Restoration of Talar Height, Alignment, and Implant Survival after Revision Total Ankle Arthroplasty with Minimum 2-Year Follow-up

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: With the introduction of improved implants and long-term outcome data, total ankle arthroplasty (TAA) is becoming an increasingly common surgical treatment for end-stage ankle osteoarthritis. However, the treatment of a failed primary TAA remains a significant challenge. Ankle arthrodesis as a salvage procedure results in high rates of non-union and collapse. Revision arthroplasty is an alternative to arthrodesis, but there is little published data on the outcomes of revision total ankle arthroplasty (RTAA). This study presents 2-year outcomes after RTAA using a modular prosthesis and metal/cement augmentation to reconstitute talar height, as well as restore sagittal and coronal alignment. Methods: A retrospective review was performed on 23 patients who underwent RTAA after failed primary TAA. Demographic data, talar height, coronal and sagittal alignment, and range of motion pre-revision and at most recent follow up were recorded. Failure was defined as need for revision surgery during the follow up period. Radiographic measurements were performed on weight bearing lateral and AP radiographs. For Agility implants, measurement on weight-bearing computed tomography (WBCT) was required. The measurement methodology was performed on both radiographs and WBCT for validation and measurements were consistent across all implants. Results: Patient follow-up ranged from 2 to 3.9 years, with a mean of 2.56 years. 17 of 22 RTAA did not require further revision. Of the five failures, one was due to deep infection, four to subsidence of the talar component. For the 17 successful revisions, average pre-operative coronal malalignment was 3.8◦ (range 7.4◦ varus to 15◦ valgus), and average post-operative malalignment improved to 2.6◦ (range 0◦ varus to 7.9◦ valgus), but this difference was not statistically significant (p=.09). Average pre-operative sagittal malalignment was 8.7◦ (range 20.7◦ plantarflexion to 20.1◦ dorsiflexion), and average post-operative malalignment improved to 3.6◦ (range 8.3◦ plantarflexion to 9.3◦ dorsiflexion), which was statistically significant (p=.01). Talar height improved by 3.9mm (p< 0.001), and range of motion from 16.9◦ to 25.0◦ (p,0.001). Conclusion: At a minimum of two years of follow up, revision arthroplasty shows improved alignment, talar height, and range of motion. While the failure rate remains significantly higher than primary ankle arthroplasty, it is comparable or superior to that of conversion to arthrodesis. The complexity of RTTA varies greatly due to surgical risk, soft tissue quality, and residual bone stock amongst other factors, which limits the generalizability of this patient cohort. RTAA is a viable option for the salvage of failed primary TAA, with functional and radiographic improvements shown at mid-term follow-up.

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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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Clinical Outcomes of Total Ankle Arthroplasty With Total Talar Prosthesis

Foot & Ankle International ◽

10.1177/1071100719847135 ◽

2019 ◽

Vol 40 (8) ◽

pp. 948-954

Author(s):

Noriyuki Kanzaki ◽

Nobuaki Chinzei ◽

Tetsuya Yamamoto ◽

Takahiro Yamashita ◽

Kazuyuki Ibaraki ◽

...

Keyword(s):

Range Of Motion ◽

Case Series ◽

Total Ankle Arthroplasty ◽

Medial Malleolus ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

The Mean ◽

End Stage ◽

Medial Malleolus Fracture

Background: Total ankle arthroplasty (TAA) has been developed to treat patients with end-stage ankle osteoarthritis (OA). However, there is often difficulty in treating complicated pathologies such as ankle OA with subtalar joint OA and severe talar collapse. Therefore, this study aimed to explore the short-term results and complications of TAA with total talar prosthesis, known as combined TAA, as the new techniques to treat such complicated pathology. Methods: We examined postoperative results including ankle range of motion, Japanese Society for Surgery of the Foot (JSSF) scale, and complications. There were 22 patients (15 women), with mean follow-up of 34.9 (range, 24–53 months), and the mean age was 72 (range, 62–80) years. The main indications for combined TAA included osteoarthritis (18 patients), rheumatoid arthritis (3 patients), and talar osteonecrosis with osteoarthritis (one patient). Results: The mean range of motion improved from 4.0 to 14.4 degrees in dorsiflexion and from 23.8 to 32.0 degrees in plantarflexion. The JSSF scale improved from 50.5 to 91.5 points. Prolonged wound healing occurred in 3 patients, and medial malleolus fracture occurred in 4 patients. Conclusion: Combined TAA was a reliable procedure for the treatment of not only ankle OA following avascular necrosis of talus but also of degeneration of both ankle and subtalar joints. Level of Evidence: Level IV, case series.

