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Millstein ID, Koneru M, Dibato JE, Gentile P, Mahjoub A, Freeland E. Comparing Rates of Radiographic Baseplate Loosening Between Cement and Cementless INFINITY Total Ankle Prostheses. Foot Ankle Spec 2024:19386400241247456. [PMID: 38676637 DOI: 10.1177/19386400241247456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Total ankle replacement is indicated for end-stage ankle osteoarthritis. Periprosthetic radiolucency, from separation between the bone and implant, is suggested to be indicative of potential prosthesis failure risk. Anchoring implants with cement may mitigate this. This study aimed to compare rates of periprosthetic radiolucency between patients with cement-affixed and cementless implants. METHODS A retrospective analysis was performed on 28 patients who underwent total ankle replacement with the INFINITY Total Ankle System (Wright Medical, Memphis, Tennessee) implant between January 2016 and May 2022. Anteroposterior, mortise, and lateral ankle X-rays were reviewed by 2 independent reviewers for tibiotalar angle, talar tilt, and periprosthetic radiolucency. The Wilcoxon rank-sum test and chi-square test were performed. RESULTS The incidence of periprosthetic radiolucency at the most recent follow-up did not significantly differ between cement and cementless groups (57.1% in both groups, P = 1.0). Follow-up tibiotalar and talar tilt angles were not significantly different (P > .51 for all comparisons). CONCLUSIONS Patients with cemented implants had a similar incidence of periprosthetic radiolucency compared with patients with cementless prostheses. Understanding of long-term clinical outcomes will help inform optimal operative approaches for ankle prostheses. LEVELS OF EVIDENCE Therapeutic, Level III, Retrospective cohort study.
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Affiliation(s)
| | - Manisha Koneru
- Cooper Medical School, Rowan University, Camden, New Jersey
| | | | | | - Adel Mahjoub
- Cooper University Health Care, Camden, New Jersey
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Kvarda P, Mills A, Shepherd D, Schneider T. Lack of Consensus on the Definition of Aseptic Loosening in Total Ankle Replacement: A Narrative Systematic Review. J Clin Med 2024; 13:786. [PMID: 38337481 PMCID: PMC10856361 DOI: 10.3390/jcm13030786] [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: 12/23/2023] [Revised: 01/23/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Aseptic loosening is one of the most common modes of failure of total ankle replacement (TAR). However, a precise definition of aseptic loosening is still lacking. This systematic review aimed to identify the variations of applied definitions and offer insights into the lack of consensus. Methods: Human studies reporting aseptic loosening of TAR published in peer-reviewed journals within the last decade were considered. The search strategy involved specific terms in Embase, MEDLINE ALL, and the Cochrane Library. Variations in aseptic loosening definitions were analysed. Results: Of 767 studies, 88 were included in this study. Only nine studies precisely defined aseptic loosening with significant variations. Twenty-two studies referenced the term and fifty-seven reported it as a complication but neither defined nor referenced it. Conclusions: Significant uncertainty exists regarding the universal definition of aseptic loosening of TAR, and many variations occur in terms of the assessment approach and criteria.
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Affiliation(s)
- Peter Kvarda
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC 3181, Australia
| | - Andreea Mills
- Royal Australasian College of Surgeons, Victoria State Office, 250-290 Spring Street, Melbourne, VIC 3002, Australia
| | - David Shepherd
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC 3181, Australia
| | - Tim Schneider
- Melbourne Orthopaedic Group, 33 The Avenue, Windsor, Melbourne, VIC 3181, Australia
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McAlister JE, Duelfer KA. Updates on Total Ankle Arthroplasty. Clin Podiatr Med Surg 2023; 40:725-733. [PMID: 37716748 DOI: 10.1016/j.cpm.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
The newer generation total ankle arthroplasty constructs afford higher levels of long-term survivability, and for the first in the history of ankle arthroplasty procedures, results are comparable to arthrodesis. Much of the success hinges on appropriate patient selection. A comprehensive workup of the patient will allow selection of adjunctive procedures as well as allowing for the determination of single versus 2-stage deformity correction. With the continual addition of implants, it is important to understand the specialization and indications that are assigned to certain models because this will help in selecting the most appropriate implant for any given patient.
