scholarly journals Age-Related Outcome of Mobile-Bearing Total Ankle Replacement

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Camilla Maccario ◽  
Ettore Vulcano ◽  
Cristian Indino ◽  
Luigi Manzi ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Mobile Bearing ◽  
The Elderly ◽  
Young Group ◽  
Total Ankle Replacement ◽  
Ankle Arthritis ◽  
Short Term Treatment ◽  
Age Related ◽  
Ankle Replacement ◽  
Significant Difference ◽  
End Stage

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is becoming increasingly popular amongst patients with end-stage ankle arthritis. This is in part related to the advances in design, technology, and technique that have improved TAR longevity. The ideal candidate for a TAR is not fully clear. For a long time patients over age 50 years, body mass index (BMI) under 30 kg/m2, and with low functional demands represented selection criteria for many patients. However, these criteria were based off a very limited number of scientific studies on older TAR designs. The aim of this study is to investigate clinical and radiographic outcome in patients of 50 years or less versus patients over 50 years undergoing a Hintegra® total ankle replacement (Integra, Plainsboro, NJ). Methods: This study includes 70 consecutive patients who underwent primary TAR from May 2011 to April 2014. The cohort was divided into 2 groups: the young group (YG) with age less than or equal to 50 years, and the older group (OG) with age above 50 years. Patients were assessed clinically and radiologically preoperatively and at 6, 12 and 24 months postoperatively. Results: A significant increase in the AOFAS and SF-12 and decrease in VAS scores was seen in both groups between preoperative and final followup (p < 0.001). There was a statistically significant difference between the YG and OG for the AOFAS score at final follow-up. The YG had significantly greater improvement compared to the OG (p = 0.046). In addition radiographic results showed no statistically significant difference in the coronal and sagittal alignment between the 2 groups. The mean postoperative angles in either study group demonstrated significant improvements compared to the preoperative alignment. Conclusion: This study demonstrates that total ankle arthroplasty is an effective short-term treatment for young, active patients with symptomatic end-stage ankle arthritis. Our findings are in disagreement with the widespread theory that ankle replacement is a more reliable treatment in the elderly

scholarly journals Prospective Randomized Trial Comparing Mobile-bearing and Fixed-bearing Total Ankle Replacement

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0009
Author(s):  
James Nunley ◽  
Samuel Adams ◽  
James DeOrio ◽  
Mark Easley
Keyword(s):  
Clinical Outcomes ◽  
Mobile Bearing ◽  
Cyst Formation ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Significant Difference ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: 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 longterm for MB-TAR and at intermediate-to-longterm follow-up for newer generation FB-TAR. Although comparisons between the two total ankle designs have been reported, to our knowledge, no investigation has compared the two 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: This investigation was approved by our institution’s IRB committee. 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, range 35 to 85) were enrolled; demographic comparison between the two 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 exam 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 (VAS), short form 36 (SF-36), foot and ankle disability index (FADI), short musculoskeletal functional assessment (SMFA) and AOFAS ankle-hindfoot score. Surgeries were performed by non-design team orthopaedic foot and ankle specialists with total ankle replacement expertise. Statistically analysis was performed by a qualified statistician. Results: 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, one had died, 4 were withdrawn after enrolling but prior to surgery and 4 were lost to follow-up. In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up. There was no statistically significant difference in improvement in clinical outcomes between the two 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 FB-TAR, respectively. Re-operations were performed in 8 MB-TAR and 3 FB-TAR, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: For the first time, with a high level of evidence, our study confirms that patient reported and clinical outcomes are favorable for both designs and that there is no significant difference in clinical improvement between the two implants. The incidence of lucency/cyst formation was similar for MB-TAR and FB-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 correlate with radiographic findings. Re-operations were more common for MB-TAR and in the majority of cases were to relieve impingement or treat cysts rather than revise or remove metal implants.

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.

Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

2021 ◽  
pp. 193864002098092
Author(s):  
Devon W. Consul ◽  
Anson Chu ◽  
Travis M. Langan ◽  
Christopher F. Hyer ◽  
Gregory Berlet
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Implant Survival ◽  
Ankle Arthritis ◽  
Single Institution ◽  
Retrospective Case ◽  
Ankle Replacement ◽  
End Stage

Total ankle replacement has become a viable alternative to ankle arthrodesis in the surgical management of advanced ankle arthritis. Total ankle replacement has generally been reserved for patients who are older and for those who will have a lower demand on the replacement. The purpose of the current study is to review patient outcomes, complications, and implant survival in patients younger than 55 years who underwent total ankle replacement at a single institution. A single-center chart and radiographic review was performed of consecutive patients who underwent total ankle replacement for treatment of end-stage ankle arthritis. All surgeries were performed by 1 of 5 fellowship-trained foot and ankle surgeons at a single institution. A total of 51 patients met inclusion criteria with a mean follow-up of 31.2 months (SD = 16.2). Implant survival was 94%, There were 7 major complications (13%) requiring an unplanned return to the operating room and 8 minor complications (15%) that resolved with conservative care. The results of this study show that total ankle replacement is a viable treatment option for patients younger than 55 years. Levels of Evidence: A retrospective case series

Revision Rates After Total Ankle Replacement: A Comparison of Clinical Studies and Arthroplasty Registers

2021 ◽  
pp. 107110072110538
Author(s):  
Georg Hauer ◽  
Reinhard Hofer ◽  
Markus Kessler ◽  
Jan Lewis ◽  
Lukas Leitner ◽  
...  
Keyword(s):  
Clinical Studies ◽  
Revision Rate ◽  
Mobile Bearing ◽  
Total Ankle Replacement ◽  
Second Step ◽  
Fixed Bearing ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Significant Difference

Background: The aim of this study was to assess the outcome of total ankle replacement (TAR) regarding revision rates by comparing clinical studies of the last decade to data displayed in arthroplasty registers. The secondary aim was to evaluate whether dependent clinical studies show a superior outcome to independent publications. Additionally, revision rates of mobile bearing implants (MB-TARs) were compared to those of fixed bearing implants (FB-TARs). Methods: Clinical studies on TARs between 2010 and 2020 were systematically reviewed, with the endpoint being a revision for any reason. The parameter “revision rate per 100 observed component years (CYs)” was calculated for each publication. The pooled revision rate for clinical studies was compared to the data reported in arthroplasty registers. In a second step, revision rates were subdivided and analyzed for independent and dependent publications and for FB-TARs and MB-TARs. Results: A total of 43 publications met the inclusion criteria comprising 5806 TARs. A revision rate of 1.8 per 100 observed CYs was calculated, corresponding to a 7-year revision rate of 12.6%. The 3 arthroplasty registers included showed revision rates ranging from 8.2% to 12.3% after 7 years. No significant difference between dependent and independent publications nor between FB-TARs and MB-TARs was detected. Conclusion: Revision rates of clinical studies and arthroplasty registers are comparable. Surgeons can compare their own revision rates with those from this study. Dependent studies do not seem to be biased, and no superiority for one bearing type can be described. Level of Evidence: Level III, systematic review of level III studies

Age-Related Outcome of Mobile-Bearing Total Ankle Replacement

Orthopedics ◽  
2017 ◽  
Vol 40 (3) ◽  
pp. e567-e573 ◽  
Author(s):  
Federico G. Usuelli ◽  
Camilla Maccario ◽  
Riccardo D'Ambrosi ◽  
Michele F. Surace ◽  
Ettore Vulcano
Keyword(s):  
Mobile Bearing ◽  
Total Ankle Replacement ◽  
Age Related ◽  
Ankle Replacement

scholarly journals Perspectives in Treatments of End-Stage Ankle Arthritis Among Orthopaedic Surgeons

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141877997
Author(s):  
Phinit Phisitkul ◽  
Natalie Glass ◽  
Patrick B. Ebeling ◽  
Sandra E. Klein ◽  
Jeffrey E. Johnson
Keyword(s):  
United States ◽  
The United States ◽  
Total Ankle Replacement ◽  
Ankle Arthritis ◽  
Cross Sectional Survey ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Orthopaedic Surgeons ◽  
Ankle Replacement ◽  
End Stage

