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

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.

Download Full-text

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00215 ◽

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]

Download Full-text

Multi-Segment Foot and Ankle Gait Kinematics Following Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00489 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0048

Author(s):

Dylan Wiese ◽

Jessica M. Fritz ◽

Karl Canseco ◽

Carolyn M. Meinerz ◽

Katherine Konop ◽

...

Keyword(s):

Stance Phase ◽

Swing Phase ◽

Total Ankle Arthroplasty ◽

Foot And Ankle ◽

Ankle Arthritis ◽

Control Data ◽

Kinematic Data ◽

Ankle Arthroplasty ◽

Gait Kinematics

Category: Ankle Arthritis; Ankle. Introduction/Purpose: Ankle arthritis is a painful disease resulting in limited function, mobility, and quality of life.1 Total ankle arthroplasty (TAA) a widely accepted treatment to reduce pain while maintaining joint motion.2,3 There are two common types of implants: fixed bearing (FB) and mobile bearing (MB). Comparisons of these implants have shown similar patient and clinical outcomes;4 however, post-operative gait kinematics from a multi-segment foot and ankle model have not been compared. This study assessed multi-segmental foot and ankle gait kinematics between persons following TAA with MB and FB implants and compared them to control data of adult ambulators without lower extremity pathology. Methods: This was a prospective analysis of persons who had previously underwent TAA with a MB (n=6; average follow-up period of 2.5 years) implant. After consenting to the IRB-approved study, participants were fitted with reflective markers for the Milwaukee Foot Model (MFM).5 Participants walked barefoot along a 30-foot walkway at a comfortable, self-selected pace for a minimum of ten trials while twelve infrared motion capture cameras recorded data. Kinematic data from the MB group and historical data from a FB population who underwent the same protocol with the MFM (n=7; average follow-up period of 2 years) were compared to control data (n=37). Welch’s two-tailed t-tests were used to calculate statistical significance at an alpha level of 0.05. Deviation from control data was compared between both implant groups. Results: In the MB group, sagittal motion of the hindfoot, forefoot, and hallux were significantly different from control for the majority of stance. The only significant MB group swing phase differences were early swing sagittal kinematics in the tibia, forefoot, and hallux segments. The FB data differed significantly for the majority of stance phase for sagittal tibia motion, all hindfoot planes, sagittal and coronal forefoot motion, and all hallux planes. The FB group kinematics also significantly differed throughout most of swing phase across all planes and segments, except coronal hindfoot motion. All FB kinematic data deviated further from control than the MB data except stance phase coronal tibia and transverse forefoot motion, where the data overlapped (Figure 1). Conclusion: Multi-segment foot and ankle gait kinematics following TAA showed the MB implant better restores healthy ambulatory motion than the FB implant. Abnormal stance phase kinematics lead to altered joint loading. This can accelerate adjacent joint arthritis, which has been seen following ankle arthrodesis.6 Both populations showed diminished forefoot plantarflexion throughout gait, compensating for decreased hindfoot dorsiflexion. Because the joints are not heavily loaded during swing phase, the primary concerns of alterations are regarding ground clearance and foot position prior to the next step. The MB implant better restores normal gait, minimizing compensations and likely decreasing arthritis-inducing stress on adjacent joints.

Download Full-text

Does Gender Influence the Outcomes of Total Ankle Arthroplasty in Patients with Ankle Osteoarthritis?

10.21203/rs.3.rs-17831/v1 ◽

2020 ◽

Author(s):

Gun-Woo Lee ◽

Keun-Bae Lee

Keyword(s):

Mobile Bearing ◽

Total Ankle Arthroplasty ◽

Complication Rates ◽

Foot And Ankle ◽

Ankle Osteoarthritis ◽

Ankle Arthroplasty ◽

Gender Influence ◽

Implant Survivorship ◽

American Orthopaedic

Abstract Background Total ankle arthroplasty has progressed as a treatment option for patients with ankle osteoarthritis. However, no studies have been conducted to evaluate the effect of gender on the outcome. The purpose of the present study was to evaluate outcomes, survivorship, and complications rates of total ankle arthroplasty, according to gender differences. Methods This study included 187 patients (195 ankles) that underwent mobile-bearing HINTEGRA prosthesis at a mean follow-up of 7.5 years (range, 4 to 14). The two groups consisted of a men’s group (106 patients, 109 ankles) and a women’s group (81 patients, 86 ankles). Average age was 64.4 years (range, 45 to 83). Results Clinical scores on the Ankle Osteoarthritis Scale for pain and disability, and American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved and were not significantly different between the two groups at the final follow-up. There were no significant differences in complication rates and implant survivorship between the two groups. The overall survival rate was 96.4% in men and 93.4% in women at a mean follow-up of 7.5 years (p=0.621). Conclusions Clinical outcomes, complication rates, and survivorship of total ankle arthroplasty were comparable between men and women. These results suggest that gender did not seem affect outcomes of total ankle arthroplasty in patients with ankle osteoarthritis.

