scholarly journals Volume and Distribution of Periprosthetic Bone Cysts in the Distal Tibia and Talus before Early Revision of Total Ankle Arthroplasty

2021 ◽  
Vol 11 (16) ◽  
pp. 7242
Author(s):  
Seoyeong Kim ◽  
Jinju Jang ◽  
Jae-Hyuk Choi ◽  
Hai-Mi Yang ◽  
Heoung-Jae Chun ◽  
...  
Keyword(s):  
Distal Tibia ◽  
Three Dimensional ◽  
Total Ankle Arthroplasty ◽  
Periprosthetic Osteolysis ◽  
Periprosthetic Bone ◽  
Careful Planning ◽  
Ankle Arthroplasty ◽  
Early Revision ◽  
Further Development ◽  
Stress Flow

Periprosthetic osteolysis is a common complication following total ankle arthroplasty (TAA). However, understanding of osteolysis volume and distribution is still evolving, undermining efforts to reduce the incidence of osteolysis via bone remodeling. We obtained data on the characteristics of osteolysis developing within the distal tibia and talus after TAA. Three-dimensional computed tomography (3D-CT) reconstructions of 12 patients who underwent HINTEGRA TAA were performed. We identified 27 volumes of interest (VOIs) in the tibia and talus and used statistical methods to identify the characteristics of osteolysis in the VOIs. The osteolysis volume was significantly larger in the talus than in the tibia (162.1 ± 13.6 and 54.9 ± 6.1 mm3, respectively, p = 0.00). The extent of osteolysis within the peri-prosthetic region was greater than within other regions (p < 0.05). Particularly, in the talus, the region around the talar pegs exhibited 24.2 ± 4.5% more osteolysis than any other talar region (p = 0.00). Our results may suggest that extensive osteolysis within the peri-prosthetic region reflects changes in stress flow and distribution, which vary according to the design and placement of the fixation components. This is the first study to report 3D osteolysis patterns after TAA. Careful planning of TAA design improvements may reduce the incidence of osteolysis. Our results will facilitate the further development of TAA systems.

scholarly journals The Fate of Bone Graft for Periprosthetic Osteolysis in Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Yoo Jung Park ◽  
Dong-Woo Shim ◽  
Yeokgu Hwang ◽  
Jin Woo Lee
Keyword(s):  
Clinical Outcome ◽  
Bone Graft ◽  
Bone Grafting ◽  
Distal Tibia ◽  
Total Ankle Arthroplasty ◽  
Implant Failure ◽  
Periprosthetic Osteolysis ◽  
Aofas Score ◽  
Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. It may cause implant failure and has potential to affect long-term implant survival. To prevent major revisional arthroplasty, it is important to make an early diagnosis of osteolysis and decide an appropriate timing of surgical intervention such as bone graft. We report our experience of bone graft for osteolysis after TAA associated with clinical and radiologic outcome. Methods: Between May 2004 and Oct. 2013, 238 primary TAA were performed on 219 patients. We excluded 37 ankles with follow-up less than 24 months; thus, 201 ankles in 185 patients with mean follow-up of 61.9 (range, 24-130) months were included in the study. Nineteen patients were treated with a total of 21 bone graft procedures for periprosthetic osteolysis after TAA. Of these patients, 12 (57.1%) were males with mean follow-up length after bone graft 35.0 months. Location of osteolysis, bone grafting method and clinical outcome parameters using visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score were recorded. Results: Radiographs revealed total of 62 osteolysis lesions in 19 patients; 35 (56.5%) distal tibial lesions, 23 (37.0%) talar lesions. Autogenous iliac bone graft was used in 18 procedures (85.7%). The mean scores (and standard deviation) improved for the VAS from 4.8 ± 1.23 points before bone graft to 3.0 ± 0.94 points at the last follow-up (p<0.05); and for the AOFAS score from 76.8 ± 5.9 before bone graft to 84.3 ± 4.5 at the last follow-up (p<0.05). After 21 bone graft procedures, 6 demonstrated detection of newly developed osteolysis. One patient needed a repeat bone graft procedure with cementation after the primary bone grafting due to large cyst on distal tibia. There was no implant failure or major revisions after the bone graft. Conclusion: Bone graft for periprosthetic osteolysis may improve patient’s clinical outcome and give support to the structures surrounding the implant. Bone grafting in optimal timing may also improve implant survivorship. However, further study is needed for the etiology of newly developed painless osteolysis even after the bone graft.

