Short-term Results of Total Ankle Arthroplasty for End-stage Ankle Arthritis With Severe Varus Deformity

2013 ◽  
Vol 35 (3) ◽  
pp. 225-231 ◽  
Author(s):  
Ki-Sun Sung ◽  
Jungtae Ahn ◽  
Keun-Ho Lee ◽  
Tae-Hwan Chun
Keyword(s):  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Short Term ◽  
Ankle Arthroplasty ◽  
End Stage

scholarly journals Short-Term Effect of the INBONE II Total Ankle Arthroplasty in the Treatment of End-Stage Ankle Arthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0050
Author(s):  
Liang Xiaojun ◽  
Zhao Hong-Mou
Keyword(s):  
Term Effect ◽  
Total Ankle Arthroplasty ◽  
Lateral Malleolus ◽  
Medial Malleolus ◽  
Ankle Arthritis ◽  
Short Term ◽  
Ankle Arthroplasty ◽  
Short Term Effect ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: To study the short-term effect of the INBONE II total ankle arthroplasty in the treatment of end-stage ankle arthritis, and to analyze the main operation points and complications. Methods: A total of 10 patients who used INBONE II for total ankle replacement in my Center from March 2016 to June 2017 were retrospective analyzed, including 2 patients who have a subtalar joint fusion at the same time. The VAS pain score and the American Orthopaedic Foot & Ankle Society (AOFAS) scores were used to evaluate the clinical efficacy. Results: All the patients were followed up, the average follow-up time was (12.80+-4.11) months (5-15 months), The AOFAS of preoperation was significantly higher (44.00+-4.06) vs (82.50+-3.17) score than that of the final follow-up, and VAS score was lower (6.80+-0.63) vs (1.60+-0.70) than that of the final follow-up (all P<0.01). There were 1 medial malleolus fracture, 1 lateral malleolus fracture intraoperation, 1 with symptomatic lateral malleolus osteophytes and lateral instability, which needs debridement, no superficial or deep infection was found,no prosthesis subsidence or malalignment and other complications was found. Conclusion: The short-term effect of total ankle arthroplasty using INBONE II prostheses for ankle end-stage arthritis is satisfactory, and further analysis was needed for its long-term efficacy and prosthetic survival rate.

The Impact of Concomitant Ipsilateral Knee Pain on Functional Outcomes in Total Ankle Arthroplasty

2020 ◽  
pp. 193864002095089
Author(s):  
Michael J. Symes ◽  
Alastair Younger ◽  
Mario Escudero ◽  
Murray J. Penner ◽  
Kevin Wing ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Knee Pain ◽  
Functional Outcomes ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Pain Group ◽  
Ankle Arthroplasty ◽  
End Stage ◽  
The Impact ◽  
Disease Specific

In end-stage ankle arthritis, little is known about the impact of concomitant knee pathology, including the impact of ipsilateral knee pain on total ankle arthroplasty (TAA) outcomes. The aim of this study was to determine the prevalence of ipsilateral preoperative knee pain in patients undergoing TAA and analyze its impact on patient-reported functional outcome measures (PROMs). A retrospective review was performed on the Vancouver End Stage Ankle Arthritis Database at a single institution. In total, 114 patients were studied, with patient demographics collected preoperatively, including the presence or absence of knee pain. Postoperative follow-up was performed at 5 years, primarily analyzing disease-specific PROMs, including the Ankle Osteoarthritis Score (AOS) and Ankle Arthritis Score (AAS). Multivariate mixed-effects linear regression models compared the scores between the groups. In total, 31 patients (27.2%) presented with concomitant ipsilateral knee pain. Despite more females in the knee pain group (64.5% vs 36.1%) there were no other significant differences at baseline between the knee pain and no knee pain groups in terms of demographics or baseline primary disease specific PROMs. At 5 years, the patients with knee pain had significantly worse AAS (37.9 ± 23.8 vs 21.2 ± 16.3, P = .004) and AOS total scores (38.1 ± 24.1 vs 21.9 ± 15.5, P = .005) compared with the no-knee pain group. Both groups improved significantly from baseline across all outcome measures; however, the magnitude of improvement was less in the knee pain group. Our study demonstrated that over one-quarter of patients with end-stage ankle arthritis undergoing TAA present with ipsilateral concomitant knee pain. If present, it is associated with worse functional outcomes at the 5-year mark. Further studies are needed to evaluate if knee pain influences complications, implant failure rates, and survival. Levels of Evidence: Level III

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.

