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Jamjoom BA, Dhar S. Outcomes of Revision Total Ankle Replacement. Foot Ankle Clin 2024; 29:171-184. [PMID: 38309801 DOI: 10.1016/j.fcl.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
The objective of this study is to provide an up-to-date review of the outcomes of revision total ankle arthroplasty (TAA). Relevant studies published over the last decade were reviewed. Twelve studies were included. At a median follow-up of 4 years, the median survival and reoperation rates were 86% and 16%, respectively. Significant postoperative improvements in patient-reported outcome measures were recorded in 6 studies. Significant improvement in alignment was documented in 1 study only. Revision TAA is a safe procedure that can produce good outcomes. Nevertheless, data relating to long-term outcome are still limited in quantity and duration.
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Affiliation(s)
- Bakur A Jamjoom
- Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds LS7 4SA, UK.
| | - Sunil Dhar
- Foot and Ankle Unit, Nottingham Elective Orthopaedics, Nottingham University Hospitals City Campus, Nottingham NG5 1PB, UK
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2
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Abstract
Aims The number of revision total ankle arthroplasties (TAAs) which are undertaken is increasing. Few studies have reported the survival after this procedure. The primary aim of this study was to analyze the survival of revision ankle arthroplasties using large datasets. Secondary aims were to summarize the demographics of the patients, the indications for revision TAA, further operations, and predictors of survival. Methods The study combined data from the National Joint Registry and NHS Digital to report the survival of revision TAA. We have previously reported the failure rates and risk factors for failure after TAA, and the outcome of fusion after a failed TAA, using the same methodology. Survival was assessed using life tables and Kaplan Meier graphs. Cox proportional hazards regression models were fitted to compare failure rates. Results A total of 228 patients underwent revision TAA. The mean follow-up was 2.6 years (SD 2.0). The mean time between the initial procedure and revision was 2.3 years (SD 1.8). The most commonly used implant was the Inbone which was used in 81 patients. A total of 29 (12.7%) failed; nine (3.9%) patients underwent a further revision, 19 (8.3%) underwent a fusion, and one (0.4%) had an amputation. The rate of survival was 95.4% (95% confidence interval (CI) 91.6 to 97.5) at one year, 87.7% (95% CI 81.9 to 91.7; n = 124) at three years and 77.5% (95% CI 66.9 to 85.0; n = 57) at five years. Revision-specific implants had a better survival than when primary implants were used at revision. A total of 50 patients (21.9%) had further surgery; 19 (8.3%) underwent reoperation in the first 12 months. Cox regression models were prepared. In crude analysis the only significant risk factors for failure were the use of cement (hazard ratio (HR) 3.02 (95% CI 1.13 to 8.09)) and the time since the primary procedure (HR 0.67 (95% CI 0.47 to 0.97)). No risk factors for failure were identified in multivariable Cox regression modelling. Conclusion Revision TAAs have good medium term survival and low rates of further surgery. New modular revision implants appear to have improved the survival compared with the use of traditional primary implants at revision.
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Affiliation(s)
- Toby Jennison
- University Hospitals Plymouth NHS Trust, Plymouth, UK
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | - Andrew J Goldberg
- Wellington Hospital, Wellington, UK
- Imperial College London, London, UK
- Royal Free Hospital, London, UK
| | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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Jennison T, Spolton-Dean C, Rottenburg H, Ukoumunne O, Sharpe I, Goldberg A. The outcomes of revision surgery for a failed ankle arthroplasty. Bone Jt Open 2022; 3:596-606. [PMID: 35880516 PMCID: PMC9350690 DOI: 10.1302/2633-1462.37.bjo-2022-0038.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations. Methods A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed. Results Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed. Conclusion Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques. Cite this article: Bone Jt Open 2022;3(7):596–606.
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Affiliation(s)
- Toby Jennison
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | | | | | - Ian Sharpe
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
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DeVries JG, Derksen TA, Scharer BM, Limoni R. Perioperative Complications and Initial Alignment of Lateral Approach Total Ankle Arthroplasty. J Foot Ankle Surg 2018. [PMID: 28645548 DOI: 10.1053/j.jfas.2017.04.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Total ankle replacement continues to become a more common treatment of end-stage ankle arthritis. A lateral approach total ankle implant system is an innovative approach for this treatment. We performed a retrospective review of 16 patients treated with lateral approach total ankle replacement. The implant was successful and retained in all cases during a follow-up period of 769 ± 221.3 days (25.3 ± 7.3 months). Initial satisfactory alignment was achieved in all cases. For patients in whom a frontal plane incongruent deformity was present preoperatively, a statistically significant correction was obtained (p = .0122). Three cases of delayed or nonunion of the fibula (18.8%) occurred, and one case of infection that led to removal of the fibular plate developed, for a total of 4 complications (25.0%) related to the fibular osteotomy. Our findings indicate that lateral approach total ankle replacement is effective with unique advantages and disadvantages for treating end-stage ankle arthritis.