Comparison of Preoperative Bone Density in Patients With and Without Periprosthetic Osteolysis Following Total Ankle Arthroplasty

2020 ◽  
pp. 107110072097609
Author(s):  
Gun-Woo Lee ◽  
Hyoung-Yeon Seo ◽  
Dong-Min Jung ◽  
Keun-Bae Lee
Keyword(s):  
Bone Density ◽  
Ankle Joint ◽  
Bone Ingrowth ◽  
Distal Tibia ◽  
Reference Points ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Periprosthetic Osteolysis ◽  
Ankle Arthroplasty ◽  
Press Fit

Background: Modern total ankle arthroplasty (TAA) prostheses are uncemented press-fit designs whose stability is dependent on bone ingrowth. Preoperative insufficient bone density reduces initial local stability at the bone-implant interface, and we hypothesized that this may play a role in periprosthetic osteolysis. We aimed to investigate the preoperative bone density of the distal tibia and talus and compare these in patients with and without osteolysis. Methods: We enrolled 209 patients (218 ankles) who underwent primary TAA using the HINTEGRA prosthesis. The overall mean follow-up duration was 66 (range, 24-161) months. The patients were allocated into 2 groups according to the presence of periprosthetic osteolysis: the osteolysis group (64 patients, 65 ankles) and nonosteolysis group (145 patients, 153 ankles). Between the 2 groups, we investigated and compared the radiographic outcomes, including the Hounsfield unit (HU) value around the ankle joint and the coronal plane alignment. Results: HU values of the tibia and talus measured at 5 mm from the reference points were higher than those at 10 mm in each group. However, comparing the osteolysis and nonosteolysis groups, we found no significant intergroup difference in HU value at every measured level in the tibia and talus ( P > .05). Concerning the coronal plane alignment, there were no significant between-group differences in the tibiotalar and talar tilt angles ( P > .05). Conclusions: Patients with osteolysis showed similar preoperative bone density of the distal tibia and talus compared with patients without osteolysis. Our results suggest that low bone density around the ankle joint may not be associated with increased development of osteolysis. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Management of Periprosthetic Osteolysis after Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0037
Author(s):  
Yoo Jung Park ◽  
Kwang Hwan Park ◽  
Jae Han Park ◽  
Seung Hwan Han ◽  
Sang B. Kim ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Bone Graft ◽  
Bone Grafting ◽  
Distal Tibia ◽  
Total Ankle Arthroplasty ◽  
Implant Failure ◽  
Time Interval ◽  
Consecutive Series ◽  
Periprosthetic Osteolysis ◽  
Ankle Arthroplasty

Category: Ankle Arthritis; Ankle Introduction/Purpose: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. It may cause implant failure and has potential to affect long-term implant survival. To prevent major revisional arthroplasty, it is important to make an early diagnosis of osteolysis and decide an appropriate timing of surgical intervention such as bone graft. We report our updated result of bone graft for osteolysis after TAA associated with clinical and radiologic outcome. Methods: We retrospectively evaluated our consecutive series of 440 primary TAAs performed between May 2004 and August 2018 and identified those who had a subsequent bone graft procedure. A total of 38 bone graft procedures for periprosthetic osteolysis after TAA were performed. Mean time-interval between primary TAA and bone graft was 5.09 years (range 17.0 to 127.0 months). Location of osteolysis, bone grafting method and clinical outcome parameters using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score were recorded. Results: Radiographs revealed periprosthetic osteolysis in 51.8% (58/112) of distal tibial lesions and 41.1% (46/112) of talar lesions. Autogenous iliac bone graft was used in most of procedures. Both mean VAS and AOFAS scores improved significantly at the last follow-up (p<0.05) One patient needed a repeat bone graft procedure with additional bone cementation after the primary bone grafting due to large cyst on distal tibia. There was no implant failure or major revisions after the bone graft. Conclusion: Bone graft for periprosthetic osteolysis may improve patient’s clinical outcome and give support to the structures surrounding the implant. Bone grafting in optimal timing may also improve implant survivorship. However, further study is needed for the etiology of newly developed painless osteolysis even after the bone graft.

