scholarly journals Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Beat Hintermann ◽  
Markus Knupp ◽  
Lukas Zwicky ◽  
Alexej Barg
Keyword(s):  
Elderly Patients ◽  
Weight Bearing ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Long Term Results ◽  
Postoperative Rehabilitation ◽  
Early Weight Bearing ◽  
Ankle Replacement ◽  
First Choice ◽  
End Stage

End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands.

Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

2021 ◽  
pp. 193864002098092
Author(s):  
Devon W. Consul ◽  
Anson Chu ◽  
Travis M. Langan ◽  
Christopher F. Hyer ◽  
Gregory Berlet
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Implant Survival ◽  
Ankle Arthritis ◽  
Single Institution ◽  
Retrospective Case ◽  
Ankle Replacement ◽  
End Stage

Total ankle replacement has become a viable alternative to ankle arthrodesis in the surgical management of advanced ankle arthritis. Total ankle replacement has generally been reserved for patients who are older and for those who will have a lower demand on the replacement. The purpose of the current study is to review patient outcomes, complications, and implant survival in patients younger than 55 years who underwent total ankle replacement at a single institution. A single-center chart and radiographic review was performed of consecutive patients who underwent total ankle replacement for treatment of end-stage ankle arthritis. All surgeries were performed by 1 of 5 fellowship-trained foot and ankle surgeons at a single institution. A total of 51 patients met inclusion criteria with a mean follow-up of 31.2 months (SD = 16.2). Implant survival was 94%, There were 7 major complications (13%) requiring an unplanned return to the operating room and 8 minor complications (15%) that resolved with conservative care. The results of this study show that total ankle replacement is a viable treatment option for patients younger than 55 years. Levels of Evidence: A retrospective case series

scholarly journals Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Robert W. Jordan ◽  
Gurdip S. Chahal ◽  
Anna Chapman
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Controlled Trial ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Online Databases ◽  
Ankle Replacement ◽  
Comparative Group ◽  
Randomised Controlled ◽  
End Stage

Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes.Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure.Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn.Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.

Nationwide Analysis of Total Ankle Replacement and Ankle Arthrodesis in Medicare Patients: Trends, Complications, and Cost

2020 ◽  
pp. 193864002095018
Author(s):  
William A. Tucker ◽  
Brandon L. Barnds ◽  
Brandon L. Morris ◽  
Armin Tarakemeh ◽  
Scott Mullen ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Complication Rates ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Procedure Cost ◽  
Medicare Patients ◽  
Retrospective Comparative Study ◽  
End Stage

Background Surgical management of end-stage ankle arthritis consists of either ankle arthrodesis (AA) or total ankle replacement (TAR). The purpose of this study was to evaluate utilization trends in TAR and AA and compare cost and complications. Methods Medicare patients with the diagnosis of ankle arthritis were reviewed. Patients undergoing surgical intervention were split into AA and TAR groups, which were evaluated for trends as well as postoperative complications, revision rates, and procedure cost. Results A total of 673 789 patients were identified with ankle arthritis. A total of 19 120 patients underwent AA and 9059 underwent TAR. While rates of AA remained relatively constant, even decreasing, with 2080 performed in 2005 and 1823 performed in 2014, TAR rates nearly quadrupled. Average cost associated with TAR was $12559.12 compared with $6962.99 for AA ( P < .001). Overall complication rates were 24.9% in the AA group with a 16.5% revision rate compared with 15.1% and 11.0%, respectively, in the TAR group ( P < .001). Patients younger than 65 years had both higher complication and revision rates. Discussion TAR has become an increasingly popular option for the management of end-stage ankle arthritis. In our study, TAR demonstrated both lower revision and complication rates than AA. However, TAR represents a more expensive treatment option. Levels of Evidence: Level III: Retrospective comparative study

Outcomes of Total Ankle Replacement, Arthroscopic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-Deformed End-Stage Ankle Arthritis

2019 ◽  
Vol 101 (17) ◽  
pp. 1523-1529 ◽  
Author(s):  
Andrea N. Veljkovic ◽  
Timothy R. Daniels ◽  
Mark A. Glazebrook ◽  
Peter J. Dryden ◽  
Murray J. Penner ◽  
...  
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
End Stage

scholarly journals Nottingham Experience with The Fixed Bearing Infinity Total Ankle Replacement

