Faculty Opinions recommendation of Clinical and radiographic outcomes of the mobility total ankle arthroplasty system: early results from a prospective multicenter study.

Category: Ankle Arthritis Introduction/Purpose: Treatment of the failed total ankle arthroplasty (TAA) is challenging, and historically arthrodesis was advocated as the salvage treatment of choice. Currently, there is limited available literature reporting on options and outcomes of revision arthroplasty despite the persistent relatively high failure rate ranging from 10-23% within the first ten years after primary TAA. Early published outcomes of intramedullary-referencing implants for primary TAA have shown improvement in clinical outcomes and radiographic parameters, sustained correction of coronal deformity, and excellent survivorship with few associated complications. The purpose of this study is to report the clinical and radiographic outcomes of revision TAA using an intramedullary-referencing implant. Methods: We reviewed a consecutive series of 24 cases (14 female and 10 male; median age, 57.9 (28.2-74.6) years; median BMI, 31 (19.4-40.2)) between 2008 to 2015 in which a failed TAA underwent revision using InBone, an intramedullary-referencing, fixed-bearing, two-component total ankle system. Demographic, radiographic, and functional outcome data were collected preoperatively, immediately postoperatively, and at the most recent follow up. The primary outcome was implant survival defined by no reoperation for subsidence/loosening or revision of the implant. Secondary outcomes included radiographic (coronal and sagittal component alignment, osteolysis, and subsidence) and functional (American Orthopaedic Foot & Ankle Society [AOFAS] score and foot function index [FFI]) outcome data. Results: Twenty-four patients underwent revision TAA with intramedullary-referencing with 87.5% implant survival at average follow up of 30.4 months. Revision was performed most commonly for aseptic talar subsidence (45.8%) or implant loosening (tibia, 12.5%; talus, 16.7%). Following revision, three (12.5%) patients required reoperation for talar subsidence or loosening at average 37.7 months. Progression of osteolysis of the tibia, talus, and fibula was observed in 14 (58%), 4 (17%), and 6 (25%) of patients, respectively, although osteolysis was present preoperatively in 17 (70.1%), 9 (37.5%), and 10 (41.7%), respectively. Subsidence of the tibial and talar components was observed in 8 (33%) and 9 (38%) patients, respectively. Clinically, the average AOFAS and FFI score were 72 (57-100) and 27.1 (11.8-82.9), respectively. Conclusion: Early results of intramedullary-referencing revision TAA demonstrated improved patient-reported outcomes and maintenance of radiographic outcomes at an average follow-up of 30 months. Additionally, early results of revision arthroplasty after failed TAA were similar to those after primary arthroplasty. Aseptic talar subsidence or loosening were the main postoperative complications which required reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant is a viable option for the failed TAA.

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Clinical and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using an Intramedullary-Referencing Implant

Foot & Ankle International ◽

10.1177/1071100720947036 ◽

2020 ◽

Vol 41 (12) ◽

pp. 1510-1518

Author(s):

Steve B. Behrens ◽

Todd A. Irwin ◽

Thomas B. Bemenderfer ◽

Oliver N. Schipper ◽

Susan M. Odum ◽

...

Keyword(s):

Case Series ◽

Revision Arthroplasty ◽

Total Ankle Arthroplasty ◽

Fixed Bearing ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

Radiographic Outcomes ◽

Early Results ◽

Patient Reported

Background: Treatment of failed total ankle arthroplasty (TAA) is challenging. Limited literature is available on options and outcomes of revision arthroplasty despite failure rates ranging from 10% to 23% within 10 years after primary TAA. This study reports the clinical and radiographic outcomes of revision TAA using a fixed-bearing, intramedullary-referencing implant. Methods: A retrospective review was performed of 18 consecutive revision TAA cases between 2008-2015 using an intramedullary-referencing, fixed-bearing, 2-component total ankle system. Demographic and radiographic data were collected preoperatively, immediately postoperatively, and at the most recent follow-up. Functional outcome data were collected immediately postoperatively and at mean follow-up 47.5 months. Results: Eighteen patients underwent revision TAA, with 77.8% (14/18) implant survival. Index revision was performed most commonly for aseptic talar subsidence (55.6%) or implant loosening (tibia, 29.4%; talus, 58.9%). Following revision, 22.2% (4/18) patients required reoperation at a mean 57.3 (39-86) months. Osteolysis of the tibia, talus, and fibula was present preoperatively in 66.7% (12/18), 38.9% (7/18), and 38.9% (7/18) of patients, respectively, with progression of osteolysis in 27.8% (5/18), 11.1% (2/18) and 11.1% (2/18) of patients, respectively. Subsidence of the tibial and talar revision components was observed in 38.9% (7/18) and 55.6% (10/18) of patients, respectively. The median American Orthopaedic Foot & Ankle Society (AOFAS) score was 74.5 (26-100) and Foot Function Index (FFI) score 10.2 (0-50.4). Conclusion: Early results of intramedullary-referencing revision TAA demonstrated good patient-reported outcomes with maintenance of radiographic parameters at mean follow-up of 47.5 months. Aseptic talar subsidence or loosening were the main postoperative causes of reoperation. Revision arthroplasty utilizing an intramedullary-referencing implant was a viable option for the failed TAA. Level of Evidence: Level IV, case series.

