scholarly journals Total Ankle Replacement Conversion to Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft and Pseudoelastic Intramedullary Nail Providing Sustained Joint Compression

2018 ◽  
Vol 3 (4) ◽  
pp. 247301141880448
Author(s):  
Mark Jay Conklin ◽  
Kathryn Elizabeth Smith ◽  
Jeremy Webster Blair ◽  
Kenneth Michael Dupont
Keyword(s):  
Femoral Head ◽  
Intramedullary Nail ◽  
Case Series ◽  
Preliminary Evidence ◽  
Total Ankle Replacement ◽  
Level Of Evidence ◽  
Computed Tomographic ◽  
Tibiotalocalcaneal Arthrodesis ◽  
First Case ◽  
Ankle Replacement

Tibiotalocalcaneal (TTC) arthrodesis is commonly performed to salvage a failed total ankle replacement. These salvage procedures are complicated by significant bone loss from the ankle replacement and are associated with low patient satisfaction. Here, we describe 2 cases of patients who presented with a failed total ankle replacement and underwent arthrodesis using a bulk femoral head allograft and a novel pseudoelastic intramedullary nail. The intramedullary nail contains an internal pseudoelastic element that adapts to bone resorption and settling allowing for compression to be maintained at the arthrodesis sites throughout healing. In the first case, a 65-year-old woman with a failed total ankle replacement underwent TTC arthrodesis. The second case involved an obese 53-year-old woman who had previously undergone 2 total ankle replacement procedures that resulted in unsuccessful outcomes. In both cases, union was demonstrated on computed tomographic scan by 6 months. At 2 years postsurgery, both patients were satisfied with the procedure. These cases provide preliminary evidence that tibiotalocalcaneal arthrodesis with a pseudoelastic IM nail and structural allograft is an appropriate treatment for failed total ankle replacements. Level of Evidence: Level IV, therapeutic, case series.

Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

2021 ◽  
pp. 107110072110044
Author(s):  
Catherine Conlin ◽  
Ryan M. Khan ◽  
Ian Wilson ◽  
Timothy R. Daniels ◽  
Mansur Halai ◽  
...  
Keyword(s):  
Hospital Setting ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Qualitative Description ◽  
Level Of Evidence ◽  
Foot Placement ◽  
Advantages And Disadvantages ◽  
Ankle Fusion ◽  
Ankle Replacement ◽  
Patient Reported

Background: Total ankle replacement (TAR) and ankle fusion are effective treatments for end-stage ankle arthritis. Comparative studies elucidate differences in treatment outcomes; however, the literature lacks evidence demonstrating what outcomes are important to patients. The purpose of this study was to investigate patients’ experiences of living with both a TAR and ankle fusion. Methods: This research study used qualitative description. Individuals were selected from a cohort of patients with TAR and/or ankle fusion (n = 1254). Eligible patients were English speaking with a TAR and contralateral ankle fusion, and a minimum of 1 year since their most recent ankle reconstruction. Surgeries were performed by a single experienced surgeon, and semistructured interviews were conducted by a single researcher in a private hospital setting or by telephone. Ankle Osteoarthritis Scale (AOS) scores, radiographs, and ancillary surgical procedures were collected to characterize patients. Themes were derived through qualitative data analysis. Results: Ten adults (8 men, 2 women), ages 59 to 90 years, were included. Average AOS pain and disability scores were similar for both surgeries for most patients. Participants discussed perceptions of each reconstructed ankle. Ankle fusions were considered stable and strong, but also stiff and compromising balance. TARs were considered flexible and more like a “normal ankle,” though patients expressed concerns about their TAR “turning” on uneven ground. Individuals applied this knowledge to facilitate movement, particularly during a first step and transitioning between positions. They described the need for careful foot placement and attention to the environment to avoid potential challenges. Conclusion: This study provides insight into the experiences of individuals living with a TAR and ankle fusion. In this unusual but limited group of patients, we found that each ankle reconstruction was generally perceived to have different characteristics, advantages, and disadvantages. Most participants articulated a preference for their TAR. These findings can help clinicians better counsel patients on expectations after TAR and ankle fusion, and improve patient-reported outcome measures by better capturing meaningful outcomes for patients. Level of Evidence: Level IV, case series.

Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement

2017 ◽  
Vol 38 (9) ◽  
pp. 952-956 ◽  
Author(s):  
Manja Deforth ◽  
Nicola Krähenbühl ◽  
Lukas Zwicky ◽  
Markus Knupp ◽  
Beat Hintermann
Keyword(s):  
Tibial Component ◽  
Corrective Osteotomy ◽  
Distal Tibia ◽  
Case Series ◽  
Outcome Data ◽  
Total Ankle Replacement ◽  
Level Of Evidence ◽  
Supramalleolar Osteotomy ◽  
Ankle Replacement ◽  
Surface Angle

Background: Persistent pain despite a total ankle replacement is not uncommon. A main source of pain may be an insufficiently balanced ankle. An alternative to the revision of the existing arthroplasty is the use of a corrective osteotomy of the distal tibia, above the stable implant. This strictly extraarticular procedure preserves the integrity of the replaced joint. The aim of this study was to review a series of patients in whom a corrective supramalleolar osteotomy was performed to realign a varus misaligned tibial component in total ankle replacement. We hypothesized that the supramalleolar osteotomy would correct the malpositioned tibial component, resulting in pain relief and improvement of function. Methods: Twenty-two patients (9 male, 13 female; mean age, 62.6 years; range, 44.7-80) were treated with a supramalleolar osteotomy to correct a painful ankle with a varus malpositioned tibial component. Prospectively recorded radiologic and clinical outcome data as well as complications and reoperations were analyzed. Results: The tibial anterior surface angle significantly changed from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively ( P < .0001), the American Orthopaedic Foot & Ankle Society hindfoot score significantly increased from 46 ± 14 to 66 ± 16 points ( P < .0001) and the patient’s pain score measured with the visual analog scale significantly decreased from 5.8 ± 1.9 to 3.3 ± 2.4 ( P < .001). No statistical difference was found in the tibial lateral surface angle and the range of motion of the ankle when comparing the preoperative to the postoperative measurements. The osteotomy healed in all but 3 patients on first attempt. Fifteen patients (68%) were (very) satisfied, 4 moderately satisfied, and 3 patients were not satisfied with the result. Conclusion: The supramalleolar osteotomy was found to be a reliable treatment option for correcting the varus misaligned tibial component in a painful replaced ankle. However, nonunion (14%) should be mentioned as a possible complication of this surgery. Nonetheless, as a strictly extraarticular procedure, it did not compromise function of the previously replaced ankle, and it was shown to relieve pain without having to have revised a well-fixed ankle arthroplasty. Level of evidence: Level IV, case series.

scholarly journals Sports and Recreational Activities following Total Ankle Replacement

Joints ◽  
2017 ◽  
Vol 05 (01) ◽  
pp. 012-016 ◽  
Author(s):  
Federico Usuelli ◽  
Andrea Pantalone ◽  
Camilla Maccario ◽  
Matteo Guelfi ◽  
Vincenzo Salini
Keyword(s):  
Los Angeles ◽  
Pain Score ◽  
Short Form ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Activity Level ◽  
Level Of Evidence ◽  
Recreational Activities ◽  
Ankle Replacement ◽  
And Function

