scholarly journals Role of Total Ankle Arthroplasty in Stiff Ankles – Long Term Follow-Up

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0001
Author(s):  
James W. Brodsky ◽  
Justin M. Kane ◽  
Andrew W. Pao ◽  
David D. Vier ◽  
Scott Coleman ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Step Length ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Post Surgery ◽  
Long Term Follow Up ◽  
Gait Function

Category: Ankle, Ankle Arthritis Introduction/Purpose: Operative treatment of end-stage ankle arthritis involves either ankle arthrodesis (AA) or total ankle arthroplasty (TAA). The theoretical benefit of TAA is the ability to preserve range of motion (ROM) at the tibiotalar joint. Previous studies have questioned whether it is justified to perform TAA over AA in stiff, arthritic ankles. However, a recent study showed that patients who underwent TAA with stiff ankles preoperatively experienced significant clinical improvement in range of motion and gait function compared to more flexible groups at 1-year follow-up. We retrospectively assessed these same gait and functional parameters to see if these improvements held up in long-term follow-up. Methods: A retrospective study of long-term, prospectively collected functional gait data in 33 TAA patients at a mean of 7.6 years postoperatively (range 4.8-13.3) used a multivariate regression model to determine the effect of ankle stiffness on the long- term, objective outcomes of TAA. Data was analyzed by quartiles (Q1, Q2+Q3, Q4) of preoperative sagittal ROM using one-way analysis of variance (ANOVA) to compare both preop and postop gait parameters. The two middle quartiles were combined to conform to distribution of the data. The multivariate analysis determined the independent effect of age, gender, BMI, years post- surgery, and preop ROM on every preop and postop parameter of gait. Results: Statistically significant differences were found in all three gait parameter categories, including temporal-spatial (step length and walking speed), kinematic (total sagittal ROM and maximum plantarflexion), and kinetic (peak ankle power). The stiffest ankles preoperatively (Q1) had the greatest absolute increase in total sagittal ROM postoperatively, +5.3o, compared to -1.3o (p<0.0174) in Q4 (most flexible). However, Q1 had the lowest absolute total postoperative sagittal ROM of 13.1 o, compared to 19.7 o (p<0.0108) in Q4. Q1 also had the lowest preoperative step length, walking speed, maximal plantarflexion, and peak ankle power when compared to the other subgroups. There was no difference in any of these same parameters postoperatively. BMI and years post-surgery had no effect on outcomes, while age and gender had a minimal effect. Conclusion: Preoperative range of motion was once again predictive of overall postoperative gait function in long-term follow-up at an average of 7.2 years. A greater degree of preoperative sagittal range of motion was predictive of greater postoperative sagittal range of motion in long-term follow-up. Patients with the stiffest ankles preoperatively once again had a statistically and clinically greater improvement in function as measured by multiple parameters of gait. This shows that the clinically meaningful improvement in gait function after total ankle arthroplasty holds up in long-term follow-up, even in the setting of limited preoperative sagittal range of motion.

scholarly journals Mid- to Long-term Follow-up of Total Ankle Arthroplasty using Salto Talaris Implant

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Chelsea S. Mathews ◽  
James S. Davitt ◽  
J. Chris Coetzee ◽  
Daniel Norvell ◽  
William R. Ledoux ◽  
...  
Keyword(s):  
Physical Function ◽  
Total Ankle Arthroplasty ◽  
Long Term Results ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
End Stage

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) continues to be investigated as a primary treatment for end-stage ankle arthritis. The objective of this study was to report mid- to long-term results of the Salto Talaris TAA using patient reported outcomes and retention rates with mid- to long-term follow up. Methods: This was a multicenter retrospective study using prospectively collected data. 316 patients received a Salto Talaris TAA at one of three institutions from 2005-2015 were included in the study. Outcomes included subdomain scores of the SF-36 (bodily pain and physical function) and adverse events including additional surgeries or revision/removal of components. Results: Statistically significant improvements were seen in pain and physical function scores at 2 year follow up and were maintained through most recent follow-up. Retention rate of the prosthesis was >95% in all patients (30/32 at > 10 years, 272/284 at 4.5-10 years). 14 patients underwent revision or removal of prosthesis. 15 patients had additional surgery that did not involve revision or removal of components. Conclusion: Treatment of end-stage ankle arthritis with the Salto Talaris implant provides patients with improved pain and functional outcome scores in long-term follow up. Low revision rates demonstrate the durability of this prosthesis.

