Total Ankle Replacement Options

Shane, Amber M.; Sahli, Hannah

doi:10.1016/j.cpm.2019.06.005

Cited by 12 publications

(7 citation statements)

References 36 publications

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“…Total ankle arthroplasty was first proposed by Richard Smith in the 1970s, and after more than 40 years of refining, it has become an option for the treatment of end-stage ankle OA 9 . Although the ankle joint mobility is retained, the lifetime of the prosthesis is shorter.…”

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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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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“…Saltzman et al [18] pointed out that 70% of advanced AOA were traumatic, including 37.0% of ankle fractures and 28.3% of ankle sprains. Stufkens et al [19] systematic analysis showed that 60% of patients developed traumatic arthritis in the long term after ankle trauma; ankle fusion or joint replacement surgery is usually required for advanced ankle arthritis [20]. With the further understanding of pathophysiology and biomechanics of ankle arthritis, as well as the progress of surgical technology, supramalleolar osteotomy has made extensive progress in the treatment of early VAO.…”

Section: Discussionmentioning

confidence: 99%

Supramalleolar Fornix Osteotomy Combined Fibular Segamental Resection for Varus Ankle Osteoarthritis

Weng¹,

Li²,

Hu³

et al. 2021

Preprint

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Background: To investigate the safety and clinical effect of supramalleolar fornix osteotomy combined with fibular segmental resection in the treatment of varus ankle osteoarthritis (VAO). Methods: from July 2014 to July 2020, 38 patients with Takakura stage II - III VAO in Affiliated Hospital of Chengdu University were retrospectively analyzed, including 31 males and 7 females, 21 left ankles and 17 right ankles. They were divided into open osteotomy group (21 cases) and fornix osteotomy group (17 cases). According to the American Society of foot and ankle surgery ankle and hindfoot score (AOFAS) and visual analogue scale (VAS) for pain function and pain score; weight-bearing ankle acupoints and lateral X-ray imaging evaluation. Results: 38 patients were followed up for 16-54 months (mean 41 months). The healing time of the supramalleolar osteotomy group (3.33 ± 0.90 months) was significantly shorter than that of the open osteotomy group (6.09 ± 1.74 months) (t = -5.932, P = 0.000). The postoperative FAS score of fornix osteotomy group (85.65 ± 6.49) was significantly better than that of open osteotomy group (63.05 ± 6.42), and the postoperative VAS score of fornix osteotomy group (2.12 ± 1.05) was significantly better than that of open osteotomy group (4.38 ± 1.60) (P < 0.05). The improvement of anterior angle of distal tibia, talus inclination angle and talus lateral displacement in the fornix osteotomy group was significantly better than that in the open osteotomy group (P < 0.05); the postoperative lateral angle of distal tibia in the fornix osteotomy group was 82.05 ± 1.74 ° on average, and that in the open osteotomy group was 80.17 ± 1.34 ° on average, with no significant difference between the two groups (P > 0.05). Conclusion: The treatment of VAO with supramalleolar fornix osteotomy combined fibular segamental resection can effectively solve the anterior and talus lesions. The deformity correction around CORA can avoid the lateral displacement of the talus and effectively reduce the incidence of postoperative ankle degeneration. Short term follow up convinced better function restoration compared with open supramalleolar osteotomy.

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“…As a matter of fact, apart from implant sizing, most of the current TAA designs are not based on real patient's anatomy and do not seem to be able to fully reestablish gait symmetry and natural ankle motion [13,17]. Three-part prostheses are generally composed of an anatomic talar element, a nonanatomic flat tibial surface, and a conforming meniscus in between [26]. This combination seems unable to reproduce ligaments isometricity and, therefore, cannot restore physiological joint function, likely leading to high failure rates [17].…”

Section: Discussionmentioning

confidence: 99%

A new ligament-compatible patient-specific 3D-printed implant and instrumentation for total ankle arthroplasty: from biomechanical studies to clinical cases

et al. 2020

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Background: Computer navigation and patient-specific instrumentation for total ankle arthroplasty have still to demonstrate their theoretical ability to improve implant positioning and functional outcomes. The purpose of this paper is to present a new and complete total ankle arthroplasty customization process for severe posttraumatic ankle joint arthritis, consisting of patient-specific 3D-printed implant and instrumentation, starting from a ligament-compatible design. Case presentation: The new customization process was proposed in a 57-year-old male patient and involved image analysis, joint modeling, prosthesis design, patient-specific implant and instrumentation development, relevant prototyping, manufacturing, and implantation. Images obtained from a CT scan were processed for a 3D model of the ankle, and the BOX ankle prosthesis (MatOrtho, UK) geometries were customized to best fit the model. Virtual in silico, i.e., at the computer, implantation was performed to optimize positioning of these components. Corresponding patient-specific cutting guides for bone preparation were designed. The obtained models were printed in ABS by additive manufacturing for a final check. Once the planning procedure was approved, the models were sent to final state-of-the-art additive manufacturing (the metal components using cobalt-chromium-molybdenum powders, and the guides using polyamide). The custom-made prosthesis was then implanted using the cutting guides. The design, manufacturing, and implantation procedures were completed successfully and consistently, and final dimensions and location for the implant corresponded with the preoperative plan. Immediate post-op X-rays showed good implant positioning and alignment. After 4 months, clinical scores and functional abilities were excellent. Gait analysis showed satisfactory joint moment at the ankle complex and muscle activation timing within normality. Conclusions: The complete customization process for total ankle arthroplasty provided accurate and reliable implant positioning, with satisfactory short-term clinical outcomes. However, further studies are needed to confirm the potential benefits of this complete customization process. Level of evidence: 5. Case report.

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Total Ankle Replacement Options

Cited by 12 publications

References 36 publications

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

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

Supramalleolar Fornix Osteotomy Combined Fibular Segamental Resection for Varus Ankle Osteoarthritis

A new ligament-compatible patient-specific 3D-printed implant and instrumentation for total ankle arthroplasty: from biomechanical studies to clinical cases

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