scholarly journals Ankle Range of Motion after Total Ankle Replacement with and without Heel Cord Lengthening

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0036
Author(s):  
Roxa Ruiz ◽  
Nicola Krähenbühl ◽  
Alexej Barg ◽  
Beat Hintermann

Category: Ankle, Ankle Arthritis Introduction/Purpose: Though total ankle replacement (TAR) has become a well-accepted alternative to fusion for treatment of end-stage ankle osteoarthritis (OA), controversy still exists regarding the appropriate indications. In 80% of the cases, trauma accounts for the primary cause of end-stage ankle OA. In these cases, the soft tissue conditions are often poor and the remaining ankle range of motion (ROM) limited. Additionally, performing a heel cord lengthening (HCL) should theoretically increase ankle ROM. However, it remains unclear to which extent a preoperative stiff ankle can become mobile after a TAR, with or without a HCL. The purpose of this study was to assess the gained ROM after TAR in end-stage ankle OA, and whether it is beneficial for patients who additionally underwent a HCL. Methods: Out of 605 primary TAR performed at our institution between 2006 and 2015, 288 ankles (280 patients; age 64.1 [39 – 88]; male, 151; female, 129) were identified with a neutral hindfoot alignment, no degenerative changes or previous fusions of adjacent joints, and no previous ligament reconstruction and tendon transfers at time of TAR. Medial and lateral gutter debridement as well as a complete posterior capsule resection was performed before the prosthesis was inserted. The ankle was then gradually mobilized into dorsiflexion. If a minimum of 10° dorsiflexion could not be obtained, HCL was performed (percutaneous triple hemisection). Postoperatively, the ankle was protected by a walker and weight-bearing was permitted as tolerated. ROM was determined during weight-bearing with the use of a goniometer preoperatively and 2-years postoperatively. Pearson correlation analysis and paired t-test were used for statistical analysis. Results: Out of 288 ankles, 41 (14.2%) underwent additional HCL. Preoperative ROM correlated with the ROM 2-years after TAR, independent whether a HCL was performed (p < 0.01) or not (p < 0.01). ROM for the ankles where no HCL was performed was 35° preoperatively and 34° 2-years postoperatively. For the ankles in which a HCL was performed, it was 28° preoperatively and 28° 2-years postoperatively. Pearson correlation analysis showed that patients with a low ROM preoperatively tended to get more motion after TAR, whereas patients with an extensive preoperative ROM even lost some motion after receiving a TAR system (Figure 1). Conclusion: The data suggests that a HCL procedure has little potential to ameliorate a preoperative low ROM. A TAR system however, may help increase the ROM in patients with little preoperative ROM while in patients with extensive preoperative ROM it may even cause a loss of ROM. The data further suggests that the heel cord contracture is not the only cause of limited motion in end-stage ankle OA, and that whether TAR nor TAR in combination with HCL should be performed with the goal of gaining ROM for the treatment of end-stage OA.

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001 ◽  
Author(s):  
Alexej Barg ◽  
Charles Saltzman

Category: Ankle, Ankle Arthritis Introduction/Purpose: In the last two decades, total ankle replacement (TAR) has gained more acceptance as a treatment option in patients with end-stage ankle osteoarthritis. However, there is a lack of literature on TAR using a lateral transfibular approach. Therefore, we sought to report early clinical and radiographic results of a patient cohort treated with TAR using a lateral transfibular approach by a single surgeon. Methods: Fifty-five primary total ankle arthroplasties using the Zimmer trabecular metal implant were performed in 54 patients (29 men and 25 women; mean age, 67.0 years) from October 2012 to December 2014. Clinical assessment including pain evaluation and measurement of ankle range of motion was done preoperatively and at the latest follow-up. Weight-bearing radiographs were used to determine the angular alignment of the tibial and talar components and to analyze the bone-implant interface. Intraoperative and postoperative complications, revision surgeries, and failures were evaluated. Results: Implant survival was 93% at 36 months follow-up. There were 3 revisions of a tibial component due to aseptic loosening. In 10 of 55 procedures, a secondary procedure was performed during follow-up. Mean follow-up duration was 26.6 ± 4.2 months. No delayed union or non-union was observed for fibula healing. The average VAS pain score decreased significantly from 7.9 ± 1.3 to 0.8 ± 1.2. The average total range of motion increased significantly from 22.9° ± 11.8° to 40.2° ± 11.8°. Conclusion: Early results of Zimmer trabecular metal total ankle replacement demonstrated improved patient-reported outcomes and increased ankle motion at a minimum follow-up of one year. In the first 55 consecutive cases, the fibular osteotomy required for access to the ankle healed without complications. Painful early loosening requiring revision due to lack of bony ingrowth was seen in 3 of 55 cases.