Ankle Range of Motion Following 3-Component Total Ankle Arthroplasty

2020 ◽  
pp. 107110072095514
Author(s):  
Roxa Ruiz ◽  
Nicola Krähenbühl ◽  
Roman Susdorf ◽  
Tamara Horn-Lang ◽  
Alexej Barg ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Current Data ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Ankle Motion ◽  
Long Term Follow Up ◽  
End Stage

Background: Although surgeons have argued that preserving motion at the level of the ankle joint may be crucial for the long-term success in the treatment of end-stage ankle osteoarthritis, there is little evidence regarding the potential of total ankle arthroplasty (TAA) to increase ankle range of motion (ROM). In addition, the effect of a percutaneous heel cord lengthening (HCL) during TAA on ankle motion is poorly understood. Methods: A total of 357 primary TAAs treated with a 3-component device (336 patients, mean age 62.6 [24-85] years) performed between May 2003 and November 2017 were retrospectively analyzed. Sagittal ankle ROM was assessed according to a previously published protocol preoperatively (PreOP), 1 year postoperatively (PostOP), and at the last available follow-up (LastFU). Pain assessed on a visual analog scale (VAS) was assessed at the same time points. The effect of a percutaneous HCL on ankle ROM and VAS for pain was also evaluated. Results: Preoperative ankle ROM increased from mean 31.3 (0-69) to 33.9 (5-65) degrees 1 year postoperatively ( P = .0002) and decreased to 31.9 (5-70) degrees at the LastFU ( P = .007). Percutaneous HCL showed no effect on ankle ROM development after TAA ( P = .141). Ankle ROM improvement after TAA (PreOP to LastFU) was higher in ankles with lower preoperative ankle motion ( P < .0001). A lower ankle ROM at the last follow-up tended to be associated with a higher pain level ( P = .056). Conclusion: Although ankles with a lower preoperative sagittal ROM gained motion, the current data suggest that TAA has little potential to increase the preoperative available ankle motion. In some patients with a high preoperative ankle ROM, a slight decrease of ankle motion was observed postoperatively. Patients with limited ankle motion at long-term follow-up tended toward experiencing higher pain levels. The short- and long-term effect of a percutaneous HCL on ankle ROM following TAA was minimal. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Radiographic and Clinical Analysis of the Salto Talaris Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Jonathan Day ◽  
Jaeyoung Kim ◽  
Andrew R. Roney ◽  
Jonathan H. Garfinkel ◽  
Scott J. Ellis ◽  
...  
Keyword(s):  
Total Ankle Arthroplasty ◽  
High Survival ◽  
X Rays ◽  
Ankle Arthritis ◽  
Term Survival ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
Component Revision

