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Lewis TL, Walker R, Alkhalfan Y, Latif A, Abbasian A. Custom Patient-Specific 3D-Printed Titanium Truss Tibiotalocalcaneal Arthrodesis Implants for Failed Total Ankle Replacements: Classification, Technical Tips, and Treatment Algorithm. Foot Ankle Int 2024:10711007241255381. [PMID: 38872312 DOI: 10.1177/10711007241255381] [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: 06/15/2024]
Abstract
BACKGROUND The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants, which offer an alternative salvage option for failed total ankle replacements. METHODS A prospective observational study was performed of 6 cases of failed total ankle replacements that were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification, and a treatment algorithm were developed based on our initial experience. RESULTS Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow-up was available for all cases. The mean follow-up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 (P < .05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 (P < .05) and the EQ-VAS also improved from 53.0 to 63.3 (P = .36). The mean VAS-Pain score at final follow-up was 27.5. There were no cases of nonunion. None of the patients were smokers. The overall complication rate was 50%. Two patients returned to surgery: one for wound washout following TAR explantation and a second for removal of metalwork 2 years following surgery for a prosthetic joint infection secondary to hematogenous spread. No patients underwent revision fixation or amputation. CONCLUSION Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable treatment option for failed total ankle replacements.
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Affiliation(s)
- Thomas L Lewis
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Roland Walker
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Yousif Alkhalfan
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ahmed Latif
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ali Abbasian
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Atesok K, Scott DJ, Hurwitz S, Gross CE. Diagnosis and Management of Periprosthetic Joint Infections After Total Ankle Arthroplasty. J Am Acad Orthop Surg 2024:00124635-990000000-00989. [PMID: 38759226 DOI: 10.5435/jaaos-d-23-01266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 04/14/2024] [Indexed: 05/19/2024] Open
Abstract
Periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a dreaded complication that may lead to catastrophic outcomes. Risk factors include a history of surgery on the operated ankle, low preoperative function scores, diabetes, extended surgical time, and postoperative wound-healing problems. Clinical presentation varies and may include increasing ankle pain and swelling, high temperature, local erythema, wound drainage, and dehiscence. The initial diagnostic evaluation should include plain radiographs, erythrocyte sedimentation rate, C-reactive protein levels, and leukocyte count. In suspected cases with elevated erythrocyte sedimentation rate and C-reactive protein, aspiration of the ankle joint for synovial fluid analysis, Gram staining, and culture should be performed. Antibiotic therapy should be based on the pathogen identified, and the surgical strategy should be determined based on the time lines of PJI. Early PJI can be treated with irrigation and débridement with polyethylene exchange. The surgical treatment of choice for late PJI is two-stage revision arthroplasty, which includes removal of the implant, insertion of an antibiotic spacer, and reimplantation of a TAA. In certain chronic PJI cases, permanent articulating antibiotic spacers can be left in place or an ankle arthrodesis can be performed. Below-knee amputation is considered as the final option after limb-sparing procedures have failed.
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Affiliation(s)
- Kivanc Atesok
- From the Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC (Atesok, Scott, and Gross), Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Hurwitz)
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Wu S, Liu S, Huang M, Liu Z, Shi J, Ling M. Different radius of curvature at the talus trochlea from northern Chinese population measured using 3D model. J Orthop Surg Res 2024; 19:266. [PMID: 38671519 PMCID: PMC11055296 DOI: 10.1186/s13018-024-04751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND To analyze the curvature characteristics of the talus trochlea in people from northern China in different sex and age groups. METHODS Computed tomography scanning data of talus from 61 specimens were collected and constructed as a three-dimensional model by Materialise's Interactive Medical Image Control System(MIMICS) software, anteromedial(AM), posteromedial(PM), anterolateral(AL), and posterolateral(PL) edge, anterior edge of medial trochlea, posterior edge of medial trochlea and anterior edge of lateral trochlea were defined according to the anatomical landmarks on trochlear surface. The curvature radii for different areas were measured using the fitting radius and measure module. RESULTS There were significant differences among the talus curvatures in the six areas (F = 54.905, P = 0.000), and more trends in the analytical results were as follows: PM > PL > MP > AL > MA > AM. The average PL radius from specimens aged > 38 years old was larger than that from specimens aged < = 38 years (t=-2.303, P = 0.038). The talus curvature of the AM for males was significantly larger than that for females (t = 4.25, P = 0.000), and the curvature of the AL for males was larger than that for females (t = 2.629, P = 0.010). For observers aged < = 38 years, the AM curvature of the right talus in the male group was significantly larger than that in the female group (P < 0.01). In age < = 38years group, the MA curvature of right talus in male was significantly larger than in female group(P < 0.01), fitting radius of talus for male (21.90 ± 1.97 mm) was significantly greater than female of this(19.57 ± 1.26 mm)(t = 6.894, P = 000). The average radius of the talus in the male population was larger than that in the female population. CONCLUSION There was no significant relationship between age and talus curvature for males and females. The radius of curvature in the posterior area was significantly larger than that in the anterior area. We recommend that this characteristic of the talus trochlea should be considered when designing the talus component in total ankle replacement (TAR).
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Affiliation(s)
- Shixun Wu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China
| | - Shizhang Liu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China
| | - Minggang Huang
- Department of CT, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Zhe Liu
- Department of CT, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, 710068, China
| | - Jiyuan Shi
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China
| | - Ming Ling
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, No. 256 Youyi West Road, Xi'an, Shaanxi, 710068, China.
- Key Laboratory of Bone Joint Disease Basic and Clinical Translation of Shaanxi Province, Xi'an, Shaanxi, 710068, China.
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Goldberg AJ, Bordea E, Chowdhury K, Hauptmannova I, Blackstone J, Brooking D, Deane EL, Bendall S, Bing A, Blundell C, Dhar S, Molloy A, Milner S, Karski M, Hepple S, Siddique M, Loveday DT, Mishra V, Cooke P, Halliwell P, Townshend D, Skene SS, Doré CJ. Cost-Utility Analysis of Total Ankle Replacement Compared with Ankle Arthrodesis for Patients Aged 50-85 Years with End-Stage Ankle Osteoarthritis: The TARVA Study. PHARMACOECONOMICS - OPEN 2024; 8:235-249. [PMID: 38189868 PMCID: PMC10884388 DOI: 10.1007/s41669-023-00449-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Patients with end-stage ankle osteoarthritis suffer from reduced mobility and quality of life and the main surgical treatments are total ankle replacement (TAR) and ankle fusion (AF). OBJECTIVES Our aim was to calculate the mean incremental cost per quality-adjusted life-year (QALY) of TAR compared with AF in patients with end-stage ankle osteoarthritis, over 52 weeks and over the patients' lifetime. METHOD We conducted a cost-utility analysis of 282 participants from 17 UK centres recruited to a randomised controlled trial (TARVA). QALYs were calculated using index values from EQ-5D-5L. Resource use information was collected from case report forms and self-completed questionnaires. Primary analysis was within-trial analysis from the National Health Service (NHS) and Personal Social Services (PSS) perspective, while secondary analyses were within-trial analysis from wider perspective and long-term economic modelling. Adjustments were made for baseline resource use and index values. RESULTS Total cost at 52 weeks was higher in the TAR group compared with the AF group, from the NHS and PSS perspective (mean adjusted difference £2539, 95% confidence interval [CI] £1142, £3897). The difference became very small from the wider perspective (£155, 95% CI - £1947, £2331). There was no significant difference between TAR and AF in terms of QALYs (mean adjusted difference 0.02, 95% CI - 0.015, 0.05) at 52 weeks post-operation. The incremental cost-effectiveness ratio (ICER) was £131,999 per QALY gained 52 weeks post-operation. Long-term economic modelling resulted in an ICER of £4200 per QALY gained, and there is a 69% probability of TAR being cost effective at a cost-effectiveness threshold of £20,000 per QALY gained. CONCLUSION TAR does not appear to be cost effective over AF 52 weeks post-operation. A decision model suggests that TAR can be cost effective over the patients' lifetime but there is a need for longer-term prospectively collected data. Clinical trial registration ISRCTN60672307 and ClinicalTrials.gov NCT02128555.
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Affiliation(s)
- Andrew J Goldberg
- Division of Surgery, UCL Institute of Orthopaedics and Musculoskeletal Science, Royal Free Hospital, 9th Floor (East), 2QG, 10 Pond St, London, NW3 2PS, UK
- Department of Research and Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, UK
- MSK Lab, Imperial College London, Sir Michael Uren Hub Imperial College London White City Campus, 86 Wood Lane, London, W12 0BZ, UK
| | - Ekaterina Bordea
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK.
| | - Kashfia Chowdhury
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK
| | - Iva Hauptmannova
- Department of Research and Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, UK
| | - James Blackstone
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK
| | - Deirdre Brooking
- Department of Research and Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, UK
| | - Elizabeth L Deane
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK
| | - Stephen Bendall
- University Hospitals Sussex NHS Foundation Trust, Lewes Road, Haywards Heath, RH16 4EX, UK
| | - Andrew Bing
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, Shropshire, UK
| | - Chris Blundell
- Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, S5 7AU, UK
| | - Sunil Dhar
- Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Andrew Molloy
- Liverpool University Hospitals NHS Foundation Trust, Fazakerley, L9 7AL, Liverpool, UK
| | - Steve Milner
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, DE22 3NE, UK
| | - Mike Karski
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, WN6 9EP, Lancashire, UK
| | - Steve Hepple
- North Bristol NHS Trust, Southmead Rd, Bristol, BS10 5NB, UK
| | - Malik Siddique
- Newcastle Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK
| | - David T Loveday
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk and Norwich University Hospital Colney Lane, Norwich, NR4 7UY, UK
| | - Viren Mishra
- Hull University Teaching Hospitals NHS Trust, Hull Royal Infirmary, Anlaby Road, Hull, HU3 2JZ, UK
| | - Paul Cooke
- Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Paul Halliwell
- Royal Surrey NHS Foundation Trust, Guildford, GU2 7XX, Surrey, UK
| | - David Townshend
- Northumbria Healthcare NHS Foundation Trust, Tyne and Wear, North Shields, NE29 8NH, UK
| | - Simon S Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, Surrey, UK
| | - Caroline J Doré
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, 90 High Holborn, London, WC1V 6LJ, UK
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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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6
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Strydom A, Saragas NP, Ferrao PN. The use of a 3D printed titanium implant for arthrodesis in the management of large osseous defects in the ankle. Foot Ankle Surg 2023; 29:576-583. [PMID: 37833130 DOI: 10.1016/j.fas.2023.05.005] [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: 09/04/2022] [Revised: 05/01/2023] [Accepted: 05/13/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Large osseous defects (LOD) in the ankle occur because of multiple aetiologies. Advancement in 3-dimensional (3D) printing technologies has led to the use of custom implants and instrumentation their management. A 3D printed patient-specific porous titanium cage which allows for peripheral osteo-integration and autogenous bone-grafting could be an ideal implant in these cases. METHODS Retrospective review of a multi-centre, multi-surgeon consecutive cohort of patients requiring either TTC or AA for a large osseous defect between June 2019 - August 2020. A custom titanium prosthesis was 3D-printed according to CT measurements for implantation. RESULTS Mean follow up was 19.5 months (range 12-24 months). Plain radiographs and CT scans at 12 months confirmed osseointegration (stability) in 11of 13 patients (84%). Two patients developed late infection, one requiring revision surgery. CONCLUSIONS 3D-Printed titanium implants in the management of LODs in the ankle offer a comparable success rate to other reported procedures, with unlimited geometric possibilities in the design allowing for accurate length correction. Their structural stability may offer an advantage over conventional bone graft techniques and limits the amount of bone-graft required. LEVELS OF EVIDENCE LOE III.
