Tibio-Talo-Calcaneal Arthrodesis After Failed Total Ankle Replacement: Autograft and Bulk Structural Allograft Techniques

2021 ◽  
pp. 467-479
Author(s):  
Mitchell J. Thompson ◽  
Thomas S. Roukis
Keyword(s):  
Total Ankle Replacement ◽  
Structural Allograft ◽  
Ankle Replacement

scholarly journals Ankle Arthrodesis with Structural Grafts Can Work for the Salvage of Failed Total Ankle Replacement

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Adam Halverson ◽  
Gregory Berlet
Keyword(s):  
Femoral Head ◽  
Limb Salvage ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Limb Length ◽  
Bone Block ◽  
Structural Allograft ◽  
Ankle Replacement ◽  
Patient Reported

Category: Ankle, Ankle Arthritis Introduction/Purpose: Surgical treatment options after failed total ankle replacement (TAR) are limited to revision total ankle replacements, revision bone block interposition arthrodesis, or amputation. In patients where revision TAR is not an option and limb salvage is desired, conversion to an ankle arthrodesis can provide a stable, plantigrade foot. Revision arthrodesis is challenged by significant bone loss with removal of the TAR implant. The purpose of this study was to report midterm outcomes and radiographic results in a single surgeon’s group of patients who have undergone revision ankle arthrodesis with intramedullary nail fixation and structural allograft augmentation following failed TAR. Methods: Institutional review board approval was obtained for this study. A retrospective chart and radiographic review was performed. Patients with a minimum follow-up of 1 year who underwent failed TAR revision with structural femoral head allograft and intramedullary tibiotalocalcaneal (TTC) nail fixation were included. Patients with less than 1-year follow-up and alternative fixation or graft constructs were excluded from the study. Data were collected upon enrollment visit and again at midterm follow-up ranging from 3-7 years post-operatively. Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) outcomes scores and radiographs were obtained at each visit. Primary outcomes of interest were the rate of limb salvage and patient reported outcome scores. Secondary outcomes include limb length correction and the fate of the structural allograft. Results: Five patients were available for enrollment. Average age at surgery was 63.2 (range 56-69) years. Enrollment visits averaged 1.68 years post-operative (range 0.95 - 3.78). Midterm follow-up was at an average of 5.2 years (range 4.7-5.6). Upon enrollment average FFI was 34.82 (range 8.82-75.88) and at midterm follow-up was 20.42 (range 0-35.38). AOFAS scores upon enrollment averaged 66.6 (range 61-77) and at midterm follow-up averaged 70.33 (range 54-88). Radiographic results show union in 4 of 5 patients at enrollment and in 2 of 3 patients upon midterm follow-up. Average limb length discrepancy at enrollment was 1.4 cm (range 0.5 - 2.0) and 1.6 cm (range 0.2 – 2.4) at midterm follow-up. Conclusion: Conversion of failed TAR to TTC fusion with femoral head allograft is a salvage technique that can lead to a functional arthrodesis and limb salvage in a situation where options are challenging. Our results show continued improvement in patient reported outcomes scores moving from short-term to midterm follow-up with preservation of limb length and no trend towards structural allograft resorption.

Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

2021 ◽  
pp. 107110072110044
Author(s):  
Catherine Conlin ◽  
Ryan M. Khan ◽  
Ian Wilson ◽  
Timothy R. Daniels ◽  
Mansur Halai ◽  
...  
Keyword(s):  
Hospital Setting ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Qualitative Description ◽  
Level Of Evidence ◽  
Foot Placement ◽  
Advantages And Disadvantages ◽  
Ankle Fusion ◽  
Ankle Replacement ◽  
Patient Reported

Background: Total ankle replacement (TAR) and ankle fusion are effective treatments for end-stage ankle arthritis. Comparative studies elucidate differences in treatment outcomes; however, the literature lacks evidence demonstrating what outcomes are important to patients. The purpose of this study was to investigate patients’ experiences of living with both a TAR and ankle fusion. Methods: This research study used qualitative description. Individuals were selected from a cohort of patients with TAR and/or ankle fusion (n = 1254). Eligible patients were English speaking with a TAR and contralateral ankle fusion, and a minimum of 1 year since their most recent ankle reconstruction. Surgeries were performed by a single experienced surgeon, and semistructured interviews were conducted by a single researcher in a private hospital setting or by telephone. Ankle Osteoarthritis Scale (AOS) scores, radiographs, and ancillary surgical procedures were collected to characterize patients. Themes were derived through qualitative data analysis. Results: Ten adults (8 men, 2 women), ages 59 to 90 years, were included. Average AOS pain and disability scores were similar for both surgeries for most patients. Participants discussed perceptions of each reconstructed ankle. Ankle fusions were considered stable and strong, but also stiff and compromising balance. TARs were considered flexible and more like a “normal ankle,” though patients expressed concerns about their TAR “turning” on uneven ground. Individuals applied this knowledge to facilitate movement, particularly during a first step and transitioning between positions. They described the need for careful foot placement and attention to the environment to avoid potential challenges. Conclusion: This study provides insight into the experiences of individuals living with a TAR and ankle fusion. In this unusual but limited group of patients, we found that each ankle reconstruction was generally perceived to have different characteristics, advantages, and disadvantages. Most participants articulated a preference for their TAR. These findings can help clinicians better counsel patients on expectations after TAR and ankle fusion, and improve patient-reported outcome measures by better capturing meaningful outcomes for patients. Level of Evidence: Level IV, case series.

Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

2021 ◽  
pp. 193864002098092
Author(s):  
Devon W. Consul ◽  
Anson Chu ◽  
Travis M. Langan ◽  
Christopher F. Hyer ◽  
Gregory Berlet
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Implant Survival ◽  
Ankle Arthritis ◽  
Single Institution ◽  
Retrospective Case ◽  
Ankle Replacement ◽  
End Stage

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

scholarly journals Adverse Events in Total Ankle Arthroplasty, Analysis of the FDA Medical and User Facility Device Experience Database

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Karim Mahmoud ◽  
Sreenivasulu Metikala ◽  
Kathryn O’Connor ◽  
Daniel Farber
Keyword(s):  
Adverse Events ◽  
Aseptic Loosening ◽  
Mandatory Reporting ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Mode Of Failure ◽  
User Facility

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement has become a popular treatment option for end stage ankle arthritis. Most of the reports of adverse events following total ankle replacement have been from high volume institutions and are subject to either observational or selection bias as well as potential under-reporting as they do not include the experience of community and lower volume centers and surgeons. The FDA’s Medical and User Facility Device Experience (MAUDE) Database provides a more complete scope of adverse events due to the mandatory reporting requirements by the FDA of implant manufactures. We reviewed the database to identify the common modes of failure and complications of total ankle implants Methods: We retrospectively reviewed reports of the MAUDE database from November 2011 to September 2018 regarding all total ankle implants. Each device in the MAUDE database is classified with a 3-letter code, we identified the 2 codes assigned to total ankle arthroplasty devices, and manually searched the FDA’s published Device Classification list for adverse events. All events were reviewed and classified. Data related to patient age or sex, surgeon, medical center location are not available in the database Results: We identified 1000 adverse reports in the period between November 2011 and September 2018. After exclusion of duplicate reports for single events or reports irrelevant to total ankle arthroplasty, a total of 697 adverse event reports were noted. The most common mode of failure was aseptic loosening (21%), followed by infection (16%), alignment and mechanical issues (instability, malalignment, malposition, stiffness, impingement) (15%), implantation issues (pin, screw or drill breakage, alignment guide problems) (9%), polyethylene related problems (wear, displaced or fractured implants) (7%), bony and soft tissue overgrowth (6%), and peri-prosthetic fractures (5%). Conclusion: Our analysis reveals that the most reported mode of failure was aseptic loosening followed by infection. However, it is notable that there are a significant number of issues with implant alignment and mechanics, complications during implantation and polyethylene component failure that are under-reported in the literature. Knowledge of these adverse events may help surgeons avoid similar complications as well as lead to improvement in component implantation and design

scholarly journals Clinical Radiographical Outcomes and Complications after a Brand-New Total Ankle Replacement Design through an Anterior Approach: A Retrospective at a Short-Term Follow Up

2021 ◽  
Vol 10 (11) ◽  
pp. 2258
Author(s):  
Massimiliano Mosca ◽  
Silvio Caravelli ◽  
Emanuele Vocale ◽  
Simone Massimi ◽  
Davide Censoni ◽  
...  
Keyword(s):  
Mean Value ◽  
Total Ankle Replacement ◽  
P Value ◽  
Ankle Osteoarthritis ◽  
Ankle Replacement ◽  
Patient Reported ◽  
End Stage ◽  
Term Performance ◽  
Replacement Design

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.

The effect of accuracy of implantation on range of movement of the Scandinavian Total Ankle Replacement

2005 ◽  
Vol 87-B (5) ◽  
pp. 736-740 ◽  
Author(s):  
Y. Tochigi ◽  
M. J. Rudert ◽  
T. D. Brown ◽  
T. E. McIff ◽  
C. L. Saltzman
Keyword(s):  
Total Ankle Replacement ◽  
Range Of Movement ◽  
Ankle Replacement

scholarly journals Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Robert W. Jordan ◽  
Gurdip S. Chahal ◽  
Anna Chapman
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Controlled Trial ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Online Databases ◽  
Ankle Replacement ◽  
Comparative Group ◽  
Randomised Controlled ◽  
End Stage

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.

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