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Anastasio AT, Kim BI, Wixted CM, DeOrio JK, Nunley JA, Easley ME, Adams SB. Younger Patients Undergoing Total Ankle Arthroplasty Experience Higher Complication Rates and Worse Functional Outcomes. J Bone Joint Surg Am 2024; 106:10-20. [PMID: 37922342 DOI: 10.2106/jbjs.23.00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
BACKGROUND Although many patients with posttraumatic ankle arthritis are of a younger age, studies evaluating the impact of age on outcomes of primary total ankle arthroplasty (TAA) have revealed heterogenous results. The purpose of the present study was to determine the effect of age on complication rates and patient-reported outcomes after TAA. METHODS We retrospectively reviewed the records of 1,115 patients who had undergone primary TAA. The patients were divided into 3 age cohorts: <55 years (n = 196), 55 to 70 years (n = 657), and >70 years (n = 262). Demographic characteristics, intraoperative variables, postoperative complications, and patient-reported outcome measures were compared among groups with use of univariable analyses. Competing-risk regression analysis with adjustment for patient and implant characteristics was performed to assess the risk of implant failure by age group. The mean duration of follow-up was 5.6 years. RESULTS Compared with the patients who were 55 to 70 years of age and >70 years of age, those who were <55 years of age had the highest rates of any reoperation (19.9%, 11.7%, and 6.5% for the <55, 55 to 70, and >70-year age groups, respectively; p < 0.001), implant failure (5.6%, 2.9%, and 1.1% for the <55, 55 to 70, and >70-year age groups, respectively; p = 0.019), and polyethylene exchange (7.7%, 4.3%, and 2.3% for the <55, 55 to 70, and >70-year age groups, respectively; p = 0.021). Competing-risk regression revealed a decreased risk of implant failure for patients who were >70 of age compared with those who were <55 years of age (hazard ratio [HR], 0.21 [95% confidence interval (CI), 0.05 to 0.80]; p = 0.023) and for patients who were 55 to 70 years of age compared with those who were <55 years of age (HR, 0.35 [95% CI, 0.16 to 0.77]; p = 0.009). For all subscales of the Foot and Ankle Outcome Score (FAOS) measure except activities of daily living, patients who were <55 years of age reported the lowest (worst) mean preoperative and postoperative scores compared with those who were 55 to 70 years of age and >70 years of age (p ≤ 0.001). Patients who were <55 years of age had the highest mean numerical pain score at the time of the latest follow-up (23.6, 14.4, 12.9 for the <55, 55 to 70, and >70-year age groups, respectively; p < 0.001). CONCLUSIONS Studies involving large sample sizes with intermediate to long-term follow-up are critical to reveal age-related impacts on outcomes after TAA. In the present study, which we believe to be the largest single-institution series to date evaluating the effect of age on outcomes after TAA, younger patients had higher rates of complications and implant failure and fared worse on patient-reported outcome measures. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Albert T Anastasio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Billy I Kim
- Duke University School of Medicine, Durham, North Carolina
| | | | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Sandomirski A, Johanshon J, Lohmann C, Lietz J. [Total arthroplasty of the ankle joint : Limitations and potentials]. Z Rheumatol 2023; 82:852-858. [PMID: 37819406 DOI: 10.1007/s00393-023-01422-6] [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] [Accepted: 06/16/2023] [Indexed: 10/13/2023]
Abstract
Total arthroplasty of the ankle joint (TAA) has become an established treatment option for patients with advanced osteoarthritis of the ankle joint. A crucial factor for good long-term clinical results and standing times is careful patient selection, taking the indications, contraindications, and defined prognostic factors into account. Despite modern prosthetic designs, TAA remains a complex surgical procedure that requires precise surgical techniques in a specialized center. Various limitations exist, such as the implantation technique and experience of the surgeon and perioperative complications due to concomitant medications. Current research focuses on the optimization of implant designs, development of personalized surgical techniques, improvement of the long-term performance and minimization of perioperative complications. Future developments, such as the introduction of robot-assisted surgical systems and the integration of biological procedures are also discussed as technological perspectives.
