scholarly journals First-generation total ankle arthroplasty

2019 ◽  
Vol 13 (3) ◽  
pp. 228-31
Author(s):  
Carolina Tiago Afonso ◽  
António José Pereira de Andrade ◽  
Miguel Martins Pereira Pinto de Freitas ◽  
Afonso Salgado Ruano
Keyword(s):  
First Generation ◽  
Surgical Techniques ◽  
Total Ankle Arthroplasty ◽  
Bone Resection ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
The Poor ◽  
Biomechanical Compatibility ◽  
Initial Results

Ankle prostheses are a source of disagreement within the orthopedic community due to the poor initial results. The lack of alternatives to arthrodesis has promoted the evolution of arthroplasties. Biomechanical compatibility has been improved, new surgical techniques and instrumentation devices have been developed, and biological techniques for fixation of the various components have been introduced. The first-generation arthroplasty prostheses introduced in the 1970s were cemented and had a stable constrictive design, but because they required extensive bone resection for implantation, they failed due to loosening and extensive osteolysis. We report a case of left total ankle arthroplasty performed in 1980 that is still “in situ”. Based on the bibliographic research performed, this case seems to represent the longest-lasting implant reported to date. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Analysis of Retrieved Agility™ Total Ankle Arthroplasty Systems

2009 ◽  
Vol 30 (9) ◽  
pp. 815-823 ◽  
Author(s):  
Zachary Vaupel ◽  
Erin A. Baker ◽  
Kevin C. Baker ◽  
Michael D. Kurdziel ◽  
Paul T. Fortin
Keyword(s):  
Clinical Outcomes ◽  
Wear Debris ◽  
First Generation ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Implant Design ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Improved Outcomes ◽  
Component Loosening

Background: First generation total ankle arthroplasty (TAA) systems showed high rates of failure. The Agility™ (DePuy, Warsaw, IN) TAA system, a second generation design, had improved outcomes; however, implant failure due to loosening of the metallic components persisted. The purpose of this study was to analyze the damage modes and radiographic mode(s) of failure observed in retrieved Agility™ TAA. Materials and Methods: Ten devices were collected and each component was analyzed for common damage modes using microscopy. Clinical damage was analyzed with postoperative implant and preoperative revision procedure radiographs. Results: Analyses revealed damage/wear to retrieved components, including abrasion, dishing, and pitting. These third-body wear particles may be a precursor to wear debris induced osteolysis which could cause component loosening. Seven TAA systems were removed due to loosening or subsidence, suggesting component damage/wear may lead to clinically observed component loosening. Retrieval analysis indicated the polyethylene experiences edge loading, resulting in increased contact stresses to polyethylene in the primary articulation region and wear. Conclusion: Since poor clinical outcomes have been associated with component instability and osteolysis, analyzing retrieved components wear and damage may be an important step toward improving implant design, thereby decreasing wear debris induced osteolysis and improving clinical outcomes. Level of Evidence: IV, Case Series

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)

Possible Implications for Bundled Payment Models of Comorbidities and Complications as Drivers of Cost in Total Ankle Arthroplasty

2018 ◽  
Vol 40 (2) ◽  
pp. 210-217 ◽  
Author(s):  
Daniel Cunningham ◽  
Vasili Karas ◽  
James K. DeOrio ◽  
James A. Nunley ◽  
Mark E. Easley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
Patient Factors ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Bundled Payment ◽  
Significance Threshold ◽  
Ed Visits

