scholarly journals Trends in Total Ankle Replacement in Scotland

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Taegyeong T. Ha ◽  
Chinnasamy Senthil Kumar ◽  
Taegyeong T. Ha ◽  
Zoe Higgs ◽  
Chris Watling ◽  
...  
Keyword(s):  
Total Ankle Replacement ◽  
Implant Design ◽  
Time Period ◽  
Ankle Replacement ◽  
Inflammatory Arthropathy ◽  
Surgeon Experience ◽  
Picture Archiving And Communication ◽  
Patient Selection Criteria ◽  
Using Data ◽  
Over Time

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is performed for post-traumatic arthritis, inflammatory arthropathy, osteoarthritis and other indications. The Scottish Arthroplasty Project (SAP) began collection of data on TAR in 1997. In this study, using data from the SAP, we look at trends in the use and outcomes of TAR in Scotland. Methods: We identified 499 patients from the SAP who underwent TAR between 1997 and 2015 with imaging available on the National Picture Archiving and Communication System (PACS). We identified, and looked at trends in, implant type over the following time periods: 1998-2005; 2006-2010 and 2011-2015. Age, gender, indication and outcomes for each time period were examined and also trends with implant type over time. Results: There were 499 primary TAR procedures with an overall incidence of 0.5/105 population per year. The peak incidence of TAR was in the 6th decade. The mean age of patients undergoing TAR from 59 years in 1998-2005, to 65 years in 2011-15 (p<0.0001). The percentage of patients with inflammatory arthropathy was 49% in 1998-2005, compared with 10% in 2011-2015. Subsequent arthrodesis and infection rates appeared to be higher during the first time period. The female to male ratio also changed over time. The incidence of TAR increased overall during the study period (r= 0.9, p=<0.0001). This may be due to a broadening range of indications and patient selection criteria, in turn due to increased surgeon experience and the evolution of implant design. Conclusion: This study examines a large number of TARs from an established national arthroplasty database. The rate of TAR has increased significantly in Scotland from 1997 to 2015. Indication and patient age has changed over time and this could potentially impact outcomes after ankle replacement.

scholarly journals Finite-element analysis of the influence of tibial implant fixation design of total ankle replacement on bone–implant interfacial biomechanical performance

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902096612
Author(s):  
Jian Yu ◽  
Chao Zhang ◽  
Wen-Ming Chen ◽  
Dahang Zhao ◽  
Pengfei chu ◽  
...  
Keyword(s):  
Finite Element ◽  
Total Ankle Replacement ◽  
Implant Design ◽  
Fixation Method ◽  
Implant Loosening ◽  
Implant Fixation ◽  
Bone Resection ◽  
Bone Implant ◽  
Initial Stability ◽  
Ankle Replacement

Purpose: Implant loosening in tibia after primary total ankle replacement (TAR) is one of the common postoperative problems in TAR. Innovations in implant structure design may ideally reduce micromotion at the bone–implant interface and enhance the bone-implant fixation and initial stability, thus eventually prevents long-term implant loosening. This study aimed to investigate (1) biomechanical characteristics at the bone–implant interface and (2) the influence of design features, such as radius, height, and length. Methods: A total of 101 finite-element models were created based on four commercially available implants. The models predicted micromotion at the bone–implant interface, and we investigated the impact of structural parameters, such as radius, length, and height. Results: Our results suggested that stem-type implants generally required the highest volume of bone resection before implantation, while peg-type implants required the lowest. Compared with central fixation features (stem and keel), peripherally distributed geometries (bar and peg) were associated with lower initial micromotions. The initial stability of all types of implant design can be optimized by decreasing fixation size, such as reducing the radius of the bars and pegs and lowering the height. Conclusion: Peg-type tibial implant design may be a promising fixation method, which is required with a minimum bone resection volume and yielded minimum micromotion under an extreme axial loading scenario. Present models can serve as a useful platform to build upon to help physicians or engineers when making incremental improvements related to implant design.

