scholarly journals Restoration of Talar Height using a Modular Revision Prosthesis after Failed Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0011
Author(s):  
Brian Steginsky ◽  
Steven Haddad
Keyword(s):  
Postoperative Complications ◽  
Bone Loss ◽  
Cement Augmentation ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Modular Prosthesis ◽  
Ankle Replacement ◽  
The Mean

Category: Ankle Arthritis Introduction/Purpose: Talar component subsidence is the most common indication for revision total ankle replacement. The management of talar bone loss and alteration in the ankle joint center of rotation is challenging following component subsidence. Unfortunately, ankle arthrodesis as a salvage procedure for failed ankle arthroplasty has been associated with high rates of nonunion and collapse. Equally unfortunate, there is paucity in the literature on revision total ankle arthroplasty. The purpose of this study was to report the early outcomes of revision total ankle replacement using a modular prosthesis and metal/cement augmentation to reconstitute talar height following catastrophic failure of the index total ankle arthroplasty. Methods: A retrospective review was performed on sixteen patients who underwent revision total ankle replacement for failed arthroplasty associated with talar component subsidence and subsequent talar bone loss. Demographic data, postoperative complications, index implant, and concomitant procedures were recorded. Radiographic measurements were performed at three time-points (preoperative, immediately postoperative, and most recent follow-up) to evaluate alignment of the prosthesis, talar height restoration, and range of motion. Results: Patient follow-up ranged from 9.3 –19.1 months, with a mean follow-up period of 12.2 months. The maximum preoperative and postoperative talar coronal misalignment was 16.2° and 3.5°, respectively. The mean preoperative and immediate postoperative talar height was 28.7 mm and 33.3 mm, respectively. There was a significant improvement in talar height of 4.6 mm after revision total ankle replacement (P<0.001). There was no difference in talar height between the immediate postoperative visit and latest follow-up visit (33.2 mm). The mean preoperative and postoperative radiographic arc of motion was 19.5° and 24.0°, respectively. Ten patients (62.5%) did not sustain complications post surgical. Three patients developed a superficial wound complication that healed without additional surgery. One patient required a transmetatarsal amputation. Other complications included neuritis and DVT. Conclusion: Revision ankle replacement using a modular prosthesis with metal/cement augmentation allows restoration of talar height. Though we recognize this data constitutes a very early follow up, this cohort has utilized the revision ankle implant with significant repetitive load after which older generation implants underwent secondary subsidence due to poor talar bone stock. Early outcomes demonstrate a predictable method to salvage catastrophic prosthesis failure associated with severe talar subsidence and deformity. The risk of postoperative complications, although moderate, is an acceptable alternative to lower limb amputation/arthrodesis. Further follow up is warranted to determine functional outcomes and longevity of revision implant systems.

scholarly journals Restoration of Talar Height using a Modular Revision Prosthesis after Failed Total Ankle Arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Brian Steginsky ◽  
Steven L. Haddad
Keyword(s):  
Postoperative Complications ◽  
Bone Loss ◽  
Ankle Arthrodesis ◽  
Cement Augmentation ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
The Mean

