5 Year Follow Up Evaluation of a Third Generation Fixed Bearing Total Ankle Arthroplasty with an Intramedullary Tibial Component and a Central Sulcus Talus

Category: Ankle Arthritis, Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be a viable option in the treatment of end stage ankle arthritis (ESAA). Early reports demonstrated good results with intramedullary fixation implants. Third generation implants of this kind added a central sulcus to the talar component. This is a report of clinical follow up data from a prospectively collected database at a single US institution using a Third generation fixed bearing total ankle arthroplasty implant with a stemmed tibial component and a talar component with a central sulcus. To our knowledge, this is the first report of 5 year follow up data for this implant. Methods: Patients undergoing primary TAA at a single institution by one of four fellowship trained orthopedic foot and ankle surgeons with a Third generation fixed bearing implant consisting of an intramedullary stemmed tibial component and a sulcus talus that were at least 5 years postoperative were reviewed from a prospectively collected database. These patients were followed at regular intervals with history, physical examination and radiographs. All ankles were classified using the Canadian Orthopedic Foot and Ankle Society (COFAS) End-Stage Ankle Arthritis Classification System. The primary outcome was implant survivability. Secondary outcomes included pre- and postoperative coronal plane radiographic alignment, evaluation for osteolysis, and failure mode when applicable. All reoperation events were recorded using the COFAS Reoperations Coding System (CROCS). Results: 126 TAA with this implant were performed in 124 patients between 2010 and 2013; 74 met inclusion criteria for our study. The mean age at surgery was 61.6 +- 10.0 years (range 38.7-84.3). Four patients died with their initial implants in place. The mean duration of follow up for living patients that retained both initial components at final follow-up was 6.2 +- .9 years (range 4.7-8.1 years). 35% (26 of 74) of ankles had a preoperative coronal plane deformity of at least 10 degrees. 11% (8 of 74) of the ankles had a preoperative coronal plane deformity of at least 20 degrees. There were 6 (8%) implant failures that occurred at a mean 2.0 +- 1.4 years postoperative. Two failures were due to deep infection. One failure was related to talar component subsidence. All failures occurred in patients with =preoperative coronal plane deformity of less than 5 degrees. 81% (60 of 74) of TAA had no reoperation events in the follow up period. Conclusion: This cohort of TAA patients with minimum 5 year follow up using a third generation fixed bearing implant demonstrates acceptable implant survival, improved reoperation rates, and maintenance of coronal plane alignment. These data also suggest tolerance of a larger preoperative deformity with improved implant design. Continued follow up and reporting is needed to ensure that these favorable outcomes are maintained. Additionally, further investigation on acceptable coronal plane alignment correction with TAA is needed to determine the possible limitations of this procedure.

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Minimum 5 Year Follow-Up Evaluation of a Third Generation Fixed Bearing Total Ankle Arthroplasty with an Intramedullary Tibial Component and a Central Suclus Talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00278 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0027

Author(s):

Evan M. Loewy ◽

Robert B. Anderson ◽

Bruce E. Cohen ◽

Carroll P. Jones ◽

W. Hodges Davis

Keyword(s):

