preoperatively, at 6 weeks postoperative, and during the latest follow-up. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et al, respectively. Univariate and multivariate analyses were performed. RESULTS Survivorship for TAA with concurrent BG/ATLAS was 97%. Overall, TAA with concurrent BG had higher incidences of early TAA revision (4%), recurrent instability (4%), reoperation (16%), and complications (29%) compared to ATLAS. Postoperative coronal and sagittal tibiotalar alignment changes were significant for both groups (P < .001, P = .014); however, the differences were greater for ATLAS (P = .045, P < .001). CONCLUSION The present study is the first to compare outcomes between techniques for addressing ankle instability in the TAA population. At short-term follow-up, anatomic reconstruction produced better outcomes than the traditional BG procedure. Additional comparative studies between techniques to address instability in the TAA population are warranted. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
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23
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Zhao D, Zhang G, Huang D, Yu J, Wang K, Wang X, Zhang T, Ma X. Investigation on the contour and bone mineral density of the distal tibial cutting surface used for total ankle arthroplasty. J Orthop Surg (Hong Kong) 2021; 29:23094990211028048. [PMID: 34196230 DOI: 10.1177/23094990211028048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study was designed to investigate (1) the contour of the distal tibial cutting surface, and (2) the bone mineral density (BMD) of the distal tibial cutting surface used during total ankle arthroplasty (TAA). METHODS Eight-four distal tibial models were created using foot and ankle computerized tomographic (CT) images taken from normal people. The distal tibial cutting surface for TAA was determined to be 10 mm proximal to the tibial plafond. The bony contour and BMD values were determined from the CT image at that level. A bounding box was made on the contour and the width and length of the contour was measured. Regional BMD was evaluated by Hounsfield units (HU) value measurement, with 7 regions of interest (ROI) on 8 different directions for all the 84 CT images. Two different observers made independent measurements and mean HU values for all the 56 ROIs were calculated. RESULTS Great variations were found among the contours of the cutting surface especially in term of the shape of the anterior and posterior tibial tubercle, and the fibular notch. These variations could be grouped into six categories. For the BMD of the cutting surface, the medial border of the cutting surface did not included cortical bone. The HU value of seven ROIs, which included cortical bone, were significantly greater than all the other ROIs. Few statistical differences were found by multiple comparisons among HU value of all the 49 ROIs without cortex. CONCLUSIONS Great variability existed in the shape and the BMD of the distal tibial cutting surface.
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Affiliation(s)
- Dahang Zhao
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Gonghao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Dichao Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Department of Traumatic Orthopaedics, Ningbo No.6 Hospital, Zhengjiang, People's Republic of China
| | - Jian Yu
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Kan Wang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Tiansong Zhang
- Department of TCM, Jing' an District Center Hospital, Shanghai, People's Republic of China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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24
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Chen J, Akoh CC, Kadakia R, Somerson JS, Easley ME, Adams SB, DeOrio JK, Nunley JA. Analysis of 408 Total Ankle Arthroplasty Adverse Events Reported to the US Food and Drug Administration From 2015 to 2018. Foot Ankle Spec 2021; 14:393-400. [PMID: 32383635 DOI: 10.1177/1938640020919538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Total ankle arthroplasty (TAA) use has increased with newer generation implants. Current reports in the literature regarding complications use data extracted from high-volume centers. The types of complications experienced by lower-volume centers may not be reflected in these reports. The purpose of this study was to determine a comprehensive TAA adverse event profile from a mandatory-reporting regulatory database. Methods. The US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database was reviewed from 2015 to 2018 to determine reported adverse events for approved implants. Results. Among 408 unique TAA device failures, the most common modes of failure were component loosening (17.9%), intraoperative guide or jig error (15.4%), infection (13.7%), and cyst formation (12.7%). In addition, the percentage distribution of adverse event failure types differed among implants. Conclusion. The MAUDE database is a publicly available method that requires mandatory reporting of approved device adverse events. Using this report, we found general agreement in types of complications reported in the literature, although there were some differences, as well as differences between implants. These data may more accurately reflect a comprehensive profile of TAA complications as data were taken from a database of all device users rather than only high-volume centers.Levels of Evidence: NA.
