Functional and radiological assessment of total ankle replacement with infinity prosthesis

Objective: To present mid-term functional and radiological outcomes obtained with the use of Infinity prosthesis in Bogotá (Colombia). Methods: This cross-sectional observational study selected consecutive patients subjected to total ankle replacement with the fourth generation Infinity prosthesis (Wright Medical Technology). Results: Fifty-two patients with ankle arthrosis were followed for a mean period of 24 months, and the most frequently reported case of joint degeneration was trauma. Postoperative improvement was observed in perception of pain (visual analog scale increased from 8/10 to 2/10; p<0.0005), AOFAS functional scale (from 23 to 84.5; p < 0.0005), and range of motion (from 11° to 29°; p<0.0005). Similarly, radiological findings, implant positioning, and signs of loosening did not reveal implant failure. Conclusions: The use of fluoroscopically navigated prostheses allows us to achieve predictable outcomes, with satisfactory mid-term clinical and imaging results. Level of Evidence IV; Therapeutic Studies; Case Series.

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Scandinavian Total Ankle Replacement: 15-Year Follow-up

Foot & Ankle International ◽

10.1177/1071100717738747 ◽

2018 ◽

Vol 39 (2) ◽

pp. 135-142 ◽

Cited By ~ 28

Author(s):

Ariel Palanca ◽

Roger A. Mann ◽

Jeffrey A. Mann ◽

Andrew Haskell

Keyword(s):

Case Series ◽

Mobile Bearing ◽

The United States ◽

Clinical Findings ◽

Total Ankle Replacement ◽

Fourth Generation ◽

Level Of Evidence ◽

Prosthetic Alignment ◽

Ankle Replacement

Background: Over the past decade, total ankle arthroplasty (TAA) has become a mainstay in the treatment of end-stage ankle arthritis. Currently in its fourth generation, the Scandanavian Total Ankle Replacement (STAR) is the only 3-piece mobile bearing ankle prosthesis available in the United States. Our current study reports implant survivorship at 15 years and patient outcomes for a subset of these survivors available for study. Methods: Eighty-four TAAs were performed between 1998 and 2000. Metal component survivorship at 15 years was calculated with a Kaplan-Meier curve. Twenty-four (29%) of 84 patients were available for participation with a minimum 15-year follow-up. Any radiographic changes were documented. All additional procedures and complications were recorded. Clinical findings, self-reported performance and pain evaluations, and AOFAS ankle/hindfoot scores were noted. Results: Metal implant survival was 73% at 15 years. Of the 24 patients available for clinical evaluation, 18 of 24 patients (70.7%) had no change in prosthetic alignment from the immediate postoperative radiograph. Only 1 subtalar fusion was required for symptomatic adjacent joint arthritis. Three patients sustained a broken polyethylene component. AOFAS scores improved from an average of 39.6 points preoperatively, to an average of 71.6. More than half (52.4%) of patients with retained implants required an additional surgical procedure; 3 required 2 additional procedures. The average time to subsequent procedure was 10.2 years. Conclusion: Our small cohort demonstrated STAR ankles with retention at 9 years were highly likely to survive to 15 years, and patients continued to have significant improvement in pain relief and minimal decrease in function. At 15 years from TAA, metal survivorship was 73%. As with all ankle replacements, supplementary procedures were common. Level of Evidence: Level IV, case series.

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Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

Foot & Ankle International ◽

10.1177/10711007211004447 ◽

2021 ◽

pp. 107110072110044

Author(s):

Catherine Conlin ◽

Ryan M. Khan ◽

Ian Wilson ◽

Timothy R. Daniels ◽

Mansur Halai ◽

...

