Total Ankle Arthroplasty for the Treatment of Symptomatic Nonunion Following Tibiotalar Fusion

Huntington, William P.; Davis, W. Hodges; Anderson, Robert B.

doi:10.1177/1938640016640890

Cited by 13 publications

(8 citation statements)

References 34 publications

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“…The authors reported adequate patient satisfaction and reliable short-term outcomes, but the navigation process was not described. 1 To our knowledge, this is the first case report describing the navigation process of a fixed-bearing, computer-guided total ankle implant on a patient who underwent conversion from a painful nonunion arthrodesis to total ankle arthroplasty.…”

Section: Discussionmentioning

confidence: 92%

“…Ankle arthrodesis is the standard procedure performed for the treatment of end-stage ankle arthritis 1–3. Nonunion is a common complication reported after primary ankle arthrodesis, with rates ranging from 0% to 40% 1,4. Such complications can lead to further pain and disability, patient dissatisfaction, and surgical interventions.…”

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confidence: 99%

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confidence: 99%

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Conversion of Symptomatic Ankle Arthrodesis Nonunion to Total Ankle Arthroplasty Using Patient-specific Instrumentation and Computer-assisted Surgery Guides: A Case Report

Iturregui

Haupt

2022

Techniques in Foot &Amp; Ankle Surgery

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A 69-year-old woman developed a painful ankle fusion nonunion and underwent conversion to a total ankle replacement. Preoperative navigation was performed using a computed tomography scan and computer modeling system to develop patient-specific instrumentation and surgery guides. We described the navigation process of a fixed-bearing, computer-guided total ankle implant when performing an ankle arthrodesis takedown due to symptomatic nonunion and converting to a total ankle arthroplasty. The use of this technology is relatively new, and, in this case, preoperative navigation allowed for precise implant planning while accounting for the osseous deformities from previous implants, which already fixated the ankle joint. Level of Evidence: Level IV.

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Section: Discussionmentioning

confidence: 92%

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confidence: 99%

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Conversion of Symptomatic Ankle Arthrodesis Nonunion to Total Ankle Arthroplasty Using Patient-specific Instrumentation and Computer-assisted Surgery Guides: A Case Report

Iturregui

Haupt

2022

Techniques in Foot &Amp; Ankle Surgery

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“…no hay evidencia de que esta «inutilidad» muscular dirija la evolución hacia un mal resultado funcional. 15 El paciente del caso 2 estuvo satisfecho funcionalmente por un año con la artrodesis y después de repetidas caminatas de larga distancia durante un viaje empezó a referir dolor constante. Al cabo de 20 meses, refiere poder caminar largas distancias con un mínimo dolor al final del día y estar satisfecho con el procedimiento.…”

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Desartrodesis de tobillo, experiencia en México. Reporte de dos casos

Carlín¹,

Galindo²,

Guerrero³

2021

Anales Médicos De La Asociación Médica Del Centro Médico ABC

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Se presentan dos casos clínicos de artrosis de tobillo que fueron tratados con artrodesis tibioastragalina. En el primero la artrodesis fue exitosa; el paciente se presentó con una inestabilidad subastragalina que provoca los síntomas al paciente; mientras que en el segundo, se trató de una pseudoartrosis de tobillo que se manifestaba con dolor medial de tobillo, lo que limitaba la función ambulatoria del paciente. En ambos casos se realizó la conversión a una prótesis total de tobillo con buenos resultados. La conversión de una artrodesis de tobillo hacia una artroplastia total del mismo es un concepto relativamente nuevo que ofrece la alternativa de sumar movilidad en el tobillo y, sobre todo, disminuir las cargas de las articulaciones vecinas que evitarán una artrosis secundaria. Aunque es baja la incidencia de este procedimiento por cada cirujano, se está formando una buena cantidad de experiencia a través de la complicación de casos en grupos organizados para evidenciar su eficacia en casos determinados. Dentro de los más comunes están la conversión por una artrodesis fallida, ya sea por pseudoartrosis o mala consolidación y por trastornos de la subastragalina posterior a una artrodesis de tobillo.Palabras clave: Conversión de artrodesis de tobillo, artrodesis de tobillo, artroplastia total de tobillo.

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“…There is a paucity of literature on the outcomes of ankle fusion takedown to TAA though few studies show ankle fusion takedown may result in improved function, pain, and range of motion (ROM). 12,14,15,24,26 The reality is there are no great alternatives when a patient presents with a painful ankle fusion. Discussions with patients center around nonsurgical options including bracing, unloading ankle foot orthosis (AFO), and even amputation in some cases.…”

Section: Introductionmentioning

confidence: 99%

Takedown of Ankle Fusions and Conversion to Total Ankle Replacements

et al. 2022

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Background: With ankle replacements gaining credibility, there is a small subset of patients who might benefit from a conversion of an ankle fusion to a replacement. The objective of this study is to present clinical and radiographic results of patients who had their ankle fusion converted to total ankle arthroplasty (TAA). Methods: Patients presented to the senior author with ongoing ankle pain following fusion or increasing pain after a period of relative comfort after an ankle fusion. Outcomes were evaluated preoperatively and postoperatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS), and visual analog scale (VAS) pain scale. A patient satisfaction survey was also distributed. Results: All ankle fusion conversions between April 2010 and December 2019 were included. Fifty-one patients (30 females) with the mean age of 62.6 (range, 37-83) years were followed. Mean follow-up was 4.2±2.3 (range, 2-11.5) years. Two patients were lost to follow-up (1 is deceased). Pre- and postoperative mean patient-reported outcome scores were all significantly different between groups except VR-12 mental subscale scores. VR-12 physical scores improved from 28.7±8.9 preoperatively to 38.9±9.9 ( P < .001) postoperatively; VR-12 mental score was stable. AOS pain and disability subscales similarly improved: 55.9±24.4 to 27.9±25.4 ( P < .001) and 61.7±21.1 to 31.1±25.7 ( P < .001), respectively. VAS pain improved from a mean of 64.5±27.3 to 29.4±27.7 ( P < .001). There was no tibiotalar dorsiflexion or plantarflexion with the ankle fusion. Initial postoperative visit revealed that average dorsiflexion was 10.9±5.93 degrees and average plantarflexion was 14.1±5.22 degrees. At the latest follow-up, dorsiflexion improved significantly to 15.5±6.33 degrees ( P < .001), with no significant improvement in plantarflexion ( P = .980). Conclusion: In this single-surgeon longitudinal study of 51 patients with a painful, malaligned, or nonhealed ankle fusion treated with an ankle replacement, we found highly satisfactory functional outcomes at an average of 4.2 years. Continued long-term follow-up will reveal whether the longevity of these replacements is comparable to primary replacements.

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Total Ankle Arthroplasty for the Treatment of Symptomatic Nonunion Following Tibiotalar Fusion

Abstract: Therapeutic, Level IV: Case series.

Cited by 13 publications

References 34 publications

Conversion of Symptomatic Ankle Arthrodesis Nonunion to Total Ankle Arthroplasty Using Patient-specific Instrumentation and Computer-assisted Surgery Guides: A Case Report

Conversion of Symptomatic Ankle Arthrodesis Nonunion to Total Ankle Arthroplasty Using Patient-specific Instrumentation and Computer-assisted Surgery Guides: A Case Report

Desartrodesis de tobillo, experiencia en México. Reporte de dos casos

Takedown of Ankle Fusions and Conversion to Total Ankle Replacements

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