Tibial Component ◽

Patient Reported Outcomes ◽

Total Ankle Arthroplasty ◽

Coronal Plane ◽

Third Generation ◽

Fixed Bearing ◽

Ankle Arthroplasty ◽

Patient Reported ◽

The Mean

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be a viable option in the treatment of end stage ankle arthritis (ESAA). Early reports demonstrated good results with intramedullary fixation implants. Third generation implants of this kind added a central sulcus to the talar component. This is a report of clinical follow up data from a prospectively collected database at a single US institution using a third generation fixed bearing total ankle arthroplasty implant with a stemmed tibial component and a talar component with a central sulcus. To our knowledge, this is the first report of 5 year follow up data for this implant. Methods: Patients undergoing primary TAA at a single institution by one of four fellowship trained orthopedic foot and ankle surgeons with a third generation fixed bearing implant consisting of an intramedullary stemmed tibial component and a sulcus talus that were at least 5 years postoperative were reviewed from a prospectively collected database. These patients were followed at regular intervals with history, physical examination and radiographs; multiple patient reported outcomes (PRO) measures were obtained. Primary outcomes included implant survivability and PRO scores. Secondary outcomes included coronal plane radiographic alignment (Medial distal tibial articular angle (MDTA) and talar tilt angle (TTA)), evaluation for osteolysis, and failure mode when applicable. All reoperation events were recorded using the Canadian Orthopedic Foot and Ankle Society (COFAS) Reoperations Coding System (CROCS). Results: 121 TAA with this implant were performed in 119 patients between 2010 and 2013; 64 met inclusion criteria. The mean age at surgery was 61.3 ± 10.0 years (range 38.7-84.3). The mean duration of follow up for living patients that retained both initial components at final follow-up was 6.1 ± 0.9 years (range 4.7 – 8.1 years). 26.6% of ankles had a preoperative MDTA and/or TTA greater than 10 degrees. There were 6 (9.4%) failures that occurred at a mean 2.0 ± 1.4 years postoperative. Two failures were due to deep infection. Only one failure was related to tibial component subsidence. One patient is currently scheduled for revision due to talar component subsidence. Conclusion: This cohort of TAA patients with minimum 5 year follow up using a third generation fixed bearing implant demonstrates acceptable implant survival, improved patient reported outcomes scores and maintenance of coronal plane alignment. These data also suggest tolerance of a larger preoperative deformity with improved implant design. To our knowledge, this is the first report with 5 year data on this implant. Continued follow up and reporting is needed to ensure that these favorable outcomes are maintained. Additionally, further investigation on acceptable coronal plane alignment correction with TAA is needed to determine the possible limitations of this procedure.

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Mid-Term (4-10 year) Outcomes of INBONE I Total Ankle Arthroplasty with Deformity Analysis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000190 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Andrew Harston ◽

James Nunley ◽

Mark Easley ◽

James DeOrio ◽

Samuel Adams ◽

...

Keyword(s):

Short Form ◽

Total Ankle Arthroplasty ◽

Coronal Plane ◽

Consecutive Series ◽

Ankle Arthroplasty ◽

Sf 36 ◽

Significant Difference ◽

Patient Reported ◽

Plane Deformity

Category: Ankle, Ankle Arthritis Introduction/Purpose: Concerns for limited coronal plane stability prompted the manufacturer and designers of the INBONE total ankle arthroplasty system to replace the original saddle-shaped talar component (INBONE I) with a sulcus-shaped talar component (INBONE II). Prior to the availability of the INBONE II talar component, numerous INBONE I total ankle replacements were performed. To our knowledge mid-term outcomes of INBONE I total ankle arthroplasty have not been reported. This study compares the mid-term outcomes of patients with and without preoperative coronal plane deformity who underwent total ankle replacement with the INBONE I prosthesis. In our opinion, the longer-term outcomes of the INBONE I prosthesis are important for patient and surgeon education. Methods: A consecutive series of patients, from May, 2007 to September, 2011, at a single institution who underwent total ankle arthroplasty with the INBONE I Total Ankle Arthroplasty (Wright Medical) were prospectively enrolled. Pain and patient- reported function were assessed preoperatively and at yearly follow-ups with use of a visual analog scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle- hindfoot score, the Short Musculoskeletal Function Assessment (SMFA), and the Short Form-36 (SF-36) Health Survey. We analyzed the data for complications, reoperations, and failures (defined as undergoing revision for exchange or removal of the metallic components for any reason). Patients were grouped according to coronal plane tibiotalar alignment (preoperative coronal plane malalignment of >10 degrees and <10 degrees deformity) and outcomes compared. Results: One-hundred fifty-five INBONE I prostheses were implanted in 151 patients, with minimum 4 year clinical and radiographic follow-up. Follow-up ranged from 48-113 months with an average of 67 months. There was significant (p<0.05) improvement in the VAS, AOFAS, SMFA, and SF-36 scores at most recent follow-up. Forty-five patients (29%) had 49 additional surgeries for impingement, loosening/subsidence, malalignment, ligament instability, polyethylene exchange, and/or infection. There were 14 implant failures with overall survivorship of 90.3%. There was no statistically significant difference in outcomes between patients with coronal plane deformity >10 degrees (47.7%) and <10 degrees (52.3%). Patients with >10 degrees had fewer reoperations (19 vs. 30) and fewer revisions (5 vs. 9) when compared to patients with <10 degrees deformity. Conclusion: Patients who underwent INBONE I total ankle arthroplasty demonstrated significant improvement in pain and patient-reported outcomes at a mean of 5.7 years post-operatively. The patients with preoperative coronal plane tibiotalar deformity had similar pain relief, function, and need for additional surgeries and revisions. Despite the presumed shortcomings of the INBONE I’s saddle-shaped talar design, this operation shows promising results, with or without deformity, at mid-term follow- up with survivorship of 90.3%.

