Primary total ankle replacement surgery is a cost-effective intervention

The Foot ◽  
2021 ◽  
Vol 49 ◽  
pp. 101830
Author(s):  
Zach J. Place ◽  
Deborah J. Macdonald ◽  
Nicholas D. Clement ◽  
Hisham Shalaby ◽  
John C. McKinley
Keyword(s):  
Cost Effective ◽  
Total Ankle Replacement ◽  
Effective Intervention ◽  
Replacement Surgery ◽  
Ankle Replacement

scholarly journals Total Ankle Replacement Requiring Distal Tibiofibular Arthrodesis in a Dog

VCOT Open ◽  
2021 ◽  
Vol 04 (01) ◽  
pp. e12-e19
Author(s):  
Neil J. Burton ◽  
Maciej Krukowski
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Surgical Technique ◽  
Tibial Component ◽  
Subjective Assessment ◽  
Total Ankle Replacement ◽  
Labrador Retriever ◽  
Radiological Assessment ◽  
Replacement Surgery ◽  
Ankle Replacement

AbstractThis case report describes distal tibiofibular arthrodesis as a technique for achieving increased confluent bone support for the placement of oversized arthroplasty components for talocrural arthroplasty in an 18-month-old Labrador Retriever with talocrural osteoarthritis secondary to talar osteochondrosis. Computed tomography assessment for suitability for BioMedtrix canine ankle replacement surgery revealed the tibia to be undersized relative to the tibial component. Distal tibiofibular arthrodesis was performed to increase lateral bone support to permit placement of an otherwise oversized prosthesis. Subjective assessment of outcome with owner Liverpool Osteoarthritis in Dogs questionnaire to 6 months postoperatively as well as radiological assessment to 4 months postoperatively documented significant improvement in lameness in the operated limb with no complications. Distal tibiofibular arthrodesis is a means by which to achieve increased bone support prior to BioMedtrix canine total ankle replacement surgery. The surgical technique described herein permitted placement of an oversized talocrural prosthesis in this patient with good clinical function. This technique may permit use of this arthroplasty system in otherwise undersized patients until such a time that smaller implants are available from the manufacturer.

scholarly journals Anterior Incision Offloading for Primary and Revision Total Ankle Replacement: A Comparative Analysis of Two Techniques

2017 ◽  
Vol 11 (1) ◽  
pp. 678-686 ◽  
Author(s):  
Andrew D. Elliott ◽  
Thomas S. Roukis
Keyword(s):  
Wound Healing ◽  
Total Ankle Replacement ◽  
Wound Complications ◽  
Comparison Study ◽  
Delayed Wound Healing ◽  
Replacement Surgery ◽  
Ankle Replacement ◽  
Significant Difference ◽  
Incision Wound ◽  
Anterior Incision

Background: There exists a high risk of post-operative complications with primary and revision total ankle replacement surgery. Delayed wound healing of the anterior incision is common. The reason for this is multi-factorial and, to date, most of the research has focused on predisposing factors involving the patients themselves. Only recently have researchers begun to look at the post-operative dressing as a possible consideration when trying to prevent incision wound healing complications. Currently, no standard post-operative dressing for primary or revision total ankle replacement exists. However, the principles of post-operative edema reduction to improve healing, as advocated by Sir Robert Jones and demonstrated in his compressive dressing, have been known for decades. We have been using a modified Sir Robert Jones compressive dressing for both primary and revision total ankle replacements. Recently, we have added an aperture pad made of cotton cast padding over the anterior incision in order to protect the area from pressure necrosis. Methods: This is a comparison study of the post-operative wound complications involving 35 patients that received the original dressing and 33 patients that received the addition of the aperture pad. Results: With no significant difference in the patient populations, the results demonstrate a 3-fold decrease in the number of anterior incision wound healing complications with the use of the aperture pad. Conclusion: This dressing represents a simple, reproducible, easy to apply and inexpensive way to prevent post-operative edema and anterior incision wound healing complications.

scholarly journals Risk factors for intra-operative and post-operative fractures associated with primary total ankle replacement surgery - a data linkage study from the UK National Joint Registry

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Razi Zaidi ◽  
Andrew Goldberg
Keyword(s):  
Logistic Regression ◽  
Data Linkage ◽  
Patient Characteristics ◽  
Linkage Study ◽  
Total Ankle Replacement ◽  
National Joint Registry ◽  
Joint Registry ◽  
Replacement Surgery ◽  
Ankle Replacement ◽  
The Uk