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]

scholarly journals Brazilian Total Ankle Replacement Experience

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0011
Author(s):  
Daniel Baumfeld ◽  
André V. Lemos ◽  
César E. Martins ◽  
Caio A. Nery
Keyword(s):  
Personal Data ◽  
National Registry ◽  
Total Ankle Replacement ◽  
First Year ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Surgeon Experience ◽  
Post Traumatic ◽  
Traumatic Arthritis ◽  
Post Infectious

Category: Ankle Arthritis Introduction/Purpose: Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early TAR generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience, Brazilian surgeon could not participate in the development of the technique and implants designs during all these years. This paper present the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed. Methods: Data since the first series of TARs in Brazil were colect from university institution, personal data base from surgeons and previous publication, survivalship, complications, number of each implant and implant availability were recorded. Results: In Brazil, indications for TAR are not so different from around the world, the data we had access demonstrate 65% of post-traumatic arthritis, 26 % of inflammatory arthritis, 2% post-infectious arthritis and 7 % of primary arthritis. In fortheen years 263 surgeries were performed, in different parts of the country, but only one surgeon performed 43 cases (27,3% of the total). Table 1 demonstrate the number of procedures performed per year. Survivor rate of each implant available in the country in the first year were 94%, 86,19% in the second year, 82,84% in the third year, 81,62% in the fourth year and 71,47% in the fifth year. Conclusion: In Brazil there are limited and different ankle arthroplasty systems available for use. The procedure itself continues to be technically demanding and require surgical sophistication and expertise. A national registry to justify the procedure indication; report the outcomes and survivorship has not been developed. This procedure is growing around the county, as well as the surgeon experience, but we should remember that TAR is not for every patient and that the appropriate indication, based on the evidence available, is fundamental to obtaining durable and predictable outcomes. [Table: see text]

scholarly journals Hindfoot Alignment after Total Ankle Replacement

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0000
Author(s):  
Christopher E. Gross ◽  
Federico Guiseppe Usuelli ◽  
Christian Indino
Keyword(s):  
Sagittal Alignment ◽  
Mobile Bearing ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Hindfoot Alignment ◽  
Time Points ◽  
Ankle Replacement ◽  
Temporal Course ◽  
Over Time

Category: Ankle Arthritis; Ankle Introduction/Purpose: End-stage ankle arthritis can involve misalignment of the ankle in both the coronal and sagittal planes as up to reported 33% to 44% of patients who present for total ankle replacement have greater than 10° of coronal plane deformity. Improvements in both the design and surgical technique for total ankle replacements (TAR) have allowed surgeons to tackle the most challenging of multiplanar ankle deformities. Normalization of the sagittal and coronal alignment is key in improving survivorship and functional outcomes in TAR. In the present study, we analyzed how both the ankle and hindfoot alignment for both a fixed-bearing and mobile bearing TAR system changes over time. Specifically, we measured coronal and sagittal alignment of both the ankle and hindfoot complex. We hypothesize that both significant differences would be seen between all time points and pre-operative radiographs, and that these differences would not change over time. Methods: A retrospective study performed by a single orthopaedic surgeon was performed on two independent groups of patients undergoing two different systems for total ankle replacement: Zimmer TAR (lateral-approach, fixed-bearing, n=89) and Hintegra (anterior approach, mobile-bearing, n=81). We noted specific demographic data and radiographic data were measured including: Hindfoot alignment view angle (HAV), Hindfoot alignment distance (HAVD), tibiotalar ratio, α angle and β angle. These were measured pre-operatively, and 6 months, 12 months, and 24 months post-operatively. Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points, e.g. T0vsT6vsT12vsT24) within the Hintegra and Zimmer groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed for SA, SD, TT ratio, α and β angle. Specifically, time*group interaction was tested. Results: At the ankle joint itself, as measured by the α and β angles (p>.05), the position of the components remains relatively similar in both the fixed and mobile bearing TAR over the course of 24 months. The sagittal alignment, as measured by the TT ratio, demonstrated a posterior shifting of the talus in the mobile bearing group (p=.036). Though the fixed and mobile- bearing TAR had both significant hindfoot alignment improvement between the pre-op radiographs and twenty-four months, over time, the fixed-bearing ankle had a significant increase in both the HAV and HAVD (p<.001), suggesting a dynamism of the hindfoot in the fixed-bearing ankle. Conclusion: Correcting coronal and sagittal alignment is important for the long-term survivorship of a TAR. The fixed and mobile-bearing implants had maintained coronal and sagittal alignment in the short term, the temporal course of the fixed-bearing ankle showed an increased in the valgus positioning of the hindfoot.

