Total ankle replacement leads to high revision rates in post-traumatic end-stage arthrosis

Gramlich, Yves; Neun, Oliver; Klug, Andreas; Buckup, Johannes; Stein, Thomas; Neumann, Arvid; Fischer, Sebastian; Abt, Hans-Peter; Hoffmann, Reinhard

doi:10.1007/s00264-018-3885-z

Cited by 30 publications

(32 citation statements)

References 17 publications

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“…Interestingly, if we had considered only the peak axial force during level walking as has been done by previous investigators, 5,6 the results would have been smaller peak micromotions (Table 3) and smaller amounts of bone at risk of failure (Table 4) We found that the fixation design played an important role in the magnitude of the maximum peak micromotion: the stem design had four to five times larger values (874-1125 µm) than the three spikes and keel designs, for which the peak micromotion was both smaller and similar to one another (~54-140 µm). Moreover, the distribution of micromotion at the instant of the maximum peak micromotion was also dependent on the fixation design: for the three spikes design, the highest micromotion was located posteriorly; for the keel, the highest micromotion was located anteriorly; and the stem design showed a concentric pattern around the stem.…”

Section: Resultsmentioning

confidence: 99%

“…3 To ensure both adequate micromotion and successful load transfer, TAA designs have incorporated supplemental fixation features, such as keels, stems, or spikes ( Figure 1). Despite these design efforts, reported revision rates range from 5% in 2 years 4 to 42% in 5 years, 5 with the leading causes for failure being periprosthetic osteolysis, component loosening, and subsidence. [4][5][6] These failure modes are thought to be related to the mechanics of the interaction between the implant and the bone.…”

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confidence: 99%

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Biomechanical evaluation of total ankle arthroplasty. Part II: Influence of loading and fixation design on tibial bone–implant interaction

Gonzalez

Steineman

Sturnick

et al. 2020

Journal Orthopaedic Research

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Finite element (FE) models to evaluate the burden placed on the interaction between total ankle arthroplasty (TAA) implants and the bone often rely on peak axial forces. However, the loading environment of the ankle is complex, and it is unclear whether peak axial forces represent a challenging scenario for the interaction between the implant and the bone. Our goal was to determine how the loads and the design of the fixation of the tibial component of TAA impact the interaction between the implant and the bone. To this end, we developed a framework that integrated robotic cadaveric simulations to determine the ankle kinematics, musculoskeletal models to determine the ankle joint loads, and FE models to evaluate the interaction between TAA and the bone. We compared the bone-implant micromotion and the risk of bone failure of three common fixation designs for the tibial component of TAA: spikes, a stem, and a keel. We found that the most critical conditions for the interaction between the implant and the bone were dependent on the specimen and the fixation design, but always involved submaximal forces and large moments. We also found that while the fixation design influenced the distribution and the peak value of bone-implant micromotion, the amount of bone at risk of failure was specimen dependent. To account for the most critical conditions for the interaction between the implant and the bone, our results support simulating multiple specimens under complex loading profiles that include multiaxial moments and span entire activity cycles.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Biomechanical evaluation of total ankle arthroplasty. Part II: Influence of loading and fixation design on tibial bone–implant interaction

Gonzalez

Steineman

Sturnick

et al. 2020

Journal Orthopaedic Research

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“…Although the ankle joint mobility is retained, the lifetime of the prosthesis is shorter. Total ankle arthroplasty is characterized by a high failure rate; in fact, the overhaul rate is as high as 32.9%-42% 10,11 . With recent progress in the research on ankle joint biomechanics, prosthesis design, and simulation technology, the clinical outcomes of total ankle replacement are now adequate for the early and middle stages of the disease 12 .…”

Section: Introductionmentioning

confidence: 99%

End‐stage Ankle Arthritis Treated by Ankle Arthrodesis with Screw Fixation Through the Transfibular Approach: A Retrospective Analysis

