1
|
Teehan E, Demetracopoulos C. Outcomes of Total Ankle Replacement. Orthop Clin North Am 2024; 55:503-512. [PMID: 39216955 DOI: 10.1016/j.ocl.2024.05.002] [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: 09/04/2024]
Abstract
Total ankle replacement (TAR) is an effective operative treatment of end-stage ankle osteoarthritis (OA) in the appropriate patient, conferring improved kinematic function, decreased stress across adjacent joints, and offering equivalent pain relief in comparison to ankle arthrodesis (AA). It is important to consider patient age, weight, coronal tibiotalar deformity, joint line height, and adjacent joint OA to maximize clinical and patient outcomes. Both mobile-bearing and fixed-bearing implants have demonstrated favorable clinical outcomes, marked improvement in patient-reported outcomes, and good survivorship; however, implant survivorship decreases with longer term follow-up, necessitating constant improvement of primary and revision TAR options.
Collapse
Affiliation(s)
- Emily Teehan
- Foot & Ankle Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | | |
Collapse
|
2
|
Zygogiannis K, Thivaios GC, Kouramba A, Drakou A, Vlasis K, Panayiotidis P, Kalatzis D, Koulalis D. comparison of postoperative gait parameters after total ankle arthroplasty and ankle fusion: A systematic review. Medicine (Baltimore) 2024; 103:e38727. [PMID: 38968510 PMCID: PMC11224871 DOI: 10.1097/md.0000000000038727] [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: 02/16/2024] [Accepted: 06/07/2024] [Indexed: 07/07/2024] Open
Abstract
Ankle pathology, such as severe arthritis, often necessitates surgical intervention to restore mobility and alleviate pain. Two commonly performed procedures for end-stage ankle disease are ankle fusion (AF) and total ankle arthroplasty (TAA). This review aims to compare the impact of AF and TAA on postoperative gait parameters. An extensive search in PubMed, Scopus, and Web of Science electronic databases was conducted with the use of the keywords ("ankle arthrodesis" OR "ankle fusion") AND ("ankle replacement" OR "ankle arthroplasty") AND "gait." Clinical studies in terms of postoperative gait parameters were included in this review. At least one of the following gait parameters, included in gait analysis, should be researched: spatiotemporal variables and joint kinematics and kinetics. An initial search revealed 221 studies. After the removal of duplicates and screening of titles,10 studies (7 prospective and 3 retrospective case series) were included for qualitative analysis. In the majority of studies, there is no significant difference in spatiotemporal parameters, such as walking speed, cadence, stance duration, step length, and stride length among AF and TAA patients. Postoperative sagittal ankle ROM, mainly maximum ankle dorsiflexion angle is significantly higher in TAA patients, while results concerning hip and knee ROM are variable. The comparison of AF and TAA in terms of postoperative gait parameters has shown variable results. In the majority of studies, there is no significant difference in spatiotemporal and kinetic parameters among AF and TAA patients. Further high-quality prospective studies are needed to fully elucidate the comparison of postoperative gait parameters.