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

scholarly journals A New Surgical Method for the End-Stage Ankle Arthritis–Total Ankle Arthroplasty with Artificial Talus

2016 ◽  
Vol 1 (1) ◽  
pp. 2473011416S0011
Author(s):  
Yasuhito Tanaka ◽  
Yoshinori Takakura ◽  
Akira Taniguchi ◽  
Hiroaki Kurokawa
Keyword(s):  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Surgical Method ◽  
End Stage

scholarly journals The painful total ankle replacement

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ettore Vulcano ◽  
Mark Myerson
Keyword(s):  
Systematic Approach ◽  
Considerable Increase ◽  
Treatment Algorithm ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Total Knee ◽  
End Stage ◽  
Hip Arthroplasties

Category: Ankle Arthritis Introduction/Purpose: The last decade has seen a considerable increase in the use of in total ankle arthroplasty (TAA) to treat patients with end-stage arthritis of the knee. However, the longevity of the implants is still far from that of total knee and hip arthroplasties Methods: To introduce a systematic approach to the painful TAA based on the literature and on the senior author’s experience Results: See algorithm attached Conclusion: This new diagnostic and treatment algorithm may be useful to guide less experienced surgeons navigate through the possible causes and treatments of a painful TAA

scholarly journals PROMS and Radiological Outcomes in Mobile Bearing Total Ankle Arthroplasty for Patients with Varus or Valgus Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0001
Author(s):  
Jack Allport ◽  
Adam Bennett ◽  
Jayasree Ramaskandhan ◽  
Malik Siddique
Keyword(s):  
Physical Health ◽  
Weight Bearing ◽  
Mobile Bearing ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ap Weight ◽  
Radiological Analysis

Category: Ankle Arthritis Introduction/Purpose: There is increasing evidence that outcomes for total ankle arthroplasty (TAA) are not adversely affected by pre-operative varus deformity. There is a sparsity of evidence relating to outcomes in valgus ankle arthritis. We present our outcomes using a mobile bearing prosthesis (Mobility TAA system, DePuy, Raynham, Massachusetts, USA) with a comparison of neutral, varus and valgus ankles. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual intervals. Patients undergoing primary TAA between March 2006 and June 2014 were included. Rrevision procedures along with those with inadequate radiographic images for deformity analysis were excluded. Patients with inadequate PROMS data were included in the radiological analysis but not the PROMS analysis. Data collected included FAOS (Womac Pain, Function and Stiffness), SF-36 scores and patient satisfaction. Radiological data was gathered from routinely taken AP weight bearing radiographs pre-operatively, immediately post-operatively and at final follow up. Pre-operative deformity was measured between the tibial anatomical axis and a line perpendicular to the talus. Patients were classified as neutral, varus (≥10 degrees varus) or valgus (≥10 degrees valgus). Results: 230 cases (see image) underwent radiological classification (152 neutral, 60 varus, 18 valgus) and were included in the radiological analysis (mean follow-up 55.9 months). 164 cases were included in the PROMS analysis (mean follow-up 61.6 months). The groups were similar with regards to BMI and length of follow-up but neutral ankles were younger (P<0.001). Baseline scores were equal except physical health with valgus ankles scoring lowest (P=0.045). Valgus ankles had statistically better post-operative pain (P=0.0247) and function (P=0.012) than neutral ankles. Pre to post-operative change did not reach statistical significance except physical health where valgus outperformed neutral and varus (p=0.039). Mean post-operative angle was 3.1 and final angle 3.7 with no significant differences. There was no significant differences in revision rates. Conclusion: Our study confirms previous evidence that varus deformity does not affect outcome in TAA. Contrary to this, valgus ankles in our cohort performed better post-operatively than neutral ankles. Post-operative coronal radiological alignment was not affected by pre-operative deformity and was maintained over a number of years. Coronal plane deformity does not negatively impact either radiological or clinical outcomes in TAA should not be considered an absolute contra-indication.

