Surgical Treatment of Bony and Soft-Tissue Impingement in Total Ankle Arthroplasty

2016 ◽  
Vol 10 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Christopher E. Gross ◽  
Samuel B. Adams ◽  
Mark Easley ◽  
James A. Nunley ◽  
James K. DeOrio
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Treatment Options ◽  
Arthroscopic Surgery ◽  
Total Ankle Arthroplasty ◽  
Consecutive Series ◽  
Ankle Arthroplasty ◽  
Open Treatment ◽  
Secondary Procedures

Background. Impingement may be an underreported problem following modern total ankle replacements (TARs). The etiology of impingement is unclear and likely multifactorial. Because of the lack of conservative treatment options for symptomatic impingement after TAR, surgery is often necessary. Methods. We retrospectively identified a consecutive series of 1001 primary TARs performed between January 1998 and December 2014. We identified patients who required a secondary surgery to treat soft-tissue and bony impingement by either an open or arthroscopic procedure. Functional and clinical outcomes, including secondary procedures, infections, complications, and failure rates, were recorded. Results. In all, 75 patients (7.5%) required either open (n = 49) or arthroscopic debridement for impingement after TAR; 44 patients had >12 months of follow-up, with a follow-up of 26.5 months after their debridement procedure. The mean time to the debridement procedure for all prostheses was 29.3 months, with an average of 38.7 months in STAR, 21.8 months in INBONE, and 10.5 months in Salto Talaris patients. Of the patients with more than 1 year’s follow-up from their debridement, 84.1% were asymptomatic; 9 patients (20.4%) had repeat operations after their debridement procedure. Of these, 5 patients required a repeat debridement of their medial or lateral gutters for a failure rate of 11.4%. Conclusion. Both arthroscopic and open treatment of impingement after total ankle arthroplasty are safe and effective in improving function and pain. Although the rates for revision impingement surgery are higher in arthroscopic compared with open procedures, they are not significantly so. Therefore, we recommend arthroscopic surgery whenever possible because of earlier time to weight bearing and mobility. Levels of Evidence: Level IV

scholarly journals Total Ankle Arthroplasty for Rheumatoid Arthritis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0024
Author(s):  
Makoto Hirao ◽  
Jun Hashimoto ◽  
Hideki Tsuboi ◽  
Takaaki Noguchi
Keyword(s):  
Rheumatoid Arthritis ◽  
Treatment Group ◽  
Soft Tissue ◽  
Bone Strength ◽  
Total Ankle Arthroplasty ◽  
Soft Tissue Balance ◽  
Biologic Treatment ◽  
Ankle Arthroplasty ◽  
Loading Axis

Category: Ankle Introduction/Purpose: Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (1. augmentation of bone strength, 2. control of soft tissue balance, 3. adjustment of the loading axis) for rheumatoid arthritis (RA) cases were evaluated after mid to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated. Methods: We performed a retrospective observational study involving 50 ankles (44 patients) that underwent TAA for the treatment of rheumatoid arthritis. The mean duration of follow-up was 7.1 years. Clinical outcomes were evaluated with use of the Japanese Society for Surgery of the Foot (JSSF) scale score and a postoperative self-administered foot-evaluation questionnaire (SAFE-Q). Radiographic findings were evaluated as well. These parameters also were compared between patients managed with and without biologic treatment. Results: This procedure significantly improved the clinical scores of the JSSF rheumatoid arthritis foot and ankle scale (p < 0.0001). Forty-eight of the 50 ankles had no revision TAA surgery. Subsidence of the talar component was seen in 8 ankles (6 in the biologic treatment group and 2 in the non-biologic treatment group); 2 of these ankles (both in the biologic treatment group) underwent revision TAA. The social functioning score of the SAFE-Q scale at the time of the latest follow-up was significantly higher in the biologic treatment group (p = 0.0079). The dosage of prednisolone (p = 0.0003), rate of usage of prednisolone (p = 0.0001), and disease-activity score (p < 0.01) at the latest follow-up were all significantly lower in the biologic treatment group. Conclusion: TAA is recommended for RA cases, if disease control, augmentation of bone strength, control of soft tissue balance, and adjustment of loading axis are taken into account. The prevention of talar component subsidence remains a challenge in patients with the combination of subtalar fusion, rheumatoid arthritis, and higher social activity levels.