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Analysis of the Effect of Tibial Stem Length on Coronal Plane Deformity of the Tibial Component in Total Ankle Arthroplasty

Foot & Ankle International ◽

10.1177/1071100719862744 ◽

2019 ◽

Vol 40 (10) ◽

pp. 1166-1174 ◽

Cited By ~ 1

Author(s):

Gregory C. Berlet ◽

Travis M. Langan ◽

Marissa D. Jamieson ◽

Allen M. Ferrucci

Keyword(s):

Tibial Component ◽

Case Series ◽

Total Ankle Arthroplasty ◽

Coronal Plane ◽

Stem Length ◽

Term Survival ◽

Ankle Arthroplasty ◽

Significant Difference ◽

Plane Deformity ◽

Stem Segments

Background:Coronal plane deformity is common in patients who undergo total ankle arthroplasty. The correction of this deformity is paramount to the long-term survival of the implant. Coronal plane correction is achieved with soft tissue balancing and, in some part, is maintained through articular geometry constraint. The purpose of this study was to assess the influence of tibial component stem length on the coronal plane stability.Methods:A consecutive case series of stemmed implants that met inclusion criteria were reviewed to determine the correction and maintenance of the correction of coronal plane deformity with special emphasis on the effect of modular tibial stem lengths of 2 and >2 segments. Twenty patients received a tibial component with 2 stem segments, and 23 patients received a tibial component with >2 stem segments. At an average patient age of 62.1 years at implantation, there was no significant difference between the 2 cohorts with respect to preoperative deformity or demographics.Results:Our case series had a mean coronal deformity of 5.7 degrees, with valgus being more common than varus. At a mean final radiographic follow-up of 266.3 days after the first postoperative weightbearing radiography, coronal deformity increased by 0.4 degrees ( P = .031). From the first postoperative measurement to the last postoperative measurement, there was no difference in mean coronal plane ankle deformity change between patients who received 2 stem segments and patients who received >2 stem segments ( t = −1.14, df = 41, P = .259).Conclusion:Coronal plane deformity had a tendency to recur, albeit at a much smaller angle than preoperatively. This recurrence of deformity did not occur because of tibial component movement. Tibial stem lengths of >2 segments did not influence the maintenance of correction of coronal plane deformity or the stability of the tibial component in the coronal plane.Level of Evidence:Level III, retrospective comparative series.

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Total Ankle Arthroplasty Results Using Fixed Bearing CT-Guided Implants in Post-Traumatic Versus Non-Traumatic Arthritis

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00097 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0009

Author(s):

Assaf Albagli ◽

Susan M. Ge ◽

Patrick Park ◽

Dan Cohen ◽

E. Ruth Chaytor ◽

...