Purpose In literature, there is a controversy regarding whether patients who have undergone total ankle replacement (TAR) can participate in sports and recreational activities. The purpose of this study was to report change in sports activity level after TAR. Methods A retrospective study was performed, enrolling 76 patients with symptomatic end-stage ankle arthritis who underwent TAR from May 2011 to October 2014. Patients were mainly males (44/76; 58%) and 56 years old on average (range: 22.3–79.6 years) at the time of surgery. They were treated with mobile-bearing prosthesis implanted with an anterior approach. Patients were evaluated preoperatively and 12 months postoperatively. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, the visual analog scale (VAS) pain score, and the 12-Item Short Form Health Survey (SF-12) – physical component summary (PCS) and mental component summary (MCS). Activity level was assessed with the University of California at Los Angeles (UCLA) activity scale. Results At 12 months postoperatively, statistically significant increase was reported for AOFAS scores (from 32.8 ± 12.7 preoperatively to 72.6 ± 13.3; p < 0.001), SF-12 PCS (from 34.3 ± 5.1 preoperatively to 45.4 ± 6.4; p < 0.001), and SF-12 MCS (from 39.8 ± 7.5 preoperatively to 51.4 ± 6.1; p < 0.001). A statistically significant decrease was detected in VAS pain score (from 8.7 ± 1.6 preoperatively to 2.2 ± 1.6; p < 0.001). The UCLA activity levels increased significantly from 2.4 ± 0.8 to 6.3 ± 2.3 (p < 0.001). Conclusion Pain and function significantly improved in patients affected by ankle osteoarthritis, who underwent TAR, at 1-year follow-up. In addition, activity level showed a significant increase respect to preoperative condition. Level of Evidence Level IV, retrospective case series.

Secondary Subtalar Joint Osteoarthritis Following Total Ankle Replacement

2019 ◽  
Vol 40 (10) ◽  
pp. 1122-1128 ◽  
Author(s):  
Marc Sokolowski ◽  
Nicola Krähenbühl ◽  
Chen Wang ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Case Series ◽  
Fusion Rate ◽  
Total Ankle Replacement ◽  
Time Interval ◽  
Level Of Evidence ◽  
Joint Fusion ◽  
Ankle Replacement ◽  
Cystic Changes

Background:An advantage of total ankle replacement (TAR) compared to ankle fusion is that by maintaining motion, the occurrence of hypermobility of adjacent joints may be prevented. This could affect the development of symptomatic subtalar joint osteoarthritis (OA). The aim of the study was to determine the incidence of subtalar joint fusion and the progression of subtalar joint OA following TAR.Methods:Secondary subtalar joint fusion rate was determined from a cohort of 941 patients receiving primary TAR between 2000 and 2016. The indication for fusion, the time interval from primary TAR to fusion, and the union rate were evaluated. To assess the progression of subtalar joint OA, degenerative changes of the subtalar joint were classified in 671 patients using the Kellgren-Lawrence score (KLS) prior to TAR and at latest follow-up.Results:In 4% (37) of the patients, a secondary subtalar joint fusion was necessary. The indication for fusion was symptomatic OA in 51% (19), hindfoot instability in 27% (10), osteonecrosis of the talus in 19% (7), and cystic changes of the talus in 3% (1) of the patients. Time from primary TAR to subtalar joint fusion due to progressive OA was 5.0 (range, 0.3-10) years and for other reasons 1.6 (range, 0.2-11.6) years ( P = .3). In 68% (456) of the patients, no progression of subtalar joint OA was observed.Conclusion:The incidence of secondary subtalar joint fusion was low. The most common reason for subtalar joint fusion following TAR was symptomatic OA.Level of Evidence:Level IV, case series.

Syndesmotic Overload in 3-Component Total Ankle Replacement

2019 ◽  
Vol 41 (3) ◽  
pp. 275-285 ◽  
Author(s):  
Roxa Ruiz ◽  
Roman Susdorf ◽  
Nicola Krähenbühl ◽  
Alexej Barg ◽  
Beat Hintermann
Keyword(s):  
Revision Surgery ◽  
Case Series ◽  
Mobile Bearing ◽  
Cyst Formation ◽  
Total Ankle Replacement ◽  
Effective Treatment Option ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Ankle Replacement