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Affiliation(s)
- Alexander Sandomirski
- Orthopädische Universitätsklinik, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Jana Johanshon
- Orthopädische Universitätsklinik, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Christoph Lohmann
- Orthopädische Universitätsklinik, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Jan Lietz
- Orthopädische Universitätsklinik, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Gupta R, Grove K, Wei A, Lee J, Akkouch A. Ankle and Foot Arthroplasty and Prosthesis: A Review on the Current and Upcoming State of Designs and Manufacturing. MICROMACHINES 2023; 14:2081. [PMID: 38004938 PMCID: PMC10673427 DOI: 10.3390/mi14112081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
The foot and ankle serve vital roles in weight bearing, balance, and flexibility but are susceptible to many diverse ailments, making treatment difficult. More commonly, Total Ankle Arthroplasty (TAA) and Total Talus Replacement (TTR) are used for patients with ankle degeneration and avascular necrosis of the talus, respectively. Ankle prosthesis and orthosis are also indicated for use with lower limb extremity amputations or locomotor disability, leading to the development of powered exoskeletons. However, patient outcomes remain suboptimal, commonly due to the misfitting of implants to the patient-specific anatomy. Additive manufacturing (AM) is being used to create customized, patient-specific implants and porous implant cages that provide structural support while allowing for increased bony ingrowth and to develop customized, lightweight exoskeletons with multifunctional actuators. AM implants and devices have shown success in preserving stability and mobility of the joint and achieving fast recovery, as well as significant improvements in gait rehabilitation, gait assistance, and strength for patients. This review of the literature highlights various devices and technologies currently used for foot and ankle prosthesis and orthosis with deep insight into improvements from historical technologies, manufacturing methods, and future developments in the biomedical space.
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Affiliation(s)
- Richa Gupta
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Kyra Grove
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Alice Wei
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Jennifer Lee
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA; (R.G.); (K.G.); (A.W.); (J.L.)
| | - Adil Akkouch
- Department of Orthopaedic Surgery and Medical Engineering Program, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, USA
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Ito H, Nishida K, Kojima T, Matsushita I, Kojima M, Hirata S, Kaneko Y, Kishimoto M, Kohno M, Mori M, Morinobu A, Murashima A, Seto Y, Sugihara T, Tanaka E, Nakayama T, Yamanaka H, Kawahito Y, Harigai M. Non-drug and surgical treatment algorithm and recommendations for the 2020 update of the Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis-secondary publication. Mod Rheumatol 2023; 33:36-45. [PMID: 35294030 DOI: 10.1093/mr/roac019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study was to update the Japan College of Rheumatology (JCR) clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) and prepare an algorithm for non-drug and surgical treatments. This article is a digest version of the guidelines. METHODS The Japanese Ministry of Health, Labour and Welfare's research group, in collaboration with the JCR, used the Grading of Recommendations, Assessment, Development, and Evaluation method to update the 2014 JCR CPG for RA. The consensus was formed by CPG panel members. RESULTS We raised 19 clinical questions regarding non-drug and surgical treatments for RA and developed recommendations. The treatments included exercise therapy; occupational therapy; joint injection of corticosteroids; and orthopaedic surgeries including cervical spine surgery, wrist and foot arthroplasty, ankle arthrodesis, and replacement arthroplasty of the shoulder, elbow, finger, hip, knee, and ankle. Recommendations regarding the risks of surgery and perioperative discontinuation of medications have also been developed. Based on these recommendations, we created an original algorithm for the non-drug and surgical treatment of RA. CONCLUSIONS These recommendations are expected to serve rheumatologists, health care professionals, and patients with RA as tools for shared decision-making to treat residual limb joint symptoms and functional impairment.