Collapse
Affiliation(s)
| | | | - Anna Kouramba
- Blood Unit and National Reference Centre for Congenital Bleeding Disorders, Laiko General Hospital, Athens, Greece
| | - Androniki Drakou
- Laiko General Hospital of Athens – Orthopaedic Department, Athens, Greece
| | - Konstantinos Vlasis
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Panayiotidis
- 1st Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, General Hospital LAIKO, Athens, Greece
| | - Dimitrios Kalatzis
- Laiko General Hospital of Athens – Orthopaedic Department, Athens, Greece
| | - Dimitrios Koulalis
- 1st Department of Orthopedics, Medical School, National and Kapodistrian University of Athens, Attiko University Hospital, Athens, Greece
| |
Collapse
|
3
|
Lee GW, Kwak WK, Jung WC, Lee KB. Tibial Axis-to-Talus Distance: A Clinically Reliable Measurement for Sagittal Translation of the Talus in Total Ankle Arthroplasty. Clin Orthop Surg 2024; 16:485-493. [PMID: 38827755 PMCID: PMC11130628 DOI: 10.4055/cios23343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 06/04/2024] Open
Abstract
Background Sagittal talar translation is an important factor influencing the sagittal alignment of total ankle arthroplasty (TAA). Thus, accurate measurement of sagittal talar translation is crucial. This study proposes a simple method (tibiotalar distance [TTD]) that can quantify talar translation without being affected by the ankle and subtalar joint condition or the talar component position in patients with TAA. Methods We enrolled 280 eligible patients (296 ankles) who underwent primary TAA between 2005 and 2019 and retrospectively reviewed them for sagittal talar translation. The TTD was measured for each patient on weight-bearing lateral ankle radiographs by 3 raters. In addition, we analyzed interrater and intrarater reliability for the TTD method. Results We found that the TTD method could quantify the talar translation and was not affected by the preoperative condition of the ankle joint surface, subtalar joint pathologies, or the postoperative talar component position. The TTD method showed an excellent intraclass correlation coefficient (> 0.9) in all interrater and intrarater reliability analyses. In the analysis of 157 healthy, unoperated contralateral ankles, we identified that TTD showed a Gaussian distribution (p = 0.284) and a mean of 38.91 mm (normal range, 29.63-48.20 mm). Conclusions The TTD method is a simple and reliable method that could be applied to patients with TAA to assess the sagittal talar translation regardless of the pre-and postoperative joint condition and implantation status.
Collapse
Affiliation(s)
- Gun-Woo Lee
- Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Korea
- Department of Orthopedic Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Woo Kyoung Kwak
- Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Woo-Chul Jung
- Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Bae Lee
- Department of Orthopedic Surgery, Chonnam National University Hospital, Gwangju, Korea
- Department of Orthopedic Surgery, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
4
|
Rodriguez-Merchan EC, Moracia-Ochagavia I. Results of Total Ankle Arthroplasty Versus Ankle Arthrodesis. Foot Ankle Clin 2024; 29:27-52. [PMID: 38309802 DOI: 10.1016/j.fcl.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
No differences have been found between total ankle arthroplasty (TAA) and ankle arthrodesis (AA) with respect to patient-reported outcome measures (PROMs), although both interventions were shown to improve PROMs with respect to the preoperative situation. That is, both interventions (AA and TAA) were effective in improving preoperative symptoms. On the other hand, 2-year complication rates were higher after AA (27%) than after TAA (16%); however, infection rates were similar (4%). The published revision rate after AA is 16% versus 11% after TAA. In short, TAA and AA appear to offer the same PROMs, but TAA has a lower rate of complications (except for infection) and revisions.
Collapse
Affiliation(s)
| | - Inmaculada Moracia-Ochagavia
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, 28046-Madrid, Spain
| |
Collapse
|
5
|
Wang Y, Qi Y, Ma B, Wu H, Wang Y, Wei B, Wei X, Xu Y. Three-dimensional gait analysis of orthopaedic common foot and ankle joint diseases. Front Bioeng Biotechnol 2024; 12:1303035. [PMID: 38456008 PMCID: PMC10919227 DOI: 10.3389/fbioe.2024.1303035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
Walking is an indispensable mode of transportation for human survival. Gait is a characteristic of walking. In the clinic, patients with different diseases exhibit different gait characteristics. Gait analysis describes the specific situation of human gait abnormalities by observing and studying the kinematics and dynamics of limbs and joints during human walking and depicting the corresponding geometric curves and values. In foot and ankle diseases, gait analysis can evaluate the degree and nature of gait abnormalities in patients and provide an important basis for the diagnosis of patients' diseases, the correction of abnormal gait and related treatment methods. This article reviews the relevant literature, expounds on the clinical consensus on gait, and summarizes the gait characteristics of patients with common ankle and foot diseases. Starting from the gait characteristics of individuals with different diseases, we hope to provide support and reference for the diagnosis, treatment and rehabilitation of clinically related diseases.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Yongsheng Xu