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Affiliation(s)
- Andrew Strydom
- Consultant Foot and Ankle Surgeon, Suite 3A, -2 Level, Westwing, Netcare Sunninghill Hospital, Cnr Nanyuki & Witkoppen Road, Sunninghill, 2157, South Africa.
| | - Nikiforos P Saragas
- The Orthopaedic Foot and Ankle Unit, Suite 303 Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, 2192, Johannesburg, South Africa; Honorary Adjunct Professor and Head, Foot and Ankle Unit, Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - Paulo Nf Ferrao
- The Orthopaedic Foot and Ankle Unit, Suite 303 Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, 2192, Johannesburg, South Africa; Foot and Ankle Unit, Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
Aims When a total ankle arthroplasty (TAA) fails, it can be converted to a fusion or a revision arthroplasty. Despite the increasing numbers of TAAs being undertaken, there is little information in the literature about the management of patients undergoing fusion following a failed TAA. The primary aim of this study was to analyze the survival of fusions following a failed TAA using a large dataset from the National Joint Registry (NJR). Methods A data linkage study combined NJR and NHS Digital data. Failure of a TAA was defined as a fusion, revision to a further TAA, or amputation. Life tables and Kaplan-Meier graphs were used to record survival. Cox proportional hazards regression models were fitted to compare the rates of failure. Results A total of 131 patients underwent fusion as a salvage procedure following TAA. Their mean age was 65.7 years (SD 10.6) and 73 (55.7%) were male. The mean follow-up was 47.5 months (SD 27.2). The mean time between TAA and fusion was 5.3 years (SD 2.7). Overall, 32 (24.4%) underwent reoperations other than revision and 29 (22.1%) failed. Of these 24 (18.3%) underwent revision of the fusion and five (3.8%) had a below-knee amputation. No patients underwent conversion to a further TAA. Failure usually occurred in the first three postoperative years with one-year survival of fusion being 96.0% (95% confidence interval (CI) 90.7 to 98.3) and three-year survival in 69 patients being 77.5% (95% CI 68.3 to 84.4). Conclusion Salvage fusion after a failed TAA shows moderate rates of failure and reoperations. Nearly 25% of patients required revision within three years. This study is an extension of studies using the same methodology reporting the failure rates and risk factors for failure, which have recently been published, and also one reporting the outcome of revision TAA for a failed primary TAA, using the same methodology, which will shortly be published.
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Affiliation(s)
- Toby Jennison
- Plymouth Hospitals NHS Trust, Plymouth, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Andrew J Goldberg
- Wellington Hospital, London, UK
- UCL Division of Surgery, Royal Free Hospital, London, UK
- Imperial College London, London, UK
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Kvarda P, Ruiz R, Hintermann B. Use of Femoral Head Allograft for Extended Bone Loss in Revision Total Ankle Arthroplasty: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00062. [PMID: 37616417 DOI: 10.2106/jbjs.cc.22.00787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
CASE A 38-year-old male patient presented with severe ankle pain 13 years after a total ankle arthroplasty (TAA). Radiographic evaluation revealed loosening of the implant and extensive osteolytic lesions. The medial tibial plafond and malleolus were reconstructed using a fresh-frozen femoral head graft, and revision TAA was performed. The midterm results were satisfactory, with adequate integration of the allograft and stable implant components. CONCLUSION The use of the allograft technique in revision TAA is feasible in the presence of severe bone loss, including the malleoli, and allows firm component fixation of the reconstructed bone.
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Affiliation(s)
- Peter Kvarda
- Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland
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Conklin MJ, Smith KE, Blair JW, Dupont KM. Republication of "Total Ankle Replacement Conversion to Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft and Pseudoelastic Intramedullary Nail Providing Sustained Joint Compression". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231195364. [PMID: 37578855 PMCID: PMC10422903 DOI: 10.1177/24730114231195364] [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: 08/16/2023] Open
Abstract
Tibiotalocalcaneal (TTC) arthrodesis is commonly performed to salvage a failed total ankle replacement. These salvage procedures are complicated by significant bone loss from the ankle replacement and are associated with low patient satisfaction. Here, we describe 2 cases of patients who presented with a failed total ankle replacement and underwent arthrodesis using a bulk femoral head allograft and a novel pseudoelastic intramedullary nail. The intramedullary nail contains an internal pseudoelastic element that adapts to bone resorption and settling allowing for compression to be maintained at the arthrodesis sites throughout healing. In the first case, a 65-year-old woman with a failed total ankle replacement underwent TTC arthrodesis. The second case involved an obese 53-year-old woman who had previously undergone 2 total ankle replacement procedures that resulted in unsuccessful outcomes. In both cases, union was demonstrated on computed tomographic scan by 6 months. At 2 years postsurgery, both patients were satisfied with the procedure. These cases provide preliminary evidence that tibiotalocalcaneal arthrodesis with a pseudoelastic IM nail and structural allograft is an appropriate treatment for failed total ankle replacements. Level of Evidence: Level IV, therapeutic, case series.
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Affiliation(s)
- Mark Jay Conklin
- Panorama Orthopedics and Spine Center, OrthoColorado Hospital, Golden, CO, USA
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Hermus JPS, van Kuijk SM, Witlox MA, Poeze M, van Rhijn LW, Arts JJ. Alignment of CCI total ankle replacements in relation to midterm functional outcome and complication incidence. J Foot Ankle Res 2023; 16:34. [PMID: 37291623 DOI: 10.1186/s13047-023-00630-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Total ankle arthroplasty is increasingly used as a treatment for end stage ankle arthropathy. The aim of this study was to report the mid-term clinical function and survival results of Ceramic Coated Implant (CCI) ankle replacements and assess the association between the alignment of the CCI total ankle replacements and early functional outcome and complication incidence. METHODS Data of 61 patients, who received 65 CCI implants between 2010 and 2016, were obtained from a prospectively documented database. Mean follow-up time was 85.2 months (range 27-99 months). Clinical function was assessed with AOFAS questionnaire and passive range of motion (ROM). Survival analysis and elaborate radiographic analysis was performed. Furthermore, complications and reoperations were recorded for all patients. RESULTS Progression in ROM was most seen in the first 10 months from 21.8 degrees of passive range of motion preoperative to 27.6 degrees postoperative (p < 0.001), while the mean AOFAS gradually increased during follow-up postoperative from a mean of 40.9 points preoperative to an average of 82.5 but shows a small decline towards the end of follow-up (p < 0.001). During follow-up we recorded 8 failures (12.3%) resulting in a Kaplan-Meier survival analysis of 87.7% with a median follow-up of 85.2 months. CONCLUSION We observed excellent clinical results and survival after TAA with the CCI implant with only a low mid-term complication rate. LEVEL OF EVIDENCE Level III, prospective cohort study.
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Affiliation(s)
- Joris P S Hermus
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
| | - Sander M van Kuijk
- Department of Trauma Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marianne A Witlox
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Martijn Poeze
- Department of Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University, Maastricht, the Netherlands
| | - Lodewijk W van Rhijn
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Jacobus J Arts
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
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Emmelot MP, Wagner RK, Janssen SJ, Kloen P. Blade Plate With Autogenous Bone Grafting to Salvage Peri Ankle Nonunions. Foot Ankle Int 2023; 44:516-527. [PMID: 37114908 PMCID: PMC10248309 DOI: 10.1177/10711007231165303] [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: 04/29/2023]
Abstract
BACKGROUND Salvage surgery for a nonunion around the ankle is challenging. Poor bone stock, stiffness, scarring, previous (or persistent) infection, and a compromised soft tissue envelope are common in these patients. We describe 15 cases that underwent blade plate fixation as salvage for a nonunion around the ankle, including patient/nonunion characteristics, Nonunion Scoring System (NUSS), surgical technique, healing rate, complications, and long-term follow-up with 2 patient-reported outcome measures. METHODS This is a retrospective case series from a level 1 trauma referral center. We included all patients that underwent blade plate fixation for a long-standing nonunion of the distal tibia, talus, or failed subtalar fusion. All patients had autogenous bone grafting, including 14 with posterior iliac crest grafts and 2 with femoral reamer irrigator aspirator grafting. Median follow-up was 24.4 months (interquartile range [IQR], 7.7-40). Main outcome measures were (time to) union, and functional outcomes using the 36-item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), and the Foot and Ankle Outcome Score (FAOS). RESULTS We included 15 adults with a median age of 58 years (IQR, 54-62). The median NUSS score at the time of index surgery was 46 (IQR, 34-54). Union was achieved after the index procedure in 11 of 15 patients. Additional surgery was performed in 4 of 15 patients. Union was achieved in all patients at a median of 4.2 months (IQR, 2.9-11). The median score for the PCS was 38 (IQR, 34-48, range 17-58, P = .009), for the MCS 52 (IQR, 45-60, range 33-62, P = .701), and for the FAOS 73 (IQR, 48-83). CONCLUSION In this series, our use of blade plate fixation with autogenous grafting was an effective method for managing a nonunion around the ankle allowing for alignment correction, stable compression and fixation, union, and fair patient-reported outcome scores. LEVEL OF EVIDENCE Level IV, therapeutic.
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Affiliation(s)
- Mees Paulus Emmelot
- Department of Orthopedic Surgery and
Sports Medicine, Amsterdam UMC location Meibergdreef, Amsterdam, the
Netherlands
- Amsterdam Movement Sciences,
Musculoskeletal Health, Amsterdam, the Netherlands
| | - Robert Kaspar Wagner
- Department of Orthopedic Surgery and
Sports Medicine, Amsterdam UMC location Meibergdreef, Amsterdam, the
Netherlands
- Amsterdam Movement Sciences,
Musculoskeletal Health, Amsterdam, the Netherlands
| | - Stein Jasper Janssen
- Department of Orthopedic Surgery and
Sports Medicine, Amsterdam UMC location Meibergdreef, Amsterdam, the
Netherlands
- Amsterdam Movement Sciences,
Musculoskeletal Health, Amsterdam, the Netherlands
| | - Peter Kloen
- Department of Orthopedic Surgery and
Sports Medicine, Amsterdam UMC location Meibergdreef, Amsterdam, the
Netherlands
- Amsterdam Movement Sciences,
Musculoskeletal Health, Amsterdam, the Netherlands
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12
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Hur ES, Mehta N, Lee S, Bohl DD. Management of Periprosthetic Bone Cysts After Total Ankle Arthroplasty. Orthop Clin North Am 2023; 54:109-119. [PMID: 36402507 DOI: 10.1016/j.ocl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Modern improvements in total ankle arthroplasty (TAA) have increased the performance of this procedure for treatment of end-stage ankle arthritis. A common finding after TAA is the formation of periprosthetic bone cysts, which can be clinically silent or result in TAA failure. The exact cause of periprosthetic bones cysts has not been established, but major theories are related to osteolysis secondary to implant wear, micromotion, and stress shielding. Treatment can be nonoperative with clinical observation for small, asymptomatic cysts. Large, progressive, and symptomatic cysts often merit surgical treatment with debridement and grafting, revision TAA, or salvage arthrodesis.