Category: Ankle Introduction/Purpose: Talar component subsidence is the most common indication for revision total ankle replacement. The management of talar bone loss and alteration in the ankle joint center of rotation is challenging following component subsidence. Unfortunately, ankle arthrodesis as a salvage procedure for failed ankle arthroplasty has been associated with high rates of nonunion and collapse. Equally unfortunate, there is paucity in the literature on revision total ankle arthroplasty. The purpose of this study was to report the early outcomes of revision total ankle replacement using a modular prosthesis and metal/cement augmentation to reconstitute talar height following catastrophic failure of the index total ankle arthroplasty. Methods: Retrospective review was performed on sixteen patients who underwent revision total ankle replacement for failed arthroplasty associated with talar component subsidence and subsequent talar bone loss. All patients underwent revision arthroplasty using a revision modular ankle prosthesis and had a minimum of one-year follow-up. Demographic data, postoperative complications, original prosthesis, and concomitant procedures were recorded. Radiographic measurements were performed at three time-points (preoperative, immediately after surgery, and at most recent follow-up) to evaluate alignment of the prosthesis, talar height, and ankle range of motion. Implant survivorship was determined. Failure was defined as >2 mm of talar subsidence, conversion to ankle arthrodesis or below the knee amputation, and/or revision of the prosthesis. Ankle Osteoarthritis Score (AOS), Foot Function Index (FFI), and visual analog score (VAS) were collected at the most recent postoperative visit. Results: Patient follow-up ranged from 12.1 –20.6 months, with a mean follow-up of 15.0 months. The mean preoperative and immediate postoperative talar height was 28.7 mm and 33.4 mm, respectively. There was a significant improvement in talar height of 4.7 mm after revision total ankle replacement (P<0.001). Talar height was maintained at most recent follow-up. The mean preoperative and postoperative radiographic arc of motion was 19.5° and 24.0°, respectively. Two patients, with a mean BMI of 43.5, developed >2 mm of talar subsidence (one patient required revision surgery). The mean postoperative AOS and FFI was 25.0 and 28.8, respectively. The majority of patients (84%) were satisfied with their outcome, and all patients would choose to undergo the same procedure again (vs. arthrodesis or amputation). Conclusion: Revision ankle replacement using a modular prosthesis with metal/cement augmentation allows restoration of talar height. Though we recognize this data constitutes a very early follow up, this cohort has utilized the revision ankle implant with significant repetitive load after which older generation implants underwent secondary subsidence due to poor talar bone stock. Early outcomes demonstrate a predictable method to salvage catastrophic prosthesis failure associated with severe talar subsidence and deformity. The risk of postoperative complications, although moderate, is an acceptable alternative to lower limb amputation/arthrodesis. Further follow-up is warranted to determine functional outcomes and longevity of revision implant systems.

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]

scholarly journals Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty at 2-years Follow-up

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005
Author(s):  
Francesco Granata ◽  
Camilla Maccario ◽  
Luigi Manzi ◽  
Eric Tan ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Functional Limitation ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Hindfoot Alignment ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Patient Reported ◽  
American Orthopaedic

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.

scholarly journals Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty

2018 ◽  
Vol 40 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Federico G. Usuelli ◽  
Camilla Maccario ◽  
Francesco Granata ◽  
Cristian Indino ◽  
Venus Vakhshori ◽  
...  
Keyword(s):  
Short Form ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Plate Removal ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Patient Reported

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.

scholarly journals Adverse Events in Total Ankle Arthroplasty, Analysis of the FDA Medical and User Facility Device Experience Database

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Karim Mahmoud ◽  
Sreenivasulu Metikala ◽  
Kathryn O’Connor ◽  
Daniel Farber
Keyword(s):  
Adverse Events ◽  
Aseptic Loosening ◽  
Mandatory Reporting ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Mode Of Failure ◽  
User Facility

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement has become a popular treatment option for end stage ankle arthritis. Most of the reports of adverse events following total ankle replacement have been from high volume institutions and are subject to either observational or selection bias as well as potential under-reporting as they do not include the experience of community and lower volume centers and surgeons. The FDA’s Medical and User Facility Device Experience (MAUDE) Database provides a more complete scope of adverse events due to the mandatory reporting requirements by the FDA of implant manufactures. We reviewed the database to identify the common modes of failure and complications of total ankle implants Methods: We retrospectively reviewed reports of the MAUDE database from November 2011 to September 2018 regarding all total ankle implants. Each device in the MAUDE database is classified with a 3-letter code, we identified the 2 codes assigned to total ankle arthroplasty devices, and manually searched the FDA’s published Device Classification list for adverse events. All events were reviewed and classified. Data related to patient age or sex, surgeon, medical center location are not available in the database Results: We identified 1000 adverse reports in the period between November 2011 and September 2018. After exclusion of duplicate reports for single events or reports irrelevant to total ankle arthroplasty, a total of 697 adverse event reports were noted. The most common mode of failure was aseptic loosening (21%), followed by infection (16%), alignment and mechanical issues (instability, malalignment, malposition, stiffness, impingement) (15%), implantation issues (pin, screw or drill breakage, alignment guide problems) (9%), polyethylene related problems (wear, displaced or fractured implants) (7%), bony and soft tissue overgrowth (6%), and peri-prosthetic fractures (5%). Conclusion: Our analysis reveals that the most reported mode of failure was aseptic loosening followed by infection. However, it is notable that there are a significant number of issues with implant alignment and mechanics, complications during implantation and polyethylene component failure that are under-reported in the literature. Knowledge of these adverse events may help surgeons avoid similar complications as well as lead to improvement in component implantation and design

