Ankle Fusion After Failed Total Ankle Replacement

Espinosa, Norman; Wirth, Stephan; Jankauskas, Linas

doi:10.1097/btf.0b013e3181fc85f6

Cited by 15 publications

(10 citation statements)

References 27 publications

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“…Conversion to arthrodesis can be a demanding procedure especially in patients with rheumatoid disease, and rates of nonunion between 6% and 40% have been described. [28][29][30] Inferior results were obtained with nail or screw fixation. Currently, the preferred methods of salvage arthrodesis in our centres involves the use of an anterior blade plate or anteriorly positioned bone plates held by screws.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease

Kraal

Heide

Poppel

et al. 2013

The Bone & Joint Journal

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Little is known about the long-term outcome of mobile-bearing total ankle replacement (TAR) in the treatment of end-stage arthritis of the ankle, and in particular for patients with inflammatory joint disease. The aim of this study was to assess the minimum ten-year outcome of TAR in this group of patients. We prospectively followed 76 patients (93 TARs) who underwent surgery between 1988 and 1999. No patients were lost to follow-up. At latest follow-up at a mean of 14.8 years (10.7 to 22.8), 30 patients (39 TARs) had died and the original TAR remained in situ in 28 patients (31 TARs). The cumulative incidence of failure at 15 years was 20% (95% confidence interval (CI) 11 to 28). The mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of the surviving patients at latest follow-up was 80.4 (95% CI 72 to 88). In total, 21 patients (23 TARs) underwent subsequent surgery: three implant exchanges, three bearing exchanges and 17 arthrodeses. Neither design of TAR described in this study, the LCS and the Buechel-Pappas, remains currently available. However, based both on this study and on other reports, we believe that TAR using current mobile-bearing designs for patients with end-stage arthritis of the ankle due to inflammatory joint disease remains justified.

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Section: Discussionmentioning

confidence: 99%

Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease

Kraal

Heide

Poppel

et al. 2013

The Bone & Joint Journal

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“…Those nonunion rates are comparable to data previously published in the literature with values ranging from 0% up to 39%. 4,6,7,10,14,15,19,24,26,28,33,36,38,40 The high nonunion rate in group PA could partially be explained by chance and the fact that the population was a matched control group. As such the nonunion rate does not reflect the true nonunion rate in the entire arthrodesis population of our hospital.…”

Section: Discussionmentioning

confidence: 99%

Inferior Results of Salvage Arthrodesis After Failed Ankle Replacement Compared to Primary Arthrodesis

