Outcomes of Total Ankle Arthroplasty in Moderate and Severe Valgus Deformity

2018 ◽  
Vol 12 (3) ◽  
pp. 238-245 ◽  
Author(s):  
Constantine A. Demetracopoulos ◽  
Elizabeth A. Cody ◽  
Samuel B. Adams ◽  
James K. DeOrio ◽  
James A. Nunley ◽  
...  
Keyword(s):  
Short Form ◽  
Valgus Deformity ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Short Musculoskeletal Function Assessment ◽  
Sf 36 ◽  
Patient Reported ◽  
Musculoskeletal Function ◽  
American Orthopaedic

Introduction. Failure to correct coronal deformity at the time of total ankle arthroplasty (TAA) can lead to early implant failure. We aimed to determine clinical, radiographic, and patient-reported outcomes of patients with moderate to severe valgus deformity who underwent TAA for end-stage ankle arthritis. Methods. Patients with a valgus deformity of at least 10° who underwent TAA were retrospectively reviewed. The coronal tibiotalar angle was assessed on radiographs preoperatively, at 1 year, and at final follow-up. The visual analog scale (VAS) for pain, Short Form-36 (SF-36), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle scale, and Short Musculoskeletal Function Assessment (SMFA) scores were assessed preoperatively and at final follow-up. Results. Mean preoperative valgus deformity was 15.5 ± 5.0°, and was corrected to a mean of 1.2 ± 2.6° of valgus postoperatively. VAS, SF-36, AOFAS, and SMFA scores improved significantly ( P < .001 for all). There was no significant change in tibiotalar angle between 1 year and final follow-up in either group. Reoperation and revision rates did not differ between groups. Conclusion. Correction of coronal alignment was achieved and maintained in patients with both moderate and severe preoperative valgus malalignment. Outcome scores significantly improved for all patients. Levels of Evidence: Therapeutic, Level IV

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%.

Patient Characteristics of Possible Responders and Nonresponders to Total Ankle Arthroplasty

2020 ◽  
Vol 41 (8) ◽  
pp. 893-900
Author(s):  
John R. Steele ◽  
Daniel J. Cunningham ◽  
Cynthia L. Green ◽  
Thomas J. Risoli ◽  
James K. DeOrio ◽  
...  
Keyword(s):  
Mental Health ◽  
Rheumatic Disease ◽  
Short Form ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Sf 36 ◽  
Patient Reported

Background: Characteristics of responders, or those who achieve a clinical improvement above the level of a minimal clinically important difference, have not been defined for total ankle arthroplasty (TAA). The purpose of this study was to determine patient characteristics that distinguish possible responders from possible nonresponders after TAA using criteria established for other arthroplasty surgeries. Methods: Patients undergoing TAA who were enrolled into a prospective study at a single academic center evaluating patient-reported outcomes were included. Patients were characterized as possible responders if the relative or absolute improvement in their 2-year follow-up Short Musculoskeletal Function Assessment (SMFA) function score was at least 50% or 20, respectively, compared with their preoperative score, consistent with Outcome Measures in Rheumatoid Arthritis Clinical Trials and the Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. Patient factors were then associated with possible responder or nonresponder status and a multivariable analysis was performed. A total of 491 patients with complete data and 2-year follow-up were included in this study. Results: Multivariable analysis demonstrated that a higher baseline 36-Item Short-Form Survey (SF-36) mental component summary (MCS) score (OR [95% CI], 1.02 [1.01, 1.04]; P = .003), indicating better mental health, was associated with being a possible responder to TAA. The presence of rheumatic disease (OR [95% CI], 0.38 [0.22, 0.67]; P = .001) was a significant predictor of being a possible nonresponder. Conclusion: Our data reveal that a higher baseline SF-36 MCS score was associated with increased improvement in SMFA function scores, while rheumatic disease was associated with worse improvement in SMFA function scores after TAA. Patients with rheumatic disease or poor mental health may not achieve as favorable results after TAA and should be counseled appropriately. Level of Evidence: Level III, retrospective comparative study.

Should 15° of valgus coronal-plane deformity be the upper limit for a total ankle arthroplasty?

