Total Ankle Arthroplasty Survival and Risk Factors for Failure

Escudero, Mario; Le, Vu; Barahona, Maximiliano; Symes, Michael; Wing, Kevin; Younger, Alastair; Veljkovic, Andrea; Penner, Murray

doi:10.1177/1071100719849084

Cited by 45 publications

(49 citation statements)

References 57 publications

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“…1 It is possible to hypothesize that most PPCs remain underdiagnosed, both because of the frequently used 2D radiographic follow-up postoperatively and because they probably remain clinically latent and asymptomatic until they become large enough to lead to symptoms and implant failure. 15,16,18 The authors acknowledge a number of limitations in this study. First, although the number of cases is significant for TAR, this remains a rather small series in terms of statistics.…”

Section: Discussionmentioning

confidence: 99%

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

et al. 2019

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Background: We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration. Methods: Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (<95% CI) and valgus (>95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC. Results: Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, –1.12 to 1.36). Patients with greater residual malalignment ( P < .001) and those with longer follow-up ( P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV ( P = .042), with a threshold FAO value of −2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV ( P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV. Conclusion: In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up. Level of Evidence: Level III, retrospective comparative series.

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Section: Discussionmentioning

confidence: 99%

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

et al. 2019

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“…É possível indicar o procedimento para pacientes com OA grave sem o perfil descrito previamente, mas nesse cenário as taxas de complicações como infecção, deiscência, dor residual, amplitude de movimento reduzida e taxas de reoperação são elevadas. [59][60][61] São contraindicações absolutas à artroplastia total do tornozelo (ATT):…”

Section: Realizar Os Procedimentos Adicionais Quando Necessáriosunclassified

“…As vias de acesso possíveis são via anterior ou lateral transfibular. [59][60][61] Os estudos com ATT revelam melhora clínica e dos escores de dor em até 64% dos casos. A ATT com o uso dos implantes mais modernos mostra taxas de sucesso de 70 a 90% em 10 anos.…”

Section: Realizar Os Procedimentos Adicionais Quando Necessáriosunclassified

“…A ATT com o uso dos implantes mais modernos mostra taxas de sucesso de 70 a 90% em 10 anos. Idade, índice de massa corporal (IMC) e grau da deformidade pré-operatória não estão associados a maiores taxas de falha, porém pacientes com artrodese do retropé apresentaram risco significativamente maior de falha dos implantes (►Figura 1) [59][60][61][62] Estágio IV. Artrodese -Principalmente indicada para pacientes com osteoartrite grave, na falha das opções anteriores, associada a elevada limitação funcional, secundária a qualquer etiologia, e em qualquer faixa etária.…”

Section: Realizar Os Procedimentos Adicionais Quando Necessáriosunclassified

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Osteoartrite do tornozelo

Godoy‐Santos

Fonseca

Giordano

et al. 2020

Rev Bras Ortop (Sao Paulo)

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ResumoA osteoartrite (OA) é caracterizada por uma degradação crônica, progressiva e irreversível da superfície articular, associada a inflamação articular. A principal etiologia da OA do tornozelo é pós-traumática e sua prevalência é maior entre os jovens e obesos. Apesar dos avanços no tratamento das fraturas ao redor do tornozelo, o risco geral de desenvolver OA pós-traumática do tornozelo após 20 anos do trauma é de quase 40%; especialmente nas fraturas bimaleolares de Weber tipo B e C e fraturas envolvendo a borda tibial posterior. Nas fraturas do tálus, essa prevalência se aproxima de 100%, dependendo da gravidade da lesão e do tempo de seguimento. Nesse cenário, é fundamental a compreensão atual das vias de sinalização moleculares envolvidas na senescência e apoptose dos condrócitos. O tratamento da OA do tornozelo é estagiado e guiado pelos sistemas de classificação, condições locais e do paciente. Os principais problemas são a limitada capacidade de regeneração da cartilagem articular, o baixo suprimento de sangue e a escassez de células-tronco progenitoras.A presente atualização resume evidências científicas básicas recentes da OA pós-traumática do tornozelo, com foco principal nas alterações metabólicas da sinóvia, da cartilagem e do líquido sinovial. Epidemiologia, fisiopatologia, implicações clínicas, e opções de tratamento são também discutidas.

