Total Ankle Replacement for Treatment of End-Stage Osteoarthritis in Elderly Patients

Abstract

End-stage osteoarthritis of the ankle is a disabling problem, particularly in elderly patients who experience an overall loss of mobility and functional impairment and who then need compensatory adaption. Ankle arthrodesis, which has been demonstrated to provide postoperative pain relief and hindfoot stability, leaves the patient with a stiff foot and gait changes. For elderly patient, these changes may be more critical than generally believed. Additionally, the long duration of healing and rehabilitation process needed for ankle arthrodesis may be problematic in the elderly. In contrast to ankle arthrodesis, total ankle replacement has significant advantages including a less strenuous postoperative rehabilitation and preservation of ankle motion which supports physiological gait. Recently, total ankle replacement has evolved as a safe surgical treatment in patients with end-stage ankle osteoarthritis with reliable mid- to long-term results. Total ankle replacement needs less immobilization than arthrodesis and does allow for early weight-bearing and should be considered as a treatment option of first choice in many elderly patients with end-stage osteoarthritis of the ankle, especially in elderly patients with lower expectations and physical demands.

Correlation of Physical Performance and Patient-Reported Outcomes Following Total Ankle Arthroplasty

“…45,56 In recent years, total ankle arthroplasty (TAA) has become an alternative to arthrodesis for the treatment of painful end-stage ankle arthritis. 24,36 Clinical assessments of TAA outcomes are widely available in the literature. 11,53 In these studies, researchers have used a variety of outcome measures to determine the success of the operative intervention, including the visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, Short Musculoskeletal Function Assessment (SMFA), Short-Form 36 (SF-36), and the Foot and Ankle Disability Index (FADI).…”

Ankle arthroplasty in a patient with bleeding diathesis and the mid-term clinical outcome of the case

“…In a study of 406 patients conducted by Valderrabano et al., posttraumatic ankle osteoarthritis was observed in 78% of the cases; thus, it was the most common underlying aetiology. Haemophilia, rheumatoid arthritis, haemochromatosis, congenital foot deformity, gout, aseptic necrosis of the talus and intraarticular infections were the other causes of secondary osteoarthritis of the ankle in this study (with prevalence rates of 10–15%) [2] . Once the iron absorption capacity of the synovium is exceeded, cells disintegrate and this results in the release of lysosomal enzymes, which both increase synovial tissue inflammation and lead to joint destruction.…”

Total Ankle Replacement for Treatment of Avascular Necrosis of the Talus

“…Based on this, using cementless TAR to treat AVN of the talus affecting more than 30% of the talar body is relatively contraindicated, while AVN affecting more than 50% of the body is absolutely contraindicated, as there is insufficient viable bone over the talus to ensure good bony ingrowth [4]. If this requirement is not met, this may result in talar component subsidence or migration in which it is an undesired outcome.…”