scholarly journals Salvage Arthrodesis with Femoral Head Allograft for Failed Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0032
Author(s):  
Hong S. Lee ◽  
Kiwon Young ◽  
Tae-Hoon Park ◽  
Hong Seop Lee
Keyword(s):  
Femoral Head ◽  
Subjective Assessment ◽  
Total Ankle Arthroplasty ◽  
Bone Block ◽  
Ankle Arthroplasty ◽  
Pain Scores ◽  
Walking Aids ◽  
The Mean ◽  
Final Followup

Category: Ankle Introduction/Purpose: Failed total ankle arthroplasty (TAA) often results in significant bone loss and requires salvage arthrodesis. The aim of this study was to investigate the outcomes of Salvage arthrodesis with allo-bone block for failed TAA. Methods: This study included 8 patients who underwent salvage arthrodesis with femoral head allograft for failed TAA from August 2012 to March 2018 because of loosing of TAA implant. The mean age of the patients was 71 years (range, 54-81 years), and the mean follow-up period was 32 months (range, 12 to 84 months). Allograft problem and alignment of joint were evaluated radiographically. American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and visual analogue scale (VAS) pain scores were recorded preoperatively and at the time of final followup. Functional questionnaires were used to assess the duration for which the patient could walk continuously, use of walking aids, consumption of pain medication, and the patient’s subjective assessment of the percentage of overall improvement compared with before the salvage arthrodesis. Results: The allograft was retained without collapse for a mean of 24 months (range, 12 to 36 months) in four patients. Collapse of the allograft was observed in four patients at a mean of 11 months (range, 9 to 16 months), 1 of 4 patients were conserved to retrograde intramedullary nail at postoperative 12 months because of with implant failure and nonunion. The mean AOFAS and VAS pain scores improved from 12 (range, 8 to 40) preoperatively to 63 (range, 38 to 75) postoperatively (p = 0.001) and from 7 (range, 6 to 10 to 3 (range, 2 to 8) (p = 0.001), respectively. At the final follow-up evaluation, 6 of 8 patients were able to walk continuously at least 30 minutes with walking aid. Conclusion: The successful rate of salvage arthrodesis with femoral head allograft was 75% (Six of total 8 patients). The incidence rate of allograft collapse was 50% (Four of total 8 patients).

scholarly journals 2019 IFFAS Award for Excellence Winner: Peri-Prosthetic Cysts and Alignment in Total Ankle Replacement: A 3-D, Weight Bearing Topographical Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Francois Lintz ◽  
Jef Mast ◽  
Nazim Mehdi ◽  
Alessio Bernasconi ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Coronal Plane ◽  
Unequal Distribution ◽  
Hindfoot Alignment ◽  
Cyst Volume ◽  
Ankle Replacement ◽  
The Mean ◽  
The Difference