2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Francois Lintz ◽  
Jef Mast ◽  
Nazim Mehdi ◽  
Alessio Bernasconi ◽  
Cesar de Cesar Netto ◽  
...  

Category: Ankle, Ankle Arthritis Introduction/Purpose: Peri-prosthetic cysts (PPC) in Total Ankle Replacement (TAR) are a common failure cause but the mechanisms of their development remains unclear. One possible explanation could be hindfoot malalignment and subsequent unequal distribution of load inside the joint. However, how residual malalignment influences the evolution of PPC remains unclear. Computed tomography (CT) has demonstrated superiority on conventional radiography in the follow up of PPC. Weight Bearing CT (WBCT), by combining 3D imaging and weight bearing measurements seems a valid tool to investigate this further. The objective for this work was to study the effects of residual hindfoot deformity on the distribution of PPC in the coronal plane. We hypothesized that cysts would be found predominantly medially in varus configuration, and laterally in valgus configuration. Methods: Retrospective comparative study, ethics committee approved. Forty-eight cases of TAR were included, with relevant demographics. Inclusion criteria were cases of primary TAR with available WBCT imaging of their ankle as part of normal follow up. Exclusion criteria were subsequent implant revision or cyst grafting. In each case, the localization and size of PPC’s were documented and their volume calculated by approximation of the closest ellipsoid. Hindfoot alignment was evaluated by the percentage Foot Ankle Offset (FAO) (foot-length normalized 3D ratio between the midline of the foot and the center of the ankle) using a WBCT dedicated semi-automatic software. The mean FAO value with 95%CI for the population was calculated. The difference in medial and lateral cyst volume defined by their position relative to the median axis in the coronal plane was compared in varus and valgus cases by a Mann-Whitney non-parametric test for unpaired samples. Results: Demographic distributions of the series were 32% female, mean age 65 (45-85) years. Mean FAO value was 0.12% (95%CI -1.09 to 1.33). Mean follow up was 43 months (6 to 239). The mean total cyst volume per case was 1190,7 mm3. In varus cases (defined by FAO<-1.09%), the volume of medial cysts was greater than laterally by a mean 197 mm3, whereas in valgus cases (defined by FAO>1.33%), the volume of lateral cysts was greater than medially by a mean 332 mm3. The difference was statistically significant (p<0.05). There was a weak, significant positive correlation (r=0.25, p<0,001) between FAO and total cyst volume and a moderate, significant correlation (r=0,56, p<0,001) between time to follow up and total cyst volume. Conclusion: Our hypothesis was confirmed. Periprosthetic cysts volume in this series of primary TAR was found to be relatively greater medially in postoperative varus configurations and vice-versa laterally in valgus. This confirms a possible correlation between the direction of residual hindfoot malalignment and the coronal localization of PPC in TAR, although this is certainly not the only pathophysiologic factor involved in PPC onset. Weightbearing CT may be helpful in Total Ankle Replacement follow up, in order to early detect PPC development and possibly to identify situations at risk of a more rapid evolution.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0042
Author(s):  
Hatem Salem-Saqer ◽  
Martin Raglan ◽  
Sunil Dhar

