Superiority of upper ankle arthrodesis over total ankle replacement in the treatment of end-stage posttraumatic ankle arthrosis

Fischer, Sebastian; Klug, Andreas; Faul, Philipp; Hoffmann, Reinhard; Manegold, Sebastian; Gramlich, Yves

doi:10.1007/s00402-020-03714-x

Cited by 13 publications

(8 citation statements)

References 33 publications

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“…In this study population, there was no difference regarding the incidence of revisions when comparing patients with posttraumatic OA to patients with other indications for TAA. This does not agree with other reports, which showed higher revision rates in patients with posttraumatic osteoarthritis of the ankle [ 24 , 36 , 42 ]. Although Schenk et al [ 24 ] as well as Gramlich et al [ 36 ] interestingly investigated mostly the same type of TAA.…”

Section: Discussioncontrasting

confidence: 99%

Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis

Stadler

Stöbich²,

Ruhs³

et al. 2021

Arch Orthop Trauma Surg

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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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Section: Discussioncontrasting

confidence: 99%

Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis

Stadler

Stöbich²,

Ruhs³

et al. 2021

Arch Orthop Trauma Surg

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“…Long-term complications, such as malalignment, chronic edema and symptomatic hardware, were avoided using the described surgical technique. The post-surgical AOFAS score of 79 was similar to the value reported by Haddad et al (AOFAS score: 76, [ 6 ]) in their review article, by Thomas et al (AOFAS score: 74, [ 22 ]), by Buchhorn et al (AOFAS score: 68–69, [ 23 ]) and Fischer et al (AOFAS score: 53–55, [ 15 ]). Arthrodesis after removal of an upper ankle prosthesis with allograft bone and the allograft cortical bone screws is one option to regain activity.…”

Section: Discussionsupporting

confidence: 84%

“…Long-term complications, such as malalignment, chronic edema and symptomatic hardware, were avoided using the described surgical technique. The post-surgical AOFAS score of 79 was similar to the value reported by [15]). Arthrodesis after removal of an upper ankle prosthesis with allograft bone and the allograft cortical bone screws is one option to regain activity.…”

Section: Discussionsupporting

confidence: 83%

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Arthrodesis and Defect Bridging of the Upper Ankle Joint with Allograft Bone Chips and Allograft Cortical Bone Screws (Shark Screw®) after Removal of the Salto-Prosthesis in a Multimorbidity Patient: A Case Report

Pastl¹,

Pastl²,

Flöry³

et al. 2022

Life

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The case describes the revision of an upper ankle prosthesis because of loosening. When ankle replacement is the first choice and actual bone quality does not allow a replacement of the prosthesis, arthrodesis is the only way of reducing pain and gaining stability. The amount of missing bone due to the removed prosthesis was severe. Shark Screws®, made of human allograft cortical bone, were used to fix an allograft femoral head and tibia as well as fibula and talus to each other for stabilization. This was performed without any autologous bone graft and without metal screws. The human matrix of the cortical allograft allows the creation of new vessels followed by osteoblastic activity and production of new bone. The revascularization of the allografts reduces the risk of infection and wound problems. Over time, the patient’s bone metabolism allows the allografts to be remodeled into the patient’s bone. The case reported here had severe multimorbidity. The loosening of the prosthesis mainly affected the ability to perform housework, mobility, enjoying leisure, and it had a great impact on the emotion and well-being of the patient. One year after surgery, the patient is very satisfied to be able to walk without pain and scratches for about 90 min.

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“…The posttraumatic etiology is the most common etiology of the end-stage ankle osteoarthritis [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. After failure of nonoperative treatments for severe ankle arthritis [ 5 ] including bracing/immobilization, anti-inflammatories, shoe wear and activity modification, and corticosteroid injections, patients have two operative options—arthroplasty [ 8 , 9 , 10 , 11 , 12 ] and arthrodesis [ 13 , 14 , 15 , 16 , 17 , 18 ]. Tibiotalar arthrodesis still remains the current gold standard [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

Schlickewei

Neumann

Yarar-Schlickewei

et al. 2022

JCM

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Tibiotalar arthrodesis successfully treats ankle arthritis but carries risk of nonunion. It is unclear whether concurrent distal tibiofibular arthrodesis affects tibiotalar nonunion rate. The purpose of this study is to compare tibiotalar nonunion and complication rates in patients with versus without a distal tibiofibular arthrodesis. This is a retrospective review of 516 consecutive ankle arthrodesis performed between March 2002 and May 2016. A total of 319 ankles (312 patients) underwent primary, open tibiotalar arthrodesis (227 with distal tibiofibular arthrodesis, 92 without). Primary outcome measure was nonunion rate. Secondary outcome measures were time to tibiotalar union, rate of development of post-operative deep vein thrombosis (DVT)/pulmonary embolism (PE), rate of deep wound complications, and rate of return to operating room (OR). No differences in nonunion rates were observed in both cohorts of patients with vs. without distal tibiofibular arthrodesis: 17/227 (7.5%) vs. 11/92 (12%) (p = 0.2), respectively, odds ratio was 0.74, 95% CI: 0.29~2.08 (p = 0.55). There was no difference in deep wound complications (5.3% versus 10.9%, p = 0.42), time to union (3.7 months versus 4.1 months, p = 0.72), or rate of development of DVT/PE (5.2% versus 2.2%, p = 0.18) between patients with and without distal tibiofibular arthrodesis, respectively. This is the first study directly comparing nonunion and complication rates in primary, open ankle arthrodesis with and without distal tibiofibular arthrodesis. Inclusion of the distal fibular joint with the tibiotalar fusion was not associated with a change in tibiotalar nonunion rate, time to union, wound complications, or postoperative DVT/PE.

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Superiority of upper ankle arthrodesis over total ankle replacement in the treatment of end-stage posttraumatic ankle arthrosis

Cited by 13 publications

References 33 publications

Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis

Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis

Arthrodesis and Defect Bridging of the Upper Ankle Joint with Allograft Bone Chips and Allograft Cortical Bone Screws (Shark Screw®) after Removal of the Salto-Prosthesis in a Multimorbidity Patient: A Case Report

Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

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