scholarly journals Clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged over 75 years: a multicenter, retrospective study

2022 ◽  
Author(s):  
Kentaro Amaha ◽  
Satoshi Yamaguchi ◽  
Atsushi Teramoto ◽  
Tetsuro Kokubo ◽  
Hiroyuki Seki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
The Self ◽  
Age Group ◽  
Ankle Osteoarthritis ◽  
Ankle Arthroplasty ◽  
Evaluation Questionnaire ◽  
End Stage

Abstract Background The purpose of this study was to clarify the clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥75 years and compare the outcomes with those of patients aged <75 years. Methods A total of 148 patients, including 65 post-total ankle arthroplasty and 83 post-ankle arthrodesis patients, were surveyed retrospectively. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot hindfoot scale and the self-administered foot evaluation questionnaire preoperatively and at the last follow-up. Patient characteristics, including age, sex, body mass index, radiographic severity, and follow-up period, were also assessed. Patients were divided into the older age group (≥75 years) and the younger age group (<75 years). Improvements in outcomes were then compared between the age groups using univariate analysis and analysis of covariance adjusted for patient characteristics. Post-total ankle arthroplasty and post-ankle arthrodesis were analyzed separately. Results All clinical outcome scores improved postoperatively in the older age group for both post-total ankle arthroplasty and post-ankle arthrodesis. For example, scores for pain and pain-related subscale of the self-administered foot evaluation questionnaire improved by 37 points (p < 0.001) for post-total ankle arthroplasty patients and by 35 points for post-ankle arthrodesis (p < 0.001). Furthermore, multivariate analysis showed that the improvements observed in all scores were not different between the older and younger age groups for both post-total ankle arthroplasty and post-ankle arthrodesis patients, except for the Self-Administered Foot Evaluation Questionnaire physical functioning subscale score for post-ankle arthrodesis patients. Conclusions Clinical outcomes improved significantly in post-total ankle arthroplasty and post-ankle arthrodesis patients aged ≥75 years. Moreover, the improvements were similar to those in patients aged <75 years. Therefore, surgical treatment of end-stage ankle osteoarthritis can be a viable treatment option, even in elderly patients.

scholarly journals Total ankle arthroplasty and ankle arthrodesis affect the biomechanics of the inner foot differently

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yan Wang ◽  
Duo Wai-chi Wong ◽  
Qitao Tan ◽  
Zengyong Li ◽  
Ming Zhang
Keyword(s):  
Contact Pressure ◽  
Stance Phase ◽  
Peak Stress ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Plantar Pressure Distribution ◽  
Metatarsal Bones ◽  
Biomechanical Parameters ◽  
End Stage

Abstract Ankle arthrodesis and total ankle arthroplasty are the two primary surgeries for treatment of end-stage degenerative ankle arthritis. The biomechanical effects of them on the inner foot are insufficient to identify which is superior. This study compared biomechanical parameters among a foot treated by ankle arthrodesis, a foot treated by total ankle arthroplasty, and an intact foot using computational analysis. Validated finite element models of the three feet were developed and used to simulate the stance phase of gait. The results showed total ankle arthroplasty provides a more stable plantar pressure distribution than ankle arthrodesis. The highest contact pressure, 3.17 MPa, occurred in the medial cuneonavicular joint in the total ankle arthroplasty foot. Neither of the surgeries resulted in contact pressure increase in the subtalar joint. The peak stress in the metatarsal bones was increased in both surgical models, especially the second and third metatarsals. This study enables us to get visual to the biomechanics inside of an intact foot, and feet treated by total ankle arthroplasty and ankle arthrodesis during walking.

scholarly journals Modern total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis

2020 ◽  
Vol 12 (3) ◽  
Author(s):  
Cort D. Lawton ◽  
Adam Prescott ◽  
Bennet A. Butler ◽  
Jakob F. Awender ◽  
Ryan S. Selley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Treatment Options ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
P Value ◽  
Eligibility Criteria ◽  
Ankle Arthroplasty ◽  
Significant Difference ◽  
End Stage

The controversy in surgical management of end-stage tibiotalar arthritis with Total Ankle Arthroplasty (TAA) versus Ankle Arthrodesis (AA) has grown in parallel with the evolution of both procedures. No randomized controlled trials exist due to the vast differences in surgical goals, patient expectations, and complication profiles between the two procedures. This makes high quality systematic reviews necessary to compare outcomes between these two treatment options. The aim of this study was to provide a systematic review with meta-analysis of publications reporting outcomes, complications, and revision data following third-generation TAA and/or modern AA published in the past decade. Thirtyfive articles met eligibility criteria, which included 4312 TAA and 1091 AA procedures. This review reports data from a mean follow-up of 4.9 years in the TAA cohort and 4.0 years in the AA cohort. There was no significant difference in overall complication rate following TAA compared to AA (23.6% and 25.7% respectively, P-value 0.31). Similarly, there was no significant difference in revision rate following TAA compared to AA (7.2% and 6.3% respectively, P-value 0.65). Successful treatment of end-stage tibiotalar arthritis requires an understanding of a patients’ goals and expectations, coupled with appropriate patient selection for the chosen procedure. The decision to proceed with TAA or AA should be made on a case-by-case basis following an informed discussion with the patient regarding the different goals and complication profiles for each procedure.