Download Full-text

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00009 ◽

2020 ◽

Vol 5 (2) ◽

pp. 2473011420S0000

Author(s):

Evan M. Loewy ◽

Robert B. Anderson ◽

Bruce E. Cohen ◽

Carroll P. Jones ◽

W. Hodges Davis

Keyword(s):

Tibial Component ◽

Total Ankle Arthroplasty ◽

Coronal Plane ◽

Third Generation ◽

Fixed Bearing ◽

Ankle Arthritis ◽

Central Sulcus ◽

Ankle Arthroplasty ◽

Plane Deformity

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.

Download Full-text

Accuracy and Reproducibility of a Patient-Specific Instrumentation in Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00107 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0010

Author(s):

Pierre-Marc April ◽

Philippe Hugo Champagne ◽

Magalie Angers ◽

Karl-Andre R. Lalonde ◽

Brad Meulenkamp ◽

...

Keyword(s):

Tibial Component ◽

Total Ankle Arthroplasty ◽

Patient Specific ◽

Foot And Ankle ◽

Ankle Arthritis ◽

Ankle Arthroplasty ◽

Component Size ◽

Patient Specific Instrumentation ◽

Operation Rate ◽

Accuracy Of Prediction

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis (OA) is a frequent and debilitating disease with the two primary surgical options being ankle arthrodesis or total ankle arthroplasty (TAA). TAA has the advantages maintenance of range of motion (ROM), a more normalized gait and potentially improved functional outcome over arthrodesis. Malaligned protheses have been demonstrated to have increased peak component pressures, potentially leading to component loosening, failure and overall worse outcomes. One TAA system uses pre-op CT to build patient-specific surgical instrumentation, with purported benefit of more reliable and accurate component positioning. The goal of this study is to evaluate reproducibility and accuracy of this system by surgeons without affiliation with the prosthesis design team. Methods: A retrospective radiological study was performed including two centers with four fellowship-trained foot and ankle surgeons using the patient-specific TAA system. All patients operated on between 2015-2018 were included. The primary outcome was alignment of the tibial implant in coronal and sagittal orientation relative to the tibia anatomic axis. All measurements were performed in duplicate an orthopaedic foot and ankle fellow and a musculoskeletal fellowship-trained radiologist. Secondary outcomes included accuracy of prediction of tibial and talar component size implanted compared to the engineered pre-operative plan, rate of prosthesis revision (at least one component) and overall re-operation rate. Results: 79 patients were included in the final review. The mean absolute deviation of the tibial component from tibial anatomical axis was 1.31° +/- 1.14in the coronal plane and 2.68°+/- 1.74 in sagittal alignment. 94.7 % of the implants were implanted within 3°of varus or valgus and 73.7% within 3°of dorsiflexion or plantiflexion. 86 % of the implanted tibial component were of the size predicted by the pre-op plan whereas it was found to be the case in 63 % of the talar component.At a mean follow-up of 22 months(3-52), two TAA (2.5%) have been revised due to aseptic tibial implant loosening. Conclusion: The patient-specific guide has been found to be a reliable system for coronal tibial implant alignment but less in the sagittal plane in the hand of surgeons not involved in the design of any TAA system. Accuracy of prediction of the tibial component size is high, moderate on the talar side. In this series there was a low rate of early component revision (2.5 %).

Download Full-text

Tibial Torsion May Predict Morphology of the Talus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00171 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0017

Author(s):

David J. Ciufo ◽

Erin A. Baker ◽

Paul T. Fortin

Keyword(s):

