Radiographic Outcomes of Mobile-Bearing Total Ankle Arthroplasty for Patients With Rheumatoid Arthritis

Lack of Consensus on the Definition of Aseptic Loosening in Total Ankle Replacement: A Narrative Systematic Review

Background: Aseptic loosening is one of the most common modes of failure of total ankle replacement (TAR). However, a precise definition of aseptic loosening is still lacking. This systematic review aimed to identify the variations of applied definitions and offer insights into the lack of consensus. Methods: Human studies reporting aseptic loosening of TAR published in peer-reviewed journals within the last decade were considered. The search strategy involved specific terms in Embase, MEDLINE ALL, and the Cochrane Library. Variations in aseptic loosening definitions were analysed. Results: Of 767 studies, 88 were included in this study. Only nine studies precisely defined aseptic loosening with significant variations. Twenty-two studies referenced the term and fifty-seven reported it as a complication but neither defined nor referenced it. Conclusions: Significant uncertainty exists regarding the universal definition of aseptic loosening of TAR, and many variations occur in terms of the assessment approach and criteria.

Comparison of clinical and radiographic results of mobile-bearing total ankle arthroplasty between osteoarthritis and rheumatoid arthritis

OBJECTIVES

Clinical results of mobile-bearing total ankle arthroplasty (TAA) for rheumatoid arthritis (RA) have been reported, but no studies have compared osteoarthritis (OA) and RA. Clinical and radiographic outcomes after at least 3 years were compared between OA and RA.

METHODS

Eleven ankles with OA and 22 ankles with RA were followed after mobile-bearing TAA (FINE total ankle system). Clinical outcomes were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographic outcomes were evaluated by the angular position of the implant, radiolucent lines, migration, and subsidence. Operative and postoperative complications were assessed.

RESULTS

There were no significant differences in clinical outcomes, radiographic outcomes, or complications, except the final follow-up AOFAS total score (OA: 89.4 vs RA: 78.2; p = .044) and pain score (OA: 37.3 vs RA: 30.5; p = .041) at a mean follow-up of 83.4 months. Delayed wound healing occurred in 9.1% in RA and none in OA. Radiolucent lines were observed in 45% of both groups, and implant removal was performed in 9.1% and 18.2% of OA and RA, respectively; there were no significant differences.

CONCLUSIONS

The final follow-up AOFAS total score and pain score were significantly higher in OA after the FINE total ankle system. There was a discrepancy between radiographic abnormalities and implant removal in both OA and RA.

Risk Factors for Failure of Total Ankle Replacements: A Data Linkage Study Using the National Joint Registry and NHS Digital

BACKGROUND

Despite the increasing numbers of ankle replacements, there remains debate about which patients should undergo an ankle replacement, and there are limited studies analyzing risk factors for failure of an ankle replacement. The primary aim of this study is to analyze the risk factors for failure of total ankle replacements.

METHODS

A data linkage study combining the National Joint Registry (NJR) Data and NHS (National Health Service) Digital data was performed. The primary outcome of failure is defined as the removal or exchange of any components of the implanted device. Kaplan-Meier survival charts were used to illustrate survivorship. Multivariable Cox proportional hazards regression models were fitted to analyze potential risk factors for failures or ankle replacements.

RESULTS

The overall 5-year survival was 90.2% (95% CI 89.2%-91.1%). In multivariable (adjusted) Cox regression models, only age (hazard ratio [HR] 0.96, 95% CI 0.94-0.97), body mass index (BMI; HR 1.03, 95% CI 1.01-1.06), and underlying etiology (HR 0.88, 95% CI 0.80-0.97) were associated with an increased risk of failure.

CONCLUSION

This study demonstrates that younger patients and those with an increased BMI have an increased risk of failure of a primary ankle replacement. We also show that rheumatoid patients have higher survivorship than those with osteoarthritis.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Ten-Year Follow-Up of a Customized Total Talar Prosthesis for Revision Total Ankle Arthroplasty: A Case Report

CASE

A 74-year-old woman with rheumatoid arthritis had undergone total ankle arthroplasty (TAA) for severe ankle joint destruction at our hospital 14 years earlier. Radiographs of the ankle revealed displacement of the tibial component and subsidence of the talar component. Revision TAA was performed using a customized alumina ceramic total talar prosthesis.