Category: Ankle, Ankle Arthritis Introduction/Purpose: Peri-prosthetic cysts (PPC) in Total Ankle Replacement (TAR) are a common failure cause but the mechanisms of their development remains unclear. One possible explanation could be hindfoot malalignment and subsequent unequal distribution of load inside the joint. However, how residual malalignment influences the evolution of PPC remains unclear. Computed tomography (CT) has demonstrated superiority on conventional radiography in the follow up of PPC. Weight Bearing CT (WBCT), by combining 3D imaging and weight bearing measurements seems a valid tool to investigate this further. The objective for this work was to study the effects of residual hindfoot deformity on the distribution of PPC in the coronal plane. We hypothesized that cysts would be found predominantly medially in varus configuration, and laterally in valgus configuration. Methods: Retrospective comparative study, ethics committee approved. Forty-eight cases of TAR were included, with relevant demographics. Inclusion criteria were cases of primary TAR with available WBCT imaging of their ankle as part of normal follow up. Exclusion criteria were subsequent implant revision or cyst grafting. In each case, the localization and size of PPC’s were documented and their volume calculated by approximation of the closest ellipsoid. Hindfoot alignment was evaluated by the percentage Foot Ankle Offset (FAO) (foot-length normalized 3D ratio between the midline of the foot and the center of the ankle) using a WBCT dedicated semi-automatic software. The mean FAO value with 95%CI for the population was calculated. The difference in medial and lateral cyst volume defined by their position relative to the median axis in the coronal plane was compared in varus and valgus cases by a Mann-Whitney non-parametric test for unpaired samples. Results: Demographic distributions of the series were 32% female, mean age 65 (45-85) years. Mean FAO value was 0.12% (95%CI -1.09 to 1.33). Mean follow up was 43 months (6 to 239). The mean total cyst volume per case was 1190,7 mm3. In varus cases (defined by FAO<-1.09%), the volume of medial cysts was greater than laterally by a mean 197 mm3, whereas in valgus cases (defined by FAO>1.33%), the volume of lateral cysts was greater than medially by a mean 332 mm3. The difference was statistically significant (p<0.05). There was a weak, significant positive correlation (r=0.25, p<0,001) between FAO and total cyst volume and a moderate, significant correlation (r=0,56, p<0,001) between time to follow up and total cyst volume. Conclusion: Our hypothesis was confirmed. Periprosthetic cysts volume in this series of primary TAR was found to be relatively greater medially in postoperative varus configurations and vice-versa laterally in valgus. This confirms a possible correlation between the direction of residual hindfoot malalignment and the coronal localization of PPC in TAR, although this is certainly not the only pathophysiologic factor involved in PPC onset. Weightbearing CT may be helpful in Total Ankle Replacement follow up, in order to early detect PPC development and possibly to identify situations at risk of a more rapid evolution.

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

2020 ◽  
Vol 41 (12) ◽  
pp. 1519-1528
Author(s):  
Jonathan Day ◽  
Jaeyoung Kim ◽  
Martin J. O’Malley ◽  
Constantine A. Demetracopoulos ◽  
Jonathan Garfinkel ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Patient Reported ◽  
The Mean ◽  
Component Revision

Background: The Salto Talaris is a fixed-bearing implant first approved in the US in 2006. While early surgical outcomes have been promising, mid- to long-term survivorship data are limited. The aim of this study was to present the survivorship and causes of failure of the Salto Talaris implant, with functional and radiographic outcomes. Methods: Eighty-seven prospectively followed patients who underwent total ankle arthroplasty with the Salto Talaris between 2007 and 2015 at our institution were retrospectively identified. Of these, 82 patients (85 ankles) had a minimum follow-up of 5 (mean, 7.1; range, 5-12) years. The mean age was 63.5 (range, 42-82) years and the mean body mass index was 28.1 (range, 17.9-41.2) kg/m2. Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Preoperative, immediate, and minimum 5-year postoperative AP and lateral weightbearing radiographs were reviewed; tibiotalar alignment (TTA) and the medial distal tibial angle (MDTA) were measured to assess coronal talar and tibial alignment, respectively. The sagittal tibial angle (STA) was measured; the talar inclination angle (TIA) was measured to evaluate for radiographic subsidence of the implant, defined as a change in TIA of 5 degrees or more from the immediately to the latest postoperative lateral radiograph. The locations of periprosthetic cysts were documented. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Results: Survivorship was 97.6% with 2 revisions. One patient underwent tibial and talar component revision for varus malalignment of the ankle; another underwent talar component revision for aseptic loosening and subsidence. The rate of other reoperations was 21.2% ( n = 18), with the main reoperation being exostectomy with debridement for ankle impingement ( n = 12). At final follow-up, the average TTA improved 4.4 (± 3.8) degrees, the average MDTA improved 3.4 (± 2.6) degrees, and the average STA improved 5.3 (± 4.5) degrees. Periprosthetic cysts were observed in 18 patients, and there was no radiographic subsidence. All FAOS subscales demonstrated significant improvement at final follow-up. Conclusions: We found the Salto Talaris implant to be durable, consistent with previous studies of shorter follow-up lengths. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at a minimum 5-year follow-up. Level of Evidence: Level IV, retrospective case series.