2020 ◽  
Vol 102-B (12) ◽  
pp. 1689-1696
Author(s):  
Mansur M. Halai ◽  
Ellie Pinsker ◽  
Matthew A. Mann ◽  
Timothy R. Daniels
Keyword(s):  
Short Form ◽  
Valgus Deformity ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Ankle Arthroplasty ◽  
Sf 36 ◽  
Secondary Procedures ◽  
Plane Deformity ◽  
Short Form Health

Aims Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°. Methods A matched cohort of patients similar for demographics and components used but differing in preoperative coronal-plane tibiotalar valgus deformity ≥ 15° (valgus, n = 50; 52% male, mean age 65.8 years (SD 10.3), mean body mass index (BMI) 29.4 (SD 5.2)) or < 15° (control, n = 50; 58% male, mean age 65.6 years (SD 9.8), mean BMI 28.7 (SD 4.2)), underwent TAA by one surgeon. Preoperative and postoperative radiographs, Ankle Osteoarthritis Scale (AOS) pain and disability and 36-item Short Form Health Survey (SF-36) version 2 scores were collected prospectively. Ancillary procedures, secondary procedures, and complications were recorded. Results At mean 5.1 years follow-up (SD 2.6) (valgus) and 6.6 years (SD 3.3) (controls), mean AOS scores decreased and SF-36 scores increased significantly in both groups. Improvements in scores were similar for both groups – AOS pain: valgus, mean 26.2 points (SD 24.2), controls, mean 22.3 points (SD 26.4); AOS disability: valgus, mean 41.2 points (SD 25.6); controls, mean 34.6 points (SD 24.3); and SF-36 PCS: valgus, mean 9.1 points (SD 14.1), controls, mean 7.4 points (SD 9.8). Valgus ankles underwent more ancillary procedures during TAA (40 (80%) vs 13 (26%)) and more secondary procedures postoperatively (18 (36%) vs 7 (14%)) than controls. Tibiotalar deformity improved significantly (p < 0.001) towards a normal weightbearing axis in valgus ankles. Three valgus and four control ankles required subsequent fusion, including two for deep infections (one in each group). Conclusion Satisfactory mid-term results were achieved in patients with preoperative valgus malalignment ≥ 15°, but they required more adjunctive procedures during and after TAA. Valgus coronal-plane deformity ≥ 15° is not an absolute contraindication for TAA if associated deformities are addressed. Cite this article: Bone Joint J 2020;102-B(12):1689–1696.

Comparison of Intermediate-term Outcomes of Total Ankle Arthroplasty in Primary and Ligamentous Post-traumatic Osteoarthritis

2019 ◽  
Vol 40 (11) ◽  
pp. 1273-1281 ◽  
Author(s):  
Gun-Woo Lee ◽  
Asep Santoso ◽  
Keun-Bae Lee
Keyword(s):  
Short Form ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes ◽  
Primary Osteoarthritis ◽  
Post Traumatic ◽  
American Orthopaedic ◽  
End Stage

Background: Ankle ligamentous injuries without fracture can result in end-stage ligamentous post-traumatic osteoarthritis, which may cause ligamentous imbalance after total ankle arthroplasty (TAA). However, outcomes of TAA in these patients are not well known. The purpose of this study was to evaluate intermediate-term clinical and radiographic outcomes of TAA in patients with ligamentous post-traumatic osteoarthritis and compare them with results of TAA for patients with primary osteoarthritis. Methods: We enrolled 114 patients (119 ankles) with consecutive primary TAA using HINTEGRA prosthesis at a mean follow-up duration of 6.0 years (range, 3-13). We divided all patients into 2 groups according to the etiology of osteoarthritis: (1) primary osteoarthritis group (69 ankles) and (2) ligamentous post-traumatic osteoarthritis group (50 ankles). Results: There was no significant intergroup difference in mean Ankle Osteoarthritis Scale (AOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Short Form-36 Physical Component Summary, visual analog scale pain score, ankle range of motion, or complications at the final follow-up. However, the final tibiotalar angle was less corrected to 4.2 degrees in the ligamentous post-traumatic osteoarthritis group compared to 2.7 degrees in the primary osteoarthritis group ( P = .001). More concomitant procedures were required at the index surgery for the ligamentous post-traumatic osteoarthritis group ( P = .001). The estimated 5-year survivorship was 93.4% (primary osteoarthritis group: 91.3%; ligamentous post-traumatic osteoarthritis group: 95.8%). Conclusions: Clinical outcomes, complication rate, and 5-year survivorship of TAA in ankles with primary and ligamentous post-traumatic osteoarthritis were comparable with intermediate-term follow-up. Our results suggest that TAA would be a reliable treatment in ankles with ligamentous post-traumatic osteoarthritis when neutrally aligned stable ankles are achieved postoperatively. Level of Evidence: Level III, retrospective cohort study.

scholarly journals The Impact of Pre-Operative Mental Health and Depression on Outcomes after Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Daniel J. Cunningham ◽  
John Steele ◽  
Samuel B. Adams
Keyword(s):  
Mental Health ◽  
Patient Reported Outcomes ◽  
Total Ankle Arthroplasty ◽  
Linear Regression Models ◽  
Ankle Arthroplasty ◽  
Change Scores ◽  
Short Musculoskeletal Function Assessment ◽  
Patient Reported ◽  
The Impact