scholarly journals Two-Year Outcomes of Total Ankle Replacement with the Cadence Total Ankle Replacement System

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
Timothy R. Daniels ◽  
Shahin Kayum ◽  
Ryan M. Khan ◽  
Anastasia Sanjevic
Keyword(s):  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
X Rays ◽  
Ankle Osteoarthritis ◽  
Ankle Arthroplasty ◽  
Post Surgery ◽  
Ankle Replacement ◽  
Two Component ◽  
Replacement System ◽  
End Stage

Category: Ankle, Ankle Arthritis Introduction/Purpose: Over the last few decades, total ankle replacement (TAR) emerged as a reliable treatment option in end-stage ankle osteoarthritis (OA) while preserving motion and physiological load. The Cadence™ prosthesis, manufactured by Integra LifeSciences, is a two-component, fixed-bearing implant with minimal tibial and talar resection and has been in clinical use since June 2016. The purpose of this study is to assess the two-year validated clinical outcome scores and radiological parameters of the Cadence™ prosthesis at our hospital. Methods: Thirty-one consecutive patients who received the Cadence™ prosthesis between June 2016 and December 31st, 2016 were enrolled. All patients who underwent a primary TAR with the Cadence™ prosthesis and who had at least two years follow- up were included. All surgeries were performed by a single surgeon with experience in total ankle arthroplasty. At the yearly clinical evaluation, patients were administered the Ankle Osteoarthritis Scale (AOS) and the Short Form Health Survey (SF-36), and their radiological outcomes pre and post-surgery were assessed. Results: Thirty-one patients fulfilled the inclusion criteria. Forty ancillary procedures were performed on twenty-four TAR’s. Radiological analyses showed preoperative talar sagittal translation with 25 anterior, 2 posterior, and 4 neutral. Sagittal translation decreased from an average 3.11 mm to 1.0 mm. Eleven ankles had a perioperative talar Varus and Valgus deformity that was corrected, with neutral alignment in all. At the two-year clinic visit, x-rays showed no lucencies or stress fractures and none of the ankles required revision of metal components. The pre and post-operative pain and disability scores displayed major improvement wherein AOS pain scores decreased -20.28 ± 14.34 points from an average of 47.86 points while AOS disability scores decreased -32.11 ± 22.70 from an average of 57.15 points. Conclusion: The overall outcome of the total ankle arthroplasty with the Cadence™ prosthesis showed excellent clinical and radiological outcomes. Compelling clinical evidence shows that the quality of life, functional measures, and pain in patients suffering from end-stage arthritis significantly improved following surgery with the Cadence™ total ankle replacement system. The semi- constrained design of this two-component implant and utilization of biased polyethylene inserts allowed for correction of the talus in both the sagittal (talar anterior / posterior translation) and coronal planes (talar varus / valgus).

scholarly journals Total ankle arthroplasty incorporating a total talar prosthesis

2019 ◽  
Vol 101-B (4) ◽  
pp. 443-446 ◽  
Author(s):  
H. Kurokawa ◽  
A. Taniguchi ◽  
S. Morita ◽  
Y. Takakura ◽  
Y. Tanaka
Keyword(s):  
Clinical Results ◽  
Total Ankle Arthroplasty ◽  
Ankle Osteoarthritis ◽  
Ankle Arthroplasty ◽  
Custom Made ◽  
The Mean ◽  
Ct Data ◽  
End Stage ◽  
And Function

AimsTotal ankle arthroplasty (TAA) has become the most reliable surgical solution for patients with end-stage arthritis of the ankle. Aseptic loosening of the talar component is the most common complication. A custom-made artificial talus can be used as the talar component in a combined TAA for patients with poor bone stock of the talus. The purpose of this study was to investigate the functional and clinical outcomes of combined TAA.Patients and MethodsTen patients (two men, eight women; ten ankles) treated using a combined TAA between 2009 and 2013 were matched for age, gender, and length of follow-up with 12 patients (one man, 11 women; 12 ankles) who underwent a standard TAA. All had end-stage arthritis of the ankle. The combined TAA features a tibial component of the TNK ankle (Kyocera, Kyoto, Japan) and an alumina ceramic artificial talus (Kyocera), designed using individualized CT data. The mean age at the time of surgery in the combined TAA and standard TAA groups was 71 years (61 to 82) and 75 years (62 to 82), respectively. The mean follow-up was 58 months (43 to 81) and 64 months (48 to 88), respectively. The outcome was assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, the Ankle Osteoarthritis Scale (AOS), and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q).ResultsThe mean preoperative JSSF score of the combined TAA and standard TAA groups was 44 (sd 11) and 49 (sd 10), respectively. The mean postoperative JSSF scores were 89 (sd 6.1) and 72 (sd 15), respectively. The mean postoperative JSSF score of the combined TAA group was significantly higher (p = 0.0034). The mean preoperative AOS scores for pain and function in the combined TAA and standard TAA groups were 5.8 (sd 3.3) and 5.5 (sd 3.1), and 8.6 (sd 1.3), and 7.1 (sd 2.9), respectively. The mean postoperative AOS scores of pain and function were 2.5 (sd 2.5) and 2.2 (sd 1.9), and 2.5 (sd 3.3) and 3.4 (sd 2.9), respectively. There were no significant differences between the two groups in terms of postoperative AOS scores. The mean postoperative SAFE-Q scores were: for pain, 76 (sd 23) and 70 (sd 23); for physical function, 66 (sd 25) and 55 (sd 27); for social function, 73 (sd 35) and 62 (sd 34); for shoe-related, 73 (sd 19) and 65 (sd 26); and for general health, 78 (sd 28) and 67 (sd 29), respectively. There were no significant differences between the two groups in terms of postoperative SAFE-Q scores.ConclusionCombined TAA resulted in better clinical results than standard TAA. Cite this article: Bone Joint J 2019;101-B:443–446.

