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González-Alonso M, Trapote-Cubillas AR, Madera-González FJ, Fernández-Hernández Ó, Sánchez-Lázaro JA. Fixed-bearing versus mobile-bearing total ankle replacement survivorship. A meta-analysis. Foot Ankle Surg 2024; 30:275-284. [PMID: 38388212 DOI: 10.1016/j.fas.2024.02.001] [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] [Received: 03/16/2023] [Revised: 01/03/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Main objective of this research is to know if there is a different survival rate between fixed bearing (FB) and mobile bearing (MB) total ankle replacement (TAR). We hypothesized that there are no differences between the survival rates of both implants. METHODS A systematic search was performed in PubMed, Cochrane, EMBASE and ClinicalTrials.gov databases to identify published studies from August 2018 to September 2022 including results for FB and MB TAR survivorship. Inclusion criteria included 1) primary TAR in one or both feet in which implant could be identified, 2) a minimum of 20 procedures reported, 3) reported implant survivorship or calculable and 4) a minimum of 12 months follow-up for level 1-3 studies or 60 months for level 4 studies. RESULTS 3902 ankles in 28 studies were included. 719 were FB and 3104 MB with an overall survivorship of 94% (95% CI [0.89; 0.97]) and 89% (95% CI [0.86; 0.92]) respectively. After subgroup analysis, we did not find differences among both groups (p = 0.429). Meta-regression analysis showed that longer follow-up was associated with lower survival rates in MB group (p = 0.000) while no other relationships were found with other factors (age, level of evidence or conflict of interests). CONCLUSIONS No differences in survival rates between both groups were found. Age and other studied confounders were not found to be related with implant survivorship. However, longer follow-up was found to be related with lower survival rates. Studies with longer follow-up and higher level of evidence are needed to confirm results. LEVEL OF EVIDENCE IV, systematic review of level I to IV studies.
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Affiliation(s)
- Marcos González-Alonso
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain.
| | - Ana R Trapote-Cubillas
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain
| | - Francisco J Madera-González
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain
| | - Óscar Fernández-Hernández
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain; University of Salamanca, 37007 Salamanca, Spain
| | - Jaime A Sánchez-Lázaro
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, University Hospital of Leon, Leon 24008, Spain; University of Salamanca, 37007 Salamanca, Spain; Institute of Biomedicine (IBIOMED), University of Leon, 24071 Leon, Spain
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Jyoti, Ghosh R. Printable functionally graded tibial implant for TAR: FE study comparing implant materials, FGM properties, and implant designs. Comput Biol Med 2024; 177:108645. [PMID: 38796883 DOI: 10.1016/j.compbiomed.2024.108645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/25/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
Tibial implants with functionally graded material (FGM) for total ankle replacement (TAR) can provide stiffness similar to the host tibia bone. The FGM implants with low stiffness reduce stress shielding but may increase implant-bone micromotion. A trade-off between stress shielding and implant-bone micromotion is required if FGMs are to substitute traditionally used Ti and CoCr metal implants. The FGM properties such as material gradation law and volume fraction index may influence the performance of FGM implants. Along with the FGM properties, the design of FGM implants may also have a role to play. The objective of this study was to examine FGM tibial implants for TAR, by comparing implant materials, FGM properties, and implant designs. For this purpose, finite element analysis (FEA) was conducted on 3D FE models of the intact and the implanted tibia bone. The tibial implants were composed of CoCr and Ti, besides them, the FGM of Ti and HA was developed. The FGM implants were modelled using exponential, power, and sigmoid laws. Additionally, for power and sigmoid laws, different volume fraction indices were taken. The effect of implant design was observed by using keel type and stem type TAR fixation designs. The results indicated that FGM implants are better than traditional metal implants. The power law is most suitable for developing FGM implants because it reduces stress shielding. For both power law and sigmoid law, low values of the volume fraction index are preferrable. Therefore, FGM implant developed using power law with 0.1 vol fraction index is ideal with the lowest stress shielding and marginally increased implant-bone micromotion. FGM implants are more useful for keel type fixation design than stem type design. To conclude, with FGMs the major complication of stress shielding can be solved and the longevity and durability of TAR implants can be enhanced.