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) has garnered significant interest and increased use over the past decade, with advancements made in both design and surgical technique. The main advantage of TAA for the surgical treatment of ankle arthritis is to preserve range of motion compared to ankle arthrodesis. Among the criteria guiding the choice between arthroplasty and arthrodesis, the long-term survival and postoperative outcomes are of crucial importance. The Salto Talaris is a fixed-bearing implant first approved in the US in 2006, and long-term survivorship data is limited. The purpose of this study is to determine minimum 5-year survivorship of the Salto Talaris prosthesis and causes of failure. In addition, we evaluate long-term radiographic and patient-reported outcomes. Methods: We retrospectively identified 86 prospectively followed patients from 2007 to 2014 who underwent TAA with the Salto Talaris prosthesis at our institution. Of these, 81 patients (84 feet) had a minimum follow-up of 5 years (mean, 7.1; range, 5 to 12). Mean age was 63.5 years (range, 42 to 82) and mean BMI was 28.1 (range, 17.9 to 41.2). Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Chart review was performed to record incidences of revision and reoperation. Preoperative, immediate and minimum 5-year postoperative x-rays were reviewed; coronal tibiotalar alignment (TTA) was measured on standing AP radiographs to assess alignment of the prosthesis. A TTA of +-5° from 90° indicated neutral alignment, while <85° and >95° was considered varus and valgus alignment, respectively. Radiographic subsidence as well as presence and location of periprosthetic cysts were documented. Pre- and minimum 5-year FAOS domains were compared. Results: Survivorship was 97.6% with two revisions. One patient underwent tibial and talar component revision for varus malalignment of the ankle, another underwent talar component revision for aseptic loosening and subsidence. The rate of other reoperations was 19.5% (18) with the main reoperation being exostectomy with debridement for ankle impingement (12). Average preoperative TTA was 88.8° with 48 neutral (average TTA of 90.1°), 18 varus (82.3°) and 8 valgus (99.6°) ankles. Average postoperative TTA was 89.0° with 69 neutral (89.7°), 6 varus (83°), and 1 valgus ankle (99.3°). Radiographic subsidence was observed in one patient who underwent revision, and periprosthetic cysts were observed in 18 patients. There was significant improvement in all FAOS domains at final follow-up. Conclusion: This is the largest study to date dedicated to evaluating survivorship of the Salto Talaris prosthesis. Our data reflects a high survival rate and moderate reoperation rate with long-term follow-up of the Salto Talaris implant. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at minimum 5-year follow-up.

Total Ankle Arthroplasty in Rheumatoid Arthritis: A Long-term Follow-up Study

Foot & Ankle ◽  
1988 ◽  
Vol 8 (4) ◽  
pp. 173-179 ◽  
Author(s):  
Anthony S. Unger ◽  
Allan E. Inglis ◽  
Christopher S. Mow ◽  
Harry E. Figgie
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Cement ◽  
Total Ankle Arthroplasty ◽  
Radiographic Analysis ◽  
Ankle Arthroplasty ◽  
Follow Up Study ◽  
Long Term Follow Up

Patients with rheumatoid arthritis who had undergone total ankle arthroplasty and had a minimum of 2 yr follow-up were studied. Of the original 21 patients 17 were available for review. Twenty-three ankle replacements with an average follow-up of 5.6 yr were studied. On follow-up 2 ankles were rated excellent, 13 were rated good, 4 were rated fair, and 4 were rated poor. Thus, 83% were satisfactory on follow-up. Radiographic analysis revealed migration and settling of the talar component in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 cases. Bone cement radiolucencies were found in 14 of 15 tibial components with tilting in 12 of these components. The postoperative position of the implant did not correlate with the development of radiolucencies or migration of the implant.

scholarly journals Radiographic and Clinical Analysis of the INBONE II Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
Jonathan Day ◽  
Jaeyoung Kim ◽  
Scott J. Ellis ◽  
Jonathan T. Deland ◽  
Martin J. O’Malley ◽  
...  
Keyword(s):  
Clinical Analysis ◽  
Total Ankle Arthroplasty ◽  
High Survival ◽  
X Rays ◽  
Ankle Arthritis ◽  
Term Survival ◽  
Ankle Arthroplasty ◽  
Patient Reported

