Low Rate of Peri-implant Osteolysis in Trabecular Metal Total Ankle Replacement on Short- to Midterm Follow-up

2021 ◽  
pp. 107110072110174
Author(s):  
Sami Kormi ◽  
Ia Kohonen ◽  
Helka Koivu ◽  
Hannu Tiusanen
Keyword(s):  
Surgical Technique ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Time Interval ◽  
Imaging Method ◽  
Trabecular Metal ◽  
Osteolytic Lesions ◽  
Ankle Replacement ◽  
Low Rate

Background: Peri-implant osteolysis is one of the major complications related to total ankle replacement. The aim of this study was to investigate the short- to midterm incidence of peri-implant osteolysis using computed tomography (CT) as imaging method for the Trabecular Metal Total Ankle (TMTA) implant representing a novel total ankle replacement (TAR) implant design regarding material and surgical technique. Methods: In total, 104 consecutive patients who had a primary TMTA replacement between March 2013 and October 2017 were included in the study. The radiographic evaluation included weightbearing anteroposterior and lateral views at baseline and after 3, 6, and every 12 months postoperatively. A helical CT was undertaken preoperatively and of the 80 patients available to follow up at least 12 months postoperatively, with average time interval between the TAR operation and the latest CT of 39 (range, 12-85) months. Results: Eight of 80 patients had altogether 11 osteolytic lesions around the components on CT images. Seven lesions were found in tibia, 3 in talus, and 1 in distal fibula. Four of the tibial lesions were situated in the medial malleolus and were not in contact with the prosthesis component. The sizes of the osteolytic lesions ranged between 7 and 20 mm, and the average volume of the lesions was 689 mm3. Conclusion: We conclude that the risk of peri-implant osteolysis with the TMTA implant is minimal in short to midterm. The anatomic configuration, unique material, and surgical technique may all contribute to the TMTA implant having a low rate of peri-implant osteolysis. Level of Evidence: Level IV, case series.

Secondary Subtalar Joint Osteoarthritis Following Total Ankle Replacement

2019 ◽  
Vol 40 (10) ◽  
pp. 1122-1128 ◽  
Author(s):  
Marc Sokolowski ◽  
Nicola Krähenbühl ◽  
Chen Wang ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Case Series ◽  
Fusion Rate ◽  
Total Ankle Replacement ◽  
Time Interval ◽  
Level Of Evidence ◽  
Joint Fusion ◽  
Ankle Replacement ◽  
Cystic Changes

Background:An advantage of total ankle replacement (TAR) compared to ankle fusion is that by maintaining motion, the occurrence of hypermobility of adjacent joints may be prevented. This could affect the development of symptomatic subtalar joint osteoarthritis (OA). The aim of the study was to determine the incidence of subtalar joint fusion and the progression of subtalar joint OA following TAR.Methods:Secondary subtalar joint fusion rate was determined from a cohort of 941 patients receiving primary TAR between 2000 and 2016. The indication for fusion, the time interval from primary TAR to fusion, and the union rate were evaluated. To assess the progression of subtalar joint OA, degenerative changes of the subtalar joint were classified in 671 patients using the Kellgren-Lawrence score (KLS) prior to TAR and at latest follow-up.Results:In 4% (37) of the patients, a secondary subtalar joint fusion was necessary. The indication for fusion was symptomatic OA in 51% (19), hindfoot instability in 27% (10), osteonecrosis of the talus in 19% (7), and cystic changes of the talus in 3% (1) of the patients. Time from primary TAR to subtalar joint fusion due to progressive OA was 5.0 (range, 0.3-10) years and for other reasons 1.6 (range, 0.2-11.6) years ( P = .3). In 68% (456) of the patients, no progression of subtalar joint OA was observed.Conclusion:The incidence of secondary subtalar joint fusion was low. The most common reason for subtalar joint fusion following TAR was symptomatic OA.Level of Evidence:Level IV, case series.

Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

2021 ◽  
pp. 193864002098092
Author(s):  
Devon W. Consul ◽  
Anson Chu ◽  
Travis M. Langan ◽  
Christopher F. Hyer ◽  
Gregory Berlet
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Implant Survival ◽  
Ankle Arthritis ◽  
Single Institution ◽  
Retrospective Case ◽  
Ankle Replacement ◽  
End Stage

