Does Computed Tomography Add Information on Radiographic Analysis in Detecting Periprosthetic Osteolysis After Total Ankle Arthroplasty?

2013 ◽  
Vol 34 (2) ◽  
pp. 180-188 ◽  
Author(s):  
Ia Kohonen ◽  
Helka Koivu ◽  
Tomi Pudas ◽  
Hannu Tiusanen ◽  
Tero Vahlberg ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Total Ankle Arthroplasty ◽  
Radiographic Analysis ◽  
Periprosthetic Osteolysis ◽  
Ankle Arthroplasty

Periprosthetic Osteolysis after Total Ankle Arthroplasty

2013 ◽  
Vol 35 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Hang Seob Yoon ◽  
Jongseok Lee ◽  
Woo Jin Choi ◽  
Jin Woo Lee
Keyword(s):  
Total Ankle Arthroplasty ◽  
Periprosthetic Osteolysis ◽  
Ankle Arthroplasty

scholarly journals The Fate of Bone Graft for Periprosthetic Osteolysis in Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Yoo Jung Park ◽  
Dong-Woo Shim ◽  
Yeokgu Hwang ◽  
Jin Woo Lee
Keyword(s):  
Clinical Outcome ◽  
Bone Graft ◽  
Bone Grafting ◽  
Distal Tibia ◽  
Total Ankle Arthroplasty ◽  
Implant Failure ◽  
Periprosthetic Osteolysis ◽  
Aofas Score ◽  
Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. It may cause implant failure and has potential to affect long-term implant survival. To prevent major revisional arthroplasty, it is important to make an early diagnosis of osteolysis and decide an appropriate timing of surgical intervention such as bone graft. We report our experience of bone graft for osteolysis after TAA associated with clinical and radiologic outcome. Methods: Between May 2004 and Oct. 2013, 238 primary TAA were performed on 219 patients. We excluded 37 ankles with follow-up less than 24 months; thus, 201 ankles in 185 patients with mean follow-up of 61.9 (range, 24-130) months were included in the study. Nineteen patients were treated with a total of 21 bone graft procedures for periprosthetic osteolysis after TAA. Of these patients, 12 (57.1%) were males with mean follow-up length after bone graft 35.0 months. Location of osteolysis, bone grafting method and clinical outcome parameters using visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score were recorded. Results: Radiographs revealed total of 62 osteolysis lesions in 19 patients; 35 (56.5%) distal tibial lesions, 23 (37.0%) talar lesions. Autogenous iliac bone graft was used in 18 procedures (85.7%). The mean scores (and standard deviation) improved for the VAS from 4.8 ± 1.23 points before bone graft to 3.0 ± 0.94 points at the last follow-up (p<0.05); and for the AOFAS score from 76.8 ± 5.9 before bone graft to 84.3 ± 4.5 at the last follow-up (p<0.05). After 21 bone graft procedures, 6 demonstrated detection of newly developed osteolysis. One patient needed a repeat bone graft procedure with cementation after the primary bone grafting due to large cyst on distal tibia. There was no implant failure or major revisions after the bone graft. Conclusion: Bone graft for periprosthetic osteolysis may improve patient’s clinical outcome and give support to the structures surrounding the implant. Bone grafting in optimal timing may also improve implant survivorship. However, further study is needed for the etiology of newly developed painless osteolysis even after the bone graft.

Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty

2020 ◽  
pp. 107110072097842
Author(s):  
Nabil Mehta ◽  
Joseph Serino ◽  
Edward S. Hur ◽  
Shelby Smith ◽  
Kamran S. Hamid ◽  
...  
Keyword(s):  
Basic Science ◽  
Management Strategies ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Common Occurrence ◽  
Periprosthetic Osteolysis ◽  
Level Of Evidence ◽  
Comprehensive Review ◽  
Ankle Arthroplasty ◽  
A Current

Periprosthetic osteolysis is a common occurrence after total ankle arthroplasty (TAA) and poses many challenges for the foot and ankle surgeon. Osteolysis may be asymptomatic and remain benign, or it may lead to component instability and require revision or arthrodesis. In this article, we present a current and comprehensive review of osteolysis in TAA with illustrative cases. We examine the basic science principles behind the etiology of osteolysis, discuss the workup of a patient with suspected osteolysis, and present a review of the evidence of various management strategies, including grafting of cysts, revision TAA, and arthrodesis. Level of Evidence: Level V, expert opinion.