Keyword(s):

Hospital Setting ◽

Case Series ◽

Total Ankle Replacement ◽

Qualitative Description ◽

Level Of Evidence ◽

Foot Placement ◽

Advantages And Disadvantages ◽

Ankle Fusion ◽

Ankle Replacement ◽

Patient Reported

Background: Total ankle replacement (TAR) and ankle fusion are effective treatments for end-stage ankle arthritis. Comparative studies elucidate differences in treatment outcomes; however, the literature lacks evidence demonstrating what outcomes are important to patients. The purpose of this study was to investigate patients’ experiences of living with both a TAR and ankle fusion. Methods: This research study used qualitative description. Individuals were selected from a cohort of patients with TAR and/or ankle fusion (n = 1254). Eligible patients were English speaking with a TAR and contralateral ankle fusion, and a minimum of 1 year since their most recent ankle reconstruction. Surgeries were performed by a single experienced surgeon, and semistructured interviews were conducted by a single researcher in a private hospital setting or by telephone. Ankle Osteoarthritis Scale (AOS) scores, radiographs, and ancillary surgical procedures were collected to characterize patients. Themes were derived through qualitative data analysis. Results: Ten adults (8 men, 2 women), ages 59 to 90 years, were included. Average AOS pain and disability scores were similar for both surgeries for most patients. Participants discussed perceptions of each reconstructed ankle. Ankle fusions were considered stable and strong, but also stiff and compromising balance. TARs were considered flexible and more like a “normal ankle,” though patients expressed concerns about their TAR “turning” on uneven ground. Individuals applied this knowledge to facilitate movement, particularly during a first step and transitioning between positions. They described the need for careful foot placement and attention to the environment to avoid potential challenges. Conclusion: This study provides insight into the experiences of individuals living with a TAR and ankle fusion. In this unusual but limited group of patients, we found that each ankle reconstruction was generally perceived to have different characteristics, advantages, and disadvantages. Most participants articulated a preference for their TAR. These findings can help clinicians better counsel patients on expectations after TAR and ankle fusion, and improve patient-reported outcome measures by better capturing meaningful outcomes for patients. Level of Evidence: Level IV, case series.

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Perspectives in Treatments of End-Stage Ankle Arthritis Among Orthopaedic Surgeons

Foot & Ankle Orthopaedics ◽

10.1177/2473011418779976 ◽

2018 ◽

Vol 3 (3) ◽

pp. 247301141877997

Author(s):

Phinit Phisitkul ◽

Natalie Glass ◽

Patrick B. Ebeling ◽

Sandra E. Klein ◽

Jeffrey E. Johnson

Keyword(s):

United States ◽

The United States ◽

Total Ankle Replacement ◽

Ankle Arthritis ◽

Cross Sectional Survey ◽

Level Of Evidence ◽

Cross Sectional ◽

Orthopaedic Surgeons ◽

Ankle Replacement ◽

End Stage

Background: This study aimed to assess the preferred operative treatment for patients over the age of 60 with end-stage ankle arthritis and perspectives on total ankle replacement (TAR) among American Orthopaedic Foot & Ankle Society (AOFAS) members. Associated factors were analyzed for potential contraindications among members with different levels of experience. Method: A questionnaire containing 6 questions was designed and sent to 2056 members of the AOFAS. Responses were received from 467 orthopaedic surgeons practicing in the United States (76%), Canada (5%), and 26 other countries (20%). Participants were grouped for response comparisons according to country as well as experience level. Differences in contraindications were compared using χ2 tests or exact tests. Results: Respondents practicing in the United States and surgeons who perform 11 or more TARs per year tended to recommend operative treatments favoring TAR and displayed recognition of its increasing role ( P < .05). Overall, respondents felt that 41% of typical patients over 60 years old with end-stage arthritis would be best treated with TAR. Talus avascular necrosis, morbid obesity (body mass index >40 kg/m2), and poorly controlled diabetes with neuropathy were most recognized as the absolute contraindications to TAR. Surgeon’s experience affected the consideration of these clinical factors as contraindications. Conclusions: Total ankle replacement has a substantial and increasing role in the treatment of end-stage ankle arthritis in patients over the age of 60. Absolute and potential contraindications of the procedures were indicated from a cross-sectional survey of AOFAS members. Surgeons more experienced with total ankle replacement felt more comfortable employing it in a wider range of clinical settings. Level of Evidence: Level III, therapeutic.