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Nottingham Experience with The Fixed Bearing Infinity Total Ankle Replacement

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00424 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0042

Author(s):

Hatem Salem-Saqer ◽

Martin Raglan ◽

Sunil Dhar

Keyword(s):

Complication Rate ◽

Weight Bearing ◽

Total Ankle Replacement ◽

Total Ankle Arthroplasty ◽

Implant Design ◽

Fixed Bearing ◽

Ankle Arthroplasty ◽

Ankle Replacement ◽

End Stage

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is increasingly used for treatment of end stage arthritis of the ankle; improvements continue to evolve in implant design and instrumentation. We present our experience of the Infinity Total Ankle Arthroplasty (Wright Medical), a fixed bearing 4th generation implant with improved instrumentation Methods: This is a retrospective review of prospectively collected data. From October 2016 to July 2019, we identified 92 (52M/40F) who had the infinity Total Ankle Replacement. This review is of 70 patients with a minimum of 1 year follow up (33M,37F). The mean age was 67.5 years (33-87); 32 right side and 38 left no bilaterals. The indication for surgery was end stage Osteoarthritis in 52, post traumatic arthritis 12, inflammatory arthritis 4, conversion of fusion to TAR 2. The preoperative deformity was graded according to the COFAS classification. All patients had follow up at 6 weeks, 3,6 and 12 months and then annually, with MOXFQ questionnaire and weight bearing radiographs. Results: TAA was performed with the use of fluoroscopy. 77% (54/70) had concomitant procedures as listed in Table.5% (4/70) had complications consisting of, 1 DVT, 1 intra operative medial malleolus fracture, 1 EHL tendon laceration and 1 wound break down. There were no deep or superficial infections. Improvement in clinical outcome and PROMS data was noted on follow up. The MOXFQ for Pain improved from 72 pre-op to 25 at 1year (p<0.001). The outcome for Walking improved from 83 pre-op to 30 at one year (p<0.001). Radiological alignment was maintained asymptomatic posterior heterotopic ossification was noted in 23(16%) patients, lucent lines under the tibial implant were noted in 4 ankles and 1 fibula erosion. 2 TAA (3%) needed to be revised due to malpositioning. Conclusion: Our results show significant improvement in patient outcomes, a short recovery time and marked improvement in mobility post operatively with a very low complication rate, we had no deep infection to date. Two implants were revised which we attribute to the learning curve at the start of practice. This implant is fluoroscopically navigated allowing precise implantation with dedicated instrumentation and we feel this attributed to the low complication rate and good results in our short-term study [Table: see text]

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Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00015 ◽

2018 ◽

Vol 3 (2) ◽

pp. 2473011418S0001

Author(s):

Benjamin Hendy ◽

Steven Raikin ◽

David Pedowitz ◽

Rachel Shakked ◽

Ryan Rogero ◽

...

Keyword(s):