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is increasingly used for treatment of end stage arthritis of the ankle; improvements continue to evolve in implant design and instrumentation. We present our experience of the Infinity Total Ankle Arthroplasty (Wright Medical), a fixed bearing 4th generation implant with improved instrumentation Methods: This is a retrospective review of prospectively collected data. From October 2016 to July 2019, we identified 92 (52M/40F) who had the infinity Total Ankle Replacement. This review is of 70 patients with a minimum of 1 year follow up (33M,37F). The mean age was 67.5 years (33-87); 32 right side and 38 left no bilaterals. The indication for surgery was end stage Osteoarthritis in 52, post traumatic arthritis 12, inflammatory arthritis 4, conversion of fusion to TAR 2. The preoperative deformity was graded according to the COFAS classification. All patients had follow up at 6 weeks, 3,6 and 12 months and then annually, with MOXFQ questionnaire and weight bearing radiographs. Results: TAA was performed with the use of fluoroscopy. 77% (54/70) had concomitant procedures as listed in Table.5% (4/70) had complications consisting of, 1 DVT, 1 intra operative medial malleolus fracture, 1 EHL tendon laceration and 1 wound break down. There were no deep or superficial infections. Improvement in clinical outcome and PROMS data was noted on follow up. The MOXFQ for Pain improved from 72 pre-op to 25 at 1year (p<0.001). The outcome for Walking improved from 83 pre-op to 30 at one year (p<0.001). Radiological alignment was maintained asymptomatic posterior heterotopic ossification was noted in 23(16%) patients, lucent lines under the tibial implant were noted in 4 ankles and 1 fibula erosion. 2 TAA (3%) needed to be revised due to malpositioning. Conclusion: Our results show significant improvement in patient outcomes, a short recovery time and marked improvement in mobility post operatively with a very low complication rate, we had no deep infection to date. Two implants were revised which we attribute to the learning curve at the start of practice. This implant is fluoroscopically navigated allowing precise implantation with dedicated instrumentation and we feel this attributed to the low complication rate and good results in our short-term study [Table: see text]


2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Beat Hintermann ◽  
Markus Knupp ◽  
Lukas Zwicky ◽  
Alexej Barg

End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0013
Author(s):  
Rogerio C. Bitar ◽  
Kristin C. Caolo ◽  
Guilherme H. Saito ◽  
Jaeyoung Kim ◽  
Jonathan T. Deland ◽  
...  

Category: Ankle Arthritis Introduction/Purpose: One of the proposed benefits of total ankle replacement (TAR), when compared to ankle fusion is the restoration of the functional range of motion (ROM) of the ankle. Preservation of ankle motion may improve quality of life as evidenced by patient-reported outcome measures (PROMs). However, some studies have shown a lack of improvement of ankle range of motion after the postoperative recovery period, despite satisfactory motion being observed intra-operatively. The objective of this study was to radiographically compare intraoperative and pre-operative ankle range of motion. Methods: This single-center retrospective study compared 56 patients with an average age of 62.27 years who underwent primary TAR with one of four different implants between March and December 2019. 48% of patients had post-traumatic arthritis secondary to an ankle fracture, 50% had post-traumatic arthritis secondary to instability. Seventy-two percent of patients had an associated Achilles lengthening, 16% had an associated lateral ligament reconstruction procedure. Standardized weight-bearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained pre-operatively. In order to record intraoperative fluoroscopic imaging, the primary surgeon passively placed the ankle into maximum dorsiflexion and plantarflexion. Intraoperatively, the neutral lateral position of the ankle was determined after the replacement when the talus was in perfect lateral view. All angular measurements were made using the PACS system (Picture Archiving and Communication System). The change in range of motion was analyzed using a paired t-test with a significance level of 0.05. Results: The intraoperative range of motion increased significantly for all measures when compared to the pre-operative range of motion. The average pre-operative global arc of motion significantly increased from 20.21 degrees to 38.49 degrees intra- operatively (p=2.45x10-18, t(55)=2.00). The average pre-operative plantar flexion significantly increased from 12.80 degrees to 25.50 degrees intra-operatively (p=2.56x10-15, t(55)=2.00). The average pre-operative dorsiflexion significantly increased from 7.28 degrees to 13.35 degrees intra-operatively (p=4.68x10-6 t(55)=2.00). Patients who had an Achilles lengthening had an average increase in the global arc of motion of 18.78 degrees; patients who did not have an Achilles lengthening had an average increase of 17.02 degrees (p=0.562, t(31)=2.04). Overall, 93% of patients increased their range of motion after their total ankle replacement. Conclusion: This study demonstrates notable improvement in ankle range of motion intraoperatively following total ankle replacement, especially in plantarflexion. Total Ankle Replacement provides an improvement in the functional range of motion of the ankle intraoperatively, suggesting that the loss of motion observed in previous studies may occur during the postoperative period. The present study may help inform and adjust the postoperative rehabilitation protocol after total ankle replacement in order to avoid losing the amplitude of motion gained during the operation.