Background: The Comprehensive Care for Joint Replacement (CJR) model provides bundled payments for in-hospital and 90-day postdischarge care of patients undergoing total ankle arthroplasty (TAA). Defining patient factors associated with increased costs during TAA could help identify modifiable preoperative patient factors that could be addressed prior to the patient entering the bundle, as well as determine targets for cost reduction in postoperative care. Methods: This study is part of an institutional review board–approved single-center observational study of patients undergoing TAA from January 1, 2012, to December 15, 2016. Patients were included if they met CJR criteria for inclusion into the bundled payment model. All Medicare payments beginning at the index procedure through 90 days postoperatively were identified. Patient, operative, and postoperative characteristics were associated with costs in adjusted, multivariable analyses. One hundred thirty-seven patients met inclusion criteria for the study. Results: Cerebrovascular disease (intracranial hemorrhages, strokes, or transient ischemic attacks) was initially associated with increased costs (mean, $5595.25; 95% CI, $1710.22-$9480.28) in adjusted analyses ( P = .005), though this variable did not meet a significance threshold adjusted for multiple comparisons. Increased length of stay, discharge to a skilled nursing facility (SNF), admissions, emergency department (ED) visits, and wound complications were significant postoperative drivers of payment. Conclusion: Common comorbidities did not reliably predict increased costs. Increased length of stay, discharge to an SNF, readmission, ED visits, and wound complications were postoperative factors that considerably increased costs. Lastly, reducing the rates of SNF placement, readmission, ED visitation, and wound complications are targets for reducing costs for patients undergoing TAA. Level of Evidence: Level II, prognostic prospective cohort study.

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

2020 ◽  
Vol 41 (12) ◽  
pp. 1519-1528
Author(s):  
Jonathan Day ◽  
Jaeyoung Kim ◽  
Martin J. O’Malley ◽  
Constantine A. Demetracopoulos ◽  
Jonathan Garfinkel ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
The Mean ◽  
Component Revision

Background: The Salto Talaris is a fixed-bearing implant first approved in the US in 2006. While early surgical outcomes have been promising, mid- to long-term survivorship data are limited. The aim of this study was to present the survivorship and causes of failure of the Salto Talaris implant, with functional and radiographic outcomes. Methods: Eighty-seven prospectively followed patients who underwent total ankle arthroplasty with the Salto Talaris between 2007 and 2015 at our institution were retrospectively identified. Of these, 82 patients (85 ankles) had a minimum follow-up of 5 (mean, 7.1; range, 5-12) years. The mean age was 63.5 (range, 42-82) years and the mean body mass index was 28.1 (range, 17.9-41.2) kg/m2. Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Preoperative, immediate, and minimum 5-year postoperative AP and lateral weightbearing radiographs were reviewed; tibiotalar alignment (TTA) and the medial distal tibial angle (MDTA) were measured to assess coronal talar and tibial alignment, respectively. The sagittal tibial angle (STA) was measured; the talar inclination angle (TIA) was measured to evaluate for radiographic subsidence of the implant, defined as a change in TIA of 5 degrees or more from the immediately to the latest postoperative lateral radiograph. The locations of periprosthetic cysts were documented. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Results: Survivorship was 97.6% with 2 revisions. One patient underwent tibial and talar component revision for varus malalignment of the ankle; another underwent talar component revision for aseptic loosening and subsidence. The rate of other reoperations was 21.2% ( n = 18), with the main reoperation being exostectomy with debridement for ankle impingement ( n = 12). At final follow-up, the average TTA improved 4.4 (± 3.8) degrees, the average MDTA improved 3.4 (± 2.6) degrees, and the average STA improved 5.3 (± 4.5) degrees. Periprosthetic cysts were observed in 18 patients, and there was no radiographic subsidence. All FAOS subscales demonstrated significant improvement at final follow-up. Conclusions: We found the Salto Talaris implant to be durable, consistent with previous studies of shorter follow-up lengths. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at a minimum 5-year follow-up. Level of Evidence: Level IV, retrospective case series.

scholarly journals Diagnostic Criteria and Treatment of Acute and Chronic Periprosthetic Joint Infection of Total Ankle Arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141984100
Author(s):  
Kempland C. Walley ◽  
Christopher B. Arena ◽  
Paul J. Juliano ◽  
Michael C. Aynardi
Keyword(s):  
Diagnostic Criteria ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Prosthetic Joint ◽  
Ankle Replacement ◽  
Knee And Hip Arthroplasty

