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Hunt KJ, Ross D, Fontan F. Clinical Outcomes and Registry Data in Total Ankle Arthroplasty. Foot Ankle Clin 2024; 29:11-26. [PMID: 38309795 DOI: 10.1016/j.fcl.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle arthritis consistently demonstrating good to excellent outcomes, even when considering factors such as deformity, patient age, bilaterality, and arthritis etiology. There is little consensus in the literature with regard to preferred patient-reported outcome metrics (PROMs) for assessing outcomes, although all metrics generally improve following TAA. Several countries have successful registries to track longevity of TAA in populations; however, PROMs are generally not successfully tracked in registries. A trend toward consensus on outcome metrics and collaborative registries is warranted to optimize patient selection and outcomes in TAA.
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Affiliation(s)
- Kenneth J Hunt
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA.
| | - Daniel Ross
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA
| | - Francisco Fontan
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, Room 4508, Aurora, CO 80045, USA
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Usuelli FG, Maccario C, Indino C. Outcomes of Lateral Transfibular Approach for Total Ankle Replacement. Foot Ankle Clin 2024; 29:69-80. [PMID: 38309804 DOI: 10.1016/j.fcl.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Total ankle replacement through a lateral transfibular approach with trabecular metal implants was introduced in 2012 and originally was advertised as a safer approach in terms of wound healing issues. Further studies showed no significant difference comparing anterior and lateral approach for infections and would healing issues, whereas the main advantage is deformity correction, acting on coronal, sagittal, and rotational deformities and on fibular length issues. It showed a survival rate of 97.7% at 5 years follow-up.
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Affiliation(s)
- Federico G Usuelli
- Ortopedia della Caviglia e del Piede, Humanitas San Pio X, Via Francesco Nava, 31, Milan 20159, Italy.
| | - Camilla Maccario
- Ortopedia della Caviglia e del Piede, Humanitas San Pio X, Via Francesco Nava, 31, Milan 20159, Italy
| | - Cristian Indino
- Ortopedia della Caviglia e del Piede, Humanitas San Pio X, Via Francesco Nava, 31, Milan 20159, Italy
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Fijany AJ, Olsson SE, Givechian BK, Zago I, Bishay AE, Troia T, Page TS, Barnett A, Downey MW, Pekarev M. A Novel Orthoplastic Reconstruction of Relapsed Clubfoot With Total Ankle Arthroplasty. Cureus 2023; 15:e44796. [PMID: 37809200 PMCID: PMC10558358 DOI: 10.7759/cureus.44796] [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] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Congenital clubfoot is addressed in infancy and rarely persists into adulthood. Ankle arthroplasty is an increasingly popular surgical intervention for patients with ankle arthritis since it allows a natural ankle range of motion and completely replaces a degenerative hindfoot. Here, we describe the first successful total ankle arthroplasty (TAA) for a patient with previously treated congenital clubfoot that reverted later in life. To address the patient's poor soft-tissue integument and reduce the likelihood of post-surgical complications, a perioperative latissimus muscle-free flap was performed. This two-staged, novel orthoplastic intervention addressed our patient's ankle issues and appears to be a viable option for clubfoot patients.
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Affiliation(s)
- Arman J Fijany
- Plastic Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Sofia E Olsson
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | | | - Ilana Zago
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | - Anthony E Bishay
- Neurosurgery, Vanderbilt University School of Medicine, Nashville, USA
| | - Thomas Troia
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | - Trevor S Page
- Plastic Surgery, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | | | - Michael W Downey
- Trauma and Reconstructive Surgery, Precision Orthopedics and Sports Medicine, Fort Worth, USA
| | - Maxim Pekarev
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
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Leardini A, Belvedere C, de Cesar Netto C. Total Ankle Replacement: Biomechanics of the Designs, Clinical Outcomes, and Remaining Issues. Foot Ankle Clin 2023; 28:e1-e14. [PMID: 36935170 DOI: 10.1016/j.fcl.2023.01.001] [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] [Indexed: 03/21/2023]
Abstract
The present review paper aimed at discussing the current major issues in total ankle replacement, both the technical and biomechanical concepts, and the surgical and clinical concerns. Designers shall target at the same time restoration of natural ankle kinematics and congruity of the artificial surfaces throughout the range of motion. Surgeons are recommended to expand biomechanical knowledge on ankle joint replacement, and provide appropriate training and key factors to make arthroplasty a good alternative to arthrodesis. Moreover, adequate selection of patients and careful rehabilitation are critical. In the future, custom-made prosthesis components and patient-specific instrumentation are major developments for more complex cases.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna 40136, Italy.
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA; Orthopedic Functional Imaging Research Laboratory, University of Iowa, Iowa City, IA, USA; Department of Orthopedics, Duke University, Durham, NC, USA
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Cook HR, Messerly C, Strand G, Nowak J. Addressing varus and valgus deformity of the ankle: Algorithmic approach to total ankle arthroplasty. Foot Ankle Surg 2023; 29:268-279. [PMID: 36890086 DOI: 10.1016/j.fas.2023.02.011] [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: 09/17/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
Total ankle replacements have become increasingly popular, providing a viable alternative to ankle arthrodesis in patients with end stage ankle arthritis. Continued advancements in implant design have substantially improved long term survival outcomes as well as patient pain relief, range of motion, and quality of life. Surgeons continue to advance the indications for implantation of total ankle replacements in patients with more severe varus and valgus coronal plane deformity. This report of twelve cases demonstrates our algorithmic approach to total ankle arthroplasty in patients with deformity of the foot and ankle. By proposing a clinical algorithm with case examples, we aim to aid clinicians in successfully approaching coronal plane deformities of the foot and ankle when using total ankle replacement to ultimately improve clinical outcomes.