scholarly journals A Comparison of Cyst Formation and Management in Mobile-Bearing and Fixed-Bearing Total Ankle Arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
James Lachman ◽  
Michel Taylor ◽  
Elizabeth Cody ◽  
Daniel Scott ◽  
James A. Nunley ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Patient Reported Outcomes ◽  
Mobile Bearing ◽  
Cyst Formation ◽  
Total Ankle Arthroplasty ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Patient Reported

Category: Ankle Arthritis Introduction/Purpose: The Scandinavian Total Ankle Replacement(STAR) system and Salto Talaris(ST) total ankle system are two of the more commonly studied total ankle implants. As the STAR is one of the oldest total ankle arthroplasty (TAA) implants still in use today, most studies focus on longevity and survivorship. Reported rates of cyst formation for these two prosthesis in most series vary from 11-22% but no large study has focused on surgical management of these cysts or included patient reported outcomes after surgery. In this series, we aimed to investigate rates of cyst formation between mobile(MB) and fixed-bearing(FB) TAA and examine clinical and patient reported outcomes of bone grafting or cementing of large cysts surrounding the STAR and ST implants. Methods: A prospectively collected database at a high volume total ankle replacement center was retrospectively reviewed to identify patients who underwent TAA with either the STAR or the ST total ankle system between 2007 and 2015. Cysts were identified and measured on standard weight bearing radiographs and confirmed on computed tomography(CT) when available. Visual analog scale (VAS) score, Short Form-36 (SF-36) physical and mental component scores, Short Musculoskeletal Function Assessment(SMFA), and AOFAS hindfoot scores were collected from all patients preoperatively and then at 6 months, 1 year and annually postoperatively. Patients with a minimum 2 years follow-up who underwent revision TAA secondary to catastrophic bone cysts or who were managed with either curettage and bone grafting or curettage and cementing of bone cysts surrounding the TAA prosthesis were included in the patient reported outcomes (PRO) analysis Results: Excluding 53 patients for inadequate follow-up, 232 patients (29% female, 71% male; follow-up 6.7 years) who underwent STAR-TAA and 147 patients (26.6% female, 73.5% male; follow-up 7 years) who underwent ST-TAA were identified. Cysts <20 mm diameter occurred more often in the MB TAAs, and more often in the tibia than talus (table). Cysts >10 mm were identified in 95/232 (41%) STAR and 24/147 (16%) ST ankles. In the STAR group, 24 patients underwent cyst bone grafting (13), cementing (6) or both (8) at a mean 4.8 years. In the ST group, 14 patients underwent cyst bone grafting (6), cementing (4), or both (4) at a mean of 2.7 years. PRO data improved significantly for both the STAR and ST group in all questionnaires (p<0.05 for all). Conclusion: Mobile-bearing total ankle arthroplasty in this cohort had a higher rate of cyst formation greater than 10 mm (95/232 patients, 41%) when compared to a fixed-bearing TAA (24/147, 16.3%). Only 24/95 (25%) of STAR patients and 14/24 (58%) of ST patients required surgical intervention for cyst management. Patient reported outcomes after cyst surgery improved significantly when compared to pre-cyst management surgery and did not differ between MB and FB cohorts (p=0.424). Successful surgical management of large cyst surrounding either mobile-bearing or fixed-bearing total ankle systems can be expected based on the results of this study. [Table: see text]

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