Background: Prosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a serious complication that results in significant consequences to the patient and threatens the survival of the ankle replacement. PJI in TAA may require debridement, placement of antibiotic spacer, revision arthroplasty, conversion to arthrodesis, or potentially below the knee amputation. While the practice of TAA has gained popularity in recent years, there is some minimal data regarding wound complications in acute or chronic PJI of TAA. However, of the limited studies that describe complications of PJI of TAA, even fewer studies describe the criteria used in diagnosing PJI. This review will cover the current available literature regarding total ankle arthroplasty infection and will propose a model for treatment options for acute and chronic PJI in TAA. Methods: A review of the current literature was conducted to identify clinical investigations in which prosthetic joint infections occurred in total ankle arthroplasty with associated clinical findings, radiographic imaging, and functional outcomes. The electronic databases for all peer-reviewed published works available through January 31, 2018, of the Cochrane Library, PubMed MEDLINE, and Google Scholar were explored using the following search terms and Boolean operators: “total ankle replacement” OR “total ankle arthroplasty” AND “periprosthetic joint infection” AND “diagnosis” OR “diagnostic criteria.” An article was considered eligible for inclusion if it concerned diagnostic criteria of acute or chronic periprosthetic joint infection of total ankle arthroplasty regardless of the number of patients treated, type of TAA utilized, conclusion, or level of evidence of study. Results: No studies were found in the review of the literature describing criteria for diagnosing PJI specific to TAA. Conclusions: Literature describing the diagnosis and treatment of PJI in TAA is entirely reliant on the literature surrounding knee and hip arthroplasty. Because of the limited volume of total ankle arthroplasty in comparison to knee and hip arthroplasty, no studies to our knowledge exist describing diagnostic criteria specific to total ankle arthroplasty with associated reliability. Large multicenter trials may be required to obtain the volume necessary to accurately describe diagnostic criteria of PJI specific to TAA. Level of Evidence: Level III, systematic review.

Does Deep Chronic Infection After Total Ankle Arthroplasty (TAA) Require Implant Removal?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 62S-63S
Author(s):  
Jonathan Kaplan ◽  
Steven Raikin
Keyword(s):  
Chronic Infection ◽  
Total Ankle Arthroplasty ◽  
Implant Removal ◽  
Level Of Evidence ◽  
Ankle Arthroplasty

Recommendation: Yes. Deep chronic infection after total ankle arthroplasty (TAA) requires implant removal unless otherwise contraindicated. Level of Evidence: Strong. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

Comparison of Intermediate-term Outcomes of Total Ankle Arthroplasty in Primary and Ligamentous Post-traumatic Osteoarthritis

2019 ◽  
Vol 40 (11) ◽  
pp. 1273-1281 ◽  
Author(s):  
Gun-Woo Lee ◽  
Asep Santoso ◽  
Keun-Bae Lee
Keyword(s):  
Short Form ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Radiographic Outcomes ◽  
Primary Osteoarthritis ◽  
Post Traumatic ◽  
American Orthopaedic ◽  
End Stage

Background: Ankle ligamentous injuries without fracture can result in end-stage ligamentous post-traumatic osteoarthritis, which may cause ligamentous imbalance after total ankle arthroplasty (TAA). However, outcomes of TAA in these patients are not well known. The purpose of this study was to evaluate intermediate-term clinical and radiographic outcomes of TAA in patients with ligamentous post-traumatic osteoarthritis and compare them with results of TAA for patients with primary osteoarthritis. Methods: We enrolled 114 patients (119 ankles) with consecutive primary TAA using HINTEGRA prosthesis at a mean follow-up duration of 6.0 years (range, 3-13). We divided all patients into 2 groups according to the etiology of osteoarthritis: (1) primary osteoarthritis group (69 ankles) and (2) ligamentous post-traumatic osteoarthritis group (50 ankles). Results: There was no significant intergroup difference in mean Ankle Osteoarthritis Scale (AOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Short Form-36 Physical Component Summary, visual analog scale pain score, ankle range of motion, or complications at the final follow-up. However, the final tibiotalar angle was less corrected to 4.2 degrees in the ligamentous post-traumatic osteoarthritis group compared to 2.7 degrees in the primary osteoarthritis group ( P = .001). More concomitant procedures were required at the index surgery for the ligamentous post-traumatic osteoarthritis group ( P = .001). The estimated 5-year survivorship was 93.4% (primary osteoarthritis group: 91.3%; ligamentous post-traumatic osteoarthritis group: 95.8%). Conclusions: Clinical outcomes, complication rate, and 5-year survivorship of TAA in ankles with primary and ligamentous post-traumatic osteoarthritis were comparable with intermediate-term follow-up. Our results suggest that TAA would be a reliable treatment in ankles with ligamentous post-traumatic osteoarthritis when neutrally aligned stable ankles are achieved postoperatively. Level of Evidence: Level III, retrospective cohort study.