Total ankle replacement has become a viable alternative to ankle arthrodesis in the surgical management of advanced ankle arthritis. Total ankle replacement has generally been reserved for patients who are older and for those who will have a lower demand on the replacement. The purpose of the current study is to review patient outcomes, complications, and implant survival in patients younger than 55 years who underwent total ankle replacement at a single institution. A single-center chart and radiographic review was performed of consecutive patients who underwent total ankle replacement for treatment of end-stage ankle arthritis. All surgeries were performed by 1 of 5 fellowship-trained foot and ankle surgeons at a single institution. A total of 51 patients met inclusion criteria with a mean follow-up of 31.2 months (SD = 16.2). Implant survival was 94%, There were 7 major complications (13%) requiring an unplanned return to the operating room and 8 minor complications (15%) that resolved with conservative care. The results of this study show that total ankle replacement is a viable treatment option for patients younger than 55 years. Levels of Evidence: A retrospective case series

scholarly journals Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Using Transfibular Approach

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001 ◽  
Author(s):  
Alexej Barg ◽  
Charles Saltzman
Keyword(s):  
Range Of Motion ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Trabecular Metal ◽  
Non Union ◽  
Early Loosening ◽  
Early Results ◽  
Ankle Replacement ◽  
Patient Reported

Category: Ankle, Ankle Arthritis Introduction/Purpose: In the last two decades, total ankle replacement (TAR) has gained more acceptance as a treatment option in patients with end-stage ankle osteoarthritis. However, there is a lack of literature on TAR using a lateral transfibular approach. Therefore, we sought to report early clinical and radiographic results of a patient cohort treated with TAR using a lateral transfibular approach by a single surgeon. Methods: Fifty-five primary total ankle arthroplasties using the Zimmer trabecular metal implant were performed in 54 patients (29 men and 25 women; mean age, 67.0 years) from October 2012 to December 2014. Clinical assessment including pain evaluation and measurement of ankle range of motion was done preoperatively and at the latest follow-up. Weight-bearing radiographs were used to determine the angular alignment of the tibial and talar components and to analyze the bone-implant interface. Intraoperative and postoperative complications, revision surgeries, and failures were evaluated. Results: Implant survival was 93% at 36 months follow-up. There were 3 revisions of a tibial component due to aseptic loosening. In 10 of 55 procedures, a secondary procedure was performed during follow-up. Mean follow-up duration was 26.6 ± 4.2 months. No delayed union or non-union was observed for fibula healing. The average VAS pain score decreased significantly from 7.9 ± 1.3 to 0.8 ± 1.2. The average total range of motion increased significantly from 22.9° ± 11.8° to 40.2° ± 11.8°. Conclusion: Early results of Zimmer trabecular metal total ankle replacement demonstrated improved patient-reported outcomes and increased ankle motion at a minimum follow-up of one year. In the first 55 consecutive cases, the fibular osteotomy required for access to the ankle healed without complications. Painful early loosening requiring revision due to lack of bony ingrowth was seen in 3 of 55 cases.

scholarly journals Transfibular Total Ankle Replacement Outcome at 2 Years Follow Up

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Camilla Maccario ◽  
Cristian Indino ◽  
Luigi Manzi ◽  
Federico Giuseppe Usuelli ◽  
Claudia Di Silvestri
Keyword(s):  
Normal Values ◽  
Short Form ◽  
Articular Surface ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Trabecular Metal ◽  
Ankle Arthritis ◽  
Ankle Osteoarthritis ◽  
Ankle Replacement

Category: Ankle, Ankle Arthritis Introduction/Purpose: Primary ankle osteoarthritis is very uncomon, in fact 70-78% of the case ankle arthritis has a post- traumatic cause. Ankle arthrodesis (AA), has been considered a reliable procedure for resolution of ankle osteoarthritis. Recent modifications in Total ankle replacement (TAR) designs have challenged the perception that AA is the treatment of choice for end-stage ankle arthritis. Trabecular Metal Total Ankle system is a fixed-bearing prosthesis. The new design is flanked by use of new materials. The tibial articular surface is constructed of highly crosslinked UHMWPE and Trabecular Metal lining the talar and the tibial base component. The purpose of this retrospective study was to show the preliminary result in 31 patients underwent to ankle replacement using Zimmer Trabecular Metal Total Ankle system. Methods: We retrospectively assessed prospectively collected data on the initial cohort of 31 patients undergoing TAR with this implant. Clinical evaluation was determined pre and postoperatively for a minimum of 24 months after surgery. Pain was rated using the visual analogue scale (VAS). Functional results were assessed as well as ankle range of motion (ROM). Clinical outcomes used where the Short Form SF-12 Quality of Life score, the American Foot and Ankle Society (AOFAS). The imaging follow-up included ankle radiographs done at 6, 12 and 24 months. Radiological parameters were angles??(normal values 90 +- 2),?? (normal value 85 +- 2),??? normal values 20 +- 2) and TTratio? normal values: 27% to 42%). Results: The study included 31 ankles of TM Ankle Replacement in 31 consecutive patients over a period of 2 years (2013–2015). Out of 31 patients, 13 were females and 18 were males (average age 49.4 years, range, 30–75 years). All procedures were performed by a single surgeon. The ROM plantarflexion and dorsiflexion improved significantly (p <0.001) at the last follow up. The mean VAS pain score decreased significantly from 7.42 points (range 4 – 10 points) preoperatively to 1.42 points (range, 0 - 3 points) at the time of the latest follow-up (p <0.001). AOFAS and SF-12 scores both improved from postoperatively to the last follow up. (Table 1). We noted stable implants based on our radiographic parameters, with no corrections loosening. (Table 2) Conclusion: Our study evaluated the new fixed bearing Zimmer TM total ankle replacement approved by the US FDA in 2012 and is the first studies to evaluate the clinical and radiographic outcomes of this prosthesis. Of 31 ankles treated with a new transfibular arthroplasty system, only two asymptomatic fibular delayed union were registered. No implant failure was noted at 24 months postoperatively. Four ankles underwent secondary surgery for symptomatic fibular hardware with good outcome. The findings suggest that this total ankle system is safe and effective at short-term follow-up.