Background: Mobile-bearing total ankle replacement (TAR) potentially enables motion at the tibial implant–polyethylene insert (PI) interface. Such additional freedom of movement may overload periarticular ligaments and subsequently result in coronal translation of the talus. The aim of this study was to assess whether syndesmotic overload affects clinical and radiographic outcomes following mobile-bearing TAR and whether tibiofibular fusion is an effective treatment option. Methods: Thirty-one patients who underwent revision surgery for syndesmotic overload after mobile-bearing TAR were retrospectively analyzed. Clinical and radiographic outcomes were assessed before and after index TAR, preoperatively to revision surgery, and at the last follow-up after revision surgery. Computed tomography scans were also analyzed. Results: Ankles with lateral talar translation prior to revision surgery were about 10 times more likely to have valgus tibial implant position ( P = .003). A wide tibiofibular distance at the level of the syndesmosis after index TAR was associated with an increased hindfoot moment arm at revision surgery ( P = .025). Decrease of PI height at revision surgery and a PI fracture were evident in 10 (32%) and 4 (13%) cases, respectively. Talar cyst formation at revision surgery was evident in 12 (39%) cases. Tibiofibular fusion was effective in restoring function of the replaced ankle and providing pain relief. Conclusion: Syndesmotic overload impaired clinical and radiographic outcomes after mobile-bearing TAR. Proper implant positioning and additional realignment procedures may prevent overload of periarticular soft tissue structures after mobile-bearing TAR. Level of Evidence: Level IV, retrospective case series.

Scandinavian Total Ankle Replacement: 15-Year Follow-up

2018 ◽  
Vol 39 (2) ◽  
pp. 135-142 ◽  
Author(s):  
Ariel Palanca ◽  
Roger A. Mann ◽  
Jeffrey A. Mann ◽  
Andrew Haskell
Keyword(s):  
Case Series ◽  
Mobile Bearing ◽  
The United States ◽  
Clinical Findings ◽  
Total Ankle Replacement ◽  
Fourth Generation ◽  
Level Of Evidence ◽  
Prosthetic Alignment ◽  
Ankle Replacement

Background: Over the past decade, total ankle arthroplasty (TAA) has become a mainstay in the treatment of end-stage ankle arthritis. Currently in its fourth generation, the Scandanavian Total Ankle Replacement (STAR) is the only 3-piece mobile bearing ankle prosthesis available in the United States. Our current study reports implant survivorship at 15 years and patient outcomes for a subset of these survivors available for study. Methods: Eighty-four TAAs were performed between 1998 and 2000. Metal component survivorship at 15 years was calculated with a Kaplan-Meier curve. Twenty-four (29%) of 84 patients were available for participation with a minimum 15-year follow-up. Any radiographic changes were documented. All additional procedures and complications were recorded. Clinical findings, self-reported performance and pain evaluations, and AOFAS ankle/hindfoot scores were noted. Results: Metal implant survival was 73% at 15 years. Of the 24 patients available for clinical evaluation, 18 of 24 patients (70.7%) had no change in prosthetic alignment from the immediate postoperative radiograph. Only 1 subtalar fusion was required for symptomatic adjacent joint arthritis. Three patients sustained a broken polyethylene component. AOFAS scores improved from an average of 39.6 points preoperatively, to an average of 71.6. More than half (52.4%) of patients with retained implants required an additional surgical procedure; 3 required 2 additional procedures. The average time to subsequent procedure was 10.2 years. Conclusion: Our small cohort demonstrated STAR ankles with retention at 9 years were highly likely to survive to 15 years, and patients continued to have significant improvement in pain relief and minimal decrease in function. At 15 years from TAA, metal survivorship was 73%. As with all ankle replacements, supplementary procedures were common. Level of Evidence: Level IV, case series.

scholarly journals Functional and radiological assessment of total ankle replacement with infinity prosthesis

2021 ◽  
Vol 15 (2) ◽  
pp. 105-109
Author(s):  
Álvaro Santiago Guerrero Forero ◽  
Ricardo Rodríguez Ciodaro ◽  
Carlos Castillo Forero ◽  
Claudia Caicedo Donoso
Keyword(s):  
Case Series ◽  
Total Ankle Replacement ◽  
Fourth Generation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Implant Positioning ◽  
Ankle Replacement ◽  
Imaging Results ◽  
Wright Medical Technology ◽  
Pain Visual Analog Scale