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Affiliation(s)
- Jeffrey E McAlister
- Foot and Ankle Surgical Fellowship Program, Phoenix Foot and Ankle Institute, 7301 East 2nd Street Suite 206, Scottsdale, AZ 85251, USA
| | - Keegan A Duelfer
- Foot and Ankle Surgical Fellowship Program, Phoenix Foot and Ankle Institute, 7301 East 2nd Street Suite 206, Scottsdale, AZ 85251, USA.
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Biela G, Piraino J, Roukis TS. An Analysis of 50 Consecutive Total Ankle Replacements Undergoing Preoperative Computerized Tomography Scan-Based, Engineer-Provided Planning From a Single Noninventor, Nonconsultant Surgeon. J Foot Ankle Surg 2023; 62:228-236. [PMID: 35871115 DOI: 10.1053/j.jfas.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/14/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023]
Abstract
Preoperative computerized tomography (CT) scan-based, engineer-provided alignment plans and patient-specific pinning blocks for total ankle replacement (TAR) are available for use in the United States. However, nonbiased studies that justify the additional expense associated with this technology through support of the marketed benefits of less procedural complexity, less intraoperative radiation and reduced surgical time, are lacking. Therefore, to verify the manufacturer's proposed benefits, we sought to investigate our experience with this preoperative CT scan-based, engineer-provided plan and patient-specific pinning blocks during primary TAR. In review of our 50 TAR patients, we found that "perfect" radiographic alignment was not consistently achieved and the accuracy of component prediction was modest. Furthermore, the preoperative plans and patient-specific pinning blocks did not simplify the complexity of our operations since the operative time, intraoperative image intensification time and radiation dose per case all exceeded published historical TAR controls. Interestingly, we identified a significant difference in placement accuracy between the arced and flat-top talar component types that were implanted with the arced being more frequently malaligned. We did not find associations between preoperative deformity severity and accuracy of postoperative alignment. These findings suggest that it is imperative to have surgeons continue to rely on their own surgical planning and experience to achieve optimum radiographic alignment rather than depending on engineer-based recommendations or "surface matched" pinning blocks. Ultimately, we were unable to support the purported benefits of this CT scan-based, engineer-provided alignment plan and patient-specific pinning blocks for this manufacturer's primary TAR systems.
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Affiliation(s)
- Garrett Biela
- Post-Graduate Year 2 Resident, Department of Orthopaedic Surgery & Rehabilitation, Foot & Ankle Service Line, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
| | - Jason Piraino
- Associate Professor, Department of Orthopaedic Surgery & Rehabilitation, Chairman, Foot & Ankle Service Line, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | - Thomas S Roukis
- Professor, Department of Orthopaedic Surgery & Rehabilitation, Foot & Ankle Service Line, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
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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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Heisler L, Vach W, Katz G, Egelhof T, Knupp M. Patient-Specific Instrumentation vs Standard Referencing in Total Ankle Arthroplasty: A Comparison of the Radiologic Outcome. Foot Ankle Int 2022; 43:741-749. [PMID: 35209725 PMCID: PMC9168897 DOI: 10.1177/10711007221077100] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Existing literature on the superiority of patient-specific instrumentation (PSI) in total ankle arthroplasty (TAA) over standard referencing (SR) is limited. Advantages presented include better implant alignment, shorter operating times, and increased accuracy of implant size prediction. The aim of this retrospective study was to analyze PSI in the hands of an experienced foot and ankle surgeon