scholarly journals Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty

2018 ◽  
Vol 40 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Federico G. Usuelli ◽  
Camilla Maccario ◽  
Francesco Granata ◽  
Cristian Indino ◽  
Venus Vakhshori ◽  
...  
Keyword(s):  
Short Form ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Plate Removal ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Patient Reported

Background: Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proven to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with follow-up of at least 2 years. Methods: This prospective study included 89 patients who underwent transfibular total ankle arthroplasty from May 2013 to February 2016. The mean age was 53.2 ± 13.5 years. All patients were followed for at least 24 months postoperatively with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiographically preoperatively and at 6, 12, and 24 months postoperatively. Results: At 24 months postoperatively, patients demonstrated statistically significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score from 33.8 ± 14.3 to 88.5 ± 6.6 ( P < .001), visual analog scale (VAS) from 80.5 ± 17.0 to 14.1 ± 9.2 ( P < .001), and Short Form-12 Physical and Mental Composite Scores from 29.9 ± 6.7 and 43.3 ± 8.6 to 47.0 ± 7.6 and 53.3 ± 8.1, respectively ( P < .001). In addition, ankle dorsiflexion and plantarflexion improved from 6.2 ± 5.5 and 9.6 ± 5.8 degrees to 24.2 ± 7.9 and 18.1 ± 7.6 degrees, respectively ( P < .001). Radiographically, patients demonstrated maintained neutral alignment of the ankle at 24 months. No patient demonstrated any radiographic evidence of tibial or talar lucency at final follow-up. Seven patients underwent reoperation for removal of symptomatic hardware (6 fibular plates, 1 syndesmotic screw); 2 patients experienced delayed wound healing. The first one was treated with plate removal and flap coverage. The second one required fibular plate removal. One patient developed a postoperative prosthetic infection requiring operative debridement, removal of implants, and placement of an antibiotic spacer. Conclusion: This study found that transfibular total ankle replacement was a safe and effective option for patients with ankle arthritis resulting in improvements in patient-reported outcomes, range of motion, and radiographic parameters. However, further studies are required to determine the mid- and long-term performance of these implants. Level of Evidence: Level IV, case series.

scholarly journals Total Joint Replacement of Ankle, Knee, and Hip: How Do Patients Perceive Their Operative Outcomes at 10 Years?

2021 ◽  
Vol 6 (3) ◽  
pp. 247301142110227
Author(s):  
Jayasree Ramaskandhan ◽  
Karen Smith ◽  
Simon Kometa ◽  
Nachiappan Chockalingam ◽  
Malik Siddique
Keyword(s):  
Patient Satisfaction ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Short Form ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Ankle Replacement ◽  
Sf 36 ◽  
Patient Reported

Background: Patient-reported outcomes (PROMs) are an integral part of national joint registers in measuring outcomes of operative procedures and improving quality of care. There is lack of literature comparing outcomes of total ankle replacement (TAR) to total knee replacement (TKR) and total hip replacement (THR). The aim of this study was to compare PROMs between TAR, TKR, and THR patient groups at 1, 5, and 10 years. Methods: Prospective PROMs from patients who underwent a TAR, TKR, or THR procedure between 2003 and 2010 were studied. Patients were divided into 3 groups based on their index joint replacement (hip, knee, or ankle). Patient demographics (age, gender, body mass index), patient-reported outcome scores (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 36-Item Short Form Health Survey [SF-36]) and patient satisfaction scores (4-point Likert scale) at follow-up were compared between the 3 groups. Results: Data was available on 1797 THR, 2475 TKR, and 146 TAR patients. TAR patients were younger and reported fewer number of comorbidities. All 3 groups improved significantly from preoperative to 10 years for WOMAC scores ( P < .001). For SF-36 scores at 10 years, the THR group (32.2% follow-up) scored the highest for 3 domains ( P = .031) when compared to the TKR group (29.1% follow-up). All 3 groups had similar outcomes for 5 of 8 domains; P < .05). For patient satisfaction, the THR group reported overall 95.1% satisfaction followed by 89.8% for the TKR group and 83.9% in the TAR group (42.4% follow-up). Conclusion: In this cohort with diminishing numbers over the decade of time the patients were followed up we found that patients are equally happy with functional and general health outcomes from total ankle replacement vs other major lower extremity joint replacement. TAR surgery should be considered as a viable treatment option in this patient group. Level of Evidence: Level III, retrospective case series.