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Affiliation(s)
- Edward S Hur
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Nabil Mehta
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Simon Lee
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA
| | - Daniel D Bohl
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Suite 400, Chicago, IL 60612, USA.
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13
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Mehdi N, Lintz F, Alsafi M, Laborde J, Bernasconi A. Revision tibiotalar arthrodesis with posterior iliac autograft after failed arthroplasty: A matched comparative study with primary ankle arthrodeses. Orthop Traumatol Surg Res 2022; 108:103269. [PMID: 35288327 DOI: 10.1016/j.otsr.2022.103269] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Tibiotalar arthrodeses performed after failed ankle arthroplasties are known to be complex procedures with often disappointing functional outcomes. This study reports the results of a revision technique using a posterior iliac crest autograft. HYPOTHESES We hypothesized that: (1) revision tibiotalar arthrodeses (RTTAs) had functional outcomes which were similar to those of a reference cohort of primary tibiotalar arthrodeses (TTAs) and that (2) the union rate was satisfactory. MATERIALS AND METHODS This retrospective study compared 16 RTTAs performed for failed arthroplasties that caused pain and a functional disability (4 aseptic loosening, 4 massive progressive periprosthetic cysts, 5 malpositioning of implants, and 3 cases of unexplained mechanical pain) with a series of 16 primary TTAs performed for painful ankle osteoarthritis. The groups were matched at a 1:1 ratio for age, sex, side and body mass index. The preoperative workup included a physical exam, the American Orthopaedic Foot and Ankle Society (AOFAS) score, weight bearing radiographs, CT and SPECT scans. Outcomes were assessed both clinically (AOFAS score) and radiographically (X-rays and scans). The mean duration of the procedure (DP), average length of stay (LOS), fusion and complication rates, and time to union were also compared. RESULTS At the mean follow-up of 30 months (range, 12-88) for the RTTA group and 59 months (range, 23-94) for the TTA group (p=.001), the AOFAS score increased from 27 to 70.8 points (p<.001) and from 29.8 to 76.2 points (p<.001), respectively; values were similar at the last follow-up (p=.442). Both groups had similar fusion (94%) and complication rates (12%). The DP was 196.9±33.6min (range, 179-213) vs. 130±28.4min (range, 118-141) (p<.001) and the LOS was 3.8 days (range, 2-6) vs. 3.9 days (range, 2-6) (p<.445) for both groups (RTTA vs. TTA). CONCLUSION This RTTA technique using a posterior iliac crest allograft for filling bone defects was validated by the quality of the functional outcomes obtained. LEVEL OF EVIDENCE IV; Comparative retrospective study.
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Affiliation(s)
- Nazim Mehdi
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France.
| | - François Lintz
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France
| | | | - Julien Laborde
- Clinique de l'Union, Centre de Chirurgie de la cheville et du pied, Boulevard de Ratalens, 31240 Saint-Jean, France
| | - Alessio Bernasconi
- University of Naples "Federico II", Department of Public Health, Orthopaedic and Traumatology Unit, Via S. Pansini 5, Napoli, 80131, Italy
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14
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Liu T, Dong SJ, Li WL, Wang D, Zheng YP, Qu WQ. Ankle Arthrodesis Combined With Mosaic Bone Autograft Transplantation for End-Stage Ankle Osteoarthritis With Large Cysts of Talar Dome. J Foot Ankle Surg 2022; 61:932-937. [PMID: 35649964 DOI: 10.1053/j.jfas.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/08/2020] [Accepted: 11/28/2021] [Indexed: 02/03/2023]
Abstract
End-stage ankle osteoarthritis with large cysts of talar dome can be challenging to treat. Twenty patients diagnosed as end-stage ankle arthritis with large talar cysts between 04/2010 and 02/2016 were randomly divided into experimental group (10 cases) and conventional group (10 cases) by random number method. Patients in the experimental group were treated with ankle arthrodesis combined with a concomitant procedure of mosaic bone autograft transplantation, the conventional group under the ankle arthrodesis. The operation time, intraoperative blood loss, postoperative hospital stay, the time of bone union, and postoperative height of the talus between the 2 groups were compared. The preoperative and postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score were also recorded and compared. There was no significant difference in the operation time, intraoperative blood loss, and postoperative hospital stay between the 2 groups. The postoperative height of the talus body and the time of bone union were better in the experimental group than that in the conventional group (p < .05). The results of follow-up showed that the American Orthopaedic Foot and Ankle Society scores of the conventional group were lower than those in the experimental group (p < .001). And the incidence of complication (10%) in the experimental group was significantly lower than that in the conventional group (40%). The use of tibiotalar arthrodesis combined with mosaic bone autograft transfer may be potentially an effective option for the treatment of end-stage ankle arthritis with large talar cysts.
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Affiliation(s)
- Tong Liu
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Sheng-Jie Dong
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Wen-Liang Li
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Dan Wang
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Yan-Ping Zheng
- Department of Orthopaedics, Qilu Hospital (Qingdao) of Shandong University, Jinan, Shandong, China
| | - Wen-Qing Qu
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China; Department of Orthopaedics, Qilu Hospital (Qingdao) of Shandong University, Jinan, Shandong, China.
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15
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Jennison T, Spolton-Dean C, Rottenburg H, Ukoumunne O, Sharpe I, Goldberg A. The outcomes of revision surgery for a failed ankle arthroplasty. Bone Jt Open 2022; 3:596-606. [PMID: 35880516 PMCID: PMC9350690 DOI: 10.1302/2633-1462.37.bjo-2022-0038.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed. Results Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed. Conclusion Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques. Cite this article: Bone Jt Open 2022;3(7):596–606.
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Affiliation(s)
- Toby Jennison
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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16
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Fischer S, Klug A, Faul P, Hoffmann R, Manegold S, Gramlich Y. Superiority of upper ankle arthrodesis over total ankle replacement in the treatment of end-stage posttraumatic ankle arthrosis. Arch Orthop Trauma Surg 2022; 142:435-442. [PMID: 33389022 DOI: 10.1007/s00402-020-03714-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Surgical treatment of end-stage posttraumatic upper ankle arthrosis is challenging. Highly variable revision rates have been reported with total ankle arthroplasty (TAA) of the upper ankle joint. The aim of this retrospective study was to compare revision rates with tibiotalar arthrodesis (TTA) and TAA with a prosthesis to determine the superior treatment approach. METHODS Data for 148 patients (96 males and 52 females) with end-stage posttraumatic upper ankle arthrosis-including 88 treated with TTA and 60 with TAA between 2008 and 2013, with a mean follow-up of 59 months-were analysed. Bone fusion was confirmed by x-ray radiography and computed tomography. RESULTS The overall revision rate was 28%; the rate was higher with TAA (42%) than with TTA (18%). The TAA group showed an increase in revisions from 12- to 24-month postsurgery. The most common cause of revision in the TAA group was cysts (20%), and the most frequent reason for revision was nonunion (8%). Mean American Orthopaedic Foot and Ankle Society (AOFAS) and Foot and Ankle Outcome (FAO) scores in all patients were 55.5 and 53.1, respectively, with no significant difference between the TTA and TAA groups (p > 0.05). In nine cases (15%) the prosthesis was explanted or converted to TTA. TAA patients who underwent conversion to TTA had worse outcomes (AOFAS score = 39; FAO score = 35.29). CONCLUSION TAA is associated with a high rate of revisions, especially from the 2nd year postsurgery. Therefore, TTA is the treatment of choice for end-stage posttraumatic upper ankle arthrosis. Level of evidence Level III, comparative series.
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Affiliation(s)
- Sebastian Fischer
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt, Germany.
| | - Alexander Klug
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Philipp Faul
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Reinhard Hoffmann
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
| | - Sebastian Manegold
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt, Germany
| | - Yves Gramlich
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt, Germany
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17
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Abstract
Open ankle arthrodesis remains a reliable solution for ankle arthritis, especially in the setting of deformity. Careful preoperative evaluation needs to be performed, both clinically and radiographically. The specific deformity present helps determine the approach used and the fixation choices. Deformity is most commonly seen intraarticularly, though deformity can also be present anywhere along the lower extremity, including compensatory deformity in the foot. Multiple different techniques can be used to address both the deformity and achieve a successful ankle arthrodesis. Patient outcomes reported in the literature are generally good, with high union rates and improved functional outcomes.
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18
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Buchhorn T, Baumbach SF, Böcker W, Szymski D, Polzer H. [Salvage options following failed total ankle arthroplasty]. Unfallchirurg 2022; 125:211-218. [PMID: 35091802 DOI: 10.1007/s00113-022-01141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
The number of patients with osteoarthritis of the ankle, which are treated by arthroplasty, has continuously increased in recent years. The survival time of these implants is far below the results following hip and knee arthroplasty. In some cases a failure rate of approximately 1% per year or a survival rate of 70% after 10 years has been reported. The most frequent reasons for revision of an ankle prosthesis are aseptic loosening, technical implantation errors and persisting pain. For the revision of an ankle prosthesis there are basically two treatment options. For a long time, ankle arthrodesis was considered the gold standard after a failed prosthesis. In recent years, there has been an increasing trend towards re-implantation of an ankle prosthesis, as this preserves the functionality and mobility of the ankle joint as far as possible. Depending on the reason for failure and the size of the bony defect, a decision must be made regarding a one-stage and a two-stage procedure with bone augmentation. This article presents the advantages and disadvantages of arthrodesis and revision arthroplasty after failed primary ankle arthroplasty and highlights the special features of surgery.
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Affiliation(s)
- T Buchhorn
- Sporthopädicum Straubing-Regensburg-Berlin, 94315, Straubing, Deutschland
| | - S F Baumbach
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland
| | - W Böcker
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland
| | - D Szymski
- Sporthopädicum Straubing-Regensburg-Berlin, 94315, Straubing, Deutschland.,Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland
| | - H Polzer
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland.
