Bibliographies thématiques / Total Ankle Replacement (TAR)

Littérature scientifique sur le sujet « Total Ankle Replacement (TAR) »

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Publié le 10 mars 2023

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Articles de revues sur le sujet "Total Ankle Replacement (TAR)"

1

Ruiz, Roxa, Lukas Zwicky et Beat Hintermann. « Syndesmotic Instability After Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 3, no 3 (1 juillet 2018) : 2473011418S0010. http://dx.doi.org/10.1177/2473011418s00103.

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Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) evolved over the last decades and has been shown to be an effective concept in the treatment of ankle osteoarthritis (OA). In three-component designs, the second interface between polyethylene insert (PI) and tibial component allows the PI to find its position according the individual physiological properties. This was believed to decrease shear forces within the ankle joint. However, it is not clarified to which extent such an additional degree of freedom may overload the ligamentous structures of the ankle joint over time. This may in particular be the case for the syndesmotic ligaments. Therefore, the purpose of this study was to analyze all ankles after TAR that showed a symptomatic overload of the syndesmotic ligaments and to determine the potential consequences. Methods: Between 2003 and 2017, 31 ankles (females, 17; males 14; mean age 60 [40-79] years) were treated with a tibio-fibular fusion for a symptomatic instability of the syndesmosis. The indication for TAR was posttraumatic OA in 27 (87%), primary OA in 3 (10%), and hemochromatosis in one ankle (3%). The 31 ankles included 23 primary TAR (74%), 6 revision TAR (19%), and two take-down of a fusion and conversion to TAR (7%). Criteria for fusion were the presence of at least two of the followings: (1) tenderness over the syndesmosis, (2) pain while compressing the fibula against the tibia (squeeze test), (3) pain while rotating the foot externally (external rotation test), (4) widening of the syndesmosis on an anteroposterior view. Alignment of TAR (tibial articular surface [TAS] angle) and hindfoot alignment were measured on standard radiographs. Intraoperatively, the syndesmotic instability was confirmed before fusion. The wear of PI was documented. Results: After a mean of 63 (range, 4 – 152) months after TAR, all patients evidenced pain at the level of the syndesmosis of at least 3 months. 25 ankles (81%; 24 after posttraumatic OA) showed a widening of the syndesmotic space and 22 ankles (71%) of the medial clear space with lateral translation of the talus. The PI was seen to overlap the tibial component in 15 ankles (48%). Nine ankles (29%) evidenced cyst formation, and eight ankles (26%) showed a decrease in height of the PI; whereas, in 3 ankles (10%) a fracture of the PI was found. A valgus misalignment of the heel was found in 25 ankles (81%), a valgus TAS in 16 (52%) and a varus TAS in 11 ankles (36%). Conclusion: A syndesmotic instability after a three-component TAR apparently occurred mostly after posttraumatic OA, in particular if the heel was left in valgus. If the talus starts to move lateralward, the PI seems to be at risk for increased wear and finally mechanical failure (Figure 1). Therefore, a valgus misaligned heel should always be corrected during TAR implantation. If there is any sign of syndesmotic instability, a fusion should be considered. Further studies must proof whether in cases with a syndesmotic instability the use of a two-component design will be superior, as it stabilizes the talus in the coronal plane.
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Weber, Stephen, et James Ficke. « Cementless Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 3, no 3 (1 juillet 2018) : 2473011418S0051. http://dx.doi.org/10.1177/2473011418s00512.

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Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) was initially performed with first-generation cemented components. These constructs showed unacceptable revision and complication rates, in part due to the difficulty of obtaining a uniform cement mantle and the unique difficulties with TAR regarding the inability to dislocate the joint for exposure. Early concerns with polymethylmethacrylate (PMMA) in knees led to multiple studies evaluating fixation of total knee components by bone ingrowth using prospective randomized studies, registry data, and radiostereographic analysis. These studies have shown that if micromotion can be kept below 150 micrometers, cementless fixation could be anticipated. Similar benefits were anticipated with TAR, however the literature supporting cementless TAR by contrast appeared sparse. A systematic literature review was conducted to evaluate the literature supporting cementless TAR. Methods: A systematic review of the English language literature regarding cementless fixation in TAR was performed. Pubmed, Embase, Web of Science, and Google Scholar were searched using the terms “total ankle arthroplasty,” “total ankle replacement,” “cement,” “porous ingrowth”, “biologic fixation”, and “cementless” from the inceptions of these search engines until June 2017. To ensure that no relevant studies were missed, the reference sections of all studies selected for final analysis were additionally reviewed. All potentially relevant papers were compiled to determine whether they fit the previously established inclusion criteria. Exclusion criteria included non-English language studies, non-human or laboratory studies, and isolated case reports. The results of this literature review were analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Results: The available literature was limited to five articles. Kofoed et al. reported TAR using the STAR ankle, and stated that there was no difference. Brigido et al. using digital radiography of the uncemented INBONE implant, showed that migration was only 0.7 mm at one year and 1.0 mm at two years. Fong et al. performed a preliminary study evaluating the possibility of stereo metric analysis of micromotion, but validated the possibility only. Fevang et al. in a registry review noted that: “The failures in early studies usually occurred with cemented implants. In general, uncemented prostheses have been associated with better results than cemented ones.” Takakura et al. noted a 27% success rate with a cemented ceramic TAR versus a 67% success rate without cement Conclusion: In contrast to the robust literature regarding cementless knee and hip arthroplasty, the literature justifying cementless TAR is surprisingly limited. This lack of literature has had significant impact on the performance of TAR in the US, as virtually all TARs are put in “off-label” without cement with additional liability risks imposed by the use of medical devices in this fashion. While prospective randomized studies comparing cemented to cementless third-generation TARs may violate clinical equipoise, other techniques such as stereometric sequential radiographs, comparative registry outcome data, and systematic retrieval data would allow validation of cementless TAR as a viable technique.
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Kvarda, Peter, Lena Siegler, Tamar Horn-Lang, Roman Susdorf, Roxa Ruiz et Beat Hintermann. « 3D Analysis of the Hindfoot Following Total Ankle Replacement for Varus Ankle Osteoarthritis ». Foot & ; Ankle Orthopaedics 7, no 4 (octobre 2022) : 2473011421S0073. http://dx.doi.org/10.1177/2473011421s00736.

