scholarly journals The risk factors of subsidence of the talar component in the 3 rd generation TNK ankle

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0036
Author(s):  
Shigeki Morita ◽  
Akira Taniguchi ◽  
Yasuhito Tanaka ◽  
Yoshinori Takakura
Keyword(s):  
Risk Factors ◽  
Cox Model ◽  
Articular Surface ◽  
Weight Bearing ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Patient Specific ◽  
Ankle Arthroplasty ◽  
Tilting Angle ◽  
Before And After

Category: Ankle Arthritis Introduction/Purpose: One of the major reasons for revision surgeries after total ankle arthroplasty (TAA) was subsidence of the talar component. The purpose of this study was to evaluate mid-term outcomes after total ankle arthroplasty(TAA) using the 3 rd generation TNK ankle and investigate risk factors leading to subsidence of the talar component. Methods: Fifty consecutive patients who received the 3 rd generation TNK prosthesis between October 2007 and December 2014 were investigated in this study. Weight-bearing foot and ankle radiographies were taken and evaluated before and after surgery. At least 1 mm sinking of the talar component was defined as the subsidence. BMI, age at the surgery, complications were investigated as patient specific parameter and talar tilting angle(TTA) and inclination of the articular surface of the distal end of tibia were investigated as preoperative radiographic parameters. Position and angle of replaced implant were also investigated using postoperative radiography. Results: Preoperative TTA had positive correlation (p=0.049, Cox model), and the angle between the talar and the 1st metatarsal axis (Meary angle) had negative correlation with subsidence (p=0.042, Cox model). Conclusion: The larger TTA shows varus deformity of the ankle and indicates the potential instability of the ankle, that leads to frequent incidence of ankle sprain postoperatively. Repeated micro trauma causes the loosening and subsidence of the talar component. The smaller Meary angle shows the cavus deformity, that prevents the favorable load distribution to the navicular and calcaneus, and leads to higher pressure concentration to the implant. The larger TTA and smaller Meary angle were risk factors of subsidence of the talar component in the TAA.

scholarly journals PROMS and Radiological Outcomes in Mobile Bearing Total Ankle Arthroplasty for Patients with Varus or Valgus Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0001
Author(s):  
Jack Allport ◽  
Adam Bennett ◽  
Jayasree Ramaskandhan ◽  
Malik Siddique
Keyword(s):  
Physical Health ◽  
Weight Bearing ◽  
Mobile Bearing ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ap Weight ◽  
Radiological Analysis

Category: Ankle Arthritis Introduction/Purpose: There is increasing evidence that outcomes for total ankle arthroplasty (TAA) are not adversely affected by pre-operative varus deformity. There is a sparsity of evidence relating to outcomes in valgus ankle arthritis. We present our outcomes using a mobile bearing prosthesis (Mobility TAA system, DePuy, Raynham, Massachusetts, USA) with a comparison of neutral, varus and valgus ankles. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual intervals. Patients undergoing primary TAA between March 2006 and June 2014 were included. Rrevision procedures along with those with inadequate radiographic images for deformity analysis were excluded. Patients with inadequate PROMS data were included in the radiological analysis but not the PROMS analysis. Data collected included FAOS (Womac Pain, Function and Stiffness), SF-36 scores and patient satisfaction. Radiological data was gathered from routinely taken AP weight bearing radiographs pre-operatively, immediately post-operatively and at final follow up. Pre-operative deformity was measured between the tibial anatomical axis and a line perpendicular to the talus. Patients were classified as neutral, varus (≥10 degrees varus) or valgus (≥10 degrees valgus). Results: 230 cases (see image) underwent radiological classification (152 neutral, 60 varus, 18 valgus) and were included in the radiological analysis (mean follow-up 55.9 months). 164 cases were included in the PROMS analysis (mean follow-up 61.6 months). The groups were similar with regards to BMI and length of follow-up but neutral ankles were younger (P<0.001). Baseline scores were equal except physical health with valgus ankles scoring lowest (P=0.045). Valgus ankles had statistically better post-operative pain (P=0.0247) and function (P=0.012) than neutral ankles. Pre to post-operative change did not reach statistical significance except physical health where valgus outperformed neutral and varus (p=0.039). Mean post-operative angle was 3.1 and final angle 3.7 with no significant differences. There was no significant differences in revision rates. Conclusion: Our study confirms previous evidence that varus deformity does not affect outcome in TAA. Contrary to this, valgus ankles in our cohort performed better post-operatively than neutral ankles. Post-operative coronal radiological alignment was not affected by pre-operative deformity and was maintained over a number of years. Coronal plane deformity does not negatively impact either radiological or clinical outcomes in TAA should not be considered an absolute contra-indication.