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Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement

Foot & Ankle International ◽

10.1177/1071100717709566 ◽

2017 ◽

Vol 38 (9) ◽

pp. 952-956 ◽

Cited By ~ 4

Author(s):

Manja Deforth ◽

Nicola Krähenbühl ◽

Lukas Zwicky ◽

Markus Knupp ◽

Beat Hintermann

Keyword(s):

Tibial Component ◽

Corrective Osteotomy ◽

Distal Tibia ◽

Case Series ◽

Outcome Data ◽

Total Ankle Replacement ◽

Level Of Evidence ◽

Supramalleolar Osteotomy ◽

Ankle Replacement ◽

Surface Angle

Background: Persistent pain despite a total ankle replacement is not uncommon. A main source of pain may be an insufficiently balanced ankle. An alternative to the revision of the existing arthroplasty is the use of a corrective osteotomy of the distal tibia, above the stable implant. This strictly extraarticular procedure preserves the integrity of the replaced joint. The aim of this study was to review a series of patients in whom a corrective supramalleolar osteotomy was performed to realign a varus misaligned tibial component in total ankle replacement. We hypothesized that the supramalleolar osteotomy would correct the malpositioned tibial component, resulting in pain relief and improvement of function. Methods: Twenty-two patients (9 male, 13 female; mean age, 62.6 years; range, 44.7-80) were treated with a supramalleolar osteotomy to correct a painful ankle with a varus malpositioned tibial component. Prospectively recorded radiologic and clinical outcome data as well as complications and reoperations were analyzed. Results: The tibial anterior surface angle significantly changed from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively ( P < .0001), the American Orthopaedic Foot & Ankle Society hindfoot score significantly increased from 46 ± 14 to 66 ± 16 points ( P < .0001) and the patient’s pain score measured with the visual analog scale significantly decreased from 5.8 ± 1.9 to 3.3 ± 2.4 ( P < .001). No statistical difference was found in the tibial lateral surface angle and the range of motion of the ankle when comparing the preoperative to the postoperative measurements. The osteotomy healed in all but 3 patients on first attempt. Fifteen patients (68%) were (very) satisfied, 4 moderately satisfied, and 3 patients were not satisfied with the result. Conclusion: The supramalleolar osteotomy was found to be a reliable treatment option for correcting the varus misaligned tibial component in a painful replaced ankle. However, nonunion (14%) should be mentioned as a possible complication of this surgery. Nonetheless, as a strictly extraarticular procedure, it did not compromise function of the previously replaced ankle, and it was shown to relieve pain without having to have revised a well-fixed ankle arthroplasty. Level of evidence: Level IV, case series.

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Total Ankle Replacement Conversion to Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft and Pseudoelastic Intramedullary Nail Providing Sustained Joint Compression

Foot & Ankle Orthopaedics ◽

10.1177/2473011418804487 ◽

2018 ◽

Vol 3 (4) ◽

pp. 247301141880448

Author(s):

Mark Jay Conklin ◽

Kathryn Elizabeth Smith ◽

Jeremy Webster Blair ◽

Kenneth Michael Dupont

Keyword(s):