- Orthopedic Center (Sports Medicine Center), Inner Mongolia People’s Hospital, Hohhot, China
| |
Collapse
|
6
|
Kotlier JL, Fathi A, Ong MY, Yazditabar JM, Panoussi EE, Mayfield CK, Petrigliano FA, Liu JN, Peterson AB, Tan EW. Evidence Guiding Commercial Payer Coverage Criteria for Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241239310. [PMID: 38529013 PMCID: PMC10962051 DOI: 10.1177/24730114241239310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Background Total ankle arthroplasty (TAA), first developed as an alternative to ankle arthrodesis, has become an increasingly popular management option for end-stage ankle arthritis. Prior studies have shown commercial insurance payers base their coverage criteria on limited and low level of evidence research. This study aims to quantify and describe the evidence insurance companies use to support TAA coverage policies. Methods The top 11 national commercial health insurance payers for TAA were identified. A google search was performed to identify payer coverage policies. Policy documents were examined and cited references were classified by type of reference as well as reviewed for level of evidence (LOE). Specific coverage criteria for each individual payer were then extracted. Criteria were compared to assess for similarities among commercial payers. Finally, all references cited by each payer were examined to determine whether they mentioned the specific payer criteria. Results Six of the 11 payers had accessible coverage policies. The majority of cited references were primary journal articles (145, 60.9%) and the majority of references cited (179, 75.2%) were level III or level IV evidence. We found significant homogeneity in coverage criteria among payers. In addition, cited sources inconsistently mentioned specific payer coverage criteria. Conclusion This study demonstrates that commercial insurance payers rely on the relatively low level of currently available scientific evidence when formulating coverage policies for TAA use and adopt criteria that have not been thoroughly analyzed in the literature. More high level of evidence research is needed to help clinicians and insurance companies further refine indications for TAA so that patients who might benefit from the procedure are adequately covered. Level of Evidence Level IV, review.
Collapse
Affiliation(s)
| | - Amir Fathi
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Meng-Yung Ong
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | | | | | | | - Joseph N. Liu
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | - Eric W. Tan
- Keck School of Medicine of USC, Los Angeles, CA, USA
| |
Collapse
|
7
|
Moeller RT, Mentzel M, Gabel M, Vergote D, Bauknecht S. Anatomical principles of ankle denervation - An update. Foot Ankle Surg 2023; 29:597-602. [PMID: 37500388 DOI: 10.1016/j.fas.2023.07.005] [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: 02/14/2023] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Denervation is a surgical option in ankle arthrosis when conservative therapy has failed. Sectioning all joint branches is essential for its success. The locations of the articular branches of the saphenous (Sa), tibial (Ti), sural (Su), superficial (Ps) and deep peroneal (Pp) nerves are specified. METHODS In 16 cryopreserved specimens, the courses of the nerves were prepared. Their articular branches were identified, and their respective locations documented by using a new reference system. RESULTS The articular branches to the ankle ranged from 5 to 30 cm measured from the foot sole. The Sa should be transected at 22.5 cm, the Su at 20 cm, and the Pp at 15 cm. The Ti should be skeletonized up to 25 cm. Epifascial dissection of the Ps is to be performed below 15 cm. CONCLUSION The study specifies the joint branches of the ankle in an intraoperatively reproducible reference system and thus minimizes the required skin incisions.
Collapse
Affiliation(s)
- Richard-Tobias Moeller
- Department for Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
| | - Martin Mentzel
- Department for Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Michael Gabel
- ATOS Klinik Stuttgart GmbH, Hohenheimer Straße 91, 70184 Stuttgart, Germany
| | - Daniel Vergote
- Department for Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Simon Bauknecht
- Department for Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| |
Collapse
|
8
|
Abstract
This article discusses the biomechanics and tribology of total ankle replacements considering the influence of implant design and generation on functional outcome, before discussing the interplay between biomechanics and tribology in the clinical success of total ankle replacement. It reflects on what we know and highlights areas for further research, as well as identifying factors to consider in clinical practice.
Collapse
Affiliation(s)
- Claire Brockett
- Department of Mechanical Engineering, INSIGNEO Institute for in Silico Medicine, University of Sheffield, UK.