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Affiliation(s)
- J George DeVries
- Foot and Ankle Surgeon, Orthopedic & Sports Medicine, BayCare Clinic, Green Bay, WI.
| | - Todd A Derksen
- Foot and Ankle Surgeon, Orthopedics and Sports Institute of the Fox Valley, Appleton, WI
| | - Brandon M Scharer
- Foot and Ankle Surgeon, Orthopedic & Sports Medicine, BayCare Clinic, Green Bay, WI
| | - Robert Limoni
- Orthopedic Surgeon, Orthopedic & Sports Medicine, BayCare Clinic, Green Bay, WI
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Abstract
The design of total ankle arthroplasty systems is evolving as a result of findings from longer-term studies. Our understanding of modes of failure has increased, and surgical techniques have become more refined. Currently, five total ankle arthroplasty systems are used in the United States. The landscape has changed considerably in the decade since the latest article reviewing total ankle design was published. Some implants with acceptable intermediate results had much poorer outcomes at 7- to 10-year follow-up. As more research showing mid- to long-term outcomes is published, the design rationale and current outcomes data for each of these implants must be considered.
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Abstract
Total ankle arthroplasty has advanced rapidly in the last 20 years. Early agility implants enjoyed improved survivability compared with more archaic total ankle implants. When talar subsidence occurs, the revision options include a stemmed component to improve stability by spanning the subtalar joint. Removal and revision of these stemmed components can be difficult because of ingrowth and bone loss.
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Affiliation(s)
- Michael M Brage
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, 325, 9th Avenue, Seattle, WA 98104, USA
| | - Uma E Ramadorai
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78219, USA.
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Pagenstert G, Wimmer MD, Jacxsens M, Saltzman CL, Barg A. [Aseptic loosening of total ankle replacement : One-stage revision ankle arthroplasty]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:220-235. [PMID: 28497248 DOI: 10.1007/s00064-017-0497-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 01/16/2017] [Accepted: 03/02/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To revise one or both loosened prosthesis components, to achieve postoperative pain relief, and preserve ankle range of motion. INDICATIONS Aseptic loosening of the tibial and/or talar ankle prosthesis components without substantial bone defect of the tibial or talar bone stock. CONTRAINDICATIONS General surgical or anesthesiological risks, infections, critical soft tissue conditions, nonmanageable hindfoot instability, neurovascular impairment of the lower extremity, neuroarthropathy (e. g. Charcot arthropathy), substantial nonreconstructable osseous defects with or without cysts on the tibial and/or talar side, non-compliance, patients with primary total ankle replacement (TAR) using intramedullary fixation (stem fixation), patients with severely reduced bone quality, insulin-dependent diabetes mellitus, smoking, unrealistic patient expectations, patients with high activity in sports. SURGICAL TECHNIQUE Exposure of the ankle joint using the previous incision (anterior or lateral transfibular approach). Mobilization and removal of loosened prosthesis component. Careful debridement of bone stock at bone-prosthesis interface. Determination of prosthesis component size. Implantation of definitive prosthesis components. Wound closure in layers. POSTOPERATIVE MANAGEMENT A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts at postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot or cast for 6 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually. RESULTS Between January 2007 and December 2012 a one-stage revision TAR was performed in 14 patients with a mean age of 52.7 ± 12.0 years (29.8-70.5 years). The indication for revision surgery was aseptic loosening of one or both prosthesis components. The mean time between the initial TAR and revision surgery was 5.9 ± 2.9 years (2.0-11.5 years). In 2 patients a tibiotalocalcaneal arthrodesis was performed due to painful aseptic loosening of revision TAR. In all patients a significant pain relief was observed.
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Affiliation(s)
- G Pagenstert
- Orthopädische Klinik, Universität Basel, Basel, Schweiz
| | - M D Wimmer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Jacxsens
- Orthopädische Klinik, Universität Basel, Basel, Schweiz.,Harold K. Dunn Orthopädisches Forschungslabor, Orthopädische Klinik, Universität Utah, Salt Lake City, UT, USA
| | - C L Saltzman
- Orthopädische Klinik, Universität Utah, 590 Wakara Way, 84108, Salt Lake City, UT, USA
| | - A Barg
- Harold K. Dunn Orthopädisches Forschungslabor, Orthopädische Klinik, Universität Utah, Salt Lake City, UT, USA. .,Orthopädische Klinik, Universität Utah, 590 Wakara Way, 84108, Salt Lake City, UT, USA.