scholarly journals Nottingham Experience with The Fixed Bearing Infinity Total Ankle Replacement

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0042
Author(s):  
Hatem Salem-Saqer ◽  
Martin Raglan ◽  
Sunil Dhar
Keyword(s):  
Complication Rate ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Implant Design ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
End Stage

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is increasingly used for treatment of end stage arthritis of the ankle; improvements continue to evolve in implant design and instrumentation. We present our experience of the Infinity Total Ankle Arthroplasty (Wright Medical), a fixed bearing 4th generation implant with improved instrumentation Methods: This is a retrospective review of prospectively collected data. From October 2016 to July 2019, we identified 92 (52M/40F) who had the infinity Total Ankle Replacement. This review is of 70 patients with a minimum of 1 year follow up (33M,37F). The mean age was 67.5 years (33-87); 32 right side and 38 left no bilaterals. The indication for surgery was end stage Osteoarthritis in 52, post traumatic arthritis 12, inflammatory arthritis 4, conversion of fusion to TAR 2. The preoperative deformity was graded according to the COFAS classification. All patients had follow up at 6 weeks, 3,6 and 12 months and then annually, with MOXFQ questionnaire and weight bearing radiographs. Results: TAA was performed with the use of fluoroscopy. 77% (54/70) had concomitant procedures as listed in Table.5% (4/70) had complications consisting of, 1 DVT, 1 intra operative medial malleolus fracture, 1 EHL tendon laceration and 1 wound break down. There were no deep or superficial infections. Improvement in clinical outcome and PROMS data was noted on follow up. The MOXFQ for Pain improved from 72 pre-op to 25 at 1year (p<0.001). The outcome for Walking improved from 83 pre-op to 30 at one year (p<0.001). Radiological alignment was maintained asymptomatic posterior heterotopic ossification was noted in 23(16%) patients, lucent lines under the tibial implant were noted in 4 ankles and 1 fibula erosion. 2 TAA (3%) needed to be revised due to malpositioning. Conclusion: Our results show significant improvement in patient outcomes, a short recovery time and marked improvement in mobility post operatively with a very low complication rate, we had no deep infection to date. Two implants were revised which we attribute to the learning curve at the start of practice. This implant is fluoroscopically navigated allowing precise implantation with dedicated instrumentation and we feel this attributed to the low complication rate and good results in our short-term study [Table: see text]

Ankle Arthrodesis With Structural Grafts Can Work for the Salvage of Failed Total Ankle Arthroplasty

2019 ◽  
Vol 13 (2) ◽  
pp. 132-137 ◽  
Author(s):  
Adam L. Halverson ◽  
David A. Goss ◽  
Gregory C. Berlet
Keyword(s):  
Femoral Head ◽  
Treatment Options ◽  
Comparative Trial ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
Functional Limb ◽  
American Orthopaedic

Background. Treatment options after failed total ankle arthroplasty (TAA) are limited. This study reports midterm outcomes and radiographic results in a single-surgeon group of patients who have undergone ankle arthrodesis with intramedullary nail fixation and structural allograft augmentation following failed TAA. Methods. A retrospective review on patients who underwent failed TAA revision with structural femoral head allograft and intramedullary tibiotalocalcaneal (TTC) nail fixation was completed. Foot Function Index (FFI), American Orthopaedic Foot & Ankle Society (AOFAS) outcome scores, and radiographs were obtained at each visit with 5-year follow-up. Results. Five patients were followed to an average of 5.2 years (range 4.7-5.6). Enrollment FFI was 34.82 (range 8.82-75.88); at midterm follow-up it was 20.42 (range 0-35.38). Enrollment AOFAS scores averaged 66.6 (range 61-77); at midterm follow-up it was 70.33 (range 54-88). Radiographs showed union in 4 of 5 patients at enrollment and 2 of 3 patients at midterm. Conclusions. Utilization of TTC fusion with femoral head allograft is a salvage technique that can produce a functional limb salvage. Our results show continued improvement in patient-reported outcomes, with preservation of limb length and reasonable union rate. Levels of Evidence: Therapeutic, Level II: Prospective, comparative trial.