| |
Collapse
|
9
|
Safety and efficacy of total ankle arthroplasty versus ankle arthrodesis for ankle osteoarthritis: A systematic review and meta-analysis. Foot (Edinb) 2023; 55:101980. [PMID: 36863247 DOI: 10.1016/j.foot.2023.101980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/04/2023]
Abstract
Osteoarthritis is the most common joint disease-causing pain and disability, and its management keeps creating a debate. So, we aimed to compare the safety and efficacy of total ankle arthroplasty and ankle arthrodesis for ankle osteoarthritis. We searched PubMed, Cochrane, Scopus, and Web of Science till August 2021. The outcomes were pooled as Mean difference (MD) or Risk Ratio (RR), and 95% confidence interval. We included 36 studies. The results showed a significantly lower risk of infections in total ankle arthroplasty (TAA) than ankle arthrodesis (AA) (RR= 0.63, 95% CI [0.57, 0.70], p < 0.00001), amputations (RR= 0.40, 95% CI [0.22, 0.72], p = 0.002), postoperative non-union (RR= 0.11, 95% CI [0.03, 0.34], p = 0.0002), and a significant increase of overall range of motion in TAA than AA. Our results preferred total ankle arthroplasty over ankle arthrodesis in terms of lowering the rates of infections, amputations, and postoperative non-union, with better change in the overall range of motion.
Collapse
|
10
|
Hur ES, Mehta N, Lee S, Bohl DD. Management of Periprosthetic Bone Cysts After Total Ankle Arthroplasty. Orthop Clin North Am 2023; 54:109-119. [PMID: 36402507 DOI: 10.1016/j.ocl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Modern improvements in total ankle arthroplasty (TAA) have increased the performance of this procedure for treatment of end-stage ankle arthritis. A common finding after TAA is the formation of periprosthetic bone cysts, which can be clinically silent or result in TAA failure. The exact cause of periprosthetic bones cysts has not been established, but major theories are related to osteolysis secondary to implant wear, micromotion, and stress shielding. Treatment can be nonoperative with clinical observation for small, asymptomatic cysts. Large, progressive, and symptomatic cysts often merit surgical treatment with debridement and grafting, revision TAA, or salvage arthrodesis.
Collapse
Affiliation(s)
- Edward S Hur
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Simon Lee
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Daniel D Bohl
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA.
| |
Collapse
|
11
|
Watanabe K, Teramoto A, Kamiya T, Okada Y, Murahashi Y, Yamashita T. A Comparative Study of Foot Range of Motion and Activities of Daily Living Status of Patients Following Ankle Arthrodesis and Tibiotalocalcaneal Arthrodesis. J Foot Ankle Surg 2022; 62:519-523. [PMID: 36635140 DOI: 10.1053/j.jfas.2022.12.007] [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: 11/05/2020] [Revised: 04/03/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
Subtalar arthrodesis in addition to ankle arthrodesis (AA) should have effect on foot motion and functional capabilities pertaining to activities of daily living (ADL); however, it is not well characterized. We compared the foot range of motion and ADL-related functional capabilities between patients who had undergone AA and tibiotalocalcaneal arthrodesis (TTC). Twenty-one AA patients and 10 TTC patients were enrolled. Foot sagittal motion arc was measured by radiographs. Patient satisfaction, ADL, footwear restriction, and rating scale scores were compared between the 2 groups. The mean sagittal motion arc in the AA group (23.5 ± 6.2°) was significantly greater than that in the TTC group (15.3 ± 3.5°). Patient satisfaction and overall ADL status was comparable in the 2 groups. Difficulties in climbing stairs, wearing rubber boots, and sitting in cross-legged position were more frequently reported in the TTC group. Our findings may be valuable for both surgeons and patients in predicting post-treatment ADL status and avoiding over expectations.
Collapse
Affiliation(s)
- Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, Japan.
