scholarly journals Mid-term (5-10 year) Results of the Salto Talaris Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003 ◽  
Author(s):  
Matthew Stewart ◽  
James DeOrio ◽  
Samuel Adams ◽  
Mark Easley ◽  
James Nunley

Category: Ankle Arthritis Introduction/Purpose: The Salto Talaris total ankle replacement is a modern fixed-bearing implant used to treat symptomatic ankle arthritis with the goals of providing pain relief, restoring mechanical alignment, and allowing motion of the ankle joint. This prosthesis has been used in the United States increasingly over the last 10 years, primarily for older patients with end-stage ankle arthritis but indications are expanding to younger and more active patients. The goal of this study is to report the midterm clinical results of one of the largest cohort of patients in the United States who underwent ankle replacement with this prosthesis. Methods: This is a review of patients with a minimum of 5-year up to 10-year follow-up who were prospectively registered within our institutional database prior to proceeding with total ankle arthroplasty using the Salto Talaris prosthesis. Follow-up examinations were scheduled annually after the one-year postoperative mark to evaluate patients both clinically and radiographically. At each annual assessment, patients rated their current level of pain using the visual analog score (VAS) and reported their functional level using the American Orthopaedic Foot and Ankle (AOFAS) ankle-hindfoot scores, the Short Musculoskeletal Function Assessment (SMFA), and the Short Form-36 (SF-36) Health survey. These scores were analyzed to assess differences between their levels preoperatively, one year postoperatively and at their most recent follow-up. Preoperative and postoperative radiographs were reviewed for component loosening. Criteria for failure was defined as undergoing revision requiring exchange or removal of the metallic components for any reason. Results: We identified 106 patients who had a Salto Talaris total ankle replacement between March 2007 and February 2012. Of these, 72 patients (mean age, 61.9 years) met the requirement for a minimum follow-up of 5 years (range 60 to 115 months, mean 81.1 months). Average outcome in the VAS was 7.1 at one year post-op and 11.7 at last follow-up (preop: 70.0). Significant improvements were seen in the SMFA, AOFAS ankle-hindfoot score, and the SF-36 from preoperatively to their final follow-up. Survivorship was 97.2% with two patients undergoing revision arthroplasty for aseptic loosening and a third patient scheduled for revision for a chronic wound infection. 14 patients (19%) with midterm follow-up required a total of 17 additional surgical procedures on the ipsilateral ankle or hindfoot. Conclusion: Patients who underwent total ankle arthroplasty with the Salto Talaris prosthesis have continued to show significant improvements in pain and functional outcomes at mid-term follow-up. This has shown to be an effective treatment option with durable results for patients with end-stage ankle arthritis.

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000
Author(s):  
Taylor Den Hartog ◽  
Samuel Carlson ◽  
Greg Alvine ◽  
Frank Alvine ◽  
Bryan Den Hartog ◽  
...  

Category: Ankle Arthritis Introduction/Purpose: With the introduction of newer generations of total ankle arthroplasty (TAA) constructs, the incidence of TAA in the United States has been increasing. While TAA has emerged as an alternative to ankle arthrodesis for the management of end-stage ankle arthritis, long-term data evaluating clinical outcomes and the survivorship of ankle prostheses is lacking. The purpose of this study was to report the clinical outcomes and radiographic survivorship of a second-generation, semi-constrained titanium and cobalt-chromium total ankle prosthesis at minimum twenty-year follow-up in order to provide a benchmark comparison for future generations of TAA design. Methods: 132 total ankle replacements in 126 patients were performed by a single surgeon between July 1984 and October 1994. Follow-up evaluation consisted of determining revision status, completion of the validated ankle osteoarthritis scale, a short questionnaire, and a review of the available radiographs. All radiographs were evaluated for evidence of progressive radiolucent lines, osteolysis and component subsidence. Results: At minimum twenty-year follow-up, 37 patients were alive, 89 were deceased, and 5 were lost to follow-up. For living patients, average clinical follow up was 25.3 years. Average radiographic follow-up was 21.4 years. Over the minimum 20 year follow-up, 29 ankles were revised (23%). For living patients, 13 ankles were revised (35%). Conclusion: Twenty-three percent of all patients and 35% of living patients required a revision over the minimum 20 year follow up interval. 65% of living patients have retained their prosthesis and 75% of the entire cohort are still functioning with their original ankle replacement or died with the original ankle replacement in place. This study should provide a benchmark for newer designs when they obtain this length of follow-up.