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Affiliation(s)
- Jyoti
- Biomechanics Research Laboratory, School of Mechanical & Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India
| | - Rajesh Ghosh
- Biomechanics Research Laboratory, School of Mechanical & Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India.
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Zunarelli R, Fiore M, Lonardo G, Pace A, Persiani V, De Paolis M, Sambri A. Total Ankle Replacement Infections: A Systematic Review of the Literature. J Clin Med 2023; 12:7711. [PMID: 38137779 PMCID: PMC10743530 DOI: 10.3390/jcm12247711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Periprosthetic infection (PJI) after TAR is a serious complication, often requiring further surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. This systematic review aims to summarize the current evidence on the management of TAR PJI and provide a comprehensive overview of this topic, especially from an epidemiologic point of view. Three different databases (PubMed, Scopus, and Web of Science) were searched for relevant articles, and further references were obtained by cross-referencing. Seventy-one studies met the inclusion criteria, reporting on cases of TAR PJI. A total of 298 PJIs were retrieved. The mean incidence of PJI was 3.8% (range 0.2-26.1%). Furthermore, 53 (17.8%) were acute PJIs, whereas most of them (156, 52.3%) were late PJIs. Most of the studies were heterogeneous regarding the treatment protocols used, with a two-stage approach performed in most of the cases (107, 35.9%). While the prevalence of ankle PJI remains low, it is potentially one of the most devastating complications of TAR. This review highlights the lack of strong literature regarding TAR infections, thus highlighting a need for multicentric studies with homogeneous data regarding the treatment of ankle PJI to better understand outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.Z.); (M.F.); (G.L.); (A.P.); (V.P.); (M.D.P.)
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4
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Mathews CS, Davitt J, Coetzee JC, Shofer J, Norvell DC, Ledoux WR, Sangeorzan BJ. Prospective Multicenter Study of Salto Talaris Ankle Arthroplasty With Minimum 4-Year Follow-Up. Foot Ankle Int 2023; 44:1239-1246. [PMID: 37902218 PMCID: PMC10752572 DOI: 10.1177/10711007231203678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) continues to be investigated as a primary treatment for end-stage ankle arthritis. The objective of this study is to report mid- to long-term results of the Salto Talaris TAA using prospectively collected patient-reported outcomes and implant survival rates with 4- to 13-year follow-up. METHODS This was a retrospective study of prospectively collected data from 2 multicenter cohort studies from 3 centers. Three hundred fourteen subjects who received a Salto Talaris TAA from 2005 to 2015 were included in the study. Follow-up ranged 4-13 years following index procedure. Outcomes included 36-Item Short Form Health Survey (SF-36) mental and physical component summary scores, pain scores, and adverse events including additional surgeries, revision, or removal of components. RESULTS Significant improvements were seen in pain and physical function scores at 2-year follow-up and were generally maintained through most recent follow-up. The survival rate of the prosthesis was >95% (n = 30/32 at >10 years, n = 272/282 at 4.5-10 years). Thirteen patients (4.1%) underwent revision or removal of their prosthesis. Time to revision ranged from 2 months to 6.5 years following the index procedure. Twenty-two patients (7.0%) had additional surgery that did not involve revision or removal of components. CONCLUSION Treatment of end-stage ankle arthritis with this implant provided patients with improved pain and functional outcome scores at mid- to long-term follow-up. The significant improvements reported at 2-4 years appeared to endure through the extended follow-up period. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Chelsea S. Mathews
- Department Orthopaedic Surgery and Sports Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James Davitt
- Orthopedic + Fracture Specialists, Portland, OR, USA
| | | | - Jane Shofer
- Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Daniel C. Norvell
- Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - William R. Ledoux
- Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Bruce J. Sangeorzan
- Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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Hinh CM, Chong ACM, Bierman BR, Uglem TP. Computed Tomography Derived Patient-specific Instrumentation Total Ankle Arthroplasty Survivorship Outcomes. J Foot Ankle Surg 2023; 62:338-346. [PMID: 36180364 DOI: 10.1053/j.jfas.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/19/2022] [Accepted: 08/27/2022] [Indexed: 02/03/2023]
Abstract
Computed tomography (CT) derived patient-specific total ankle arthroplasty (TAA) systems have been utilized for improved accuracy and reproducible implant alignment. The purpose of the present study was to report the overall implant survivorship as well as radiographic analysis of patients who underwent primary TAA utilizing CT-derived patient-specific instrumentation. A retrospective review of medical charts and radiographs were performed on patients who had undergone primary TAA at a single institution in the Midwest region from March 2013 to October 2020. Radiographic analysis included preoperative, initial postoperative, and final follow-up coronal and sagittal tibiotalar alignment as well as periprosthetic radiolucency. A total of 96 patients with a mean follow-up of 3 years (range, 0.3-7.3 years) were included. Implant survivorship was found to be 92% at median follow-up of 3 years. A total of 8 cases (8.3%) required revision/reoperation, with 6 (6.3%) of these reoperations directly related for failure of one of the metallic implant components. There was significant improvement in both coronal and sagittal tibiotalar alignment from preoperative to initial postoperative follow-up (p < .001). At latest postoperative follow-up, there were 88% of TAAs that remained in a neutral alignment following surgery. A total of 10 cases were found to have radiolucency at latest follow-up. In conclusion, the use of CT derived patient-specific TAA showed high implant survivorship with significant improvement of sagittal and coronal tibiotalar alignment. With better implant alignment and position, it potentially reduces the risk of early implant failure or implant loosening in long-term follow-up.
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Affiliation(s)
- Christopher M Hinh
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND
| | - Alexander C M Chong
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND; Department of Graduate Medical Education - Sanford Health, Fargo, ND.
| | - Bennen R Bierman
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND
| | - Timothy P Uglem
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND
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6
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Miner SA, Martucci JA, Brigido SA, DiDomenico L. Time to Revision After Periprosthetic Joint Infection in Total Ankle Arthroplasty: A Systematic Review. J Foot Ankle Surg 2022; 62:186-190. [PMID: 36243626 DOI: 10.1053/j.jfas.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/14/2022] [Accepted: 09/04/2022] [Indexed: 02/03/2023]
Abstract
While not a common complication after total ankle arthroplasty (TAA), periprosthetic joint infection (PJI) presents a significant risk of implant failure. The primary aim of this systematic review was to evaluate time to revision after PJI in patients who had undergone TAA. An extensive search strategy via electronic databases initially captured 11,608 citations that were evaluated for relevance. Ultimately, 12 unique articles studying 3040 implants met inclusion criteria. The time to revision surgery due to PJI was recorded for each study and a weighted average obtained. The prevalence of PJI was 1.12% (n = 34). We found that the average time to revision due to PJI was 30.7 months, or approximately 2.6 years after the index TAA procedure. By literature definitions, the majority of cases (91.2%, n = 31) were beyond the "acute" PJI phase. The population was divided into 2 groups for further analysis of chronic infections. PJIs before the median were classified as "early" and those after as "late" chronic. The majority of cases (61.8%) were late chronic with an average time to revision of 44.3 months. A smaller number were early chronic (29.4%) with revision within 10.8 months. After summarizing the rates of infection and times to revision reported in the literature, we suggest modifying the current PJI classification to include early chronic and late chronic subgroups so that the total ankle surgeon is better prepared to prudently diagnose and treat PJIs.
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Affiliation(s)
- Samantha A Miner
- Reconstructive Foot & Ankle Surgery Fellowship, Coordinated Health-Lehigh Valley Health Network, Bethlehem, PA.