Effect of age on outcome and revision in total ankle arthroplasty

2020 ◽  
Vol 102-B (7) ◽  
pp. 925-932 ◽  
Author(s):  
Mario Gaugler ◽  
Nicola Krähenbühl ◽  
Alexej Barg ◽  
Roxa Ruiz ◽  
Tamara Horn-Lang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Clinical Outcome ◽  
Revision Surgery ◽  
Preoperative Assessment ◽  
Total Ankle Arthroplasty ◽  
Consecutive Series ◽  
Ankle Arthroplasty ◽  
Major Revision ◽  
Effect Of Age

Aims To assess the effect of age on clinical outcome and revision rates in patients who underwent total ankle arthroplasty (TAA) for end-stage ankle osteoarthritis (OA). Methods A consecutive series of 811 ankles (789 patients) that underwent TAA between May 2003 and December 2013 were enrolled. The influence of age on clinical outcome, including the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and pain according to the visual analogue scale (VAS) was assessed. In addition, the risk for revision surgery that includes soft tissue procedures, periarticular arthrodeses/osteotomies, ankle joint debridement, and/or inlay exchange (defined as minor revision), as well as the risk for revision surgery necessitating the exchange of any of the metallic components or removal of implant followed by ankle/hindfoot fusion (defined as major revision) was calculated. Results A significant improvement in the AOFAS hindfoot score and pain relief between the preoperative assessment and the last follow-up was evident. Age had a positive effect on pain relief. The risk for a minor or major revision was 28.7 % at the mean follow-up of 5.4 years and 11.0 % at a mean follow-up of 6.9 years respectively. The hazard of revision was not affected by age. Conclusion The clinical outcome, as well as the probability for revision surgery following TAA, is comparable between younger and older patients. The overall revision rate of the Hintegra total ankle is comparable with other three component designs. TAA should no longer be reserved for low demand elderly patients, but should also be recognized as a viable option for active patients of younger age. Cite this article: Bone Joint J 2020;102-B(7):925–932.

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 Mid-Term (4-10 year) Outcomes of INBONE I Total Ankle Arthroplasty with Deformity Analysis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Andrew Harston ◽  
James Nunley ◽  
Mark Easley ◽  
James DeOrio ◽  
Samuel Adams ◽  
...  
Keyword(s):  
Short Form ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Consecutive Series ◽  
Ankle Arthroplasty ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported ◽  
Plane Deformity

Category: Ankle, Ankle Arthritis Introduction/Purpose: Concerns for limited coronal plane stability prompted the manufacturer and designers of the INBONE total ankle arthroplasty system to replace the original saddle-shaped talar component (INBONE I) with a sulcus-shaped talar component (INBONE II). Prior to the availability of the INBONE II talar component, numerous INBONE I total ankle replacements were performed. To our knowledge mid-term outcomes of INBONE I total ankle arthroplasty have not been reported. This study compares the mid-term outcomes of patients with and without preoperative coronal plane deformity who underwent total ankle replacement with the INBONE I prosthesis. In our opinion, the longer-term outcomes of the INBONE I prosthesis are important for patient and surgeon education. Methods: A consecutive series of patients, from May, 2007 to September, 2011, at a single institution who underwent total ankle arthroplasty with the INBONE I Total Ankle Arthroplasty (Wright Medical) were prospectively enrolled. Pain and patient- reported function were assessed preoperatively and at yearly follow-ups with use of a visual analog scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle- hindfoot score, the Short Musculoskeletal Function Assessment (SMFA), and the Short Form-36 (SF-36) Health Survey. We analyzed the data for complications, reoperations, and failures (defined as undergoing revision for exchange or removal of the metallic components for any reason). Patients were grouped according to coronal plane tibiotalar alignment (preoperative coronal plane malalignment of >10 degrees and <10 degrees deformity) and outcomes compared. Results: One-hundred fifty-five INBONE I prostheses were implanted in 151 patients, with minimum 4 year clinical and radiographic follow-up. Follow-up ranged from 48-113 months with an average of 67 months. There was significant (p<0.05) improvement in the VAS, AOFAS, SMFA, and SF-36 scores at most recent follow-up. Forty-five patients (29%) had 49 additional surgeries for impingement, loosening/subsidence, malalignment, ligament instability, polyethylene exchange, and/or infection. There were 14 implant failures with overall survivorship of 90.3%. There was no statistically significant difference in outcomes between patients with coronal plane deformity >10 degrees (47.7%) and <10 degrees (52.3%). Patients with >10 degrees had fewer reoperations (19 vs. 30) and fewer revisions (5 vs. 9) when compared to patients with <10 degrees deformity. Conclusion: Patients who underwent INBONE I total ankle arthroplasty demonstrated significant improvement in pain and patient-reported outcomes at a mean of 5.7 years post-operatively. The patients with preoperative coronal plane tibiotalar deformity had similar pain relief, function, and need for additional surgeries and revisions. Despite the presumed shortcomings of the INBONE I’s saddle-shaped talar design, this operation shows promising results, with or without deformity, at mid-term follow- up with survivorship of 90.3%.

