Articles de revues : « Total Ankle Replacement (TAR) »

1

Ruiz, Roxa, Lukas Zwicky et Beat Hintermann. « Syndesmotic Instability After Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 3, n^o 3 (1 juillet 2018) : 2473011418S0010. http://dx.doi.org/10.1177/2473011418s00103.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

2

Weber, Stephen, et James Ficke. « Cementless Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 3, n^o 3 (1 juillet 2018) : 2473011418S0051. http://dx.doi.org/10.1177/2473011418s00512.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

3

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, n^o 4 (octobre 2022) : 2473011421S0073. http://dx.doi.org/10.1177/2473011421s00736.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

4

Rodriguez-Merchan, Emerito C. « Total Ankle Replacement in Hemophilia ». Cardiovascular & ; Hematological Disorders-Drug Targets 20, n^o 2 (14 juin 2020) : 88–92. http://dx.doi.org/10.2174/1871529x19666191210110626.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

5

Gross, Christopher E., Federico Guiseppe Usuelli et Christian Indino. « Hindfoot Alignment after Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 5, n^o 2 (1 avril 2020) : 2473011420S0000. http://dx.doi.org/10.1177/2473011420s00007.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

6

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, n^o 1 (janvier 2022) : 2473011421S0002. http://dx.doi.org/10.1177/2473011421s00022.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

7

Gross, Christopher, Luigi Manzi, Cristian Indino, Fausto Romano, Camilla Maccario et Federico Giuseppe Usuelli. « Hindfoot Alignment after Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 4, n^o 4 (1 octobre 2019) : 2473011419S0018. http://dx.doi.org/10.1177/2473011419s00189.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

8

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, n^o 3 (1 juillet 2018) : 2473011418S0005. http://dx.doi.org/10.1177/2473011418s00052.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

9

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, n^o 4 (1 octobre 2020) : 2473011420S0024. http://dx.doi.org/10.1177/2473011420s00240.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

10

Sokolowski, Marc, Lukas Zwicky, Christine Schweizer et Beat Hintermann. « Subtalar Joint Arthritis After Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 3, n^o 3 (1 juillet 2018) : 2473011418S0011. http://dx.doi.org/10.1177/2473011418s00114.

Texte intégral

Résumé :

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.

Styles APA, Harvard, Vancouver, ISO, etc.

11

Noori, Naudereh B., Jessica Yi Ouyang, Mohammad Noori et Wael A. Altabey. « A Review Study on Total Ankle Replacement ». Applied Sciences 13, n^o 1 (30 décembre 2022) : 535. http://dx.doi.org/10.3390/app13010535.

Texte intégral

Résumé :

Total ankle replacement (TAR) is the replacement of a damaged arthritic ankle joint with a prosthetic implant to eliminate the source of resultant pain and swelling. Historically, however, the ankle joint has been one of the most difficult joints to analyze and replicate for successful replacement due to its complex anatomy and multiplanar motion. Ankle fusion, the standard of care for end stage ankle arthritis, has excellent functional outcomes but results in loss of motion at the joint. TAR was first attempted in the 1970s and by the early 1990s, prosthesis designs more closely mirrored the natural anatomy of the ankle and TAR was no longer considered an experimental procedure. Although the outcomes of TAR have significantly improved over this short period of time, there are still many areas that warrant further investigation including (1) optimal patient selection, (2) number of prosthesis components, (3) bearing type, (4) revision rates and causes and (5) comprehensive finite element models (FEM) of the ankle. The main goal of this paper is to present a literature review on the background and evolution of TAR, the current state of practice and prosthesis types and challenges and directions for future improvement.

Styles APA, Harvard, Vancouver, ISO, etc.

12

Brooks, Charles N. « Left Page : Rating Total Ankle Replacement ». Guides Newsletter 10, n^o 3 (1 mai 2005) : 4–5. http://dx.doi.org/10.1001/amaguidesnewsletters.2005.mayjun02.

