The Use of Soft Tissue Expanders Prior to Total Ankle Arthroplasty

2017 ◽  
Vol 10 (5) ◽  
pp. 473-479
Author(s):  
Ameya V. Save ◽  
Daniel H. Wiznia ◽  
Mike Wang ◽  
Chang-Yeon Kim ◽  
John S. Reach
Keyword(s):  
Soft Tissue ◽  
Tissue Expander ◽  
Total Ankle Arthroplasty ◽  
Soft Tissue Coverage ◽  
Ankle Arthroplasty ◽  
Tissue Expanders ◽  
Tension Free ◽  
Levels Of Evidence ◽  
Evidence Level ◽  
Free Closure

Soft tissue coverage and tension-free closure can often be challenging in patients with ankle arthropathy being considered for total ankle arthroplasty. We present 2 patients with severe posttraumatic ankle arthropathy who underwent placement of a soft tissue expander to assist with soft tissue coverage prior to total ankle arthroplasty. Levels of Evidence: Level IV

scholarly journals Repair Exposure of the Postauricular Tissue Expander Using the Modified Brent Method: A 7-Year Experience

2021 ◽  
pp. 014556132110079
Author(s):  
Tongyu Cao ◽  
Qingguo Zhang
Keyword(s):  
Soft Tissue ◽  
Skin Flap ◽  
Tissue Expander ◽  
Tissue Expansion ◽  
Ear Reconstruction ◽  
Lower Pole ◽  
Tension Free ◽  
Subsequent Exposure ◽  
Free Closure ◽  
Complicated Conditions

Objectives: Ear reconstruction is a challenging surgery for the complicated conditions in patients with microtia. The tissue expansion techniques were necessary and relatively safe for patients with insufficient soft tissue. However, complications such as necrosis of expanded flap and exposure of tissue expander limited the popularization of this method. This study described the use of modified Brent method to handle the exposure of the postauricular tissue expander. Methods: From January 2013 to December 2019, 27 ear reconstruction patients with trauma or necrosis on an expanded skin flap and subsequent exposure of tissue expander were treated with modified Brent method, which consisted of 3 stages: removal of the expander, tension-free closure of wound, and framework fabrication; elevation of reconstructed ear; lobule rotation; and minor modification. Results: Fifty-six percent of exposures occurred in the lower pole of the tissue expander. Exposure usually occurred 54.5 days after implantation. The majority of reconstructed ears had a satisfactory appearance and showed relatively stable outcomes. Only one case of cartilage exposure required revision surgery and was repaired by the temporoparietal fascia. Conclusion: With reasonable distribution of expanded flap, prolonged interval, and sutures under tension-free conditions, complications like the occurrence of trauma or necrosis-induced exposure of tissue expander can be repaired efficiently by a staging modified Brent method.

Perioperative Complications of Total Ankle Arthroplasty

2003 ◽  
Vol 24 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Kenneth Mroczek
Keyword(s):  
Soft Tissue ◽  
Tibial Component ◽  
Peroneal Nerve ◽  
Perioperative Complications ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
Soft Tissue Coverage ◽  
Ankle Arthroplasty ◽  
Group A ◽  
Group B

A retrospective radiographic and chart review was performed for the initial 50 patients who underwent Agility (DePuy, Warsaw IN) total ankle arthroplasty by the senior author (M.S.M.). The review focused on the perioperative complications of nerve or tendon lacerations, intraoperative fractures, acute deep infections, wound complications and component positioning. Major wound complications were defined as those requiring a soft-tissue coverage procedure. Minor wound complications did not require soft tissue coverage and included wound breakdowns, wound edge necrosis, and superficial infections. The immediate mortise and lateral postoperative radiographs were reviewed to measure component positioning. The patients were divided into two groups to compare the initial 25 patients (Group A) with the subsequent 25 patients (Group B). There were no major wound complications in either group. Minor wound complications decreased from six in Group A to two in Group B. There were four lacerations (flexor hallucis longus, posterior tibial tendon, deep peroneal nerve, and superficial peroneal nerve), all occurring in Group A. Five patients sustained intraoperative fractures in Group A, as compared with two fractures in Group B. The number of components varying greater than 4° from neutral as measured by the lateral talar, lateral tibial and mortise tibial component angles decreased by 9% from Group A to Group B. The only tibial component to be placed in more than 4° of valgus occurred in Group A. It seems that a notable learning curve exists in the performance of total ankle arthroplasty as demonstrated by a comparison of the initial 25 patients with the subsequent 25 patients performed by one orthopaedic surgeon. This improvement most likely resulted from the use of enhanced techniques and further training with the prosthesis. This information can be used as a teaching tool to decrease the incidence of complications for surgeons performing their initial arthroplasties with this potentially technically demanding procedure.

scholarly journals Does Patient-specific Instrumentation Have a Higher Rate of Early Osteolysis than Standard Referencing Techniques in Total Ankle Arthroplasty?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0004 ◽  
Author(s):  
Mario Escudero ◽  
Kevin Wing ◽  
Thomas Bemenderfer ◽  
Michael Symes ◽  
Maximiliano Barahona ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Outcome Data ◽  
Total Ankle Arthroplasty ◽  
Treatment Modalities ◽  
Patient Specific ◽  
Fisher Exact Test ◽  
Ankle Arthroplasty ◽  
Patient Specific Instrumentation ◽  
Soft Tissue Dissection ◽  
Low Profile

