Prospective Three-Year Outcomes Comparing Cemented and Cementless Fixation in the Trabecular Metal Total Ankle Arthroplasty

OrthoMedia ◽  
2022 ◽  
Keyword(s):  
Total Ankle Arthroplasty ◽  
Trabecular Metal ◽  
Cementless Fixation ◽  
Ankle Arthroplasty

Results of Trabecular-Metal Total Ankle Arthroplasties With Transfibular Approach

2019 ◽  
Vol 41 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Hannu Tiusanen ◽  
Sami Kormi ◽  
Ia Kohonen ◽  
Mikhail Saltychev
Keyword(s):  
Case Series ◽  
Clinical Results ◽  
Total Ankle Arthroplasty ◽  
Trabecular Metal ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Functional Scores ◽  
Component Loosening ◽  
And Function

Background: Total ankle arthroplasty is an alternative for arthrodesis. The objective of this study was to investigate the safety of trabecular-metal ankle prosthetic system with transfibular approach and external frame and its association with changes in clinical and functional scores. Methods: Between May 2013 and June 2017, a total of 104 consecutive patients underwent primary total ankle arthroplasty with a trabecular metal implant. The prospective clinical and radiographic data were collected. The mean follow-up time was 43.6 (14.6) months. Results: Of 104 patients, 88 (89%) reported improved functioning and 65 (66%) were very satisfied with the surgery. Of the patients, 51 (50%) did not report any pain at the end of follow-up at all. The average Kofoed score was 37.6 (SD 17.4) points at baseline and 74.8 (SD 20.6) points at the end of follow-up. There were 37 additional procedures, and the complication rate was nearly 20%. Conclusion: Trabecular-metal total ankle prosthesis showed promising clinical results concerning pain and function. At 5-year follow-up, osteolysis and component loosening were rare. Level of Evidence: Level IV, case series.

scholarly journals Minimum 2 Year Prospective Follow-Up on a Laterally Placed Trabecular Metal Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0045
Author(s):  
Alastair S.E. Younger ◽  
Federico G. Usuelli ◽  
Donald Bohay ◽  
Fabian Krause ◽  
Eric Giza ◽  
...  
Keyword(s):  
Prospective Study ◽  
Statistical Significance ◽  
Lateral Approach ◽  
Total Ankle Arthroplasty ◽  
Rank Test ◽  
Wound Complications ◽  
Trabecular Metal ◽  
Ankle Arthroplasty ◽  
Time Points

Category: Ankle, Ankle Arthritis Introduction/Purpose: The laterally placed trabecular metal ankle replacement is placed using a jig and a fibular osteotomy. The tibia and talus are reamed to match the curved contour of the replacement. The lateral approach was advocated to reduce the wound complications of the anterior approach. Additional fixation is achieved using two rails on the tibial and talar component. This study outlines the outcomes of 121 ankles followed prospectively with minimum 2 years follow up. Methods: 121 total ankles were consented to enrollment in a prospective study on outcomes. 10 centers were involved in the prospective study. Enrollment was from 2014 to 2016. 3 patients underwent revision and 5 withdrew (1 death, 2 lost to follow up and 2 requested discontinuation). Demographics were obtained at baseline. The average age was 59.9 at the time of surgery. 48% were male and BMI averaged 29.2. 12.4% had inflammatory arthropathy. EQ5D, AOFAS, AOS scores were obtained preoperatively and at 6 weeks, 6 months, and yearly there after. Revision of metal components for infection or loosening were secondary end points. Statistical significance was tested by the Wilcoxon Signed Rank Test 26 and set at p= 0.05. 95% confidence intervals are given. Of 113 cases, 113 were followed at 6 weeks, 113 at 1 year, and 100 at 2 years and 67 at 3 years. Results: AOS Outcomes improved from 59.7 (SD 20.6) to 22 (SD 18) at 6 months, 18.6 (SD 19.6) at 1 year, 19.8 (SD 21) at 2 years and 21.3 (SD 25) at 3 years. AOFAS scores and EQ5 D scores showed similar improvements at all time points. The improvements were significant compared to baseline at all time points (see figure). Survivorship was .98 at 1 year (CI .92 to .99), and .96 at 2 and 3 years (CI .90 to .99). 3 components were revised, a tibial component (loosening), a talar component (instability), and a polyethylene liner (infection). Conclusion: The laterally placed trabecular metal total ankle arthroplasty has demonstrated reliable improvements in outcome and an excellent survivorship at minimum 2 years follow up. Longer term follow up and larger series will be required to clearly outline its outcome. This early outcome demonstrates very promising outcomes at 3 years and low revision rates.

