Range of motion of foot joints following total ankle replacement and subtalar fusion

2020 ◽  
Author(s):  
Federico G. Usuelli ◽  
Cristian Indino ◽  
Alberto Leardini ◽  
Luigi Manzi ◽  
Maurizio Ortolani ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Total Ankle Replacement ◽  
Subtalar Fusion ◽  
Foot Joints ◽  
Ankle Replacement

scholarly journals Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Using Transfibular Approach

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001 ◽  
Author(s):  
Alexej Barg ◽  
Charles Saltzman
Keyword(s):  
Range Of Motion ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Trabecular Metal ◽  
Non Union ◽  
Early Loosening ◽  
Early Results ◽  
Ankle Replacement ◽  
Patient Reported

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.

scholarly journals Subtalar Joint Arthritis After Total Ankle Replacement

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0011
Author(s):  
Marc Sokolowski ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
Beat Hintermann
Keyword(s):  
Subtalar Joint ◽  
Total Ankle Replacement ◽  
Consecutive Series ◽  
Secondary Degeneration ◽  
One Stage ◽  
Joint Fusion ◽  
Subtalar Fusion ◽  
Ankle Replacement ◽  
Two Stages

Category: Ankle Arthritis Introduction/Purpose: It has been shown that total ankle replacement (TAR) is effective in reducing pain and maintaining function in posttraumatic ankle osteoarthritis (OA). Compared to ankle fusion, TAR restores hindfoot kinematics more physiological. However, the assumption that the maintenance of ankle motion has a protective effect on the subtalar joint is still a matter of debate. Only a scarce number of long-term studies exist to support this statement.The purpose of this study was (1) to evaluate to which extent the integrity of the subtalar joint can be preserved by treating patients with a TAR, (2) to determine the rate of subtalar fusion following TAR, and (3) to determine whether the need of subsequent subtalar fusion was predictable at time of TAR. Methods: A consecutive series of 1140 primary TAR (508 female, 632 male, median age 63.5 years), performed between May 2000 and December 2015, were prospectively documented. The indication for TAR was posttraumatic OA in 78%, primary and systemic OA in 10% each, and other secondary OA in 3% of the cases. 199 subtalar joints were either fused before (n=73) or during TAR surgery (n=126), leaving 941 subtalar joints available for analysis. Radiographs before implantation and at latest follow-up were classified using the Kellgren and Lawrence Grading Score (KLS). In case of a subtalar fusion, the radiograph prior to the fusion was classified. Results: After a median radiographic follow-up of 6.1 years, the KLS remained unchanged in 66% of all cases. While it was increased by one stage in 30%, it was increased by two stages in 3%; whereas, signs of OA decreased by one stage in 1%. Cases with an increase of two stages on the KLS had a longer follow-up compared to cases without increase (p=0.047).37 cases (3.9%) underwent a subtalar joint fusion, of which the indication was progressive OA in 19 cases (51%), instability in 10 cases (27%) and others in 8 cases (22%). Subtalar joints that required a fusion after TAR did not show higher preoperative KLS than the group which did not need a subtalar joint fusion. Conclusion: Apparently, TAR protects the subtalar joint from secondary degeneration, as found in 67% with no increase in KLS. Although 33% showed an increase in the KLS, only 2% required a subtalar fusion due to progressive OA. Overall, the rate of subtalar joint fusion after TAR was low and comparable to the rates reported in the literature. Subtalar joints requiring fusion after TAR did not show higher preoperative rates of OA. Therefore, the KLS classification of subtalar OA on conventional radiographs provides only limited information about the need for postoperative subtalar fusion, and thus need to be interpreted with caution.

scholarly journals Total ankle replacement and simultaneous subtalar arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Luigi Manzi ◽  
Cristian Indino ◽  
Camilla Maccario ◽  
Claudia Di Silvestri ◽  
Riccardo D’Ambrosi ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Surgical Techniques ◽  
Fusion Rate ◽  
Total Ankle Replacement ◽  
Ct Scans ◽  
Talonavicular Joint ◽  
Joint Fusion ◽  
Subtalar Fusion ◽  
Ankle Replacement ◽  
Functional Scores

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Patients with arthritis or severe dysfunction involving both the ankle and the subtalar joints can benefit tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. With the evolution of prosthetic design and surgical techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint and talonavicular joint in patients simultaneously treated with total ankle replacement (TAR) and subtalar joint fusion. Methods: This study includes 11 patients who underwent primary TAR and simultaneous subtalar and talonavicular fusion from May 2011 to January 2015. Six males and five females were enrolled with a mean age of 61 years (41-75). Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Total follow-up time was 24.2±11.6 months. Radiographic examination included a postoperative CT scan obtained 12 months after surgery. Three surgeons independently reviewed the CT scans and interobserver reliability was calculated. Functional scores were also assessed. Results: At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar fusion was 92% and the talonavicular fusion rate was 88%. There was a statistically significant increase in American Orthopedic Foot & Ankle Society ankle/hindfoot score from 25.9 to 74.1 at 12 months post-operatively. Ankle range of motion significantly increased from 10.2° to 30.8 degrees. Additionally, there was a statistically significant decrease in visual analog scale (VAS) pain score from 8.8 to 1.9. Conclusion: TAR and simultaneous subtalar and talonavicular joint fusion are reliable procedures for the treatment of ankle and subtalar joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopaedic surgeons in determining the degree of successful fusion of subtalar and talonavicular arthrodesis.