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9
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Roukis TS, Iceman K, Elliott AD. Intraoperative Radiation Exposure During Revision Total Ankle Replacement. J Foot Ankle Surg 2016; 55:732-7. [PMID: 27320191 DOI: 10.1053/j.jfas.2016.01.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Indexed: 02/03/2023]
Abstract
Intraoperative C-arm image intensification is required for primary total ankle replacement implantation. Significant radiation exposure has been linked to these procedures; however, the radiation exposure during revision total ankle replacement remains unknown. Therefore, we sought to evaluate the radiation exposure encountered during revision total ankle replacement. The data from 41 patients were retrospectively analyzed from a prospective database: 19 Agility(™) to Agility(™); 4 Agility(™) to Custom Agility(™); 9 Agility(™) to INBONE(®) II; 5 Agility(™) to Salto Talaris(®) XT; 2 Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT; and 2 INBONE(®) I to INBONE(®) II revision total ankle replacements were performed. Two broad categories were identified: partial revision (Agility(™) to Agility(™), Agility(™) to Custom Agility(™), INBONE(®) I to INBONE(®) II) and complete conversion (Agility(™) to INBONE(®) II, Agility(™) to Salto Talaris(®) XT, Scandinavian Total Ankle Replacement Prosthesis to Salto Talaris(®) XT). The mean radiation exposure per case was significant at 3.49 ± 2.21 mGy. Complete conversions, specifically Agility(™) to INBONE(®) II, exhibited the greatest radiation exposure and C-arm time. Revision implant selection and revision type (complete or partial) directly contributed to radiation exposure. Accordingly, revision systems requiring less radiation exposure are preferable. Surgeons should strive to minimize intraoperative complications and limit additional procedures to those necessary, because both lead to additional radiation exposure.
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Affiliation(s)
- Thomas S Roukis
- Attending Staff, Orthopaedic Center, Gundersen Health System, La Crosse, WI.
| | - Kelli Iceman
- Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Andrew D Elliott
- Postgraduate Year III Podiatric Medicine and Surgery Resident, Gundersen Medical Foundation, La Crosse, WI
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Roukis TS, Simonson DC. Incidence of Complications During Initial Experience with Revision of the Agility and Agility LP Total Ankle Replacement Systems: A Single Surgeon's Learning Curve Experience. Clin Podiatr Med Surg 2015; 32:569-93. [PMID: 26407742 DOI: 10.1016/j.cpm.2015.06.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
As the frequency in which foot and ankle surgeons are performing primary total ankle replacement (TAR) continues to build, revision TAR will likely become more commonplace, creating a need for an established benchmark by which to evaluate the safety of revision TAR as determined by the incidence of complications. Currently, no published data exist on the incidence of intraoperative and early postoperative complications during revision of the Agility or Agility LP Total Ankle Replacement Systems during the surgeon learning curve period; therefore, the authors sought to determine this incidence during the senior author's learning curve period.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
| | - Devin C Simonson
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA
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11
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Abstract
The Salto Talaris XT Revision Ankle Prosthesis is an anatomically designed fixed-bearing prosthesis available in the United States based on the design of previous Salto systems. The Salto Talaris XT Revision Ankle Prosthesis design optimizes surface area, cortical contact, and ultrahigh-molecular-weight polyethylene conformity. Two tibial component designs, both with the same base plate dimensions, are available, the standard conical fixation plug affixed to a short keel and a long-stemmed version. The author presents an overview of the Salto Talaris XT Revision Ankle Prosthesis surgical technique and pearls for successful application.
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Affiliation(s)
- Thomas S Roukis
- Orthopaedic Center, Gundersen Health System, Mail Stop: CO2-006, 1900 South Avenue, La Crosse, WI 54601, USA.
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Toyoshima Y, Maeda T, Oh K, Namiki O, Kumamoto H, Inagaki K. Posterior Tibial Artery Perforator-Based Fascial Flap for Skin Necrosis and Exposed Extensor Tendon After Revision Total Ankle Replacement. JBJS Case Connect 2015; 5:e37. [PMID: 29252606 DOI: 10.2106/jbjs.cc.n.00089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Delayed wound-healing of anterior ankle incisions can be problematic for patients who have undergone total ankle replacement. We describe the case of a patient in whom a posterior tibial artery perforator-based fascial flap was effectively used to cover skin necrosis and to repair the extensor retinaculum in a wound following revision total ankle replacement. CONCLUSION When a tendon is exposed in the ankle, a skin flap is generally required. The creation of a perforator-based fascial flap is a useful technique for covering a wound with an exposed tendon and is an alternative to a musculocutaneous flap.