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19
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Morelli F, Princi G, Cantagalli MR, Rossini M, Caperna L, Mazza D, Ferretti A. Arthroscopic vs open ankle arthrodesis: A prospective case series with seven years follow-up. World J Orthop 2021; 12:1016-1025. [PMID: 35036344 PMCID: PMC8696599 DOI: 10.5312/wjo.v12.i12.1016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/27/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The osteoarthritis of the ankle, although less common than other joints, is associated with severe functional limitation. Surgical options are ankle arthroscopic debridement, osteotomies, ankle arthrodesis and ankle arthroplasty. Ankle arthroplasty is increasingly used thanks to the new implants design, but ankle arthrodesis still represents the most used technique and it can be performed arthroscopically or with an open procedure.
AIM To compare mid-term results of arthroscopic vs open ankle arthrodesis of patients affected by end-stage ankle arthritis.
METHODS This study enrolled 23 patients, which underwent ankle arthrodesis. The patients were divided into 2 groups: group A (open procedure; n = 11) and group B (arthroscopic procedure, n = 12), the two groups were homogeneous with regard to age and body mass index (P = 0.347). The American Orthopaedic Foot and Ankle score (AOFAS), Freiburg Ankle score (FAS) and visual analogue scale for pain intensity were evaluated preoperatively, at six months and at final follow-up of 7.6 years in group A and 7.3 years in group B (P = 0.364).
RESULTS Patients in the arthroscopic group showed better results at six-month follow-up compared to the open group at the AOFAS (group A, 62.2; group B, 78.5; P < 0.05) and the FAS (group A, 61.1; group B, 70.3; P = 0.015) scores. Pain relief was achieved in both groups at six-month follow-up (group A, 1.4; group B, 0.9; P = 0.162). Both open and arthroscopic groups showed improved clinical outcomes from baseline to final follow-up (P > 0.05). Hospital stay was shorter in group B than in group A (P = 0.001). More complications were reported in the open group than in the arthroscopic group (P = 0.459).
CONCLUSION The arthroscopic and the open arthrodesis are valid and safe options for the treatment of ankle arthritis on the basis of clinical outcomes at 7 years follow-up. Moreover, the arthroscopic treatment shows faster improvement at six-month follow-up in comparison with the open group.
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Affiliation(s)
- Federico Morelli
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | - Giorgio Princi
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | | | - Marco Rossini
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | - Ludovico Caperna
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | - Daniele Mazza
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | - Andrea Ferretti
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
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20
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Alsayel F, Alttahir M, Wiewiorski M, Barg A, Herrera M, Valderrabano V. Two-Staged Revision Total Ankle Arthroplasty Surgery with Primary Total Ankle Arthroplasty System: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00053. [PMID: 33914712 DOI: 10.2106/jbjs.cc.20.00339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Case of a 2-staged revision surgical technique for the treatment of an aseptic total ankle arthroplasty (TAA) loosening: first surgery: removal of the loosened and painful TAA Scandinavian Total Ankle Replacement, with exclusion of infection, and reconstruction of the large bone defect (bone-defect downsizing surgery); proof of successful ankle bone reconstruction by CT-scan imaging; second surgery: implantation of a primary VANTAGE TAA (ankle reconstruction with new primary TAA). CONCLUSION The present case shows the management of a failed TAA with bone defect by performing a 2-step surgical approach: removal of loosened TAA with simultaneous bone stock restoration and then implantation of a new primary TAA. This concept is a possible alternative to a post-TAA ankle arthrodesis or to the use of a TAA revision system.
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Affiliation(s)
- Faisal Alsayel
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mustafa Alttahir
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia
| | - Martin Wiewiorski
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Alexej Barg
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Mario Herrera
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.,King Fahad Specialist Hospital, Dammam, Saudi Arabia.,Macquarie Limb Reconstruction Unit, Macquarie University Hospital, New South Wales, Australia.,Head Foot and Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland.,Head Foot and Ankle Unit, Orthopaedic Department, University of Hamburg-Eppendorf, Hamburg, Germany.,Head Foot and Ankle Unit, Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Tenerife, Spain
| | - Victor Valderrabano
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland
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21
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Sundet M, Johnsen E, Eikvar KH, Eriksen ML. Retrograde nailing, trabecular metal implant and use of bone marrow aspirate concentrate after failed ankle joint replacement. Foot Ankle Surg 2021; 27:123-128. [PMID: 32273230 DOI: 10.1016/j.fas.2020.03.003] [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: 10/10/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle fusion after removal of alloplasty is known to be a procedure with a high potential for non-unions and poor function, especially tibio-talo-calcaneal fusion. We wanted to review our results after using a novel method for the procedure, combining retrograde nailing with a trabecular metal implant and bone marrow aspirate concentration applied in an ostoconductive pad in addition to autologous bone grafting. MATERIALS AND METHODS Retrospective review of a patient series, with some prospectively registered data. 31 ankles in 30 patients were operated from January 2016 to February 2019. RESULTS There were two non-unions (6.5%), and one delayed union, none of these were reoperated. The mean postoperative Manchester-Oxford Foot and Ankle Questionnaire score (MOxFQ) was 33.6 points. 9 patients scored an average MOxFQ at 72.9 immediately before surgery, while at follow-up this had decreased to 36.2, an improvement of 36.7 points (95% CI 18.3-54.9). There were 1 minor infection and 5 possible nerve injuries. One patient had the leg amputated 1 year after the surgery due to a non-related necrotizing fasciitis. CONCLUSION We present reasonably good short to medium term patient satisfaction and fusion rates with this novel combination of techniques.
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Affiliation(s)
- Mads Sundet
- Consultant Foot and Ankle Surgeon, Diakonhjemmet Hospital, Oslo, Norway.
| | - Elena Johnsen
- Consultant Radiologist, Diakonhjemmet Hospital, Oslo, Norway.
| | - Kari Helene Eikvar
- Department of Professional Affairs,The Norwegian Medical Association, Oslo, Norway.
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22
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Mehta N, Serino J, Hur ES, Smith S, Hamid KS, Lee S, Bohl DD. Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty. Foot Ankle Int 2021; 42:230-242. [PMID: 33345610 DOI: 10.1177/1071100720978426] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Periprosthetic osteolysis is a common occurrence after total ankle arthroplasty (TAA) and poses many challenges for the foot and ankle surgeon. Osteolysis may be asymptomatic and remain benign, or it may lead to component instability and require revision or arthrodesis. In this article, we present a current and comprehensive review of osteolysis in TAA with illustrative cases. We examine the basic science principles behind the etiology of osteolysis, discuss the workup of a patient with suspected osteolysis, and present a review of the evidence of various management strategies, including grafting of cysts, revision TAA, and arthrodesis.Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Nabil Mehta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Edward S Hur
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shelby Smith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Rozis M, Benetos I, Afrati SR, Polyzois VD, Pneumaticos SG. Results and Outcomes of Combined Cross Screw and Ilizarov External Fixator Frame in Ankle Fusion. J Foot Ankle Surg 2021; 59:337-342. [PMID: 32131000 DOI: 10.1053/j.jfas.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/01/2019] [Accepted: 05/19/2019] [Indexed: 02/03/2023]
Abstract
Ankle fusion is a treatment option for end-stage ankle arthritis. Fusion site stability and optimal foot positioning are crucial parameters. We present the results of our double fixation technique, combining both cross-screw fixation and Ilizarov external fixator frame via transmalleolar approach. We reviewed the files from 52 patients operated for ankle fusion in our center. In our technique, we use a transmalleolar approach, initial stabilization with 2 cannulated, half-threaded cross screws, and final stabilization with an Ilizarov external fixator frame. Fusion stability, weightbearing time, complication rates, and final functional scores were recorded and evaluated. Mean frame removal time was 11.2 ± 2.1 weeks, and 71.6% of patients were fully weightbearing at that time. Absolute fusion stability was reported in 88.46% of patients at that time, while no pseudarthrosis was noted in final follow-up at 12 months. According to the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot-ankle score evaluation at 12 months, 90.4% of patients reported excellent and 9.6% good results. None of the patients was referred for symptomatic forefoot arthritis, and there were no cases of deep infection or deep vein thrombosis. Material-related complications were reported in 1 patient who was treated with implant removal after 1 year. Ankle fusion is a salvage procedure that offers optimal results in end-stage ankle arthritis. Our technique offers absolute fusion site stability with excellent functional results, minor complications, and the advantages of early protected weightbearing. Careful patient selection in addition to fine foot positioning should be regarded as crucial for the final outcome.
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Affiliation(s)
- Meletis Rozis
- Orthopaedic Resident, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece.