2021 ◽  
pp. 193864002098092
Author(s):  
Devon W. Consul ◽  
Anson Chu ◽  
Travis M. Langan ◽  
Christopher F. Hyer ◽  
Gregory Berlet

Total ankle replacement has become a viable alternative to ankle arthrodesis in the surgical management of advanced ankle arthritis. Total ankle replacement has generally been reserved for patients who are older and for those who will have a lower demand on the replacement. The purpose of the current study is to review patient outcomes, complications, and implant survival in patients younger than 55 years who underwent total ankle replacement at a single institution. A single-center chart and radiographic review was performed of consecutive patients who underwent total ankle replacement for treatment of end-stage ankle arthritis. All surgeries were performed by 1 of 5 fellowship-trained foot and ankle surgeons at a single institution. A total of 51 patients met inclusion criteria with a mean follow-up of 31.2 months (SD = 16.2). Implant survival was 94%, There were 7 major complications (13%) requiring an unplanned return to the operating room and 8 minor complications (15%) that resolved with conservative care. The results of this study show that total ankle replacement is a viable treatment option for patients younger than 55 years. Levels of Evidence: A retrospective case series


2021 ◽  
Vol 10 (11) ◽  
pp. 2258
Author(s):  
Massimiliano Mosca ◽  
Silvio Caravelli ◽  
Emanuele Vocale ◽  
Simone Massimi ◽  
Davide Censoni ◽  
...  

Recently, the progress in techniques and in projecting new prosthetic designs has allowed increasing indications for total ankle replacement (TAR) as treatment for ankle osteoarthritis. This retrospective work comprehended 39 subjects aged between 47 and 79 years old. The patients, observed for at least 12 months (mean follow up of 18.2 ± 4.1 months), have been evaluated according to clinical and radiological parameters, both pre- and post-operatively. The AOFAS and VAS score significantly improved, respectively, from 46.2 ± 4.8 to 93.9 ± 4.1 and from 7.1 ± 1.1 to 0.7 ± 0.5 (p value < 0.05). At the final evaluation, the mean plantarflexion passed from 12.2° ± 2.3° to 18.1° ± 2.4° (p value < 0.05) and dorsiflexion from a pre-operative mean value of 8.7° ± 4.1° to 21.7° ± 5.4° post-operatively (p value < 0.05). This study found that this new total ankle replacement design is a safe and effective procedure for patients effected by end-stage ankle osteoarthritis. Improvements have been demonstrated in terms of range of motion, radiographic parameters and patient-reported outcomes. However, further studies are needed to assess the long-term performance of these prostheses.


2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Robert W. Jordan ◽  
Gurdip S. Chahal ◽  
Anna Chapman

Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes.Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure.Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn.Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.


2021 ◽  
Author(s):  
Yan Li ◽  
Xiaoying Wang ◽  
Yue Han ◽  
Xun Li

Abstract Background: Long non-coding RNAs (lncRNAs) play an important role in angiogenesis, immune response, inflammatory response and tumor development and metastasis. m6 A (N6 - methyladenosine) is one of the most common RNA modifications in eukaryotes. The aim of our research was to investigate the potential prognostic value of m6A-related lncRNAs in ovarian cancer (OC).Methods: The data we need for our research was downloaded from the Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) database. Pearson correlation analysis between 21 m6A regulators and lncRNAs was performed to identify m6A-related lncRNAs. Univariate Cox regression analysis was implemented to screen for lncRNAs with prognostic value. A least absolute shrinkage and selection operator (LASSO) Cox regression and multivariate Cox regression analyses was used to further reduct the lncRNAs with prognostic value and construct a m6A-related lncRNAs signature for predicting the prognosis of OC patients. Results: 275 m6A-related lncRNAs were obtained using pearson correlation analysis. 29 m6A-related lncRNAs with prognostic value was selected through univariate Cox regression analysis. Then, a seven m6A-related lncRNAs signature was identified by LASSO Cox regression. Each patient obtained a riskscore through multivariate Cox regression analyses and the patients were classified into high-and low-risk group using the median riskscore as a cutoff. Kaplan-Meier curve revealed that the patients in high-risk group have poor outcome. The receiver operating characteristic curve revealed that the predictive potential of the m6A-related lncRNAs signature for OC was powerful. The predictive potential of the m6A-related lncRNAs signature was successfully validated in the GSE9891, GSE26193 datasets and our clinical specimens. Multivariate analyses suggested that the m6A-related lncRNAs signature was an independent prognostic factor for OC patients. Moreover, a nomogram based on the expression level of the seven m6A-related lncRNAs was established to predict survival rate of patients with OC. Finally, a competing endogenous RNA (ceRNA) network associated with the seven m6A-related lncRNAs was constructed to understand the possible mechanisms of the m6A-related lncRNAs involed in the progression of OC.Conclusions: In conclusion, our research revealed that the m6A-related lncRNAs may affect the prognosis of OC patients and identified a seven m6A-related lncRNAs signature to predict the prognosis of OC patients.