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Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: In advanced stages of varus ankle osteoarthritis (OA) progressive destabilization of the peritalar structures is common. Total ankle replacement (TAR) is a viable treatment option although data, particularly on changes in the subtalar joint position following TAR, is scarce. Therefore, we evaluated the subtalar joint using semi-automated measurements based on weightbearing cone-beam CT scans (WBCT) before and after TAR. Methods: 14 patients (15 ankles) who received TAR without additional bony procedures for varus ankle OA were analyzed using semi-automated measurements of the hindfoot based on pre-and postoperative WBCT. Pain on visual analog scale (VAS) and American Orthopedic Foot and Ankle Society Hindfoot Score (AOFAS) were assessed. Results: Five of 6 measurements showed a significant improvement including sagittal and axial talocalcaneal angle, talar horizontal inclination angle, hindfoot angle, and talar tilt. Conclusion: Besides ankle joint realignment, TAR for varus ankle OA without additional bony procedures achieved significant correction of the subtalar joint based on WBCT.
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Rodriguez-Merchan, Emerito C. « Total Ankle Replacement in Hemophilia ». Cardiovascular & ; Hematological Disorders-Drug Targets 20, no 2 (14 juin 2020) : 88–92. http://dx.doi.org/10.2174/1871529x19666191210110626.

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Introduction: Severe ankle hemophilic arthropathy can be a calamitous sign of severe hemophilia with important inferences for activities of daily living. Aims: To summarize the contemporary, accessible information on Total Ankle Replacement (TAR) for ankle hemophilic arthropathy. Methods: A search of Cochrane Library and PubMed (MEDLINE) regarding the role of TAR in ankle hemophilic arthropathy. Results: The insufficient information regarding the results of TAR for hemophilic arthropathy is confined to scanty case series and case reports. An evaluation of the accessible literature reveals encouraging but inconstant outcomes. The reported rate of adverse events is 33%. The reported anticipated survival of TAR is 94% at 5 years, 85% at 10 years and 70% at 15 years. Conclusion: Whereas people with advanced hemophilic arthropathy of the ankle are prone to ameliorate pain and range of motion following TAR, there is deficient knowledge to regularly recommend its use. Adverse events and infection percentages are disturbing. Moreover, the lack of survival analysis knowledge makes it difficult to assess the benefit to people with hemophilia. TAR is a demanding surgical procedure and its survival is not comparable to that after hip or knee replacement.
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Gross, Christopher E., Federico Guiseppe Usuelli et Christian Indino. « Hindfoot Alignment after Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 5, no 2 (1 avril 2020) : 2473011420S0000. http://dx.doi.org/10.1177/2473011420s00007.

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Category: Ankle Arthritis; Ankle Introduction/Purpose: End-stage ankle arthritis can involve misalignment of the ankle in both the coronal and sagittal planes as up to reported 33% to 44% of patients who present for total ankle replacement have greater than 10° of coronal plane deformity. Improvements in both the design and surgical technique for total ankle replacements (TAR) have allowed surgeons to tackle the most challenging of multiplanar ankle deformities. Normalization of the sagittal and coronal alignment is key in improving survivorship and functional outcomes in TAR. In the present study, we analyzed how both the ankle and hindfoot alignment for both a fixed-bearing and mobile bearing TAR system changes over time. Specifically, we measured coronal and sagittal alignment of both the ankle and hindfoot complex. We hypothesize that both significant differences would be seen between all time points and pre-operative radiographs, and that these differences would not change over time. Methods: A retrospective study performed by a single orthopaedic surgeon was performed on two independent groups of patients undergoing two different systems for total ankle replacement: Zimmer TAR (lateral-approach, fixed-bearing, n=89) and Hintegra (anterior approach, mobile-bearing, n=81). We noted specific demographic data and radiographic data were measured including: Hindfoot alignment view angle (HAV), Hindfoot alignment distance (HAVD), tibiotalar ratio, α angle and β angle. These were measured pre-operatively, and 6 months, 12 months, and 24 months post-operatively. Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points, e.g. T0vsT6vsT12vsT24) within the Hintegra and Zimmer groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed for SA, SD, TT ratio, α and β angle. Specifically, time*group interaction was tested. Results: At the ankle joint itself, as measured by the α and β angles (p>.05), the position of the components remains relatively similar in both the fixed and mobile bearing TAR over the course of 24 months. The sagittal alignment, as measured by the TT ratio, demonstrated a posterior shifting of the talus in the mobile bearing group (p=.036). Though the fixed and mobile- bearing TAR had both significant hindfoot alignment improvement between the pre-op radiographs and twenty-four months, over time, the fixed-bearing ankle had a significant increase in both the HAV and HAVD (p<.001), suggesting a dynamism of the hindfoot in the fixed-bearing ankle. Conclusion: Correcting coronal and sagittal alignment is important for the long-term survivorship of a TAR. The fixed and mobile-bearing implants had maintained coronal and sagittal alignment in the short term, the temporal course of the fixed-bearing ankle showed an increased in the valgus positioning of the hindfoot.
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Fletcher, Amanda N., Abhinav Balu, Gregory F. Pereira, James K. DeOrio, Mark E. Easley, James A. Nunley et Selene G. Parekh. « Short-Term Efficacy and Safety of Combined Total Talus and Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 7, no 1 (janvier 2022) : 2473011421S0002. http://dx.doi.org/10.1177/2473011421s00022.

