Differences in Gait and Stair Ascent After Total Ankle Arthroplasty and Ankle Arthrodesis

2020 ◽  
pp. 107110072096514
Author(s):  
Austin E. Sanders ◽  
Andrew P. Kraszewski ◽  
Scott J. Ellis ◽  
Robin Queen ◽  
Sherry I. Backus ◽  
...  
Keyword(s):  
Standard Of Care ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Exact Test ◽  
Ankle Arthroplasty ◽  
Stair Ascent ◽  
3D Motion Analysis ◽  
Level Walking

Background: Ankle arthrodesis has historically been the standard of care for end-stage ankle arthritis; however, total ankle arthroplasty (TAA) is considered a reliable alternative. Our objective was to compare 3-dimensional foot and ankle kinetics and kinematics and determine the ankle power that is generated during level walking and stair ascent between TAA and ankle arthrodesis patients. Methods: Ten patients who underwent TAA with a modern fixed-bearing ankle prosthesis and 10 patients who previously underwent ankle arthrodesis were recruited. Patients were matched for age, sex, body mass index, time from surgery, and preoperative diagnosis. A minimum of 2-year follow-up was required. Patients completed instrumented 3D motion analysis while walking over level ground and during stair ascent. Between-group differences were assessed with a 2-tailed Mann-Whitney exact test for 2 independent samples. Results: Sagittal ankle range of motion (ROM) was significantly higher in the TAA group (21.1 vs 14.7 degrees, P = .003) during level walking. In addition, forefoot-tibia motion (25.3±5.9 degrees vs 18.6±5.1 degrees, P = .015) and hindfoot-tibia motion (15.4±3.2 degrees vs 12.2±2.5 degrees, P = .022) were significantly greater in the TAA group. During stair ascent, sagittal ankle ROM (25 vs 17.1 degrees, P = .026), forefoot-tibia motion (27.6 vs 19.6 degrees, P = .017), and hindfoot-tibia motion (16.8 vs 12 degrees, P = .012) was greater. Conclusion: There were significant differences during level walking and stair ascent between patients with TAA and ankle arthrodesis. TAA patients generated greater peak plantarflexion power and sagittal motion within the foot and ankle compared to patients with an ankle arthrodesis. Further investigation should continue to assess biomechanical differences in the foot and ankle during additional activities of daily living. Level of Evidence: Level III, comparative study.

scholarly journals Medium-term results of the HINTEGRA total ankle arthroplasty

2020 ◽  
Vol 14 (3) ◽  
pp. 231-238
Author(s):  
Mohammadali Khademi ◽  
Paulo Ferrao ◽  
Nikiforos Saragas
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Medium Term ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Secondary Objective ◽  
American Orthopaedic

Objective: The aim of this study was to determine patient satisfaction, survivorship, and revision rate of the HINTEGRA total ankle arthroplasty (TAA). Our secondary objective was to assess hindfoot function. Methods: All patients who underwent a HINTEGRA TAA between 2007 and 2014 were evaluated. We included a total of 69 patients (69 ankles), who were subjected to clinical and radiological examination and completed a visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and the self-reported foot and ankle score (SEFAS). Hindfoot function was assessed using the AOFAS hindfoot score. Mean follow-up was 62 (57–101) months. Results: The mean VAS score was 2 (0–3) and the SEFAS was 37 (26–48) at the most recent follow-up, while the AOFAS ankle score improved from 57 (52–62) to 87 (82–93). The AOFAS hindfoot score improved from 82 to 92 postoperatively. Eight patients had periprosthetic osteolysis and 5 underwent bone grafting of cysts. We detected polyethylene and hydroxyapatite particles in specimens obtained from the cysts. Eight patients had their procedures converted to an ankle arthrodesis. Conclusion: In select patients, TAA improved quality of life. Our medium-term follow-up of the HINTEGRA TAA observed a survivorship of 89% at 5 years with an improvement in the AOFAS score and a mean SEFAS score of 37. We recommend that large periprosthetic cysts, which may be caused by the hydroxyapatite coating and polyethylene particles, be bone grafted prophylactically. We found hindfoot function to be preserved. Level of Evidence IV; Therapeutic Studies; Case Series.