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“…13 Multiple studies have demonstrated that malalignment at the ankle joint following TAA increases edge-loading forces, which accelerates wear and increases the risk for revision surgery. 6,7,16 Implant survivorship has been shown to decrease substantially when there is greater than 10° deformity in the coronal plane, but success approaches that of TAA performed in anatomically neutral ankles when the deformity is properly corrected. 13,22…”

Section: Introductionmentioning

confidence: 99%

A Staged Approach to Combined Extra-articular Limb Deformity Correction and Total Ankle Arthroplasty for End-Stage Ankle Arthritis

et al. 2020

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Background: Patients presenting with end-stage ankle osteoarthritis (OA) in the setting of a concomitant extra-articular limb deformity pose a challenging problem that has not yet been described in the literature. We describe a case series of patients treated with external and internal fixation techniques followed by total ankle arthroplasty (TAA) in a staged approach to treat this complex presentation. Methods: Eight patients with limb deformity and end-stage ankle OA who underwent staged deformity correction and TAA from 2016 to 2019 at our institution were retrospectively identified. Average age was 58.5 (range, 49-68) years, with an average follow-up of 2.6 (range, 0.8-4.2) years. All patients underwent limb reconstruction with either tibial osteotomy with a circular frame (n=6) or intramedullary nail (n=2). Limb deformities consisted of the following: posttraumatic tibial malunion (2), limb length discrepancy (1), acquired tibial deformity (1), genu varum (2), or genu valgum (2). Radiographic parameters were assessed pre- and postoperatively on 51-inch standing and ankle radiographs: limb length discrepancy (LLD), genu varum/valgum deformity, recurvatum deformity, mechanical axis deviation, medial proximal tibial angle, lateral distal tibial angle, anterior distal tibial angle, and tibiotalar alignment. Pre- and postoperative patient-reported outcomes were assessed using 2 metrics, the Limb Deformity–Scoliosis Research Society (LD-SRS) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores (Physical Function, Pain Intensity, Pain Interference, Global Physical Function, and Global Mental Function). Results: Following staged limb deformity correction and TAA, all patients achieved correction of LLD and angular deformities of the lower limb, along with restoration of normal alignment of the ankle joint. There was significant mean improvement in all patient-reported LD-SRS and PROMIS domains, except for LD-SRS mental health. LD-SRS function improved from 2.6 (±0.7) to 4.6 (±0.2), P = .008; pain improved from 2.9 (±0.9) to 4.8 (±0.2), P = .012; self-image improved from 2.9 (±0.4) to 4.7 (±0.3), P < .001; and total LD-SRS improved from 3.3 (±0.4) to 4.8 (±0.2), P = .002. Average satisfaction was 4.9 (±0.3). PROMIS physical function improved from 32.3 (±6.8) to 51.3 (±5.3), P = .008; pain interference improved from 66.0 (±9.1) to 41.3 (±6.2), P = .004; pain intensity improved from 60.0 (±13.3) to 33.1 (±5.3), P = .007; global physical health improved from 39.3 (±6.8) to 60.7 (±5.1), P = .002; global mental health improved from 54.8 (±5.9) to 65.6 (±2.8), P = .007. There was one incidence of pin site infection and one reoperation. Conclusion: Deformity correction with either external frame or intramedullary nail fixation followed by TAA in a staged approach was a viable surgical option in the treatment of end-stage ankle OA with concurrent extra-articular limb deformity. This unique approach was capable of achieving deformity correction with improved patient-reported outcomes, minimal complications, and good patient satisfaction. Level of Evidence: Level IV, retrospective case series.

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Total Ankle Arthroplasty Survival and Risk Factors for Failure

Cited by 45 publications

References 57 publications

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

Osteoartrite do tornozelo

A Staged Approach to Combined Extra-articular Limb Deformity Correction and Total Ankle Arthroplasty for End-Stage Ankle Arthritis

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