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.

scholarly journals Volume and Distribution of Periprosthetic Bone Cysts in the Distal Tibia and Talus before Early Revision of Total Ankle Arthroplasty

2021 ◽  
Vol 11 (16) ◽  
pp. 7242
Author(s):  
Seoyeong Kim ◽  
Jinju Jang ◽  
Jae-Hyuk Choi ◽  
Hai-Mi Yang ◽  
Heoung-Jae Chun ◽  
...  
Keyword(s):  
Distal Tibia ◽  
Three Dimensional ◽  
Total Ankle Arthroplasty ◽  
Periprosthetic Osteolysis ◽  
Periprosthetic Bone ◽  
Careful Planning ◽  
Ankle Arthroplasty ◽  
Early Revision ◽  
Further Development ◽  
Stress Flow

Periprosthetic osteolysis is a common complication following total ankle arthroplasty (TAA). However, understanding of osteolysis volume and distribution is still evolving, undermining efforts to reduce the incidence of osteolysis via bone remodeling. We obtained data on the characteristics of osteolysis developing within the distal tibia and talus after TAA. Three-dimensional computed tomography (3D-CT) reconstructions of 12 patients who underwent HINTEGRA TAA were performed. We identified 27 volumes of interest (VOIs) in the tibia and talus and used statistical methods to identify the characteristics of osteolysis in the VOIs. The osteolysis volume was significantly larger in the talus than in the tibia (162.1 ± 13.6 and 54.9 ± 6.1 mm3, respectively, p = 0.00). The extent of osteolysis within the peri-prosthetic region was greater than within other regions (p < 0.05). Particularly, in the talus, the region around the talar pegs exhibited 24.2 ± 4.5% more osteolysis than any other talar region (p = 0.00). Our results may suggest that extensive osteolysis within the peri-prosthetic region reflects changes in stress flow and distribution, which vary according to the design and placement of the fixation components. This is the first study to report 3D osteolysis patterns after TAA. Careful planning of TAA design improvements may reduce the incidence of osteolysis. Our results will facilitate the further development of TAA systems.

Lower Bone Density on Preoperative Computed Tomography Predicts Periprosthetic Fracture Risk in Total Ankle Arthroplasty

2018 ◽  
Vol 40 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Elizabeth A. Cody ◽  
James R. Lachman ◽  
Elizabeth B. Gausden ◽  
James A. Nunley ◽  
Mark E. Easley
Keyword(s):  
Computed Tomography ◽  
Fracture Risk ◽  
Periprosthetic Fracture ◽  
Total Ankle Arthroplasty ◽  
Periprosthetic Fractures ◽  
Additional Patient ◽  
Mineral Density ◽  
Patient Factors ◽  
Ankle Arthroplasty ◽  
Preoperative Ct

Background: The effect of bone mineral density (BMD) on outcomes from total ankle arthroplasty (TAA) has not been studied. BMD can be estimated by measuring Hounsfield units (HU) on standard computed tomography (CT), which is frequently performed prior to TAA. We aimed to identify whether tibial and talar HU measured from preoperative CT scans were associated with periprosthetic fracture or revision risk in patients undergoing TAA. Methods: A prospectively collected database was used to retrospectively screen all patients undergoing primary TAA. Only patients with a preoperative CT within 1 year of surgery were included. Primary outcomes were periprosthetic fracture and prosthetic revision. HU were measured on axial CT cuts in the distal tibia and talus. Additional patient factors analyzed included age, sex, weight, body mass index (BMI), tobacco use, presence of rheumatoid arthritis, and preoperative deformity. A total of 198 ankles were included, with a mean 2.4 years of follow-up. Results: There were 7 intraoperative and 9 postoperative periprosthetic fractures (3.5% and 4.5%, respectively). Seven patients (3.5%) underwent prosthetic removal or revision. Lower tibial and talar HU, lower weight, and lower BMI were associated with periprosthetic fractures ( P < .05). After controlling for age, sex, and weight, only tibial HU was significantly associated with periprosthetic fracture ( P = .018). All intraoperative fractures occurred in patients with tibial HU less than 200. None of the patient factors analyzed were associated with revision. Conclusions: Lower tibial HU on preoperative CT was strongly associated with periprosthetic fracture risk with TAA. In patients with tibial HU less than 200, surgeons may consider prophylactic internal fixation of the medial malleolus. Level of Evidence: Level III, retrospective cohort study.