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.

Comparison of Clinical Outcomes After Total Ankle Arthroplasty Between End-Stage Osteoarthritis and Rheumatoid Arthritis

2021 ◽  
pp. 107110072097992
Author(s):  
Byung-Ki Cho ◽  
Min-Yong An ◽  
Byung-Hyun Ahn
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Outcomes ◽  
Immunosuppressive Treatment ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Ankle Arthroplasty ◽  
End Stage

Background: Total ankle arthroplasty (TAA) is known to be a reliable operative option for end-stage rheumatoid arthritis. However, higher risk of postoperative complications related to chronic inflammation and immunosuppressive treatment is still a concern. With the use of a newer prosthesis and modification of anti-rheumatic medications, we compared clinical outcomes after TAA between patients with osteoarthritis and rheumatoid arthritis. Methods: Forty-five patients with end-stage osteoarthritis (OA group) and 19 with rheumatoid arthritis (RA group) were followed for more than 3 years after 3 component mobile-bearing TAA (ZenithTM). Perioperative anti-rheumatic medications were modified using an established guideline used in total hip and knee arthroplasty. Clinical evaluations consisted of American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). Results: In the preoperative and postoperative evaluation at final follow-up, there were no significant differences in AOFAS, FAOS, and FAAM scores between 2 groups. Despite statistical similarity in total scores, the OA group showed significantly better scores in FAOS sports and leisure (mean, 57.4 ± 10.1) and FAAM sports activity (mean, 62.5 ± 13.6) subscales than those in the RA group (mean, 52.2 ± 9.8, P = .004; and 56.4 ± 13.2, P < .001, respectively). There were no significant differences in perioperative complication and revision rates between 2 groups. Conclusions: Patients with end-stage ankle RA had clinical outcomes comparable to the patients with OA, except for the ability related to sports activities. In addition, there were no significant differences in early postoperative complication rates, including wound problem and infection. Level of Evidence: Level III, prognostic, prospective comparative study.

scholarly journals Total Ankle Arthroplasty vs Ankle Arthrodesis

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0001
Author(s):  
Thomas Clanton ◽  
Lauren Matheny ◽  
Angela Chang
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Proportional Hazard ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Cox Proportional Hazard ◽  
Age At Surgery ◽  
Significant Difference ◽  
Surgical Failure