Category: Ankle Introduction/Purpose: Poor pre-operative mental health and depression have been shown to negatively impact patient- reported outcomes (PROMs) after a broad array of orthopaedic procedures involving the spine, hip, knee, shoulder, and hand. However, the relationship of mental health and patient-reported outcomes in foot and ankle surgery is less clear. The purpose of this study is to characterize the impact of pre-operative mental health and depression on patient-reported outcomes after total ankle arthroplasty. The study hypothesis is that depression and decreased SF36 MCS will be significantly associated with diminished improvement in PROMs after total ankle arthroplasty. Methods: All patients undergoing primary TAA between January 2007 and December 2016 who were enrolled into a prospective, observational study and who had at least 1 to 2-year minimum study follow-up were included. Patients were separated into 4 groups based on the presence or absence of SF36 MCS<35 and diagnosis of depression. Pre-operative to post- operative change scores in the SF36 physical and mental component summary scores (PCS and MCS), Short Musculoskeletal Function Assessment (SMFA) function and bother components, and visual analog scale (VAS) pain were calculated in 1 to 2-year follow-up. Multivariable, main effects linear regression models were constructed to evaluate the impact of SF36 and depression status on pre-operative to 1 to 2-year follow-up change scores with adjustment for age, sex, race, body mass index, current smoking, American Society of Anesthesiologist’s score, smoking, and Charlson-Deyo comorbidity score. Results: As in Table 1, adjusted analyses demonstrated that patients with MCS<35 and depression had significantly lower improvements in all change scores including SF36 MCS (-5.1 points) and PCS (-7.6 points), SMFA bother (6 points) and function scores (5.7 points), and VAS pain (7.5 points) compared with patients that had SF36>=35 and no depression. Patients with MCS<35 and no depression had significantly greater improvement in SF36 MCS (5.3 points) compared with patients that had MCS>=35 and no depression. Patients with MCS>=35 and depression had significantly lower improvement in SF36 MCS (-3.2 points) compared with patients that had MCS>=35 and no depression. Adjusted analyses of minimum 5-year outcomes demonstrated significantly increased improvement in MCS and SMFA function for patients with pre-operative MCS<35 and no depression. Conclusion: Presence of depression and decreased SF36 MCS are risk factors for diminished improvement in PROMs. Patients with depression and decreased MCS should be counseled about their risk of diminished improvement in outcomes compared to peers. As PROM’s become part of physician evaluations, it is becoming increasingly important to identify factors for diminished improvement outside of the physician’s control. [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.

scholarly journals Revision Surgery for Metal Component Failure in Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
James Lachman ◽  
Jania A. Ramos ◽  
Samuel Adams ◽  
Mark Easley ◽  
James DeOrio
Keyword(s):  
Revision Surgery ◽  
Short Form ◽  
Total Ankle Arthroplasty ◽  
Study Patient ◽  
Foot And Ankle ◽  
Metal Component ◽  
Component Failure ◽  
Ankle Arthroplasty ◽  
Patient Reported

Category: Ankle Arthritis Introduction/Purpose: Metal component failure in total ankle arthroplasty(TAA) is difficult to treat. Traditionally, to an arthrodesis has been advocated. Revision TAA surgery has become more and more common with availability of revision implants and refinement of bone conserving primary implants. It this study, patient reported results and clinical outcomes are analyzed for patients undergoing revision total ankle arthroplasty. Methods: We retrospectively reviewed prospectively collected data on 45 patients (cases) with a mean age of 63.7 +/-10.2 years who developed loosening or collapse of either major metal component in the primary total ankle arthroplasty. Cases of isolated polyethylene exchange, infection, or extra-articular realignment procedures were excluded. Prospectively collected patient reported outcomes measures including the American Orthopaedic Foot and Ankle Society(AOFAS) hindfoot score, Visual Analog Scale (VAS), Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), and the Foot and Ankle Outcomes Score (FAOS) questionnaires were collected. Clinical data was collected through thorough review of the electronic medical record to identify clinical failure defined as explant and second revision or conversion to arthrodesis or amputation. Results: The causes of failure of primary TAA in this study were aseptic loosening of both components (40%), talar component subsidence/loosening (37.7%), tibial loosening (8.8%), coronal talar subluxation (8.8%) and talar malrotation (2.2%). Twenty-four patients (53.3%) underwent revision of all components, nineteen (42.2%) just the talar and polyethylene components, and two (4.4%) the tibial and polyethylene components. The average time to revision was 5.56 years +/- 5.71 with a follow-up of 3.02 years +/- 1.25 after revision. Ten (22.2%) revision arthroplasties required further surgery; five required conversion to arthrodesis and five required second revision TAA. VAS scores, SF36 scores, SMFA scores, AOFAS Hindfoot scores, and FAOS all improved after revision surgery but took 2 years to reach scores comparable to 1 year after primary TAA. Conclusion: Clinical and patient reported results of revision ankle arthroplasty after metal component failure were comparable to those after primary ankle arthroplasty. In our series, 22.2% of revision TAAs required a second revision TAA or arthrodesis surgery. Various prosthesis performed similarly when used in revision scenarios. Patients recovered faster from primary ankle arthroplasty when compared to revision ankle arthroplasty but all scores were comparable by the two-year follow-up visit after revision arthroplasty surgery.