scholarly journals Minimum 20 Year Follow-Up of Semi-Constrained Total Ankle Arthroplasty

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000
Author(s):  
Taylor Den Hartog ◽  
Samuel Carlson ◽  
Greg Alvine ◽  
Frank Alvine ◽  
Bryan Den Hartog ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
The United States ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Cobalt Chromium ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Entire Cohort ◽  
Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: With the introduction of newer generations of total ankle arthroplasty (TAA) constructs, the incidence of TAA in the United States has been increasing. While TAA has emerged as an alternative to ankle arthrodesis for the management of end-stage ankle arthritis, long-term data evaluating clinical outcomes and the survivorship of ankle prostheses is lacking. The purpose of this study was to report the clinical outcomes and radiographic survivorship of a second-generation, semi-constrained titanium and cobalt-chromium total ankle prosthesis at minimum twenty-year follow-up in order to provide a benchmark comparison for future generations of TAA design. Methods: 132 total ankle replacements in 126 patients were performed by a single surgeon between July 1984 and October 1994. Follow-up evaluation consisted of determining revision status, completion of the validated ankle osteoarthritis scale, a short questionnaire, and a review of the available radiographs. All radiographs were evaluated for evidence of progressive radiolucent lines, osteolysis and component subsidence. Results: At minimum twenty-year follow-up, 37 patients were alive, 89 were deceased, and 5 were lost to follow-up. For living patients, average clinical follow up was 25.3 years. Average radiographic follow-up was 21.4 years. Over the minimum 20 year follow-up, 29 ankles were revised (23%). For living patients, 13 ankles were revised (35%). Conclusion: Twenty-three percent of all patients and 35% of living patients required a revision over the minimum 20 year follow up interval. 65% of living patients have retained their prosthesis and 75% of the entire cohort are still functioning with their original ankle replacement or died with the original ankle replacement in place. This study should provide a benchmark for newer designs when they obtain this length of follow-up.

Comparison of Clinical Outcomes After Total Ankle Arthroplasty Between End-Stage Osteoarthritis and Rheumatoid Arthritis

2021 ◽  
pp. 107110072097992
Author(s):  
Byung-Ki Cho ◽  
Min-Yong An ◽  
Byung-Hyun Ahn
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Outcomes ◽  
Immunosuppressive Treatment ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Ankle Arthroplasty ◽  
End Stage

Background: Total ankle arthroplasty (TAA) is known to be a reliable operative option for end-stage rheumatoid arthritis. However, higher risk of postoperative complications related to chronic inflammation and immunosuppressive treatment is still a concern. With the use of a newer prosthesis and modification of anti-rheumatic medications, we compared clinical outcomes after TAA between patients with osteoarthritis and rheumatoid arthritis. Methods: Forty-five patients with end-stage osteoarthritis (OA group) and 19 with rheumatoid arthritis (RA group) were followed for more than 3 years after 3 component mobile-bearing TAA (ZenithTM). Perioperative anti-rheumatic medications were modified using an established guideline used in total hip and knee arthroplasty. Clinical evaluations consisted of American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). Results: In the preoperative and postoperative evaluation at final follow-up, there were no significant differences in AOFAS, FAOS, and FAAM scores between 2 groups. Despite statistical similarity in total scores, the OA group showed significantly better scores in FAOS sports and leisure (mean, 57.4 ± 10.1) and FAAM sports activity (mean, 62.5 ± 13.6) subscales than those in the RA group (mean, 52.2 ± 9.8, P = .004; and 56.4 ± 13.2, P < .001, respectively). There were no significant differences in perioperative complication and revision rates between 2 groups. Conclusions: Patients with end-stage ankle RA had clinical outcomes comparable to the patients with OA, except for the ability related to sports activities. In addition, there were no significant differences in early postoperative complication rates, including wound problem and infection. Level of Evidence: Level III, prognostic, prospective comparative study.

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