scholarly journals Total Ankle Arthroplasty: Is Ankle Plantarflexion Strength Important?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0002
Author(s):  
Frank E. DiLiberto ◽  
Steven L. Haddad ◽  
Daniel H. Aslan ◽  
Anand M. Vora
Keyword(s):  
Soft Tissue ◽  
Gait Speed ◽  
Total Ankle Arthroplasty ◽  
Joint Torque ◽  
Patient Specific ◽  
Control Group ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ankle Strength ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: Ankle push off power, which requires gastroc-soleus muscle strength, is a critical aspect of healthy gait and increases as gait speed increases. It is therefore surprising that one-to-two-year outcomes following total ankle arthroplasty (TAA) include improved gait speed but deficient ankle power. One possible explanation for low ankle power following TAA is ankle plantarflexion weakness. Information on plantarflexion strength is extremely limited in people before or after TAA. Evaluating plantarflexion strength may inform postoperative expectations and guide rehabilitation programs. The purpose of this study was to evaluate the change in ankle plantarflexion strength, ankle power during gait, and gait speed before and after TAA in people with end-stage ankle arthritis, and in comparison to a healthy matched control group. Methods: Twenty-five participants were included in this prospective case-control study. TAA group participants (n = 13) [mean (SD): Age 60.9 (15.3) years; BMI 30.53 (5.5) Kg/m2; 85% male] with end-stage ankle arthritis who received a TAA were evaluated preoperatively and six months postoperatively. Performance of adjunct soft tissue procedures were patient specific (5/13 participants received tendo-achilles lengthening). All patients received formal physical therapy. Healthy control participants (n=12) were matched to the TAA group on age, gender and BMI. Ankle peak isokinetic plantarflexion strength (torque at 60 and 120 degrees/second; Nm/kg) was measured with an instrumented dynamometer. Peak ankle power (joint torque x segmental velocity; W/kg) was calculated via three-dimensional multi-segment foot motion analysis while participants walked barefoot over a force plate at controlled speeds. Gait speed (m/s) was measured with the Six-Minute Walk Test. Appropriate nonparametric comparisons were made to evaluate differences across time, between limbs, and between groups. Results: Compared to preoperative values, involved limb ankle strength was preserved at 60 and 120 degrees/second following TAA (both p > 0.59). Postoperative involved limb ankle strength at both speeds were 37-56% lower than the non-involved limb and control group (all p < 0.05) (Figure 1). Similarly, involved limb ankle power was preserved following TAA (p = 0.43), but remained at least 38% lower than the non-involved limb or control group (both p < .01). A subset analysis revealed that TAA participants with tendo-achilles lengthening had 25-33% less involved limb postoperative ankle power and strength than TAA participants without tendo-achilles lengthening. Interestingly, gait speed increased following TAA (p = 0.01) and was similar to control group speeds [TAA 1.5 vs. Control 1.6 m/s; p = 0.59]. Conclusion: Robust improvements in gait speed were observed following TAA. These values approached normative gait speed in spite of diminished ankle strength and power. Ankle plantarflexion weakness reduces the capacity to generate ankle power during gait, regardless of possible contributing factors (i.e. preexisting atrophy/weakness, tendo-achilles lengthening). Accordingly, improvements in gait speed were likely linked to proximal joint compensations (i.e. hip, knee). The long term consequences of plantarflexion weakness may negatively affect implant loading. Study findings provide new information and point to the importance of targeting strength during postoperative TAA rehabilitation, potentially adjusting strategies for patients receiving soft tissue lengthening procedures.

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