| | - John A Martucci
- Reconstructive Rearfoot and Ankle Surgical Fellowship, NOMS Ankle & Foot Care Centers, Youngstown, OH
| | - Stephen A Brigido
- Reconstructive Foot & Ankle Surgery Fellowship, Coordinated Health-Lehigh Valley Health Network, Bethlehem, PA
| | - Lawrence DiDomenico
- Reconstructive Rearfoot and Ankle Surgical Fellowship, NOMS Ankle & Foot Care Centers, Youngstown, OH
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7
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Stadler C, Stöbich M, Ruhs B, Kaufmann C, Pisecky L, Stevoska S, Gotterbarm T, Klotz MC. Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis. Arch Orthop Trauma Surg 2022; 142:3697-3704. [PMID: 34086075 PMCID: PMC9596531 DOI: 10.1007/s00402-021-03946-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Osteoarthritis of the ankle is a major burden to affected patients. While tibio-talar arthrodesis has been the gold-standard regarding the treatment of osteoarthritis of the ankle joint for many years, at present total ankle arthroplasty (TAA) provides appealing clinical outcomes and is continually gaining popularity. The aim of this study was to evaluate the intermediate- to long-term clinical outcome including the survival rate of Salto Mobile Bearing TAA (Tonier SA, Saint Ismier, France). MATERIAL AND METHODS In this retrospective study intermediate- to long-term outcomes measures [Ankle Range of Motion (ROM), American Orthopaedic Foot and Ankle Score (AOFAS score) and survival rate] of 171 consecutive TAA were analysed and compared before and after surgery. Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. RESULTS At a mean follow-up (FU) period of 7.2 ± 2.7 years (range 2.0 to 14.1 years) there was a significant improvement in ankle ROM (total ROM improved from 25.0° ± 15.0° to 28.7° ± 11.3°, p = 0.015; plantarflexion improved from 18.4° ± 11.7° to 20.6° ± 8.2°, p = 0.044; dorsiflexion improved from 6.6° ± 5.7° to 8.1° ± 4.9°, p = 0.011). AOFAS score increased significantly by 41 ± 15 points after surgery (43.3 ± 11.1 before and 84.3 ± 12.0 after surgery, p < 0.001). Overall survival rate within the FU was 81.3% (95% CI 75.3% to 87.3%) with any secondary surgery, 89.9% (95% CI 84.1% to 93.6%) with revision and 93.6% (95% CI 89.8% to 97.3%) with reoperation as endpoint. CONCLUSION This study endorses the previously reported appealing intermediate- to long-term outcomes of the Salto Mobile Bearing TAA. There was a significant increase in ROM and AOFAS score as well as decent implant survival at final FU.
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Affiliation(s)
- C Stadler
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria.
| | - M Stöbich
- Orthopaedics and Traumatology, Klinik Diakonissen, Weißenwolffstrasse 13, 4020, Linz, Austria
| | - B Ruhs
- Orthopaedics, Klinik Diakonissen, Weißenwolffstrasse 13, 4020, Linz, Austria
| | - C Kaufmann
- Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
| | - L Pisecky
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
| | - S Stevoska
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
| | - T Gotterbarm
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
| | - M C Klotz
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
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Vesely BD, King MA, Scott AT. Intermediate to Long-Term Follow-up of the Salto Talaris Fixed-Bearing Total Ankle Prosthesis. Foot Ankle Spec 2022:19386400221118495. [PMID: 36004433 DOI: 10.1177/19386400221118495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) remains a viable option for recalcitrant, end-stage ankle arthritis. Among the various Food and Drug Administration (FDA)-approved prosthetic options is the fixed-bearing Salto Talaris implant. The aim of the present study was to evaluate the intermediate to long-term clinical outcomes and radiographic complications following implantation of the Salto Talaris TAA. METHODS Nineteen Salto Talaris total ankle implants were included in the present retrospective study. Medical records were reviewed to determine pre- and postoperative visual analog scale (VAS) pain scores, and both medical records and radiographs were utilized to assess for complications. Telephone interviews were then conducted to assess for overall patient satisfaction. RESULTS At a mean follow of 6.9 years (range, 3.5-12 years), there was a 21% complication rate according to the classification system described by Glazebrook et al. The reoperation rate was low at 10.5%, and there was 100% survivorship of the total ankle implant. The average pain decreased from 9.1 (range, 7-10) preoperatively to 2.6 (range, 0-10) postoperatively. Patients reported a 95% satisfaction rate, and 16% of patients reported using a brace postoperatively. CONCLUSION The Salto Talaris arthroplasty was associated with low complication and reoperation rates, and a high survivorship at intermediate to long-term follow-up. LEVELS OF EVIDENCE 4.
