Transfibular Total Ankle Replacement Outcome at 2 Years Follow Up

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.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00093 ◽

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.

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Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty

Foot & Ankle International ◽

10.1177/1071100718798851 ◽

2018 ◽

Vol 40 (1) ◽

pp. 24-33 ◽

Cited By ~ 11

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.

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Should 15° of Valgus Coronal-Plane Deformity Be the Upper Limit for a Total Ankle Replacement?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00060 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0006

Author(s):

Mansur Halai ◽

Matthew Mann ◽

Ryan Khan ◽

Ellie Pinsker ◽

Timothy Daniels

Keyword(s):

Short Form ◽

Valgus Deformity ◽

Total Ankle Replacement ◽

Coronal Plane ◽

Control Group ◽

Ankle Arthritis ◽

Ankle Replacement ◽

Sf 36 ◽

Plane Deformity

Category: Ankle Arthritis Introduction/Purpose: Preoperative talar valgus deformity increases the technical difficulty of total ankle replacement (TAR) and is associated with an increased failure rate. Deformity of ≥15° has been reported to be a contraindication to arthroplasty. The goal of the present study was to determine whether the clinical outcomes of TAR for treatment of end-stage ankle arthritis were comparable for patients with preoperative talar valgus deformity of ≥15° as compared to those with <15°. Methods: Fifty ankles with preoperative coronal-plane tibiotalar valgus deformity of ≥15° (“valgus” group) and 50 ankles with valgus deformity of <15° (“control” group) underwent TAR. The cohorts were similar with respect to demographics and components used. All TARs were performed by a single surgeon. The mean duration of clinical follow-up was 5.5 years (minimum two years). Preoperative and postoperative radiographic measurements of coronal-plane deformity, Ankle Osteoarthritis Scale (AOS) scores and Short Form (SF)-36 scores were prospectively recorded. All ancillary (intraoperative) and secondary procedures, complications and measurements were collected. Results: The AOS pain and disability subscale scores decreased significantly in both groups. The improvement in AOS and SF-36 scores did not differ significantly between the groups at the time of the final follow-up. The valgus group underwent more ancillary procedures during the index surgery (80% vs 26%). Tibio-talar deformity improved significantly toward a normal weight-bearing axis in the valgus group. Secondary postoperative procedures were more common in the valgus group (36%) than the controls (20%). Overall, re-operation was not associated with poorer patient outcome scores. Metal component revision surgery occurred in seven patients (three valgus and four controls). These revisions included two deep infections (2%), one in each group, which were converted to hindfoot fusions. Therefore, 94% of the valgus group retained their original components at final follow-up. Conclusion: Satisfactory midterm results were achieved in patients with valgus mal-alignment of ≥15°. The valgus cohort required more procedures during and after their TAR, as well as receiving more novel techniques to balance their TAR. Whilst longer term studies are needed, valgus coronal-plane alignment of ≥15° should not be considered an absolute contraindication to TAR if the associated deformities are addressed.

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Survival of the Scandinavian Total Ankle Replacement (STAR)

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00223 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0022

Author(s):

Arno Frigg ◽

Ursula Germann ◽

Martin Huber ◽

Monika Horisberger

Keyword(s):

Survival Rate ◽

Total Ankle Replacement ◽

Ankle Arthritis ◽

Ankle Osteoarthritis ◽

Metallic Component ◽

Kaplan Meier ◽

Ankle Replacement ◽

One Year ◽

End Stage

Category: Ankle Arthritis Introduction/Purpose: The purpose of this study was to evaluate survival and clinical outcome of the Scandinavian total ankle replacement (STAR) prosthesis after a minimum of ten years up to a maximum of 19 years. Methods: Fifty STAR prostheses in 46 patients with end stage ankle osteoarthritis operated between 1996 and 2006 by the same surgeon (MH) were included. Minimal follow-up was ten years (median 14.6 years, 95% confidence interval [CI] 12.9-16.4). Clinical (Kofoed score) and radiological assessments were taken before the operation and at one, ten (+2), and 16 (±3) years after implantation. The primary endpoint was defined as exchange of the whole prosthesis or conversion to arthrodesis (def. 1), exchange of at least one metallic component (def. 2), or exchange of any component including the inlay (due to breakage or wear) (def. 3). Survival was estimated according to Kaplan-Meier. Further reoperations related to STAR were also recorded. Results: The ten year survival rate was (def. 1) 94% (CI 82- 98%), (def. 2) 90% (CI, 77-96%), and (def. 3) 78% (CI 64-87%). The 19-year survival rate was (def. 1) 91% (CI 78-97%), (def. 2) 75% (CI 53-88%), and (def. 3) 55% (CI 34-71%). Considering any re-operations related to STAR, 52% (26/50) of prostheses were affected by re-operations. Mean pre-operative Kofoed score was 49, which improved to 84 after one year (n = 50), to 90 after ten years (n = 46), and to 89 after 16 years (n = 28). Conclusion: The survival rate for def. 1 and 2 was high. However, re-operations occurred in 52% of all STAR prosthesis.

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

Foot & Ankle Specialist ◽

10.1177/1938640020980925 ◽

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

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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

Journal of Clinical Medicine ◽

10.3390/jcm10112258 ◽

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.

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Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Using Transfibular Approach

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000107 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001 ◽

Cited By ~ 1

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.

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

Foot & Ankle International ◽

10.1177/1071100719879680 ◽

2019 ◽

Vol 40 (11) ◽

pp. 1239-1248 ◽

Cited By ~ 4

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.

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Nottingham Experience with The Fixed Bearing Infinity Total Ankle Replacement

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00424 ◽

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]

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00201 ◽

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.

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