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) have been standard treatment modalities for end-stage ankle osteoarthritis. Final implant position and successful soft tissue balancing are key components to the longevity of total ankle implants. Patient-specific instrumentation (PSI) has been developed for TAA, with proven cost effectiveness, accurate and reproducible radiographic outcomes and less operative time. However, one concern regarding PSI is the need for more soft tissue dissection in order to accurately position the PSI guides, which has the theoretical disadvantage of increased localized adjacent tissue necrosis that may lead to early osteolysis. As such the purpose of our study is to compare the incidence and magnitude of osteolysis for a low-profile tibia and talar resurfacing implant between PSI and standard referencing (SR) techniques. Methods: The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American sites between 2013 and 2015 were reviewed in a prospective observational study. Demographic, radiographic, and functional outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter. Osteolysis was assessed at two years after TAA, dividing the ankle into eight zones, and then a number was assigned according to lucency magnitude (see Figure) Osteolysis incidence was calculated by a binomial distribution. The number of zones compromised and magnitude of osteolysis was calculated using the median as resume statistic and interquartile range as dispersion statistic. Fisher exact test was used to compare osteolysis presence between groups; then a regression model was estimated to calculate the odds ratio for osteolysis. The comparison of osteolysis magnitude between groups was done with the Chi-squared test. A significance of 5% was used. Results: Of a total of 67 TAAs included, 51 were in the PSI group and 16 in the SRI group. In the PSI group the incidence, the number of compromised zones (CZ) and magnitude was 0.42% (0.25-0.61%), 3 [2-4] and 2[2-4] respectively. In the SR group, the incidence, number of CZ and magnitude was0.36% (0.13-0.65%), 2 [2-2], 4 [2-4] respectively. These differences were not statistically significant (p=0.46, p=0.86, p=0.70). A slightly higher risk of osteolysis was found in the PSI Groups (OR=1.33 [0.36- 4.83]). This difference was not statistically significant (p=0.46). Conclusion: According to our data, PSI is not different to SR in terms of risk, incidence and magnitude of early osteolysis in a low-profile tibia and talar resurfacing implant. We acknowledge that osteolysis is a multifactorial pathology, but these results suggest that the use of PSI does not increase its early occurrence. It appears that the higher rate of soft tissue stripping in the PSI group does not affect osteolysis and implant survival in the short term.

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.

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: 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.

Soft Tissue Reconstruction After Total Ankle Arthroplasty

2015 ◽  
Vol 37 (5) ◽  
pp. 522-527 ◽  
Author(s):  
Christopher E. Gross ◽  
Ryan Garcia ◽  
Samuel B. Adams ◽  
James K. DeOrio ◽  
Mark E. Easley ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Total Ankle Arthroplasty ◽  
Soft Tissue Reconstruction ◽  
Ankle Arthroplasty ◽  
Tissue Reconstruction

Tension-free closure with capsular lengthening in mini posterior total hip replacement

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 3-9
Author(s):  
Nicola Santori
Keyword(s):  
Soft Tissue ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Tissue Repair ◽  
Posterior Approach ◽  
Dislocation Rate ◽  
Soft Tissue Repair ◽  
Tension Free ◽  
Total Hip ◽  
Free Closure

Purpose: Choice of the best mini invasive surgical approach for total hip replacement remains a controversial topic. The posterior approach is traditionally associated with a higher dislocation rate and the obligation of postoperative restrictions. Soft tissue repair reduces the risk of dislocation yet, posterior closure it is often challenging because of capsular and external rotator contractures. In this article, an original procedure of capsular lengthening and tension-free closure is described and the results of a retrospective single surgeon series of minimally invasive posterior total hip replacement (THR) with capsular repair are presented. Methods: A total of 925 mini posterior total hip replacements performed between 2009 and 2015 were retrospectively reviewed. 2 original types of capsulorrhaphy to decrease tension of the repaired tissues were employed. Absence of posterior envelope stretch during flexion and internal rotation was confirmed intraoperatively with a dynamic test. No postoperative restrictions were used. Results: Capsular lengthening with 1 of the described techniques was required in over 50% of cases for a tension-free closure. 3 patients dislocated in the 867 reviewed procedures (0.35%), 1 requiring revision for instability (0.11%). Conclusions: This soft tissue repair technique after mini posterior approach THR is technically easy, provides a tension-free closure and a low dislocation rate.

What Is the Optimal Management of Patients With Prior Septic Arthritis of the Ankle Who Are Undergoing Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 9S-10S
Author(s):  
Brian Winters ◽  
Ferdinando Da Rin de Lorenzo ◽  
Jake O’Neil
Keyword(s):  
Soft Tissue ◽  
Physical Examination ◽  
Septic Arthritis ◽  
Soft Tissues ◽  
Total Ankle Arthroplasty ◽  
Optimal Management ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Serologic Tests ◽  
Prior Infection

Recommendation: There is a paucity of data regarding total ankle arthroplasty (TAA) in patients with prior infection involving the ankle, whether it be septic arthritis, osteomyelitis, or infection of the surrounding soft tissues. We recommend that patients with prior infections in the affected ankle be worked up for infection, including a thorough history and physical examination, as well as ordering serologic tests and possible aspiration of the joint. During ankle arthroplasty in patients with prior infection, antibiotics should be added to the cement (if used), and the joint should be thoroughly cleansed. Intraoperative cultures of bone and soft tissue should also be obtained. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

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