Stability and change in class membership over time

2020 ◽  
pp. 69-86
Author(s):  
Shannon N. Davis ◽  
Theodore N. Greenstein
Keyword(s):  
Class Membership ◽  
Stability And Change ◽  
Individual Level ◽  
New Class ◽  
Latent Trajectory ◽  
Time Period ◽  
High Workload ◽  
Using Data ◽  
Labor Patterns ◽  
Over Time

Chapter 7 of the book reports the results of Latent Trajectory Analysis examining stability and change in class membership over time. Using data from Waves 1 and 2 of the NSFH we document change and stability in class membership in the five classes (Ultra-traditional, Traditional, Transitional Husbands, Egalitarian, and Egalitarian High Workload). We describe the couple and individual level characteristics associated with both change and stability as well as the new class profiles in Wave 2. We find great change in housework class over the time period studied with some couples becoming more egalitarian and others more traditional in their division of labor. Patterns in this change over time are presented and discussed.

scholarly journals Hindfoot Alignment after Total Ankle Replacement

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0018
Author(s):  
Christopher Gross ◽  
Luigi Manzi ◽  
Cristian Indino ◽  
Fausto Romano ◽  
Camilla Maccario ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Mobile Bearing ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Hindfoot Alignment ◽  
Time Points ◽  
Ankle Replacement ◽  
Temporal Course ◽  
Over Time

Category: Ankle, Ankle Arthritis Introduction/Purpose: End-stage ankle arthritis can involve misalignment of the ankle in both the coronal and sagittal planes as up to reported 33% to 44% of patients who present for total ankle replacement have greater than 10° of coronal plane deformity. Normalization of the sagittal and coronal alignment is key in improving survivorship and functional outcomes in TAR. In the present study, we analyzed how both the ankle and hindfoot alignment for both a fixed-bearing and mobile bearing TAR system changes over time. Specifically, we measured coronal and sagittal alignment of both the ankle and hindfoot complex. We hypothesize that both significant differences would be seen between all time points and pre-operative radiographs, and that these differences would not change over time. Methods: A retrospective study performed by a single orthopaedic surgeon was performed on two independent groups of patients undergoing two different systems for total ankle replacement: Zimmer TAR (lateral-approach, fixed-bearing, n=89) and Hintegra (anterior approach, mobile-bearing, n=81). We noted specific demographic data and radiographic data were measured including: Hindfoot alignment view angle (HAV), Hindfoot alignment distance (HAVD), tibiotalar ratio, a angle and ß angle. These were measured pre-operatively, and 6 months, 12 months, and 24 months post-operatively. Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points, e.g. T0vsT6vsT12vsT24) within the Hintegra and Zimmer groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed for SA, SD, TT ratio, a and ß angle. Specifically, time*group interaction was tested. Results: At the ankle joint itself, as measured by the a and ß angles (p>.05), the position of the components remains relatively similar in both the fixed and mobile bearing TAR over the course of 24 months. The sagittal alignment, as measured by the TT ratio, demonstrated a posterior shifting of the talus in the mobile bearing group (p=.036). Though the fixed and mobile-bearing TARhad both significant hindfoot alignment improvement between the pre-op radiographs and twenty-four months, over time, the fixed-bearing ankle had a significant increase in both the HAV and HAVD (p<.001), suggesting a dynamism of the hindfoot in the fixed-bearing ankle. Conclusion: Correcting coronal and sagittal alignment is important for the long-term survivorship of a TAR. The fixed and mobile-bearing implants had maintained coronal and sagittal alignment in the short term, the temporal course of the fixed-bearing ankle showed an increased in the valgus positioning of the hindfoot. The mobile-bearing implant maintained its hindfoot alignment over the course of the study. More studies are needed to explore the clinical implications of this new data.

