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 Revision Total Ankle Replacement using the Inbone 2 System, Nottingham Experience

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0008
Author(s):  
Hatem Salem-Saqer ◽  
Martin Raglan ◽  
Sunil Dhar
Keyword(s):  
Heterotopic Ossification ◽  
Revision Surgery ◽  
Weight Bearing ◽  
T Test ◽  
Total Ankle Replacement ◽  
Cement Spacer ◽  
Early Results ◽  
Ankle Replacement ◽  
Paired T Test

Category: Ankle Arthritis; Ankle Introduction/Purpose: The Inbone Total Ankle Replacement System (Wright) is a modular stemmed ankle replacement, it is marketed as for both primary and revision TAR, it has been in use at Nottingham since 2016 mainly for revisions, we are reporting our experience with this system and our early results. Methods: This is a retrospective study with prospective collected data. We identified 27 (18M/9F) patients who had Inbone 2 TAR for revision surgery during the period August 2016 -March 2019. The mean follow up was 21 months (7-38months). Mean age of 69 years (51-81).All ankle revisions were a single-stage revision apart from 1 patient who had a 2 stage revision as at the first stage infection was suspected, it was left with a cement spacer and when all samples came back negative the second stage was carried out.All patients had follow up appointments at 6 weeks, 3,6 and 12 months. Patients were required to fill in MOXFQ questioner and all had weight-bearing radiographs on every follow up appointment.The indication for the surgery was aseptic Loosening 23, Malalignment 1 Insert wear 2 and heterotopic ossification 1. Results: 20 patients had concurrent procedure during the surgery(Table 1). There was 1 deep wound infection that required DAIR procedure 3 weeks after the revision surgery and has gone to make full recovery, no other complication were reported.Improvement in clinical outcome and PROMS data was noted on follow up, MOXFQ for Pain improved from 70 pre op to 34 at 6 months and 32 at 1 year(p<0.001 paired t test),The outcome for Walking improved from 69 pre op to 41 at 6 months and 40 at 1 year(p<0.001 paired t test).Radiological alignment was maintained in all ankles both in the coronal and the sagittal plain, posterior heterotopic ossification was noted in 8(29%), No loosening or signs of failure at any follow up appointment Conclusion: This is one of the largest series of this implant used in revision TAR. Our early results show considerable improvement in patient outcomes with very low complications and no failures.This implant provides a good option as a revision implant and our view that it is a superior solution to ankle fusions for failed total ankle replacements [Table: see text]

scholarly journals Assessment of Intraoperative of Range of Motion after Total Ankle Replacement: Radiographic Cohort Study

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0013
Author(s):  
Rogerio C. Bitar ◽  
Kristin C. Caolo ◽  
Guilherme H. Saito ◽  
Jaeyoung Kim ◽  
Jonathan T. Deland ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Recovery Period ◽  
Total Ankle Replacement ◽  
Average Increase ◽  
Ankle Replacement ◽  
Patient Reported ◽  
Post Traumatic ◽  
Traumatic Arthritis

Category: Ankle Arthritis Introduction/Purpose: One of the proposed benefits of total ankle replacement (TAR), when compared to ankle fusion is the restoration of the functional range of motion (ROM) of the ankle. Preservation of ankle motion may improve quality of life as evidenced by patient-reported outcome measures (PROMs). However, some studies have shown a lack of improvement of ankle range of motion after the postoperative recovery period, despite satisfactory motion being observed intra-operatively. The objective of this study was to radiographically compare intraoperative and pre-operative ankle range of motion. Methods: This single-center retrospective study compared 56 patients with an average age of 62.27 years who underwent primary TAR with one of four different implants between March and December 2019. 48% of patients had post-traumatic arthritis secondary to an ankle fracture, 50% had post-traumatic arthritis secondary to instability. Seventy-two percent of patients had an associated Achilles lengthening, 16% had an associated lateral ligament reconstruction procedure. Standardized weight-bearing maximum dorsiflexion and plantarflexion sagittal radiographs were obtained pre-operatively. In order to record intraoperative fluoroscopic imaging, the primary surgeon passively placed the ankle into maximum dorsiflexion and plantarflexion. Intraoperatively, the neutral lateral position of the ankle was determined after the replacement when the talus was in perfect lateral view. All angular measurements were made using the PACS system (Picture Archiving and Communication System). The change in range of motion was analyzed using a paired t-test with a significance level of 0.05. Results: The intraoperative range of motion increased significantly for all measures when compared to the pre-operative range of motion. The average pre-operative global arc of motion significantly increased from 20.21 degrees to 38.49 degrees intra- operatively (p=2.45x10-18, t(55)=2.00). The average pre-operative plantar flexion significantly increased from 12.80 degrees to 25.50 degrees intra-operatively (p=2.56x10-15, t(55)=2.00). The average pre-operative dorsiflexion significantly increased from 7.28 degrees to 13.35 degrees intra-operatively (p=4.68x10-6 t(55)=2.00). Patients who had an Achilles lengthening had an average increase in the global arc of motion of 18.78 degrees; patients who did not have an Achilles lengthening had an average increase of 17.02 degrees (p=0.562, t(31)=2.04). Overall, 93% of patients increased their range of motion after their total ankle replacement. Conclusion: This study demonstrates notable improvement in ankle range of motion intraoperatively following total ankle replacement, especially in plantarflexion. Total Ankle Replacement provides an improvement in the functional range of motion of the ankle intraoperatively, suggesting that the loss of motion observed in previous studies may occur during the postoperative period. The present study may help inform and adjust the postoperative rehabilitation protocol after total ankle replacement in order to avoid losing the amplitude of motion gained during the operation.