Range Of Motion ◽

Weight Bearing ◽

Total Ankle Arthroplasty ◽

Measurement Tool ◽

Fixed Bearing ◽

Ankle Arthroplasty ◽

Functional Scores ◽

The Mean ◽

Picture Archiving And Communication ◽

And Function

Category: Ankle, Ankle Arthritis Introduction/Purpose: Reports of ankle range of motion and how it affects patient outcomes following total ankle arthroplasty (TAA) have been mixed. Furthermore, recent studies have relied on clinical exam to obtain postoperative range of motion and have lacked preoperative functional scores. The purpose of our study was to analyze how preoperative range of motion and functional scores change with time following TAA using postoperative functional scores and radiographs for range of motion calculations. Methods: A retrospective chart review was performed on 107 patients (109 ankles) that had undergone fixed-bearing implant TAA by a single surgeon between 2010 and 2015. Preoperative range of motion was gathered clinically in office by the senior author. Postoperative range of motion through the ankle joint was evaluated with dedicated weight-bearing maximum dorsiflexion and plantarflexion lateral radiographs at 3 and 6 months, 1 and 2 years. The range of motion was measured using the angle measurement tool on the picture archiving and communication system. Patients completed visual analogue scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire subcategorized into activities of daily (ADL) and sports subscale preoperatively and at postoperative intervals of 3 and 6 months, 1 and 2 years. The mean age was 65 years (range, 31-83 years). Mean BMI was 28.1 (range, 14.9-44.9). There were 53 males (50%). Results: The mean total arc of ankle motion preoperatively was 20.7 degrees and improved significantly to 28.3, 34.3, 33.3, and 33.3 degrees at 3 and 6 months, 1 and 2 years, respectively (P<0.001) (Figure 1). Mean VAS pain and mean FAAM ADL preoperative scores improved significantly at each postoperative time point as seen in Figure 1 (P<0.001). Increased ankle range of motion was correlated with lower VAS preoperatively (r=-0.38, P=0.007), and at 1 year (r=-0.36, P<0.001), and 2 years (r=-0.2, P=0.033) postoperatively. Increased ankle range of motion was significantly correlated with higher FAAM-ADL at 3 months (r=0.48, P=0.012), 1 year (r=0.24, P<0.034), and 2 years (r=0.37, P<0.001) postoperatively. Conclusion: Patients undergoing fixed-bearing TAA had continued and sustained improvement from preoperative total arc of motion, pain, and function at each postoperative visit, up to 2 years. Ankle range of motion was noted to peak at 6 months, while pain and FAAM-ADL continued to improve up to 2 years postoperatively. Patients with greater ankle range of motion correlated with less pain and improved function at 1 and 2 years postoperatively. Though pain and function may continue to improve even as far out as 2 years postoperatively, it is not likely that range of motion will continue to increase.

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Surgical Treatment of Bony and Soft-Tissue Impingement in Total Ankle Arthroplasty

Foot & Ankle Specialist ◽

10.1177/1938640016666918 ◽

2016 ◽

Vol 10 (1) ◽

pp. 37-42 ◽

Cited By ~ 8

Author(s):

Christopher E. Gross ◽

Samuel B. Adams ◽

Mark Easley ◽

James A. Nunley ◽

James K. DeOrio

Keyword(s):

Soft Tissue ◽

Weight Bearing ◽

Treatment Options ◽

Arthroscopic Surgery ◽

Total Ankle Arthroplasty ◽

Consecutive Series ◽

Ankle Arthroplasty ◽

Open Treatment ◽

Secondary Procedures

Background. Impingement may be an underreported problem following modern total ankle replacements (TARs). The etiology of impingement is unclear and likely multifactorial. Because of the lack of conservative treatment options for symptomatic impingement after TAR, surgery is often necessary. Methods. We retrospectively identified a consecutive series of 1001 primary TARs performed between January 1998 and December 2014. We identified patients who required a secondary surgery to treat soft-tissue and bony impingement by either an open or arthroscopic procedure. Functional and clinical outcomes, including secondary procedures, infections, complications, and failure rates, were recorded. Results. In all, 75 patients (7.5%) required either open (n = 49) or arthroscopic debridement for impingement after TAR; 44 patients had >12 months of follow-up, with a follow-up of 26.5 months after their debridement procedure. The mean time to the debridement procedure for all prostheses was 29.3 months, with an average of 38.7 months in STAR, 21.8 months in INBONE, and 10.5 months in Salto Talaris patients. Of the patients with more than 1 year’s follow-up from their debridement, 84.1% were asymptomatic; 9 patients (20.4%) had repeat operations after their debridement procedure. Of these, 5 patients required a repeat debridement of their medial or lateral gutters for a failure rate of 11.4%. Conclusion. Both arthroscopic and open treatment of impingement after total ankle arthroplasty are safe and effective in improving function and pain. Although the rates for revision impingement surgery are higher in arthroscopic compared with open procedures, they are not significantly so. Therefore, we recommend arthroscopic surgery whenever possible because of earlier time to weight bearing and mobility. Levels of Evidence: Level IV

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00019 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0001

Author(s):

Jack Allport ◽

Adam Bennett ◽

Jayasree Ramaskandhan ◽

Malik Siddique

Keyword(s):

Physical Health ◽

Weight Bearing ◽

Mobile Bearing ◽

Varus Deformity ◽

Total Ankle Arthroplasty ◽

Ankle Arthritis ◽

Ankle Arthroplasty ◽

Ap Weight ◽

Radiological Analysis

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

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Heterotopic Ossification in Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00029 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0002

Author(s):

Thomas Bemenderfer ◽

Robert Anderson ◽

Mario Escudero ◽

Feras Waly ◽

Kevin Wing ◽

...