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Affiliation(s)
- Hiromu Ito
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Orthopedic Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Keiichiro Nishida
- Department of Orthopedic Surgery, Okayama University Academic Field of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Toshihisa Kojima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Isao Matsushita
- Department of Rehabilitation Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Masayo Kojima
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuko Kaneko
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsumasa Kishimoto
- Department of Nephrology and Rheumatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Masataka Kohno
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Mori
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Akio Morinobu
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsuko Murashima
- Center for Maternal-Fetal, Neonatal, and Reproductive Medicine/Japan Drug Information Institute in Pregnancy, National Center for Child Health and Development, Tokyo, Japan
| | - Yohei Seto
- Department of Rheumatology, Yachiyo Medical Center, Tokyo Women's Medical University School of Medicine, Yachiyo, Japan
| | - Takahiko Sugihara
- Division of Rheumatology and Allergology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eiichi Tanaka
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | | | - Yutaka Kawahito
- Inflammation and Immunology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masayoshi Harigai
- Department of Internal Medicine, Division of Rheumatology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Coye TL, Tirabassi N, Foote CM, Heddy B. An Umbrella Systematic Review and Meta-Analysis of Systematic Reviews on the Topic of Foot and Ankle Arthrodesis Nonunion Rates. J Foot Ankle Surg 2022; 61:1341-1347. [PMID: 35705455 DOI: 10.1053/j.jfas.2022.04.012] [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] [Received: 03/03/2022] [Revised: 04/20/2022] [Accepted: 04/29/2022] [Indexed: 02/03/2023]
Abstract
The purpose of this systematic review and meta-analysis was to appraise and combine the available systematic reviews reporting nonunion incidence and prevalence in foot and ankle arthrodesis procedures. The Cochrane Library and MEDLINE were searched for relevant systematic reviews from inception to January 2022. Two independent reviewers selected and reviewed eligible studies. Studies were included if they were systematic reviews or meta-analyses reporting nonunion incidence and prevalence in foot or ankle arthrodesis procedures. Fourteen systematic reviews of 8 types of joint arthrodesis procedures were included for meta-analysis. These reviews comprised 138 studies with 5793 joint arthrodesis procedures. Quality of the included reviews were assessed using the AMSTAR2 checklist. Overall and subgroup meta-analysis of prevalence were performed using random effects model. Publication bias was determined by evaluation of a DOI plot with the Luis Furuya-Kanamori index of asymmetry. The pooled prevalence for foot and ankle nonunion rate was 8.1% (95% confidence interval [CI] 6.5%-9.9%). Overall prevalence of nonunion for single joint foot and ankle joint arthrodesis was 6.1% (95% CI 4.8%-7.6%). Subgroup analysis found that the highest rate of nonunion occurred during tibiotalocalcaneal arthrodesis with 27.1% (95% CI 19.4%-35.2%). We have reported the first meta-analysis of systematic reviews on nonunion rates in foot and ankle arthrodesis procedures. The overall nonunion rate for foot and ankle arthrodesis procedures was 8.1%. For single joint fusion procedures, the nonunion prevalence was 6.1%. Our reported nonunion rates are lower than previously published numbers.
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Affiliation(s)
- Tyler L Coye
- Resident (PGY-3), Division of Podiatric Medicine and Surgery, Department of Orthopedics, Rochester General Hospital, Rochester, NY.
| | - Nathan Tirabassi
- Resident (PGY-3), Division of Podiatric Medicine and Surgery, Department of Orthopedics, Rochester General Hospital, Rochester, NY
| | - Courtney M Foote
- Resident (PGY-3), Division of Podiatric Medicine and Surgery, Department of Orthopedics, Rochester General Hospital, Rochester, NY
| | - Benjamin Heddy
- Resident (PGY-3), Division of Podiatric Medicine and Surgery, Department of Orthopedics, Rochester General Hospital, Rochester, NY
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Shih CL, Chen SJ, Huang PJ. Clinical Outcomes of Total Ankle Arthroplasty Versus Ankle Arthrodesis for the Treatment of End-Stage Ankle Arthritis in the Last Decade: a Systematic Review and Meta-analysis. J Foot Ankle Surg 2021; 59:1032-1039. [PMID: 32709528 DOI: 10.1053/j.jfas.2019.10.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Abstract
Ankle arthrodesis (AA) and total ankle arthroplasty (TAA) are the 2 primary surgical treatments for patients with end-stage ankle arthritis. The comparative outcomes between AA and TAA using modern techniques remain unclear. A systematic search to identify all relevant articles comparing AA with TAA was conducted through 3 online databases. The clinical outcomes were extracted for meta-analysis, including AOFAS (American Orthopaedic Foot & Ankle Society) score, VAS (visual analog scale), AOS (Ankle Osteoarthritis Scale), gait analysis, ROM (range of motion), satisfaction, complication, and reoperation. Our meta-analysis shows no heterogeneity in any subgroup analyses. There were no significant differences in AOFAS total, pain, and alignment scores between the AA and TAA groups. The TAA group had significant improvement in AOFAS function score compared with the AA group. There was no significant difference in VAS and AOS total scores between the 2 groups. No significant differences in gait analysis were observed between the 2 groups. The TAA group had significant improvement in both ROM and change in ROM compared with the AA group. There was no significant difference in satisfaction rate between the 2 groups. The TAA group had significantly higher complication and reoperation rates compared with the AA group. Our meta-analysis provides updated evidence on clinical outcomes comparing AA with TAA using third-generation implants. The TAA group had better improvement in AOFAS function and ROM than the AA group. No significant differences in pain relief, gait analysis, or patient satisfaction were observed between the 2 groups.