Background: This study aimed to assess the preferred operative treatment for patients over the age of 60 with end-stage ankle arthritis and perspectives on total ankle replacement (TAR) among American Orthopaedic Foot & Ankle Society (AOFAS) members. Associated factors were analyzed for potential contraindications among members with different levels of experience. Method: A questionnaire containing 6 questions was designed and sent to 2056 members of the AOFAS. Responses were received from 467 orthopaedic surgeons practicing in the United States (76%), Canada (5%), and 26 other countries (20%). Participants were grouped for response comparisons according to country as well as experience level. Differences in contraindications were compared using χ2 tests or exact tests. Results: Respondents practicing in the United States and surgeons who perform 11 or more TARs per year tended to recommend operative treatments favoring TAR and displayed recognition of its increasing role ( P < .05). Overall, respondents felt that 41% of typical patients over 60 years old with end-stage arthritis would be best treated with TAR. Talus avascular necrosis, morbid obesity (body mass index >40 kg/m2), and poorly controlled diabetes with neuropathy were most recognized as the absolute contraindications to TAR. Surgeon’s experience affected the consideration of these clinical factors as contraindications. Conclusions: Total ankle replacement has a substantial and increasing role in the treatment of end-stage ankle arthritis in patients over the age of 60. Absolute and potential contraindications of the procedures were indicated from a cross-sectional survey of AOFAS members. Surgeons more experienced with total ankle replacement felt more comfortable employing it in a wider range of clinical settings. Level of Evidence: Level III, therapeutic.

Nationwide Analysis of Total Ankle Replacement and Ankle Arthrodesis in Medicare Patients: Trends, Complications, and Cost

2020 ◽  
pp. 193864002095018
Author(s):  
William A. Tucker ◽  
Brandon L. Barnds ◽  
Brandon L. Morris ◽  
Armin Tarakemeh ◽  
Scott Mullen ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Complication Rates ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Procedure Cost ◽  
Medicare Patients ◽  
Retrospective Comparative Study ◽  
End Stage

Background Surgical management of end-stage ankle arthritis consists of either ankle arthrodesis (AA) or total ankle replacement (TAR). The purpose of this study was to evaluate utilization trends in TAR and AA and compare cost and complications. Methods Medicare patients with the diagnosis of ankle arthritis were reviewed. Patients undergoing surgical intervention were split into AA and TAR groups, which were evaluated for trends as well as postoperative complications, revision rates, and procedure cost. Results A total of 673 789 patients were identified with ankle arthritis. A total of 19 120 patients underwent AA and 9059 underwent TAR. While rates of AA remained relatively constant, even decreasing, with 2080 performed in 2005 and 1823 performed in 2014, TAR rates nearly quadrupled. Average cost associated with TAR was $12559.12 compared with $6962.99 for AA ( P < .001). Overall complication rates were 24.9% in the AA group with a 16.5% revision rate compared with 15.1% and 11.0%, respectively, in the TAR group ( P < .001). Patients younger than 65 years had both higher complication and revision rates. Discussion TAR has become an increasingly popular option for the management of end-stage ankle arthritis. In our study, TAR demonstrated both lower revision and complication rates than AA. However, TAR represents a more expensive treatment option. Levels of Evidence: Level III: Retrospective comparative study

Outcomes of Total Ankle Replacement, Arthroscopic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-Deformed End-Stage Ankle Arthritis

2019 ◽  
Vol 101 (17) ◽  
pp. 1523-1529 ◽  
Author(s):  
Andrea N. Veljkovic ◽  
Timothy R. Daniels ◽  
Mark A. Glazebrook ◽  
Peter J. Dryden ◽  
Murray J. Penner ◽  
...  
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
End Stage

scholarly journals Comparison of Tibial and Talar Bone Density as a Function of Resection Level in Patients Undergoing Total Ankle Replacement vs Demographic-Matched Controls

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0020
Author(s):  
Thos Harnroongroj ◽  
Lauren Volpert ◽  
Daniel Sturnick ◽  
Carolyn Sofka ◽  
Scott J. Ellis ◽  
...  
Keyword(s):  
Bone Density ◽  
Articular Surface ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Control Group ◽  
Ankle Arthritis ◽  
Relative Level ◽  
Percentage Decrease ◽  
Ankle Replacement ◽  
Significant Difference

