Periprosthetic Osteolysis after Total 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.

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

Foot & Ankle International ◽

10.1177/1071100720978426 ◽

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.

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

Applied Sciences ◽

10.3390/app11167242 ◽

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.

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

Foot & Ankle International ◽

10.1177/1071100720976096 ◽

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.

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Management of Periprosthetic Osteolysis after Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00378 ◽

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

Foot & Ankle International ◽

10.1177/1071100712460224 ◽

2013 ◽

Vol 34 (2) ◽

pp. 180-188 ◽

Cited By ~ 34

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

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Bone graft for periprosthetic osteolysis in total ankle arthroplasty

Foot and Ankle Surgery ◽

10.1016/j.fas.2017.07.492 ◽

2017 ◽

Vol 23 ◽

pp. 132

Author(s):

Y.J. Park ◽

Y.G. Hwang ◽

K.H. Park ◽

S.H. Han ◽

J.W. Lee

Keyword(s):

Bone Graft ◽

Total Ankle Arthroplasty ◽

Periprosthetic Osteolysis ◽

Ankle Arthroplasty

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Efficacy of Negative Pressure Wound Therapy After Total Ankle Arthroplasty

Case Medical Research ◽

10.31525/ct1-nct03886818 ◽

2019 ◽

Author(s):

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Total Ankle Arthroplasty ◽

Wound Therapy ◽

Ankle Arthroplasty

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Does Intra-articular Injection of the Ankle With Corticosteroids Increase the Risk of Subsequent Periprosthetic Joint Infection (PJI) Following Total Ankle Arthroplasty (TAA)? If So, How Long After a Prior Intra-articular Injection Can TAA Be Safely Performed?

Foot & Ankle International ◽

10.1177/1071100719857082 ◽

2019 ◽

Vol 40 (1_suppl) ◽

pp. 3S-4S

Author(s):

Ilker Uçkay ◽

Christopher B. Hirose ◽

Mathieu Assal

Keyword(s):

Periprosthetic Joint Infection ◽

Corticosteroid Injection ◽

Joint Infection ◽

Invasive Procedure ◽

Total Ankle Arthroplasty ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

Strong Consensus ◽

Healthcare Associated ◽

The Ideal

Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

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