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Affiliation(s)
- Bryanna D Vesely
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (BDV, MAK, ATS)
| | - Matthew A King
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (BDV, MAK, ATS)
| | - Aaron T Scott
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina (BDV, MAK, ATS)
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Mazzotti A, Viglione V, Gerardi S, Bonelli S, Zielli S, Geraci G, Faldini C. Post-operative management after total ankle arthroplasty: A systematic review of the literature. Foot Ankle Surg 2022; 28:535-542. [PMID: 34088605 DOI: 10.1016/j.fas.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Currently, there is no consensus on the most appropriate post-operative management for patients undergoing total ankle arthroplasty. The aim of this study is therefore to offer a systematic review of the pertaining literature to identify current post-operative protocols and describe possible differences. METHODS A systematic review to identify recent studies concerning the post-operative management after total ankle arthroplasty was conducted. Five topics were analyzed: length of hospital stay, type and duration of immobilization, weight-bearing management, post-operative pharmacological therapies, adopted rehabilitation scheme. RESULTS Eighty-four studies met the inclusion criteria and were included in the review process. Most of the papers appear to have conflicting opinions with no consensus and homogeneous protocols. CONCLUSION Due to various methodological limitations, it is not possible to provide sufficiently supported evidence-based recommendations, and it is therefore difficult to determine the superiority of one post-operative protocol over the others after total ankle arthroplasty.
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Affiliation(s)
- A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - V Viglione
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Gerardi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Bonelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G Geraci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
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10
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Hauer G, Hofer R, Kessler M, Lewis J, Leitner L, Radl R, Leithner A, Sadoghi P. Revision Rates After Total Ankle Replacement: A Comparison of Clinical Studies and Arthroplasty Registers. Foot Ankle Int 2022; 43:176-185. [PMID: 34766517 DOI: 10.1177/10711007211053862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to assess the outcome of total ankle replacement (TAR) regarding revision rates by comparing clinical studies of the last decade to data displayed in arthroplasty registers. The secondary aim was to evaluate whether dependent clinical studies show a superior outcome to independent publications. Additionally, revision rates of mobile bearing implants (MB-TARs) were compared to those of fixed bearing implants (FB-TARs). METHODS Clinical studies on TARs between 2010 and 2020 were systematically reviewed, with the endpoint being a revision for any reason. The parameter "revision rate per 100 observed component years (CYs)" was calculated for each publication. The pooled revision rate for clinical studies was compared to the data reported in arthroplasty registers. In a second step, revision rates were subdivided and analyzed for independent and dependent publications and for FB-TARs and MB-TARs. RESULTS A total of 43 publications met the inclusion criteria comprising 5806 TARs. A revision rate of 1.8 per 100 observed CYs was calculated, corresponding to a 7-year revision rate of 12.6%. The 3 arthroplasty registers included showed revision rates ranging from 8.2% to 12.3% after 7 years. No significant difference between dependent and independent publications nor between FB-TARs and MB-TARs was detected. CONCLUSION Revision rates of clinical studies and arthroplasty registers are comparable. Surgeons can compare their own revision rates with those from this study. Dependent studies do not seem to be biased, and no superiority for one bearing type can be described. LEVEL OF EVIDENCE Level III, systematic review of level III studies.