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Affiliation(s)
- Jie Chen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Craig C Akoh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (JC, CCA, RK, MEE, SBA, JKD, JAN).,Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas (JC, JSS)
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Kooner S, Kayum S, Pinsker EB, Al Khalifa A, Khan RM, Halai M, Daniels TR. Two-Year Outcomes After Total Ankle Replacement With a Novel Fixed-Bearing Implant. Foot Ankle Int 2021; 42:1002-1010. [PMID: 34024139 DOI: 10.1177/10711007211005781] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Integra Cadence total ankle replacement (TAR) is a fourth-generation anatomic, fixed-bearing implant requiring minimal tibial and talar resection, which has been in clinical use since June 2016. The primary purpose of this study is to assess its short-term clinical and radiographic outcomes after TAR using this prosthesis. METHODS This is a prospective case series of consecutive patients that underwent TAR using this novel fourth-generation prosthesis between June 2016 and November 2017. The primary outcome of interest was the Ankle Osteoarthritis Scale (AOS). Secondary outcomes included Short Form Health Survey-36 (SF-36) scores, radiographic alignment, complications, reoperations, and revisions. RESULTS In total, 69 patients were included in our study. Fifty-one patients (73.9%) required a total of 91 ancillary procedures. Postoperatively, AOS pain scores decreased significantly by an average of 17.8±30.1 points from 45.9±18.2 to 28.4±27.3 (P < .001). AOS disability scores also decreased significantly following surgery by an average of 22.0±30.5 points from 53.9±18.5 to 32.5±27.9 (P < .001). The SF-36 physical component summary score improved 10.4±9.8 points from 33.1±9.1 to 42.6±9.1 (P < .001). Radiographic analysis demonstrated significant improvement to neutral coronal plane alignment, which was achieved in 97% of patients (P < .01) with no cyst formation at 2 years. There was 1 reported complication, 9 reoperations, and no metal or polyethylene component revisions. Overall, the 2-year implant survivorship was 100% in our cohort. Eighteen patients (26.1%) demonstrated fibrous ingrowth of the tibial component. However, outcome scores for these patients did not demonstrate any negative effects. CONCLUSION In our hands, this TAR system demonstrated excellent early clinical and radiographic outcomes. Patients reported improved physical health status, pain, and disability in the postoperative period. Total ankle instrumentation allowed for accurate and reproducible implantation with correction of coronal and sagittal plane deformities. Early results for the clinical use of this TAR system are promising, but further long-term prospective outcome studies are necessary. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Shahin Kayum
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
| | - Ellie B Pinsker
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Ryan M Khan
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
| | - Mansur Halai
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Timothy R Daniels
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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26
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Townshend DN, Bing AJF, Clough TM, Sharpe IT, Goldberg A. Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties. Bone Joint J 2021; 103-B:1270-1276. [PMID: 34192928 PMCID: PMC9948432 DOI: 10.1302/0301-620x.103b7.bjj-2020-2058.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. METHODS Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. RESULTS In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. CONCLUSION The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270-1276.
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Affiliation(s)
- David N. Townshend
- Northumbria HealthCare NHS Trust, North Shields, Tyne and Wear, UK,Correspondence should be sent to David N. Townshend. E-mail:
| | - Andrew J. F. Bing
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire, UK
| | | | - Ian T. Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Andy Goldberg
- The Wellington Hospital, London, UK,UCL Division of Surgery, London, UK,Imperial College, London, UK
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27
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Rushing CJ, Mckenna BJ, Zulauf EA, Hyer CF, Berlet GC. Intermediate-Term Outcomes of a Third-Generation, 2-Component Total Ankle Prosthesis. Foot Ankle Int 2021; 42:935-943. [PMID: 33508961 DOI: 10.1177/1071100720986114] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Short-term outcomes for the INBONE I and INBONE II tibial stems have been favorable. The INBONE-II talus has been shown to have lower reoperation and failure rates compared to its predecessor at short term follow-up. The purpose of the present study was to assess mid-term outcomes for the third generation, two component total ankle prosthesis at 5 to 9 years follow-up, evaluating both the tibial and talar components. METHODS All patients who underwent primary total ankle arthroplasty (TAA) with INBONE-II between July 2010 and July 2014 at a single institution and who were at least 5 years postoperative were included. A total of 15 ankles with a mean follow-up of 85 months (range, 61-113 months) met the criteria. Radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 weeks postoperatively, and at the most recent follow-up. Medical records were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et al, respectively. RESULTS The survivorship of the prosthesis at a mean of 85 months was 93.7%. The coronal and sagittal tibiotalar alignments 6 weeks after surgery were 2.1 degrees (P = .081) and 36% (P = .15), respectively. Maintenance of this alignment was observed during the latest follow-up (P = .684 and P = .837, respectively). One ankle (6.7%) required early component revision, while 4 (26.7%) required a non-implant-related revision. Six complications (2 high grade, 1 intermediate, and 3 low) in 5 ankles (33.3%) were recorded according to the Glazebrook classification system. CONCLUSION The present study is the first to report midterm follow-up after TAA with this third-generation, 2-component prothesis. High survivorship, maintenance of correction, and a low incidence of major complications were observed in this small case series. The most common complication overall was lateral gutter impingement, which accounted for the majority of the nonrevisional reoperations. LEVEL OF EVIDENCE Level IV, case series.