scholarly journals Early Outcomes and Complications Following Initiation of a Total Ankle Arthroplasty Program

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142098578
Author(s):  
Gregory Lundeen ◽  
Kaitlin C. Neary ◽  
Cody Kaiser ◽  
Lyle Jackson
Keyword(s):  
Intraoperative Complications ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Radiographic Evaluation ◽  
Wound Complications ◽  
Consecutive Series ◽  
Complication Rates ◽  
Ankle Arthroplasty ◽  
Intermediate Outcomes

Background: Surgeons who lack experience with total ankle arthroplasty (TAA) may remain hesitant to introduce this procedure owing to previously published results of high complication rates during initial cases. The purpose of the present study was to report the development of a TAA program through intermediate outcomes and complications for an initial consecutive series of TAA patients of a single community-based foot and ankle fellowship–trained orthopedic surgeon with little TAA experience using a co-surgeon with similar training and TAA exposure. Methods: The initial 20 patients following third-generation TAA with a single surgeon were reviewed. Clinical outcomes were measured and radiographs were evaluated to determine postoperative implant and ankle position. Complications were also measured including intraoperative, early (<3 months), and intermediate postoperative complications. Results: With a minimum follow-up of 2 years and average follow-up of 51 months (range 24-70 months), the mean American Orthopaedic Ankle & Foot Society Ankle-Hindfoot score was 87.7 (59-100) and VAS was 1.0 (0-5.5). All patients were improved following TAA. Radiographic evaluation demonstrated no evidence of component malalignment or ankle joint incongruity. There were no intraoperative complications nor any wound complications. Three patients returned to the operating room for placement of medial malleolar screw placement, and 1 had asymptomatic tibial component subsidence. Conclusions: Orthopedic surgeons with a proper background and updated training may be able to perform TAA with good outcomes. A TAA program was developed to define minimum training criteria to perform this procedure in our community. Our complication rate is consistent with those reported in the literature for experienced TAA centers, which contrasts previous literature suggesting increased complication rates and worse outcomes when surgeons perform initial TAAs. Utilization of an orthopedic co-surgeon was felt to be instrumental in the success of the program. Level of Evidence: Level IV, retrospective case series.

scholarly journals Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary Referencing Implant

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0002 ◽  
Author(s):  
Steve Behrens ◽  
Thomas Bemenderfer ◽  
Oliver Schipper ◽  
Robert Anderson ◽  
W. Hodges Davis
Keyword(s):  
Revision Arthroplasty ◽  
Outcome Data ◽  
Total Ankle Arthroplasty ◽  
Consecutive Series ◽  
Implant Survival ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes ◽  
Early Results ◽  
Patient Reported

