Low Rate of Peri-implant Osteolysis in Trabecular Metal Total Ankle Replacement on Short- to Midterm Follow-up

Kormi, Sami; Kohonen, Ia; Koivu, Helka; Tiusanen, Hannu

doi:10.1177/10711007211017468

Cited by 7 publications

(6 citation statements)

References 41 publications

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“…Due to the small number of patients who underwent 5-year radiographic follow-up, the exact percentage of periprosthetic cyst development at 5 years for the entire study population could not be determined. However, a short-term to midterm follow-up study by Kormi et al 15 found a low osteolysis rate of 10% with this trabecular metal TAA system, which is actually much lower than those reported in midterm studies of other implants such as the Salto Talaris (21.2%) and INBONE II (18.2%). 1,4 The lower rate of cyst formation for the trabecular metal implant supports the idea that the use of this material may benefit overall osteointegration of the prosthesis, as previously discussed.…”

Section: Discussionmentioning

confidence: 54%

“…Each average of the differences was superior to the previously published MCID. 2,15 As reported in Table 4 as well, for each individual component, more than 50% of patients were above the MCID. As seen in Figure 2, the postoperative outcomes seemed to plateau after 1 year, with a slight tendency for improvement.…”

Section: Resultsmentioning

confidence: 79%

“…This implant demonstrated a good 5-year survivorship of 92.1% in this study, which is in accordance with findings from previous short-term studies on the trabecular metal implant. 15,16,19,20 Only one other minimum-5-year study that has been conducted by Tiusanen et al 8 reported an implant removal rate of 2.9%, indicating excellent implant survivorship. The consistently high survivorship rate found in the literature suggest that the use of the trabecular metal and curved designed tibia may aid in the osteointegration process of the prosthesis.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of the Lateral Trabecular Metal Total Ankle Replacement at a 5-Year Minimum Follow-up

Kim

Gagné²,

Rajan

et al. 2022

Foot & Ankle Specialist

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Background The Trabecular Metal (Zimmer Biomet, Warsaw, IN) total ankle arthroplasty (TAA) system uses a lateral approach with a fibular osteotomy to gain access to the tibiotalar joint and a sagittally curved tibial component. This is the first TAA system to laterally approach the ankle, and few studies have explored outcomes associated with this implant. This study aimed to report the 5-year clinical and radiographic outcomes as well as the survivorship of the implant. Methods Over a 3-year period, 2 fellowship-trained foot and ankle surgeons used this implant system to treat 38 end-stage arthritic ankles. Reoperation and revision data were collected from all patients (100%) as part of the local prospective database. Patients completed the Foot and Ankle Outcome Score (FAOS) questionnaire preoperatively and at each annual follow-up visit; scores for a minimum of 5 years were available for 28 (73.7%) patients. A radiographic analysis compared postoperative coronal and sagittal alignment in weightbearing radiographs at a minimum of 5 years with that at 3 months postoperatively, as well as cyst or lucency formation, which was available for 21 patients (55.3%). Results At 5 years, there were 3 revisions (7.9%) and 9 reoperations (23.7%). Reoperations included 4 fibular hardware removal and 5 medial gutter debridement procedures. The FAOS significantly improved for all domains (P < .05). Implant positioning did not significantly change between 3 months and 5 years postoperatively. Conclusion Our 5-year results in this small series using this unique prosthesis showed good overall survivorship (92.1%) and a reoperation rate of 23.7%, along with clinically significant improvement in patient-reported outcomes. Levels of Evidence: Level IV: Retrospective case series

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Section: Discussionmentioning

confidence: 54%

Section: Resultsmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Clinical Outcomes of the Lateral Trabecular Metal Total Ankle Replacement at a 5-Year Minimum Follow-up

Kim

Gagné²,

Rajan

et al. 2022

Foot & Ankle Specialist

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“…37 As with many TARs, survival rates diminish with longer follow-up. 4,5,19,25,32 However, similar to the AES prosthesis, results of the CCI compare unfavorably to other third-generation mobile- 7,18,21,28,30,37 and fixed-bearing implants 21 because of high complication rates and the formation of osteolytic cysts. 19,20,41 In our series, 45% of the reoperations performed were because of osteolytic cysts or loosening, which is comparable to other CCI studies.…”

Section: Discussionmentioning

confidence: 97%

Long-term Follow-up of 254 Ceramic Coated Implant (CCI) Evolution Total Ankle Replacements

Plaat²,

Sierevelt

et al. 2022

Foot Ankle Int.