Keyword(s):

Total Ankle Arthroplasty ◽

Patient Specific ◽

Foot And Ankle ◽

Fixed Bearing ◽

Ankle Arthritis ◽

Ankle Osteoarthritis ◽

Ankle Arthroplasty ◽

Traumatic Group ◽

Post Traumatic

Category: Ankle; Ankle Arthritis; Trauma Introduction/Purpose: The majority of ankle osteoarthritis are post-traumatic in etiology. Previous studies have shown that patients with post-traumatic ankle osteoarthritis are less satisfied, experience significantly more pain during normal activities and have higher revision rates. However, these studies were performed with older generation implants. The objective of this study was to compare patients hat had undergone total ankle arthroplasty secondary to either post-traumatic or non-traumatic etiologies using patient specific, third generation fixed bearing implants and compare clinical as well as radiographic outcomes. Methods: A retrospective chart review was conducted on 41 patients who had undergone total ankle arthroplasty using a third- generation fixed bearing implant with CT-based patient specific cutting guides from July 21, 2015 to December 13, 2017 performed by 2 foot and ankle surgeons. Demographic and operative data was collected. Etiology was determined based on clinical notes, operative notes, and x-rays. Clinical outcomes were obtained using the Foot and Ankle Ability Measure questionnaire. Radiographic assessment of the coronal and sagittal alignments were carried out to assess implant migration or loosening. Results: We had 26 patients in the post-traumatic group and 15 in the non-traumatic group with a mean follow-up of 32.5 months and 30.4 months respectively. There was no significant difference between both groups in terms of FAAM ADL subscore with the post-traumatic group did slightly better with 7 patients scoring ‘nearly normal’ (26.9%) and 18 patients scoring ‘normal’ (69.2%). Whereas in the non-traumatic group 5 patients score ‘nearly normal’ (33.3%) and 9 patients score ‘normal’ (60%). In terms of the self-rated subjective functioning score, mean score of 79.2% and 73.4% respectively. On radiographs, there was no subsidence or significant implant movement for both groups at mean follow-up of 28.3 months for the post-traumatic group and 26.3 months for the non-traumatic group. Conclusion: Unlike in previous studies in older implants where clinical outcomes were worse in post-traumatic ankle arthritis, our study showed that those receiving total ankle arthroplasty due to post traumatic osteoarthritis do slightly better than those with non-traumatic osteoarthritis, with more patients reporting normal levels of activity. These results may help quantify improvements in newer generation patient specific implants as well as to gain insight into how different implant designs affect post- operative outcomes based on etiology of ankle osteoarthritis.

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Should 15° of valgus coronal-plane deformity be the upper limit for a total ankle arthroplasty?

The Bone & Joint Journal ◽

10.1302/0301-620x.102b12.bjj-2020-0140.r1 ◽

2020 ◽

Vol 102-B (12) ◽

pp. 1689-1696

Author(s):

Mansur M. Halai ◽

Ellie Pinsker ◽

Matthew A. Mann ◽

Timothy R. Daniels

Keyword(s):

Short Form ◽

Valgus Deformity ◽

Total Ankle Arthroplasty ◽

Coronal Plane ◽

Ankle Arthroplasty ◽

Sf 36 ◽

Secondary Procedures ◽

Plane Deformity ◽

Short Form Health

Aims Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°. Methods A matched cohort of patients similar for demographics and components used but differing in preoperative coronal-plane tibiotalar valgus deformity ≥ 15° (valgus, n = 50; 52% male, mean age 65.8 years (SD 10.3), mean body mass index (BMI) 29.4 (SD 5.2)) or < 15° (control, n = 50; 58% male, mean age 65.6 years (SD 9.8), mean BMI 28.7 (SD 4.2)), underwent TAA by one surgeon. Preoperative and postoperative radiographs, Ankle Osteoarthritis Scale (AOS) pain and disability and 36-item Short Form Health Survey (SF-36) version 2 scores were collected prospectively. Ancillary procedures, secondary procedures, and complications were recorded. Results At mean 5.1 years follow-up (SD 2.6) (valgus) and 6.6 years (SD 3.3) (controls), mean AOS scores decreased and SF-36 scores increased significantly in both groups. Improvements in scores were similar for both groups – AOS pain: valgus, mean 26.2 points (SD 24.2), controls, mean 22.3 points (SD 26.4); AOS disability: valgus, mean 41.2 points (SD 25.6); controls, mean 34.6 points (SD 24.3); and SF-36 PCS: valgus, mean 9.1 points (SD 14.1), controls, mean 7.4 points (SD 9.8). Valgus ankles underwent more ancillary procedures during TAA (40 (80%) vs 13 (26%)) and more secondary procedures postoperatively (18 (36%) vs 7 (14%)) than controls. Tibiotalar deformity improved significantly (p < 0.001) towards a normal weightbearing axis in valgus ankles. Three valgus and four control ankles required subsequent fusion, including two for deep infections (one in each group). Conclusion Satisfactory mid-term results were achieved in patients with preoperative valgus malalignment ≥ 15°, but they required more adjunctive procedures during and after TAA. Valgus coronal-plane deformity ≥ 15° is not an absolute contraindication for TAA if associated deformities are addressed. Cite this article: Bone Joint J 2020;102-B(12):1689–1696.