Category: Ankle Arthritis Introduction/Purpose: Treatment of the failed total ankle arthroplasty (TAA) is challenging, and historically arthrodesis was advocated as the salvage treatment of choice. Currently, there is limited available literature reporting on options and outcomes of revision arthroplasty despite the persistent relatively high failure rate ranging from 10-23% within the first ten years after primary TAA. Early published outcomes of intramedullary-referencing implants for primary TAA have shown improvement in clinical outcomes and radiographic parameters, sustained correction of coronal deformity, and excellent survivorship with few associated complications. The purpose of this study is to report the clinical and radiographic outcomes of revision TAA using an intramedullary-referencing implant. Methods: We reviewed a consecutive series of 24 cases (14 female and 10 male; median age, 57.9 (28.2-74.6) years; median BMI, 31 (19.4-40.2)) between 2008 to 2015 in which a failed TAA underwent revision using InBone, an intramedullary-referencing, fixed-bearing, two-component total ankle system. Demographic, radiographic, and functional outcome data were collected preoperatively, immediately postoperatively, and at the most recent follow up. The primary outcome was implant survival defined by no reoperation for subsidence/loosening or revision of the implant. Secondary outcomes included radiographic (coronal and sagittal component alignment, osteolysis, and subsidence) and functional (American Orthopaedic Foot & Ankle Society [AOFAS] score and foot function index [FFI]) outcome data. Results: Twenty-four patients underwent revision TAA with intramedullary-referencing with 87.5% implant survival at average follow up of 30.4 months. Revision was performed most commonly for aseptic talar subsidence (45.8%) or implant loosening (tibia, 12.5%; talus, 16.7%). Following revision, three (12.5%) patients required reoperation for talar subsidence or loosening at average 37.7 months. Progression of osteolysis of the tibia, talus, and fibula was observed in 14 (58%), 4 (17%), and 6 (25%) of patients, respectively, although osteolysis was present preoperatively in 17 (70.1%), 9 (37.5%), and 10 (41.7%), respectively. Subsidence of the tibial and talar components was observed in 8 (33%) and 9 (38%) patients, respectively. Clinically, the average AOFAS and FFI score were 72 (57-100) and 27.1 (11.8-82.9), respectively. Conclusion: Early results of intramedullary-referencing revision TAA demonstrated improved patient-reported outcomes and maintenance of radiographic outcomes at an average follow-up of 30 months. Additionally, early results of revision arthroplasty after failed TAA were similar to those after primary arthroplasty. Aseptic talar subsidence or loosening were the main postoperative complications which required reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant is a viable option for the failed TAA.

scholarly journals Outcomes of Revision Ankle Arthroplasty using a Fixed-bearing, Stemmed Intramedullary Prosthesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003 ◽  
Author(s):  
Oliver Schipper ◽  
Steven Haddad ◽  
Alexander Van den Avont
Keyword(s):  
Revision Surgery ◽  
Plantar Flexion ◽  
Treatment Options ◽  
Total Ankle Arthroplasty ◽  
Medial Malleolus ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
Additional Surgery ◽  
The Mean

Category: Ankle, Ankle Arthritis Introduction/Purpose: As in all total joint arthroplasty, longevity is finite, and the need for predictable revision surgery is mandatory. Literature is sparse describing revision total ankle arthroplasty (TAA) feasibility and outcomes. Revision total ankle arthroplasty involving implant exchange remains in its infancy, making critical assessment of outcomes necessary to guide future treatment options. The purpose of this study was to analyze the clinical outcomes of revision TAA using a minimum 2-year follow-up to evaluate for early failure and outcomes. Methods: Retrospective chart review identified 18 patients that underwent revision of their TAA to a third generation FDA approved fixed-bearing, intramedullary stemmed implant with a minimum 2 year follow up. Once identified, all patients were contacted for an in-office outcomes questionnaire, examination, and radiographic follow up. Outcomes included the Foot & Ankle Disability Index (FADI) Score, Foot Function Index (FFI), Visual Analog Scale (VAS) used for pain, and ankle range of motion. Results: The mean age of patients at the time of revision was 59.6±9.7years and the mean follow up was 4.2±2.1 years. The mean FADI score was 69.9±17.9, the mean FFI was 49.1±15.2, and the mean VAS score was 33.3±25.8. Mean ankle dorsiflexion was 19.6±7.8 degrees and mean ankle plantar flexion was 18.6±7.5degrees. Postoperative complications included one infection requiring irrigation and debridement with hardware removal for a medial ankle soft tissue abscess, and one medial malleolus fracture that underwent open reduction and internal fixation. Three revision prostheses failed during the follow-up period, requiring additional surgery. Reasons for failure included talar subsidence in 2 patients secondary to osteolysis and/or avascular changes to the talus, and medial/lateral gutter impingement due to an oversized talar component in 1 patient. Conclusion: Revision of ankle arthroplasty requires significant planning in extraction of the failed prosthesis, implantation of the revision prosthesis, and alignment of the foot. Major complications are potentially avoidable through careful bone assessment prior to revision surgery, and results are acceptable in this early follow-up study using a fixed-bearing intramedullary stemmed implant system.