Texte intégral

Résumé :

Abstract Total ankle replacement (TAR), also known as total ankle arthroplasty, has been used since the early 1970s, but, because of improvements in both techniques and materials, the procedure is used more frequently, and examiners are asked to rate permanent impairment resulting from TAR. The AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) is silent about rating ankle impairment following arthroplasty but does provide a two-step method to rate the results of total hip and knee replacements. Using tables in the AMA Guides, examiners can rate disability associated with TAR. To provide a standard method for reporting the clinical status of the ankle and foot, the American Orthopaedic Foot and Ankle Society (AOFAS) published rating scales for four anatomic regions, one of which (the ankle-hindfoot scale), can be used to rate the clinical status of ankle, subtalar, talonavicular, and calcaneocuboid joints before and after treatment. The AOFAS scale includes neither patient satisfaction nor many other functional, physical, and radiographic findings, and the AOFAS ankle-hindfoot scale is not and never was intended to be comprehensive. Examiners can follow the same procedures for rating hip and knee replacements, substituting the AOFAS scale for rating clinical outcomes. [Two Quick References in this issue of The Guides Newsletter provide tables and figures relevant to rating upper extremity sensory and motor deficits and to measuring impairments of the hand and digits.]

Styles APA, Harvard, Vancouver, ISO, etc.

13

Ruiz, Roxa, Peter Kvarda, Roman Susdorf, Nicola Krähenbühl, Alexej Barg et Beat Hintermann. « Syndesmotic Overload in 3-Component Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 7, n^o 1 (janvier 2022) : 2473011421S0042. http://dx.doi.org/10.1177/2473011421s00421.

Texte intégral

Résumé :

Category: Ankle; Ankle Arthritis; Other Introduction/Purpose: Mobile-bearing total ankle replacement (TAR) potentially enables motion at the tibial implant- polyethylene insert (PI) interface. Such additional freedom of movement may overload periarticular ligaments and subsequently result in coronal translation of the talus. The aim of this study was to assess whether syndesmotic overload affects clinical and radiographic outcomes following mobile-bearing TAR and whether tibiofibular fusion is an effective treatment option. Methods: Thirty-one patients who underwent revision surgery for syndesmotic overload after mobile-bearing TAR were retrospectively analyzed. Clinical and radiographic outcome, including computed tomography scans, were assessed before and after index TAR, preoperatively to revision surgery, and at the last follow-up after revision surgery. Additionally, available computed tomography scans were analyzed. Results: Ankles with lateral talar translation prior to revision surgery were about 10 times more likely to have valgus tibial implant position (P =.003). A wide tibiofibular distance at the level of the syndesmosis after index TAR was associated with an increased hindfoot moment arm at revision surgery (P =.025). Decrease of PI height at revision surgery and a PI fracture were evident in 10 (32%) and 4 (13%) cases, respectively. Talar cyst formation at revision surgery was evident in 12 (39%) cases. Tibiofibular fusion was effective in restoring function of the replaced ankle and providing pain relief. Conclusion: Syndesmotic overload impaired clinical and radiographic outcomes after mobile-bearing TAR. Proper implant positioning and additional realignment procedures may prevent overload of periarticular soft tissue structures after mobile-bearing TAR.

Styles APA, Harvard, Vancouver, ISO, etc.

14

Richman, Seth, Tyler Rutherford, Timothy Rearick, John T. Campbell, Rebecca Cerrato et Clifford Jeng. « Comparing Sports Activity Following Total Ankle Replacement Versus Ankle Arthrodesis ». Foot & ; Ankle Orthopaedics 2, n^o 3 (1 septembre 2017) : 2473011417S0003. http://dx.doi.org/10.1177/2473011417s000338.

Texte intégral

Résumé :