scholarly journals Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Daniel J. Cunningham ◽  
Sean Ryan ◽  
Samuel B. Adams
Keyword(s):  
Risk Factors ◽  
Total Ankle Arthroplasty ◽  
Patient Specific ◽  
Wound Complications ◽  
Diabetes Diagnosis ◽  
Ankle Arthroplasty ◽  
Medical Comorbidities ◽  
Flap Coverage ◽  
Wound Breakdown ◽  
The Impact

Category: Ankle Arthritis; Ankle; Diabetes Introduction/Purpose: Total ankle arthroplasty (TAA) results in improved patient outcomes and preserved range of motion for patients with end-stage arthritis. Wound complications following these procedures, while rare, can have a significant impact on patient morbidity, particularly when they require return to the operating room and flap coverage. We sought to determine the risk factors associated with the need for flap coverage over TAA, and hypothesized that intraoperative variables such as additional procedures to provide angular correction would play a more important role than patient-specific variables. Methods: We performed a single center retrospective review of primary total ankle arthroplasties from April 2007 - February 2019. Patients demographics and medical comorbidities were collected in addition to concomitant procedures performed at the time of TAA such as tibial osteotomies, removal of hardware, and subtalar fusion. Multivariable, main effects logistic regression models were performed to evaluate the impact of specific concomitant procedures during primary TAA on the rate of subsequent flap coverage with adjustment for age, sex, and medical comorbidities. Results: 2,124 TAA resulted in 29 flaps after an average of 1.1 (range 0-5) surgeries and 89.7 (range 18-591) days after the index arthroplasty. The most common flap was a radial forearm free flap performed in 15 (51.7%) patients. Patients requiring flap coverage were significantly older (p=0.044), were more likely to be diabetic (p=0.029), and were more likely to present to the ED and be readmitted within 90-days of their surgery (p<0.001). In a multivariable model controlling for age, gender, and diabetes diagnosis, patients with flaps were more likely to have a concomitant osteotomy (OR 3.720, 95% CI 1.693-8.177; p=0.001) at the time of there TAA. Other concomitant procedures did not show a significant association with subsequent need for flap coverage. Conclusion: Simultaneous procedures during TAA may place patients at higher risk of wound breakdown, specifically requiring flap coverage. In particular, osteotomies, namely tibial osteotomies for realignment, carry a special risk for wound healing difficulty. This should be considered as the indications for TAA continue to expand. [Table: see text]

Accuracy of CT-Derived Patient-Specific Instrumentation for Total Ankle Arthroplasty: The Impact of the Severity of Preoperative Varus Ankle Deformity

2022 ◽  
pp. 193864002110682
Author(s):  
Benjamin D. Umbel ◽  
Taylor Hockman ◽  
Devon Myers ◽  
B. Dale Sharpe ◽  
Gregory C. Berlet
Keyword(s):  
Case Series ◽  
Varus Deformity ◽  
Total Ankle Arthroplasty ◽  
Patient Specific ◽  
Level Of Evidence ◽  
Neutral Group ◽  
Ankle Arthroplasty ◽  
Patient Specific Instrumentation ◽  
Implant Alignment ◽  
The Impact

Background Significant preoperative varus tibiotalar deformity was once believed to be a contraindication for total ankle arthroplasty (TAA). Our primary goal was to evaluate the influence of increasing preoperative varus tibiotalar deformity on the accuracy of final implant positioning using computed tomography (CT)-derived patient-specific guides for TAA. Methods Thirty-two patients with varus ankle arthritis underwent TAA using CT-derived patient-specific guides. Patients were subcategorized into varying degrees of deformity based on preoperative tibiotalar angles (0°-5° neutral, 6°-10° mild, 11°-15° moderate, and >15° severe). Postoperative weightbearing radiographs were used to measure coronal plane alignment of the tibial implant relative to the target axis determined by the preoperative CT template. Average follow-up at the time of data collection was 36.8 months. Results Average preoperative varus deformity was 6.06° (range: 0.66°-16.3°). Postoperatively, 96.9% (30/31) of patients demonstrated neutral implant alignment. Average postoperative tibial implant deviation was 1.54° (range: 0.17°-5.7°). Average coronal deviation relative to the target axis was 1.61° for the neutral group, 1.78° for the mild group, 0.94° for the moderate group, and 1.41° for the severe group (P = .256). Preoperative plans predicted 100% of tibial and talar implant sizes correctly within 1 size of actual implant size. Conclusion. Our study supports the claim that neutral postoperative TAA alignment can be obtained using CT-derived patient-specific instrumentation (PSI). Furthermore, final implant alignment accuracy with PSI does not appear to be impacted by worsening preoperative varus deformity. All but one patient (96.9%) achieved neutral postoperative alignment relative to the predicted target axis. Level of Evidence: Level IV, Clinical Case Series