scholarly journals The Talar Body Prosthesis Treated End Stage Ankle Arthrosis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Thos Harnroongroj
Keyword(s):  
Surgical Technique ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Walking Ability ◽  
Prosthesis Failure ◽  
Talocrural Joint ◽  
Ankle Replacement ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrosis creates patient disability. Ankle arthrodesis is treatment of choice which creates ankle stiffness and arthrosis of neighboring joints. Total ankle replacement can preserve ankle motions but the results at mid and long- term follow up needed further evaluation. Talar body prosthesis (TBP) can provide long-term satisfactory foot-ankle function of the ankle sustaining talar body damages. Due to ankle biomechanics is different to hip and knee joints. So, we inserted TBP for treating end stage ankle arthrosis. The present study evaluated outcomes at 5-10 years of follow up and described surgical technique. Methods: Between 2001 and 2011, the TBPs were inserted in 23 ankle arthrosis patients. The data were reviewed. We included grade 3 Bargon and Henkemeyer radiographic grading of ankle arthrosis and deformed talar body. The patient with neurological, hip, knee, mid-foot problems which impeded walking ability and age more than 70 were excluded. The patient consisted of 13 females and 10 males. Mean age at index operation and the latest follow up were 54.70 (39-70) and 61.17 (47-75) years old. Mean BMI at the latest follow up was 25.56 kg/m2 (21.89-29.76). Surgical technique included TBP insertion with addressing and applying tensor fascia lata at the articular end of distal tibia. Pre- and the latest follow up AOFAS (American Orthopaedic Foot and Ankle Society) ankle-hindfoot score and radiographs were reviewed. Neighboring joint arthrosis was evaluated by Kellgren-Lawrence radiographic system. The data was statistically analyzed. Results: Mean follow up duration was 6.48 years (5-10 years). All 23 TBPs maintained congruent talocrural joint. There was no prosthesis failure in term of subsidence into calcaneus and prosthetic stem perforation into talar head at the last follow up. No neighboring joint arthrosis occurred according to the radiographs. The mean range of motion of last follow up was 22.17° of plantar flexion (median 22°, ranged from 15° to 29°) and 0° to 5° of dorsiflexion. The patients could perform activity daily life. Mean AOFAS ankle-hindfoot score at preoperative period and last follow up were 40 points (Median 36, Ranged from 31 to 58) and 74 points (median 75, ranged from 61 to 83), respectively. The statistical analysis showed significant improvement of the score (p<0.001). Conclusion: TBP can provide satisfactory result of ankle-hindfoot functions at 5-10 years follow up. Advantages of the prosthesis over ankle arthrodesis and total ankle replacement included preservation of the ankle motion without neighboring joint arthrosis and no prosthesis failure.

scholarly journals Bone Impaction Grafting with Trabecular Metal Augments in Large Defects in Young Patients: Unravelling A New Perspective in Surgical Technique

2020 ◽  
Author(s):  
Basilio De la Torre-Escurero ◽  
Eva Gómez-González ◽  
Slavador Álvarez-Villar ◽  
Julia Bujan ◽  
Miguel A Ortega
Keyword(s):  
Surgical Technique ◽  
Young Patients ◽  
Case Series ◽  
Abduction Angle ◽  
Acetabular Reconstruction ◽  
Impaction Grafting ◽  
Trabecular Metal ◽  
Bone Impaction Grafting ◽  
Acetabular Defects

Abstract Background: Acetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results. Methods: This was a retrospective study of a case series of five patients with a young age (≤50 years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79 months. We describe the surgical technique in detail.Results: Improvement was significant on the WOMAC and SF-36 scales (p < 0.05). The radiographs taken at the last follow-up examination showed no migration of the polyethylene cup (p = 0.31) or differences in the abduction angle (p = 0.27) compared to the radiographs from the immediate postoperative period. One patient presented two dislocation episodes as a complication.Conclusion: The combination of trabecular metal augments with the bone impaction grafting technique in young patients with large acetabular defects provides satisfactory results in the long term and restores the bone stock.

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