What Preoperative Optimization Should Be Implemented to Reduce the Risk of Surgical Site Infection/Periprosthetic Joint Infection (SSI/PJI) in Patients Undergoing Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 6S-8S ◽  
Author(s):  
Khaled Emara ◽  
Christopher B. Hirose ◽  
Ryan Rogero
Keyword(s):  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Site Infection ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Preoperative Optimization ◽  
Control Body ◽  
Skin Cleansing ◽  
Status Enhancement ◽  
Timely Administration

Recommendation: We recommend that patients awaiting total ankle arthroplasty (TAA) be optimized prior to surgery by implementing skin cleansing, nutritional status enhancement, glycemic control, body mass index (BMI) optimization, smoking cessation, and management of immune-modulating comorbidities. At the time of surgery, there is strong evidence that optimal preparation of the surgical site with an alcohol-containing agent, weight-based and timely administration of antibiotic prophylaxis, and reducing operating room traffic should also be put in place. Level of Evidence: Moderate. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

What Metrics Can Be Used to Determine the Optimal Timing of Reimplantation in Patients Who Have Undergone Resection Arthroplasty as Part of a Two-Stage Exchange for Infected Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 58S-60S
Author(s):  
Eric Senneville ◽  
Valeria Lopez ◽  
Gaston Slullitel
Keyword(s):  
Clinical Signs ◽  
Resection Arthroplasty ◽  
Total Ankle Arthroplasty ◽  
Optimal Timing ◽  
Two Stage ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Serologic Markers ◽  
Conclusive Data ◽  
Diagnosis Of Infection

Recommendation: There is no conclusive data regarding what metrics can be used in order to determine the optimal timing of reimplantation for an infected TAA. We recommend that reimplantation is performed when there are clinical signs of resolution of infection (well-healed wound, lack of erythema, etc), and the serologic markers have substantially declined (>40%) from baseline (measured at the time of diagnosis of infection). Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

scholarly journals Quality of Modern Total Ankle Arthroplasty Research

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Daniel Bohl ◽  
Emily Vafek ◽  
Simon Lee ◽  
Johnny Lin ◽  
George Holmes ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Case Reports ◽  
Case Series ◽  
The United States ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is gaining popularity as an alternative to ankle arthrodesis in the setting of end-stage ankle arthritis. However, compared to hip and knee arthroplasty, there is a relative dearth of evidence to support its use. This study assesses the quality of literature surrounding modern TAA designs. Methods: A search of all peer-reviewed, English-language journals was conducted to identify publications involving TAA. The initial search identified 444 articles published during 2006-2016. Of these, 182 were excluded because they were not clinical outcomes studies, 46 because the TAA implant was no longer available, and 15 because the primary outcome of the study was not related to TAA, leaving 201 articles for analysis. Results: No Level I studies were identified. Seventeen (8%) studies were Level II, 48 (24%) Level III, 128 (64%) Level IV, and 8 (4%) Level V. One hundred forty-three studies (71%) were retrospective in nature. Stratification by study design revealed 128 (64%) case series, 33 (16%) experimental cohort studies, 19 (10%) case-control studies, 13 (6%) observational cohort studies, and 8 (4%) case reports. The number of studies published each year steadily increased from 2006 to 2016. A total of 51% of TAA research was published in only two journals: Foot and Ankle International and the Journal of Bone and Joint Surgery. Publications from the United States accounted for 36% of total publications. The most published implant was the Scandinavian Total Ankle Replacement (Figure 1). Conclusion: While the number of TAA studies published each year has steadily increased since 2006, the quality of this research as measured by level of evidence remains suboptimal. This analysis highlights the need for continued improvement in methodology and development of robust prospective registries to advance our knowledge of TAA as a treatment for end-stage ankle arthritis.

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