Heterotopic Ossification in Total Ankle Arthroplasty: Case Series and Systematic Review

2020 ◽  
Vol 59 (4) ◽  
pp. 716-721 ◽  
Author(s):  
Thomas B. Bemenderfer ◽  
W. Hodges Davis ◽  
Robert B. Anderson ◽  
Kevin Wing ◽  
Mario I. Escudero ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heterotopic Ossification ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty

scholarly journals Heterotopic Ossification in Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0002
Author(s):  
Thomas Bemenderfer ◽  
Robert Anderson ◽  
Mario Escudero ◽  
Feras Waly ◽  
Kevin Wing ◽  
...  
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Functional Outcome ◽  
Heterotopic Ossification ◽  
Functional Outcomes ◽  
Total Ankle Arthroplasty ◽  
Minimal Clinical Important Difference ◽  
Ankle Arthroplasty ◽  
Wide Range

Category: Ankle Arthritis Introduction/Purpose: Heterotopic ossification (HO) following total ankle arthroplasty (TAA) is a known sequela and has been reported to contribute to reduced postoperative range of motion and poor patient functional outcomes. However, conflicting results have been reported in the literature with respect to the correlation between HO and clinical outcome. As new strategies and implants continue to be designed, it is important to understand what instruments for measuring the outcome of treatment are important to assess when evaluating outcome measures in TAA. The present study documents the incidence of HO and functional outcome for the novel 2 component fixed bearing Infinity Total Ankle System prosthesis at minimum of two year follow up and reports a systematic review of the literature. Methods: We reviewed the incidence, degree of severity, and functional outcome in 67 consecutive patients who underwent primary Infinity TAA at two North American tertiary medical centers between 2013 and 2015 in a prospective observational study. Radiographic and functional outcome data was collected preoperatively, at 6 to 12 months postoperatively, and annually thereafter. In addition, we conducted a systematic review of studies reporting the incidence of HO following TAA. We included peer-reviewed studies reporting on at least 20 TAAs with minimum follow up of two years. Results: While the incidence of HO was 68% at 2.4 years in the 67 patients who underwent primary Infinity TAA, there was no association between HO and AOFAS (HO 73.9, no HO 55.0), SF36-PCS (HO 50.1, no HO 45.2), FFI (HO 22.1, no HO 26.4), and VAS (HO 2.6, no HO 2.3). Fourteen studies with 1201 TAAs were included. The overall incidence of HO following TAA was approximately 56.6% at average 3.8 years with a wide range (range, 22.2-100%). Four studies (299 ankles) did not address functional outcomes. Nine studies (822 ankles) reported no association between functional outcomes and HO. One study (80 ankles) reported a statistically significant difference in range of motion of 7 degrees of dorsiflexion and a 7-point difference in AOFAS score. Conclusion: There was no association between HO and functional outcome in our observational cohort. Only one study demonstrated statistically significant differences in range of motion and functional outcome due to HO. Although the minimal clinical important difference in ankle dorsiflexion and AOFAS has not been established in TAA, these differences are below the minimal clinical important difference established in other foot and ankle procedures. Available data, including the results in our 67 patients, suggests that clinical function is independent of the presence of HO.

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

2020 ◽  
Vol 41 (12) ◽  
pp. 1519-1528
Author(s):  
Jonathan Day ◽  
Jaeyoung Kim ◽  
Martin J. O’Malley ◽  
Constantine A. Demetracopoulos ◽  
Jonathan Garfinkel ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
The Mean ◽  
Component Revision