new to both PSI and SR for this specific implant, in regard to determining implant alignment, operative times, and radiologic short-term outcome and predicting implant size for tibial and talar components. METHODS Twenty-four patients undergoing TAA using PSI were compared to 25 patients using SR instrumentation. Outcome measures included alignment of the tibial component (α coronal plane, γ sagittal plane), the tibiotalar tilt (β), and the talar offset x on the sagittal view as well as the presence of radiolucent lines, operation time, and wound healing. Postoperative outcome was assessed at 6 weeks, 4 months, and 1 year postoperatively. RESULTS Implant positioning was similar in both groups, and no advantage in regard to the operative time could be seen when comparing TAA using PSI to SR. Implant size prediction was more reliable for the tibia than for the talus. Three patients (1 from the SR group and 2 from the PSI group) showed radiolucent lines around the tibial component. Two patients (both SR group) suffered delayed wound healing, albeit not requiring any additional measures. CONCLUSION The PSI method did not show an advantage over SR in regard to positioning of the components or the duration of the surgery. The current study suggests that no initial advantage of PSI over SR are to be expected in standard total ankle replacement. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
| | - Werner Vach
- Basel Academy for Quality and Research
in Medicine, Basel, Switzerland
| | - Georg Katz
- Merian Iselin Klinik, Institute for
Radiology, Basel, Switzerland
| | - Thomas Egelhof
- Merian Iselin Klinik, Institute for
Radiology, Basel, Switzerland
| | - Markus Knupp
- University of Basel, Basel,
Switzerland,Orthopedic Surgery & Traumatology,
Mein Fusszentrum AG, Basel, Switzerland,Markus Knupp, MD, Specialist in Orthopedic
Surgery & Traumatology, Mein Fusszentrum AG, Eichenstrasse 31, Basel CH
4054, Switzerland.
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Doyle MD, Ishibashi MA, Sherick RM, Mitchell LH, Castellucci-Garza FM, Rao NM. Outcomes and Complications of the INFINITY Total Ankle: A Systematic Review. Foot Ankle Spec 2022:19386400221079491. [PMID: 35189714 DOI: 10.1177/19386400221079491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew D Doyle
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, California
| | - Megan A Ishibashi
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Foundation Hospitals, Oakland, California
| | - Ryan M Sherick
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, California
| | - Logan H Mitchell
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Kaiser Foundation Hospitals, Oakland, California
| | - Francesca M Castellucci-Garza
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Kaiser Foundation Hospitals, Antioch, California
| | - Nilin M Rao
- Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, California
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Patient-specific instrumentation (PSI) in total ankle arthroplasty: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2445-2452. [PMID: 34345975 DOI: 10.1007/s00264-021-05145-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient-specific instrument (PSI) may theoretically make total ankle arthroplasty (TAA) more accurate. Several studies have reported the outcomes of PSI TAA. The aim of this study is to systematically review the literature of PSI TAA. METHODS PubMed, Embase, Web of Science, and Cochrane Library databases were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines for PSI TAA. The quality of the included studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). RESULT Nine articles were ultimately included in the systematic review. The implant position and function outcome of TAA was similar between PSI and SI. Prediction accuracy of implant size remained great difference. PSI can shorten the operative time and fluoroscopy time. The quality of current studies on PSI TAA is insufficient to produce high-level evidence. CONCLUSION PSI can get similar implant position and clinical outcome in TAA compared to SI, but current evidence is not strong enough to evaluate PSI TAA.