Comparison of Preoperative Bone Density in Patients With and Without Periprosthetic Osteolysis Following Total Ankle Arthroplasty

2020 ◽  
pp. 107110072097609
Author(s):  
Gun-Woo Lee ◽  
Hyoung-Yeon Seo ◽  
Dong-Min Jung ◽  
Keun-Bae Lee
Keyword(s):  
Bone Density ◽  
Ankle Joint ◽  
Bone Ingrowth ◽  
Distal Tibia ◽  
Reference Points ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Periprosthetic Osteolysis ◽  
Ankle Arthroplasty ◽  
Press Fit

Background: Modern total ankle arthroplasty (TAA) prostheses are uncemented press-fit designs whose stability is dependent on bone ingrowth. Preoperative insufficient bone density reduces initial local stability at the bone-implant interface, and we hypothesized that this may play a role in periprosthetic osteolysis. We aimed to investigate the preoperative bone density of the distal tibia and talus and compare these in patients with and without osteolysis. Methods: We enrolled 209 patients (218 ankles) who underwent primary TAA using the HINTEGRA prosthesis. The overall mean follow-up duration was 66 (range, 24-161) months. The patients were allocated into 2 groups according to the presence of periprosthetic osteolysis: the osteolysis group (64 patients, 65 ankles) and nonosteolysis group (145 patients, 153 ankles). Between the 2 groups, we investigated and compared the radiographic outcomes, including the Hounsfield unit (HU) value around the ankle joint and the coronal plane alignment. Results: HU values of the tibia and talus measured at 5 mm from the reference points were higher than those at 10 mm in each group. However, comparing the osteolysis and nonosteolysis groups, we found no significant intergroup difference in HU value at every measured level in the tibia and talus ( P > .05). Concerning the coronal plane alignment, there were no significant between-group differences in the tibiotalar and talar tilt angles ( P > .05). Conclusions: Patients with osteolysis showed similar preoperative bone density of the distal tibia and talus compared with patients without osteolysis. Our results suggest that low bone density around the ankle joint may not be associated with increased development of osteolysis. Level of Evidence: Level III, retrospective cohort study.

Total ankle arthroplasty: optimizing computed tomography imaging protocol

2013 ◽  
Vol 42 (11) ◽  
pp. 1507-1513 ◽  
Author(s):  
Ia Kohonen ◽  
Helka Koivu ◽  
Tero Vahlberg ◽  
Heli Larjava ◽  
Kimmo Mattila
Keyword(s):  
Computed Tomography ◽  
Total Ankle Arthroplasty ◽  
Computed Tomography Imaging ◽  
Imaging Protocol ◽  
Ankle Arthroplasty ◽  
Tomography Imaging

scholarly journals Management of Periprosthetic Osteolysis after Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0037
Author(s):  
Yoo Jung Park ◽  
Kwang Hwan Park ◽  
Jae Han Park ◽  
Seung Hwan Han ◽  
Sang B. Kim ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Bone Graft ◽  
Bone Grafting ◽  
Distal Tibia ◽  
Total Ankle Arthroplasty ◽  
Implant Failure ◽  
Time Interval ◽  
Consecutive Series ◽  
Periprosthetic Osteolysis ◽  
Ankle Arthroplasty

Category: Ankle Arthritis; Ankle Introduction/Purpose: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. It may cause implant failure and has potential to affect long-term implant survival. To prevent major revisional arthroplasty, it is important to make an early diagnosis of osteolysis and decide an appropriate timing of surgical intervention such as bone graft. We report our updated result of bone graft for osteolysis after TAA associated with clinical and radiologic outcome. Methods: We retrospectively evaluated our consecutive series of 440 primary TAAs performed between May 2004 and August 2018 and identified those who had a subsequent bone graft procedure. A total of 38 bone graft procedures for periprosthetic osteolysis after TAA were performed. Mean time-interval between primary TAA and bone graft was 5.09 years (range 17.0 to 127.0 months). Location of osteolysis, bone grafting method and clinical outcome parameters using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score were recorded. Results: Radiographs revealed periprosthetic osteolysis in 51.8% (58/112) of distal tibial lesions and 41.1% (46/112) of talar lesions. Autogenous iliac bone graft was used in most of procedures. Both mean VAS and AOFAS scores improved significantly at the last follow-up (p<0.05) One patient needed a repeat bone graft procedure with additional bone cementation after the primary bone grafting due to large cyst on distal tibia. There was no implant failure or major revisions after the bone graft. Conclusion: Bone graft for periprosthetic osteolysis may improve patient’s clinical outcome and give support to the structures surrounding the implant. Bone grafting in optimal timing may also improve implant survivorship. However, further study is needed for the etiology of newly developed painless osteolysis even after the bone graft.

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