Keyword(s):

Systematic Review ◽

Range Of Motion ◽

Functional Outcome ◽

Heterotopic Ossification ◽

Functional Outcomes ◽

Total Ankle Arthroplasty ◽

Minimal Clinical Important Difference ◽

Ankle Arthroplasty ◽

Wide Range

Category: Ankle Arthritis Introduction/Purpose: Heterotopic ossification (HO) following total ankle arthroplasty (TAA) is a known sequela and has been reported to contribute to reduced postoperative range of motion and poor patient functional outcomes. However, conflicting results have been reported in the literature with respect to the correlation between HO and clinical outcome. As new strategies and implants continue to be designed, it is important to understand what instruments for measuring the outcome of treatment are important to assess when evaluating outcome measures in TAA. The present study documents the incidence of HO and functional outcome for the novel 2 component fixed bearing Infinity Total Ankle System prosthesis at minimum of two year follow up and reports a systematic review of the literature. Methods: We reviewed the incidence, degree of severity, and functional outcome in 67 consecutive patients who underwent primary Infinity TAA at two North American tertiary medical centers between 2013 and 2015 in a prospective observational study. Radiographic and functional outcome data was collected preoperatively, at 6 to 12 months postoperatively, and annually thereafter. In addition, we conducted a systematic review of studies reporting the incidence of HO following TAA. We included peer-reviewed studies reporting on at least 20 TAAs with minimum follow up of two years. Results: While the incidence of HO was 68% at 2.4 years in the 67 patients who underwent primary Infinity TAA, there was no association between HO and AOFAS (HO 73.9, no HO 55.0), SF36-PCS (HO 50.1, no HO 45.2), FFI (HO 22.1, no HO 26.4), and VAS (HO 2.6, no HO 2.3). Fourteen studies with 1201 TAAs were included. The overall incidence of HO following TAA was approximately 56.6% at average 3.8 years with a wide range (range, 22.2-100%). Four studies (299 ankles) did not address functional outcomes. Nine studies (822 ankles) reported no association between functional outcomes and HO. One study (80 ankles) reported a statistically significant difference in range of motion of 7 degrees of dorsiflexion and a 7-point difference in AOFAS score. Conclusion: There was no association between HO and functional outcome in our observational cohort. Only one study demonstrated statistically significant differences in range of motion and functional outcome due to HO. Although the minimal clinical important difference in ankle dorsiflexion and AOFAS has not been established in TAA, these differences are below the minimal clinical important difference established in other foot and ankle procedures. Available data, including the results in our 67 patients, suggests that clinical function is independent of the presence of HO.

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Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary Referencing Implant

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00027 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0002 ◽

Cited By ~ 1

Author(s):

Steve Behrens ◽

Thomas Bemenderfer ◽

Oliver Schipper ◽

Robert Anderson ◽

W. Hodges Davis

Keyword(s):