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28
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Chu AK, Wilson MD, Houng B, Thompson J, So E. Outcomes of Ankle Arthrodesis Conversion to Total Ankle Arthroplasty: A Systematic Review. J Foot Ankle Surg 2021; 60:362-367. [PMID: 33422442 DOI: 10.1053/j.jfas.2020.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/30/2020] [Indexed: 02/03/2023]
Abstract
Ankle arthrodesis (AA) provides reliable pain relief, good patient satisfaction scores, and improved overall function. However, this procedure has been associated with numerous complications and sequelae, such as pseudoarthrosis, malunion, gait abnormalities, increased demand on surrounding joints, and a long period of convalescence. Conversion to total ankle arthroplasty (TAA) is a potential option in the management of these complex and challenging situations. The purpose of this study is to investigate the outcomes of AA conversion to TAA. A systematic review of electronic databases was performed. Six studies involving 172 ankles met inclusion criteria. The weighted mean preoperative Visual Analogue Scale (VAS) score at the time of TAA conversion was 7.8 and the weighted mean postoperative VAS score at the time of final follow-up was 2.5. The weighted mean preoperative AOFAS score at the time of TAA conversion was 32 and the weighted mean postoperative AOFAS score at the time of final follow-up was 72.4. The rate of salvage tibiotalocalcaneal arthrodesis was 2.3% and rate of transtibial amputation was also 2.3% after attempted conversion from initial AA to TAA. Conversion of AA to TAA appears to be a viable option to improve patient outcomes and prevent extensive hindfoot arthrodesis and transtibial amputation. More prospective studies with consistent reporting of outcomes, complications, and revision rates with long-term follow-up are needed.
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Affiliation(s)
- Anson K Chu
- Fellow, Foot and Ankle Reconstruction, Coordinated Health-Lehigh Valley, Bethlehem, PA.
| | - Matthew D Wilson
- Fellow, The CORE Institute Foot and Ankle Advanced Reconstruction Fellowship, Phoenix, AZ
| | - Brian Houng
- Resident, Grant Medical Center, Columbus, OH
| | | | - Eric So
- Fellowship-Trained Foot and Ankle Surgeon, Bryan Health, Lincoln, NE; Member, Ohio Innovation Group, Columbus, OH
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29
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Rushing CJ, Law R, Hyer CF. Early Experience With the CADENCE Total Ankle Prosthesis. J Foot Ankle Surg 2021; 60:67-73. [PMID: 33129676 DOI: 10.1053/j.jfas.2020.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 02/03/2023]
Abstract
A number of 2-component, fourth-generation total ankle arthroplasty prostheses have been introduced to the market. The purpose of the present study was to present early experience with the CADENCE total ankle prosthesis. All patients who underwent primary total ankle arthroplasty using the prosthesis between August 2016 and June 2018 at a single institution and who were at least 1 year postoperative were included. A total of 32 ankles with a mean follow-up of 24 (range, 12-33) months met the criteria. Weightbearing radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 weeks postoperative, and at the most recent follow-up. Medical records and charts were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et el, respectively. Coronal and sagittal tibiotalar alignment significantly improved after surgery (p < .001, p < .005), and was maintained during the latest follow-up (p = .44, p = .30). Two (6.3%) ankles underwent early revision for aseptic loosening; while 6 (18.8%) underwent a nonrevisional reoperation. Nine (28.1%) ankles presented a total of 13 (4 high grade, 2 intermediate, and 7 low) complications according to the Glazebrook classification. The most common was intraoperative periprosthetic medial malleolar fracture (5 ankles, 15.6%), a low-grade complication. The present study is the first to report early outcomes and experience with the CADENCE total ankle. Overall, survivorship was 94% at short-term follow-up of 2 years. As with all arthroplasty devices, surgeons new to the prosthesis should be cognizant of the potential learning curve. Intraoperative medial malleolar fracture was found to be the most common complication.