et al. 2014

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BACKGROUND: Up to now, there has been no evidence that salvage arthrodesis would perform inferior when compared with primary ankle arthrodesis. The purpose of this study was to compare their clinical and radiographic results. METHODS: A retrospective analysis was performed using 2 validated scores and assessment of radiographic union by comparing 23 patients who underwent salvage ankle arthrodesis (group SA = salvage arthrodesis) after failed total ankle replacement with 23 matched patients who received primary ankle arthrodesis (group PA = primary arthrodesis). The mean follow-up period was 38 (range 16-92) months in group SA and 56 (23-94) months in group PA. RESULTS: Complete union was achieved in 17 patients (74%) after a mean time of 50 (13-114) weeks in group SA and in 16 patients (70%) after a mean time of 23 (10-115) weeks in group PA. The SF-36 score averaged 48 points (7-80) in SA and 66 points (14-94; P = .006) in group PA. In group SA the mean FFI was 57% (22-82) for pain and 71% (44-98) for function. In group PA significantly better results for pain with 34% (0-88; P = .002) and function with 48% (1-92; P = .002) were found. CONCLUSION: Salvage arthrodesis led to impaired life quality and reduced function combined with significantly higher pain when compared with primary ankle arthrodesis. These findings can be used to counsel our patients preoperatively. LEVEL OF EVIDENCE: Level III, retrospective case series. (Original) Clinical Research ArticleThere is an ongoing debate whether to choose total ankle replacement (TAR) or ankle arthrodesis in the surgical treatment of symptomatic end-stage ankle osteoarthritis. 2,6,7,10,17,21,24,34,37 While contemporary TAR designs, reveal superior and more reliable overall clinical outcomes and low revision rates, 2,11,13,21,27,36 the long-term results are still not yet predictable and do not match those in total kneeand total hip arthroplasty. 1,3,5,17,19,25,32 With an increasing number of patients undergoing TAR the number of patients who will need a revision operation will rise. Neglected misalignment, medial or lateral gutter impingement, component loosening, polyethylene displacement and progressive wear, infection and persistent pain are potential factors that ultimately led to revision operation. 4,30,38 It sounds logical that-whenever possible-the implant should be salvaged and retained. This can be achieved by adding surgeries (eg, osteotomies, ligament reconstructions) 2,6,7,10,12,21,24,35,37 or simple component exchange. 2,9,11,18,20,21,23,27,29,31,36,39 However, there will always be patients who are not amenable to this kind of treatment and conversion to an arthrodesis can be considered.While several studies investigated the radiographic and clinical outcomes after primary ankle arthrodesis, there is a paucity of reports available in the literature that deal with salvage arthrodesis after failed TAR. 2,3,[6][7][8]10,17,21,24,34,37 To the best of our knowledge there has been no comparative analysis performed to assess salvage arthrodesis aft...

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“…Der modifizierte Behandlungsalgorithmus basiert auf einem erst kürzlich publizierten Artikel unserer Arbeitsgruppe [6]. …”

Section: Behandlungsstrategien Bei Aseptischer Prothesenlockerungunclassified

Sprunggelenkarthrodese nach gescheiterter Endoprothesenimplantation

Espinosa

Wirth

2011

Orthopäde

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Entwicklung der SprunggelenkendoprotheseDie Geschichte der oberen Sprunggelenkendoprothese (OSG-TP) war nicht immer von großem Erfolg geprägt. Aufgrund der exorbitant hohen Versagerquoten musste Ende der 70er Jahre die Verwendung von OSG-TPs zur Therapie der symptomatischen und fortgeschrittenen OSG-Arthrose beinahe vollständig verboten werden [10] Die Röntgenuntersuchung schließt immer belastete Aufnahmen des Fuß-und Sprunggelenks ein (. Abb. 1). Zudem sind ein "long-axial view" oder die Saltzman-Aufnahme ("hindfoot alignment view") zur Bestimmung der Rückfußaus-richtung bei der präoperativen Planung sehr hilfreich [15,16]. Letztere hat sich im Vergleich zur ersteren als etwas weniger zuverlässig gezeigt. Degenerationen der angrenzenden Gelenke sind festzustellen, da diese das Gesamtresultat nach einer Arthrodese negativ beeinflussen. Hierfür eignen sich dorsoplantare, schräge und laterale Aufnahmen des Fußes. Die Computertomographie hat sich an unserer Klinik als wichtiges Hilfsmittel für die Ausmessung der erwarteten knöchernen Defekte erwiesen. Dreidimensionale Rekonstruktionen ermöglichen die Ausmessung in mindestens 2 Ebenen und damit die Bestimmung der optimalen Graftgröße. Es ist wichtig, die u. U. notwendige Implantation eines femoralen Allografts zu antizipieren. Die Fluorid-PET-CT-Untersuchung erlaubt fakultativ das Ausmaß der Lockerung in einem bildgebenden Verfahren zu bestimmen (. Abb. 2; [8]). Behandlungsstrategien bei aseptischer Prothesenlockerung

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Ankle Fusion After Failed Total Ankle Replacement

Cited by 15 publications

References 27 publications

Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease

Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease

Inferior Results of Salvage Arthrodesis After Failed Ankle Replacement Compared to Primary Arthrodesis

Sprunggelenkarthrodese nach gescheiterter Endoprothesenimplantation

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