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Affiliation(s)
- Chia-Lung Shih
- Assistant Research Fellow, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Jung Chen
- Attending Physician, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Peng-Ju Huang
- Attending Physician, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Associate Professor, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Anastasio AT, Patel PS, Farley KX, Kadakia R, Adams SB. Total ankle arthroplasty and ankle arthrodesis in rheumatic disease patients: An analysis of outcomes and complications using the National Inpatient Sample (NIS) database. Foot Ankle Surg 2021; 27:321-325. [PMID: 32782226 DOI: 10.1016/j.fas.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA), can manifest as an inflammatory arthropathy in the ankle. As a result, this study sought to examine the role of RA with respect to complications in patients undergoing either total ankle arthroplasty or ankle arthrodesis by utilizing the National Inpatient Sample to assess for correlations. METHODS Admissions for TAA and AA were extracted from the National Inpatient Sample using primary ICD-9-CM diagnosis codes. Patients aged 18-65 years with a duration of hospital stay of >3 days and isolated complications were included. Multivariable regression was then performed within matched groups to determine differences. RESULTS There was decreased risk of myocardial infarction, pulmonary embolism, surgical site infection, and urinary tract infection in patients with RA. Postoperative development of pneumonia was seen at a higher rate in patients with RA. CONCLUSION RA is not associated with a markedly increased complication burden in the appropriately chosen surgical candidate for ankle arthrodesis and ankle arthroplasty.
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Affiliation(s)
| | - Preet S Patel
- Duke University Department of Orthopedic Surgery, United States.
| | - Kevin X Farley
- Emory University Department of Orthopedic Surgery, United States
| | - Rishin Kadakia
- Duke University Department of Orthopedic Surgery, United States
| | - Samuel B Adams
- Duke University Department of Orthopedic Surgery, United States
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Lawton CD, Prescott A, Butler BA, Awender JF, Selley RS, Dekker Ii RG, Balderama ES, Kadakia AR. Modern total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis. Orthop Rev (Pavia) 2020; 12:8279. [PMID: 33312482 PMCID: PMC7726823 DOI: 10.4081/or.2020.8279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 01/15/2023] Open
Abstract
The controversy in surgical management of end-stage tibiotalar arthritis with Total Ankle Arthroplasty (TAA) versus Ankle Arthrodesis (AA) has grown in parallel with the evolution of both procedures. No randomized controlled trials exist due to the vast differences in surgical goals, patient expectations, and complication profiles between the two procedures. This makes high quality systematic reviews necessary to compare outcomes between these two treatment options. The aim of this study was to provide a systematic review with meta-analysis of publications reporting outcomes, complications, and revision data following third-generation TAA and/or modern AA published in the past decade. Thirtyfive articles met eligibility criteria, which included 4312 TAA and 1091 AA procedures. This review reports data from a mean follow-up of 4.9 years in the TAA cohort and 4.0 years in the AA cohort. There was no significant difference in overall complication rate following TAA compared to AA (23.6% and 25.7% respectively, P-value 0.31). Similarly, there was no significant difference in revision rate following TAA compared to AA (7.2% and 6.3% respectively, P-value 0.65). Successful treatment of end-stage tibiotalar arthritis requires an understanding of a patients’ goals and expectations, coupled with appropriate patient selection for the chosen procedure. The decision to proceed with TAA or AA should be made on a case-by-case basis following an informed discussion with the patient regarding the different goals and complication profiles for each procedure.