Category: Ankle Arthritis; Ankle Introduction/Purpose: The use of total ankle arthroplasty (TAA) in the treatment of ankle arthritis has grown substantially as advancements are made in design and surgical technique. Among the criteria guiding the choice between arthroplasty versus arthrodesis, the long-term survival and postoperative outcomes are of crucial importance. First FDA approved in 2005, the INBONE I prosthesis was subsequently replaced by the INBONE II in 2010. While outcomes of the INBONE I have been published, there is limited long-term survivorship data for the INBONE II. The purpose of this study is to determine the minimum 5-year survivorship of the INBONE II prosthesis and causes of failure. In addition, we evaluate long-term radiographic and patient- reported outcomes. Methods: We retrospectively identified 46 prospectively followed patients from 2010 to 2015 who underwent TAA with the INBONE II prosthesis at our institution. Of these, 44 cases (41 patients) had minimum follow-up of 5 years (mean, 6; range, 5 to 9). Mean age was 65.6 years (range, 42 to 81) and mean BMI was 27.6 (range 20.1 to 33). Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Chart review was performed to record incidences of revision and reoperation. Preoperative, immediate and minimum 5-year x-rays were reviewed; coronal tibiotalar alignment (TTA) was measured on standing AP radiographs to assess alignment of the prosthesis. A TTA of +-5° from 90° indicated neutral alignment, while <85° and >95° was considered varus and valgus alignment, respectively. Radiographic subsidence as well as presence and location of periprosthetic cysts were documented. Pre- and minimum 5-year FAOS domains were compared. Results: Survivorship was 97.7% with one revision of the talar component due to aseptic loosening and subsidence. The rate of other reoperations was 4.5% (2); one patient underwent medializing calcaneal osteotomy for valgus heel alignment, another patient underwent ostectomy and debridement for ankle impingement. Average preoperative TTA was 88.5 degrees with 15 neutral (average TTA of 89.7°), 14 varus (74°) and 12 valgus (104°) ankles. Average postoperative TTA was 88.6° with 35 neutral (89.3°), 6 varus (84.7°), and no valgus ankles. Radiographic subsidence was observed in one patient who underwent revision, and periprosthetic cysts were observed in 7 patients. There was significant improvement in all FAOS domains at final follow-up. Conclusion: This is the largest study to date dedicated to evaluating survivorship of the INBONE II prosthesis. Our data suggests a high survival rate and low reoperation rate with long-term follow-up of the INBONE II implant. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at minimum 5-year follow-up.

Long-term follow-up of Bologna-Oxford (BOX) total ankle arthroplasty

2021 ◽  
Author(s):  
Alberto Bianchi ◽  
Nicolò Martinelli ◽  
Eleonora Caboni ◽  
Giorgio Raggi ◽  
Francesca Manfroni ◽  
...  
Keyword(s):  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Long Term Follow Up

scholarly journals Long Term Functional Outcomes after Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0014
Author(s):  
James W. Brodsky ◽  
Daniel J. Scott ◽  
Samuel E. Ford ◽  
Scott Coleman ◽  
Yahya Daoud
Keyword(s):  
Gait Analysis ◽  
Functional Outcomes ◽  
Walking Speed ◽  
Step Length ◽  
Total Ankle Arthroplasty ◽  
Initial Contact ◽  
Ankle Arthroplasty ◽  
Objective Functional

Category: Ankle; Ankle Arthritis; Hindfoot Introduction/Purpose: In vivo gait analysis is the objective functional measurement compared to subjective patient-reported outcomes. Intermediate-term gait studies showed positive results of Total Ankle Arthroplasty (TAA). To date, there are no published Long-Term functional outcomes of TAA. Methods: Three-dimensional gait analysis with twelve-camera digital-motion capture system and double force plates recorded temporal-spatial (TS), kinematic (KM), and kinetic (KN) measures, in 33 patients who had STAR (28) or Salto Talaris (5) TAA, done pre-operatively and at intervals post-operatively, with last testing at a mean of 7.6 years. Almost half the patients had 8-13 year follow up. Results: Improvements were found in multiple gait parameters, with TS increases in cadence, (+9.5 steps/min; P <0.001), step length (+4.4 cm; P = 0.001) and walking speed (+0.2 m/s; P<0.001), KM increases in total ROM (+2.0 deg; P = 0.026), plantarflexion at initial contact (+2.7 deg; P=0.004), and maximum plantarflexion (+2.0 deg; P=0.049), and KN analysis showed no loss of ankle power, despite patients’ aging. When examining 15 patients with 8 to 13 year follow-up (mean 10.3 years), there were gains in cadence (+9.8 steps/min, p=0.003), step length (3.6 cm, p=0.024), and walking speed (0.17 m/s, p=0.003), and preservation of the increased sagittal ROM of 2.0 deg. The only difference between prostheses was increased dorsiflexion at initial contact in the STARs vs SALTOs (5.9 degrees, p=0.014). Conclusion: This is the first study to report long-term, objective, functional outcomes of TAA, as measured by 3-D digital gait analysis. Even at a decade or more after TAA, patients had sustained improvement in multiple, objective parameters of gait compared to their preoperative function.