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Affiliation(s)
- Georg Hauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Reinhard Hofer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Markus Kessler
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Jan Lewis
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Roman Radl
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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11
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Assal M, Kutaish H, Acker A, Hattendorf J, Lübbeke A, Crevoisier X. Three-Year Rates of Reoperation and Revision Following Mobile Versus Fixed-Bearing Total Ankle Arthroplasty: A Cohort of 302 Patients with 2 Implants of Similar Design. J Bone Joint Surg Am 2021; 103:2080-2088. [PMID: 34424866 DOI: 10.2106/jbjs.20.02172] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Currently, the implants utilized in total ankle arthroplasty (TAA) are divided between mobile-bearing 3-component and fixed-bearing 2-component designs. The literature evaluating the influence of this mobility difference on implant survival is sparse. The purpose of the present study was therefore to compare the short-term survival of 2 implants of similar design from the same manufacturer, surgically implanted by the same surgeons, in fixed-bearing or mobile-bearing versions. METHODS All patients were enrolled who underwent TAA with either the mobile-bearing Salto (Tornier and Integra) or the fixed-bearing Salto Talaris (Integra) in 3 centers by 2 surgeons between January 2004 and March 2018. All patients who underwent TAA from January 2004 to April 2013 received the Salto implant, and all patients who underwent TAA after November 2012 received the Salto Talaris implant. The primary outcome was time, within 3 years, to first all-cause reoperation, revision of any metal component, and revision of any component, including the polyethylene insert. Secondary outcomes included the frequency, cause, and type of reoperation. RESULTS A total of 302 consecutive patients were included, of whom 171 received the mobile-bearing and 131 received the fixed-bearing implant. The adjusted hazard ratio for all-cause reoperation was 1.42 (95% confidence interval [CI], 0.67 to 3.00; p = 0.36); for component revision, 3.31 (95% CI, 0.93 to 11.79; p = 0.06); and for metal component revision, 2.78 (95% CI, 0.58 to 13.33; p = 0.20). A total of 31 reoperations were performed in the mobile-bearing group compared with 14 in the fixed-bearing group (p = 0.07). More extensive reoperation procedures were performed in the mobile-bearing group. CONCLUSIONS With the largest comparison of 2 implants of similar design from the same manufacturer, the present study supports the use of a fixed-bearing design in terms of short-term failure. We found a 3-times higher rate of revision among mobile-bearing implants compared with fixed-bearing implants at 3 years after TAA. Reoperations, including first and subsequent procedures, tended to be less common and the causes and types of reoperations less extensive among fixed-bearing implants. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- M Assal
- Centre of Foot and Ankle Surgery, Clinique La Colline, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - H Kutaish
- Centre of Foot and Ankle Surgery, Clinique La Colline, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - A Acker
- Centre of Foot and Ankle Surgery, Clinique La Colline, Geneva, Switzerland
| | - J Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Basel University, Basel, Switzerland
| | - A Lübbeke
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva University Hospitals, Geneva, Switzerland
| | - X Crevoisier
- Lausanne University Hospitals (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
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Claassen L, Luedtke P, Nebel D, Yao D, Ettinger S, Daniilidis K, Stukenborg-Colsman C, Plaass C. Establishing a New Patient-Specific Implantation Technique for Total Ankle Replacement: An In Vitro Study. Foot Ankle Spec 2021:19386400211029741. [PMID: 34253082 DOI: 10.1177/19386400211029741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Revision rates after total ankle replacements (TARs) are higher compared with other total joint replacements. The present study aimed to establish a new patient-specific implantation (PSI) technique for TAR. MATERIAL AND METHODS A total of 10 complete Caucasian cadaver legs had whole leg computed tomography scans. The individual geometrical ankle joint axis was determined, and based on this axis, the position of the prosthesis was planned. We assessed prosthesis placement, guiding block position, and preoperative and postoperative ankle rotational axes. RESULTS The guiding block position interobserver reliability was 0.37 mm 0.45 (mean ± SD) for the tibial guiding block. The value for the first talar guiding block was 1.72 ± 1.3 mm and for the second talar guiding block, 0.61 ± 0.39 mm. The tibial slope as well as the frontal angles of the anatomical tibial axis compared to the tibial and talar articular surfaces showed no statistically relevant differences with numbers available. The deviation of the assessed preoperative joint axis to the postoperative joint axis was 14.6° ± 7.8. CONCLUSION The present study describes the results of an establishing process of a new PSI technique for TAR. The reliability of guiding block positioning and, thereby, prosthesis placement is sufficient. LEVEL OF EVIDENCE Biomechanical study.