Category: Ankle, Ankle Arthritis Introduction/Purpose: Ankle arthritis is a debilitating disorder which significantly limits activities of daily living and can lead to reduced quality of life. Total ankle arthroplasty(TAA) and ankle arthrodesis are common treatments for ankle arthritis; however, patient indications may differ based on individual patient needs. Few studies compare proportional hazard modeling, survivorship and patient-centered outcomes following these two procedures, which may be useful in determining the appropriate procedure for end-stage ankle arthritis in different patient populations. The purpose of this study was to determine proportional hazards for the risk of failure in patients who underwent TAA vs. arthrodesis, as well as survivorship and outcomes. Methods: All patients >18 years, between January 2009 and November 2013, who underwent TAA or ankle arthrodesis by a single surgeon for treatment of ankle arthritis were included. Patients completed a subjective questionnaire at minimum 2-years following index surgery. Outcomes measures included Foot and Ankle Ability Measure(FAAM), Foot and Ankle Disability Index(FADI), Lysholm, WOMAC, SF-12 physical component summary(PCS) and mental component summary(MCS), Tegner activity scale and patient satisfaction with outcome. Detailed surgical data/intraoperative findings were documented at time of surgery. All data were collected prospectively. Cox proportional hazard modeling and survivorship analysis were performed to assess differences between the two cohorts. Survivorship utilizing Kaplan-Meier method, using a log-rank test, was used to compare median survivorship. Cox-proportional hazard model was conducted to compare hazard rates of surgical failure for patients in each cohort, while adjusting for age at surgery, body mass index(BMI) and sex. All outcome measures were compared between cohorts. Results: There were 97 patients available for analysis. Eight patients failed surgery(9.2%). Demographic data were documented (Table 1). There was no significant difference in failures (TAA=2 failures (6.5%) vs. arthrodesis=6 failures (11.8%)(p=0.709). There was no significant difference in survivorship of surgery between the arthrodesis cohort and the TAA cohort(p=0.785)(Table 1, Figure 1). There was a decrease in survivorship at 4 years in TAA cohort compared to arthrodesis cohort, which was not significant. The hazard ratio was 0.804 [95%CI: 0.111–5.842], indicating that cohort did not have a significant effect on the hazard of surgical failure(p=0.829). Sex, age and BMI did not have a significant effect on the hazard of surgical failure(p>0.05). There was no significant difference in any outcome measures between cohorts(Table 1). Conclusion: There was no significant difference in survivorship or in the hazard of surgical failure based on cohort (TAA and arthrodesis) while accounting for sex, age at surgery and BMI. There was no significant difference in the hazard of surgical failure for factors including age at surgery, BMI or sex. There was no significant difference in survivorship or outcomes between cohorts. Total ankle arthroplasty seems to provide similar results as arthrodesis; however, there was a decrease in survivorship at 4 years in the TAA cohort. Although not significant, this may indicate that survivorship differs during the longer-term follow-up period.

Is There a Role for the Use of Dilute Povidone-Iodine (Betadine) Irrigation or Other Antiseptic Irrigation Solutions During Total Ankle Arthroplasty (TAA) or Other Foot and Ankle Procedures?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 14S-15S
Author(s):  
Kristin Englund ◽  
Nima Heidari
Keyword(s):  
Povidone Iodine ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Antiseptic Irrigation

Recommendation: With regard to total ankle arthroplasty (TAA), there is a lack of evidence to recommend for or against the use of betadine solution. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

Comparison of Total Ankle Arthroplasty and Ankle Arthrodesis in End-Stage Hemophilic Arthropathy

2020 ◽  
Vol 41 (8) ◽  
pp. 937-944
Author(s):  
Jungtae Ahn ◽  
Myung Chul Yoo ◽  
Jeunghwan Seo ◽  
Moonsu Park ◽  
Bi O Jeong
Keyword(s):  
Ankle Arthrodesis ◽  
Outcome Evaluation ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
The Mean ◽  
Retrospective Comparative Study ◽  
End Stage ◽  
Clinical And Radiological Results

Background: Total ankle arthroplasty (TAA) can result in excellent outcomes in patients with end-stage arthritis, but most patients with end-stage hemophilic ankle arthropathy (ESHAA) still undergo ankle arthrodesis (AA). The purpose of this study was to analyze clinical and radiological results of TAA and AA for ESHAA. Methods: A total of 29 cases (16 TAAs and 13 AAs) of painful ESHAA were included. For clinical outcome evaluation, visual analog scale (VAS) for pain, Foot Function Index (FFI), and range of motion (ROM) were analyzed. Postoperative clinical and radiological complications were also analyzed. The mean duration of follow-up was 6.8 ± 3.0 years. The mean age was 44.1 ± 9.9 years. Results: The VAS for pain was significantly improved from 5.5 ± 2.3 to 0.9 ± 1.2 ( P < .001). The FFI scale was significantly improved from 61.6% ± 15.5% to 16.6% ± 15.4% ( P < .001). In FFI disability and activity subscales, the TAA group exhibited meaningful outcomes relative to those of the AA group ( P = .012 and .036, respectively). The total ROM in the TAA group changed from 30.8 ± 12.6 degrees to 37.3 ± 12.8 degrees at final follow-up ( P = .090). Three cases of osteolysis and 1 case of heterotopic ossification were noted in the TAA group. No cases of nonunion were noted in the AA group. Progressive arthrosis of adjacent joints after AA was observed in 1 case. Conclusion: Both TAA and AA in ESHAA exhibited significant improvement in pain based on VAS and FFI scales. Compared to AA, TAA resulted in superior outcomes in FFI disability and activity subscales, suggesting that TAA may be considered as a surgical option alongside AA for ESHAA. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Imaging of Total Ankle Arthroplasty: Normal Imaging Findings and Hardware Complications

