scholarly journals 20 Degree Post Traumatic Ankle Valgus and Distal Lateral Tibial Osteonecrosis Treated with Staged Deformity Correction and Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Lawrence DiDomenico ◽  
Danielle Butto
Keyword(s):  
Ankle Joint ◽  
Deformity Correction ◽  
Total Ankle Arthroplasty ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Ankle Arthroplasty ◽  
Initial Surgery ◽  
Post Traumatic ◽  
Ankle Valgus

Category: Ankle, Ankle Arthritis Introduction/Purpose: The purpose of this review is to present a case of post-traumatic ankle valgus and distal lateral tibial osteonecrosis successfully treated with staged deltoid repair, opening wedge tibial osteotomy, fibular lengthening, syndesmotic fusion and total ankle arthroplasty. Methods: Initial surgery consisted of ankle joint arthrotomy and deltoid imbrication. The second surgery consisted of a tibial opening wedge osteotomy with autogenous cortical fibular bone graft superior to the area of osteonecrosis to correct the 20 degree ankle valgus. Fibular lengthening osteotomy and fusion of the distal syndesmosis were also performed. CT scan confirmed bony consolidation at the distal tibiofibular syndesmosis as well as union of the allograft opening wedge. The final surgery was total ankle joint replacement with bone grafting of the area of osteonecrosis. Results: After 5 years of follow up the patient has progressed out of his AFO to full weightbearing. He reports no ankle pain, improved function and range of motion and is ambulating independently with no assistive devices. Conclusion: We successfully treated a case of distal lateral tibial osteonecrosis, and a 20 degree ankle valgus with staged deformity correction and ankle replacement. Radiographs demonstrate a well seated and positioned implant. We believe that with proper alignment that total ankle arthroplasty is a safe treatment option in the face of bone infarction.

Hindfoot Alignment Change After Total Ankle Arthroplasty for Varus Osteoarthritis

2020 ◽  
pp. 107110072097093
Author(s):  
Hyuck Sung Son ◽  
Jung Gyu Choi ◽  
Jungtae Ahn ◽  
Bi O Jeong
Keyword(s):  
Ankle Joint ◽  
Case Series ◽  
Deformity Correction ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Hindfoot Alignment ◽  
Ankle Arthroplasty ◽  
End Stage ◽  
Surface Angle

Background: In patients with end-stage varus ankle osteoarthritis (OA), hindfoot varus malalignment resulting from the varus deformity of the ankle joint is common. Although total ankle arthroplasty (TAA) performed to correct varus deformity of the ankle joint has the effect of correcting hindfoot alignment, no reports to date have described how much hindfoot alignment correction can be achieved. The purpose of this study was to identify correlation between ankle deformity correction and hindfoot alignment change after performing TAA in patients with end-stage varus ankle OA. Methods: A total of 61 cases that underwent TAA for end-stage varus ankle OA and followed up for at least 1 year were enrolled for this study. Correlation between changes of tibial-ankle surface angle (TAS), talar tilt (TT), and tibiotalar surface angle (TTS) and changes of hindfoot alignment angle (HA), hindfoot alignment ratio (HR), and hindfoot alignment distance (HD) measured preoperatively and at postoperative year 1 was analyzed. Results: TAS, TT, and TTS changed from 83.9 ± 4.1 degrees, 5.8 ± 5.0 degrees, and 78.1 ± 5.9 degrees, respectively, before operation to 89.2 ± 2.1 degrees, 0.4 ± 0.5 degrees, and 88.7 ± 2.3 degrees, respectively, after operation. HA, HR, and HD also changed from −9.2 ± 4.6 degrees, 0.66 ± 0.18, and −11.2 ± 6.9 mm to −3.7 ± 4.1 degrees, 0.48 ± 0.14, and −5.0 ± 5.3 mm. All the changes were statistically significant ( P < .001, respectively). The regression slope of correlation was 0.390 ( R2 = 0.654) between TTS and HA; 0.017 ( R2 = 0.617) between TTS and HR; and 0.560 ( R2 = 0.703) between TTS and HD. Conclusion: In patients with end-stage varus ankle OA, changes of hindfoot alignment could be predicted based on degree of ankle deformity corrected with TAA. Level of Evidence: Level IV, case series.