2016 ◽  
Vol 1 (1) ◽  
pp. 27-42
Author(s):  
Hazlin Kadir @ Shahar ◽  
Razaleigh Muhamat @ Kawangit ◽  
Rosmawati Mohamad Rasit ◽  
Badlihisham Mohd Nasir

This article examines the relationship between learning and behavioural evaluation among religious officers in Malaysia after attending the Manual on HIV/AIDS in Islam Training Programmes organized by the Islamic Development Department of Malaysia (JAKIM). The training programmes were implemented to deliver the most accurate and the latest information on HIV / AIDS as well as to train religious officers in Malaysia to address the issues among Muslims. The training programmes apply the theoretical and practical activities where participants had the opportunity to carry out outreach activities with People Living with HIV / AIDS (ODHA). Quantitative methods through questionnaires were used to obtain data. A total of 350 religious officers who had attended the training programmes were selected as respondents by simple random sampling technique. Pearson correlation analysis was conducted to determine the relationship between the learning and behavioural evaluation. The results of the Pearson correlation analysis found that there was a significant relationship between learning evaluation in terms of the information obtained from programmes’ contents and behaviour evaluation with r = 0.489 and sig = 0.000 (p <0.05) at the medium positive range.. While the relationship between learning evaluation in terms of the information obtained from outreach activities with behavioural evaluation showed a strong positive correlation with the strength values obtained were r = 0.539 and sig = 0.000 (p <0.05). This analysis shows that the information acquired through the training program Manual Islam and HIV / AIDS has been successful in changing the behaviour of religious officers’ awareness in terms of the role of dakwah to ODHA. ABSTRAK Artikel ini bertujuan melihat hubungan antara penilaian pembelajaran dengan penilaian tingkah laku dalam kalangan Pegawai Agama di Malaysia setelah mengikuti Program Latihan Manual Islam dan HIV/AIDS anjuran Jabatan Kemajuan Islam Malaysia (JAKIM). Program latihan ini dilaksanakan untuk menyampaikan maklumat yang tepat serta informasi terkini isu HIV/AIDS di samping melatih Pegawai-pegawai Agama di Malaysia untuk menangani isu tersebut dalam kalangan umat Islam. Program latihan ini berbentuk teori dan praktikal di mana peserta program berpeluang melaksanakan dakwah secara temu seru (outreach) dengan Orang Yang Hidup dengan HIV/AIDS (ODHA) secara langsung. Kaedah kuantitatif melalui soal selidik telah digunakan untuk memperoleh data. Seramai 350 orang Pegawai Agama yang telah mengikuti program latihan ini dipilih sebagai responden melalui teknik pensampelan rawak mudah. Analisis korelasi Pearson dijalankan bagi mengenal pasti hubungan di antara penilaian pembelajaran dengan penilaian tingkah laku peserta yang mengikuti Program Latihan Manual Islam dan HIV/AIDS. Hasil analisis ujian korelasi Pearson tersebut mendapati bahawa terdapat hubungan yang signifikan di antara penilaian pembelajaran dari segi maklumat yang diperoleh daripada kandungan program dengan penilaian tingkah laku dengan nilai r = 0.489 dan sig = 0.000 (p<0.05). Kekuatan hubungan ialah positif sederhana. Manakala hubungan antara penilaian pembelajaran dari segi maklumat yang diperoleh daripada program temu seru dengan penilaian tingkah laku pula menunjukkan kekuatan hubungan positif kuat dengan nilai yang diperoleh ialah r = 0.539 dan sig = 0.000 (p<0.05). Analisis ini menunjukkan bahawa pembelajaran yang diperoleh melalui program latihan Manual Islam dan HIV/AIDS ini telah berjaya mengubah tingkah laku Pegawai Agama dari segi kesedaran peranan berdakwah kepada ODHA.


Sign in / Sign up

Export Citation Format

Share Document