Preoperative Planning ◽

Total Ankle Arthroplasty ◽

Patient Specific ◽

Tibial Rotation ◽

Foot And Ankle ◽

Tibial Torsion ◽

Ankle Arthritis ◽

Body Angle ◽

Ankle Arthroplasty ◽

End Stage

Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: The role of implant positioning in total ankle arthroplasty (TAA) has garnered increasing attention, particularly in defining coronal and sagittal plane alignment. With the ongoing developments in patient specific instrumentation, advanced imaging is becoming a more common tool in preoperative planning. Despite this, there is limited information available on axial rotation of the ankle or variations in anatomy of the talus and foot. We aim to evaluate the rotational profile of the distal tibia and its relationship to morphology of the talus, as well as assess tibiotalar tilt, in a cohort of end-stage arthritic ankles. Methods: Computed tomography (CT) scans and plain radiographs were reviewed in 59 patients with end-stage ankle arthritis. Patients with previous tibial or ankle trauma were excluded. Scans were obtained prior to total ankle arthroplasty surgery as part of standard preoperative planning protocol. Demographic data was recorded. Measurements were obtained at the posterior condyles of the tibial plateau and transmalleolar axis to calculate tibial torsion, as well as along the talar neck and body to evaluate talar angle. Tibiotalar tilt angle was measured on weightbearing mortise view radiographs. Linear regression was performed to evaluate statistical associations between tibial torsion and other measured parameters. Results: The mean tibial torsion was 29.5±9.2 degrees external (range 13.6-50.8 degrees), no internal torsion was found. Mean talar neck-body angle was 38.2±8.8 degrees medial (range 24.1-59.5 degrees). Tibiotalar angle ranged from 26.5 degrees varus to 23.5 degree valgus. There was a statistically significant relationship between increasing tibial torsion and decreasing talar neck-body angle (r=-0.49, p<0.001), demonstrating more angulation of the talar neck corresponding to the least tibial torsion as seen in Figure 1. No relationship was found between tibial rotation and tibiotalar angle when assessing varus/valgus tilt on a spectrum (p=.89) or when evaluating absolute angulation from neutral (p=.43). Our cohort had a mean age of 63.1±8.2 years, and 54% were male. Conclusion: Our cohort displayed wide variation in axial anatomy of the ankle. Our analysis identifies a statistically significant correlation between tibial torsion and morphology of the talus. This is a previously unreported association that could help understand development of foot and ankle deformity and pathology. While there was no clear correlation to degree of tibiotalar angulation, these axial deformities surely play a role in altered foot and ankle mechanics and the development of end-stage ankle arthrosis. In patients undergoing ankle arthroplasty, these are important parameters for the surgeon to consider in conjunction with other aspects of the hindfoot deformity.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Comparison of Intermediate-term Outcomes of Total Ankle Arthroplasty in Primary and Ligamentous Post-traumatic Osteoarthritis

Foot & Ankle International ◽

10.1177/1071100719866472 ◽

2019 ◽

Vol 40 (11) ◽

pp. 1273-1281 ◽

Cited By ~ 2

Author(s):

Gun-Woo Lee ◽

Asep Santoso ◽

Keun-Bae Lee

Keyword(s):

Short Form ◽

Total Ankle Arthroplasty ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

Radiographic Outcomes ◽

Primary Osteoarthritis ◽

Post Traumatic ◽

American Orthopaedic ◽

End Stage

Background: Ankle ligamentous injuries without fracture can result in end-stage ligamentous post-traumatic osteoarthritis, which may cause ligamentous imbalance after total ankle arthroplasty (TAA). However, outcomes of TAA in these patients are not well known. The purpose of this study was to evaluate intermediate-term clinical and radiographic outcomes of TAA in patients with ligamentous post-traumatic osteoarthritis and compare them with results of TAA for patients with primary osteoarthritis. Methods: We enrolled 114 patients (119 ankles) with consecutive primary TAA using HINTEGRA prosthesis at a mean follow-up duration of 6.0 years (range, 3-13). We divided all patients into 2 groups according to the etiology of osteoarthritis: (1) primary osteoarthritis group (69 ankles) and (2) ligamentous post-traumatic osteoarthritis group (50 ankles). Results: There was no significant intergroup difference in mean Ankle Osteoarthritis Scale (AOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Short Form-36 Physical Component Summary, visual analog scale pain score, ankle range of motion, or complications at the final follow-up. However, the final tibiotalar angle was less corrected to 4.2 degrees in the ligamentous post-traumatic osteoarthritis group compared to 2.7 degrees in the primary osteoarthritis group ( P = .001). More concomitant procedures were required at the index surgery for the ligamentous post-traumatic osteoarthritis group ( P = .001). The estimated 5-year survivorship was 93.4% (primary osteoarthritis group: 91.3%; ligamentous post-traumatic osteoarthritis group: 95.8%). Conclusions: Clinical outcomes, complication rate, and 5-year survivorship of TAA in ankles with primary and ligamentous post-traumatic osteoarthritis were comparable with intermediate-term follow-up. Our results suggest that TAA would be a reliable treatment in ankles with ligamentous post-traumatic osteoarthritis when neutrally aligned stable ankles are achieved postoperatively. Level of Evidence: Level III, retrospective cohort study.

Download Full-text

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]

Download Full-text