Objective: To present mid-term functional and radiological outcomes obtained with the use of Infinity prosthesis in Bogotá (Colombia). Methods: This cross-sectional observational study selected consecutive patients subjected to total ankle replacement with the fourth generation Infinity prosthesis (Wright Medical Technology). Results: Fifty-two patients with ankle arthrosis were followed for a mean period of 24 months, and the most frequently reported case of joint degeneration was trauma. Postoperative improvement was observed in perception of pain (visual analog scale increased from 8/10 to 2/10; p<0.0005), AOFAS functional scale (from 23 to 84.5; p < 0.0005), and range of motion (from 11° to 29°; p<0.0005). Similarly, radiological findings, implant positioning, and signs of loosening did not reveal implant failure. Conclusions: The use of fluoroscopically navigated prostheses allows us to achieve predictable outcomes, with satisfactory mid-term clinical and imaging results. Level of Evidence IV; Therapeutic Studies; Case Series.

Long-term Results of Scandinavian Total Ankle Replacement

2017 ◽  
Vol 38 (7) ◽  
pp. 723-731 ◽  
Author(s):  
Helka Koivu ◽  
Ia Kohonen ◽  
Kimmo Mattila ◽  
Eliisa Loyttyniemi ◽  
Hannu Tiusanen
Keyword(s):  
Case Series ◽  
Total Ankle Replacement ◽  
Long Term Results ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Evaluation Point ◽  
Subjective Measurements

Background: The purpose of this study was to evaluate the long-term results of the Scandinavian Total Ankle Replacement (STAR) implant in a single center. Methods: Between 1997 and 2002, 34 consecutive ankles were replaced with the STAR ankle prosthesis and reviewed in 2016. Patients were followed both radiologically and clinically; clinical outcomes were measured with the Kofoed ankle score and subjective measurements. The median follow-up period was 159 months (13.3 years; range, 13-202 months). Results: The implant survival rate was 93.9% (95% confidence interval [CI], 92.2%-86.7%) at 5 years, 86.7% (95% CI, 69.3%-96.2%) at 10 years, and 63.6% (95% CI, 30.8%-89.0%) at 15 years. A total of 15 ankles (44%) had been revised: 2 by fusion, 3 by further replacement, 5 by insert exchange, and 5 by bone grafting for marked osteolysis. The improvements in the Kofoed ankle score and Kofoed ankle score for pain were statistically significant at every postoperative evaluation point compared to the preoperative values (all P < .0001), and subjective patient satisfaction was high. Conclusion: Our results were satisfactory and in agreement with previously reported findings of STAR implants. Level of Evidence: Level IV, retrospective case series.

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

Lessons learned from volar plate fixation of scaphoid fracture nonunions

2017 ◽  
Vol 43 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Seth D. Dodds ◽  
John B. Williams ◽  
Max Seiter ◽  
Clark Chen
Keyword(s):  
Plate Fixation ◽  
Scaphoid Fracture ◽  
Case Series ◽  
Lessons Learned ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Computed Tomographic ◽  
Volar Aspect ◽  
Fracture Nonunions ◽  
New Type

Treating scaphoid nonunions presents difficulties particularly when there is bone loss, significant humpback deformity or avascular necrosis. We describe a new type of fixation with a volar scaphoid plate that adds to the methods of internal fixation that are available for the treatment of recalcitrant scaphoid nonunions. We will also discuss ‘lessons learned’ from a cases series. The case series includes 20 consecutive patients treated with volar buttress plating and a pedicled vascularized bone graft from the ipsilateral volar distal radius. There was clinical and radiographic evidence of union in 18 of 20 patients, 13 of which were verified by computed tomographic scan. The range of motion was improved in all patients post-operatively. Four patients with radiographic union experienced intermittent clicking with maximal wrist flexion, believed to be due to the impingement of the plate on the volar aspect of the radioscaphoid articulation and underwent removal at approximately 1 year after the index procedure. Volar scaphoid plating is a useful alternative to headless scaphoid screw fixation in the treatment of unstable scaphoid waist fractures and nonunions. Level of evidence: IV

Sign in / Sign up

Export Citation Format

Share Document