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Affiliation(s)
- Calvin J Rushing
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH.
| | - Rona Law
- Foot and Ankle Surgeon, Grant Medical Center, Columbus, OH
| | - Christopher F Hyer
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
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30
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Rushing CJ, Zulauf E, Hyer CF, Berlet GC. Risk Factors for Early Failure of Fourth Generation Total Ankle Arthroplasty Prostheses. J Foot Ankle Surg 2021; 60:312-317. [PMID: 33168439 DOI: 10.1053/j.jfas.2020.10.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
A number of 2-component, fourth generation total ankle arthroplasty (TAA) prostheses have been introduced to the market in the past few years, as the popularity and indications for TAA have continued to expand. The purpose of the present study was to identify independent risk factors for the early failure of fourth generation TAA prostheses. A total of 97 ankles underwent TAA with a fourth generation prostheses (INFINITY, CADENCE) between August 2015 and June 2018 at a single institution and were at least 6 months postoperative (mean 18.3 months, range 6-43). The primary outcome assessed was the need for revision surgery, defined as removal of 1 or both metal components for any reason, excluding infection. Baseline patient demographics, characteristics, radiographic alignment parameters, and distal tibia cortical bone thickness (CBT) were assessed. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et al, respectively. Univariate and multivariate analyses were performed. Three ankles (3.1%) underwent revision surgery for aseptic loosening at a mean of 24.3 (range, 16-31) months; all had a CBT <4 mm. Independent predictors for reoperation were CBT <4 mm, presence of diabetes, and ipsilateral hindfoot fusion (p = .04). No associations were identified for purported risk factors (age, body mass index, and coronal deformity). The present study is the first to suggest a potential relationship between reduced CBT of the distal tibia, and TAA failure. Additional studies are warranted to better understand the role of bone density in TAA survivorship.
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Affiliation(s)
- Calvin J Rushing
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH.
| | - Emily Zulauf
- Foot and Ankle Surgeon, Grant Medical Center, Columbus, OH
| | - Christopher F Hyer
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Gregory C Berlet
- Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH
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Abstract
AIMS We report the medium-term outcomes of a consecutive series of 118 Zenith total ankle arthroplasties (TAAs) from a single, non-designer centre. METHODS Between December 2010 and May 2016, 118 consecutive Zenith prostheses were implanted in 114 patients. Demographic, clinical, and patient-reported outcome measures (PROMs) data were collected. The endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan-Meier survival curves were generated with 95% confidence intervals (CIs) and the rate of failure calculated for each year. RESULTS Eight patients (ten ankles) died during follow-up, but none required revision. Of the surviving 106 patients (108 ankles: rheumatoid arthritis (RA), n = 15; osteoarthritis (OA), n = 93), 38 were women and 68 were men, with a mean age of 68.2 years (48 to 86) at the time of surgery. Mean follow-up was 5.1 years (2.1 to 9.0). A total of ten implants failed (8.5%), thus requiring revision. The implant survival at seven years, using revision as an endpoint, was 88.2% (95% CI 100% to 72.9%). There was a mean improvement in Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) from 85.0 to 32.8 and visual analogue scale (VAS) scores from 7.0 to 3.2, and overall satisfaction was 89%. The three commonest complications were malleolar fracture (14.4%, n = 17), wound healing (13.6%, n = 16), and superficial infection (12.7%, n = 15). The commonest reason for revision was aseptic loosening. No patients in our study were revised for deep infection. CONCLUSION Our results show that Zenith survival rates are comparable with those in the literature for other implants and in the National Joint Registry (NJR). Overall patient satisfaction was high as were functional outcomes. However, the data highlight potential complications associated with this surgery. The authors believe that these figures support ankle arthroplasty as an option in the treatment of ankle arthritis. Cite this article: Bone Joint J 2021;103-B(4):696-703.
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Affiliation(s)
| | - Joseph Ring
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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32
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Giardini P, Di Benedetto P, Mercurio D, Gisonni R, Molinari M, Causero A, Cortese F. Infinity ankle arthroplasty with traditional instrumentation and PSI prophecy system: preliminary results. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020021. [PMID: 33559635 PMCID: PMC7944708 DOI: 10.23750/abm.v91i14-s.10989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 02/01/2023]
Abstract
Ankle arthrodesis has been considered the surgical Gold Standard for advanced ankle arthritis; prosthetic replacement of the tibio-talar joint played a secondary role.The introduction of last generation ankle prostheses lead to better outcome and a lower rate of complication. PSI represents the most recent innovations introduced on the market of ankle arthroplasty:PSI is proposed as a surgical technique capable of making ankle arthroplasty more accurate and more reproducible compared to standard referencing guides Aim of the study is to report early clinical and radiographic outcomes obtained from a single surgeon experience by implanting the same ankle prosthesis using a standard (STD) or a PSI instrumentation Unlike no difference in the average increment of normalized sub score related to function in each group (PSI vs STD), the analysis of normalized pain sub score pointed out a greater average improvement in the PSI group(+75%)compared to the STD group(+62%);this result has been adovacated to the absence of post operative gutter impingement syndrome in the PSI group compared to the STD referencing group. The analysis of radiographic angles revealed a more accurate and reproducible positioning of the components in the PSI group; ankle arthroplasty performed with PSI reported a reduction of both surgical times and the need of intraop.fluoroscopy. PSI ankle arthroplasty achived more accurate and reproducible clinical and radiographic results compared to STD instrumentation;long-term follow-up are needed to demonstrate whether a better positioning of the implant is associated with an increased survival of the prosthesis and therefore justifies the additional costs of PSI.