| | - Ioannis Benetos
- Orthopaedic Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
| | - Spyridoula-Roberta Afrati
- Anesthesiologist Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
| | - Vasilios D Polyzois
- Orthopaedic Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
| | - Spyros G Pneumaticos
- Orthopaedic Professor, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
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Behrens SB, Irwin TA, Bemenderfer TB, Schipper ON, Odum SM, Anderson RB, Davis WH. Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary-Referencing Implant. Foot Ankle Int 2020; 41:1510-1518. [PMID: 32795097 DOI: 10.1177/1071100720947036] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of failed total ankle arthroplasty (TAA) is challenging. Limited literature is available on options and outcomes of revision arthroplasty despite failure rates ranging from 10% to 23% within 10 years after primary TAA. This study reports the clinical and radiographic outcomes of revision TAA using a fixed-bearing, intramedullary-referencing implant. METHODS A retrospective review was performed of 18 consecutive revision TAA cases between 2008-2015 using an intramedullary-referencing, fixed-bearing, 2-component total ankle system. Demographic and radiographic data were collected preoperatively, immediately postoperatively, and at the most recent follow-up. Functional outcome data were collected immediately postoperatively and at mean follow-up 47.5 months. RESULTS Eighteen patients underwent revision TAA, with 77.8% (14/18) implant survival. Index revision was performed most commonly for aseptic talar subsidence (55.6%) or implant loosening (tibia, 29.4%; talus, 58.9%). Following revision, 22.2% (4/18) patients required reoperation at a mean 57.3 (39-86) months. Osteolysis of the tibia, talus, and fibula was present preoperatively in 66.7% (12/18), 38.9% (7/18), and 38.9% (7/18) of patients, respectively, with progression of osteolysis in 27.8% (5/18), 11.1% (2/18) and 11.1% (2/18) of patients, respectively. Subsidence of the tibial and talar revision components was observed in 38.9% (7/18) and 55.6% (10/18) of patients, respectively. The median American Orthopaedic Foot & Ankle Society (AOFAS) score was 74.5 (26-100) and Foot Function Index (FFI) score 10.2 (0-50.4). CONCLUSION Early results of intramedullary-referencing revision TAA demonstrated good patient-reported outcomes with maintenance of radiographic parameters at mean follow-up of 47.5 months. Aseptic talar subsidence or loosening were the main postoperative causes of reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant was a viable option for the failed TAA. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Todd A Irwin
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
| | | | | | - Susan M Odum
- Atrium Health, Musculoskeletal Institute, Charlotte, NC, USA.,OrthoCarolina Research Institute, Charlotte, NC, USA
| | - Robert B Anderson
- Bellin Health, Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin
| | - W Hodges Davis
- OrthoCarolina Foot & Ankle Institute, Charlotte, NC, USA
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25
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Morita S, Taniguchi A, Miyamoto T, Kurokawa H, Tanaka Y. Application of a Customized Total Talar Prosthesis for Revision Total Ankle Arthroplasty. JB JS Open Access 2020; 5:e20.00034. [PMID: 33283130 PMCID: PMC7593043 DOI: 10.2106/jbjs.oa.20.00034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The rate of revision surgery for total ankle arthroplasty (TAA) is higher than for hip and knee arthroplasties. Tibiotalocalcaneal arthrodesis is widely used; however, it requires a large allograft. Thus, the use of a customized total talar prosthesis in combination with the tibial component of TAA (combined TAA) may be an effective strategy for talar component subsidence. This study aimed to evaluate the clinical and radiographic effectiveness of the combined TAA in such revision cases. METHODS Between 2000 and 2015, 10 patients (10 women; 10 ankles) were treated using the combined TAA for revision after standard TAA or combined procedures that included the use of a talar body prosthesis. In 6 patients, the tibial component was concurrently replaced. The median follow-up period was 49 months (interquartile range [IQR], 24.5 to 90 months). The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score, a numerical rating scale (NRS) pain score, passive range of motion of the ankle, and the presence of osteophytes and degenerative changes in the adjacent joints were assessed preoperatively and at final postoperative follow-up. RESULTS The median NRS pain score improved significantly, from 7 (IQR, 6.25 to 8.75) to 2 (IQR, 1 to 3). The median JSSF ankle-hindfoot scale total score improved significantly, from 64 (IQR, 56.25 to 71.5) to 88.5 (IQR, 79.75 to 96). In the subcategories of this scale, the median pain score improved from 20 (IQR, 20 to 27.5) to 35 (IQR, 30 to 40), and the median function score improved from 34 (IQR, 26.5 to 37) to 43.5 (IQR, 39.75 to 46). The median range of motion improved from 29° (IQR, 25.5° to 35°) to 35° (IQR, 31.25° to 43.75°). No significant difference in osteophyte formation was found. Degenerative changes in the adjacent joint were found only in the talonavicular joint. CONCLUSIONS The combined TAA, used in revision for postoperative complications after standard TAA or combined procedures including the use of a talar body prosthesis, was associated with improved objective JSSF ankle-hindfoot scale scores, subjective pain assessment, and range of motion in the ankle. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Shigeki Morita
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Akira Taniguchi
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Takuma Miyamoto
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Hiroaki Kurokawa
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yasuhito Tanaka
- Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
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26
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Egglestone A, Kakwani R, Aradhyula M, Kingman A, Townshend D. Outcomes of revision surgery for failed total ankle replacement: revision arthroplasty versus arthrodesis. INTERNATIONAL ORTHOPAEDICS 2020; 44:2727-2734. [DOI: 10.1007/s00264-020-04784-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
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Velasco BT, Briceño J, Miller CP, Ye MY, Savage-Elliott I, Ellington JK, Kwon JY. Peri-implant fractures around hindfoot fusion nails: A systematic literature review and classification system. Injury 2020; 51:1497-1508. [PMID: 32389394 DOI: 10.1016/j.injury.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Tibio-talo calcaneal (TTC) arthrodesis is increasingly performed for hindfoot arthrosis and other indications. Peri-implant fracture around hindfoot fusion nails has been previously reported and can be problematic to treat given multiple surgical considerations including the status of hindfoot arthrodesis at time of fracture. We present a systematic review of the literature regarding peri-implant fractures around hindfoot fusion nails and propose a classification system to help guide treatment based on findings from the current literature as well as the collective experience of the senior authors. METHODS A review of the literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify clinical investigations in which peri-implant fractures or other hardware failures were observed as complications following TTC arthrodesis using hindfoot nails. The electronic database of PubMed/Medline/Cochrane Library was explored using specific search terms. Inclusion criteria was any clinical investigation that reported on outcomes after TTC arthrodesis using a hindfoot nail in at least one patient. Cadaveric and non-clinical investigations were excluded. RESULTS A total of 36 studies were identified which met inclusion criteria and reported clinical outcomes after TTC arthrodesis using a hindfoot fusion nail. Of the 36 studies, there was a total of 13 intraoperative fractures, 43 tibial stress fractures and 24 peri-implant fractures recorded in 12 of the 36 studies. CONCLUSION Peri-implant fracture following tibio-talo calcaneal arthrodesis using a hindfoot intramedullary nail is an uncommon but problematic condition to treat. General heterogeneity of patients and indications as well as a lack of descriptive detail in the current literature makes meta-analysis difficult. Given the lack of consensus on treatment, a classification system may be helpful to guide clinical practice.
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Affiliation(s)
- Brian T Velasco
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA 18510, United States.
| | - Jorge Briceño
- Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile.
| | - Christopher P Miller
- Carl J. Shapiro Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, United States.
| | - Michael Y Ye
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, United States.
| | - Ian Savage-Elliott
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States.
| | - J Kent Ellington
- Department of Orthopaedic Surgery, OrthoCarolina, 250 N Caswell Rd, Charlotte, NC 28207, United States.
| | - John Y Kwon
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States.
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Abstract
Salvage arthrodesis for failed total ankle replacement can be a successful procedure. The decision to perform salvage arthrodesis is based on many factors, but the following are the most important indications: severe loss of bonestock (tibia, talus, or both), inadequate soft tissue coverage, or the inability to eradicate an infection. With few revision implants on the market, salvage arthrodesis is currently the most common treatment for failed replacement and justification for revision ankle replacement is limited when any of these factors are present.
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Affiliation(s)
- Samuel B Adams
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Durham, NC 27703, USA.
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Halverson AL, Goss DA, Berlet GC. Ankle Arthrodesis With Structural Grafts Can Work for the Salvage of Failed Total Ankle Arthroplasty. Foot Ankle Spec 2020; 13:132-137. [PMID: 31006273 DOI: 10.1177/1938640019843317] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background. Treatment options after failed total ankle arthroplasty (TAA) are limited. This study reports midterm outcomes and radiographic results in a single-surgeon group of patients who have undergone ankle arthrodesis with intramedullary nail fixation and structural allograft augmentation following failed TAA. Methods. A retrospective review on patients who underwent failed TAA revision with structural femoral head allograft and intramedullary tibiotalocalcaneal (TTC) nail fixation was completed. Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) outcome scores, and radiographs were obtained at each visit with 5-year follow-up. Results. Five patients were followed to an average of 5.2 years (range 4.7-5.6). Enrollment FFI was 34.82 (range 8.82-75.88); at midterm follow-up it was 20.42 (range 0-35.38). Enrollment AOFAS scores averaged 66.6 (range 61-77); at midterm follow-up it was 70.33 (range 54-88). Radiographs showed union in 4 of 5 patients at enrollment and 2 of 3 patients at midterm. Conclusions. Utilization of TTC fusion with femoral head allograft is a salvage technique that can produce a functional limb salvage. Our results show continued improvement in patient-reported outcomes, with preservation of limb length and reasonable union rate. Levels of Evidence: Therapeutic, Level II: Prospective, comparative trial.
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Affiliation(s)
| | - David A Goss
- Orthopaedic Foot and Ankle Center, Westerville, Ohio
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30
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KIM JUNBEOM, LEE BONGJU, JUNG DEUKHEE, JEONG UITAK, CHUNGHAN AN. COMPARING OUTCOMES OF THE ANKLE ARTHRODESIS BY USING TWO DIFFERENT MATERIALS VIA A TRANSFIBULAR APPROACH. ACTA ORTOPEDICA BRASILEIRA 2020; 28:55-59. [PMID: 32425664 PMCID: PMC7224319 DOI: 10.1590/1413-785220202802223986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To compare clinical and radiologic results and complications of patients who
underwent arthrodesis using a transfibular approach with either a cannulated
screw or an anterior fusion plate. Methods: Patients who underwent ankle arthrodesis were divided into two groups
according to the used materials: 6.5 mm cannulated screw (A) and anterior
fusion plate (B). The clinical scores were compared between groups. The
radiologic results were then assessed by union time. The results were
statistically analyzed using SPSS 20. Results: There was no significant difference between both groups in the American
Orthopedic Foot & Ankle Society (AOFAS) score (p =
0.75), and in the visual analog scale (p = 0.42). In group
B, two cases included wound infection at the surgical site. In tt A, the
mean union time was 10.5 ± 2.3 weeks. In group B, it was 7.8 ± 1.3. There
was a statistically significant difference (p = 0.007)
between union time in both groups. Conclusion: Anterior fusion plate is an effective method for shorter union time, but the
surgeon should be careful with the surgical wound at the skin incision site
in the lesion of the distal tibia. Level of Evidence III,
Retrospective comparative study.
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Affiliation(s)
| | - BONG-JU LEE
- Daejeon Sun Medical Center, Republic of Korea
| | | | - UITAK JEONG
- Daejeon Sun Medical Center, Republic of Korea
| | - AN CHUNGHAN
- Daejeon Sun Medical Center, Republic of Korea
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Kruidenier J, van der Plaat LW, Sierevelt IN, Hoornenborg D, Haverkamp D. Ankle fusion after failed ankle replacement in rheumatic and non-rheumatic patients. Foot Ankle Surg 2019; 25:589-593. [PMID: 30321923 DOI: 10.1016/j.fas.2018.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/19/2018] [Accepted: 08/15/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND With longer follow-up, survival rate of total ankle replacements (TAR) diminishes. It is therefore important to have a reliable fall-back option in case of failed TAR. Revision arthroplasty is often impossible because of loss of bonestock or infection. Conversion to ankle fusion is then indicated. We investigated the clinical, radiographic and patient reported results for fusion after failed TAR in a consecutive group of patients. We concentrated on the influence of inflammatory joint disease (IJD) on union rate. METHODS Patient files and radiographic images of 46 consecutive patients (47 ankles) were reviewed. There were 22 patients with IJD. Fixation methods included; anterior plating, blade plate fixation, intramedullary nailing, compression screws and external fixation. Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM) were used to determine patient related outcomes. RESULTS Forty out of 47 ankles (85%) Fused. Union rate in the non-IJD group (96%) was significantly higher compared to the IJD-group (73%, p=0.04). Revisions and complications were more frequent in the IJD group, but numbers were too small to detect a significant difference. Mean PROM scores were: FAOS-symptoms; 68.5, FAOS-pain; 70.3, FAOS-QoL; 43.7, FAOS-ADL; 68.1 and FAAM-ADL; 52.1, with no significant difference between IJD and non-IJD patients. CONCLUSIONS IJD-patients have a higher nonunion rate after ankle fusion for failed TAR. However, patient reported outcome is not significantly different between the two groups. LEVEL OF EVIDENCE IV, retrospective cohort.