Does Intra-articular Injection of the Ankle With Corticosteroids Increase the Risk of Subsequent Periprosthetic Joint Infection (PJI) Following Total Ankle Arthroplasty (TAA)? If So, How Long After a Prior Intra-articular Injection Can TAA Be Safely Performed?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 3S-4S
Author(s):  
Ilker Uçkay ◽  
Christopher B. Hirose ◽  
Mathieu Assal
Keyword(s):  
Periprosthetic Joint Infection ◽  
Corticosteroid Injection ◽  
Joint Infection ◽  
Invasive Procedure ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Strong Consensus ◽  
Healthcare Associated ◽  
The Ideal

Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

The Effect of Patient Characteristics on 1 to 2-Year and Minimum 5-Year Outcomes After Total Ankle Arthroplasty

2019 ◽  
Vol 101 (3) ◽  
pp. 199-208 ◽  
Author(s):  
Daniel J. Cunningham ◽  
James K. DeOrio ◽  
James A. Nunley ◽  
Mark E. Easley ◽  
Samuel B. Adams
Keyword(s):  
Patient Characteristics ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty

Midfoot Function Before and After Total Ankle Arthroplasty

2021 ◽  
pp. 107110072199578
Author(s):  
Frank E. DiLiberto ◽  
Steven L. Haddad ◽  
Steven A. Miller ◽  
Anand M. Vora
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Peak Power ◽  
Nonparametric Tests ◽  
Total Ankle Arthroplasty ◽  
Control Group ◽  
Ankle Arthroplasty ◽  
First Metatarsal ◽  
Before And After

Background: Information regarding the effect of total ankle arthroplasty (TAA) on midfoot function is extremely limited. The purpose of this study was to characterize midfoot region motion and power during walking in people before and after TAA. Methods: This was a prospective cohort study of 19 patients with end-stage ankle arthritis who received a TAA and 19 healthy control group participants. A motion capture and force plate system was used to record sagittal and transverse plane first metatarsal and lateral forefoot with respect to hindfoot motion, as well as sagittal plane midfoot region positive and negative peak power during walking. Parametric or nonparametric tests to examine differences and equivalence across time were conducted. Comparisons to examine differences between postoperative TAA group and control group foot function were also performed. Results: Involved-limb midfoot function was not different between the preoperative and 6-month postoperative time point in the TAA group (all P ≥ .17). Equivalence testing revealed similarity in all midfoot function variables across time (all P < .05). Decreased first metatarsal and lateral forefoot motion, as well as positive peak power generation, were noted in the TAA group postoperative involved limb in comparison to the control group (all P ≤ .01). Conclusion: The similarity of midfoot function across time, along with differences in midfoot function in comparison to controls, suggests that TAA does not change midfoot deficits by 6 months postoperation. Level of Evidence: Level II, prospective cohort study.