Category: Ankle, Ankle Arthritis, Sports Introduction/Purpose: Total ankle replacement (TAR) and ankle arthrodesis (AA) are two common surgical treatment modalities for end stage tibiotalar arthritis. A key deciding point between the two is anticipated functional outcome postoperatively, especially in regards to sports related activities. However, there is a paucity of data available to help advise patients in their decision making. While TAR provides a theoretical benefit of improved functionality, the outcomes of several European studies have shown mixed results. These studies are limited by small sample size, obsolete TAR implants not used in the United States, and nonspecific outcome measures. The purpose of this study was to compare postoperative sports activity levels following modern TAR and AA in a U.S. population, which may benefit surgical decision making and guide patient expectations. Methods: We conducted a retrospective comparative study that consisted of patients who underwent a TAR (N=62) or AA (N=51) between 2009-2015. The mean age of the arthrodesis group was 57.7 years ± 12.12 (28.84-85.26). There were 27 male participants and 24 female participants. The TAR group had 31 male and 31 female participants with a mean age of 64.9 years ± 8.57 (45-79.6). Exclusion criteria included paralysis, rheumatoid arthritis, revision surgery, incomplete pre- and post-operative scores, and follow up less than 2 years. General health and foot-ankle function were assessed using the SF-12 Health Survey and the revised Foot Function Index (FFI-R) preoperatively and at final follow-up. In addition, activity levels were assessed using a Return to Activities Following Surgery questionnaire that was administered at final follow up. This form included a Visual Analog Scale for Pain, satisfaction questions, and a list of 25 activities. Patients were asked to record their current level of activity, ability to participate pre- and post-surgery, and whether their desired level was met. All three measurements tools were compared between both treatment groups. Results: The SF-12 physical score both groups significantly increased postoperatively from 33.18 ± 10.37 to 43 ± 10.32 for AA’s and from 32.88 ± 9.44 to 45.81 ± 12.94 (p < 0.001) for TAR’s. The FFI scores showed a significant increase in both groups (p < 0.001). In the AA group, 88% of patients returned to work and would repeat the surgery, compared to 92% of patients in the TAR group. In terms of satisfaction and pain, the TAR group was more satisfied (1.78 vs. 1.44) and had less postoperative pain (1.32 vs. 2.56 p < 0.05). The AA group reported a significant increase in six activities including: golf (p < 0.05), weight lifting, and walking (p<0.001), while the TAR group reported significant increase in 15 activities, including hiking, tennis, and yoga (p<0.001). Conclusion: Our study revealed a significant increase in general physical function, foot function, and activity level in both groups. The TAR group was able to perform a wider range of activity and sports compared to the AA group. Overall, TAR patients were significantly more satisfied with their procedure compared to AA patients.

Styles APA, Harvard, Vancouver, ISO, etc.

15

Manzi, Luigi, Cristian Indino, Camilla Maccario, Claudia Di Silvestri, Riccardo D’Ambrosi et Federico Giuseppe Usuelli. « Total ankle replacement and simultaneous subtalar arthrodesis ». Foot & ; Ankle Orthopaedics 2, n^o 3 (1 septembre 2017) : 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000279.

Texte intégral

Résumé :

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Patients with arthritis or severe dysfunction involving both the ankle and the subtalar joints can benefit tibiotalocalcaneal (TTC) arthrodesis or total ankle replacement and subtalar fusion. With the evolution of prosthetic design and surgical techniques, total ankle replacement (TAR) has become a reasonable alternative to arthrodesis. The aim of this study was to investigate the fusion rate of the subtalar joint and talonavicular joint in patients simultaneously treated with total ankle replacement (TAR) and subtalar joint fusion. Methods: This study includes 11 patients who underwent primary TAR and simultaneous subtalar and talonavicular fusion from May 2011 to January 2015. Six males and five females were enrolled with a mean age of 61 years (41-75). Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively. Total follow-up time was 24.2±11.6 months. Radiographic examination included a postoperative CT scan obtained 12 months after surgery. Three surgeons independently reviewed the CT scans and interobserver reliability was calculated. Functional scores were also assessed. Results: At 12 months postoperatively, the subtalar fusion rate in patients treated with TAR and simultaneous subtalar fusion was 92% and the talonavicular fusion rate was 88%. There was a statistically significant increase in American Orthopedic Foot & Ankle Society ankle/hindfoot score from 25.9 to 74.1 at 12 months post-operatively. Ankle range of motion significantly increased from 10.2° to 30.8 degrees. Additionally, there was a statistically significant decrease in visual analog scale (VAS) pain score from 8.8 to 1.9. Conclusion: TAR and simultaneous subtalar and talonavicular joint fusion are reliable procedures for the treatment of ankle and subtalar joint arthritis. Furthermore, CT scans showed an excellent reliability among orthopaedic surgeons in determining the degree of successful fusion of subtalar and talonavicular arthrodesis.

Styles APA, Harvard, Vancouver, ISO, etc.