Background: The Salto Talaris is a fixed-bearing implant first approved in the US in 2006. While early surgical outcomes have been promising, mid- to long-term survivorship data are limited. The aim of this study was to present the survivorship and causes of failure of the Salto Talaris implant, with functional and radiographic outcomes. Methods: Eighty-seven prospectively followed patients who underwent total ankle arthroplasty with the Salto Talaris between 2007 and 2015 at our institution were retrospectively identified. Of these, 82 patients (85 ankles) had a minimum follow-up of 5 (mean, 7.1; range, 5-12) years. The mean age was 63.5 (range, 42-82) years and the mean body mass index was 28.1 (range, 17.9-41.2) kg/m2. Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Preoperative, immediate, and minimum 5-year postoperative AP and lateral weightbearing radiographs were reviewed; tibiotalar alignment (TTA) and the medial distal tibial angle (MDTA) were measured to assess coronal talar and tibial alignment, respectively. The sagittal tibial angle (STA) was measured; the talar inclination angle (TIA) was measured to evaluate for radiographic subsidence of the implant, defined as a change in TIA of 5 degrees or more from the immediately to the latest postoperative lateral radiograph. The locations of periprosthetic cysts were documented. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Results: Survivorship was 97.6% with 2 revisions. One patient underwent tibial and talar component revision for varus malalignment of the ankle; another underwent talar component revision for aseptic loosening and subsidence. The rate of other reoperations was 21.2% ( n = 18), with the main reoperation being exostectomy with debridement for ankle impingement ( n = 12). At final follow-up, the average TTA improved 4.4 (± 3.8) degrees, the average MDTA improved 3.4 (± 2.6) degrees, and the average STA improved 5.3 (± 4.5) degrees. Periprosthetic cysts were observed in 18 patients, and there was no radiographic subsidence. All FAOS subscales demonstrated significant improvement at final follow-up. Conclusions: We found the Salto Talaris implant to be durable, consistent with previous studies of shorter follow-up lengths. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at a minimum 5-year follow-up. Level of Evidence: Level IV, retrospective case series.

Takedown of Painful Ankle Arthrodesis to Total Ankle Arthroplasty: A Case Series of 77 Patients

2020 ◽  
Vol 59 (3) ◽  
pp. 535-540 ◽  
Author(s):  
John M. Schuberth ◽  
Christy M. King ◽  
Shen-fang Jiang ◽  
Justin S. Ross ◽  
Jeffrey C. Christensen ◽  
...  
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty

scholarly journals Quality of Modern Total Ankle Arthroplasty Research

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Daniel Bohl ◽  
Emily Vafek ◽  
Simon Lee ◽  
Johnny Lin ◽  
George Holmes ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Case Reports ◽  
Case Series ◽  
The United States ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is gaining popularity as an alternative to ankle arthrodesis in the setting of end-stage ankle arthritis. However, compared to hip and knee arthroplasty, there is a relative dearth of evidence to support its use. This study assesses the quality of literature surrounding modern TAA designs. Methods: A search of all peer-reviewed, English-language journals was conducted to identify publications involving TAA. The initial search identified 444 articles published during 2006-2016. Of these, 182 were excluded because they were not clinical outcomes studies, 46 because the TAA implant was no longer available, and 15 because the primary outcome of the study was not related to TAA, leaving 201 articles for analysis. Results: No Level I studies were identified. Seventeen (8%) studies were Level II, 48 (24%) Level III, 128 (64%) Level IV, and 8 (4%) Level V. One hundred forty-three studies (71%) were retrospective in nature. Stratification by study design revealed 128 (64%) case series, 33 (16%) experimental cohort studies, 19 (10%) case-control studies, 13 (6%) observational cohort studies, and 8 (4%) case reports. The number of studies published each year steadily increased from 2006 to 2016. A total of 51% of TAA research was published in only two journals: Foot and Ankle International and the Journal of Bone and Joint Surgery. Publications from the United States accounted for 36% of total publications. The most published implant was the Scandinavian Total Ankle Replacement (Figure 1). Conclusion: While the number of TAA studies published each year has steadily increased since 2006, the quality of this research as measured by level of evidence remains suboptimal. This analysis highlights the need for continued improvement in methodology and development of robust prospective registries to advance our knowledge of TAA as a treatment for end-stage ankle arthritis.