Midfoot Function Before and After Total Ankle Arthroplasty

2021 ◽  
pp. 107110072199578
Author(s):  
Frank E. DiLiberto ◽  
Steven L. Haddad ◽  
Steven A. Miller ◽  
Anand M. Vora
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Peak Power ◽  
Nonparametric Tests ◽  
Total Ankle Arthroplasty ◽  
Control Group ◽  
Ankle Arthroplasty ◽  
First Metatarsal ◽  
Before And After

Background: Information regarding the effect of total ankle arthroplasty (TAA) on midfoot function is extremely limited. The purpose of this study was to characterize midfoot region motion and power during walking in people before and after TAA. Methods: This was a prospective cohort study of 19 patients with end-stage ankle arthritis who received a TAA and 19 healthy control group participants. A motion capture and force plate system was used to record sagittal and transverse plane first metatarsal and lateral forefoot with respect to hindfoot motion, as well as sagittal plane midfoot region positive and negative peak power during walking. Parametric or nonparametric tests to examine differences and equivalence across time were conducted. Comparisons to examine differences between postoperative TAA group and control group foot function were also performed. Results: Involved-limb midfoot function was not different between the preoperative and 6-month postoperative time point in the TAA group (all P ≥ .17). Equivalence testing revealed similarity in all midfoot function variables across time (all P < .05). Decreased first metatarsal and lateral forefoot motion, as well as positive peak power generation, were noted in the TAA group postoperative involved limb in comparison to the control group (all P ≤ .01). Conclusion: The similarity of midfoot function across time, along with differences in midfoot function in comparison to controls, suggests that TAA does not change midfoot deficits by 6 months postoperation. Level of Evidence: Level II, prospective cohort study.

Predicting ground reaction and tibiotalar contact forces after total ankle arthroplasty during walking

2020 ◽  
Vol 234 (12) ◽  
pp. 1432-1444
Author(s):  
Yanwei Zhang ◽  
Zhenxian Chen ◽  
Yinghu Peng ◽  
Hongmou Zhao ◽  
Xiaojun Liang ◽  
...  
Keyword(s):  
Motion Capture ◽  
Multibody Dynamics ◽  
Contact Forces ◽  
Total Ankle Arthroplasty ◽  
Contact Model ◽  
Patient Specific ◽  
Ground Reaction Forces ◽  
Ground Contact ◽  
Ankle Arthroplasty ◽  
Reaction Forces

The motion capture and force plates data are essential inputs for musculoskeletal multibody dynamics models to predict in vivo tibiotalar contact forces. However, it could be almost impossible to obtain valid force plates data in old patients undergoing total ankle arthroplasty under some circumstances, such as smaller gait strides and inconsistent walking speeds during gait analysis. To remove the dependence of force plates, this study has established a patient-specific musculoskeletal multibody dynamics model with total ankle arthroplasty by combining a foot-ground contact model based on elastic contact elements. And the established model could predict ground reaction forces, ground reaction moments and tibiotalar contact forces simultaneously. Three patients’ motion capture and force plates data during their normal walking were used to establish the patient-specific musculoskeletal models and evaluate the predicted ground reaction forces and ground reaction moments. Reasonable accuracies were achieved for the predicted and measured ground reaction forces and ground reaction moments. The predicted tibiotalar contact forces for all patients using the foot-ground contact model had good consistency with those using force plates data. These findings suggested that the foot-ground contact model could take the place of the force plates data for predicting the tibiotalar contact forces in other total ankle arthroplasty patients, thus providing a simplified and valid platform for further study of the patient-specific prosthetic designs and clinical problems of total ankle arthroplasty in the absence of force plates data.

scholarly journals Mechanical and Anatomical Axis in Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0008
Author(s):  
Ali-Asgar Najefi ◽  
Andrew Goldberg
Keyword(s):  
Lower Limb ◽  
Mechanical Axis ◽  
Normal Group ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Patient Specific ◽  
Ankle Arthroplasty ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Anatomical Axis