Evaluation of Hindfoot Alignment After Fixed- and Mobile-Bearing Total Ankle Prostheses

2019 ◽  
Vol 41 (3) ◽  
pp. 286-293
Author(s):  
Federico G. Usuelli ◽  
Camilla Maccario ◽  
Cristian Indino ◽  
Luigi Manzi ◽  
Fausto Romano ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Sagittal Alignment ◽  
Mobile Bearing ◽  
Lateral Approach ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Hindfoot Alignment ◽  
Ankle Replacement ◽  
Temporal Course ◽  
Over Time

Background: End-stage ankle arthritis can involve malalignment of the ankle in both the coronal and sagittal planes. Up to 33% to 44% of patients who present for total ankle replacement (TAR) have greater than 10° of coronal plane deformity. Normalization of the sagittal and coronal alignment is key in improving survivorship and functional outcomes in TAR. In the present study, we analyzed how both the ankle and hindfoot alignment for both a fixed-bearing and mobile-bearing TAR system changed over time. Specifically, we measured coronal and sagittal alignment of both the ankle and hindfoot complex. Methods: A retrospective study was performed on 2 independent groups of patients undergoing 2 different systems for total ankle replacement: Zimmer (lateral approach, fixed-bearing) and Hintegra (anterior approach, mobile bearing). Specific demographic data and radiographic data were measured. Within-group comparisons were performed using 1-way repeated measures ANOVA, analyzing the temporal course of clinical data within the Hintegra and Zimmer groups. Results: At the ankle joint, as measured by the α and β angles ( P > .05), the position of the components remained relatively similar in both the fixed- and mobile-bearing TAR at 24-month follow-up. The sagittal alignment, as measured by the TT (tibiotalar) ratio, demonstrated a posterior shifting of the talus in the mobile bearing group ( P = .036). Although the fixed- and mobile-bearing TAR had both significant hindfoot alignment improvement between the preoperative radiographs and at 24 months, over time, the fixed-bearing ankle had a significant increase in both the hindfoot alignment view angle and hindfoot alignment distance ( P < .001), suggesting a possible dynamism of the hindfoot in the fixed-bearing TAR. Conclusion: The lateral-approach fixed and anterior approach mobile-bearing implants maintained coronal and sagittal alignment in the short term; the temporal course of the lateral approach fixed-bearing ankle showed an increase in the valgus positioning of the hindfoot. The anterior approach mobile-bearing implant maintained its hindfoot alignment over the course of the study. Level of Evidence: Level III, case-control study.

scholarly journals The Demographics of Total Ankle Replacement in the USA: A Study of 21,222 Cases Undergoing Pre- Operative CT Scan-Based Planning

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0038
Author(s):  
Murray J. Penner ◽  
Gregory C. Berlet ◽  
Ricardo Calvo ◽  
Eric Molina ◽  
David Reynolds ◽  
...  
Keyword(s):  
Ct Scan ◽  
Demographic Data ◽  
Total Ankle Replacement ◽  
Patient Specific ◽  
Clear Understanding ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
The Usa ◽  
The Mean ◽  
Over Time