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Affiliation(s)
- Leif Claassen
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH)-Hannover Medical School
| | - Philipp Luedtke
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH)-Hannover Medical School
| | - Dennis Nebel
- Laboratory for Biomechanics and Biomaterials of the Hannover Medical School
| | - Daiwei Yao
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH)-Hannover Medical School
| | - Sarah Ettinger
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH)-Hannover Medical School
| | | | | | - Christian Plaass
- DIAKOVERE Annastift, Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH)-Hannover Medical School
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13
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Henricson A, Popelka S, Rydholm U. Six year results of the Rebalance mobile bearing total ankle replacement. Foot Ankle Surg 2021; 27:66-69. [PMID: 32089439 DOI: 10.1016/j.fas.2020.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/16/2020] [Accepted: 02/08/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND We report the outcomes of a prospective consecutive series of 267 total ankle replacements (TARs) using a new mobile bearing Rebalance® prosthesis. METHODS Between April 2011 and December 2018, 267 consecutive Rebalance® prostheses were implanted in 255 patients at 3 different centers. Estimated survival curves with 95% confidence intervals were produced with the Kaplan-Meier method. 110 ankles were followed for at least 5 years and clinical and radiological outcomes were assessed in 92 of these ankles. RESULTS Twenty-one ankles were revised at a mean of 34 (7-60) months. The estimated survival was 90% (95% CI 86-95) at 5 years and 88.3% (95% CI 83.-94 at 6 years. The ankles followed for at least 5 years demonstrated a median Likert score of 1 (1-4). Radiolucent zones were detected in 14% and osteolytic cysts in 3%. CONCLUSION The survival rate of the Rebalance prosthesis conforms with other reports of similar designs. The satisfaction rate was high. Radiological zones and osteolytic cysts were found at a lower rate than usually reported for mobile bearing TARs. These results favour further use of this implant.
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Affiliation(s)
- Anders Henricson
- Department of Orthopedic Surgery, Falun Central Hospital, 791 82 Falun, Sweden.
| | - Stanislav Popelka
- Teaching Hospital, Motol, First Faculty of Medicine, Charles University, V uvalu 84, 15200 Prague, Czech Republic.
| | - Urban Rydholm
- Department of Orthopaedics, Skåne University Hospital, 221 85 Lund, Sweden.
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Cheung T, Din A, Zubairy A. Quality measure of total ankle replacement outcomes in a non-designer centre. J Orthop 2020; 20:286-292. [PMID: 32467657 DOI: 10.1016/j.jor.2020.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/18/2020] [Accepted: 03/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background Total ankle replacement (TAR) is a high-risk procedure with significant revision rates, post-op complications and implant failures. Long term follow-up data is less available for TAR compared to other joint replacement surgeries. To identify optimal follow-up parameters for patients with TAR, we conducted a study on the clinical outcomes and patient-reported outcome measurements (PROMs) in patients who had TAR performed in a non-designer's centre belonging to one of the hospitals of East Lancashire Hospitals NHS Trust (ELHT). Methods 60 TAR procedures were identified. Clinical outcomes being studied include post-op ankle range of movement (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores, reoperation/revision rates, radiological parameters and general surgical outcomes. A Kaplan-Meier survival analysis was also conducted. PROMs data included the EQ-5D index and the Manchester-Oxford Foot Questionnaire (MOX-FQ). Results Ankle range of movement and AOFAS scores improved from pre-op to post-op with statistical significance. The reoperation rate and revision rate were 3.3% and 8.3% respectively. 5-year survival of implant was 97.3% and 10-year survival was 84.2%. Overall PROMs data showed improvement from pre-op to post-op. Conclusion The clinical outcomes of TARs were comparable with conventional literature. Improvements in clinical, radiological and patient-reported outcomes were observed from pre-op to post-op. Further follow-up studies are required to assess the long-term survival of implants.
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Affiliation(s)
- T Cheung
- Medical Student, University of Central Lancashire, United Kingdom
| | - A Din
- Specialty Trainee Year 6 in Trauma & Orthopaedics, North West Deanery, United Kingdom
| | - A Zubairy
- Consultant Trauma & Orthopaedic Surgeon, East Lancashire Hospitals NHS Trust, England, United Kingdom
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