scholarly journals Subtalar Joint Arthritis After Total Ankle Replacement

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0011
Author(s):  
Marc Sokolowski ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
Beat Hintermann
Keyword(s):  
Subtalar Joint ◽  
Total Ankle Replacement ◽  
Consecutive Series ◽  
Secondary Degeneration ◽  
One Stage ◽  
Joint Fusion ◽  
Subtalar Fusion ◽  
Ankle Replacement ◽  
Two Stages

Category: Ankle Arthritis Introduction/Purpose: It has been shown that total ankle replacement (TAR) is effective in reducing pain and maintaining function in posttraumatic ankle osteoarthritis (OA). Compared to ankle fusion, TAR restores hindfoot kinematics more physiological. However, the assumption that the maintenance of ankle motion has a protective effect on the subtalar joint is still a matter of debate. Only a scarce number of long-term studies exist to support this statement.The purpose of this study was (1) to evaluate to which extent the integrity of the subtalar joint can be preserved by treating patients with a TAR, (2) to determine the rate of subtalar fusion following TAR, and (3) to determine whether the need of subsequent subtalar fusion was predictable at time of TAR. Methods: A consecutive series of 1140 primary TAR (508 female, 632 male, median age 63.5 years), performed between May 2000 and December 2015, were prospectively documented. The indication for TAR was posttraumatic OA in 78%, primary and systemic OA in 10% each, and other secondary OA in 3% of the cases. 199 subtalar joints were either fused before (n=73) or during TAR surgery (n=126), leaving 941 subtalar joints available for analysis. Radiographs before implantation and at latest follow-up were classified using the Kellgren and Lawrence Grading Score (KLS). In case of a subtalar fusion, the radiograph prior to the fusion was classified. Results: After a median radiographic follow-up of 6.1 years, the KLS remained unchanged in 66% of all cases. While it was increased by one stage in 30%, it was increased by two stages in 3%; whereas, signs of OA decreased by one stage in 1%. Cases with an increase of two stages on the KLS had a longer follow-up compared to cases without increase (p=0.047).37 cases (3.9%) underwent a subtalar joint fusion, of which the indication was progressive OA in 19 cases (51%), instability in 10 cases (27%) and others in 8 cases (22%). Subtalar joints that required a fusion after TAR did not show higher preoperative KLS than the group which did not need a subtalar joint fusion. Conclusion: Apparently, TAR protects the subtalar joint from secondary degeneration, as found in 67% with no increase in KLS. Although 33% showed an increase in the KLS, only 2% required a subtalar fusion due to progressive OA. Overall, the rate of subtalar joint fusion after TAR was low and comparable to the rates reported in the literature. Subtalar joints requiring fusion after TAR did not show higher preoperative rates of OA. Therefore, the KLS classification of subtalar OA on conventional radiographs provides only limited information about the need for postoperative subtalar fusion, and thus need to be interpreted with caution.

scholarly journals Total ankle replacement and simultaneous subtalar arthrodesis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Luigi Manzi ◽  
Cristian Indino ◽  
Camilla Maccario ◽  
Claudia Di Silvestri ◽  
Riccardo D’Ambrosi ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Surgical Techniques ◽  
Fusion Rate ◽  
Total Ankle Replacement ◽  
Ct Scans ◽  
Talonavicular Joint ◽  
Joint Fusion ◽  
Subtalar Fusion ◽  
Ankle Replacement ◽  
Functional Scores

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Patients with arthritis or severe dysfunction involving both the ankle and the subtalar joints can benefit tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. With the evolution of prosthetic design and surgical techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint and talonavicular joint in patients simultaneously treated with total ankle replacement (TAR) and subtalar joint fusion. Methods: This study includes 11 patients who underwent primary TAR and simultaneous subtalar and talonavicular fusion from May 2011 to January 2015. Six males and five females were enrolled with a mean age of 61 years (41-75). Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Total follow-up time was 24.2±11.6 months. Radiographic examination included a postoperative CT scan obtained 12 months after surgery. Three surgeons independently reviewed the CT scans and interobserver reliability was calculated. Functional scores were also assessed. Results: At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar fusion was 92% and the talonavicular fusion rate was 88%. There was a statistically significant increase in American Orthopedic Foot & Ankle Society ankle/hindfoot score from 25.9 to 74.1 at 12 months post-operatively. Ankle range of motion significantly increased from 10.2° to 30.8 degrees. Additionally, there was a statistically significant decrease in visual analog scale (VAS) pain score from 8.8 to 1.9. Conclusion: TAR and simultaneous subtalar and talonavicular joint fusion are reliable procedures for the treatment of ankle and subtalar joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopaedic surgeons in determining the degree of successful fusion of subtalar and talonavicular arthrodesis.