Category: Ankle Arthritis Introduction/Purpose: Initial implant fixation is critical for long-term success of total ankle replacement (TAR). One important factor which contributes to implant stability is the quality of the surrounding bone. Previous studies characterized a decrease in bone density with increasing distance from the level of the joint in the tibia and talus in non-arthritic ankles. However, ankle arthritis affects bone density remains unclear. The objective of this study is to compare the bone density in patients with and without ankle arthritis as a function of resection level from the joint. We hypothesized that there would be no difference in bone densities at each resection level between groups and bone density would decrease with greater distance from articular surface in both groups. Methods: We retrospectively reviewed 93 end-stage ankle arthritis patients with available preoperative non-weight bearing ankle computed tomography scans (CT)(Group A) and identified another cohort of 83 patients with non-arthritic ankles as a demographic-matched control group(Group B). Patients with retained ankle hardware, history of osteomyelitis, osteoporosis, and cysts greater than 1 cm in diameter at the ankle were excluded. There was no difference in term of gender, age and body mass index (BMI) between the groups(Table 1). The ROI tool in Sectra IDS7 picture archiving and communication system (PACS) was used to calculate Hounsfield Unit (HU) values in the cancellous region of the tibia and talus around the ankle joint. Measurements were obtained on axial CTs from 6 mm to 12 mm above the distal tibial plafond, and from 1 mm to 4 mm below the talar dome. The HU measurements and percentage decrease of HU values at each level were compared between groups. Results: Patients with ankle arthritis demonstrated significantly greater bone density than the control group between 6 mm and 10 mm from the joint in the tibia. There was no significant difference in bone density between 10 mm and 12 mm from the joint on the tibia, and at all levels in the talus between groups (Table 1). In both groups, bone density decreased significantly at each successive level from the joint for the tibia and talus. In addition, the percentage decrease of HU values at each relative level was the same in both groups. Conclusion: Patients with ankle arthritis demonstrated greater bone density at 6 mm to 10 mm from the joint in the tibia compared to demographic-matched controls. The increased bone density close to the joint may stem from bone eburnation that occurs as part of the arthritic process. In TAR, a tibial bone resection between 6 mm and 10 mm may provide improved initial stability of the implant. Contrary to traditional thinking, fixation into the talus may be of less concern.

scholarly journals Outcomes of Revision Total Ankle Replacement: A Minimum of 2 Year Follow-up

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0032
Author(s):  
Andrea Pujol Nicolas ◽  
Jayasree Ramas Ramaskandhan ◽  
Triin Nurm ◽  
Malik Siddique
Keyword(s):  
Total Ankle Replacement ◽  
Return To Sports ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Patient Reported ◽  
The Mean ◽  
End Stage ◽  
Average Domain

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement as a valid treatment for end stage ankle arthritis, is gaining popularity and every year there is an increasing number of procedures. With revision rates as high as 21% at 5 years and 43% at 10 years there is a need for understanding and reporting the outcome of revision ankle replacement. Our aim was to study the patient reported outcomes following revision TAR with a minimum of 2 year follow up. Methods: All patients that underwent a revision total ankle replacement between 2012 and 2016 were included in the study. All patients received a post-operative questionnaire comprising of MOX-FQ score, EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) and patients satisfaction questionnaire with a minimum of 2 years follow up. Results: 32 patients had a revision total ankle replacement between 2012 and 2016. 2 patients were deceased therefore 30 patients were included in the study. 5 patients declined participation for completing questionnaires. We received 21 (66%) completed questionnaires. The mean MOX-FQ average domain score for pain was 58.8, walking/standing 65.8 and social function was 48.2. The mean FAOS scores were 50.7 for pain, 50.6 for symptoms, 54.9 for ADL and 28.2 for quality of life. The mean overall health score today for EQ-5D was 67.8/100. 45% of patients were satisfied with the pain relief and return to sports and recreation obtained following the operation, 48% were satisfied with the improved in daily activities. 52% were overall satisfied with the results from surgery. Conclusion: Revision total ankle replacement gives overall satisfactory results demonstrated from patients reported outcomes at a minimum of 2 years following surgery.

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