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Axial Rotational Alignment of Mobile-Bearing Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00216 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0021

Author(s):

Beat Hintermann ◽

Lukas Zwicky ◽

Christine Schweizer ◽

Alexej Barg ◽

Roxa Ruiz

Keyword(s):

Tibial Component ◽

Mobile Bearing ◽

Total Ankle Arthroplasty ◽

Axial Position ◽

Anterior Surface ◽

Ankle Arthroplasty ◽

Medial Border ◽

Wide Range ◽

Angle Of Rotation

Category: Ankle Arthritis Introduction/Purpose: In total ankle arthroplasty (TAA), component malpositioning is a major cause of implant failure, possibly due to the altered force patterns caused by the malpositioning which are then transmitted to the bone-implant interface or neighboring joints during physiological loading. Mobile-bearing TAA with their second interface, may allow the talus to adapt its position based upon the individual anatomy. However, no data exist on the change in component positioning after implantation. It is unclear whether it is the result of initial positioning during implantation or secondary adjustments such as possible soft tissue adaptions. We aimed to determine the relative axial rotation between the talar and tibial components at the end of surgery and after a minimum of 3 years follow-up. Methods: The relative rotation between the tibial and talar components was measured in two groups. First, intraoperatively before wound closure, in a consecutive series of 58 patients (60 ankles; age 61.8 [31 to 86] years; females 25, males, 35) who underwent TAA between February and November 2018. A K-wire inserted along the medial border of the tibial component and a rectangular marker positioned at the anterior surface of PE insert were used to determine the angle of rotation. Second, in 48 patients (48 ankles; age 60.2 [31 - 82] years; females, 24; males, 24) out of 1411 patients who underwent TAA between January 2003 and December 2015, and in whom a weight-bearing CT scan was taken for evaluation at 6.3 (range, 3.0 -16.3) years. The medial border of the tibial component and a perpendicular line to the anterior surface of the PE insert were used to determine the angle of rotation. Results: The angle of rotation, thus the relative position of the talar component compared to the tibial component, did not differ between the two groups (p = 0.2). While the talus was internally rotated by 1.7 (range, -14.0 - 14.0) degrees at the end of surgery, it was internally rotated by 1.5 (range, -13.0 – 19.5) degrees after a minimum follow-up of 3 years (Figure 1). Conclusion: Although there was no significant difference in average axial position measured intraoperatively compared to a 3- years follow-up, there was a wide range of rotational measurements. The possibility of the talar component to find its position as given by individual anatomy may be crucial in TAA to avoid non-physiological joint loads and shear forces which may otherwise result in increased PE wear. Due to the wide range of measurements, our data suggests that axial talar rotation cannot be predicted preoperatively or intraoperatively by surgical techniques that reference the transtibial axis, tibial tuberosity and transmalleolar axis as guidance for tibial component positioning.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00013 ◽

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.