2019 ◽  
Vol 23 (02) ◽  
pp. 177-194
Author(s):  
Imran Omar ◽  
Samir Abboud ◽  
Jonathan Youngner
Keyword(s):  
Biological Effects ◽  
Surgical Techniques ◽  
Standard Of Care ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Hardware Complications ◽  
Ultimate Failure ◽  
End Stage ◽  
Knee And Hip Arthroplasty

AbstractEnd-stage ankle osteoarthritis often significantly impacts patients' quality of life. This can be managed surgically either by ankle arthrodesis or total ankle arthroplasty (TAA). Although ankle arthrodesis is considered by some as the standard-of-care surgical option for this condition, it restricts range of motion and may lead to accelerated osteoarthritis of neighboring joints. Better understanding of ankle biomechanics, the biological effects of orthopaedic devices, and new surgical techniques have led to significant improvements in the designs of TAAs, and over the last several decades TAA has been used increasingly to treat patients with end-stage tibiotalar osteoarthritis. However, complication and ultimate failure rates remain greater than those seen with total knee and hip arthroplasty, and imaging is often critical in determining whether a prosthesis is beginning to fail. As a result, imagers should be familiar with the basic types of TAAs in clinical use, the normal radiographic appearances, as well as the common complications seen with this procedure.

What Are the Benefits and Risks Associated With the Use of Vancomycin Powder in the Wound During Total Ankle Arthroplasty (TAA) or Other Foot and Ankle Procedures?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 12S-14S ◽  
Author(s):  
Gaston Slullitel ◽  
Yasuhito Tanaka ◽  
Ryan Rogero ◽  
Valeria Lopez ◽  
Eiichiro Iwata ◽  
...  
Keyword(s):  
General Population ◽  
Deep Infection ◽  
Total Ankle Arthroplasty ◽  
Diabetic Patients ◽  
Foot And Ankle ◽  
Insufficient Evidence ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Ankle Surgery ◽  
Vancomycin Powder

Recommendation: Though one study supporting topically applied vancomycin has shown it to reduce the rate of deep infection in diabetic patients undergoing foot and ankle surgery, there is insufficient evidence to show benefits or to show any risks associated with the use of vancomycin powder during total ankle arthroplasty (TAA) or other foot and ankle procedures in a general population. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

Role of Postoperative Patient-Reported Outcomes to Predict Ankle Arthroplasty and Arthrodesis Revision

2019 ◽  
Vol 41 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Sameer Desai ◽  
Jason M. Sutherland ◽  
Alastair Younger ◽  
Murray Penner ◽  
Andrea Veljkovic ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Patient Reported Outcomes ◽  
Cox Regression ◽  
Ankle Arthrodesis ◽  
Hazard Ratio ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Patient Reported