scholarly journals A Retrospective Analysis of Results and Outcomes after Cadence Total Ankle Arthroplasty Implanted through the End of 2017

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Brianna R. Fram ◽  
Ryan G. Rogero ◽  
Daniel Corr ◽  
David I. Pedowitz ◽  
Justin Tsai
Keyword(s):  
Range Of Motion ◽  
Repeated Measures ◽  
Failure Modes ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Component Loosening

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is an increasingly popular operative treatment of ankle arthritis, due to its ability to decrease adjacent joint degeneration and preserve gait mechanics compared to ankle arthrodesis. However, ankle arthroplasty components have a shorter mean longevity then their hip, knee, or shoulder counterparts. The Cadence TAA entered clinical use in 2016 and was designed to address common failure modes of prior systems. We report here on radiographic and clinical outcomes and early complications of the Cadence TAA system at a minimum of 2 years follow-up. Methods: Patients who underwent primary Cadence TAA from 2016 through 2017 by one fellowship-trained foot and ankle surgeon were eligible. Exclusion criteria included prior ipsilateral ankle arthrodesis or arthroplasty and lack of followup. Chart review was performed for eligible patients to identify complications and reoperations. Patients were contacted to obtain Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sport subscores, SF-12 Mental (MCS) and Physical Health (PCS) subscores, and Visual Analog Scale (VAS) pain levels (rated 0-100). Scores were analyzed with 2-sided repeated measures T- tests, with P<0.05 as significant. A second, blinded, fellowship-trained foot and ankle surgeon evaluated followup 5-view radiographs of each ankle to measure range of motion (ROM), alignment, peri-implant osteolysis, and component loosening or subsidence. Subsidence or loosening were defined, respectively, as >2mm or >2⁰ change in position for the tibial component and >5mm or >5⁰ change for the talar component. Results: Sixty patients were included with mean age 64 and mean BMI 32.0. Thirty patients (50%) had concurrent other procedure(s). FAAM-ADL, FAAM-Sports, SF-12 PCS, and VAS pain scores all improved significantly at mean 2.24 years post-op (Table 1). Ten patients (6.7%) had operative complications requiring 15 surgeries (mean 265 days to first reoperation). Three patients (5%) required removal of one or both components, for 2-year implant survival of 95.0%. Two revisions were for infection and one for osteolysis. This produced a mechanical failure rate of 1/60 (1.7%). Radiographic analysis revealed average coronal alignment improved from 7.4⁰ from neutral preoperatively to 2.2⁰ postoperatively. Average ROM was 36.5⁰ total arc of motion. One of 38 (2.6%) had signs of peri-implant osteolysis, with no cases demonstrating loosening or subsidence. Conclusion: Two-year follow-up of the Cadence TAA system demonstrates mechanically stable implants resulting in improved patient function and preserved ankle range of motion. Outcomes compare favorably to those of other TAA systems at 2-year follow-up. Further radiographic and clinical follow-up are needed to evaluate implant longevity and long-term patient functional outcomes. [Table: see text]

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