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Category: Ankle; Ankle Arthritis Introduction/Purpose: The indications for both total talus replacement (TTR) and total ankle replacement (TAR) are expanding. Combined total ankle-total talus (combined TAR) is a novel treatment option for patients with end-stage ankle arthritis and talar avascular necrosis (AVN) and patients with a prior TAR and talar component collapse. End-stage talar AVN with subchondral collapse is a challenging entity to treat. Historically, an alternative treatment option was tibiotalocalcaneal arthrodesis with structural allograft which results in fair outcomes including nonunion rates up to 40%. Combined TAR is a treatment option that theoretically maintains joint range of motion and restores anatomic alignment. The purpose of this study is to evaluate the short-term outcomes for combined TAR including pain, functional outcomes, radiographic outcomes, and complications. Methods: Consecutive patients who underwent combined TAR from 2016-2020 were retrospectively reviewed. All surgeries were performed by one of four fellowship-trained foot and ankle orthopaedic surgeons at a single academic institution. All talus implants were custom 3D printed total tali (Additive Orthopaedics, Little Silver, NJ), composed of an alloy primarily made of cobalt chrome. The implants were sized based on computed tomography scans of the contralateral talus and created to articulate with multiple TAR systems. Patient demographics, comorbidities, and surgical data were collected. Outcomes included the Visual Analog Scale (VAS) scores, radiographic alignment, range of motion, and complications. Data analysis was performed with paired t- tests and a significance level of p<0.05. Results: A total of 66 patients (67 ankles) were included with an average 12-month follow-up. There were 35 (52.2%) men, and the average age was 56.4 years old. The majority of patients (n=42, 62.7%) underwent combined TAR for talar AVN and tibiotalar arthritis while 21 (31.3%) patients were converted from an isolated TAR and 4 patients (6.0%) from an isolated TTR to combined TAR. A total of 23 (34.3%) patients had a previous talus fracture. Significant postoperative improvements compared to preoperative included: VAS (2.8 vs. 8.2; p<0.0001), ankle dorsiflexion (11.0° vs. 4.7°; p=0.0007), ankle plantarflexion (31.9° vs. 23.7°; p<0.0001), talar declination angle (20.7° vs. 11.6°; p=0.0007), Meary’s angle (2.2° vs. 10.4°; p=0.0043), and talocalcaneal height (79.6mm vs. 74.2mm; p <0.0001). There was a total of 10 (14.9%) complications, 7 (10.4%) of which required repeat surgery. There were 3 (4.5%) failures requiring explant, revision, or amputation (Table 1). Conclusion: Combined TAR is an efficacious and safe procedure. Patients experienced improvement in pain, ankle range of motion, and radiographic parameters postoperatively. This technique provides an anatomic treatment with preservation of ankle motion for patients with severely deficient bone stock due to talar AVN with ankle arthritis or failed TAR. To confirm these preliminary positive results, further studies are required including continued longer-term follow-up, prospective cohorts, and comparative analyses to other treatment options.
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Gross, Christopher, Luigi Manzi, Cristian Indino, Fausto Romano, Camilla Maccario et Federico Giuseppe Usuelli. « Hindfoot Alignment after Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 4, no 4 (1 octobre 2019) : 2473011419S0018. http://dx.doi.org/10.1177/2473011419s00189.

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Category: Ankle, Ankle Arthritis Introduction/Purpose: End-stage ankle arthritis can involve misalignment of the ankle in both the coronal and sagittal planes as up to reported 33% to 44% of patients who present for total ankle replacement have greater than 10° of coronal plane deformity. Normalization of the sagittal and coronal alignment is key in improving survivorship and functional outcomes in TAR. In the present study, we analyzed how both the ankle and hindfoot alignment for both a fixed-bearing and mobile bearing TAR system changes over time. Specifically, we measured coronal and sagittal alignment of both the ankle and hindfoot complex. We hypothesize that both significant differences would be seen between all time points and pre-operative radiographs, and that these differences would not change over time. Methods: A retrospective study performed by a single orthopaedic surgeon was performed on two independent groups of patients undergoing two different systems for total ankle replacement: Zimmer TAR (lateral-approach, fixed-bearing, n=89) and Hintegra (anterior approach, mobile-bearing, n=81). We noted specific demographic data and radiographic data were measured including: Hindfoot alignment view angle (HAV), Hindfoot alignment distance (HAVD), tibiotalar ratio, a angle and ß angle. These were measured pre-operatively, and 6 months, 12 months, and 24 months post-operatively. Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points, e.g. T0vsT6vsT12vsT24) within the Hintegra and Zimmer groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed for SA, SD, TT ratio, a and ß angle. Specifically, time*group interaction was tested. Results: At the ankle joint itself, as measured by the a and ß angles (p>.05), the position of the components remains relatively similar in both the fixed and mobile bearing TAR over the course of 24 months. The sagittal alignment, as measured by the TT ratio, demonstrated a posterior shifting of the talus in the mobile bearing group (p=.036). Though the fixed and mobile-bearing TARhad both significant hindfoot alignment improvement between the pre-op radiographs and twenty-four months, over time, the fixed-bearing ankle had a significant increase in both the HAV and HAVD (p<.001), suggesting a dynamism of the hindfoot in the fixed-bearing ankle. Conclusion: Correcting coronal and sagittal alignment is important for the long-term survivorship of a TAR. The fixed and mobile-bearing implants had maintained coronal and sagittal alignment in the short term, the temporal course of the fixed-bearing ankle showed an increased in the valgus positioning of the hindfoot. The mobile-bearing implant maintained its hindfoot alignment over the course of the study. More studies are needed to explore the clinical implications of this new data.
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Franz, Anne-Constance, Manja Deforth, Lukas Zwicky, Christine Schweizer et Beat Hintermann. « Complications, Reoperations, and Postoperative Outcomes of Simultaneous Supramalleolar Osteotomy and Total Ankle Replacement in Misaligned Osteoarthritic Ankles in Comparison to Total Ankle Replacement Alone ». Foot & ; Ankle Orthopaedics 3, no 3 (1 juillet 2018) : 2473011418S0005. http://dx.doi.org/10.1177/2473011418s00052.

