Radiographic effects observed in the coronal view after medial malleolar osteotomy at total ankle arthroplasty in rheumatoid arthritis cases

2020 ◽  
Vol 25 (6) ◽  
pp. 1072-1078
Author(s):  
Makoto Hirao ◽  
Jun Hashimoto ◽  
Kosuke Ebina ◽  
Hideki Tsuboi ◽  
Koichiro Takahi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Medial Malleolar Osteotomy ◽  
Coronal View

Radiographic Outcomes of Mobile-Bearing Total Ankle Arthroplasty for Patients With Rheumatoid Arthritis

2019 ◽  
Vol 40 (9) ◽  
pp. 1037-1042
Author(s):  
Koichiro Yano ◽  
Katsunori Ikari ◽  
Ken Okazaki
Keyword(s):  
Rheumatoid Arthritis ◽  
Tibial Component ◽  
Patient Reported Outcomes ◽  
Mobile Bearing ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Patient Reported

Background: Ankle disorders in patients with rheumatoid arthritis (RA) reduce their quality of life and activities of daily living. The aim of this study was to evaluate the midterm clinical and radiographic outcomes of TAA in patients with RA. Methods: This retrospective study included patients with a minimum follow-up of 2 years. A total of 37 RA patients (39 ankles) were enrolled in this study from August 2006 to March 2016. All the patients had undergone primary cemented mobile-bearing total ankle arthroplasty (TAA). Nine ankles received arthrodesis of the subtalar joint simultaneously. Patient-reported outcomes were measured preoperatively and at the latest follow-up by Self-Administered Foot-Evaluation Questionnaire (SAFE-Q). Radiographs of the ankle were analyzed preoperatively and at all follow-up visits to measure the periprosthetic radiolucent line, migration of the tibial component, and the subsidence of the talar component. Intraoperative and postoperative complications were recorded. The average duration of follow-up for the entire cohort was 5.0 ± 2.0 years (range 2.1-10.1 years). Results: All subscales of the SAFE-Q had improved significantly at the latest follow-up. No significant difference was found between the range of motion of the ankle before and after the surgery. Radiolucent lines were observed in 28 (73.7%) ankles. Migration of the tibial component and subsidence of the talar component were found in 8 (21.1%) and 11 (28.9%) ankles, respectively. Intraoperative malleolus fractures occurred in 3 (7.7%) ankles and delayed wound healing in 10 (25.6%) ankles. Four ankles were removed because of deep infection or noninfective loosening, resulting in an implant survival rate of 88.4% (95% CI, 0.76-1.0) at 10 years. Conclusion: The midterm patient-reported outcomes and implant retention rate after cemented mobile-bearing TAA for RA patients were satisfactory. However, a low radiographic implant success rate was observed. Level of Evidence: Level IV, retrospective case series.

scholarly journals Total Ankle Arthroplasty for Rheumatoid Arthritis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0024
Author(s):  
Makoto Hirao ◽  
Jun Hashimoto ◽  
Hideki Tsuboi ◽  
Takaaki Noguchi
Keyword(s):  
Rheumatoid Arthritis ◽  
Treatment Group ◽  
Soft Tissue ◽  
Bone Strength ◽  
Total Ankle Arthroplasty ◽  
Soft Tissue Balance ◽  
Biologic Treatment ◽  
Ankle Arthroplasty ◽  
Loading Axis

Category: Ankle Introduction/Purpose: Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (1. augmentation of bone strength, 2. control of soft tissue balance, 3. adjustment of the loading axis) for rheumatoid arthritis (RA) cases were evaluated after mid to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated. Methods: We performed a retrospective observational study involving 50 ankles (44 patients) that underwent TAA for the treatment of rheumatoid arthritis. The mean duration of follow-up was 7.1 years. Clinical outcomes were evaluated with use of the Japanese Society for Surgery of the Foot (JSSF) scale score and a postoperative self-administered foot-evaluation questionnaire (SAFE-Q). Radiographic findings were evaluated as well. These parameters also were compared between patients managed with and without biologic treatment. Results: This procedure significantly improved the clinical scores of the JSSF rheumatoid arthritis foot and ankle scale (p < 0.0001). Forty-eight of the 50 ankles had no revision TAA surgery. Subsidence of the talar component was seen in 8 ankles (6 in the biologic treatment group and 2 in the non-biologic treatment group); 2 of these ankles (both in the biologic treatment group) underwent revision TAA. The social functioning score of the SAFE-Q scale at the time of the latest follow-up was significantly higher in the biologic treatment group (p = 0.0079). The dosage of prednisolone (p = 0.0003), rate of usage of prednisolone (p = 0.0001), and disease-activity score (p < 0.01) at the latest follow-up were all significantly lower in the biologic treatment group. Conclusion: TAA is recommended for RA cases, if disease control, augmentation of bone strength, control of soft tissue balance, and adjustment of loading axis are taken into account. The prevention of talar component subsidence remains a challenge in patients with the combination of subtalar fusion, rheumatoid arthritis, and higher social activity levels.