Category: Ankle; Ankle Arthritis Introduction/Purpose: To understand the role of total ankle replacement (TAR) in treating the spectrum of arthritis of the ankle, a clear understanding of the epidemiology of ankle arthritis is required. The largest pools of epidemiologic data available to date come from international registries. In the USA, the largest market for TAR, where an estimated 10,000 TARs are implanted per year, the largest pool of demographic data on patients undergoing TAR is comprised of just 805 cases collected over 6 years. With the advent of patient-specific instrumentation (PSI), detailed demographic and CT scan data can now be collected. These data on 21,222 cases undergoing CT scan-based PSI planning were reviewed to define the demographics of a very large cohort of TAR patients. Methods: The cohort contained 21,222 patients from the USA and Canada, with surgery dates from 2012 - 2019. Data analysed included deformity measures, presence of existing hardware and joint fusion status. To date, a subset sample of 4800 cases was available for analysis. Extraction is ongoing and data for the full cohort will soon be available. This subset described cases with surgery dates ranging from November 2015 through May 2019. Summary statistics to describe age, gender, ankle size, and tibio- talar deformity were calculated. Of the 4800 patients analyzed, 53% were male. Mean age 63.6 years (SD 10.4) (Age distribution in Figure 1a). The deformity distribution is shown in Figure 1b, with varus more common than valgus. The mean degree of deformity increased with every decade of patient age from 6.1° (age 30-39) to 9.2° (age 80-89), and over time from 9.3°(2016) to 11.8° (2019) [in stemmed- implant cases]. Results: Tibia size varied with gender. Females ranged between 34-38mm in 85% of cases; males from 41-48mm in 79%. Of 21,222 cases, 5964 (28%) had adjacent hardware (screws, etc) in situ and pre-existing ankle fusions were present in 517 (2.4%), increasing from 1.2% in 2013 to 2.9% in 2019.The mean age of TAR patients is similar to that reported in smaller series. Tibia size was significantly greater in males than females, a finding not previously reported in demographic literature. In contrast to knee arthritis, intra-articular deformity >5° is common, present in > 51% of cases (varus > valgus). This is the first series to show the degree of deformity increases with age. Over time, TAR is being used in cases with greater deformity. Conclusion: Hardware is seen to be commonly present in TAR, increasing complexity. Conversion of fusion to TAR, while rare, is more common than existing literature suggests, with the rate increasing each year, suggesting this may be an increasingly important role for TAR in the future. This study presents the largest set of demographic data on TAR patients in the literature. The demographics of USA patients undergoing TAR are similar to those seen in non-USA registries. Deformity is common, increasing with age. The severity of deformity treated with TAR and conversion of fusion to TAR are increasing over time.

scholarly journals Shape Approximation and Size Difference of the Upper Part of the Talus: Implication for Implant Design of the Talar Component for Total Ankle Replacement

2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Jian Yu ◽  
Dahang Zhao ◽  
Shuo Wang ◽  
Chao Zhang ◽  
Jiazhang Huang ◽  
...  
Keyword(s):  
Surface Morphology ◽  
Cutting Plane ◽  
Total Ankle Replacement ◽  
Implant Design ◽  
Size Difference ◽  
Average Radius ◽  
Ankle Replacement ◽  
Fitting Method ◽  
Reported Data ◽  
Sphere Fitting

The implant design of the talar component for total ankle replacement (TAR) should match the surface morphology of the talus so that the replaced ankle can restore the natural motion of the tibiotalar joint and may reduce postoperative complications. The purpose of this study was to introduce a new 3D fitting method (the two-sphere fitting method of the talar trochlea with three fitting resection planes) to approximate the shape of the upper part of the talus for the Chinese population. 90 models of the tali from CT images of healthy volunteers were used in this study. Geometrical fitting and morphological measurements were performed for the surface morphology of the upper part of the talus. The accuracy of the two-sphere fitting method of the talar trochlea was assessed by a comparison of previously reported data. Parameters of the fitting geometries with different sizes were recorded and compared. Results showed that compared with previously reported one-sphere, cylinder, and bitruncated cone fitting methods, the two-sphere fitting method presented the smallest maximum distance difference, indicating that talar trochlea can be approximated well as two spheres. The radius of the medial fitting sphere R M was 20.69 ± 2.19  mm which was significantly smaller than the radius of the lateral fitting sphere R L of 21.32 ± 1.88  mm. After grouping all data by the average radius of fitting spheres, the result showed that different sizes of the upper part of the talus presented significantly different parameters except the orientation of the lateral cutting plane, indicating that the orientation of the lateral cutting plane may keep consistent for all upper part of the talus and have no relationship with the size. The linear regression analyses demonstrated a weak correlation ( R 2 < 0.5 ) between the majority of parameters and the average radius of the fitting spheres. Therefore, different sizes of the upper part of the talus presented unique morphological features, and the design of different sizes of talar components for TAR should consider the size-specific characteristics of the talus. The parameters measured in this study provided a further understanding of the talus and can guide the design of different sizes of the talar components of the TAR implant.

Sign in / Sign up

Export Citation Format

Share Document