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Kooner S, Kayum S, Pinsker EB, Al Khalifa A, Khan RM, Halai M, Daniels TR. Two-Year Outcomes After Total Ankle Replacement With a Novel Fixed-Bearing Implant. Foot Ankle Int 2021; 42:1002-1010. [PMID: 34024139 DOI: 10.1177/10711007211005781] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Integra Cadence total ankle replacement (TAR) is a fourth-generation anatomic, fixed-bearing implant requiring minimal tibial and talar resection, which has been in clinical use since June 2016. The primary purpose of this study is to assess its short-term clinical and radiographic outcomes after TAR using this prosthesis. METHODS This is a prospective case series of consecutive patients that underwent TAR using this novel fourth-generation prosthesis between June 2016 and November 2017. The primary outcome of interest was the Ankle Osteoarthritis Scale (AOS). Secondary outcomes included Short Form Health Survey-36 (SF-36) scores, radiographic alignment, complications, reoperations, and revisions. RESULTS In total, 69 patients were included in our study. Fifty-one patients (73.9%) required a total of 91 ancillary procedures. Postoperatively, AOS pain scores decreased significantly by an average of 17.8±30.1 points from 45.9±18.2 to 28.4±27.3 (P < .001). AOS disability scores also decreased significantly following surgery by an average of 22.0±30.5 points from 53.9±18.5 to 32.5±27.9 (P < .001). The SF-36 physical component summary score improved 10.4±9.8 points from 33.1±9.1 to 42.6±9.1 (P < .001). Radiographic analysis demonstrated significant improvement to neutral coronal plane alignment, which was achieved in 97% of patients (P < .01) with no cyst formation at 2 years. There was 1 reported complication, 9 reoperations, and no metal or polyethylene component revisions. Overall, the 2-year implant survivorship was 100% in our cohort. Eighteen patients (26.1%) demonstrated fibrous ingrowth of the tibial component. However, outcome scores for these patients did not demonstrate any negative effects. CONCLUSION In our hands, this TAR system demonstrated excellent early clinical and radiographic outcomes. Patients reported improved physical health status, pain, and disability in the postoperative period. Total ankle instrumentation allowed for accurate and reproducible implantation with correction of coronal and sagittal plane deformities. Early results for the clinical use of this TAR system are promising, but further long-term prospective outcome studies are necessary. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Shahin Kayum
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
| | - Ellie B Pinsker
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Ryan M Khan
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
| | - Mansur Halai
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Timothy R Daniels
- Unity Health Toronto-St Michael's Hospital, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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Escudero MI, Le V, Bemenderfer TB, Barahona M, Anderson RB, Davis H, Wing KJ, Penner MJ. Total Ankle Arthroplasty Radiographic Alignment Comparison Between Patient-Specific Instrumentation and Standard Instrumentation. Foot Ankle Int 2021; 42:851-858. [PMID: 33749342 DOI: 10.1177/1071100721996379] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several benefits are published supporting patient-specific instrumentation (PSI) in total ankle arthroplasty (TAA). This study seeks to determine if TAA with PSI yields different radiographic outcomes vs standard instrumentation (SI). METHODS Sixty-seven primary TAA patients having surgery using PSI or SI between 2013 and 2015 were retrospectively reviewed using weightbearing radiographs at 6-12 weeks postsurgery. Radiographic parameters analyzed were the medial distal tibia angle (MDTA), talar-tilt angle (TTA), anatomic sagittal distal tibia angle (aSDTA), lateral talar station (LTS), and talar component inclination angle (TCI). A comparison of the 2 groups for each radiologic parameter's distribution was performed using a nonparametric median test and Fisher exact test. Furthermore, TAAs with all radiographic measurements within acceptable limits were classified as "perfectly aligned." The rate of "perfectly aligned" TAAs between groups was compared using a Fisher exact test with a significance of .05. RESULTS Of the 67 TAAs, 51 were done with PSI and 16 with SI. There were no differences between groups in MDTA (P = .174), TTA (P = .145), aSDTA (P = .98), LTS (P = .922), or TCI angle (P = .98). When the rate of "perfectly aligned TAA" between the 2 groups were compared, there was no significant difference (P = .35). CONCLUSION No significant radiographic alignment differences were found between PSI and SI implants. This study showed that both techniques achieve reproducible TAA radiographic coronal and sagittal alignment for the tibial component when performed by experienced surgeons. The talar component's sagittal alignment is similar whether or not PSI was used but is noticeably different from normal anatomic alignment by design. LEVEL OF EVIDENCE Level III, retrospective cohort study using prospectively collected data.
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Affiliation(s)
- Mario I Escudero
- Department of Orthopaedics, University of Chile, Santiago, Chile
| | - Vu Le
- Pacific Orthopaedic Associates, Alhambra, CA, USA
| | | | | | | | - Hodges Davis
- Department of Orthopaedics, OrthoCarolina, Charlotte, NC, USA
| | - Kevin J Wing
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray J Penner
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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