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0042
Author(s):  
Hatem Salem-Saqer ◽  
Martin Raglan ◽  
Sunil Dhar
Keyword(s):  
Complication Rate ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Implant Design ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
End Stage

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is increasingly used for treatment of end stage arthritis of the ankle; improvements continue to evolve in implant design and instrumentation. We present our experience of the Infinity Total Ankle Arthroplasty (Wright Medical), a fixed bearing 4th generation implant with improved instrumentation Methods: This is a retrospective review of prospectively collected data. From October 2016 to July 2019, we identified 92 (52M/40F) who had the infinity Total Ankle Replacement. This review is of 70 patients with a minimum of 1 year follow up (33M,37F). The mean age was 67.5 years (33-87); 32 right side and 38 left no bilaterals. The indication for surgery was end stage Osteoarthritis in 52, post traumatic arthritis 12, inflammatory arthritis 4, conversion of fusion to TAR 2. The preoperative deformity was graded according to the COFAS classification. All patients had follow up at 6 weeks, 3,6 and 12 months and then annually, with MOXFQ questionnaire and weight bearing radiographs. Results: TAA was performed with the use of fluoroscopy. 77% (54/70) had concomitant procedures as listed in Table.5% (4/70) had complications consisting of, 1 DVT, 1 intra operative medial malleolus fracture, 1 EHL tendon laceration and 1 wound break down. There were no deep or superficial infections. Improvement in clinical outcome and PROMS data was noted on follow up. The MOXFQ for Pain improved from 72 pre-op to 25 at 1year (p<0.001). The outcome for Walking improved from 83 pre-op to 30 at one year (p<0.001). Radiological alignment was maintained asymptomatic posterior heterotopic ossification was noted in 23(16%) patients, lucent lines under the tibial implant were noted in 4 ankles and 1 fibula erosion. 2 TAA (3%) needed to be revised due to malpositioning. Conclusion: Our results show significant improvement in patient outcomes, a short recovery time and marked improvement in mobility post operatively with a very low complication rate, we had no deep infection to date. Two implants were revised which we attribute to the learning curve at the start of practice. This implant is fluoroscopically navigated allowing precise implantation with dedicated instrumentation and we feel this attributed to the low complication rate and good results in our short-term study [Table: see text]

Sex Differences in End-Stage Ankle Arthritis and Following Total Ankle Replacement or Ankle Arthrodesis

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Andrew Dodd ◽  
Ellie Pinsker ◽  
Alastair S.E. Younger ◽  
Murray J. Penner ◽  
Kevin J. Wing ◽  
...  
Keyword(s):  
Sex Differences ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
End Stage

scholarly journals Outcome after 52 Salto Ankle Prostheses Implanted by a Single Surgeon

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Frank W. M. Faber ◽  
Monique J. L. Mastboom ◽  
Sabine T. van Vliet-Koppert ◽  
Ilse C. E. Bouman ◽  
Paulien M. van Kampen
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Ankle Arthritis ◽  
Hospital Data ◽  
Gold Standard Method ◽  
Satisfaction Rate ◽  
Ankle Replacement ◽  
High Satisfaction Rate ◽  
Reliable Solution ◽  
End Stage

While ankle arthrodesis was traditionally the gold standard method of treatment for disabling end-stage ankle arthritis, total ankle replacement (TAR) has been an acceptable alternative. The satisfaction rate of patients with TAR however differs. The purpose of our study is to investigate whether implant survival and results with special emphasis on the satisfaction rate of patients treated with a TAR implanted by a single surgeon were comparable to the literature. This was a retrospective cohort study in a teaching hospital. Data was collected from 52 patients who received a total ankle replacement (TAR) between 05/2002 and 06/2014. The mean follow-up time was 4.2 years (95% CI 3.3 – 5.0). Results showed a high satisfaction rate of 94% and 94% survival of the TAR after 5 years. We conclude that TAR with the Salto prosthesis is, in our hands, a reliable solution for end-stage ankle arthritis, with results comparable to the literature.