30-Day Outcomes for Total Ankle Arthroplasty in Patients With Anemia

2021 ◽  
pp. 107110072110175
Author(s):  
Jordan R. Pollock ◽  
Matt K. Doan ◽  
M. Lane Moore ◽  
Jeffrey D. Hassebrock ◽  
Justin L. Makovicka ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Univariate Analysis ◽  
Hospital Length ◽  
Total Ankle Arthroplasty ◽  
Hospital Length Of Stay ◽  
Preoperative Anemia ◽  
Improvement Project ◽  
Average Hospital ◽  
Ankle Arthroplasty ◽  
Reoperation Rates

Background: While anemia has been associated with poor surgical outcomes in total knee arthroplasty and total hip arthroplasty, the effects of anemia on total ankle arthroplasty remain unknown. This study examines how preoperative anemia affects postoperative outcomes in total ankle arthroplasty. Methods: A retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from 2011 to 2018 for total ankle arthroplasty procedures. Hematocrit (HCT) levels were used to determine preoperative anemia. Results: Of the 1028 patients included in this study, 114 patients were found to be anemic. Univariate analysis demonstrated anemia was significantly associated with an increased average hospital length of stay (2.2 vs 1.8 days, P < .008), increased rate of 30-day readmission (3.5% vs 1.1%, P = .036), increased 30-day reoperation (2.6% vs 0.4%, P = .007), extended length of stay (64% vs 49.9%, P = .004), wound complication (1.75% vs 0.11%, P = .002), and surgical site infection (2.6% vs 0.6%, P = .017). Multivariate logistic regression analysis found anemia to be significantly associated with extended hospital length of stay (odds ratio [OR], 1.62; 95% CI, 1.07-2.45; P = .023) and increased reoperation rates (OR, 5.47; 95% CI, 1.15-26.00; P = .033). Anemia was not found to be a predictor of increased readmission rates (OR, 3.13; 95% CI, 0.93-10.56; P = .066) or postoperative complications (OR, 1.27; 95% CI, 0.35-4.56; P = .71). Conclusion: This study found increasing severity of anemia to be associated with extended hospital length of stay and increased reoperation rates. Providers and patients should be aware of the increased risks of total ankle arthroplasty with preoperative anemia. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Adverse Events in Total Ankle Arthroplasty, Analysis of the FDA Medical and User Facility Device Experience Database

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Karim Mahmoud ◽  
Sreenivasulu Metikala ◽  
Kathryn O’Connor ◽  
Daniel Farber
Keyword(s):  
Adverse Events ◽  
Aseptic Loosening ◽  
Mandatory Reporting ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Mode Of Failure ◽  
User Facility

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement has become a popular treatment option for end stage ankle arthritis. Most of the reports of adverse events following total ankle replacement have been from high volume institutions and are subject to either observational or selection bias as well as potential under-reporting as they do not include the experience of community and lower volume centers and surgeons. The FDA’s Medical and User Facility Device Experience (MAUDE) Database provides a more complete scope of adverse events due to the mandatory reporting requirements by the FDA of implant manufactures. We reviewed the database to identify the common modes of failure and complications of total ankle implants Methods: We retrospectively reviewed reports of the MAUDE database from November 2011 to September 2018 regarding all total ankle implants. Each device in the MAUDE database is classified with a 3-letter code, we identified the 2 codes assigned to total ankle arthroplasty devices, and manually searched the FDA’s published Device Classification list for adverse events. All events were reviewed and classified. Data related to patient age or sex, surgeon, medical center location are not available in the database Results: We identified 1000 adverse reports in the period between November 2011 and September 2018. After exclusion of duplicate reports for single events or reports irrelevant to total ankle arthroplasty, a total of 697 adverse event reports were noted. The most common mode of failure was aseptic loosening (21%), followed by infection (16%), alignment and mechanical issues (instability, malalignment, malposition, stiffness, impingement) (15%), implantation issues (pin, screw or drill breakage, alignment guide problems) (9%), polyethylene related problems (wear, displaced or fractured implants) (7%), bony and soft tissue overgrowth (6%), and peri-prosthetic fractures (5%). Conclusion: Our analysis reveals that the most reported mode of failure was aseptic loosening followed by infection. However, it is notable that there are a significant number of issues with implant alignment and mechanics, complications during implantation and polyethylene component failure that are under-reported in the literature. Knowledge of these adverse events may help surgeons avoid similar complications as well as lead to improvement in component implantation and design

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