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Conversion of Ankle Fusions to Ankle Replacements

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00515 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0051

Author(s):

Stephen White ◽

Bruce Cohen ◽

Carroll Jones ◽

Michael Le ◽

W. Hodges Davis

Keyword(s):

Ankle Arthrodesis ◽

Total Ankle Arthroplasty ◽

Ankle Arthritis ◽

Ankle Arthroplasty ◽

Patient Reported ◽

Fusion Site ◽

Foot Function ◽

Patient Related Outcome ◽

Improved Function

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis remains a prominent treatment choice for ankle arthritis in a majority of patients. Long term studies have shown a compensatory development of ipsilateral adjacent joint arthritis after ankle arthrodesis, and some patients who receive an ankle arthrodesis develop pain in surrounding joints, or even at the fusion site. As total ankle arthroplasty (TAA) design, instrumentation, and techniques have improved, the use of total ankle arthroplasty has become more widespread. Very few studies have been published on conversion of ankle arthrodesis to ankle arthroplasty, but they have shown improved function and patient-related outcome scores. The purpose of this study was to assess the radiographic, clinical, and patient-reported outcomes of patients undergoing ankle arthroplasty after conversion from a CT-confirmed ankle arthrodesis. Methods: This was a retrospective cohort study of patients with previous CT-confirmed ankle arthrodesis who underwent conversion to total ankle arthroplasty. Minimum follow up was 1 year. Nonunions of ankle arthrodesis were excluded. AOFAS ankle-hindfoot score, foot function index (FFI), pain, revision surgeries, complications, and patient demographics were assessed. Radiographs prior to TAA, and at latest follow-up were also reviewed. Results: 10 patients were included in the study with an average age of 54.5 years. No implants had to be revised. 1/10 (10%) patients had to undergo secondary surgery for heterotopic ossification removal. The same patient had to undergo another subsequent surgery for posterior ankle decompression. 2/10 (20%) patients had a mild talar subsidence of the TAA at latest follow-up, with no patients having tibial subsidence. Talar osteolysis was noticed in 2 patients (20%) at latest follow-up, with no patients having tibial osteolysis. Only one patient (10%) was noted to have a mild valgus alignment of TAA with no varus malalignments. All radiographic changes noted were clinically asymptomatic. The average AOFAS total score was 58 (range 23,89). The mean FFI total score was 41.9 (range 0,90). Conclusion: Conversion of ankle fusion to TAA is a challenging operation but can be a viable option for patients with ongoing pain after an ankle arthrodesis. We noted low revision rates and few complications at 1 year.

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A Comparison of Cyst Formation and Management in Mobile-Bearing and Fixed-Bearing Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00005 ◽

2019 ◽

Vol 4 (2) ◽

pp. 2473011419S0000

Author(s):

James Lachman ◽

Michel Taylor ◽

Elizabeth Cody ◽

Daniel Scott ◽

James A. Nunley ◽

...

Keyword(s):