scholarly journals Clinical Radiographical Outcomes and Complications after a Brand-New Total Ankle Replacement Design through an Anterior Approach: A Retrospective at a Short-Term Follow Up

2021 ◽  
Vol 10 (11) ◽  
pp. 2258
Author(s):  
Massimiliano Mosca ◽  
Silvio Caravelli ◽  
Emanuele Vocale ◽  
Simone Massimi ◽  
Davide Censoni ◽  
...  
Keyword(s):  
Mean Value ◽  
Total Ankle Replacement ◽  
P Value ◽  
Ankle Osteoarthritis ◽  
Ankle Replacement ◽  
Patient Reported ◽  
End Stage ◽  
Term Performance ◽  
Replacement Design

Recently, the progress in techniques and in projecting new prosthetic designs has allowed increasing indications for total ankle replacement (TAR) as treatment for ankle osteoarthritis. This retrospective work comprehended 39 subjects aged between 47 and 79 years old. The patients, observed for at least 12 months (mean follow up of 18.2 ± 4.1 months), have been evaluated according to clinical and radiological parameters, both pre- and post-operatively. The AOFAS and VAS score significantly improved, respectively, from 46.2 ± 4.8 to 93.9 ± 4.1 and from 7.1 ± 1.1 to 0.7 ± 0.5 (p value < 0.05). At the final evaluation, the mean plantarflexion passed from 12.2° ± 2.3° to 18.1° ± 2.4° (p value < 0.05) and dorsiflexion from a pre-operative mean value of 8.7° ± 4.1° to 21.7° ± 5.4° post-operatively (p value < 0.05). This study found that this new total ankle replacement design is a safe and effective procedure for patients effected by end-stage ankle osteoarthritis. Improvements have been demonstrated in terms of range of motion, radiographic parameters and patient-reported outcomes. However, further studies are needed to assess the long-term performance of these prostheses.

Prospective Randomized Trial Comparing Mobile-Bearing and Fixed-Bearing Total Ankle Replacement

2019 ◽  
Vol 40 (11) ◽  
pp. 1239-1248 ◽  
Author(s):  
James A. Nunley ◽  
Samuel B. Adams ◽  
Mark E. Easley ◽  
James K. DeOrio
Keyword(s):  
Mobile Bearing ◽  
Cyst Formation ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Significant Difference ◽  
Patient Reported ◽  
End Stage

Background: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported long term for MB-TAR and at intermediate- to long-term follow-up for newer generation FB-TAR. Although comparisons between the 2 total ankle designs have been reported, to our knowledge, no investigation has compared the 2 designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes, and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65 years, range 35-85 years) were enrolled; a demographic comparison between the 2 cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees, or extensive talar dome wear pattern (“flat-top talus”). Prospective patient-reported outcomes, physical examination, and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score, Short Form 36, Foot and Ankle Disability Index, Short Musculoskeletal Functional Assessment, and American Orthopaedic Foot & Ankle Society ankle-hindfoot score. Surgeries were performed by a nondesign team of orthopedic foot and ankle specialists with total ankle replacement expertise. Statistical analysis was performed by a qualified statistician. At average follow-up of 4.5 years (range, 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, 1 had died, 4 were withdrawn after enrolling but prior to surgery, and 4 were lost to follow-up. Results: In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up with no statistically significant difference between the 2 groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FH-TAR, respectively. Reoperations were performed in 8 MB-TARs and 3 FH-TARs, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: With a high level of evidence, our study found that patient-reported and clinical outcomes were favorable for both designs and that there was no significant difference in clinical improvement between the 2 implants. The incidence of lucency/cyst formation was similar for MB-TAR and FH-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not necessarily correlate with radiographic findings. Reoperations were more common for MB-TAR and, in most cases, were to relieve impingement or treat cysts rather than revise or remove metal implants. Level of Evidence: Level I, prospective randomized study.

scholarly journals 2019 IFFAS Award for Excellence Winner: Peri-Prosthetic Cysts and Alignment in Total Ankle Replacement: A 3-D, Weight Bearing Topographical Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Francois Lintz ◽  
Jef Mast ◽  
Nazim Mehdi ◽  
Alessio Bernasconi ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Coronal Plane ◽  
Unequal Distribution ◽  
Hindfoot Alignment ◽  
Cyst Volume ◽  
Ankle Replacement ◽  
The Mean ◽  
The Difference