Femoral Head ◽

Intramedullary Nail ◽

Case Series ◽

Preliminary Evidence ◽

Total Ankle Replacement ◽

Level Of Evidence ◽

Computed Tomographic ◽

Tibiotalocalcaneal Arthrodesis ◽

First Case ◽

Ankle Replacement

Tibiotalocalcaneal (TTC) arthrodesis is commonly performed to salvage a failed total ankle replacement. These salvage procedures are complicated by significant bone loss from the ankle replacement and are associated with low patient satisfaction. Here, we describe 2 cases of patients who presented with a failed total ankle replacement and underwent arthrodesis using a bulk femoral head allograft and a novel pseudoelastic intramedullary nail. The intramedullary nail contains an internal pseudoelastic element that adapts to bone resorption and settling allowing for compression to be maintained at the arthrodesis sites throughout healing. In the first case, a 65-year-old woman with a failed total ankle replacement underwent TTC arthrodesis. The second case involved an obese 53-year-old woman who had previously undergone 2 total ankle replacement procedures that resulted in unsuccessful outcomes. In both cases, union was demonstrated on computed tomographic scan by 6 months. At 2 years postsurgery, both patients were satisfied with the procedure. These cases provide preliminary evidence that tibiotalocalcaneal arthrodesis with a pseudoelastic IM nail and structural allograft is an appropriate treatment for failed total ankle replacements. Level of Evidence: Level IV, therapeutic, case series.

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Sports and Recreational Activities following Total Ankle Replacement

Joints ◽

10.1055/s-0037-1601408 ◽

2017 ◽

Vol 05 (01) ◽

pp. 012-016 ◽

Cited By ~ 3

Author(s):

Federico Usuelli ◽

Andrea Pantalone ◽

Camilla Maccario ◽

Matteo Guelfi ◽

Vincenzo Salini

Keyword(s):

Los Angeles ◽

Pain Score ◽

Short Form ◽

Case Series ◽

Total Ankle Replacement ◽

Activity Level ◽

Level Of Evidence ◽

Recreational Activities ◽

Ankle Replacement ◽

And Function

Purpose In literature, there is a controversy regarding whether patients who have undergone total ankle replacement (TAR) can participate in sports and recreational activities. The purpose of this study was to report change in sports activity level after TAR. Methods A retrospective study was performed, enrolling 76 patients with symptomatic end-stage ankle arthritis who underwent TAR from May 2011 to October 2014. Patients were mainly males (44/76; 58%) and 56 years old on average (range: 22.3–79.6 years) at the time of surgery. They were treated with mobile-bearing prosthesis implanted with an anterior approach. Patients were evaluated preoperatively and 12 months postoperatively. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, the visual analog scale (VAS) pain score, and the 12-Item Short Form Health Survey (SF-12) – physical component summary (PCS) and mental component summary (MCS). Activity level was assessed with the University of California at Los Angeles (UCLA) activity scale. Results At 12 months postoperatively, statistically significant increase was reported for AOFAS scores (from 32.8 ± 12.7 preoperatively to 72.6 ± 13.3; p < 0.001), SF-12 PCS (from 34.3 ± 5.1 preoperatively to 45.4 ± 6.4; p < 0.001), and SF-12 MCS (from 39.8 ± 7.5 preoperatively to 51.4 ± 6.1; p < 0.001). A statistically significant decrease was detected in VAS pain score (from 8.7 ± 1.6 preoperatively to 2.2 ± 1.6; p < 0.001). The UCLA activity levels increased significantly from 2.4 ± 0.8 to 6.3 ± 2.3 (p < 0.001). Conclusion Pain and function significantly improved in patients affected by ankle osteoarthritis, who underwent TAR, at 1-year follow-up. In addition, activity level showed a significant increase respect to preoperative condition. Level of Evidence Level IV, retrospective case series.

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Two-Year Outcomes After Total Ankle Replacement With a Novel Fixed-Bearing Implant

Foot & Ankle International ◽

10.1177/10711007211005781 ◽

2021 ◽

pp. 107110072110057

Author(s):

Sahil Kooner ◽

Shahin Kayum ◽

Ellie B. Pinsker ◽

Ahmed Al Khalifa ◽

Ryan M. Khan ◽

...