2018 ◽  
Vol 3 (3) ◽  
pp. 247301141877997
Author(s):  
Phinit Phisitkul ◽  
Natalie Glass ◽  
Patrick B. Ebeling ◽  
Sandra E. Klein ◽  
Jeffrey E. Johnson

Background: This study aimed to assess the preferred operative treatment for patients over the age of 60 with end-stage ankle arthritis and perspectives on total ankle replacement (TAR) among American Orthopaedic Foot & Ankle Society (AOFAS) members. Associated factors were analyzed for potential contraindications among members with different levels of experience. Method: A questionnaire containing 6 questions was designed and sent to 2056 members of the AOFAS. Responses were received from 467 orthopaedic surgeons practicing in the United States (76%), Canada (5%), and 26 other countries (20%). Participants were grouped for response comparisons according to country as well as experience level. Differences in contraindications were compared using χ2 tests or exact tests. Results: Respondents practicing in the United States and surgeons who perform 11 or more TARs per year tended to recommend operative treatments favoring TAR and displayed recognition of its increasing role ( P < .05). Overall, respondents felt that 41% of typical patients over 60 years old with end-stage arthritis would be best treated with TAR. Talus avascular necrosis, morbid obesity (body mass index >40 kg/m2), and poorly controlled diabetes with neuropathy were most recognized as the absolute contraindications to TAR. Surgeon’s experience affected the consideration of these clinical factors as contraindications. Conclusions: Total ankle replacement has a substantial and increasing role in the treatment of end-stage ankle arthritis in patients over the age of 60. Absolute and potential contraindications of the procedures were indicated from a cross-sectional survey of AOFAS members. Surgeons more experienced with total ankle replacement felt more comfortable employing it in a wider range of clinical settings. Level of Evidence: Level III, therapeutic.


2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0016
Author(s):  
Daniel Bohl ◽  
Emily Vafek ◽  
Simon Lee ◽  
Johnny Lin ◽  
George Holmes ◽  
...  

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.


2020 ◽  
pp. 193864002091312
Author(s):  
Gregory C. Berlet ◽  
Roberto A. Brandão ◽  
Devon Consul ◽  
Pierce Ebaugh ◽  
Christopher F. Hyer

Background: Total ankle arthroplasty is a viable option for the treatment of end stage ankle arthritis. The purpose of this study is to report on the mid-term results with a cemented total ankle prosthesis, the Inbone™ II implant over a 5 year period. Methods: A retrospective, single-center chart and radiographic review of all patients with end stage ankle arthritis treated with Inbone™ II TAR) as the primary index procedure from 12/1/2012 to 3/1/2017. Clinical data were evaluated at 3 month, 6 month, 1 year and subsequent intervals for the study period. Preoperative diagnosis, pertinent patient demographics adjunctive procedures, implant associated complications, subsequent surgeries, and revisions were recorded. Results: 121 total ankles met our inclusion criteria. Patients had an INBONE™ II TAR implant placed with bone cement with a minimum of a 12 months follow up. Average age was 62.88 (range, 32-87) years, average body mass index was 32.74 (range, 21.8-56.04) kg/m2 and average follow up was 28.51(range, 12-69) months. Using the COFAS complication classification there were 14 minor, 11 moderate, and 5 major complications. 6/121 (5.0%) revisions which included: polyethylene exchange, device explant/fusion, and antibiotic spacer in situ. No complications over the course of this study ended in amputation. Conclusion: Total Ankle Arthroplasty utilizing the cemented INBONE™ II yielded good midterm results with regards to minor, moderate, and major complications. Rate of revision 6/121 (5.0%) was within the reported range with only 5 patients converted to fusion during the study period resulting in a 95% survivability at mid-term follow up. Levels of Evidence: Level IV: Retrospective case series