Category: Ankle, Ankle Arthritis Introduction/Purpose: Peri-prosthetic cysts (PPC) in Total Ankle Replacement (TAR) are a common failure cause but the mechanisms of their development remains unclear. One possible explanation could be hindfoot malalignment and subsequent unequal distribution of load inside the joint. However, how residual malalignment influences the evolution of PPC remains unclear. Computed tomography (CT) has demonstrated superiority on conventional radiography in the follow up of PPC. Weight Bearing CT (WBCT), by combining 3D imaging and weight bearing measurements seems a valid tool to investigate this further. The objective for this work was to study the effects of residual hindfoot deformity on the distribution of PPC in the coronal plane. We hypothesized that cysts would be found predominantly medially in varus configuration, and laterally in valgus configuration. Methods: Retrospective comparative study, ethics committee approved. Forty-eight cases of TAR were included, with relevant demographics. Inclusion criteria were cases of primary TAR with available WBCT imaging of their ankle as part of normal follow up. Exclusion criteria were subsequent implant revision or cyst grafting. In each case, the localization and size of PPC’s were documented and their volume calculated by approximation of the closest ellipsoid. Hindfoot alignment was evaluated by the percentage Foot Ankle Offset (FAO) (foot-length normalized 3D ratio between the midline of the foot and the center of the ankle) using a WBCT dedicated semi-automatic software. The mean FAO value with 95%CI for the population was calculated. The difference in medial and lateral cyst volume defined by their position relative to the median axis in the coronal plane was compared in varus and valgus cases by a Mann-Whitney non-parametric test for unpaired samples. Results: Demographic distributions of the series were 32% female, mean age 65 (45-85) years. Mean FAO value was 0.12% (95%CI -1.09 to 1.33). Mean follow up was 43 months (6 to 239). The mean total cyst volume per case was 1190,7 mm3. In varus cases (defined by FAO<-1.09%), the volume of medial cysts was greater than laterally by a mean 197 mm3, whereas in valgus cases (defined by FAO>1.33%), the volume of lateral cysts was greater than medially by a mean 332 mm3. The difference was statistically significant (p<0.05). There was a weak, significant positive correlation (r=0.25, p<0,001) between FAO and total cyst volume and a moderate, significant correlation (r=0,56, p<0,001) between time to follow up and total cyst volume. Conclusion: Our hypothesis was confirmed. Periprosthetic cysts volume in this series of primary TAR was found to be relatively greater medially in postoperative varus configurations and vice-versa laterally in valgus. This confirms a possible correlation between the direction of residual hindfoot malalignment and the coronal localization of PPC in TAR, although this is certainly not the only pathophysiologic factor involved in PPC onset. Weightbearing CT may be helpful in Total Ankle Replacement follow up, in order to early detect PPC development and possibly to identify situations at risk of a more rapid evolution.

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]

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.

Effect of Achilles Tendon Lengthening and Gastrocnemius Recession on Radiographic Tibiotalar Motion Following Total Ankle Replacement

2020 ◽  
pp. 107110072096961
Author(s):  
Clifford L. Jeng ◽  
John T. Campbell ◽  
Patrick J. Maloney ◽  
Lew C. Schon ◽  
Rebecca A. Cerrato
Keyword(s):  
Achilles Tendon ◽  
Range Of Motion ◽  
Total Ankle Replacement ◽  
Level Of Evidence ◽  
Tendon Lengthening ◽  
Ankle Replacement ◽  
Gastrocnemius Recession ◽  
Achilles Tendon Lengthening ◽  
Retrospective Comparative Study

Background: Surgeons frequently add an Achilles tendon lengthening or gastrocnemius recession to increase dorsiflexion following total ankle replacement. Previous studies have looked at the effects of these procedures on total tibiopedal motion. However, tibiopedal motion includes motion of the midfoot and hindfoot as well as the ankle replacement. The current study examined the effects of Achilles tendon lengthening and gastrocnemius recession on radiographic tibiotalar motion at the level of the prosthesis only. Methods: Fifty-four patients with an average of 25 months follow-up after total ankle replacement were divided into 3 groups: (1) patients who underwent Achilles tendon lengthening, (2) patients who had a gastrocnemius recession, (3) patients with no lengthening procedure. Tibiotalar range of motion was measured on lateral dorsiflexion-plantarflexion radiographs using reference lines on the surface of the implants. Results: Both Achilles tendon lengthening and gastrocnemius recession significantly increased tibiotalar dorsiflexion when compared to the group without lengthening. However, the total tibiotalar range of motion among the 3 groups was the same. Interestingly, the Achilles tendon lengthening group lost 11.7 degrees of plantarflexion compared to the group without lengthening, which was significant. Conclusion: Both Achilles tendon lengthening and gastrocnemius recession increased radiographic tibiotalar dorsiflexion following arthroplasty. Achilles tendon lengthening had the unexpected effect of significantly decreasing plantarflexion. Gastrocnemius recession may be a better choice when faced with a tight ankle replacement because it increases dorsiflexion without a compensatory loss of plantarflexion. Level of Evidence: Level III, retrospective comparative study.

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.

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