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Affiliation(s)
- Cort D Lawton
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | - Adam Prescott
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | - Bennet A Butler
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | - Jakob F Awender
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | - Ryan S Selley
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | | | - Earvin S Balderama
- Department of Mathematics and Statistics, Loyola University Chicago, IL, USA
| | - Anish R Kadakia
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
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Kohring JM, Houck JR, Oh I, Flemister AS, Ketz JP, Baumhauer JF. Pattern of recovery and outcomes of patient reported physical function and pain interference after ankle fusion: a retrospective cohort study. J Patient Rep Outcomes 2020; 4:40. [PMID: 32462241 PMCID: PMC7253567 DOI: 10.1186/s41687-020-00203-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 05/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background Research on outcomes after ankle fusion focuses on basic activities of daily living, fusion rates, and gait parameters. Little has been reported on the patient’s perspective after surgery. The purpose of this study was to determine the change in patient reported physical function and pain interference after ankle fusion surgery to guide patient expectations and improve provider communication. Methods This was a retrospective review of prospectively collected patient reported outcome measurement information system (PROMIS) data in 88 ankle arthrodesis procedures performed from May 2015 to March 2018. The PROMIS Physical function (PF) and pain interference (PI) measures were collected as routine care. Linear mixed models were used to assess differences at each follow-up point for PF and PI. Preoperative to last follow-up in the 120–365 day interval was assessed using analysis of variance. Outcomes included T-scores, z-scores, and PROMIS-Preference (PROPr) utility scores for PF and PI and the percentage of patients improving by at least 4 T-score points. Results The linear mixed model analysis for PF after the 120–149 days, and for PI, after 90–119 days, indicated recovery plateaued at 39–40 for PF and 57–59 for PI T-scores. The change in the PI T-score was the greatest with a mean T-score improvement of − 5.4 (95% CI − 7.7 to − 3.1). The proportion of patients improving more than 4 points was 66.2% for either PF or PI or both. The change in utility T-scores for both PF (0.06, 95% CI 0.02 to 0.11) and PI (0.15, 95% CI 0.09 to 0.20) was significantly improved, however, only PI approached clinical significance. Conclusion Average patients undergoing ankle fusion experience clinically meaningful improvement in pain more so than physical function. Average patient recovery showed progressive improvement in pain and function until the four-month postoperative time point. Traditional dogma states that recovery after an ankle fusion maximizes at a year, however based on the findings in this study, 4 months is a more accurate marker of recovery. A decline in function or an increase in pain after 4 months from surgery may help to predict nonunion and other complications after ankle arthrodesis. Level of evidence Level II, prospective single cohort study.
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Affiliation(s)
- Jessica M Kohring
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Jeffrey R Houck
- Department of Physical Therapy, George Fox University, Newberg, OR, USA
| | - Irvin Oh
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Adolf S Flemister
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - John P Ketz
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Judith F Baumhauer
- Department of Orthopaedics, University of Rochester, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.
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Patient and Practice Trends in Total Ankle Replacement and Tibiotalar Arthrodesis in the United States From 2007 to 2013. J Am Acad Orthop Surg 2019; 27:e77-e84. [PMID: 30169446 DOI: 10.5435/jaaos-d-17-00526] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Both total ankle replacement (TAR) and tibiotalar arthrodesis (TTA) are used in the surgical management of ankle arthritis. Over the past decade, TAR instrumentation, techniques, and implants have improved, making the procedure more reliable and reproducible, thus making TAR more common. METHODS The Nationwide Inpatient Sample database from 2007 to 2013 was used to obtain data on patients elder than 50 years who underwent either TAR or TTA. Differences in temporal, demographic, and diagnosis trends between TAR and TTA were analyzed. RESULTS Between 2007 and 2013, 15,060 patients underwent TAR and 35,096 underwent TTA. Patients undergoing TTA had significantly more comorbidities (2.17 versus 1.55; P < 0.001). The share of TAR performed increased significantly from 2007 (14%) to 2013 (45%) (P < 0.001). From 2007 to 2013, we found a 12-fold increase in the odds of having a TAR for patients with posttraumatic osteoarthritis (P < 0.001), a 4.9-fold increase for those with primary osteoarthritis, and a 3.1-fold increase for patients with rheumatoid arthritis (P < 0.001). CONCLUSIONS Over the past decade, the frequency of TAR has increased, particularly in patients with posttraumatic arthritis and osteoarthritis. Surgeons still perform TAR in healthier patients compared with TTA; however, because surgeons become more experienced with the technique, patients are undergoing TAR at a markedly higher rate. LEVEL OF EVIDENCE Level III: retrospective comparative study.