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Background: The ceramic coated implant (CCI) Evolution was a third-generation implant design used in approximately 2000 total ankle replacements (TARs) between 2003 and 2016. Because this implant was abandoned, long-term follow-up studies are lacking. Methods: All patients undergoing TAR using a CCI prosthesis between 2004 and 2012 were included for analysis. Preoperatively the tibiotalar alignment was measured, and postoperatively the patients were followed up clinically, with radiographs and by questionnaire. The primary outcome was implant survival at 10 years of follow-up. Implant survival was also compared for (1) inflammatory joint disease vs noninflammatory joint disease and (2) preoperative tibiotalar neutral vs varus or valgus alignment. The secondary outcomes were complications, reoperations, and function (assessed by patient-reported outcome measures). Results: Two hundred fifty-four TARs were performed in 237 patients. Two hundred twelve additional procedures were performed to achieve stable ankles. At 10-year follow-up, the survival was 67.5%, with an average time to revision of 4.5 years. The 10-year survival of the inflammatory joint disease group was 76.8% and of the noninflammatory joint group 63.1% ( P = .44). In 248 TARs, the preoperative tibiotalar alignment was measured; (62% neutral, 25% varus, and 13% valgus), these showed 10-year survival rates of 74.7%, 48.2%, and 68.9% respectively ( P = .07). The complication rate was 54%; 37% of patients underwent reoperation. At a mean of 8.5 years, postoperative satisfaction scored an average of 7.0 (SD 2.26) on a 0- to 10-point numeric rating scale. The mean Foot and Ankle Ability Measure sports subscore was 24.7, the mean Foot and Ankle Outcome Score (FAOS) sports subscore was 42.8, and the mean 36-Item Short Form Health Survey score was 40.0. Regarding daily activities, the mean FAOS was 81.0. Conclusion: This is currently the sole study reporting the long-term results of the CCI prosthesis. The survival and functional outcomes were inferior to other third-generation mobile-bearing ankle implants.

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“…The Zimmer TAR was selected because of a low rate of aseptic loosening of prosthetic components and functional outcomes noted by superior postoperative range of motion. 3,21 All surgeries were performed by a single fellowship-trained orthopaedic foot and ankle surgeon. Medical charts were reviewed to exclude patients who had died, were >95 years old, and/ or had comorbidities, including chronic pain, peripheral neuropathy, rheumatoid arthritis, stroke, muscular dystrophy, Charcot-Marie-Tooth disease, or a body mass index (BMI) of >40.…”

Section: Participant Recruitment and Screeningmentioning

confidence: 99%

Total Ankle Replacement Provides Symmetrical Postoperative Kinematics: A Biplane Fluoroscopy Imaging Study

et al. 2022

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Background: In vivo measurements of tibiotalar and subtalar joint motion following TAR are unavailable. Using biplane fluoroscopy, we tested the hypothesis that the prosthetic tibiotalar joint and adjacent subtalar joint would demonstrate kinematic and range of motion differences compared to the contralateral untreated limb, and control participants. Methods: Six patients of 41 identified candidates that all underwent unilateral Zimmer TAR (5.4 ± 1.9 years prior) and 6 control participants were imaged with biplane fluoroscopy during overground walking and a double heel-rise activity. Computed tomography scans were acquired; images were segmented and processed to serve as input for model-based tracking of the biplane fluoroscopy data. Measurements included tibiotalar and subtalar kinematics for the TAR, untreated contralateral, and control limbs. Statistical parametric mapping quantified differences in kinematics throughout overground walking and the double heel-rise activity. Results: Patients with this TAR performed walking and heel-rise activities symmetrically with no significant kinematic differences at the tibiotalar and subtalar joints between limbs. Compared to control participants, patients exhibited reduced dorsi/plantarflexion range of motion that corresponded to decreased peak dorsiflexion, but only in the late stance phase of walking. This reduction in tibiotalar dorsi/plantarflexion range of motion in the TAR group became more apparent with double heel-rise activity. Conclusion: Patients with a Zimmer TAR had symmetric kinematics during activities of walking and double heel-rise, but they did exhibit minor compensations in tibiotalar kinematics as compared to controls. Clinical Relevance: The lack of significant kinematic compensation at the subtalar joint may explain why secondary subtalar osteoarthritis is reported as being relatively uncommon in patients with some TAR designs.

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Low Rate of Peri-implant Osteolysis in Trabecular Metal Total Ankle Replacement on Short- to Midterm Follow-up

Cited by 7 publications

References 41 publications

Clinical Outcomes of the Lateral Trabecular Metal Total Ankle Replacement at a 5-Year Minimum Follow-up

Clinical Outcomes of the Lateral Trabecular Metal Total Ankle Replacement at a 5-Year Minimum Follow-up

Long-term Follow-up of 254 Ceramic Coated Implant (CCI) Evolution Total Ankle Replacements

Total Ankle Replacement Provides Symmetrical Postoperative Kinematics: A Biplane Fluoroscopy Imaging Study

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