Background: Patient-reported outcomes are becoming common for measuring patient-centric outcomes in surgery. However, there is little known about the relationship between postoperatively collected patient-reported outcomes and objective clinical outcomes. The objective of this study was to measure whether postoperative Ankle Osteoarthritis Scale (AOS) values were associated with risk of revision among patients having ankle arthrodesis or total ankle arthroplasty for treatment of symptomatic end-stage ankle arthritis. Methods: This is a retrospective analysis of a longitudinal cohort of ankle arthrodesis and total ankle arthroplasty patients. A single center recruited patients between 2003 and 2013 and follow-up was at least 4 years. Patients completed the AOS preoperatively and annually following surgery. An extended Cox regression model incorporating time-varying AOS values was used to model risk of failure. A total of 336 patients and 348 ankles were included, representing 139 ankle arthrodesis procedures and 209 total ankle arthroplasties. Results: The median follow-up time for revisions was 8.2 years and 46 patients had a revision. Higher values of patients’ AOS scores in the postoperative period were associated with a higher likelihood of revision (hazard ratio, 1.04 per 1-point increase; 95% confidence interval, 1.03-1.05). Ankle arthrodesis was associated with a reduced risk of revision compared with ankle fusion (hazard ratio, 0.12; 95% confidence interval, 0.03-0.49). Conclusion: This study showed that persistent pain and poor function after fusion or replacement surgery, as measured by elevated values of the AOS, were associated with higher risk of further surgery. Level of Evidence: Level III, retrospective cohort study.

scholarly journals A Retrospective Analysis of Results and Outcomes after Cadence Total Ankle Arthroplasty Implanted through the End of 2017

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0021
Author(s):  
Brianna R. Fram ◽  
Ryan G. Rogero ◽  
Daniel Corr ◽  
David I. Pedowitz ◽  
Justin Tsai
Keyword(s):  
Range Of Motion ◽  
Repeated Measures ◽  
Failure Modes ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Component Loosening

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is an increasingly popular operative treatment of ankle arthritis, due to its ability to decrease adjacent joint degeneration and preserve gait mechanics compared to ankle arthrodesis. However, ankle arthroplasty components have a shorter mean longevity then their hip, knee, or shoulder counterparts. The Cadence TAA entered clinical use in 2016 and was designed to address common failure modes of prior systems. We report here on radiographic and clinical outcomes and early complications of the Cadence TAA system at a minimum of 2 years follow-up. Methods: Patients who underwent primary Cadence TAA from 2016 through 2017 by one fellowship-trained foot and ankle surgeon were eligible. Exclusion criteria included prior ipsilateral ankle arthrodesis or arthroplasty and lack of followup. Chart review was performed for eligible patients to identify complications and reoperations. Patients were contacted to obtain Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sport subscores, SF-12 Mental (MCS) and Physical Health (PCS) subscores, and Visual Analog Scale (VAS) pain levels (rated 0-100). Scores were analyzed with 2-sided repeated measures T- tests, with P<0.05 as significant. A second, blinded, fellowship-trained foot and ankle surgeon evaluated followup 5-view radiographs of each ankle to measure range of motion (ROM), alignment, peri-implant osteolysis, and component loosening or subsidence. Subsidence or loosening were defined, respectively, as >2mm or >2⁰ change in position for the tibial component and >5mm or >5⁰ change for the talar component. Results: Sixty patients were included with mean age 64 and mean BMI 32.0. Thirty patients (50%) had concurrent other procedure(s). FAAM-ADL, FAAM-Sports, SF-12 PCS, and VAS pain scores all improved significantly at mean 2.24 years post-op (Table 1). Ten patients (6.7%) had operative complications requiring 15 surgeries (mean 265 days to first reoperation). Three patients (5%) required removal of one or both components, for 2-year implant survival of 95.0%. Two revisions were for infection and one for osteolysis. This produced a mechanical failure rate of 1/60 (1.7%). Radiographic analysis revealed average coronal alignment improved from 7.4⁰ from neutral preoperatively to 2.2⁰ postoperatively. Average ROM was 36.5⁰ total arc of motion. One of 38 (2.6%) had signs of peri-implant osteolysis, with no cases demonstrating loosening or subsidence. Conclusion: Two-year follow-up of the Cadence TAA system demonstrates mechanically stable implants resulting in improved patient function and preserved ankle range of motion. Outcomes compare favorably to those of other TAA systems at 2-year follow-up. Further radiographic and clinical follow-up are needed to evaluate implant longevity and long-term patient functional outcomes. [Table: see text]

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