scholarly journals Restoration of Talar Height, Alignment, and Implant Survival after Revision Total Ankle Arthroplasty with Minimum 2-Year Follow-up

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0031
Author(s):  
Robert Kulwin ◽  
Steven L. Haddad
Keyword(s):  
Range Of Motion ◽  
Weight Bearing ◽  
Revision Arthroplasty ◽  
Total Ankle Arthroplasty ◽  
Published Data ◽  
Salvage Procedure ◽  
Tissue Quality ◽  
Long Term Outcome ◽  
Ankle Arthroplasty

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: With the introduction of improved implants and long-term outcome data, total ankle arthroplasty (TAA) is becoming an increasingly common surgical treatment for end-stage ankle osteoarthritis. However, the treatment of a failed primary TAA remains a significant challenge. Ankle arthrodesis as a salvage procedure results in high rates of non-union and collapse. Revision arthroplasty is an alternative to arthrodesis, but there is little published data on the outcomes of revision total ankle arthroplasty (RTAA). This study presents 2-year outcomes after RTAA using a modular prosthesis and metal/cement augmentation to reconstitute talar height, as well as restore sagittal and coronal alignment. Methods: A retrospective review was performed on 23 patients who underwent RTAA after failed primary TAA. Demographic data, talar height, coronal and sagittal alignment, and range of motion pre-revision and at most recent follow up were recorded. Failure was defined as need for revision surgery during the follow up period. Radiographic measurements were performed on weight bearing lateral and AP radiographs. For Agility implants, measurement on weight-bearing computed tomography (WBCT) was required. The measurement methodology was performed on both radiographs and WBCT for validation and measurements were consistent across all implants. Results: Patient follow-up ranged from 2 to 3.9 years, with a mean of 2.56 years. 17 of 22 RTAA did not require further revision. Of the five failures, one was due to deep infection, four to subsidence of the talar component. For the 17 successful revisions, average pre-operative coronal malalignment was 3.8◦ (range 7.4◦ varus to 15◦ valgus), and average post-operative malalignment improved to 2.6◦ (range 0◦ varus to 7.9◦ valgus), but this difference was not statistically significant (p=.09). Average pre-operative sagittal malalignment was 8.7◦ (range 20.7◦ plantarflexion to 20.1◦ dorsiflexion), and average post-operative malalignment improved to 3.6◦ (range 8.3◦ plantarflexion to 9.3◦ dorsiflexion), which was statistically significant (p=.01). Talar height improved by 3.9mm (p< 0.001), and range of motion from 16.9◦ to 25.0◦ (p,0.001). Conclusion: At a minimum of two years of follow up, revision arthroplasty shows improved alignment, talar height, and range of motion. While the failure rate remains significantly higher than primary ankle arthroplasty, it is comparable or superior to that of conversion to arthrodesis. The complexity of RTTA varies greatly due to surgical risk, soft tissue quality, and residual bone stock amongst other factors, which limits the generalizability of this patient cohort. RTAA is a viable option for the salvage of failed primary TAA, with functional and radiographic improvements shown at mid-term follow-up.

Sign in / Sign up

Export Citation Format

Share Document