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Category: Ankle Arthritis Introduction/Purpose: A key for success in total ankle replacement (TAR) is a balanced ankle joint with a physiological loading of the implant, minimizing the wear of the polyethylene insert. Theoretically, in ankles with distal tibial deformities, this can be achieved with a correcting tibial resection cut. As an alternative, supramalleolar osteotomy (SMOT) can be used for balancing the ankle during TAR surgery. To date, however, no data exist whether a SMOT in addition to TAR results in better outcome over time, and which are the additional risks with such extensive surgery. The aim of the study was therefore 1) to determine the risk of a simultaneously performed SMOT in comparison to TAR only, and 2) to compare the postoperative clinical outcomes. Methods: Between 2002 and 2014, 23 patients (male, 12; female, 11; mean age 60 [22-72] years) underwent simultaneously a SMOT and a TAR for treatment of a severe misaligned osteoarthritic ankle (tibial anterior surface angle [TAS] <84° [n=9] or >96° [n=1], or tibial lateral surface angle [TLS] <70° [n=13]) (SMOT&TAR group). Statistical matching was applied to extract a subgroup out of 510 TAR patients from our prospectively collected database with the same baseline characteristics, including similar preoperative alignments (control group). The matched 23 TAR patients (male, 16; female, 7; mean age 58 [35 - 79] years) were compared regarding additional procedures, complications and reoperations. Pre- and postoperative alignment measured on radiographs and clinical outcome (range of motion [ROM], pain on the visual analogue scale [VAS] and AOFAS hindfoot score) were compared. Results: While more additional osteotomies were done in the SMOT&TAR group (calcaneus, 5:1; fibula, 7:1), more ligament reconstructions and tendon transfers were done in control group (ligament reconstruction, 0:6; tendon transfer, 0:6). There was no difference, neither in the complication rate nor in the reoperation rate between both groups. However, there was a tendency of instability, subsequent polyethylene wear and cyst formation in the TAR group. The postoperative TAS was closer to neutral in the SMOT&TAR (pre- to postoperatively: 82.9° to 90.4° vs. 82.6° to 87.8°). While ROM was lower in the SMOT&TAR (30°) than in the TAR group (39°) (p=0.01), there was no difference in the clinical outcome (VAS pain 1.2 vs. 1.5 [p=0.58], AOFAS score 82 vs. 82 [p=0.99]). Conclusion: A SMOT performed simultaneously with TAR for the treatment of a severely deformed ankle resulted in a more neutral and better balanced ankle, and it was not associated with a greater risk of complications or reoperations. The only disadvantage was a slightly smaller ROM. Thus, SMOT should be considered in TAR with greater hindfoot deformities at the distal tibia as it is more powerful to address deforming forces. As shown, SMOT and TAR can be done simultaneously without taking greater risks.
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Ha, Taegyeong T., Chinnasamy Senthil Kumar, Taegyeong T. Ha, Zoe Higgs, Chris Watling, Cemre Su Osam, N. Jane Madeley et Mansur Halai. « Trends in Total Ankle Replacement in Scotland ». Foot & ; Ankle Orthopaedics 5, no 4 (1 octobre 2020) : 2473011420S0024. http://dx.doi.org/10.1177/2473011420s00240.

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Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is performed for post-traumatic arthritis, inflammatory arthropathy, osteoarthritis and other indications. The Scottish Arthroplasty Project (SAP) began collection of data on TAR in 1997. In this study, using data from the SAP, we look at trends in the use and outcomes of TAR in Scotland. Methods: We identified 499 patients from the SAP who underwent TAR between 1997 and 2015 with imaging available on the National Picture Archiving and Communication System (PACS). We identified, and looked at trends in, implant type over the following time periods: 1998-2005; 2006-2010 and 2011-2015. Age, gender, indication and outcomes for each time period were examined and also trends with implant type over time. Results: There were 499 primary TAR procedures with an overall incidence of 0.5/105 population per year. The peak incidence of TAR was in the 6th decade. The mean age of patients undergoing TAR from 59 years in 1998-2005, to 65 years in 2011-15 (p<0.0001). The percentage of patients with inflammatory arthropathy was 49% in 1998-2005, compared with 10% in 2011-2015. Subsequent arthrodesis and infection rates appeared to be higher during the first time period. The female to male ratio also changed over time. The incidence of TAR increased overall during the study period (r= 0.9, p=<0.0001). This may be due to a broadening range of indications and patient selection criteria, in turn due to increased surgeon experience and the evolution of implant design. Conclusion: This study examines a large number of TARs from an established national arthroplasty database. The rate of TAR has increased significantly in Scotland from 1997 to 2015. Indication and patient age has changed over time and this could potentially impact outcomes after ankle replacement.
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Sokolowski, Marc, Lukas Zwicky, Christine Schweizer et Beat Hintermann. « Subtalar Joint Arthritis After Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 3, no 3 (1 juillet 2018) : 2473011418S0011. http://dx.doi.org/10.1177/2473011418s00114.

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Category: Ankle Arthritis Introduction/Purpose: It has been shown that total ankle replacement (TAR) is effective in reducing pain and maintaining function in posttraumatic ankle osteoarthritis (OA). Compared to ankle fusion, TAR restores hindfoot kinematics more physiological. However, the assumption that the maintenance of ankle motion has a protective effect on the subtalar joint is still a matter of debate. Only a scarce number of long-term studies exist to support this statement.The purpose of this study was (1) to evaluate to which extent the integrity of the subtalar joint can be preserved by treating patients with a TAR, (2) to determine the rate of subtalar fusion following TAR, and (3) to determine whether the need of subsequent subtalar fusion was predictable at time of TAR. Methods: A consecutive series of 1140 primary TAR (508 female, 632 male, median age 63.5 years), performed between May 2000 and December 2015, were prospectively documented. The indication for TAR was posttraumatic OA in 78%, primary and systemic OA in 10% each, and other secondary OA in 3% of the cases. 199 subtalar joints were either fused before (n=73) or during TAR surgery (n=126), leaving 941 subtalar joints available for analysis. Radiographs before implantation and at latest follow-up were classified using the Kellgren and Lawrence Grading Score (KLS). In case of a subtalar fusion, the radiograph prior to the fusion was classified. Results: After a median radiographic follow-up of 6.1 years, the KLS remained unchanged in 66% of all cases. While it was increased by one stage in 30%, it was increased by two stages in 3%; whereas, signs of OA decreased by one stage in 1%. Cases with an increase of two stages on the KLS had a longer follow-up compared to cases without increase (p=0.047).37 cases (3.9%) underwent a subtalar joint fusion, of which the indication was progressive OA in 19 cases (51%), instability in 10 cases (27%) and others in 8 cases (22%). Subtalar joints that required a fusion after TAR did not show higher preoperative KLS than the group which did not need a subtalar joint fusion. Conclusion: Apparently, TAR protects the subtalar joint from secondary degeneration, as found in 67% with no increase in KLS. Although 33% showed an increase in the KLS, only 2% required a subtalar fusion due to progressive OA. Overall, the rate of subtalar joint fusion after TAR was low and comparable to the rates reported in the literature. Subtalar joints requiring fusion after TAR did not show higher preoperative rates of OA. Therefore, the KLS classification of subtalar OA on conventional radiographs provides only limited information about the need for postoperative subtalar fusion, and thus need to be interpreted with caution.
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Thèses sur le sujet "Total Ankle Replacement (TAR)"