Indications of total ankle arthroplasty for rheumatoid arthritis: evaluation at 5 years or more after the operation

2003 ◽  
Vol 13 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Fumio Shinomiya ◽  
Masahiko Okada ◽  
Yoshiaki Hamada ◽  
Takuya Fujimura ◽  
Daisuke Hamada
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty

Total Ankle Arthroplasty in Rheumatoid Arthritis: A Long-term Follow-up Study

Foot & Ankle ◽  
1988 ◽  
Vol 8 (4) ◽  
pp. 173-179 ◽  
Author(s):  
Anthony S. Unger ◽  
Allan E. Inglis ◽  
Christopher S. Mow ◽  
Harry E. Figgie
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Cement ◽  
Total Ankle Arthroplasty ◽  
Radiographic Analysis ◽  
Ankle Arthroplasty ◽  
Follow Up Study ◽  
Long Term Follow Up

Patients with rheumatoid arthritis who had undergone total ankle arthroplasty and had a minimum of 2 yr follow-up were studied. Of the original 21 patients 17 were available for review. Twenty-three ankle replacements with an average follow-up of 5.6 yr were studied. On follow-up 2 ankles were rated excellent, 13 were rated good, 4 were rated fair, and 4 were rated poor. Thus, 83% were satisfactory on follow-up. Radiographic analysis revealed migration and settling of the talar component in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 tibial components with tilting in 12 of these components. The postoperative position of the implant did not correlate with the development of radiolucencies or migration of the implant.

Comparison of Clinical Outcomes After Total Ankle Arthroplasty Between End-Stage Osteoarthritis and Rheumatoid Arthritis

2021 ◽  
pp. 107110072097992
Author(s):  
Byung-Ki Cho ◽  
Min-Yong An ◽  
Byung-Hyun Ahn
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Outcomes ◽  
Immunosuppressive Treatment ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Ankle Arthroplasty ◽  
End Stage

Background: Total ankle arthroplasty (TAA) is known to be a reliable operative option for end-stage rheumatoid arthritis. However, higher risk of postoperative complications related to chronic inflammation and immunosuppressive treatment is still a concern. With the use of a newer prosthesis and modification of anti-rheumatic medications, we compared clinical outcomes after TAA between patients with osteoarthritis and rheumatoid arthritis. Methods: Forty-five patients with end-stage osteoarthritis (OA group) and 19 with rheumatoid arthritis (RA group) were followed for more than 3 years after 3 component mobile-bearing TAA (ZenithTM). Perioperative anti-rheumatic medications were modified using an established guideline used in total hip and knee arthroplasty. Clinical evaluations consisted of American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). Results: In the preoperative and postoperative evaluation at final follow-up, there were no significant differences in AOFAS, FAOS, and FAAM scores between 2 groups. Despite statistical similarity in total scores, the OA group showed significantly better scores in FAOS sports and leisure (mean, 57.4 ± 10.1) and FAAM sports activity (mean, 62.5 ± 13.6) subscales than those in the RA group (mean, 52.2 ± 9.8, P = .004; and 56.4 ± 13.2, P < .001, respectively). There were no significant differences in perioperative complication and revision rates between 2 groups. Conclusions: Patients with end-stage ankle RA had clinical outcomes comparable to the patients with OA, except for the ability related to sports activities. In addition, there were no significant differences in early postoperative complication rates, including wound problem and infection. Level of Evidence: Level III, prognostic, prospective comparative study.

scholarly journals Defining Responders vs Non-Responders After Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0040
Author(s):  
John R. Steele ◽  
Daniel J. Cunningham ◽  
James K. DeOrio ◽  
James A. Nunley ◽  
Mark E. Easley ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Multivariate Analysis ◽  
Total Ankle Arthroplasty ◽  
Successful Outcome ◽  
Function Score ◽  
Ankle Arthroplasty ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported

Category: Ankle, Ankle Arthritis Introduction/Purpose: The literature for total ankle arthroplasty (TAA) demonstrates significant improvements in patient- reported outcomes. While these reports focus on the overall study population, it is clear that some patients do not have a successful outcome. In regards to total hip and knee arthroplasty there is literature helping to define responders, or those who achieve a clinical improvement above the level of a minimally clinically important difference. However, characteristics of responders versus non-responders to TAA have not been defined. The purpose of this study was to determine patient comorbidities and characteristics that help distinguish responders from non-responders after TAA. Methods: Patients undergoing TAA between 1/2007 and 12/2016 were enrolled into a prospective study at a single academic center. Patients completed multiple patient reported outcome measures before surgery and in follow-up including the Short Musculoskeletal Function Assessment (SMFA). Patients were characterized as responders if their 2-year follow-up SMFA function score increased by 50% or more compared to preoperatively and were characterized as non-responders if their SMFA score increased by less than 50% at 2-year follow-up, consistent with OMERACT–OARSI responder criteria. Patient and operative factors along with prevalent pre-operative comorbidities were then associated with responder or non-responder status. Comorbidities that met a significance threshold of p<0.05 in adjusted analyses were incorporated into multivariable outcome models. Results: A total of 492 patients with complete data and 2-year follow-up were included in this study. Based on the SMFA function score improvement cutoff of at least 50% at 2-year follow-up, 332 patients were defined as responders and 160 were defined as non-responders. There was no significant difference between pre-operative SMFA function scores between the groups. Responders had significantly higher preoperative SF-36 Mental Component Summary (MCS) scores (p<0.001) and significantly lower rates of rheumatoid arthritis (p<0.001), obesity (p=0.05) and depression (p=0.026) as compared to non-responders. In multivariate analysis, preoperative SF-36 MCS score was found to be significantly associated with responder status (p=0.0056). Conclusion: Patients defined as responders after TAA based on 50% or greater improvement in SMFA function scores at 2-year follow-up had significantly higher pre-operative SF-36 MCS scores and significantly lower rates of rheumatoid arthritis, obesity and depression compared to non-responders. Pre-operative SF-36 MCS score was found to be significantly associated with responder status in multivariate analysis. This suggests that patients with depressive symptoms, but not necessarily a diagnosis of depression may not achieve as favorable results after TAA and should be counseled appropriately.

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