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Affiliation(s)
- J Kruidenier
- MC Slotervaart, Department of Orthopedics, Louwesweg 6, 1066EC Amsterdam, Noord-Holland, The Netherlands
| | - L W van der Plaat
- Noordwest Ziekenhuisgroep, Department of Orthopedics, Wilhelminalaan 12, 1815 JD Alkmaar, Noord-Holland, The Netherlands
| | - I N Sierevelt
- MC Slotervaart, Department of Orthopedics, Louwesweg 6, 1066EC Amsterdam, Noord-Holland, The Netherlands
| | - D Hoornenborg
- MC Slotervaart, Department of Orthopedics, Louwesweg 6, 1066EC Amsterdam, Noord-Holland, The Netherlands
| | - D Haverkamp
- MC Slotervaart, Department of Orthopedics, Louwesweg 6, 1066EC Amsterdam, Noord-Holland, The Netherlands.
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Egrise F, Parot J, Bauer C, Galliot F, Kirsch M, Mainard D. Complications and results of the arthrodesis after total ankle arthroplasty failure: a retrospective monocentric study of 12 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:373-381. [PMID: 31563987 DOI: 10.1007/s00590-019-02561-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Total ankle arthroplasty (TAA) has the objective to maintain the range of motion of the tibiotarsal joint and to preserve the nearby joints. However, the complication rate and failures remain quite high after TAA. The main objective of the study was to evaluate the improvement in the functional scores of the tibiotarsal arthrodesis after TAA failure. The secondary objective was to assess the specific complications. MATERIALS AND METHODS This monocentric retrospective series includes 12 patients (nine men, three women, average age 52.5 years) operated between 2003 and 2018. An iliac graft was used in all cases. The arthrodesis was stabilized either by screws or by retrograde nailing. RESULTS The reoperation was due to painful malleolar conflicts or loosening. The AOFAS score increased from 38/100 to 67/100 (51-86) post-operatively. The fusion was acquired at 3.7 months (3-6) except in two cases. DISCUSSION AND CONCLUSION The 83% primary fusion rate is in the low average of the literature and 92% fusion rate in the high average after reoperation. All patients were improved even in two non-unions. The results of this study confirm that the arthrodesis after TAA failure is a reliable alternative to the TAA replacement. However, they are lower than those after a first-line arthrodesis.
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Affiliation(s)
- F Egrise
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France.
| | - J Parot
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - C Bauer
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - F Galliot
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - M Kirsch
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
| | - D Mainard
- Department of Orthopedic and Trauma Surgery, hôpital central, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, Nancy, France
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Kasai T, Yasui T, Matsumoto T, Tanaka Y, Takakura Y, Tanaka S. Synovial Metallosis After Ceramic Total Ankle Arthroplasty Treated With a Total Talar Prosthesis: A Case Report. J Foot Ankle Surg 2019; 58:1010-1013. [PMID: 31474391 DOI: 10.1053/j.jfas.2018.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 02/03/2023]
Abstract
Total ankle arthroplasty is a useful surgical procedure for osteoarthritis of the ankle, but aseptic loosening of components is an issue. We report here a case of aseptic implant loosening with metallosis after total ankle arthroplasty using the TNK ankle (Kyocera, Kyoto, Japan), which occurred despite the components being ceramic. We also report favorable results from our method of treatment using a total talar prosthesis in the revision surgery. During the revision surgery, synovial metallosis was found, probably related to superficial damage to the screw affixing the tibial component to the bone. Because both the tibial and talar components were loose, all the components and the remaining talar bone were removed. A new tibial component and a custom-made alumina-ceramic total talar prosthesis was inserted. Pain relief was achieved and maintained through the latest follow-up visit at 42 months after revision surgery. Dorsiflexion of the ankle improved from 0° to 5° and plantarflexion remained unchanged from its preoperative range of 20°. The American Orthopaedic Foot & Ankle Society ankle-hindfoot score improved from 38 to 80 points. To the best of our knowledge, this is the first reported case of an alumina-ceramic total ankle prosthesis loosening caused by metallosis resulting from screw abrasion. Favorable treatment results were obtained by using a total talar prosthesis in the revision surgery.
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Affiliation(s)
- Taro Kasai
- Surgeon, Department of Orthopedic Sugery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tetsuro Yasui
- Associate Professor, Department of Orthopedic Surgery, Teikyo University Hospital Mizonokuchi, Kanagawa, Japan; Lecturer, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Takumi Matsumoto
- Attending Surgeon, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhito Tanaka
- Professor, Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Yoshinori Takakura
- Professor Emeritus, Department of Orthopedic Surgery, Nara Medical University, Nara, Japan
| | - Sakae Tanaka
- Professor, Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Gaul F, Barr CR, McCauley JC, Copp SN, Bugbee WD. Outcomes of Salvage Arthrodesis and Arthroplasty for Failed Osteochondral Allograft Transplantation of the Ankle. Foot Ankle Int 2019; 40:537-544. [PMID: 30698469 DOI: 10.1177/1071100718824082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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 Osteochondral allograft (OCA) transplantation is a useful treatment for posttraumatic ankle arthritis in young patients, but failure rates are high and reoperations are not uncommon. The aim of this study was to evaluate the outcomes of failed ankle OCA transplantation converted to ankle arthrodesis (AA) or total ankle arthroplasty (TAA). METHODS We evaluated 24 patients who underwent salvage procedures (13 AA and 11 TAA) after primary failed ankle OCA transplantation. Reoperations were assessed. Failure of the salvage procedure was defined as an additional surgery that required a revision AA/TAA or amputation. Evaluation among nonfailing ankles included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM), pain, and satisfaction. RESULTS In the salvage AA cohort, 3 patients were classified as failures (2 revision AA and 1 amputation). The 10 nonfailing patients had a mean follow-up of 7.4 years. Eighty-eight percent were satisfied with the procedure, but 63% reported continued problems with their ankle (eg, pain, swelling, stiffness). Mean pain level was 1.9 and AAOS-FAM core score was 83±13. In the salvage TAA cohort, 2 patients were classified as failures (both revision TAA). The 9 nonfailing patients had a mean follow-up of 3.8 years. Fifty percent were satisfied with the procedure, but 40% reported continued problems with their ankle. The mean pain level was 1.3, and the median AAOS-FAM core score was 82±26. CONCLUSION Revision and reoperation rates for salvage procedures following failed OCA transplantation of the ankle are higher compared to published data for primary AA and TAA procedures. However, we believe OCA transplantation can serve as an interim procedure for younger patients with advanced ankle joint disease who may not be ideal candidates for primary AA or TAA at the time of initial presentation. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Florian Gaul
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
- 2 Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
- 4 Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Germany
| | - Cameron R Barr
- 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Julie C McCauley
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Steven N Copp
- 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - William D Bugbee
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
- 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
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Kurokawa H, Taniguchi A, Morita S, Takakura Y, Tanaka Y. Total ankle arthroplasty incorporating a total talar prosthesis. Bone Joint J 2019; 101-B:443-446. [DOI: 10.1302/0301-620x.101b4.bjj-2018-0812.r2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims Total ankle arthroplasty (TAA) has become the most reliable surgical solution for patients with end-stage arthritis of the ankle. Aseptic loosening of the talar component is the most common complication. A custom-made artificial talus can be used as the talar component in a combined TAA for patients with poor bone stock of the talus. The purpose of this study was to investigate the functional and clinical outcomes of combined TAA. Patients and Methods Ten patients (two men, eight women; ten ankles) treated using a combined TAA between 2009 and 2013 were matched for age, gender, and length of follow-up with 12 patients (one man, 11 women; 12 ankles) who underwent a standard TAA. All had end-stage arthritis of the ankle. The combined TAA features a tibial component of the TNK ankle (Kyocera, Kyoto, Japan) and an alumina ceramic artificial talus (Kyocera), designed using individualized CT data. The mean age at the time of surgery in the combined TAA and standard TAA groups was 71 years (61 to 82) and 75 years (62 to 82), respectively. The mean follow-up was 58 months (43 to 81) and 64 months (48 to 88), respectively. The outcome was assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, the Ankle Osteoarthritis Scale (AOS), and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q). Results The mean preoperative JSSF score of the combined TAA and standard TAA groups was 44 (sd 11) and 49 (sd 10), respectively. The mean postoperative JSSF scores were 89 (sd 6.1) and 72 (sd 15), respectively. The mean postoperative JSSF score of the combined TAA group was significantly higher (p = 0.0034). The mean preoperative AOS scores for pain and function in the combined TAA and standard TAA groups were 5.8 (sd 3.3) and 5.5 (sd 3.1), and 8.6 (sd 1.3), and 7.1 (sd 2.9), respectively. The mean postoperative AOS scores of pain and function were 2.5 (sd 2.5) and 2.2 (sd 1.9), and 2.5 (sd 3.3) and 3.4 (sd 2.9), respectively. There were no significant differences between the two groups in terms of postoperative AOS scores. The mean postoperative SAFE-Q scores were: for pain, 76 (sd 23) and 70 (sd 23); for physical function, 66 (sd 25) and 55 (sd 27); for social function, 73 (sd 35) and 62 (sd 34); for shoe-related, 73 (sd 19) and 65 (sd 26); and for general health, 78 (sd 28) and 67 (sd 29), respectively. There were no significant differences between the two groups in terms of postoperative SAFE-Q scores. Conclusion Combined TAA resulted in better clinical results than standard TAA. Cite this article: Bone Joint J 2019;101-B:443–446.
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Affiliation(s)
- H. Kurokawa
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - A. Taniguchi
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - S. Morita
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Y. Takakura
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
| | - Y. Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan
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Loewy EM, Sanders TH, Walling AK. Intermediate-term Experience With the STAR Total Ankle in the United States. Foot Ankle Int 2019; 40:268-275. [PMID: 30413131 DOI: 10.1177/1071100718808743] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. METHODS: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years). RESULTS: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 ( P < .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place. CONCLUSION: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates. LEVEL OF EVIDENCE: Level IV, case series.
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Affiliation(s)
- Evan M Loewy
- 1 USF Health Morsani College of Medicine, Department of Orthopedics and Sports Medicine, University of South Florida, Tampa, FL, USA
| | | | - Arthur K Walling
- 3 Division of Foot & Ankle Surgery, Florida Orthopaedic Institute, Tampa, FL, USA
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Conklin MJ, Smith KE, Blair JW, Dupont KM. Total Ankle Replacement Conversion to Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft and Pseudoelastic Intramedullary Nail Providing Sustained Joint Compression. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418804487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tibiotalocalcaneal (TTC) arthrodesis is commonly performed to salvage a failed total ankle replacement. These salvage procedures are complicated by significant bone loss from the ankle replacement and are associated with low patient satisfaction. Here, we describe 2 cases of patients who presented with a failed total ankle replacement and underwent arthrodesis using a bulk femoral head allograft and a novel pseudoelastic intramedullary nail. The intramedullary nail contains an internal pseudoelastic element that adapts to bone resorption and settling allowing for compression to be maintained at the arthrodesis sites throughout healing. In the first case, a 65-year-old woman with a failed total ankle replacement underwent TTC arthrodesis. The second case involved an obese 53-year-old woman who had previously undergone 2 total ankle replacement procedures that resulted in unsuccessful outcomes. In both cases, union was demonstrated on computed tomographic scan by 6 months. At 2 years postsurgery, both patients were satisfied with the procedure. These cases provide preliminary evidence that tibiotalocalcaneal arthrodesis with a pseudoelastic IM nail and structural allograft is an appropriate treatment for failed total ankle replacements. Level of Evidence: Level IV, therapeutic, case series.