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 Changes in the Plantarflexion Moment Arm of the Achilles Tendon Following Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0048
Author(s):  
Francesca E. Wade ◽  
Gregory Lewis ◽  
Andrea H. Horne ◽  
Lauren Hickox ◽  
Michael C. Aynardi ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Ankle Joint ◽  
Sagittal Plane ◽  
Total Ankle Arthroplasty ◽  
Moment Arm ◽  
Talar Dome ◽  
Ankle Arthroplasty ◽  
Joint Structure ◽  
Joint Axis ◽  
Mean Differences

Category: Ankle; Ankle Arthritis Introduction/Purpose: Deficits in ankle joint kinetics following total ankle arthroplasty (TAA) may be attributed to a reduction in the force-generating capacity of ankle joint muscles, but it is also important to consider the alterations to joint structure that may accompany this procedure. One key parameter indicative of joint structure with the potential to be influenced by TAA is the plantarflexion moment arm of the Achilles tendon (ATma). ATma is an indicator of the potential for the tendon force to produce plantarflexion moment that is determined by the three-dimensional line of action of the tendon relative to the ankle joint axis. The purpose of this study was to assess pre-to-post TAA changes in ATma; we hypothesized that pre- and post-TAA moment arms would not be different. Methods: We tested 10 TAA patients (age at surgery: 62.86 +- 9.72 y; height: 1.72 +- 0.08 m; body mass: 97.81 +- 20.89 kg) at pre-operative (˜ 1 mo pre) and post-operative (˜6 mo post) visits. All procedures involving testing of human subjects were approved by the Penn State Hershey Medical Center Institutional Review Board. ATma were measured using a method that combined ultrasound imaging of the tendon with 3D motion tracking of both the ultrasound probe and the ankle joint. The tendon and joint axis were located during trials in which the patients were seated with the knee extended while the ankle joint was voluntarily rotated in the sagittal plane. We also examined sagittal-plane weightbearing radiographs (pre- and post-op) to determine the AP distance from the center of the talar dome to the posterior margin of the calcaneus. Pre- and post-op ATma were compared using a paired t-test and regression. Results: No significant mean differences were found between post-op ATma and pre-op ATma (p = 0.360). Despite this, some patients were found to have large differences between pre- and postoperative ATma. For example, participants 1, 3, and 8 exhibited changes of -54.22%, +64.14% and +123.98% (pre-to-post) respectively (Figure 1). A moderate correlation between pre- and post-op ATma was found (r2 = 0.461, p = 0.031), indicating that only 46.1% of the variance in post-op ATma was explained by pre-op ATma (Figure 1). The normalized AP distance measured from the radiographs did not significantly change on average pre- to post-TAA (p = 0.561), and we found the change in this distance to correlate with the change in ATma (r2 = 0.370, p = 0.062). Conclusion: This is the first investigation of whether TAA alters ATma. Our results supported our hypothesis that pre-operative ATma predicts post-operative ATma. However, our hypothesis is supported only when the mean differences are considered, as there were sizeable differences for individuals. Despite a non-significant average change in ATma following TAA, at the individual level substantial changes in ATma were observed in seven of the 10 patients. Change in ATma was only partly explained by change in the AP position of the talar dome. Change in ATma has potential consequences for function in terms of ankle plantarflexor strength and walking velocity.

scholarly journals High, open wedge tibial osteotomy: Finite element analysis of five internal fixation modalities