scholarly journals Functional Range of Motion Following Total Ankle Replacement

2016 ◽  
Vol 1 (1) ◽  
pp. 2473011416S0019
Author(s):  
Richard M. Marks ◽  
William P. Huntington ◽  
Stephen M. Brennan
Keyword(s):  
Range Of Motion ◽  
Total Ankle Replacement ◽  
Ankle Replacement

Effect of Achilles Tendon Lengthening and Gastrocnemius Recession on Radiographic Tibiotalar Motion Following Total Ankle Replacement

2020 ◽  
pp. 107110072096961
Author(s):  
Clifford L. Jeng ◽  
John T. Campbell ◽  
Patrick J. Maloney ◽  
Lew C. Schon ◽  
Rebecca A. Cerrato
Keyword(s):  
Achilles Tendon ◽  
Range Of Motion ◽  
Total Ankle Replacement ◽  
Level Of Evidence ◽  
Tendon Lengthening ◽  
Ankle Replacement ◽  
Gastrocnemius Recession ◽  
Achilles Tendon Lengthening ◽  
Retrospective Comparative Study

Background: Surgeons frequently add an Achilles tendon lengthening or gastrocnemius recession to increase dorsiflexion following total ankle replacement. Previous studies have looked at the effects of these procedures on total tibiopedal motion. However, tibiopedal motion includes motion of the midfoot and hindfoot as well as the ankle replacement. The current study examined the effects of Achilles tendon lengthening and gastrocnemius recession on radiographic tibiotalar motion at the level of the prosthesis only. Methods: Fifty-four patients with an average of 25 months follow-up after total ankle replacement were divided into 3 groups: (1) patients who underwent Achilles tendon lengthening, (2) patients who had a gastrocnemius recession, (3) patients with no lengthening procedure. Tibiotalar range of motion was measured on lateral dorsiflexion-plantarflexion radiographs using reference lines on the surface of the implants. Results: Both Achilles tendon lengthening and gastrocnemius recession significantly increased tibiotalar dorsiflexion when compared to the group without lengthening. However, the total tibiotalar range of motion among the 3 groups was the same. Interestingly, the Achilles tendon lengthening group lost 11.7 degrees of plantarflexion compared to the group without lengthening, which was significant. Conclusion: Both Achilles tendon lengthening and gastrocnemius recession increased radiographic tibiotalar dorsiflexion following arthroplasty. Achilles tendon lengthening had the unexpected effect of significantly decreasing plantarflexion. Gastrocnemius recession may be a better choice when faced with a tight ankle replacement because it increases dorsiflexion without a compensatory loss of plantarflexion. Level of Evidence: Level III, retrospective comparative study.

Interval Changes in Postoperative Range of Motion of Salto-Talaris Total Ankle Replacement

2011 ◽  
Vol 50 (5) ◽  
pp. 562-565 ◽  
Author(s):  
John M. Schuberth ◽  
Michael J. McCourt ◽  
Jeffrey C. Christensen
Keyword(s):  
Range Of Motion ◽  
Total Ankle Replacement ◽  
Ankle Replacement

Ratio of Range of Motion of the Ankle and Surrounding Joints After Total Ankle Replacement

2017 ◽  
Vol 99 (7) ◽  
pp. 576-582 ◽  
Author(s):  
Travis J. Dekker ◽  
Kamran S. Hamid ◽  
Mark E. Easley ◽  
James K. DeOrio ◽  
James A. Nunley ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Total Ankle Replacement ◽  
Ankle Replacement

Preoperative and Postoperative Range of Motion: A Retrospective Comparison of Two Total Ankle Replacement Systems

2015 ◽  
Vol 54 (5) ◽  
pp. 809-814 ◽  
Author(s):  
Stephen A. Brigido ◽  
Jennifer L. Mulhern ◽  
Garrett M. Wobst ◽  
Nicole M. Protzman
Keyword(s):  
Range Of Motion ◽  
Total Ankle Replacement ◽  
Ankle Replacement ◽  
Retrospective Comparison

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
Keyword(s):  
Correlation Analysis ◽  
Range Of Motion ◽  
Pearson Correlation ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Hindfoot Alignment ◽  
Ankle Replacement ◽  
Pearson Correlation Analysis ◽  
End Stage ◽  
Limited Motion

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.

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