Bone Grafting ◽

Patient Reported Outcomes ◽

Mobile Bearing ◽

Cyst Formation ◽

Total Ankle Arthroplasty ◽

Fixed Bearing ◽

Ankle Arthroplasty ◽

Ankle Replacement ◽

Patient Reported

Category: Ankle Arthritis Introduction/Purpose: The Scandinavian Total Ankle Replacement(STAR) system and Salto Talaris(ST) total ankle system are two of the more commonly studied total ankle implants. As the STAR is one of the oldest total ankle arthroplasty (TAA) implants still in use today, most studies focus on longevity and survivorship. Reported rates of cyst formation for these two prosthesis in most series vary from 11-22% but no large study has focused on surgical management of these cysts or included patient reported outcomes after surgery. In this series, we aimed to investigate rates of cyst formation between mobile(MB) and fixed-bearing(FB) TAA and examine clinical and patient reported outcomes of bone grafting or cementing of large cysts surrounding the STAR and ST implants. Methods: A prospectively collected database at a high volume total ankle replacement center was retrospectively reviewed to identify patients who underwent TAA with either the STAR or the ST total ankle system between 2007 and 2015. Cysts were identified and measured on standard weight bearing radiographs and confirmed on computed tomography(CT) when available. Visual analog scale (VAS) score, Short Form-36 (SF-36) physical and mental component scores, Short Musculoskeletal Function Assessment(SMFA), and AOFAS hindfoot scores were collected from all patients preoperatively and then at 6 months, 1 year and annually postoperatively. Patients with a minimum 2 years follow-up who underwent revision TAA secondary to catastrophic bone cysts or who were managed with either curettage and bone grafting or curettage and cementing of bone cysts surrounding the TAA prosthesis were included in the patient reported outcomes (PRO) analysis Results: Excluding 53 patients for inadequate follow-up, 232 patients (29% female, 71% male; follow-up 6.7 years) who underwent STAR-TAA and 147 patients (26.6% female, 73.5% male; follow-up 7 years) who underwent ST-TAA were identified. Cysts <20 mm diameter occurred more often in the MB TAAs, and more often in the tibia than talus (table). Cysts >10 mm were identified in 95/232 (41%) STAR and 24/147 (16%) ST ankles. In the STAR group, 24 patients underwent cyst bone grafting (13), cementing (6) or both (8) at a mean 4.8 years. In the ST group, 14 patients underwent cyst bone grafting (6), cementing (4), or both (4) at a mean of 2.7 years. PRO data improved significantly for both the STAR and ST group in all questionnaires (p<0.05 for all). Conclusion: Mobile-bearing total ankle arthroplasty in this cohort had a higher rate of cyst formation greater than 10 mm (95/232 patients, 41%) when compared to a fixed-bearing TAA (24/147, 16.3%). Only 24/95 (25%) of STAR patients and 14/24 (58%) of ST patients required surgical intervention for cyst management. Patient reported outcomes after cyst surgery improved significantly when compared to pre-cyst management surgery and did not differ between MB and FB cohorts (p=0.424). Successful surgical management of large cyst surrounding either mobile-bearing or fixed-bearing total ankle systems can be expected based on the results of this study. [Table: see text]

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Radiographic Outcomes of Mobile-Bearing Total Ankle Arthroplasty for Patients With Rheumatoid Arthritis

Foot & Ankle International ◽

10.1177/1071100719851469 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1037-1042

Author(s):

Koichiro Yano ◽

Katsunori Ikari ◽

Ken Okazaki

Keyword(s):

Rheumatoid Arthritis ◽

Tibial Component ◽

Patient Reported Outcomes ◽

Mobile Bearing ◽

Total Ankle Arthroplasty ◽

Ankle Arthroplasty ◽

Radiographic Outcomes ◽

Significant Difference ◽

Patient Reported

Background: Ankle disorders in patients with rheumatoid arthritis (RA) reduce their quality of life and activities of daily living. The aim of this study was to evaluate the midterm clinical and radiographic outcomes of TAA in patients with RA. Methods: This retrospective study included patients with a minimum follow-up of 2 years. A total of 37 RA patients (39 ankles) were enrolled in this study from August 2006 to March 2016. All the patients had undergone primary cemented mobile-bearing total ankle arthroplasty (TAA). Nine ankles received arthrodesis of the subtalar joint simultaneously. Patient-reported outcomes were measured preoperatively and at the latest follow-up by Self-Administered Foot-Evaluation Questionnaire (SAFE-Q). Radiographs of the ankle were analyzed preoperatively and at all follow-up visits to measure the periprosthetic radiolucent line, migration of the tibial component, and the subsidence of the talar component. Intraoperative and postoperative complications were recorded. The average duration of follow-up for the entire cohort was 5.0 ± 2.0 years (range 2.1-10.1 years). Results: All subscales of the SAFE-Q had improved significantly at the latest follow-up. No significant difference was found between the range of motion of the ankle before and after the surgery. Radiolucent lines were observed in 28 (73.7%) ankles. Migration of the tibial component and subsidence of the talar component were found in 8 (21.1%) and 11 (28.9%) ankles, respectively. Intraoperative malleolus fractures occurred in 3 (7.7%) ankles and delayed wound healing in 10 (25.6%) ankles. Four ankles were removed because of deep infection or noninfective loosening, resulting in an implant survival rate of 88.4% (95% CI, 0.76-1.0) at 10 years. Conclusion: The midterm patient-reported outcomes and implant retention rate after cemented mobile-bearing TAA for RA patients were satisfactory. However, a low radiographic implant success rate was observed. Level of Evidence: Level IV, retrospective case series.

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