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.

scholarly journals Was Mark Reiley Right? A Outcome Analysis of Intramedullary Versus Extramedullaryalignment Referencing for Total Ankle Replacement

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0009
Author(s):  
Craig C. Akoh ◽  
Amanda N. Fletcher ◽  
Rishin J. Kadakia ◽  
Jie Chen ◽  
Young-uk Park ◽  
...  
Keyword(s):  
Patient Reported Outcome ◽  
Total Ankle Replacement ◽  
Outcome Analysis ◽  
P Value ◽  
Consecutive Series ◽  
Ankle Replacement ◽  
Implant Survivorship ◽  
Patient Reported ◽  
Outcome Scores

Category: Ankle Arthritis; Ankle Introduction/Purpose: The purpose of this study was to report on the radiographic outcomes, clinical outcomes, and implant survivorship following extramedullary-referenced (EMr) versus intramedullary-referenced (IMr) total ankle replacement (TAR). Methods: From May 2007 to February 2018, a consecutive series of patients with end-stage tibiotalar osteoarthritis undergoing TAR for primary arthritis, post-traumatic arthritis, and inflammatory arthritis was enrolled in this study. Analyses were performed comparing IMr versus EMr components for patient-reported outcomes data, pre and postoperative radiographic ankle alignment, concomitant procedures, and complications. Kaplan-Meier survivorship analyses served to determine implant reoperation and revision surgery. Data was prospectively collected and retrospectively analyzed. A p-value of < 0.05 was considered significant for all statistical analyses. Results: A total of 340 TARs were included with 105 IMr TAR and 235 EMr TAR. The mean follow-up was 5.3 years ( +- 2.5, range 2-12). The absolute value for preoperative coronal alignment was significantly greater for IMr compared to EMr TAR (13.0 vs 6.4 degrees; p < 0.0001), but both groups achieved near neutral alignment postoperatively (1.4 vs 1.5 degrees; p=0.6655). The odds of having a concomitant procedure was 2.7 times higher in patients with an IMr TAR (OR 2.7, CI 1.7-4.4; p-value <0.0001). There were similar improvements in patient-reported outcome scores at one year and final follow up (all p > 0.05). The 5-year implant survivorship was 98.6.% for IMr versus 97.5% for EMr at final follow-up. Conclusion: Despite the IMr TAR group having more severe preoperative coronal and sagittal malalignment, both IMr and EMr TAR components had comparable postoperative alignment, patient-reported outcome scores, and complications. Among the patients with preoperative varus, valgus, or anterior distal tibial slope, the IMr patients achieved greater correction than the EMr patients. Although the 5-year implant survivorship was similar between the two cohorts with 98.6% survival for IMr TAR and 97.5% for EMr TAR, impending failures were greater for the mobile-bearing EMr TAR.

Intermediate-term Patient-Reported Outcomes and Radiographic Evaluation Following Intramedullary- vs Extramedullary-Referenced Total Ankle Replacement

2021 ◽  
pp. 107110072098002
Author(s):  
Craig C. Akoh ◽  
Rishin Kadakia ◽  
Amanda Fletcher ◽  
Young Uk Park ◽  
Hyongnyun Kim ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Patient Reported Outcome ◽  
Total Ankle Replacement ◽  
Radiographic Evaluation ◽  
Consecutive Series ◽  
Ankle Replacement ◽  
Implant Survivorship ◽  
Patient Reported ◽  
Outcome Scores

