Early outcomes of the Exactech Vantage fixed-bearing total ankle replacement

Early Experience With the Quantum Total Ankle Prosthesis

The Quantum total ankle prosthesis is a newer Food and Drug Administration (FDA)-approved fourth-generation 2-component, fixed-bearing implant in its first-generation design. The purpose of this study was to evaluate early outcome data and present our initial experience with the Quantum implant with a minimum of a 1-year follow-up. A retrospective, single-centered chart and radiographic review was performed on all patients who underwent total ankle arthroplasty with the Quantum implant from December 2021 to August 2023. Implant survivorship, radiographic outcomes, clinical outcomes, and complications were evaluated. The survivorship for the implant was 100% for the tibial component and 91.67% for the talar component, respectively. Pre-operatively, there were 3 ankles with a coronal deformity greater than 10 degrees. Post-operatively, coronal plane deformity was 100% corrected into neutral alignment. This study is the first to report on short-term outcomes for the Quantum total ankle prosthesis. Our findings showed promising results of short-term implant survivorship with good clinical and radiographic outcomes.Level of Evidence: IV.

Early Periprosthetic Tibial Lucency Following Low-Profile Total Ankle Arthroplasty

BACKGROUND

Most modern total ankle arthroplasty (TAA) implants have low-profile designs that minimize tibial resection and use small pegs or posts for fixation. A number of studies have identified concerning rates of lucencies around the tibial components of these implants. In this study, we evaluated a consecutive series of patients receiving an anterior approach low-profile TAA prosthesis to describe the incidence, characteristics, and progression of tibial component lucencies at short-term (minimum 1-year) follow-up.

METHODS

Patients who underwent primary TAA with a modern low-profile TAA tibial implant from 2014 through 2021 were identified from a prospectively collected TAA registry. Poorly defined lucency around the tibial component in all 4 tibial zones, as agreed on by 2 independent reviewers, was considered "global lucency." Intraoperative, 1-year, and 2-year postoperative radiographs were assessed for periprosthetic lucencies. Patients with global lucency at 1 year were compared to the remaining patients.

RESULTS

554 ankles with a mean 29 ± 19 months of follow-up met inclusion criteria. Twenty-one ankles (3.8%) were revised for tibial loosening. Thirty-six ankles (6.5%) had global tibial lucency at 1 year. Of these, 15 (42%) were eventually revised and the remaining 21 (58%) were doing well clinically at final follow-up. Following multivariable regression, postoperative coronal tibiotalar offset ≥2 degrees (adjusted odds ratio [OR] = 3.60, P = .017), use of the Vantage implant (adjusted OR = 2.84, P = .006), and male sex (adjusted OR = 2.71, P = .016) were predictors of global lucency at 1 year.

CONCLUSION

At 1 year after anterior approach low-profile TAA, we found a 6.5% incidence of global lucency around the tibial component, suggestive of lack of osseous integration of the prosthesis. Fifty-eight percent of patients with global lucency did not require revision and were doing well clinically at early follow-up. Higher postoperative coronal tibiotalar offset, use of the Vantage implant, and male sex were all significantly associated with development of global lucency.

Advances in foot and ankle surgery : a review of recent innovations

The last five years have seen notable advancements in foot and ankle surgery as a result of technical innovations and more consistent reporting of results. Much progress has been made in improving patient-reported outcome measures, in the development of basic research in this area, and in the development of personalized approaches which optimize outcomes for specific groups of patients. This review focuses on five main areas of development within foot and ankle surgery: ankle arthroplasty, osteomyelitis and the diabetic foot, sports injuries, minimally invasive surgery, and orthobiologics. The aim of this annotation is to discuss the progress made in these fields during recent years and propose avenues for further development.

Sports Activity with Ankle Osteoarthritis and Total Ankle Arthroplasty

Background/Objectives: The interest in performing total ankle arthroplasty (TAA) to address end-stage ankle osteoarthritis (OA) is continuously growing. Sports activity plays an important role in our world. The literature is sparse regarding return-to-sports activity following TAA. The levels and types of sports in TAA are rarely reported. The purpose of this prospective case series study is to investigate sports activity in ankle osteoarthritis (OA) and TAA in terms of rate, frequency, type, and clinical outcomes with a minimum 2 years of follow-up after surgery. Methods: A total of 103 patients (105 implants, 52 female, and 51 male), mean age 60.5 years (range, 23-84 years) with end-stage ankle OA were treated using a three-component, uncemented, mobile-bearing VANTAGE Total Ankle System. The mean follow-up was 2.9 years (range, 2-5 years). Visual Analogic Scale Pain Score (VAS, 0-10 points), Ankle Dorsiflexion/Plantarflexion (DF/PF) range of motion (ROM; degrees), functional American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0-100 points), Subjective Patients' Satisfaction Score (0-10 points), Sports Activity Rate, Sports Frequency Score, and sports type were assessed. Results: The mean preoperative VAS Pain Score was 6.7 points (range, 3-10 points) and 0.2 points for postoperative (range, 0-3 points) (p < 0.001). The mean DF/PF ROM was 24.9° preoperative (range, 0-60°) and 52.9° postoperative (range, 15-85°) (p < 0.001). The mean preoperative functional AOFAS Ankle/Hindfoot Score was 39.5 points (range, 4-57 points) and 97.8 points for postoperative (range, 75-100 points) (p < 0.001). The mean postoperative Subjective Patients' Satisfaction Score was 9.7 points (range, 7-10 points). The preoperative Sports Activity Rate was 31.1%, with 85.4% for postoperative (p < 0.001). All the groups exhibited substantial Sports Frequency Score increases (p < 0.001). The most practised sports were hiking, biking, fitness, and swimming. Conclusions: total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle OA. TAA facilitates a noteworthy increase in sports activity. This research offers important sports insights to patients with ankle OA and TAA.

Outcomes of Total Ankle Replacement

Total ankle replacement (TAR) is an effective operative treatment of end-stage ankle osteoarthritis (OA) in the appropriate patient, conferring improved kinematic function, decreased stress across adjacent joints, and offering equivalent pain relief in comparison to ankle arthrodesis (AA). It is important to consider patient age, weight, coronal tibiotalar deformity, joint line height, and adjacent joint OA to maximize clinical and patient outcomes. Both mobile-bearing and fixed-bearing implants have demonstrated favorable clinical outcomes, marked improvement in patient-reported outcomes, and good survivorship; however, implant survivorship decreases with longer term follow-up, necessitating constant improvement of primary and revision TAR options.