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

Foot & Ankle International ◽

10.1177/1071100719866472 ◽

2019 ◽

Vol 40 (11) ◽

pp. 1273-1281 ◽

Cited By ~ 2

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.

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Radiographic Outcomes of Mobile-Bearing Total Ankle Arthroplasty for Patients With Rheumatoid Arthritis

Foot & Ankle International ◽

10.1177/1071100719851469 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1037-1042

Author(s):

Koichiro Yano ◽

Katsunori Ikari ◽

Ken Okazaki

Keyword(s):

Rheumatoid Arthritis ◽

Tibial Component ◽

Patient Reported Outcomes ◽

Mobile Bearing ◽

Total Ankle Arthroplasty ◽

Ankle Arthroplasty ◽

Radiographic Outcomes ◽

Significant Difference ◽

Patient Reported

Background: Ankle disorders in patients with rheumatoid arthritis (RA) reduce their quality of life and activities of daily living. The aim of this study was to evaluate the midterm clinical and radiographic outcomes of TAA in patients with RA. Methods: This retrospective study included patients with a minimum follow-up of 2 years. A total of 37 RA patients (39 ankles) were enrolled in this study from August 2006 to March 2016. All the patients had undergone primary cemented mobile-bearing total ankle arthroplasty (TAA). Nine ankles received arthrodesis of the subtalar joint simultaneously. Patient-reported outcomes were measured preoperatively and at the latest follow-up by Self-Administered Foot-Evaluation Questionnaire (SAFE-Q). Radiographs of the ankle were analyzed preoperatively and at all follow-up visits to measure the periprosthetic radiolucent line, migration of the tibial component, and the subsidence of the talar component. Intraoperative and postoperative complications were recorded. The average duration of follow-up for the entire cohort was 5.0 ± 2.0 years (range 2.1-10.1 years). Results: All subscales of the SAFE-Q had improved significantly at the latest follow-up. No significant difference was found between the range of motion of the ankle before and after the surgery. Radiolucent lines were observed in 28 (73.7%) ankles. Migration of the tibial component and subsidence of the talar component were found in 8 (21.1%) and 11 (28.9%) ankles, respectively. Intraoperative malleolus fractures occurred in 3 (7.7%) ankles and delayed wound healing in 10 (25.6%) ankles. Four ankles were removed because of deep infection or noninfective loosening, resulting in an implant survival rate of 88.4% (95% CI, 0.76-1.0) at 10 years. Conclusion: The midterm patient-reported outcomes and implant retention rate after cemented mobile-bearing TAA for RA patients were satisfactory. However, a low radiographic implant success rate was observed. Level of Evidence: Level IV, retrospective case series.

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The Infinity Total Ankle System

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00382 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0038

Author(s):

Murray Penner ◽

W. Hodges Davis ◽

Thomas Bemenderfer ◽

Feras Waly ◽

Robert Anderson

Keyword(s):