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yasutaka Murahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| |
Collapse
|
12
|
Brodeur PG, Walsh DF, Modest JM, Salameh M, Licht AH, Hartnett DA, Gil J, Cruz AI, Hsu RY. Trends and Reported Complications in Ankle Arthroplasty and Ankle Arthrodesis in the State of New York, 2009-2018. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221117150. [PMID: 36046550 PMCID: PMC9421042 DOI: 10.1177/24730114221117150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Ankle arthroplasty has emerged as a viable alternative to ankle arthrodesis due in large part to recent advancements in both surgical technique and implant design. This study seeks to document trends of arthroplasty and arthrodesis for ankle osteoarthritis in New York State from 2009-2018 in order to determine if patient demographics play a role in procedure selection and to ascertain the utilization of each procedure and rates of complications. Methods: Patients 40 years and older from 2009-2018 were identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10), Clinical Modification (CM) diagnosis and procedure codes for ankle osteoarthritis, ankle arthrodesis, and ankle arthroplasty in the New York statewide planning and research cooperative system database. A trend analysis for both inpatient and outpatient procedures was performed to evaluate the changing trends in utilization of ankle arthrodesis and ankle arthroplasty over time. A multivariable logistic regression was used to assess the odds of receiving ankle arthrodesis relative to ankle arthroplasty. Complications were compared between inpatient ankle arthrodesis and arthroplasty using multivariable Cox proportional hazards regression. Results: A total of 3735 cases were included. Ankle arthrodesis increased by 25%, whereas arthroplasty increased by 757%. African American race, federal insurance, workers compensation, presence of comorbidities, and higher social deprivation were associated with increased odds of having an ankle arthrodesis vs an ankle arthroplasty. Compared with ankle arthroplasty, ankle arthrodesis was associated with increased rates of readmission, surgical site infection, acute renal failure, cellulitis, urinary tract infection, and deep vein thrombosis. Conclusion: Ankle arthroplasty volume has grown substantially without a decrease in ankle arthrodesis volume, suggesting that ankle arthroplasty may be selectively used for a different population of patients than ankle arthrodesis patients. Despite the increased growth of ankle arthroplasty, certain patient demographics including patients from minority populations, federal insurance, and from areas of high social deprivation have higher odds of receiving arthrodesis. Level of Evidence: Level III, retrospective cohort.
Collapse
Affiliation(s)
| | - Devin F. Walsh
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacob M. Modest
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Motasem Salameh
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Aron H. Licht
- Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Joseph Gil
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Aristides I. Cruz
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Raymond Y. Hsu
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
13
|
Stadler C, Luger M, Stevoska S, Gahleitner M, Pisecky L, Gotterbarm T, Klasan A, Klotz MC. High Reoperation Rate in Mobile-Bearing Total Ankle Arthroplasty in Young Patients. Medicina (B Aires) 2022; 58:medicina58020288. [PMID: 35208611 PMCID: PMC8877183 DOI: 10.3390/medicina58020288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Due to inferior survival rates compared to hip and knee arthroplasty, total ankle arthroplasty (TAA) was previously mainly recommended for older and less active patients. However, given the encouraging survival rates and clinical outcomes of modern generations of TAA, some authors have also advocated TAA in young patients. Thus, the aim of this study was to evaluate age related reoperation, revision and survival rates of third-generation mobile-bearing TAAs. Materials andMethods: In this retrospective study, 224 consecutive TAA patients with a minimum follow up (FU) of 2 years were analyzed. Patients were retrospectively assigned to two study groups (Group A: age < 50 years; Group B: age ≥ 50 years). Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. Results: After a mean FU of 7.1 ± 3.2 years, the reoperation rate (Group A: 22.2%; Group B: 5.3%; p = 0.003) and revision rate (Group A: 36.1%; Group B: 13.8%; p = 0.003) were higher within Group A. An age of under 50 years at time of surgery was associated with higher reoperation (odds ratio (OR): 6.54 (95% CI: 1.96–21.8); p = 0.002) and revision rates (OR: 3.13 (95% CI: 1.22–8.04); p = 0.018). Overall, lower patient age was associated with higher reoperation (p = 0.009) and revision rates (p = 0.001). Conclusions: The ideal indication for TAA remains controversial, especially regarding patient age. The findings of this study show high reoperation and revision rates in patients aged under 50 years at time of surgery. Therefore, the outcomes of this study suggest that the indication for TAA in young patients should be considered very carefully and that the association between low patient age and high reoperation rate should be disclosed to all eligible patients.
Collapse
Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
- Correspondence:
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Manuel Gahleitner
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Lorenz Pisecky
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Matthias C. Klotz
- Marienkrankenhaus Soest, Orthopaedics and Trauma Surgery, Widumgasse 5, 59494 Soest, Germany;
| |
Collapse
|
14
|
Queen R, Hyer C, Lewis JS, Clements JR, Truitt Cooper M. Is the Solution to a Painful Ankle Fusion an Ankle Replacement? Vice Versa? Foot Ankle Spec 2021; 14:64-67. [PMID: 33605162 DOI: 10.1177/1938640021992589] [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: 11/17/2022]
|