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Gundapaneni, Dinesh. « Computational Simulations of Biomechanical Kinematics in WSU Total Ankle Replacement Systems ». Wright State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=wright151559184243815.

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Smyth, Alexandra. « Wear of a total ankle replacement ». Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/19367/.

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Ankle arthritis affects 1% of the population and can be a painful debilitating problem. One motion preserving treatment option is total ankle replacement (TAR). These devices are currently under researched and have poor clinical outcomes. Despite significant variation amongst device designs no pre-clinical test standards exist to allow comparison of tribological function. Furthermore, malalignment of TARs is a potential result of surgical technique or failure to correct existing natural varus/valgus deformity. TAR malalignment can result in instability, deformity and is associated with increased wear and higher failure rates. Good alignment is considered instrumental for long term success. The aim of this research was to develop clinically relevant wear test methodologies for both natural gait and adverse conditions. First a parameterised test was undertaken to understand the critical parameters for the Zentih (Corin Group) TAR. A knee simulator was used to vary the combination of rotation and displacement and the change in wear rate was assessed gravimetrically. The effects of malalignment were investigated biomechanically in terms of component lift-off, changing contact area and stress. Adverse conditions were defined based on these results and edge loading observed in retrieved TARs. One coronal malalignment condition and a 3mm translational offset were tested in the wear simulator previously developed. Rotation proved to significantly increase the TAR wear rate while displacement had no significant effect. Implementing coronal malalignment alone resulted in a significant decrease in the wear rate, due to the reduced contact area while edge loading had no significant effect. This outcome may not translate to reduced wear in a complex biological environment, however simulation methods produced clinically comparable surface form. This PhD highlighted the critical parameters for TAR wear simulation, however, TAR failure is bigger than wear alone. Further factors must be considered to develop a truly adverse pre-clinical test protocol.
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Elliott, Bradley Jay. « Optimization of WSU Total Ankle Replacement Systems ». Wright State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=wright1341333609.

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Stratton-Powell, Ashley Alexander. « On the failure of total ankle replacement : a retrieval analysis ». Thesis, University of Leeds, 2018. http://etheses.whiterose.ac.uk/20588/.

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Total ankle replacement (TAR) has been under development for 40 years but is not considered as successful as other lower limb total joint replacements (TJR). The failure rate of TAR is more than double that of total hip replacement at 10 years, yet the failure mechanisms remain largely unknown. The research in this thesis aimed to identify the wear modes and possible origins of failure for a cohort of failed TARs using a retrieval analysis approach. Explants, medical imaging and periprosthetic tissue samples were retrieved for 44 participants following revision TAR surgery. Five TAR brands were retrieved, all of which were uncemented, three-component, mobile-bearing designs. Each resource was investigated using established and novel retrieval analysis methods including, but not limited to: photogrammetry, microscopy, non-contacting 3D surface profilometry, computed tomography and wear particle isolation. Ballooning osteolysis was highly prevalent. Component alignment was within alignment variations considered acceptable in the published literature, yet high rates of edge-loading (70.5%) and impingement (57%) were evident. Fixation and bearing surface wear affected 98% of tibial components. The volumetric wear rate for eight bearing inserts was 2.5 times higher than the greatest wear rate reported by in-vitro simulation studies. Hydroxyapatite wear particles were micron-sized with a high aspect ratio (AR = 3.7). Flake-like micron-sized cobalt chromium alloy and large titanium wear particles (>10 μm) were also isolated and characterised. The total wear particle population for TAR was generally larger and more elongated than the wear particle characteristics identified for other TJRs. Edge-loading, bearing insert subluxation and impingement contributed to wear modes 2, 3 and 4, which indicate device dysfunction and should be minimised by design. Mobile-bearing constraint, cortical window surgical approach and the rapid accrual of wear particles may be important contributors to the failure of TAR.
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Bingenheimer, Heidi Kirsten Johanna. « Analysis of hindfoot alignment for total ankle arthroplasties ». Thesis, University of Iowa, 2016. https://ir.uiowa.edu/etd/2183.

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Total ankle arthroplasties (TAAs) are mechanical devices used to replace the articular surfaces of the ankle joint in order to relieve pain for patients with osteoarthritis. Since most osteoarthritis is post-traumatic, and due to the highly variable individual foot geometry, TAAs are rarely inserted into normal geometry. This leads to serious problems with stresses and contact pressures in TAA components. This study uses finite element (FE) modeling to determine how hindfoot alignment, or how far in varus or valgus the most distal part of the calcaneus is perpendicularly from the axis of the tibia, affects the stresses and contact pressures in the articulating surfaces of two different TAA models. To investigate the effects of foot alignment on hardware stresses after TAA, FE models were generated. Models of the mobile bearing, three component Scandinavian Total Ankle Replacement (STAR) and the fixed bearing, two component Zimmer Trabecular Metal Total Ankle (Zimmer) were generated from laser scans of the hardware and virtually implanted into 3D models of the tibia and talus. Ligaments were modeled as linear springs to impart physiologically realistic flexibility in the model. The stance phase of a walking gait cycle was applied and stresses and contact pressures at the articulation between model components were recorded for various degrees of hindfoot alignment [1]. Data analyzed shows that both models have areas of high concentrations of stress and contact pressure. The Zimmer TAA seems to favor a valgus alignment due to the lower stresses and contact pressures in valgus alignments compared to varus. Though the STAR does not generally favor one alignment over the other, it does have significantly lower stresses and contact pressures than the Zimmer. These differences may be due to the geometric congruency of the STAR versus the anatomical articulation of the Zimmer.
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McInnes, Kurtis Anthony. « Biomechanical comparison of two total ankle replacement designs : micromotion and kinematic patterns ». Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/42747.