Category: Ankle Introduction/Purpose: Intra and post-operative fractures are recognised complications of total ankle replacement (TAR) surgery. Intra-operative fractures are captured on the National Joint Registry (NJR) in the UK. The NJR has been capturing data on ankle replacement surgery since April 2010 and the number of TARs on the register is approaching 4000. Post-operative fractures are captured in the Hospital Episodes Statistics (HES) database. HES stores all patients admitted to NHS hospitals in England and captures 125 million records each year. Diagnostic information is stored using the International Classification of Diseases (ICD) and operative details using the Office of Population, Censuses and Surveys Classification (OPCS) codes. The purpose of this work was to determine the rate of intra and post-operative fracture with primary TAR and determine risk factors. Methods: A data-linkage study of the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) database was peformed using the first 3 years of NJR data. These two databases were linked in a deterministic fashion. 1522 NJR records were linked with the HES data set of over 90 million records. 1110 records were able to linked and available for analysis. Unlinked NJR data was analysed to identify intra-operative fractures. Linked data was analysed to identify post-operative fractures using ICD codes. Logistic regression was used to model predictors of intra and post-operative fractures. Every model was adjusted for patient characteristics including age, BMI, comorbidity and ASA grade. Results: The rate of intra-operative fracture was 2.69% (95% CI 2.67% to 2.74%). When looking at patient characteristics no significant predictors emerged. Logistic regression adjusted for patient characteristics showed that patients with rheumatoid arthritis were twice as likely to have a intra-operative fractures. The rate of post-operative fracture in the 12 months following primary TAR was 1.08% (95% CI 1.05% to 1.14%). Age emerged as a risk factor with a 5 five fold increase in risk of post-operative fracture with age 65-74 compared with those below 65. Adjusted logistic regression showed an increase risk of post-operative fracture in rheumatoid patients, hybrid operations and with those with multiple concurrent procedures. The risk of fracture was doubled with one associated procedure and tripled with two procedures. Conclusion: The rate of intra and post-operative fracture associated with primary total ankle replacement is low. However care should be taken with patients over 65 as they are at greater risk of intra operative fractures. Patients with rheumatoid arthritis are at greater risk of both, likely due to the effect of drug treatment. All efforts should be made to review medications and bone protective medication prescribed for these patents when undergoing TAR.

scholarly journals Can the introduction of Enhanced Recovery After Surgery (ERAS) reduce the variation in length of stay after total ankle replacement surgery?

2019 ◽  
Vol 25 (3) ◽  
pp. 294-297 ◽  
Author(s):  
Thomas W. Wainwright ◽  
Tikki Immins ◽  
Johannes H.A. Antonis ◽  
Heath Taylor ◽  
Robert G. Middleton
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Total Ankle Replacement ◽  
Replacement Surgery ◽  
Ankle Replacement

scholarly journals Total Ankle Replacement Digital Templating Method

2019 ◽  
Vol 8 (4) ◽  
pp. 8245-8250
Keyword(s):  
Ankle Joint ◽  
Joint Replacement ◽  
Surgical Procedure ◽  
Total Ankle Replacement ◽  
Templating Method ◽  
Surgery Planning ◽  
Digital Templating ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Ankle Replacement

Total ankle replacement (TAR) requires a step in the pre-surgery planning procedure that can help in determining the most suitable size for the implant. In recent years, digital implants of a size that is suitable for the patient have been widely used in the process of joint replacement surgery for hip and knee joints. Many patients have experienced traumatic damage to the ankle joint, and pre-surgery planning is currently still at the stage of using acetate templates and radiographs, which can cause errors in the surgical procedure. Therefore, a method of determining the implant size by trial and error needs to be developed so that pre-surgical planning can be implemented effectively. In this study, the Orthopaedic-TAR (OrthoAnkle) system is developed using Java software and is supported by Adobe Photoshop. This system allows a surgeon to determine the size of the implant effectively. The components involved in ankle joint replacement are Hintegra implants, designed using AutoCAD. In this way, the size of the Hintegra implant is determined based on the damage to the patient's ankle joint. DICOM X-ray images for several patients were randomly selected to test the accuracy and effectiveness of the size of the implant. A suitable size of implant can facilitate the surgical procedure and reduce damage to the implant after surgery. The results of this study, and particularly the model constructed here, contribute to the templating of digital implants for total ankle replacement. The results of the prototype test show a good response and a high level of effectiveness.

Comparison of Three Total Ankle Replacement Systems Done at a Single Facility

2016 ◽  
Vol 10 (1) ◽  
pp. 20-25 ◽  
Author(s):  
J. Chris Coetzee ◽  
Daryle Petersen ◽  
Rebecca M. Stone
Keyword(s):  
Randomized Study ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Single Institution ◽  
Replacement Surgery ◽  
Ankle Replacement ◽  
Comparative Results ◽  
End Stage ◽  
Single Implant

Background. Ankle replacement surgery is an established and accepted way to treat end stage ankle arthritis. Though there are multiple publications looking at results with various ankle replacement systems, most of them are single implant longitudinal studies from a single institution. There are, however, no prospective randomized studies evaluating the outcomes of different total ankle arthroplasty (TAA) systems; in fact, there are no comparative studies at all. Methods. The comparative results of 3 different total ankle systems (INBONE, STAR, and Salto Talaris) were evaluated. All the TAA system implants were performed at a single institution from 2007 to 2011. The data were evaluated by authors completely independent from the study institution. The goal was to look at the results in an objective, noninstitution perspective. Results. At minimum 2-year follow-up there is no statistical difference in outcomes scores or functional tests between the INBONE, STAR, or Salto Talaris, with all 3 TAA systems resulting in statistically significant improvement of all parameters since baseline. Conclusions. This is the first study that compares the results of 3 different total ankle replacement systems done at a single institution over the same period of time. Even though it is not a randomized study, it gives a valuable perspective of the short-term results. Levels of Evidence: Therapeutic, Level IV: Case series

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.

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