scholarly journals Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty at 2-years Follow-up

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005
Author(s):  
Francesco Granata ◽  
Camilla Maccario ◽  
Luigi Manzi ◽  
Eric Tan ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Functional Limitation ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Hindfoot Alignment ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Patient Reported ◽  
American Orthopaedic

Category: Ankle Arthritis Introduction/Purpose: 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 proved 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 two years follow-up. Methods: This prospective study included 59 patients who underwent transfibular total ankle arthroplasty from May 2013 to December 2015. The mean age was 51.6 ± 13.4 years. All patients were followed for at least 24 months postoperative with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiologically preoperatively and at 6, 12, and 24 months postoperatively. Results: At 24 months, patients demonstrated statistically significant improvement in the American Orthopaedic Foot and Ankle Society score from 33.6 to 88.1 (P<0.01), VAS scale from 79.3 to 14.0 (P<0.01) and SF-12 Physical and Mental Composite Scores from 29.9 and 44.6 to 74.4 and 95.3, respectively (P<0.01). Ankle dorsiflexion and plantarflexion improved from 5.5 and 8.8 degrees to 24.2 and 20.0 degrees, respectively (P<0.01). Radiographically, patients demonstrated neutral alignment of the ankle with a tibio-talar ratio of 34.9 ± 9.2 and hindfoot alignment view angle of 1.2 ± 7.0 degrees. No patient demonstrated any radiographic evidence of tibial or talar lucency at 24 months. Seven patients underwent reoperation for removal of symptomatic hardware; one patient developed a postoperative prosthetic infection requiring placement of an antibiotic spacer. Conclusion: This study demonstrates that transfibular total ankle replacement is a safe and effective option for the patients for ankle arthritis with improvements in patient-reported outcomes, range of motion, and radiological parameters. However, further studies are required to determine the mid- and long-term performance of these implants.

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.

The HINTEGRA total ankle arthroplasty

2019 ◽  
Vol 101-B (6) ◽  
pp. 695-701 ◽  
Author(s):  
H-Y Yang ◽  
S-H Wang ◽  
K-B Lee
Keyword(s):  
Functional Outcome ◽  
Short Form ◽  
Major Complication ◽  
Mobile Bearing ◽  
Total Ankle Arthroplasty ◽  
Range Of Movement ◽  
Ankle Arthroplasty ◽  
Implant Survivorship ◽  
American Orthopaedic

Aims The purpose of this study was to determine the functional outcome and implant survivorship of mobile-bearing total ankle arthroplasty (TAA) performed by a single surgeon. Patients and Methods We reviewed 205 consecutive patients (210 ankles) who had undergone mobile-bearing TAA (205 patients) for osteoarthritis of the ankle between January 2005 and December 2015. Their mean follow-up was 6.4 years (2.0 to 13.4). Functional outcome was assessed using the Ankle Osteoarthritis Scale, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, 36-Item Short-Form Health Survey (SF-36) score, visual analogue scale, and range of movement. Implant survivorship and complications were also evaluated. Results There were significant improvements in all functional outcome categories between the preoperative and final follow-up assessments (p < 0.001). Patients showed marked improvement in clinical outcomes in terms of pain, function, and quality of life. The overall implant survivorship was 91.7% at a mean follow-up of 6.4 years. In all, 33 major complications were identified with a 15.7% rate, resulting in 12 prosthesis failures (5.7%). Periprosthetic osteolysis (19 cases; 9.0%) was the most frequent complication. Conclusion Mobile-bearing TAA resulted in improved functional outcomes, a low major complication rate, and excellent implant survivorship at a mean follow-up of 6.4 years. Cite this article: Bone Joint J 2019;101-B:695–701.

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