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Introduction: Arthritis is a degenerative disease that causes irreversible damage to a joint’s articular cartilage. Despite having high failure rates in early total ankle arthroplasty (TAA) models, recent improvements have increased the success of this procedure, providing end-stage ankle arthritis patients a viable alternative to fusion with better functional outcomes. Currently, the most prevalent cause of failure is aseptic loosening, which is believed to be affected by motion at the bone-implant interface. The objective of this study was to compare micromotion and kinematic patterns of two TAA designs. Methods: A mechanical simulator was designed to apply compressive loads and bending moments to human cadaveric ankles, intact and replaced. It induced a maximal range of motion in the ankle about 3 orthogonal axes: plantarflexion-dorsiflexion (PF-DF), inversion-eversion (INV-EV), and internal-external rotation (IR-ER). Six ankle pairs were tested and compared. The implants analyzed were the Agility™ and the Scandinavian Total Ankle Replacement (S.T.A.R.®). Using an optical motion capture system, tibiocalcaneal kinematics and the relative bone-implant motion for each implant were recorded and analyzed. Results: The Agility exhibited a greater amount of micromotion between the bone and prosthesis than the STAR for the tibial component in INV-EV (p=0.037), and for the talar component in PF-DF (p=0.002) and IR-ER (p=0.038). Micromotion magnitudes were affected by loading direction and compression. Kinematic changes were observed following replacement of the ankle joint. There were decreases in the amount of motion coupling for both implants when loaded in INV-EV and IR-ER. There were increases in joint translation for both implants in the medial/lateral direction under INV-EV loading, and for the STAR in the anterior/posterior and compression/distraction directions under PF-DF loading. No significant ROM differences were found. Discussion: Increased micromotion in the Agility supports the hypothesis that higher aseptic loosening rates are correlated with reduced initial post-op fixation. The effect of loading direction on micromotion magnitude confirms the need to apply a variety of loading conditions to obtain a comprehensive micromotion analysis. Kinematic differences between implanted and intact ankles show that there is still room for improvement towards an ankle replacement design that replicates the performance of a healthy ankle.
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Deleu, Paul-André. « Arthrose de cheville et ses traitements : impact sur la biomécanique du pied et de la cheville ». Thesis, Lyon, 2019. https://n2t.net/ark:/47881/m6np23rc.

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L'arthrose de cheville est une dégénérescence progressive du cartilage caractérisée par une douleur et une incapacité fonctionnelle importante. Cependant, bien que la marche soit améliorée suite à une arthrodèse ou à une prothèse totale de cheville, les patients présentent toujours une altération de la fonction du membre inférieur. Afin d'améliorer notre compréhension des déficiences fonctionnelles associées à cette pathologie et à ces traitements chirurgicaux connexes, une revue systématique de la littérature a été réalisée. Celle-ci démontre un manque de caractérisation de cette pathologie dans les études d'analyse de marche. Cela signifie que les conséquences fonctionnelles sont difficiles à définir sans tenir compte des changements morphologiques et structurels du pied liés à l’arthrose. Par conséquent, des groupes homogènes de patients ont été recrutés sur base de l’étiologie de l’arthrose et de la présence de déformations concomittantes. L’analyse cinétique des articulations intrinsèques du pied chez ces patients a montré que les altérations de la fonction n’étaient pas limitées à la cheville douloureuse, mais affectaient également les articulations adjacentes du pied. De plus, les déformations du pied associées à l’arthrose de cheville influencent la mécanique du pied durant la marche. Enfin, une étude pilote a été réalisée pour donner une première évaluation de la prothèse totale de cheville sur la performance biomécanique des patients souffrant d'arthrose. Nos résultats ont révélé que la mécanique de la cheville après prothèse ressemble à celle des chevilles saines mais que leurs performances biomécaniques restent diminuées par rapport à des sujets asymptomatiques
Ankle osteoarthritis is a degenerative joint disease characterized by significant pain and disability. Although gait is improved after surgery, patients still experience impaired lower limb function. Therefore, this doctoral project compared outcomes following common surgical procedures for ankle osteoarthritis by analyzing patients’ perception of recovery. Evidence showed that half of the patients were still experiencing functional impairments after surgery. To increase our understanding of functional impairment experienced by these patients, a meta-analysis was performed to assess the biomechanical effects of total ankle replacement and ankle arthrodesis during gait. It showed that characterization of ankle osteoarthritis is lacking in gait studies and that functional consequences are difficult to define without considering the morphological and structural changes associated with this pathology. Therefore, homogenous study groups of patients were recruited based on the aetiology of ankle osteoarthritis and the presence of concomitant foot deformities. Analyzing the kinetics of the intrinsic foot joints of ankle osteoarthritis patients revealed that the impairment in foot mechanics was not restricted to the painful ankle joint, but also affected neighboring foot joints. Further evidence showed that malalignment of the hindfoot and the ankle does indeed influence foot mechanics during gait. Finally, a pilot study providing a first estimation of how total ankle replacement benefits the biomechanical performance of patients, revealed that ankle mechanics after surgery resembles that of unaffected ankles, but remain impaired compared to control subjects
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SPINELLI, MICHELE. « Experimental tribological investigations of articular bearings for lower limb prosthesis ». Doctoral thesis, 2009. http://hdl.handle.net/2158/590125.

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Madureira, António Luís Costa Mendes Barbosa. « Total ankle replacement - review article ». Master's thesis, 2020. https://hdl.handle.net/10216/128200.

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Madureira, António Luís Costa Mendes Barbosa. « Total ankle replacement - review article ». Dissertação, 2020. https://hdl.handle.net/10216/128200.