Clinical Outcomes of Total Ankle Arthroplasty With Total Talar Prosthesis

2019 ◽  
Vol 40 (8) ◽  
pp. 948-954
Author(s):  
Noriyuki Kanzaki ◽  
Nobuaki Chinzei ◽  
Tetsuya Yamamoto ◽  
Takahiro Yamashita ◽  
Kazuyuki Ibaraki ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Medial Malleolus ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
The Mean ◽  
End Stage ◽  
Medial Malleolus Fracture

Background: Total ankle arthroplasty (TAA) has been developed to treat patients with end-stage ankle osteoarthritis (OA). However, there is often difficulty in treating complicated pathologies such as ankle OA with subtalar joint OA and severe talar collapse. Therefore, this study aimed to explore the short-term results and complications of TAA with total talar prosthesis, known as combined TAA, as the new techniques to treat such complicated pathology. Methods: We examined postoperative results including ankle range of motion, Japanese Society for Surgery of the Foot (JSSF) scale, and complications. There were 22 patients (15 women), with mean follow-up of 34.9 (range, 24–53 months), and the mean age was 72 (range, 62–80) years. The main indications for combined TAA included osteoarthritis (18 patients), rheumatoid arthritis (3 patients), and talar osteonecrosis with osteoarthritis (one patient). Results: The mean range of motion improved from 4.0 to 14.4 degrees in dorsiflexion and from 23.8 to 32.0 degrees in plantarflexion. The JSSF scale improved from 50.5 to 91.5 points. Prolonged wound healing occurred in 3 patients, and medial malleolus fracture occurred in 4 patients. Conclusion: Combined TAA was a reliable procedure for the treatment of not only ankle OA following avascular necrosis of talus but also of degeneration of both ankle and subtalar joints. Level of Evidence: Level IV, case series.

Short- to Midterm Follow-up of Cemented Total Ankle Replacement Using the INBONE II: A Retrospective Chart Review

2020 ◽  
pp. 193864002091312
Author(s):  
Gregory C. Berlet ◽  
Roberto A. Brandão ◽  
Devon Consul ◽  
Pierce Ebaugh ◽  
Christopher F. Hyer
Keyword(s):  
Case Series ◽  
Retrospective Chart Review ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Retrospective Case ◽  
Ankle Arthroplasty ◽  
Major Complications ◽  
End Stage ◽  
Complications Rate

Background: Total ankle arthroplasty is a viable option for the treatment of end stage ankle arthritis. The purpose of this study is to report on the mid-term results with a cemented total ankle prosthesis, the Inbone™ II implant over a 5 year period. Methods: A retrospective, single-center chart and radiographic review of all patients with end stage ankle arthritis treated with Inbone™ II TAR) as the primary index procedure from 12/1/2012 to 3/1/2017. Clinical data were evaluated at 3 month, 6 month, 1 year and subsequent intervals for the study period. Preoperative diagnosis, pertinent patient demographics adjunctive procedures, implant associated complications, subsequent surgeries, and revisions were recorded. Results: 121 total ankles met our inclusion criteria. Patients had an INBONE™ II TAR implant placed with bone cement with a minimum of a 12 months follow up. Average age was 62.88 (range, 32-87) years, average body mass index was 32.74 (range, 21.8-56.04) kg/m2 and average follow up was 28.51(range, 12-69) months. Using the COFAS complication classification there were 14 minor, 11 moderate, and 5 major complications. 6/121 (5.0%) revisions which included: polyethylene exchange, device explant/fusion, and antibiotic spacer in situ. No complications over the course of this study ended in amputation. Conclusion: Total Ankle Arthroplasty utilizing the cemented INBONE™ II yielded good midterm results with regards to minor, moderate, and major complications. Rate of revision 6/121 (5.0%) was within the reported range with only 5 patients converted to fusion during the study period resulting in a 95% survivability at mid-term follow up. Levels of Evidence: Level IV: Retrospective case series

A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty

2017 ◽  
Vol 39 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Todd R. Borenstein ◽  
Kapil Anand ◽  
Quanlin Li ◽  
Timothy P. Charlton ◽  
David B. Thordarson
Keyword(s):  
Wound Infection ◽  
Pain Control ◽  
Perioperative Complications ◽  
Case Series ◽  
Arterial Occlusion ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Ankle Arthroplasty ◽  
Wound Breakdown