Keyword(s):

Short Form ◽

Case Series ◽

Total Ankle Replacement ◽

Fourth Generation ◽

Clinical Use ◽

Fixed Bearing ◽

Radiographic Outcomes ◽

Early Results ◽

Ankle Replacement ◽

Sf 36

Background: The Integra Cadence total ankle replacement (TAR) is a fourth-generation anatomic, fixed-bearing implant requiring minimal tibial and talar resection, which has been in clinical use since June 2016. The primary purpose of this study is to assess its short-term clinical and radiographic outcomes after TAR using this prosthesis. Methods: This is a prospective case series of consecutive patients that underwent TAR using this novel fourth-generation prosthesis between June 2016 and November 2017. The primary outcome of interest was the Ankle Osteoarthritis Scale (AOS). Secondary outcomes included Short Form Health Survey–36 (SF-36) scores, radiographic alignment, complications, reoperations, and revisions. Results: In total, 69 patients were included in our study. Fifty-one patients (73.9%) required a total of 91 ancillary procedures. Postoperatively, AOS pain scores decreased significantly by an average of 17.8±30.1 points from 45.9±18.2 to 28.4±27.3 ( P < .001). AOS disability scores also decreased significantly following surgery by an average of 22.0±30.5 points from 53.9±18.5 to 32.5±27.9 ( P < .001). The SF-36 physical component summary score improved 10.4±9.8 points from 33.1±9.1 to 42.6±9.1 ( P < .001). Radiographic analysis demonstrated significant improvement to neutral coronal plane alignment, which was achieved in 97% of patients ( P < .01) with no cyst formation at 2 years. There was 1 reported complication, 9 reoperations, and no metal or polyethylene component revisions. Overall, the 2-year implant survivorship was 100% in our cohort. Eighteen patients (26.1%) demonstrated fibrous ingrowth of the tibial component. However, outcome scores for these patients did not demonstrate any negative effects. Conclusions: In our hands, this TAR system demonstrated excellent early clinical and radiographic outcomes. Patients reported improved physical health status, pain, and disability in the postoperative period. Total ankle instrumentation allowed for accurate and reproducible implantation with correction of coronal and sagittal plane deformities. Early results for the clinical use of this TAR system are promising, but further long-term prospective outcome studies are necessary. Level of Evidence: Level IV, case series.

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Secondary Subtalar Joint Osteoarthritis Following Total Ankle Replacement

Foot & Ankle International ◽

10.1177/1071100719859216 ◽

2019 ◽

Vol 40 (10) ◽

pp. 1122-1128 ◽

Cited By ~ 4

Author(s):

Marc Sokolowski ◽

Nicola Krähenbühl ◽

Chen Wang ◽

Lukas Zwicky ◽

Christine Schweizer ◽

...

Keyword(s):

Subtalar Joint ◽

Case Series ◽

Fusion Rate ◽

Total Ankle Replacement ◽

Time Interval ◽

Level Of Evidence ◽

Joint Fusion ◽

Ankle Replacement ◽

Cystic Changes

Background:An advantage of total ankle replacement (TAR) compared to ankle fusion is that by maintaining motion, the occurrence of hypermobility of adjacent joints may be prevented. This could affect the development of symptomatic subtalar joint osteoarthritis (OA). The aim of the study was to determine the incidence of subtalar joint fusion and the progression of subtalar joint OA following TAR.Methods:Secondary subtalar joint fusion rate was determined from a cohort of 941 patients receiving primary TAR between 2000 and 2016. The indication for fusion, the time interval from primary TAR to fusion, and the union rate were evaluated. To assess the progression of subtalar joint OA, degenerative changes of the subtalar joint were classified in 671 patients using the Kellgren-Lawrence score (KLS) prior to TAR and at latest follow-up.Results:In 4% (37) of the patients, a secondary subtalar joint fusion was necessary. The indication for fusion was symptomatic OA in 51% (19), hindfoot instability in 27% (10), osteonecrosis of the talus in 19% (7), and cystic changes of the talus in 3% (1) of the patients. Time from primary TAR to subtalar joint fusion due to progressive OA was 5.0 (range, 0.3-10) years and for other reasons 1.6 (range, 0.2-11.6) years ( P = .3). In 68% (456) of the patients, no progression of subtalar joint OA was observed.Conclusion:The incidence of secondary subtalar joint fusion was low. The most common reason for subtalar joint fusion following TAR was symptomatic OA.Level of Evidence:Level IV, case series.