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0042
Author(s):  
Hatem Salem-Saqer ◽  
Martin Raglan ◽  
Sunil Dhar

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]


2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005
Author(s):  
Francesco Granata ◽  
Camilla Maccario ◽  
Luigi Manzi ◽  
Eric Tan ◽  
Federico Giuseppe Usuelli

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proved to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with two years follow-up. Methods: This prospective study included 59 patients who underwent transfibular total ankle arthroplasty from May 2013 to December 2015. The mean age was 51.6 ± 13.4 years. All patients were followed for at least 24 months postoperative with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiologically preoperatively and at 6, 12, and 24 months postoperatively. Results: At 24 months, patients demonstrated statistically significant improvement in the American Orthopaedic Foot and Ankle Society score from 33.6 to 88.1 (P<0.01), VAS scale from 79.3 to 14.0 (P<0.01) and SF-12 Physical and Mental Composite Scores from 29.9 and 44.6 to 74.4 and 95.3, respectively (P<0.01). Ankle dorsiflexion and plantarflexion improved from 5.5 and 8.8 degrees to 24.2 and 20.0 degrees, respectively (P<0.01). Radiographically, patients demonstrated neutral alignment of the ankle with a tibio-talar ratio of 34.9 ± 9.2 and hindfoot alignment view angle of 1.2 ± 7.0 degrees. No patient demonstrated any radiographic evidence of tibial or talar lucency at 24 months. Seven patients underwent reoperation for removal of symptomatic hardware; one patient developed a postoperative prosthetic infection requiring placement of an antibiotic spacer. Conclusion: This study demonstrates that transfibular total ankle replacement is a safe and effective option for the patients for ankle arthritis with improvements in patient-reported outcomes, range of motion, and radiological parameters. However, further studies are required to determine the mid- and long-term performance of these implants.


2018 ◽  
Vol 40 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Federico G. Usuelli ◽  
Camilla Maccario ◽  
Francesco Granata ◽  
Cristian Indino ◽  
Venus Vakhshori ◽  
...  

Background: Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proven to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with follow-up of at least 2 years. Methods: This prospective study included 89 patients who underwent transfibular total ankle arthroplasty from May 2013 to February 2016. The mean age was 53.2 ± 13.5 years. All patients were followed for at least 24 months postoperatively with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiographically preoperatively and at 6, 12, and 24 months postoperatively. Results: At 24 months postoperatively, patients demonstrated statistically significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score from 33.8 ± 14.3 to 88.5 ± 6.6 ( P < .001), visual analog scale (VAS) from 80.5 ± 17.0 to 14.1 ± 9.2 ( P < .001), and Short Form-12 Physical and Mental Composite Scores from 29.9 ± 6.7 and 43.3 ± 8.6 to 47.0 ± 7.6 and 53.3 ± 8.1, respectively ( P < .001). In addition, ankle dorsiflexion and plantarflexion improved from 6.2 ± 5.5 and 9.6 ± 5.8 degrees to 24.2 ± 7.9 and 18.1 ± 7.6 degrees, respectively ( P < .001). Radiographically, patients demonstrated maintained neutral alignment of the ankle at 24 months. No patient demonstrated any radiographic evidence of tibial or talar lucency at final follow-up. Seven patients underwent reoperation for removal of symptomatic hardware (6 fibular plates, 1 syndesmotic screw); 2 patients experienced delayed wound healing. The first one was treated with plate removal and flap coverage. The second one required fibular plate removal. One patient developed a postoperative prosthetic infection requiring operative debridement, removal of implants, and placement of an antibiotic spacer. Conclusion: This study found that transfibular total ankle replacement was a safe and effective option for patients with ankle arthritis resulting in improvements in patient-reported outcomes, range of motion, and radiographic parameters. However, further studies are required to determine the mid- and long-term performance of these implants. Level of Evidence: Level IV, case series.