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Livres sur le sujet "Total Ankle Replacement (TAR)"

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Roukis, Thomas S., Christopher F. Hyer, Gregory C. Berlet, Christopher Bibbo et Murray J. Penner, dir. Primary and Revision Total Ankle Replacement. Cham : Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-69269-8.

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Roukis, Thomas S., Gregory C. Berlet, Christopher Bibbo, Christopher F. Hyer, Murray J. Penner, Markus Wünschel et Mark A. Prissel, dir. Primary and Revision Total Ankle Replacement. Cham : Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-24415-0.

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Saad, Amir Putra Bin Md, Ardiyansyah Syahrom, Muhamad Noor Harun et Mohammed Rafiq Abdul Kadir. Wear Prediction on Total Ankle Replacement. Cham : Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-21723-9.

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Roukis, Thomas S. Revision Total Ankle Replacement. Elsevier, 2013.

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Hintermann, Beat. Total Ankle Arthroplasty. Springer, 2005.

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Total Ankle Replacement : An Operative Manual. Lippincott Williams & Wilkins, 2014.

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7

Espinosa, Norman. Total Ankle Replacement, an Issue of Foot and Ankle Clinics. Elsevier - Health Sciences Division, 2012.

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Bibbo, Christopher, Thomas S. Roukis, Gregory C. Berlet, Christopher F. Hyer, Murray J. Penner, Markus Wünschel et Mark A. Prissel. Primary and Revision Total Ankle Replacement : Evidence-Based Surgical Management. Springer, 2015.

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9

Bibbo, Christopher, Thomas S. Roukis, Gregory C. Berlet, Christopher F. Hyer et Murray J. Penner. Primary and Revision Total Ankle Replacement : Evidence-Based Surgical Management. Springer International Publishing AG, 2022.

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Bibbo, Christopher, Thomas S. Roukis, Gregory C. Berlet, Christopher F. Hyer et Murray J. Penner. Primary and Revision Total Ankle Replacement : Evidence-Based Surgical Management. Springer London, Limited, 2016.

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Chapitres de livres sur le sujet "Total Ankle Replacement (TAR)"

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Saad, Amir Putra Bin Md, Ardiyansyah Syahrom, Muhamad Noor Harun et Mohammed Rafiq Abdul Kadir. « Wear of Total Ankle Replacement (TAR) ». Dans Wear Prediction on Total Ankle Replacement, 33–41. Cham : Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-21723-9_3.

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Saad, Amir Putra Bin Md, Ardiyansyah Syahrom, Muhamad Noor Harun et Mohammed Rafiq Abdul Kadir. « Contact Pressure of Total Ankle Replacement (TAR) ». Dans Wear Prediction on Total Ankle Replacement, 19–32. Cham : Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-21723-9_2.

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Cooke, Paul H., et Andy J. Goldberg. « Total Ankle Replacement ». Dans European Surgical Orthopaedics and Traumatology, 3705–23. Berlin, Heidelberg : Springer Berlin Heidelberg, 2014. http://dx.doi.org/10.1007/978-3-642-34746-7_240.

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Saghieh, Said. « Total Ankle Replacement ». Dans Operative Dictations in Orthopedic Surgery, 217–18. New York, NY : Springer New York, 2013. http://dx.doi.org/10.1007/978-1-4614-7479-1_60.

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Steginsky, Brian, et Steven L. Haddad. « Revision Total Ankle Replacement ». Dans Revision Surgery of the Foot and Ankle, 335–59. Cham : Springer International Publishing, 2019. http://dx.doi.org/10.1007/978-3-030-29969-9_20.

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Schneiderbauer, Michaela Maria. « Total Ankle Replacement Infections ». Dans Infected Total Joint Arthroplasty, 249–53. London : Springer London, 2012. http://dx.doi.org/10.1007/978-1-4471-2482-5_21.

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DeOrio, James K., James A. Nunley, Mark Easley et Victor Valerrabano. « Vantage Total Ankle Replacement ». Dans Primary and Revision Total Ankle Replacement, 151–63. Cham : Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-69269-8_13.

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Boffeli, Troy J., Stephen A. Brigido, W. Bret Smith et Anson K. Chu. « STAR Total Ankle Replacement ». Dans Primary and Revision Total Ankle Replacement, 211–34. Cham : Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-69269-8_16.

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Daniels, Timothy R., et Sagar J. Desai. « Total Ankle Replacement Versus Ankle Arthrodesis ». Dans Primary and Revision Total Ankle Replacement, 41–52. Cham : Springer International Publishing, 2015. http://dx.doi.org/10.1007/978-3-319-24415-0_5.

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Habib, Anthony, Monther Abuhantash, Kevin Wing et Andrea Velkjovic. « Total Ankle Replacement Versus Ankle Arthrodesis ». Dans Primary and Revision Total Ankle Replacement, 37–49. Cham : Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-69269-8_4.

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Actes de conférences sur le sujet "Total Ankle Replacement (TAR)"

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Dharia, Mehul A., Jeff E. Bischoff, Duane Gillard, Fred Wentorf et Matt Mroczkowski. « Impact of Articulation Geometry on Contact Mechanics in Total Ankle Replacement Design ». Dans ASME 2011 Summer Bioengineering Conference. American Society of Mechanical Engineers, 2011. http://dx.doi.org/10.1115/sbc2011-53107.

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Total ankle replacement designs have evolved since their introduction in the mid 1970s. While the first-generation total ankle replacement (TAR) designs had unacceptably high failure rates, recent designs have demonstrated improved outcomes [1]. Two philosophies are commonly used in TAR design: mobile-bearing and fixed-bearing. Unlike mobile-bearing designs which have two articulating surfaces, fixed-bearing designs have only one articulating surface. While fixed-bearing designs have lower risk of dislocation than mobile-bearing designs, the single articulation feature can produce higher contact stress on the articulating surface, increasing the potential for polyethylene wear [1, 2].
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Handoko, Budi Basuki et Rini Dharmastiti. « Numerical Study on the Effects of Coefficient of Friction to the Dynamic Sliding Contact between Bearing and Talar Components of Metal on Polymer Total Ankle Replacement Implants ». Dans International Conference on Mechanical Engineering. Switzerland : Trans Tech Publications Ltd, 2023. http://dx.doi.org/10.4028/p-s80w27.