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Clough T, Bodo K, Majeed H, Davenport J, Karski M. Survivorship and long-term outcome of a consecutive series of 200 Scandinavian Total Ankle Replacement (STAR) implants. Bone Joint J 2019; 101-B:47-54. [PMID: 30601052 DOI: 10.1302/0301-620x.101b1.bjj-2018-0801.r1] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We report the long-term clinical and radiological outcomes of a consecutive series of 200 total ankle arthroplasties (TAAs, 184 patients) at a single centre using the Scandinavian Total Ankle Replacement (STAR) implants. PATIENTS AND METHODS Between November 1993 and February 2000, 200 consecutive STAR prostheses were implanted in 184 patients by a single surgeon. Demographic and clinical data were collected prospectively and the last available status was recorded for further survival analysis. All surviving patients underwent regular clinical and radiological review. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scoring system. The principal endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan-Meier survival curves were generated with 95% confidence intervals and the rate of failure calculated for each year. RESULTS A total of 84 patients (87 ankles) were alive by the end of this study. Of the surviving 84 patients (87 ankles; rheumatoid arthritis (RA), n = 40; OA, n = 47), 45 were women and 39 were men, with a mean age of 54 years (18 to 72 years) at the time of surgery. A total of 32 implants failed (16%), requiring revision surgery. The mean time to revision was 80 months (2 to 257). The implant survival at 15.8 years, using revision as an endpoint, was 76.16% (95% confidence interval (CI) 64.41 to 87.91). We found a steady but low decrease in survival over the study period. The mean AOFAS score improved from 28 (10 to 52) preoperatively to 61 (20 to 90) at long-term follow-up. CONCLUSION STAR prostheses in the United Kingdom have now been largely superseded by newer design TAAs, potentially with improved characteristics and surgical techniques. The long-term survivorship for the STAR prosthesis can provide a benchmark for these later designs of ankle arthroplasty.
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Affiliation(s)
- T Clough
- Wrightington Hospital, Wigan, UK
| | - K Bodo
- Locum Consultant Foot and Ankle Surgeon, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - H Majeed
- Wrightington Hospital, Wigan, UK
| | | | - M Karski
- Wrightington Hospital, Wigan, UK
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Kamrad I, Carlsson Å, Henricson A, Magnusson H, Karlsson MK, Rosengren BE. Good outcome scores and high satisfaction rate after primary total ankle replacement. Acta Orthop 2017; 88:675-680. [PMID: 28812410 PMCID: PMC5694814 DOI: 10.1080/17453674.2017.1366405] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Total ankle replacement (TAR) is gaining popularity for treatment of end-stage ankle arthritis. Large patient-centered outcome studies are, however, few. Here, we report data from the Swedish Ankle Registry. Patients and methods - We examined outcomes after primary TAR in patients from the Swedish Ankle Registry using PROMs (Patient Reported Outcome Measures; generic: EQ-5D and SF-36, region specific: SEFAS (Self-Reported Foot and Ankle Score), and a question on satisfaction). We included 241 patients registered with primary TAR between 2008 and 2016 and who completed PROMs preoperatively and postoperatively up to 24 months. We evaluated changes in PROMs following surgery and estimated effects of age, diagnosis, prosthetic design, and preoperative functional score on the outcomes. Results - All absolute scores improved from preoperative to 24 months after surgery (p ≤ 0.001). 71% of the patients were satisfied or very satisfied at the latest follow-up and 12% dissatisfied or very dissatisfied. Postoperative SEFAS correlated with age (r = 0.2, p = 0.01) and preoperative SEFAS (r = 0.3, p < 0.001), as did patient satisfaction (r = -0.2; p ≤ 0.03). Postoperative SEFAS and EQ-5D were similar between different diagnoses or prosthetic designs. Preoperative SF-36 was associated with diagnosis (p ≤ 0.03), postoperative SF-36 with age (r = 0.2, p = 0.01) and diagnosis (p < 0.03). Interpretation - We found statistically and clinically significant improvements in patient-reported outcomes following TAR surgery. The postoperative region-specific SEFAS was positively associated with older age. Prosthetic design seemed not to influence patient-reported outcome, whereas diagnosis partly did. Studies with longer follow-up are necessary to establish the long-term outcome of TAR and to elucidate whether short- and mid-term outcomes may predict implant failure.