CONCLUSION

The 10-year outcome of revision TAA with a total talar prosthesis was satisfactory, with no postoperative complications, such as displacement of the tibial component, dislocation of alumina ceramic artificial talus, or progression of degenerative changes in the talonavicular and subtalar joints.

Clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years: a multicenter, retrospective study

BACKGROUND

This study aimed to clarify the clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years and compare these outcomes with those of patients aged < 75 years.

METHODS

A total of 148 patients, including 65 who underwent total ankle arthroplasty and 83 who underwent ankle arthrodesis, were retrospectively surveyed. Clinical outcomes were assessed preoperatively and at the last follow-up using the Japanese Society for Surgery of the Foot Hindfoot Scale and a self-administered foot evaluation questionnaire (SAFE-Q). Patient characteristics, including age, sex, body mass index, radiographic severity, and follow-up period, were also assessed. The patients were divided into older (≥ 75 years) and younger (< 75 years) age groups. Improvements in outcomes were then compared between age groups using univariate analysis and analysis of covariance adjusted for patient characteristics. Total ankle arthroplasty and ankle arthrodesis were analyzed separately.

RESULTS

All clinical outcome scores improved postoperatively in the older age groups for both procedures. Scores for the pain and pain-related subscale of the SAFE-Q improved by 37 points (p < 0.001) in post-total ankle arthroplasty patients and by 35 points in post-ankle arthrodesis patients (p < 0.001). Furthermore, multivariate analysis showed that the improvements observed in all scores were not different between the older and younger age groups for both post-total ankle arthroplasty and post-ankle arthrodesis patients, except for the SAFE-Q physical functioning subscale score for post-ankle arthrodesis patients. The clinical outcomes improved significantly in post-total ankle arthroplasty and post-ankle arthrodesis patients aged ≥ 75 years. Moreover, these improvements were similar to those observed in patients aged < 75 years.

CONCLUSIONS

Surgical treatment of end-stage ankle osteoarthritis can be a viable treatment option, even in elderly patients, and can be expected to improve similarly to younger patients.

Stress fractures in the forefoot after arthrodesis of the hindfoot in a patient with rheumatoid arthritis: A case report

Rheumatoid arthritis (RA) is an autoimmune disease that attacks multiple joints throughout the body. Ankle arthrodesis (AA) has been the gold standard surgery for end-stage ankle arthritis in patients with RA. Here, we report the case of a 67-year-old woman with RA who had displacement and loosening of total ankle arthroplasty. The ankle was converted to AA using a metal spacer and an intramedullary nail. The patient had no complications in perioperative terms of arthrodesis. However, multiple fractures were found in the metatarsal bones at the routine 3-year follow-up. Although the patient did not remember any symptoms, the clinical outcome deteriorated compared to that a year before. The hindfoot in this case report was fixed completely by an intramedullary nail, while the midfoot had already involved ankylosis because of severe joint destruction present before the surgery. As a result, the range of motion in the joints of the midfoot and hindfoot was lost, and it is probable that an excessive load was applied to the forefoot during push-off by the toes, resulting in a stress fracture. Patients with RA remain at risk of future progressive joint destruction in every joint of their body. Therefore, surgeons should choose a surgery that preserves ankle motion to decrease the rate of adjacent joint degeneration for severe ankle arthropathy in patients with RA.

Ankle arthrodesis using a retrograde intramedullary rod with fins for highly destructive joints in elderly patients with rheumatoid arthritis: A report of two cases

Herein, we present two cases of older adult patients with highly destructive changes in ankle joints (Larsen grade IV) who underwent retrograde intramedullary ankle nail fixation with fins. In both patients, bony union was achieved, and full weight-bearing was attained at 3 months after surgery.