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Affiliation(s)
- Helene R Cook
- Fellow, Northern California Reconstructive Foot and Ankle Fellowship, Shasta Orthopedics & Sports Medicine, Redding, CA, USA
| | - Collin Messerly
- Attending Physician, Town Center Orthopedics, 44095 Pipeline Plaza, Suite 370 Ashburn VA USA
| | - Garret Strand
- Assistant Fellowship Director, Northern California Reconstructive Foot and Ankle Fellowship, Shasta Orthopedics & Sports Medicine, Redding, CA, USA
| | - Jason Nowak
- Fellowship Director, Northern California Reconstructive Foot and Ankle Fellowship, Shasta Orthopedics & Sports Medicine, Redding, CA, USA.
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Usuelli FG, Paoli T, Indino C, Maccario C, Di Silvestri CA. Fast-Track for Total Ankle Replacement: A Novel Enhanced Recovery Protocol for Select Patients. Foot Ankle Int 2023; 44:148-158. [PMID: 36576024 DOI: 10.1177/10711007221140841] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND Enhanced recovery after surgery programs, also called fast-track protocols, were developed and successfully applied in the last decade for hip and knee reconstruction. Specific fast-track protocols have not yet been applied to ankle prostheses. The aim of the study was to develop and validate an enhanced recovery protocol for total ankle replacement (TAR) evaluating the clinical and radiographic results. We hypothesize that on the basis of well-defined pre- and postoperative characteristics, the current knowledge on ankle replacement, and referring to hip and knee reconstruction, it is possible to identify a "patient type" to be safely eligible to a Fast-Track Protocol with at least comparable results and without increasing the complications risk. METHODS We identified 8 predictive variables that might affect the outcome of TAR. Those variables were the body mass index, the state of anxiety or depression, the functional preoperative status, ankle equinus, the coronal malalignment, the surgical time, the surgical accessory procedures, and the bone quality. These characteristics were evaluated for each patient with almost validated outcome tools attributing a specific score. Based on the score obtained, the patients were divided into 2 groups: the Standard Protocol group (Control Group) and the Fast-Track Protocol group (Study Group). The main difference between treatment of the 2 groups relates to the use of postoperative plaster casts: in the Fast-Track group the cast was removed the first day after surgery and walking was allowed in sports shoes assisted with crutches, whereas in the Standard Protocol group, the cast was removed after 3 weeks. Clinical and radiographic evaluation was performed for all patients preoperatively and postoperatively every 6 months. RESULTS A total of 163 patients received a score between 1 and 5 and were included in the control group (Standard Protocol); 47 patients received a score of 0 and were allocated to the study group (Fast-Track Protocol). Clinically, except for the preoperative American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score, no statistically significant differences were recorded in the multiple comparisons between the 2 groups. No significant differences were found regarding complications. CONCLUSION In selected patients, it is possible to apply an enhanced recovery protocol of rehabilitation, focused on immediate weightbearing and mobilization without any plaster or boot. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Kim J, Rajan L, Kumar P, Kim JB, Lee WC. Lower limb alignment in patients with primary valgus ankle arthritis: A comparative analysis with patients with varus ankle arthritis and healthy controls. Foot Ankle Surg 2023; 29:72-78. [PMID: 36229331 DOI: 10.1016/j.fas.2022.09.008] [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: 07/28/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND While it is commonly acknowledged that the combined effect of lower limb orientation and ankle and hindfoot alignment play a fundamental role in ankle arthritis, supramalleolar/lower limb alignment has received less attention in valgus ankle arthritis. The purpose of this study was to analyze the lower limb alignment of patients with valgus ankle arthritis with primary origin, compared to that of varus ankle arthritis and normal controls. We hypothesized that patients with valgus ankle arthritis would have the opposite pattern of lower limb alignment as those with varus ankle arthritis. METHODS A retrospective radiographic analysis was performed on 61 patients (62 ankles, mean age, 59.3 ± 12 years) with primary valgus ankle arthritis. On preoperative radiographs, seven parameters, including talar tilt angle, medial distal tibial angle (MDTA), talar center migration, anterior distal tibial angle, talo-first metatarsal (Meary's) angle, hindfoot moment arm (HMA), and mechanical axis deviation (MAD), were measured and compared to those of primary varus ankle arthritis (n = 55; mean age, 59.7 ± 8.1 years) and control patients (n = 59; mean age, 29.3 ± 7.3 years). RESULTS The valgus group had a significantly lower mean MDTA than the control group (p < 0.0001), indicating a varus distal tibial plafond in comparison to the control group. Meary's angle and HMA were significantly lower in the valgus group compared to the varus group (p < 0.05 and p < 0.0001, respectively), indicating a lower medial longitudinal arch and valgus hindfoot alignment. On whole limb radiographs, the valgus group showed a greater MAD than the control group, indicating varus lower limb alignment (p < 0.05). However, the MAD did not differ significantly between the valgus and varus groups (p = 0.7031). CONCLUSION Our findings indicate that a significant proportion of ankles with primary valgus arthritis have a varus tibial plafond and a varus lower limb mechanical axis. This study contributes to our understanding of primary valgus ankle arthritis and suggests that lower limb alignment should be analyzed and considered throughout valgus ankle arthritis realignment procedures.
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Affiliation(s)
- Jaeyoung Kim
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Lavan Rajan
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | | | - Ji-Beom Kim
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 45, Apgujeong-ro 30 gil, Gangnam-gu, Seoul, Republic of Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, 45, Apgujeong-ro 30 gil, Gangnam-gu, Seoul, Republic of Korea.
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