Mobile Bearing ◽

Clinical Results ◽

Outcome Data ◽

Total Ankle Arthroplasty ◽

Ankle Arthroplasty ◽

Radiographic Outcomes ◽

Wright Medical Technology ◽

The Usa ◽

Component Revision

Category: Ankle Arthritis Introduction/Purpose: Background: Increasing interest in 2-component total ankle arthroplasty (TAA) designs and the increased use of TAA overall has led to the development of a new generation of 2-component TAA implants. The first of these to become available was the Infinity Total Ankle System (Wright Medical Technology, Memphis, TN), introduced in 2014. Despite it currently being the most commonly used TAA implant in the UK and among the most commonly used in the USA, published clinical results are lacking. Purpose: This study presents the first report of the clinical and radiographic outcomes of the Infinity Total Ankle System with minimum 2 year follow-up Methods: The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American sites between 2013 and 2015 were reviewed in a prospective observational study. Demographic, radiographic, and functional outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter. Results: The overall implant survival rate was 97% (65 of 67 implants) at mean follow up of 3 years (range 27-47 months). Two cases underwent talar component revision for aseptic loosening. Six of the 67 cases (9%) required a non-revision reoperation. Mean FFI and AOS scores at latest follow up improved from preoperative by 21.6 (p<0.0001) and 34.0 (p<0.0001), respectively. No radiographic loosening of any talar or tibial components was identified in the 65 non-revised cases. Conclusion: Early clinical and radiographic outcomes with the Infinity TAA are promising and compare favorably to those reported for both fixed- and mobile-bearing third generation TAA designs, even when used in cases with deformity and increased case complexity.

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The Salto Talaris Total Ankle Arthroplasty System: A Review and Report of Early Results

Seminars in Arthroplasty ◽

10.1053/j.sart.2010.09.010 ◽

2010 ◽

Vol 21 (4) ◽

pp. 282-287 ◽

Cited By ~ 6

Author(s):

Siddhant K. Mehta ◽

Brian G. Donley ◽

Jeffrey R. Jockel ◽

Mark P. Slovenkai ◽

Mark M. Casillas ◽

...

Keyword(s):

Total Ankle Arthroplasty ◽

Ankle Arthroplasty ◽

System A ◽

Early Results

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Does Patient-specific Instrumentation Yield Better Component Position than Standard Instrumentation in Total Ankle Arthroplasty?

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00046 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0004

Author(s):

Mario Escudero ◽

Kevin Wing ◽

Feras Waly ◽

Thomas Bemenderfer ◽

W. Hodges Davis ◽

...

Keyword(s):

Computer Navigation ◽

Outcome Data ◽

Total Ankle Arthroplasty ◽

Patient Specific ◽

Published Data ◽

Time Efficiency ◽

Ankle Arthroplasty ◽

Radiographic Outcomes ◽

Patient Specific Instrumentation ◽

Standard Instrumentation

Category: Ankle Arthritis Introduction/Purpose: The unique anatomy and biomechanics of the ankle joint have made total ankle arthroplasty (TAA) challenging over the past few decades. Final implant position and successful soft tissue balancing are key components to the longevity of total ankle implants. Preoperative computer navigation, templating, and patient-specific instrumentation (PSI) have shown promising results in total ankle replacement with accurate and reproducible radiographic outcomes. Recent data has also suggested that even experienced surgeons benefit from the improved time efficiency of PSI. The purpose of this study is to determine if radiographic outcomes differ between patients undergoing TAA with PSI and those who undergo TAA with standard instrumentation (SI). Methods: The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American sites between 2013 and 2015 were reviewed in a prospective observational study. All TAA’s were performed by one of four fellowship-trained foot and ankle surgeons. Demographic, radiographic, and functional outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter. The radiographic variables measured were the medial distal tibial angle (MDTA), talar tilt angle (TTA), lateral talar station (LTS), sagittal distal tibial articular angle (sDTAA), and the gamma angle. Acceptable intervals for each parameter were selected and TAAs were then categorized as being “correctly aligned” or “not correctly aligned” for all the parameters described. The rate of “correctly aligned” TAA’s was compared between cases with PSI and those with SI. Fisher’s exact test was used to analyze difference by groups. A significance of 5% was used. Results: Of a total of 67 TAAs included, 51 were in the PSI group and 16 in the SI group. No significant statistically differences were found between PSI and NPSI regarding MDTA (p=0.174), LTS (p=0.922), sDTAA (p=0.986), gamma angle (p=0.252) and TTA (p=0.145). We did not find a significant statistical difference in the rate of “correctly aligned TAR” when we compared both groups (p=0.35). Conclusion: This study suggests that both PSI and SI provide accurate and reproducible TAA radiographic alignment when performed by experienced surgeons. In view of previously published data demonstrating high levels of reproducibility for PSI in TAA, these data also suggest that PSI may offer a means for less experienced surgeons to achieve radiographic results similar to those achieved by experienced surgeons. It also suggests that experienced surgeons may not need to use PSI to achieve satisfactory implant alignment, though improved time efficiency with PSI, as demonstrated in other studies, may still be of benefit for experienced surgeons.

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