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Affiliation(s)
- Ilka Kamrad
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö,Correspondence:
| | - Åke Carlsson
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
| | - Anders Henricson
- Department of Orthopedics, Falu Central Hospital and Centre for Clinical Research Dalarna, Falun, Sweden
| | - Håkan Magnusson
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
| | - Magnus K Karlsson
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
| | - Björn E Rosengren
- Departments of Orthopedics and Clinical Sciences, Lund University and Skåne University Hospital, Malmö
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Kerkhoff YRA, Keijsers NLW, Louwerens JWK. Sports Participation, Functional Outcome, and Complications After Ankle Arthrodesis: Midterm Follow-up. Foot Ankle Int 2017; 38:1085-1091. [PMID: 28708946 DOI: 10.1177/1071100717717221] [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 Ankle arthrodesis provides satisfactory functional outcome based on basic daily activities, but information regarding more demanding tasks is limited. Also, studies reporting longer term survival and complication rates are sparse and concern small study populations. This study reports functional outcome with more focus on demanding tasks and sports and reports the mid- to long-term union and complication rates in a large study population. METHODS Between 2005 and 2010, an ankle arthrodesis was performed on 185 ankles. Clinical results were retrospectively assessed with the Foot Function Index (FFI), visual analog scale (VAS) for pain, and the Foot and Ankle Ability Measure (FAAM). Information regarding sports pre- and postoperatively was obtained through a questionnaire. In addition, postoperative complications, reoperations, and failures (defined as nonunion of the ankle arthrodesis) were determined. Mean follow-up time was 8 years. RESULTS FFI scores significantly improved, the FAAM ADL score was 70%, and the mean VAS for pain at the ankle/hindfoot at follow-up was 20. Sports participation slightly diminished from 79.5% prior to the onset of disabling complaints to 68.9% postoperatively. Of the patients, 73.1% were able to hike with a median hiking time of 40 minutes (range, 2-600 minutes). Kneeling could be performed on average 10 minutes (range, 2-60 minutes) in 39.8% and jumping down from steps by 23.5% of the patients. A small selection of patients was able to sprint (14%), and 16.8% of the patients were able to run a median distance of 60 meters (range, 3-1000 meters). Failure occurred in 9.2% and other postoperative complications were present in 21.6%, requiring reoperation in 8.6% of the cases. CONCLUSION Ankle arthrodesis led to satisfactory functional outcome and pain reduction. Most patients remained active in sports, but a transition to less demanding sporting activities was seen. The complication and failure rates were similar with previous literature, and the incidence of nonrevision secondary surgery was relatively low. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Yvonne R A Kerkhoff
- 1 Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël L W Keijsers
- 2 Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
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14
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Abstract
Total ankle arthroplasty is a viable surgical technique for the treatment of end-stage degenerative joint disease. With continued advancement in prosthetic design, refined surgical techniques, and improved outcomes, the indications for total ankle replacement have expanded to include cases of increasing complexity. With meticulous preoperative planning and exacting execution, many frontal plane deformities and cases of avascular necrosis can now be successfully addressed at the time of prosthesis implantation or in a staged procedure.
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Affiliation(s)
- Stephen A Brigido
- Foot and Ankle Reconstruction, Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA.