Revision Arthroplasty ◽

Outcome Data ◽

Total Ankle Arthroplasty ◽

Consecutive Series ◽

Implant Survival ◽

Ankle Arthroplasty ◽

Radiographic Outcomes ◽

Early Results ◽

Patient Reported

Category: Ankle Arthritis Introduction/Purpose: Treatment of the failed total ankle arthroplasty (TAA) is challenging, and historically arthrodesis was advocated as the salvage treatment of choice. Currently, there is limited available literature reporting on options and outcomes of revision arthroplasty despite the persistent relatively high failure rate ranging from 10-23% within the first ten years after primary TAA. Early published outcomes of intramedullary-referencing implants for primary TAA have shown improvement in clinical outcomes and radiographic parameters, sustained correction of coronal deformity, and excellent survivorship with few associated complications. The purpose of this study is to report the clinical and radiographic outcomes of revision TAA using an intramedullary-referencing implant. Methods: We reviewed a consecutive series of 24 cases (14 female and 10 male; median age, 57.9 (28.2-74.6) years; median BMI, 31 (19.4-40.2)) between 2008 to 2015 in which a failed TAA underwent revision using InBone, an intramedullary-referencing, fixed-bearing, two-component total ankle system. Demographic, radiographic, and functional outcome data were collected preoperatively, immediately postoperatively, and at the most recent follow up. The primary outcome was implant survival defined by no reoperation for subsidence/loosening or revision of the implant. Secondary outcomes included radiographic (coronal and sagittal component alignment, osteolysis, and subsidence) and functional (American Orthopaedic Foot & Ankle Society [AOFAS] score and foot function index [FFI]) outcome data. Results: Twenty-four patients underwent revision TAA with intramedullary-referencing with 87.5% implant survival at average follow up of 30.4 months. Revision was performed most commonly for aseptic talar subsidence (45.8%) or implant loosening (tibia, 12.5%; talus, 16.7%). Following revision, three (12.5%) patients required reoperation for talar subsidence or loosening at average 37.7 months. Progression of osteolysis of the tibia, talus, and fibula was observed in 14 (58%), 4 (17%), and 6 (25%) of patients, respectively, although osteolysis was present preoperatively in 17 (70.1%), 9 (37.5%), and 10 (41.7%), respectively. Subsidence of the tibial and talar components was observed in 8 (33%) and 9 (38%) patients, respectively. Clinically, the average AOFAS and FFI score were 72 (57-100) and 27.1 (11.8-82.9), respectively. Conclusion: Early results of intramedullary-referencing revision TAA demonstrated improved patient-reported outcomes and maintenance of radiographic outcomes at an average follow-up of 30 months. Additionally, early results of revision arthroplasty after failed TAA were similar to those after primary arthroplasty. Aseptic talar subsidence or loosening were the main postoperative complications which required reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant is a viable option for the failed TAA.

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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]

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Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary-Referencing Implant

Foot & Ankle International ◽

10.1177/1071100720947036 ◽

2020 ◽

Vol 41 (12) ◽

pp. 1510-1518

Author(s):

Steve B. Behrens ◽

Todd A. Irwin ◽

Thomas B. Bemenderfer ◽

Oliver N. Schipper ◽

Susan M. Odum ◽

...

Keyword(s):

Case Series ◽

Revision Arthroplasty ◽

Total Ankle Arthroplasty ◽

Fixed Bearing ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

Radiographic Outcomes ◽

Early Results ◽

Patient Reported

Background: Treatment of failed total ankle arthroplasty (TAA) is challenging. Limited literature is available on options and outcomes of revision arthroplasty despite failure rates ranging from 10% to 23% within 10 years after primary TAA. This study reports the clinical and radiographic outcomes of revision TAA using a fixed-bearing, intramedullary-referencing implant. Methods: A retrospective review was performed of 18 consecutive revision TAA cases between 2008-2015 using an intramedullary-referencing, fixed-bearing, 2-component total ankle system. Demographic and radiographic data were collected preoperatively, immediately postoperatively, and at the most recent follow-up. Functional outcome data were collected immediately postoperatively and at mean follow-up 47.5 months. Results: Eighteen patients underwent revision TAA, with 77.8% (14/18) implant survival. Index revision was performed most commonly for aseptic talar subsidence (55.6%) or implant loosening (tibia, 29.4%; talus, 58.9%). Following revision, 22.2% (4/18) patients required reoperation at a mean 57.3 (39-86) months. Osteolysis of the tibia, talus, and fibula was present preoperatively in 66.7% (12/18), 38.9% (7/18), and 38.9% (7/18) of patients, respectively, with progression of osteolysis in 27.8% (5/18), 11.1% (2/18) and 11.1% (2/18) of patients, respectively. Subsidence of the tibial and talar revision components was observed in 38.9% (7/18) and 55.6% (10/18) of patients, respectively. The median American Orthopaedic Foot & Ankle Society (AOFAS) score was 74.5 (26-100) and Foot Function Index (FFI) score 10.2 (0-50.4). Conclusion: Early results of intramedullary-referencing revision TAA demonstrated good patient-reported outcomes with maintenance of radiographic parameters at mean follow-up of 47.5 months. Aseptic talar subsidence or loosening were the main postoperative causes of reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant was a viable option for the failed TAA. Level of Evidence: Level IV, case series.

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