2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ettore Vulcano ◽  
Mark Myerson

Category: Ankle Arthritis Introduction/Purpose: The last decade has seen a considerable increase in the use of in total ankle arthroplasty (TAA) to treat patients with end-stage arthritis of the knee. However, the longevity of the implants is still far from that of total knee and hip arthroplasties Methods: To introduce a systematic approach to the painful TAA based on the literature and on the senior author’s experience Results: See algorithm attached Conclusion: This new diagnostic and treatment algorithm may be useful to guide less experienced surgeons navigate through the possible causes and treatments of a painful TAA


2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0013
Author(s):  
Kevin Wing ◽  
Jason Sutherland ◽  
Timothy Daniels ◽  
Peter Dryden ◽  
Murray Penner ◽  
...  

Category: Ankle Arthritis Introduction/Purpose: There is much interest in the surgical treatment of end-stage ankle arthritis. Our team has previously reported comparisons between ankle fusion and replacement outcomes for 321 ankles at 5.5 years from a prospective cohort. This research extends the observational period for another six years, ending in 2013. Our primary hypothesis is that patient-reported clinical outcomes for ankle fusion and replacements would be similar at last follow up. Methods: Patients in the Canadian Orthopaedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstructive Database were treated with total ankle replacement (involving Agilty, Star, Mobilty, Hintegra, or Inbone) or fusion (open or arthroscopic). Patient characteristics collected included demographics, comorbidities, smoking status and body mass index. Patient-reported outcomes (PROs) completed by patients were the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36). Pre-operative and most recent patient data, with at least four years follow-up, were analyzed. Sensitivity analyses excluded ankles that had undergone revision. A linear mixed-effects regression model compared scores between total ankle replacement and fusion groups, adjusting for patient characteristics, baseline data and surgeon. Results: The sample included 844 ankles (556 ankle replacements and 284 arthrodesis). The mean follow up period was 8.0 years (standard deviation 3.1 years), with minimum and maximum of 4 and 14 years, respectively. Patients treated with arthrodesis were younger, more likely to be diabetic and smokers, and somewhat less likely to have inflammatory arthritis. Overall, 19.4% of ankle fusion and 30.8% of ankle replacements underwent all-cause re-operation. The mean AOS total score improved from 58.6 points pre-operatively to 31.4 post-operatively (delta 27.2), and from 57.0 to 26.9 points (delta 30.1) in the ankle replacement group. Differences in the change in AOS and SF-36 scores between the arthrodesis and ankle replacement groups were minimal after adjustment for baseline characteristics and surgeon. Conclusion: Clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort of patients whose follow up period ranged between 4 and 14 years post-operatively.


2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Chelsea S. Mathews ◽  
James S. Davitt ◽  
J. Chris Coetzee ◽  
Daniel Norvell ◽  
William R. Ledoux ◽  
...  

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) continues to be investigated as a primary treatment for end-stage ankle arthritis. The objective of this study was to report mid- to long-term results of the Salto Talaris TAA using patient reported outcomes and retention rates with mid- to long-term follow up. Methods: This was a multicenter retrospective study using prospectively collected data. 316 patients received a Salto Talaris TAA at one of three institutions from 2005-2015 were included in the study. Outcomes included subdomain scores of the SF-36 (bodily pain and physical function) and adverse events including additional surgeries or revision/removal of components. Results: Statistically significant improvements were seen in pain and physical function scores at 2 year follow up and were maintained through most recent follow-up. Retention rate of the prosthesis was >95% in all patients (30/32 at > 10 years, 272/284 at 4.5-10 years). 14 patients underwent revision or removal of prosthesis. 15 patients had additional surgery that did not involve revision or removal of components. Conclusion: Treatment of end-stage ankle arthritis with the Salto Talaris implant provides patients with improved pain and functional outcome scores in long-term follow up. Low revision rates demonstrate the durability of this prosthesis.


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