| | - Scott C Carrington
- Foot and Ankle Reconstruction, Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA
| | - Nicole M Protzman
- Clinical Integration Department, Coordinated Health, 3435 Winchester Road, Allentown, PA 18104, USA
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15
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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: 144] [Impact Index Per Article: 20.6] [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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16
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Weber NJ, McPoil TG. Use of a temporary supramalleolar orthosis to manage foot pain in a patient with rheumatoid arthritis: A case report. Foot (Edinb) 2016; 27:53-8. [PMID: 26598284 DOI: 10.1016/j.foot.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/15/2015] [Accepted: 09/22/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rheumatoid arthritis is a chronic inflammatory condition characterized by joint pain, stiffness, and functional disability. Approximately 90% of patients will report symptoms in the foot or ankle during the course of their disease. CASE DESCRIPTION A case of a 40-year-old woman with a 12-year history of rheumatoid arthritis referred to outpatient physical therapy with a chief complaint of pain in the lateral rearfoot and forefoot is presented. At the time of the initial examination, the patient reported persistent pain ranging from 3 to 9/10, aggravated when standing and walking during activities of daily living. Treatment consisted of the fabrication of a supramalleolar orthosis that incorporated an in-shoe foot orthosis to address functional limitations and abnormal foot and ankle posture. A home exercise program was prescribed to address potential balance deficits and strength loss following the application of the orthosis. OUTCOMES Clinically significant improvements were seen in pain, gait speed, and on the Foot Function Index following the implementation of the orthotic device. The patient returned to standing and walking with minimal symptom limitations. DISCUSSION This case report highlights the short-term clinical outcomes when using a supramalleolar orthosis in conjunction with an in-shoe foot orthosis to manage lateral rearfoot and forefoot pain in a patient with rheumatoid arthritis.
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Affiliation(s)
- Nicholas J Weber
- The University of Wisconsin Hospital and Clinics and Meriter Hospital Orthopaedic Physical Therapy Residency Program, Madison, WI, United States
| | - Thomas G McPoil
- School of Physical Therapy, Regis University, Denver, CO, United States.
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17
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Rodriguez-Merchan EC. Total ankle replacement or ankle fusion in painful advanced hemophilic arthropathy of the ankle. Expert Rev Hematol 2015; 8:727-31. [DOI: 10.1586/17474086.2015.1087846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Brigido SA, Galli MM, Bleazey ST, Protzman NM. Modular stem fixed-bearing total ankle replacement: prospective results of 23 consecutive cases with 3-year follow-up. J Foot Ankle Surg 2014; 53:692-9. [PMID: 24891091 DOI: 10.1053/j.jfas.2014.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Indexed: 02/03/2023]
Abstract
In the present report, the 3-year outcomes of 23 consecutive patients treated with a modular stem fixed-bearing total ankle replacement are described. Pain, functional impairment, and disability were assessed annually using a visual analog scale. Complications and additional procedures also were recorded. Compared with preoperative pain (8.4 ± 1.4), functional impairment (8.7 ± 2.3), and disability (3.0 ± 2.5), there were statistically significant postoperative improvements at 1 year (pain, 2.6 ± 1.6; functional impairment, 3.1 ± 2.1; disability, 0.9 ± 1.2), 2 years (pain, 1.5 ± 1.3; functional impairment, 1.9 ± 1.4; disability, 0.6 ± 1.4), and 3 years (pain, 1.3 ± 1.3; functional impairment, 1.9 ± 1.9; disability, 0.4 ± 0.9; p ≤ .001). Pain, function, and disability significantly improved postoperatively from 1 to 2 years (p ≤ .008) and from 1 to 3 years (p ≤ .008). The reductions in pain, functional impairment, and disability were maintained from 2 to 3 years (p ≥ .08). Nine complications (39.1%) were encountered: 1 deep infection, 2 pulmonary embolisms, 3 wounds, 1 ectopic bone formation, 1 stiff joint, and 1 talar subsidence. In the 3-year follow-up period, 3 patients (13.0%) required additional procedures after the immediate postoperative phase. Our results have demonstrated that modular stem fixed-bearing prostheses can be implanted in a predictable and consistent fashion with resultant improvements in pain, function, and disability. Future studies evaluating the clinical outcomes after modular stem fixed-bearing total ankle replacement are warranted.
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Affiliation(s)
- Stephen A Brigido
- Fellowship Director, Department of Foot Ankle, Coordinated Health, Bethlehem, PA.
| | - Melissa M Galli
- Fellow, Department of Foot Ankle, Coordinated Health, Bethlehem, PA
| | - Scott T Bleazey
- Fellow, Department of Foot Ankle, Coordinated Health, Bethlehem, PA
| | - Nicole M Protzman
- Research Associate, Department of Clinical Education and Research, Coordinated Health, Bethlehem, PA
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