2011 ◽  
Vol 68 (10) ◽  
pp. 867-871
Author(s):  
Zeljko Stepanovic ◽  
Miroslav Zivkovic ◽  
Snezana Vulovic ◽  
Ljubisa Acimovic ◽  
Branko Ristic ◽  
...  
Keyword(s):  
Stress Distribution ◽  
Numerical Models ◽  
Deformity Correction ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Open Wedge ◽  
Outer Cortex ◽  
Angle Stable ◽  
Metal Block ◽  
Distribution Of Stresses

Background/Aim. Medial open wedge tibial osteotomy is one of the most widely accepted method of treatment for varus knee deformity in younger patient population. Its success depends on the quality of fixation and preservation of the outer cortex of the tibia. The aim of the study was to evaluate stress distribution in five numerically designed plate configurations which can be used in open wedge tibial osteotomy. Methods. The paper describes the 3D numerical model of the tibia with 10? varus deformity correction obtained by an optical scanner ATOS. The simulation anticipated axial compressive loads of 700 N, 1 400 N and 2 100 N. We used a modification of the standard T-plate in all of the five tested models. Modalities were tested with and without a metal block, and with and without a stable angle fixation plates and screws. Software PAK was used in the analysis of stress distribution. Results. With exception for the standard T-plate configuration without the supporting block, the loads up to 1400 N did not result in critical stresses on the outer cortex of the tibia in the remaining four models. There is an objective risk of possible failure of the outer cortex and loss of correction at a load of 2100 N in all configurations. The plate model with the angle stable fixation and the supporting metal block showed the most optimal distribution of stresses on the plate-bone composite compared to other models. Conclusion. The standard T-plate configuration without supporting metal block is not sufficient to stabilize the open wedge osteotomy of the tibia. Numerical models of the angle stable T-plate and the supporting metal block achieved a favorable distribution of stresses on the bone and implant which require further biomechanical testing.

The Effect of Medial Opening Wedge Proximal Tibial Osteotomy on Patellofemoral Contact

2012 ◽  
Vol 41 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Pooya Javidan ◽  
Gregory J. Adamson ◽  
Jennifer R. Miller ◽  
Pierre Durand ◽  
Patrick A. Dawson ◽  
...  
Keyword(s):  
Contact Forces ◽  
Wedge Osteotomy ◽  
Materials Testing ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Proximal Tibial Osteotomy ◽  
Pressure Sensitive ◽  
Sensitive Film ◽  
Significant Difference ◽  
Pressure Sensitive Film

Background: It has been suggested that patellofemoral contact pressures and contact forces may be altered secondary to an opening wedge high tibial osteotomy, yet few data are available that quantify the effect of varying degrees of medial opening wedge osteotomy on the patellofemoral joint contact characteristics. Hypothesis: Opening wedge medial proximal tibial osteotomy will increase patellofemoral contact force and pressure. Study Design: Controlled laboratory study. Methods: Nine human cadaver knees were used. Pressure-sensitive film was placed in the suprapatellar pouch, leaving the patellar tendon and medial and lateral retinacula intact. The quadriceps tendon was attached to a materials testing machine along the axis of the femur, whereby a pulley mechanism generated 950 N of force. Patellofemoral contact characteristics were measured with pressure-sensitive film at 30°, 60°, 90°, and 120° of flexion for the native knee and after subsequent 10-mm and 15-mm medial opening wedge proximal tibial osteotomies. The film was analyzed with imaging software. Results: There was a statistically significant increase ( P < .05) in mean contact pressure at 30° and 120° between the 10-mm osteotomy and native knee and across all flexion angles between the 15-mm osteotomy and native knee. Furthermore, a significant difference was seen in peak pressures when native knees were compared with 10-mm and 15-mm opening wedge osteotomies at all flexion angles. Conclusion: There was a significant increase in patellofemoral pressures at varying degrees of knee flexion after medial opening wedge proximal tibial osteotomies of only 10 mm; a larger osteotomy resulted in a greater increase. Clinical Relevance: When performing a medial opening wedge proximal tibial osteotomy, the surgeon should consider the negative effects of increased patellofemoral peak pressure.

Sign in / Sign up

Export Citation Format

Share Document