Total Ankle Arthroplasty in Patients with Hereditary Hemochromatosis

Abstract

Background More than half of patients with hereditary hemochromatosis (HH) have painful arthritis, often including hindfoot osteoarthritis. Total ankle arthroplasty (TAA) is increasingly recommended for patients with painful ankle osteoarthritis. However, the pain relief and function experienced by patients continues to be debated particularly as compared with ankle fusion. Questions/purposes We asked whether (1) the complication rates were low; (2) the components were stable; (3) the patients achieved pain relief; and (4) the patients had satisfactory midterm function, ROM, and quality of life. Patients and MethodsWe retrospectively reviewed all 16 prospectively followed patients (21 implants) with HH who underwent ankle arthroplasty. They had an average age of 59.5 years at the time of surgery. We obtained a visual analog scale for pain, the SF-36, and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Component stability was assessed using weightbearing radiographs. The minimum followup was 3.1 years (average, 5.3 years; range, 3.1-8.6 years).Results Postoperatively, one patient had débridement of a painful cyst on the tibial side and one patient had a subfibular débridement with a lateral ligament reconstruction. The tibial and talar components were stable in all ankles. The average pain score decreased from 6.7 (range, 3-10) to 1.9 (range, 0-4). All eight categories of SF-36 score showed improvement. The hindfoot score increased from 46 (range, 22-67) to 84 (range, 74-94). Conclusions Our data suggest TAA in patients with ankle osteoarthritis secondary to HH is associated with a low risk of postoperative complications and produces pain relief and good function.

Inconsistency in the Reporting of Adverse Events in Total Ankle Arthroplasty

“…Revision surgery occurred 1021 times and was reported in 82.9% of papers (97/117). Of the 20 studies that did not report revisions, 6 were designed to analyze specific outcomes, 6,14,50,56,63,66 4 had an average follow-up shorter than 2 years, 7,45,61,62 and 3 studied fewer than 20 arthroplasties. 5,25,35…”

“…Revision surgery occurred 1021 times and was reported in 82.9% of papers (97/117). Of the 20 studies that did not report revisions, 6 were designed to analyze specific outcomes, 6,14,50,56,63,66…”

Heterotopic ossification after total ankle arthroplasty

“…Heterotopic ossification is fairly common after total hip and knee replacement, 16,17 with a reported incidence ranging between 2% and 90% but severe functional loss only affects between 1% and 2% of patients. 18 The incidence of ossification after TAR also varies greatly between 7% and 64%, 6,10,[19][20][21][22][23] but the literature contains little information about its natural history and clinical significance. Some reports have suggested it as a source of pain.…”

Can a Three-Component Prosthesis be Used for Conversion of Painful Ankle Arthrodesis to Total Ankle Replacement?

“…The frequency of arthrofibrosis in our small series seemed comparable to that previously recognized with primary TAR. Other studies suggest that arthrofibrosis occurs in up to 22% of patients undergoing primary TAR [5,6,14,31,32]. Hintermann et al [27] reported clinical and radiographic outcomes in 28 patients who underwent 30 conversion procedures.…”