Background: Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. Outpatient TAA are increasingly common and have been shown to decrease costs compared to inpatient surgery. However, there are very few studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive patients who received outpatient TAA to identify complication rates. Methods: The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum 6-month follow-up were reviewed. All patients received popliteal and saphenous blocks prior to surgery and were managed with oral pain medication postoperatively. All received a STAR total ankle. Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and perioperative complications including wound breakdown, infection, revision, and nonrevision surgeries were observed. Mean follow-up was 16.6 ± 9.1 months (range, 6-42 months). Results: There were no readmissions for pain control and 1 patient had a wound infection. The overall complication rate was 15.4%. One ankle (1.5%) had a wound breakdown requiring debridement and flap coverage. This patient thrombosed a popliteal artery stent 1 month postop. The 1 ankle (1.5%) with a wound infection occurred in a patient with diabetes, obesity, hypertension, and rheumatoid arthritis. Conclusion: This study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory experience with no readmissions for pain control and 1 wound infection. The 1 wound breakdown complication (1.5%) was attributed to arterial occlusion and not outpatient management. Level of Evidence: Level IV, retrospective case series.

scholarly journals Safety and Effectiveness of Outpatient Total Ankle Arthroplasty

2021 ◽  
Vol 6 (4) ◽  
pp. 247301142110578
Author(s):  
Shahin Kayum ◽  
Sahil Kooner ◽  
Ryan M. Khan ◽  
Mansur Halai ◽  
Adam Awoke ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Pain Control ◽  
Primary Outcome ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Postoperative Pain Control ◽  
Ankle Arthroplasty ◽  
Secondary Outcomes ◽  
Numeric Scale

Background: Total ankle arthroplasty (TAA) is a surgical procedure commonly reserved for patients suffering from symptomatic end-stage ankle arthritis. As the number of TAAs increases, so does the associated economic burden. Given these economic constraints, there has been interest in the feasibility of outpatient TAA. The purpose of this study is to evaluate the safety, efficacy, and satisfaction of patients undergoing outpatient TAA. Methods: This is a retrospective case series of consecutive patients who underwent outpatient TAA from July 2018 to June 2019. Inclusion criteria included any patient undergoing a primary TAA in the outpatient setting. This was defined as discharge on the same day of surgery or within 12 hours of surgery. All surgeries were completed by a single experienced surgeon through an anterior approach using the Cadence Total Ankle System. Prior to surgery, all patients received a popliteal nerve block. Patients were then discharged home with oral analgesic and a popliteal nerve catheter, which they removed after 48 hours. The primary outcome of interest was postoperative pain control, which was measured using a numeric scale. Secondary outcomes included complication rate, readmission rate, and patient satisfaction. A review of the current literature was then completed to supplement our results. Results: In total, 41 patients were included in our analysis. In terms of the primary outcome, the average numeric scale score was 1.98, indicating excellent pain control. Additionally, nearly all 41 patients stated they were very satisfied with their postoperative pain control regimen. In terms of secondary outcomes, the majority of patients stated they were satisfied with discharge on the same day as surgery. There were no readmissions or major complications in our outpatient TAA cohort. When asked if they would recommend the care they experienced to a friend with the same condition, 95% of patients said that they would recommend this care pathway. Our literature review included 5 original studies, which were all retrospective level IV studies. These studies uniformly demonstrated the safety and efficacy of outpatient TAA. Conclusions: The results of our study demonstrate the outpatient TAA is associated with excellent pain control using a multidisciplinary pain approach. The use of standardized outpatient postoperative pathways was effective in preventing readmissions and complications, while still resulting in high patient satisfaction scores. A review of the literature complemented our results, as there are largely no significant differences between outpatient and inpatient TAA. Level of Evidence: Level IV, case series.

Sign in / Sign up

Export Citation Format

Share Document