Background: The purpose of this study was to report on the radiographic outcomes, clinical outcomes, and implant survivorship following extramedullary-referenced (EMr) vs intramedullary-referenced (IMr) total ankle replacement (TAR). Methods: From May 2007 to February 2018, a consecutive series of patients with end-stage tibiotalar osteoarthritis undergoing TAR was enrolled in this study. Analyses were performed comparing IMr vs EMr components for patient-reported outcomes data, pre- and postoperative radiographic ankle alignment, concomitant procedures, and complications. Kaplan-Meier survivorship analyses served to determine implant reoperation and revision surgery. A total of 340 TARs were included with 105 IMr TAR and 235 EMr TAR. The mean follow-up was 5.3 years (±2.5, range 2-12). Results: The absolute value for preoperative coronal alignment was significantly greater for IMr compared to EMr TAR (13.0 vs 6.4 degrees; P < .0001), but both groups achieved near neutral alignment postoperatively (1.4 vs 1.5 degrees; P = .6655). The odds of having a concomitant procedure was 2.7 times higher in patients with an IMr TAR (OR 2.7, CI 1.7-4.4; P < .0001). There were similar improvements in patient-reported outcome scores at 1 year and final follow-up (all P > .05). The 5-year implant survivorship was 98.6% for IMr vs 97.5% for EMr at final follow-up. Conclusion: The IMr and EMr TAR components had comparable postoperative alignment, patient-reported outcome scores, and complications. The 5-year implant survivorship was similar between the IMr and EMr groups. Level of Evidence: Level III, retrospective comparative 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

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

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

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

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

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001 ◽  
Author(s):  
Alexej Barg ◽  
Charles Saltzman
Keyword(s):  
Range Of Motion ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Trabecular Metal ◽  
Non Union ◽  
Early Loosening ◽  
Early Results ◽  
Ankle Replacement ◽  
Patient Reported

Category: Ankle, Ankle Arthritis Introduction/Purpose: In the last two decades, total ankle replacement (TAR) has gained more acceptance as a treatment option in patients with end-stage ankle osteoarthritis. However, there is a lack of literature on TAR using a lateral transfibular approach. Therefore, we sought to report early clinical and radiographic results of a patient cohort treated with TAR using a lateral transfibular approach by a single surgeon. Methods: Fifty-five primary total ankle arthroplasties using the Zimmer trabecular metal implant were performed in 54 patients (29 men and 25 women; mean age, 67.0 years) from October 2012 to December 2014. Clinical assessment including pain evaluation and measurement of ankle range of motion was done preoperatively and at the latest follow-up. Weight-bearing radiographs were used to determine the angular alignment of the tibial and talar components and to analyze the bone-implant interface. Intraoperative and postoperative complications, revision surgeries, and failures were evaluated. Results: Implant survival was 93% at 36 months follow-up. There were 3 revisions of a tibial component due to aseptic loosening. In 10 of 55 procedures, a secondary procedure was performed during follow-up. Mean follow-up duration was 26.6 ± 4.2 months. No delayed union or non-union was observed for fibula healing. The average VAS pain score decreased significantly from 7.9 ± 1.3 to 0.8 ± 1.2. The average total range of motion increased significantly from 22.9° ± 11.8° to 40.2° ± 11.8°. Conclusion: Early results of Zimmer trabecular metal total ankle replacement demonstrated improved patient-reported outcomes and increased ankle motion at a minimum follow-up of one year. In the first 55 consecutive cases, the fibular osteotomy required for access to the ankle healed without complications. Painful early loosening requiring revision due to lack of bony ingrowth was seen in 3 of 55 cases.

Mid- to long-term results of total ankle replacement in patients with haemophilic arthropathy: A 10-year follow-up

Haemophilia ◽  
2017 ◽  
Vol 24 (2) ◽  
pp. 307-315 ◽  
Author(s):  
F. Eckers ◽  
D. E. Bauer ◽  
A. Hingsammer ◽  
R. Sutter ◽  
B. Brand ◽  
...  
Keyword(s):  
Total Ankle Replacement ◽  
Long Term Results ◽  
Haemophilic Arthropathy ◽  
Ankle Replacement

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.

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