Periprosthetic Osteolysis after Total Ankle Arthroplasty

2013 ◽  
Vol 35 (1) ◽  
pp. 14-21 ◽  
Author(s):  
Hang Seob Yoon ◽  
Jongseok Lee ◽  
Woo Jin Choi ◽  
Jin Woo Lee
Keyword(s):  
Total Ankle Arthroplasty ◽  
Periprosthetic Osteolysis ◽  
Ankle Arthroplasty

Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty

2020 ◽  
pp. 107110072097842
Author(s):  
Nabil Mehta ◽  
Joseph Serino ◽  
Edward S. Hur ◽  
Shelby Smith ◽  
Kamran S. Hamid ◽  
...  
Keyword(s):  
Basic Science ◽  
Management Strategies ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Common Occurrence ◽  
Periprosthetic Osteolysis ◽  
Level Of Evidence ◽  
Comprehensive Review ◽  
Ankle Arthroplasty ◽  
A Current

Periprosthetic osteolysis is a common occurrence after total ankle arthroplasty (TAA) and poses many challenges for the foot and ankle surgeon. Osteolysis may be asymptomatic and remain benign, or it may lead to component instability and require revision or arthrodesis. In this article, we present a current and comprehensive review of osteolysis in TAA with illustrative cases. We examine the basic science principles behind the etiology of osteolysis, discuss the workup of a patient with suspected osteolysis, and present a review of the evidence of various management strategies, including grafting of cysts, revision TAA, and arthrodesis. Level of Evidence: Level V, expert opinion.

Total Ankle Arthroplasty Radiographic Alignment Comparison Between Patient-Specific Instrumentation and Standard Instrumentation

2021 ◽  
pp. 107110072199637
Author(s):  
Mario I. Escudero ◽  
Vu Le ◽  
Thomas Bradford Bemenderfer ◽  
Maximiliano Barahona ◽  
Robert B. Anderson ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Distal Tibia ◽  
Total Ankle Arthroplasty ◽  
Patient Specific ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Ankle Arthroplasty ◽  
Patient Specific Instrumentation ◽  
Standard Instrumentation ◽  
Radiographic Alignment

Background Several benefits are published supporting patient-specific instrumentation (PSI) in total ankle arthroplasty (TAA). This study seeks to determine if TAA with PSI yields different radiographic outcomes vs standard instrumentation (SI). Methods: Sixty-seven primary TAA patients having surgery using PSI or SI between 2013 and 2015 were retrospectively reviewed using weightbearing radiographs at 6-12 weeks postsurgery. Radiographic parameters analyzed were the medial distal tibia angle (MDTA), talar-tilt angle (TTA), anatomic sagittal distal tibia angle (aSDTA), lateral talar station (LTS), and talar component inclination angle (TCI). A comparison of the 2 groups for each radiologic parameter’s distribution was performed using a nonparametric median test and Fisher exact test. Furthermore, TAAs with all radiographic measurements within acceptable limits were classified as “perfectly aligned.” The rate of “perfectly aligned” TAAs between groups was compared using a Fisher exact test with a significance of .05. Results: Of the 67 TAAs, 51 were done with PSI and 16 with SI. There were no differences between groups in MDTA ( P = .174), TTA ( P = .145), aSDTA ( P = .98), LTS ( P = .922), or TCI angle ( P = .98). When the rate of “perfectly aligned TAA” between the 2 groups were compared, there was no significant difference ( P = .35). Conclusion: No significant radiographic alignment differences were found between PSI and SI implants. This study showed that both techniques achieve reproducible TAA radiographic coronal and sagittal alignment for the tibial component when performed by experienced surgeons. The talar component’s sagittal alignment is similar whether or not PSI was used but is noticeably different from normal anatomic alignment by design. Level of Evidence: Level III, retrospective cohort study using prospectively collected data.