Category: Ankle Arthritis Introduction/Purpose: Inadequate correction of alignment in the coronal, sagittal or axial planes will inevitably lead to failure of the Total Ankle Arthroplasty (TAA). The mechanical axis of the lower limb (MAL), the mechanical axis of the tibia (MAT) and the anatomical axis of the tibia (AAT) are three recognized coronal plane measurements using plain radiography. The relationship between anatomical and mechanical axes depends on the presence of femoral or tibial deformities from trauma or inherited conditions, or previous corrective or replacement surgery. Ankle arthroplasty relies heavily on preoperative radiographs or CT scans and the purpose of this study was to assess whether MAL, MAT and AAT are the same in a cohort of patients upon which placement of TAA is considered. Methods: We analysed 75 patients operated on between 2015 and 2016 at a specialist tertiary centre for elective orthopaedic surgery. All patients had a pre-operative long leg radiograph. They were split into 2 groups. The first group had known deformity proximal to the ankle (such as previous tibial or femoral fracture, severe arthritis, or previous reconstructive surgery) and the second group had no clinically detectable deformity. The MAL, MAT and AAT were assessed and the difference between these values was calculated. Results: There were 54 patients in the normal group, and 21 patients in the deformity group. Overall, 25 patients(33%) had a difference between all three axes of less than 1 degree. In 33 patients(44%), there was a difference in one of the axes of ≥2 degrees. There was no significant difference between MAT and AAT in patients in the normal group(p=0.6). 95% of patients had a difference of <1 degree. There was a significant difference between the MAT and AAT in patients in the deformity group(p<0.01). In the normal group, 39 patients(73%) had a difference of <2 degrees between the AAT and MAL. In the deformity group, only 10 patients (48%) had a difference of <2 degrees.In fact, 24% of patients had a difference ≥3 degrees. Conclusion: Malalignment in the coronal plane in TAA may be an issue that we have not properly addressed. Up to 66% of patients without known deformity may have a TAA that is placed at least 1 degree incorrectly relative to the MAL. We recommend the use of full-length lower limb radiographs when planning a TAA in order to plan the placement of implants. The decision to perform extramedullary referencing, intramedullary referencing, or patient specific Instrumentation must be part of the pre-operative planning process.

scholarly journals Does Patient-specific Instrumentation Have a Higher Rate of Early Osteolysis than Standard Referencing Techniques in Total Ankle Arthroplasty?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0004 ◽  
Author(s):  
Mario Escudero ◽  
Kevin Wing ◽  
Thomas Bemenderfer ◽  
Michael Symes ◽  
Maximiliano Barahona ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Outcome Data ◽  
Total Ankle Arthroplasty ◽  
Treatment Modalities ◽  
Patient Specific ◽  
Fisher Exact Test ◽  
Ankle Arthroplasty ◽  
Patient Specific Instrumentation ◽  
Soft Tissue Dissection ◽  
Low Profile

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) have been standard treatment modalities for end-stage ankle osteoarthritis. Final implant position and successful soft tissue balancing are key components to the longevity of total ankle implants. Patient-specific instrumentation (PSI) has been developed for TAA, with proven cost effectiveness, accurate and reproducible radiographic outcomes and less operative time. However, one concern regarding PSI is the need for more soft tissue dissection in order to accurately position the PSI guides, which has the theoretical disadvantage of increased localized adjacent tissue necrosis that may lead to early osteolysis. As such the purpose of our study is to compare the incidence and magnitude of osteolysis for a low-profile tibia and talar resurfacing implant between PSI and standard referencing (SR) techniques. Methods: The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American sites between 2013 and 2015 were reviewed in a prospective observational study. Demographic, radiographic, and functional outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter. Osteolysis was assessed at two years after TAA, dividing the ankle into eight zones, and then a number was assigned according to lucency magnitude (see Figure) Osteolysis incidence was calculated by a binomial distribution. The number of zones compromised and magnitude of osteolysis was calculated using the median as resume statistic and interquartile range as dispersion statistic. Fisher exact test was used to compare osteolysis presence between groups; then a regression model was estimated to calculate the odds ratio for osteolysis. The comparison of osteolysis magnitude between groups was done with the Chi-squared test. A significance of 5% was used. Results: Of a total of 67 TAAs included, 51 were in the PSI group and 16 in the SRI group. In the PSI group the incidence, the number of compromised zones (CZ) and magnitude was 0.42% (0.25-0.61%), 3 [2-4] and 2[2-4] respectively. In the SR group, the incidence, number of CZ and magnitude was0.36% (0.13-0.65%), 2 [2-2], 4 [2-4] respectively. These differences were not statistically significant (p=0.46, p=0.86, p=0.70). A slightly higher risk of osteolysis was found in the PSI Groups (OR=1.33 [0.36- 4.83]). This difference was not statistically significant (p=0.46). Conclusion: According to our data, PSI is not different to SR in terms of risk, incidence and magnitude of early osteolysis in a low-profile tibia and talar resurfacing implant. We acknowledge that osteolysis is a multifactorial pathology, but these results suggest that the use of PSI does not increase its early occurrence. It appears that the higher rate of soft tissue stripping in the PSI group does not affect osteolysis and implant survival in the short term.

scholarly journals Nottingham Experience with The Fixed Bearing Infinity Total Ankle Replacement

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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