scholarly journals Salvage arthrodesis of a failed total ankle replacement using a custom 3D-printed cage implant: A case report and review of the literature

2018 ◽  
Vol 27 (4) ◽  
pp. 277-281 ◽  
Author(s):  
Nathaniel LP Preston ◽  
Matthew Wilson ◽  
Elizabeth A Hewitt
Keyword(s):  
Case Report ◽  
Weight Bearing ◽  
Treatment Algorithm ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Ankle Replacement ◽  
Ankle Brace ◽  
Adult Mesenchymal Stem Cells ◽  
3D Printed ◽  
Further Development

We present a case report of a 66-year-old female who underwent salvage arthrodesis after a failed Scandinavian Total Ankle Replacement secondary to aseptic loosening and talar subsidence. Secondary to the loss of talar integrity the decision was made to proceed with revisional ankle arthrodesis. To maintain limb length the primary surgeon (EH) elected to use a custom cage implant in combination with an intramedullary nail construct in a single stage approach. The custom cage was augmented with autograft & allograft cancellous bone in addition to allograft recombinant human bone morphogenic protein, and allograft adult mesenchymal stem cells. The incision sites healed post-operatively without incident and at post-op week 16 the patient progressed to full unrestricted weight bearing in normal shoe wear with a gauntlet ankle brace. Although an isolated report, this case shows promise for further development of the technique. We believe this revisional arthrodesis technique warrants further research and consideration as a potential addition to the failed total ankle arthroplasty treatment algorithm.

scholarly journals The Talar Body Prosthesis Treated End Stage Ankle Arthrosis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Thos Harnroongroj
Keyword(s):  
Surgical Technique ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Walking Ability ◽  
Prosthesis Failure ◽  
Talocrural Joint ◽  
Ankle Replacement ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrosis creates patient disability. Ankle arthrodesis is treatment of choice which creates ankle stiffness and arthrosis of neighboring joints. Total ankle replacement can preserve ankle motions but the results at mid and long- term follow up needed further evaluation. Talar body prosthesis (TBP) can provide long-term satisfactory foot-ankle function of the ankle sustaining talar body damages. Due to ankle biomechanics is different to hip and knee joints. So, we inserted TBP for treating end stage ankle arthrosis. The present study evaluated outcomes at 5-10 years of follow up and described surgical technique. Methods: Between 2001 and 2011, the TBPs were inserted in 23 ankle arthrosis patients. The data were reviewed. We included grade 3 Bargon and Henkemeyer radiographic grading of ankle arthrosis and deformed talar body. The patient with neurological, hip, knee, mid-foot problems which impeded walking ability and age more than 70 were excluded. The patient consisted of 13 females and 10 males. Mean age at index operation and the latest follow up were 54.70 (39-70) and 61.17 (47-75) years old. Mean BMI at the latest follow up was 25.56 kg/m2 (21.89-29.76). Surgical technique included TBP insertion with addressing and applying tensor fascia lata at the articular end of distal tibia. Pre- and the latest follow up AOFAS (American Orthopaedic Foot and Ankle Society) ankle-hindfoot score and radiographs were reviewed. Neighboring joint arthrosis was evaluated by Kellgren-Lawrence radiographic system. The data was statistically analyzed. Results: Mean follow up duration was 6.48 years (5-10 years). All 23 TBPs maintained congruent talocrural joint. There was no prosthesis failure in term of subsidence into calcaneus and prosthetic stem perforation into talar head at the last follow up. No neighboring joint arthrosis occurred according to the radiographs. The mean range of motion of last follow up was 22.17° of plantar flexion (median 22°, ranged from 15° to 29°) and 0° to 5° of dorsiflexion. The patients could perform activity daily life. Mean AOFAS ankle-hindfoot score at preoperative period and last follow up were 40 points (Median 36, Ranged from 31 to 58) and 74 points (median 75, ranged from 61 to 83), respectively. The statistical analysis showed significant improvement of the score (p<0.001). Conclusion: TBP can provide satisfactory result of ankle-hindfoot functions at 5-10 years follow up. Advantages of the prosthesis over ankle arthrodesis and total ankle replacement included preservation of the ankle motion without neighboring joint arthrosis and no prosthesis failure.

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