scholarly journals Increased Early Revision Rate With the INFINITY Total Ankle Prosthesis

2018 ◽  
Vol 40 (1) ◽  
pp. 9-17 ◽  
Author(s):  
Elizabeth A. Cody ◽  
Michel A. Taylor ◽  
James A. Nunley ◽  
Selene G. Parekh ◽  
James K. DeOrio
Keyword(s):  
Tibial Component ◽  
Revision Rate ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Secondary Outcome ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Early Revision ◽  
Component Loosening

Background: A number of new 2-component total ankle arthroplasty systems that emphasize minimal bone resection have been introduced for which few clinical outcomes reports are available. Our aim was to identify the rate of early revision among patients receiving the 2-component INFINITY prosthesis. Methods: Patients from 2 prospectively collected databases at the authors’ institution were screened for inclusion in the present study. All patients who underwent a primary total ankle arthroplasty (TAA) with the INFINITY prosthesis and who were at least 1 year postoperative were included. A total of 159 ankles with a mean 20 months of follow up (range, 12-37) met these criteria. All surgeries were performed by 1 of 2 orthopedic foot and ankle surgeons with extensive experience in TAA. The primary outcome was the need for revision surgery, defined as removal of 1 or both metal components. Peri-implant lucency at most recent follow-up was a secondary outcome. Weightbearing radiographs at most recent follow-up were graded for lucency independently by 2 reviewers. Results: Sixteen ankles (10%) underwent revision at a mean 13 months postoperatively. The most common reasons for revision were symptomatic tibial component loosening and deep infection (6 patients each, 3.8%). Of the 108 ankles with retained components and at least 1 year of radiographic follow-up, 8 (7.4%) had global lucency around the tibial component suggestive of loosening at most recent follow-up. Conclusions: Our initial review of patients undergoing TAA with this new 2-component prosthesis demonstrates an elevated early revision rate due to tibial component loosening compared to other implant systems. Level of Evidence: Level IV, case series.

scholarly journals Risk Factors for Early Failure of 4th Generation Total Ankle Arthroplasty Prostheses

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0042
Author(s):  
Calvin J. Rushing ◽  
Christopher F. Hyer ◽  
Gregory C. Berlet
Keyword(s):  
Risk Factors ◽  
Revision Surgery ◽  
Distal Tibia ◽  
Total Ankle Arthroplasty ◽  
Early Failure ◽  
Ankle Arthroplasty ◽  
Patient Demographics ◽  
Independent Risk Factors ◽  
Hindfoot Fusion

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: A number of two-component, 4th generation total ankle arthroplasty (TAA) prostheses have been introduced to the market in the past few years, as the popularity and indications for TAA have continued to expand. The purpose of the present study was to identify independent risk factors for the early failure of 4th generation TAA prostheses. Methods: A total of 97 ankles underwent TAA with a 4th generation prostheses (INFINITY, CADENCE) between August 2015 and June 2018 at a single institution and were at least 6 months postoperative (mean 18.3 months, range 6-43). The primary outcome assessed was the need for revision surgery, defined as removal of 1 or both metal components for any reason, excluding infection. Baseline patient demographics, characteristics, radiographic alignment parameters, and distal tibia cortical bone thickness (CBT) were assessed. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al. and Glazebrook et el., respectively. Univariate and multivariate analyses were performed. Results: Three ankles (3.1%) underwent revision surgery for aseptic loosening at a mean of 24.3 (range, 16-31) months; all had a CBT <4mm. Independent predictors for reoperation were a CBT < 4mm, the presence of diabetes, and ipsilateral hindfoot fusion (p=0.04). No associations were identified for purported risk factors (age, BMI, and coronal deformity). Conclusion: The present study is the first to suggest a potential relationship between CBT of the distal tibia and TAA failure. Additional studies are warranted to better understand the role of bone density in TAA survivorship.

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