Suo

Liang

et al. 2020

Orthopaedic Surgery

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Objective To evaluate the clinical outcome of ankle arthrodesis with screw fixation through the transfibular approach for end‐stage ankle arthritis. Methods Data of 22 patients (28 ankles) with end‐stage ankle arthritis admitted to the Department of Orthopedics and Surgery of the First Hospital of Jilin University from May 2015 to December 2018 were analyzed retrospectively. The study included 9 men and 13 women, with a mean age of 56.86 ± 11.27 years (range, 37–75 years). The mean duration of the disease was 11.36 ± 12.80 years (range, 3 months‐50 years). A total of 16 patients had posttraumatic arthritis, 5 patients had osteoarthritis, and 1 patient had rheumatoid arthritis. There were 12 cases of the left ankle and 16 cases of the right ankle; 16 cases were unilateral and 6 were bilateral. The same surgical procedure was applied to all patients. Collected data included the operation time, intraoperative and postoperative blood loss, hospitalization time, bone union rate, time to bone union, and complications. The American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score and the visual analogue scale (VAS) were used to evaluate the preoperative status and the postoperative outcome at the last follow up. Results The mean follow‐up period was 26.14 ± 10.99 months. The mean operation time was 101.82 ± 33.33 min. The mean blood loss was 116.78 ± 68.86 mL during the procedure and 111.07 ± 52.18 mL after the procedure. The mean hospitalization time was 14.22 ± 5.42 days. Bone union of the ankle joint was achieved in all patients. The mean time to bone union was 14.83 ± 2.14 weeks. There was significant difference in the operation time between the patients undergoing unilateral and bilateral ankle arthrodesis. The AOFAS ankle hindfoot score increased from the preoperative value of 43.46 ± 4.39 points to 80.39 ± 5.37 points at the last follow up. During the same interval, the VAS score improved from 6.14 ± 0.80 points to 1.64 ± 0.73 points. The AOFAS ankle hindfoot score of patients who underwent unilateral ankle arthrodesis improved from the preoperative 43.19 ± 3.95 points to 81.75 ± 5.23 points at the last follow up, and the VAS score improved from 6.19 ± 0.83 points to 1.69 ± 0.70 points. The AOFAS ankle hindfoot score of patients undergoing bilateral ankle arthrodesis improved from the preoperative value of 43.83 ± 5.08 points to 78.67 ± 5.05 points at the last follow up, while the VAS score improved from 6.08 ± 0.82 points to 1.58 ± 0.79 points. There was significant difference in the maximum walking distance and walking on any surface between the patients undergoing unilateral and bilateral ankle arthrodesis. One patient developed superficial peroneal nerve palsy, which resolved within 1 year after the operation. In another patient, healing of the incision skin was delayed. During the follow‐up period, none of the patients developed an infection of the incision or local skin necrosis; screw loosening, withdrawal, or breakage did not occur in any patient. Conclusion The ankle arthrodesis with screw ...

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“…According to Hurowitz and colleagues, 16 there was a 10% failure rate at the first year for the agility total ankle replacement, and this rate rose to over 30% in the next year. Gramlich et al 12 also reported a high revision rate and unsatisfactory outcomes after total ankle replacement for end-stage posttraumatic arthritis. A recent meta-analysis demonstrated a higher overall complication rate after ankle arthrodesis, but a higher revision rate after total ankle arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

Liu

Zhang

et al. 2019

Foot Ankle Int.

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Background: Posttraumatic arthritis of tibiotalar joints after AO/OTA type C3 pilon fractures, especially in young patients with a significant osteochondral defect in the tibial plafond joint surface, is a challenging situation. We report a joint-preserving technique using autologous osteochondral graft in combination with ankle distraction and supramalleolar osteotomy (SMOT), if necessary, to improve its outcome. Methods: Seventeen patients with an average age of 32.1 years with Takakura grade 1 to 3A posttraumatic arthritis of the tibiotalar joint after AO/OTA type C3 pilon fractures received osteochondral autograft transplantation, ankle distraction, and SMOT, when supramalleolar malalignment was present, between February 2010 and November 2015. The visual analog scale (VAS), Short-Form 36 (SF-36) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and ankle range of motion were used for outcome analysis. Radiographic assessment of any SMOT and the apparent joint space was performed. Fourteen patients were followed for an average of 18 months. Results: The VAS, SF-36, and AOFAS scores as well as the ankle range of motion all improved significantly at the last follow-up after the surgery ( P < .01). No deep surgical site infection, donor site complication, nonunion, osteochondral block loosening, or resorption was noted. No secondary arthrodesis was needed at the end of follow-up. Conclusion: Autologous osteochondral graft transplantation in combination with ankle distraction and SMOT was a promising joint-preserving technique for early posttraumatic arthritis of tibiotalar joint after severe pilon fractures in young patients. Level of Evidence: Level IV, case series.

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Total ankle replacement leads to high revision rates in post-traumatic end-stage arthrosis

Abstract: Total ankle replacement in post-traumatic end-stage arthrosis patients is associated with high revision rates. High rates of symptomatic periprosthetic bone cysts caused high rates of revision surgery and worse outcomes, which were not improved by secondary TTA.

Cited by 30 publications

References 17 publications

Biomechanical evaluation of total ankle arthroplasty. Part II: Influence of loading and fixation design on tibial bone–implant interaction

Biomechanical evaluation of total ankle arthroplasty. Part II: Influence of loading and fixation design on tibial bone–implant interaction

End‐stage Ankle Arthritis Treated by Ankle Arthrodesis with Screw Fixation Through the Transfibular Approach: A Retrospective Analysis

Autologous Osteochondral Graft for Early Posttraumatic Arthritis of Tibiotalar Joints After Comminuted Pilon Fractures in Young Patients

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