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Coefficient of friction (cof) is an important variable when dealing with con-tact between mechanical parts. It depends on various tribological variables and the value can be determined only by experiments. Cof correlates with the wear of material and this is a severe problem in biomedical engineering. This research numerically studied the effects of cof between talar and bear-ing in the total ankle replacement (TAR) implants. The aim is to evaluate the contact situations affected by cof. The TAR models consist of cobalt chrome (CoCr) alloy and ultra high molecular weight polyethylene (UHMWPE) bio-materials. Five cof values of the dry, lubricated and frictionless TAR me-chanical contacts under ankle gait load were examined. The models use a fixed 1 mm element size for UHMWPE bearing component and four element sizes for the talar component, range from 1 mm to 0.4 mm. Results show that, 1) higher cof induces higher contact pressure, 2) contact stress is not af-fected by cof, 3) proper talar element size is 0.4 mm and 4) frictionless model can be used for the TAR contact mechanic computation. Frictionless model calculates equal contact stress and lower contact pressures with an error of 2.68 % compared to the smooth model.
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Serrano, Marco V. Bedoya, et Paola Vega-Castillo. « Finite element analysis of MEMS flexible pressure sensor for total ankle replacement ». Dans 2016 IEEE 36th Central American and Panama Convention (CONCAPAN XXXVI). IEEE, 2016. http://dx.doi.org/10.1109/concapan.2016.7942351.

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Mussawy, H., A. Strahl, T. Rolvien et A. Strauss. « Clinical and patient reported outcome of total ankle replacement compared to ankle fusion in end-stage heamophilic arthropathy ». Dans Deutscher Kongress für Orthopädie und Unfallchirurgie. Georg Thieme Verlag KG, 2020. http://dx.doi.org/10.1055/s-0040-1717389.

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Smolinski, Patrick, Karol Galik, Stephen Conti et Mark C. Miller. « The Effect of Talar Component Design on Talar Stresses in Total Ankle Arthroplasty ». Dans ASME 2001 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 2001. http://dx.doi.org/10.1115/imece2001/bed-23049.

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Abstract Total ankle arthroplasty offers an alternative to ankle arthrodesis or fusion in the treatment of diseases of the ankle. Due to the high complication rate in early designs, ankle replacement components have not evolved into any accepted standard form and several widely varying designs are currently in use.
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McIff, Terence E., Charles L. Saltzman et Thomas D. Brown. « Assessment of Orientation-Dependent Torsional Constraints Provided by a Contemporary Total Ankle Replacement ». Dans ASME 1999 International Mechanical Engineering Congress and Exposition. American Society of Mechanical Engineers, 1999. http://dx.doi.org/10.1115/imece1999-0425.

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Abstract This paper describes torsional testing on the components of a unique total ankle design, to establish the range and conditions of torsional constraint. For this design, the torsional constraint was found to be dependent on the relative flexion and inversion angles between components. Dorsiflexion provides greater torsional stability than plantarflexion. The maximum torque values were recorded at 25 degrees of dorsiflexion with no relative inversion. Under these conditions, and with a weight bearing load of 1200 N, the ankle resisted 2200 N-mm at 5 degrees of rotation and 3300 N-mm at 15 degrees of rotation. Torsional stability decreased as the relative inversion or eversion of the components increased. When the components were inverted more than a few degrees, the initial rotational stiffness became negligible.
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Coppola, A., G. Platania, S. Gitto, M. C. Cortese, D. Albano, C. Messina et L. M. Sconfienza. « Precision of Periprosthetic Bone Mineral Density Around Total Ankle Replacement Using Dual-Energy X-ray Absorptiometry ». Dans 26th Annual Scientific Meeting of the European Society of Musculoskeletal Radiology (ESSR). Georg Thieme Verlag KG, 2019. http://dx.doi.org/10.1055/s-0039-1692563.

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McIff, Terence E., et Greg A. Horton. « Finite Element Modeling of Ankle Joint Replacement Incorporating Subject-Specific Soft Tissue Constraints for Prediction of Intercomponent Motion and Loading ». Dans ASME 2004 International Mechanical Engineering Congress and Exposition. ASMEDC, 2004. http://dx.doi.org/10.1115/imece2004-60010.

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This paper describes the use of finite element modeling methods to predict intercomponent sliding, rotation, constraint, and contact mechanics in a total ankle replacement device. Ligaments are modeled to constrain motion occurring during physiologic loading and articulation over a full gait cycle.
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Baer, Thomas, Ryan Frisbie, Michael Willey et Jessica Goetz. « Development of a Simplified Ankle Distractor ». Dans 2017 Design of Medical Devices Conference. American Society of Mechanical Engineers, 2017. http://dx.doi.org/10.1115/dmd2017-3438.

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The physical impairment caused by OA of a single lower extremity joint is comparable to that reported for major life-altering disorders such as end-stage kidney disease and heart failure. (Buckwalter, et al) [1] Ankle distraction arthroplasty has been shown to greatly decrease pain due to end-stage ankle arthritis. Unlike arthrodesis (fusion of the joint), distraction arthroplasty maintains the joint’s natural movement, and it is far less complicated than total joint replacement surgery. There is a considerable body of research supporting the idea that distraction of an end-stage arthritic joint (most of the work thus far has been done on ankles, although there has also been some investigation of the efficacy of the treatment for knee arthritis) for a period of weeks allows the growth of new tissue in the joint. Although this tissue is not true articular cartilage, distraction arthroplasty has been shown to significantly decrease pain and, in the majority of cases, to be a long lasting remedy for a condition that would otherwise commonly be treated with arthrodesis. [2] Devices currently available for this procedure are generally quite complicated because they are designed for a wide range of functions related to bone fixation. This versatility also tends to make those systems larger and more expensive, and their aggressively mechanical appearance makes potential joint distraction patients hesitant to select the procedure. While fracture patients may not have a choice about being treated with such devices, elective patients are instinctively resistant to their use, even when assured that the end result will most likely significantly improve in the quality of their lives.
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