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Affiliation(s)
- Mark Jay Conklin
- Panorama Orthopedics and Spine Center, OrthoColorado Hospital, Golden, CO, USA
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Dujela M, Hyer CF, Berlet GC. Rate of Subtalar Joint Arthrodesis After Retrograde Tibiotalocalcaneal Arthrodesis With Intramedullary Nail Fixation: Evaluation of the RAIN Database. Foot Ankle Spec 2018; 11:410-415. [PMID: 29154697 DOI: 10.1177/1938640017740674] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hindfoot arthritis or significant deformity involving the ankle and subtalar joint (STJ) is a disabling condition with few salvage options. Many surgeons note a decreased STJ fusion rate compared with ankle union when a retrograde nail construct is used. The purpose of this study was to report the STJ fusion rate of tibiotalocalcaneal (TTC) arthrodesis with retrograde nail. METHODS A chart and radiographic review was performed. TTC fusions performed in patients with osteoarthritis, posttraumatic arthritis, or deformity correction with retrograde nail fixation were included. Exclusion criteria included neuropathy, Charcot arthropathy, and failed total ankle replacement. RESULTS Ultimately, 66 retrograde TTC fusions (in 63 patients) met inclusion criteria. The average age was 57.0 years. There were 29 female and 34 male patients. Radiographic fusion of the ankle and STJ was demonstrated in 68.2% of the patients. There were 11 cases (16.7%) of ankle arthrodesis with STJ nonunion, 6 cases (9.1%) of STJ fusion but ankle nonunion, and 4 cases (6.1%) of stable radiographic nonunion of both joints. The mean time to subtalar fusion was 112.1 days. One patient required revision surgery and conversion to below-knee amputation. One patient required a CROW walker for assistance with gait. CONCLUSION A 22.8% radiographic nonunion rate of the STJ was noted in retrograde TTC fusion. Despite this, patients were stable and pain free. LEVELS OF EVIDENCE Level IV: Retrospective Case series.
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Affiliation(s)
- Michael Dujela
- Washington Orthopaedic Center, Centralia, Washington (MD).,Orthopedic Foot and Ankle Center, Westerville, Ohio (CFH, GCB)
| | - Christopher F Hyer
- Washington Orthopaedic Center, Centralia, Washington (MD).,Orthopedic Foot and Ankle Center, Westerville, Ohio (CFH, GCB)
| | - Gregory C Berlet
- Washington Orthopaedic Center, Centralia, Washington (MD).,Orthopedic Foot and Ankle Center, Westerville, Ohio (CFH, GCB)
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Griffin MJ, Coughlin MJ. Evaluation of Midterm Results of the Panta Nail: An Active Compression Tibiotalocalcaneal Arthrodesis Device. J Foot Ankle Surg 2018; 57:74-80. [PMID: 29268906 DOI: 10.1053/j.jfas.2017.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 02/03/2023]
Abstract
A tibiotalocalcaneal intramedullary rod is a powerful construct often reserved for difficult and salvage cases. The Panta Nail (Integra LifeSciences, Plainsboro, NJ) is a second-generation rod that offers active axial compression compared with previous rod designs. We characterized our experience with this device and identified factors associated with nonunion. We retrospectively identified 19 patients receiving the Panta Nail during a 4-year period with a mean follow-up period of 16 months. We used a consecutive series approach toward inclusion. Fusion, asymptomatic fibrous union, or nonunion was determined for each ankle and subtalar joint as the primary endpoint. Patients were grouped as follows: group A, successful outcome; group B, successful outcome after dynamization; group C, no successful outcome. Secondary data were tested for association with the probability of first-attempt fusion. The Panta Nail resulted in a first-attempt fusion rate of 65% at the ankle and subtalar joints. With implementation of dynamization (31% of cases) at an average of 28 weeks after insertion (groups A and B), the bony fusion rate was 88% and 77% at the ankle and subtalar joint, respectively. Inclusion of 3 asymptomatic fibrous unions with final visual analog scale scores <4 (1 ankle; 2 subtalar) as successful outcomes resulted in 94% and 88% success rates for the ankle and subtalar joints (groups A and B). Salvaged total ankle arthroplasties with the Panta Nail device as a subgroup had an 83% fusion rate, with a 50% dynamization rate. No predictors of nonunion were found. The Panta Nail is a second-generation tibiotalocalcaneal arthrodesis device capable of providing good success rates for fusion. Also, dynamization is an appropriate and frequent augmentation method.
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Affiliation(s)
- Matthew J Griffin
- Orthopaedic Surgeon, The Coughlin Clinic of Saint Alphonsus Hospital, Boise, ID.
| | - Michael J Coughlin
- Professor and Orthopaedic Surgeon, The Coughlin Clinic of Saint Alphonsus Hospital, Boise, ID
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Miller J, Hoang V, Yoon RS, Liporace FA. Staged Treatment of Infected Tibiotalar Fusion Using a Combination Antibiotic Spacer and Antibiotic-Coated Intramedullary Nail. J Foot Ankle Surg 2018. [PMID: 28645549 DOI: 10.1053/j.jfas.2017.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pilon fractures are notoriously difficult injuries to treat. The current published data on salvage procedures after failed pilon fractures includes both total ankle arthroplasty (TAA) and tibiotalar fusion, each with its own specific indications. However, no acceptable treatment algorithm addressing the complications of these limb salvage procedures is available. We present the case of a 23-year-old patient, who sustained a complex pilon fracture after a motor vehicle accident. The patient was referred to our institution after an initial fixation attempt, followed by subsequent failed TAA, which was complicated by an infected fusion attempt. We describe a staged treatment approach to clearing the infection and obtaining the final fusion goals.
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Affiliation(s)
- Justin Miller
- Resident, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ
| | - Victor Hoang
- Medical Student, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ
| | - Richard S Yoon
- Director of Orthopaedic Research, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ
| | - Frank A Liporace
- Chairman, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ.
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Aubret S, Merlini L, Fessy M, Besse JL. Poor outcomes of fusion with Trabecular Metal implants after failed total ankle replacement: Early results in 11 patients. Orthop Traumatol Surg Res 2018; 104:231-237. [PMID: 29407072 DOI: 10.1016/j.otsr.2017.11.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 11/19/2017] [Accepted: 11/30/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION One of the reasons for revision of total ankle replacement (TAR) implants is loosening due to subchondral cysts. Reconstruction and fusion of the ankle is often the first choice for revision procedures due to the large bone defects, which are typically filled with autograft and/or allograft. Filling the defect with a trabecular metal tantalum implant is a potential alternative given the biomechanical properties of this component. HYPOTHESIS Using tantalum as a spacer provides primary stability and contributes to fusion of the ankle joint after removal of failed TAR implants. METHODS Eleven patients underwent arthrodesis an average of 6.9 years after TAR. The mean height of the bone defect was 32mm. It was filled with a specially designed quadrangular implant (Trabecular Metal™, Zimmer/Biomet) combined with an iliac crest graft. Ten patients underwent tibio-talo-calcaneal (TTC) arthrodesis fixed with an angled retrograde nail and one patient underwent talocrural arthrodesis fixed with two plates (anterolateral and anteromedial). The clinical, functional (AOFAS and SF36 scores) and radiological (plain X-rays and CT scan) outcomes were determined. RESULTS At a mean follow-up of 19.3 months, the mean total AOFAS score was 56 (21-78) and the mean SF36 score was 60.5 (19-84). One patient was lost to follow-up and four patients still had pain. The tantalum implant was integrated in six patients. Five patients achieved fusion of the subtalar joint and 8 achieved fusion of the talocrural joint. Three patients required surgical revision. DISCUSSION Our hypothesis was not confirmed. The clinical outcomes after more than 1 year of follow-up are disappointing, as was the large number of nonunion cases and the lack of tantalum integration. These technical failures can be explained by insufficient construct stability and/or insufficient implant porosity. LEVEL OF EVIDENCE IV (retrospective cohort study).
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Affiliation(s)
- S Aubret
- Service de chirurgie orthopédique et traumatologique, centre hospitalier Lyon-Sud, hospices Civils de Lyon, 69495 Pierre-Bénite cedex, France; Service de chirurgie orthopédique et traumatologique, université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - L Merlini
- Service de chirurgie orthopédique et traumatologique, centre hospitalier Lyon-Sud, hospices Civils de Lyon, 69495 Pierre-Bénite cedex, France
| | - M Fessy
- Laboratoire de biomécanique et mécanique des Chocs, IFSTTAR, LBMC UMR-T 9406, université Lyon 1, 69675 Bron cedex, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier Lyon-Sud, hospices Civils de Lyon, 69495 Pierre-Bénite cedex, France
| | - J-L Besse
- Laboratoire de biomécanique et mécanique des Chocs, IFSTTAR, LBMC UMR-T 9406, université Lyon 1, 69675 Bron cedex, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier Lyon-Sud, hospices Civils de Lyon, 69495 Pierre-Bénite cedex, France
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Preston NLP, Wilson M, Hewitt EA. Salvage arthrodesis of a failed total ankle replacement using a custom 3D-printed cage implant: A case report and review of the literature. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105818760047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We present a case report of a 66-year-old female who underwent salvage arthrodesis after a failed Scandinavian Total Ankle Replacement secondary to aseptic loosening and talar subsidence. Secondary to the loss of talar integrity the decision was made to proceed with revisional ankle arthrodesis. To maintain limb length the primary surgeon (EH) elected to use a custom cage implant in combination with an intramedullary nail construct in a single stage approach. The custom cage was augmented with autograft & allograft cancellous bone in addition to allograft recombinant human bone morphogenic protein, and allograft adult mesenchymal stem cells. The incision sites healed post-operatively without incident and at post-op week 16 the patient progressed to full unrestricted weight bearing in normal shoe wear with a gauntlet ankle brace. Although an isolated report, this case shows promise for further development of the technique. We believe this revisional arthrodesis technique warrants further research and consideration as a potential addition to the failed total ankle arthroplasty treatment algorithm.