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Affiliation(s)
| | - Paolo Di Benedetto
- Department of Orthopaedic Surgery, University Hospital of Udine, Udine, Italy.
| | - Domenico Mercurio
- Department of Orthopaedic Surgery, S. Maria della Misericordia Hospital, Rovereto, Italy.
| | - Renato Gisonni
- Department of Orthopaedic Surgery, University Hospital of Udine, Udine, Italy.
| | - Marco Molinari
- Department of Orthopaedic Surgery, Fiemme Hospital, Cavalese, Italy.
| | - Araldo Causero
- Department of Orthopaedic Surgery, University Hospital of Udine, Udine, Italy.
| | - Fabrizio Cortese
- Department of Orthopaedic Surgery, S. Maria della Misericordia Hospital, Rovereto, Italy.
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Daniels TR, Wilson IR, Fu JM. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2020; 102:856-865. [PMID: 32187125 DOI: 10.2106/jbjs.20.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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Jeyaseelan L, Si-Hyeong Park S, Al-Rumaih H, Veljkovic A, Penner MJ, Wing KJ, Younger A. Outcomes Following Total Ankle Arthroplasty: A Review of the Registry Data and Current Literature. Orthop Clin North Am 2019; 50:539-548. [PMID: 31466669 DOI: 10.1016/j.ocl.2019.06.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
End-stage ankle arthritis has a significant effect on function and quality of life. Total ankle arthroplasty continues to emerge as a safe and effective treatment of ankle arthritis. Ankle arthroplasty preserves motion at the ankle joint, while still achieving the primary goal of pain relief. With encouraging outcomes and improved implant longevity, there has been significant improvement on the results of first-generation implants. Further high-quality studies are required to clarify outcomes post ankle arthroplasty. This article reviews the latest data from national registries and the wider literature to evaluate the current status with outcomes of modern total ankle replacements.
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Affiliation(s)
- Luckshmana Jeyaseelan
- Department of Orthopaedics, University of British Columbia, Footbridge Centre for Integrated Orthopaedic Care, 221 - 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada
| | - Sam Si-Hyeong Park
- Department of Orthopaedics, University of British Columbia, Footbridge Centre for Integrated Orthopaedic Care, 221 - 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada
| | - Husam Al-Rumaih
- Department of Orthopaedics, University of British Columbia, Footbridge Centre for Integrated Orthopaedic Care, 221 - 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, Footbridge Centre for Integrated Orthopaedic Care, 221 - 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada
| | - Murray J Penner
- Department of Orthopaedics, University of British Columbia, Footbridge Centre for Integrated Orthopaedic Care, 221 - 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada
| | - Kevin J Wing
- Department of Orthopaedics, University of British Columbia, Footbridge Centre for Integrated Orthopaedic Care, 221 - 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada
| | - Alistair Younger
- Department of Orthopaedics, University of British Columbia, Footbridge Centre for Integrated Orthopaedic Care, 221 - 181 Keefer Place, Vancouver, British Columbia V6B 6C1, Canada.
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Abstract
Ankle arthritis is a major source of morbidity impacting a younger working age population than hip and knee arthritis. Unlike the hip and knee, more than 70% of ankle arthritis cases are post-traumatic, with the remainder being inflammatory or primary arthritis. Nonoperative treatment begins with lifestyle and shoe-wear modifications and progresses to bracing, physical therapy, anti-inflammatory medications, and intra-articular injections. Ankle arthrodesis and total ankle arthroplasty are the 2 main surgical options for end-stage ankle arthritis, with debridement, realignment osteotomy, and distraction arthroplasty being appropriate for limited indications.
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Affiliation(s)
- Vu Le
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Peter Salat
- Department of Radiology, University of Calgary, Alberta, Canada
| | - Kevin Wing
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Murray Penner
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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36
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Nunley JA, Parekh SG, DeOrio JK. Response to "Letter Regarding: Increased Early Revision Rate With the INFINITY Total Ankle Prosthesis". Foot Ankle Int 2019; 40:127. [PMID: 30522359 DOI: 10.1177/1071100718816682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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