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Affiliation(s)
- Yoichi Toyoshima
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Toshio Maeda
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Koei Oh
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Osamu Namiki
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Hisao Kumamoto
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
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Roukis TS, Prissel MA. Revision of agility total ankle™ replacements using agility™ components is the right choice, sometimes. J Foot Ankle Surg 2014; 53:391-3. [PMID: 24656766 DOI: 10.1053/j.jfas.2014.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Thomas S Roukis
- Department of Orthopedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, Wisconsin
| | - Mark A Prissel
- Department of Orthopedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, Wisconsin
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Demetracopoulos CA, Halloran JP, Maloof P, Adams SB, Parekh SG. Total ankle arthroplasty in end-stage ankle arthritis. Curr Rev Musculoskelet Med 2013; 6:279-84. [PMID: 23893255 DOI: 10.1007/s12178-013-9179-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent advancements in ankle prosthesis design, combined with improved surgical techniques for correction of coronal plane deformity and ligamentous balancing, have led to a resurgence of interest in total ankle arthroplasty for the treatment of end-stage ankle arthritis. Although ankle arthrodesis has long been considered the gold standard treatment for ankle arthritis, recent studies have shown that patients who undergo total ankle replacement have equivalent pain relief and improved function, when compared with patients with an ankle fusion. The purpose of this review is to summarize the indications, advantages, disadvantages, and clinical outcomes of some of the more commonly used modern prostheses for total ankle arthroplasty.
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Abstract
Joint arthroplasty registry data are meaningful when evaluating the outcomes of total joint replacement, because they provide unbiased objective information regarding survivorship and incidence of use. Critical evaluation of the registry data information will benefit the surgeon, patient, and industry. However, the implementation and acceptance of registry data for total ankle replacement has lagged behind that of hip and knee implant arthroplasty. Currently, several countries have national joint arthroplasty registries, with only some procuring information for total ankle replacement. We performed an electronic search to identify publications and worldwide registry databanks with pertinent information specific to total ankle replacement to determine the type of prostheses used and usage trends over time. We identified worldwide registry data from 33 countries, with details pertinent to total ankle replacement identified in only 6 countries. The obtained information was arbitrarily stratified into 3 distinct periods: 2000 to 2006, 2007 to 2010, and 2011. Within these study periods, the data from 13 total ankle replacement systems involving 3,980 ankles were identified. The vast majority (97%) of the reported ankle replacements were 3-component, mobile-bearing, uncemented prostheses. Three usage trends were identified: initial robust embracement followed by abrupt disuse, minimal use, and initial embracement followed by sustained growth in implantation. Before the widespread acceptance of new total ankle replacements, the United States should scrutinize and learn from the international registry data and develop its own national joint registry that would include total ankle replacement. Caution against the adoption of newly released prostheses, especially those without readily available revision components, is recommended.
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Affiliation(s)
- Thomas S Roukis
- Attending Staff, Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, WI.
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Roukis TS, Prissel MA. Management of extensive talar osteolysis with Agility™ total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. J Foot Ankle Surg 2013; 53:108-13. [PMID: 23954094 DOI: 10.1053/j.jfas.2013.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Indexed: 02/03/2023]
Abstract
The Agility™ Total Ankle Replacement System, almost exclusively without polymethylmethacrylate cement fixation, was the most commonly used implant in the United States from 1998 to 2007. Much attention has been given to the intraoperative complications and incision healing-related problems. However, it is the intermediate- and long-term complications, specifically, aseptic osteolysis, talar component loosening, subsidence, and progressive malalignment, that require careful consideration, because the revision options are limited. We describe a technique for management of extensive talar aseptic osteolysis for revision of Agility™ total ankle replacement systems with use of geometric metal-reinforced polymethylmethacrylate cement augmentation. This technique preserves the subtalar joint, provides immediate component stability and restoration of component alignment and height, and is a cost-effective alternative to other available options and still allows for additional revision should late failure occur.
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Affiliation(s)
- Thomas S Roukis
- Attending Staff, Department of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, WI.
| | - Mark A Prissel
- Postgraduate Year III Resident, Podiatric Medicine and Surgery, Gundersen Health System Medical Foundation, La Crosse, WI
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