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Affiliation(s)
- Nathaniel LP Preston
- Grant Medical Center Foot and Ankle Surgery Residency Program (PMSR&RRA), Columbus, OH, USA
| | - Matthew Wilson
- Grant Medical Center Foot and Ankle Surgery Residency Program (PMSR&RRA), Columbus, OH, USA
| | - Elizabeth A Hewitt
- Grant Medical Center Foot and Ankle Surgery Residency Program (PMSR&RRA), Columbus, OH, USA
- Step Lively Foot and Ankle, Grove City, OH, USA
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Affiliation(s)
- Anke Röser
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, D-81347, München, Deutschland.
| | - Sebastian Altenberger
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, D-81347, München, Deutschland
| | - Markus Walther
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, D-81347, München, Deutschland
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The AES total ankle arthroplasty analysis of failures and survivorship at ten years. INTERNATIONAL ORTHOPAEDICS 2017; 41:2525-2533. [PMID: 28871360 DOI: 10.1007/s00264-017-3605-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AES mobile-bearing total ankle replacement was developed from the Buechel Pappas model. It was withdrawn in 2009, after identification of a higher than expected complication rate. The purpose of the current study was to analyse clinical outcomes, failures and survival of the initial series of 50 AES published in 2009. METHODS In this single-centre continuous prospective study (2003-2006), 50 AES prostheses were included. Pre-operative osteoarthritis was mainly post-traumatic (50%) and secondary to instability (36%). All patients were assessed with clinical and radiographic follow-up at six months, one year, two years and every two to three years thereafter. A CT-scan was systematically performed before procedure, and at two years, five years and ten years. At last follow-up, all patients with TAR had a functional (SF 36, AOFAS) and clinical assessment. All complications or surgical events were analysed. RESULTS The mean follow-up was ten ± two years (range, 9-13). The mean AOFAS score was 75 points (range, 26-100). The mean SF 36 score was 69 points (range, 35-97). There was a significant deterioration in AOFAS score at five years and at last follow-up (p < 0.05). Fifteen TARs underwent reoperation for cyst curettage-graft because of development of periprosthetic lesions. Six of them ended up with prosthesis removal-arthrodesis. At the last follow-up, 14 TARs were removed for arthrodesis. Of the 30 prostheses seen at last follow-up, four are awaiting prosthesis removal-arthrodesis and one for cyst curettage-graft. The ten year survivorships free of any prosthesis removal or arthrodesis and free of any reoperation were 68% (95% CI, 55-85) and 57% (95% CI, 44-74), respectively. CONCLUSION Our data suggested a high rate of reoperation. Overall ten year survival was lower than with other designs, particularly due to cyst lesions. LEVEL OF EVIDENCE Level IV, prospective case series.
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Abstract
Total ankle arthroplasty has advanced rapidly in the last 20 years. Early agility implants enjoyed improved survivability compared with more archaic total ankle implants. When talar subsidence occurs, the revision options include a stemmed component to improve stability by spanning the subtalar joint. Removal and revision of these stemmed components can be difficult because of ingrowth and bone loss.
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Affiliation(s)
- Michael M Brage
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, 325, 9th Avenue, Seattle, WA 98104, USA
| | - Uma E Ramadorai
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78219, USA.
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Watanabe K, Teramoto A, Kobayashi T, Ogon I, Sakakibara Y, Kamiya T, Suzuki T, Yamashita T. Tibiotalocalcaneal Arthrodesis Using a Soft Tissue-Preserved Fibular Graft for Treatment of Large Bone Defects in the Ankle. Foot Ankle Int 2017; 38:671-676. [PMID: 28552043 DOI: 10.1177/1071100717696252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pathogenesis of ankle disorders with a large bone defect is varied and treatment for those problems is challenging for orthopaedic surgeons. The aims of this study were to present an operative technique of arthrodesis for the reconstruction of the ankle and hindfoot with a large bone defect using a soft tissue-preserved fibular strut graft and to report outcomes of consecutively treated patients. METHODS Twelve feet from 11 patients, including feet with aseptic necrosis of the talus and total ankle implant loosening, were treated. Bone defects were filled using iliac bone and/or resected fibula and tibiotalocalcaneal arthrodesis was performed using a retrograde intramedullary nail. A modified transfibular approach was used to expose the affected joint while preserving the lateral to posterior skin and soft tissues on the fibula. The periods of bony fusion and outcomes were radiographically and clinically evaluated. The mean follow-up period was 33.4 months. RESULTS Bony fusion was achieved within 3 months in all cases. Coronal and sagittal alignments were acceptable, and the mean American Orthopaedic Foot & Ankle Score improved from 53.8 to 75.5 at the final follow-up. All patients graded their results of treatment as "satisfied." CONCLUSION This procedure did not require special techniques and it should be applicable to complicated cases with large bone defects. High fusion rates that we believe are due to preserving blood supply to the fibular graft can be expected with preservation of the hindfoot height. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Kota Watanabe
- 1 Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Hokkaido, Japan
| | - Atsushi Teramoto
- 2 Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Takuma Kobayashi
- 2 Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Izaya Ogon
- 2 Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Yuzuru Sakakibara
- 2 Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Tomoaki Kamiya
- 2 Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Tomoyuki Suzuki
- 2 Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Toshihiko Yamashita
- 2 Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan
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Alrashidi Y, Galhoum AE, Wiewiorski M, Herrera-Pérez M, Hsu RY, Barg A, Valderrabano V. How To Diagnose and Treat Infection in Total Ankle Arthroplasty. Foot Ankle Clin 2017; 22:405-423. [PMID: 28502355 DOI: 10.1016/j.fcl.2017.01.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Periprosthetic infection after total ankle arthroplasty (TAA) is a serious complication, often requiring revision surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. Risk factors for periprosthetic ankle infection include prior surgery at the site of infection, low functional preoperative score, diabetes, and wound healing problems. The clinical presentation of patients with periprosthetic ankle joint infection can be variable and dependent on infection manifestation: acute versus chronic. The initial evaluation in patients with suspected periprosthetic joint infections should include blood tests: C-reactive protein and erythrocyte sedimentation rate. Joint aspiration and synovial fluid analysis can help confirm suspected periprosthetic ankle infection.
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Affiliation(s)
- Yousef Alrashidi
- Orthopaedic Department, College of Medicine, Taibah University, P.O. Box 30001, Almadinah Almunawwarah 41411, Kingdom of Saudi Arabia
| | - Ahmed E Galhoum
- Nasser Institute for Research and Treatment, Cairo, Egypt; Department of Orthopaedics and Traumatology, Swiss Ortho Center, Schmerzklinik Basel, Hirschgässlein 15, Basel 4010, Switzerland
| | - Martin Wiewiorski
- Orthopaedic and Trauma Department, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Mario Herrera-Pérez
- Orthopaedic Department, University Hospital of Canary Islands, La Laguna, Calle El Pilar 50 4 piso, 38002 Tenerife, Spain
| | - Raymond Y Hsu
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Victor Valderrabano
- Orthopaedic Department, Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, Basel 4010, Switzerland.
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Lawton CD, Butler BA, Dekker RG, Prescott A, Kadakia AR. Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. J Orthop Surg Res 2017; 12:76. [PMID: 28521779 PMCID: PMC5437567 DOI: 10.1186/s13018-017-0576-1] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/04/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The surgical treatment of end-stage tibiotalar arthritis continues to be a controversial topic. Advances in surgical technique and implant design have lead to improved outcomes after both ankle arthrodesis (AA) and total ankle arthroplasty (TAA), yet a clear consensus regarding the most ideal form of treatment is lacking. In this study, the outcomes and complications following AA and TAA are compared in order to improve our understanding and decision-making for care and treatment of symptomatic tibiotalar arthritis. METHODS Studies reporting on outcomes and complications following TAA or AA were obtained for review from the PubMed database between January 2006 and July 2016. Results from studies reporting on a minimum of 200 total ankle arthroplasties or a minimum of 80 ankle arthrodesis procedures were reviewed and pooled for analysis. All studies directly comparing outcomes and complications between TAA and AA were also included for review. Only studies including modern third-generation TAA implants approved for use in the USA (HINTEGRA, STAR, Salto, INBONE) were included. RESULTS A total of six studies reporting on outcomes following TAA and five reporting on outcomes following AA met inclusion criteria and were included for pooled data analysis. The adjusted overall complication rate was higher for AA (26.9%) compared to TAA (19.7%), with similar findings in the non-revision reoperation rate (12.9% for AA compared to 9.5% for TAA). The adjusted revision reoperation rate for TAA (7.9%) was higher than AA (5.4%). Analysis of results from ten studies directly comparing TAA to AA suggests a more symmetric gait and less impairment on uneven surfaces after TAA. CONCLUSIONS Pooled data analysis demonstrated a higher overall complication rate after AA, but a higher reoperation rate for revision after TAA. Based on the existing literature, the decision to proceed with TAA or AA for end-stage ankle arthritis should be made on an individual patient basis.
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Affiliation(s)
- Cort D Lawton
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Bennet A Butler
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Robert G Dekker
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Adam Prescott
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Anish R Kadakia
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA. .,Department of Orthopedic Surgery, Feinberg School of Medicine, Foot and Ankle Orthopedic Fellowship, Northwestern University - Northwestern Memorial Hospital, Chicago, IL, USA. .,, 676 North Saint Clair, Suite 1350, Chicago, IL, 60611, USA. .,, 259 East Erie, 13th Floor, Chicago, IL, 60611, USA.
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Wagener J, Gross CE, Schweizer C, Lang TH, Hintermann B. Custom-made total ankle arthroplasty for the salvage of major talar bone loss. Bone Joint J 2017; 99-B:231-236. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0504.r2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/23/2016] [Indexed: 12/14/2022]
Abstract
Aims A failed total ankle arthroplasty (TAA) is often associated with much bone loss. As an alternative to arthrodesis, the surgeon may consider a custom-made talar component to compensate for the bone loss. Our aim in this study was to assess the functional and radiological outcome after the use of such a component at mid- to long-term follow-up. Patients and Methods A total of 12 patients (five women and seven men, mean age 53 years; 36 to77) with a failed TAA and a large talar defect underwent a revision procedure using a custom-made talar component. The design of the custom-made components was based on CT scans and standard radiographs, when compared with the contralateral ankle. After the anterior talocalcaneal joint was fused, the talar component was introduced and fixed to the body of the calcaneum. Results At a mean follow-up of 6.9 years (1 to 13), 11 ankles were stable with no radiological evidence of loosening. Only one was lost to follow-up. The mean arc of movement was 21° (10° to 35°). A total of nine patients (75%) were satisfied or very satisfied with the outcome, two (17%) were satisfied but with reservations and one (8%) was not satisfied. All but one patient had an improvement in the American Orthopaedic Foot and Ankle Society hindfoot score (p = 0.01). Just one patient developed deep infection, leading to arthrodesis. Conclusion A custom-made talar component yielded satisfactory results with regard to function, stability and satisfaction. This should encourage the use of such components as an alternative to arthrodesis of the ankle in patients with a failed TAA. Cite this article: Bone Joint J 2017;99-B:231–6.
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Affiliation(s)
- J. Wagener
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - C. E. Gross
- Medical University of South Carolina, Department
of Orthopaedic Surgery, Charleston, South
Carolina, USA
| | - C. Schweizer
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - T. Horn Lang
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - B. Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
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