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Syndesmotic Overload in 3-Component Total Ankle Replacement

Foot & Ankle International ◽

10.1177/1071100719894528 ◽

2019 ◽

Vol 41 (3) ◽

pp. 275-285 ◽

Cited By ~ 2

Author(s):

Roxa Ruiz ◽

Roman Susdorf ◽

Nicola Krähenbühl ◽

Alexej Barg ◽

Beat Hintermann

Keyword(s):

Revision Surgery ◽

Case Series ◽

Mobile Bearing ◽

Cyst Formation ◽

Total Ankle Replacement ◽

Effective Treatment Option ◽

Retrospective Case ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Ankle Replacement

Background: Mobile-bearing total ankle replacement (TAR) potentially enables motion at the tibial implant–polyethylene insert (PI) interface. Such additional freedom of movement may overload periarticular ligaments and subsequently result in coronal translation of the talus. The aim of this study was to assess whether syndesmotic overload affects clinical and radiographic outcomes following mobile-bearing TAR and whether tibiofibular fusion is an effective treatment option. Methods: Thirty-one patients who underwent revision surgery for syndesmotic overload after mobile-bearing TAR were retrospectively analyzed. Clinical and radiographic outcomes were assessed before and after index TAR, preoperatively to revision surgery, and at the last follow-up after revision surgery. Computed tomography scans were also analyzed. Results: Ankles with lateral talar translation prior to revision surgery were about 10 times more likely to have valgus tibial implant position ( P = .003). A wide tibiofibular distance at the level of the syndesmosis after index TAR was associated with an increased hindfoot moment arm at revision surgery ( P = .025). Decrease of PI height at revision surgery and a PI fracture were evident in 10 (32%) and 4 (13%) cases, respectively. Talar cyst formation at revision surgery was evident in 12 (39%) cases. Tibiofibular fusion was effective in restoring function of the replaced ankle and providing pain relief. Conclusion: Syndesmotic overload impaired clinical and radiographic outcomes after mobile-bearing TAR. Proper implant positioning and additional realignment procedures may prevent overload of periarticular soft tissue structures after mobile-bearing TAR. Level of Evidence: Level IV, retrospective case series.

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Long-term Results of Scandinavian Total Ankle Replacement

Foot & Ankle International ◽

10.1177/1071100717698695 ◽

2017 ◽

Vol 38 (7) ◽

pp. 723-731 ◽

Cited By ~ 21

Author(s):

Helka Koivu ◽

Ia Kohonen ◽

Kimmo Mattila ◽

Eliisa Loyttyniemi ◽

Hannu Tiusanen

Keyword(s):

Case Series ◽

Total Ankle Replacement ◽

Long Term Results ◽

Retrospective Case ◽

Level Of Evidence ◽

Ankle Replacement ◽

Evaluation Point ◽

Subjective Measurements

Background: The purpose of this study was to evaluate the long-term results of the Scandinavian Total Ankle Replacement (STAR) implant in a single center. Methods: Between 1997 and 2002, 34 consecutive ankles were replaced with the STAR ankle prosthesis and reviewed in 2016. Patients were followed both radiologically and clinically; clinical outcomes were measured with the Kofoed ankle score and subjective measurements. The median follow-up period was 159 months (13.3 years; range, 13-202 months). Results: The implant survival rate was 93.9% (95% confidence interval [CI], 92.2%-86.7%) at 5 years, 86.7% (95% CI, 69.3%-96.2%) at 10 years, and 63.6% (95% CI, 30.8%-89.0%) at 15 years. A total of 15 ankles (44%) had been revised: 2 by fusion, 3 by further replacement, 5 by insert exchange, and 5 by bone grafting for marked osteolysis. The improvements in the Kofoed ankle score and Kofoed ankle score for pain were statistically significant at every postoperative evaluation point compared to the preoperative values (all P < .0001), and subjective patient satisfaction was high. Conclusion: Our results were satisfactory and in agreement with previously reported findings of STAR implants. Level of Evidence: Level IV, retrospective case series.

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