16

Baumfeld, Daniel, André V. Lemos, César E. Martins et Caio A. Nery. « Brazilian Total Ankle Replacement Experience ». Foot & ; Ankle Orthopaedics 5, n^o 4 (1 octobre 2020) : 2473011420S0011. http://dx.doi.org/10.1177/2473011420s00116.

Texte intégral

Résumé :

Category: Ankle Arthritis Introduction/Purpose: Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early TAR generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience, Brazilian surgeon could not participate in the development of the technique and implants designs during all these years. This paper present the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed. Methods: Data since the first series of TARs in Brazil were colect from university institution, personal data base from surgeons and previous publication, survivalship, complications, number of each implant and implant availability were recorded. Results: In Brazil, indications for TAR are not so different from around the world, the data we had access demonstrate 65% of post-traumatic arthritis, 26 % of inflammatory arthritis, 2% post-infectious arthritis and 7 % of primary arthritis. In fortheen years 263 surgeries were performed, in different parts of the country, but only one surgeon performed 43 cases (27,3% of the total). Table 1 demonstrate the number of procedures performed per year. Survivor rate of each implant available in the country in the first year were 94%, 86,19% in the second year, 82,84% in the third year, 81,62% in the fourth year and 71,47% in the fifth year. Conclusion: In Brazil there are limited and different ankle arthroplasty systems available for use. The procedure itself continues to be technically demanding and require surgical sophistication and expertise. A national registry to justify the procedure indication; report the outcomes and survivorship has not been developed. This procedure is growing around the county, as well as the surgeon experience, but we should remember that TAR is not for every patient and that the appropriate indication, based on the evidence available, is fundamental to obtaining durable and predictable outcomes. [Table: see text]

Styles APA, Harvard, Vancouver, ISO, etc.

17

Benedetti, Maria Grazia, Alberto Leardini, Matteo Romagnoli, Lisa Berti, Fabio Catani et Sandro Giannini. « Functional Outcome of Meniscal-Bearing Total Ankle Replacement ». Journal of the American Podiatric Medical Association 98, n^o 1 (1 janvier 2008) : 19–26. http://dx.doi.org/10.7547/0980019.

Texte intégral

Résumé :

Background: Most clinical studies on total ankle replacement (TAR) report assessments based on traditional clinical scores or radiographic analysis. Only a few studies have used modern instrumentation for quantitative functional analysis during the execution of activities of daily living. The aim of this study was to use gait analysis to compare the functional performance of patients who underwent TAR versus a control population. Methods: A retrospective analysis was performed of ten consecutive patients who had undergone meniscal-bearing TAR. Clinical and functional assessments were performed at a mean follow-up of 34 months with a modified Mazur scoring system and state-of-the-art gait analysis. Results: Gait analysis assessment of TAR at medium-term follow-up showed satisfactory results for all patients, with adequate recovery of range of motion. Because the literature reports unsatisfying long-term results, it is important to evaluate these patients over a longer follow-up period. Conclusions: This study showed that TAR yields satisfactory, but not outstanding, general functional results at nearly 3 years’ follow-up. These gait analysis results highlight the importance of integrating in vivo measurements with the standard clinical assessments of patients who underwent TAR while they perform activities of daily living. These results also emphasize the importance of evaluating the functional outcome of TAR over time. (J Am Podiatr Med Assoc 98(1): 19–26, 2008)

Styles APA, Harvard, Vancouver, ISO, etc.

18

Ruiz, Roxa, Roman Susdorf, Nicola Krähenbühl, Alexej Barg et Beat Hintermann. « Syndesmotic Overload in 3-Component Total Ankle Replacement ». Foot & ; Ankle International 41, n^o 3 (17 décembre 2019) : 275–85. http://dx.doi.org/10.1177/1071100719894528.

Texte intégral

Résumé :

Background: Mobile-bearing total ankle replacement (TAR) potentially enables motion at the tibial implant–polyethylene insert (PI) interface. Such additional freedom of movement may overload periarticular ligaments and subsequently result in coronal translation of the talus. The aim of this study was to assess whether syndesmotic overload affects clinical and radiographic outcomes following mobile-bearing TAR and whether tibiofibular fusion is an effective treatment option. Methods: Thirty-one patients who underwent revision surgery for syndesmotic overload after mobile-bearing TAR were retrospectively analyzed. Clinical and radiographic outcomes were assessed before and after index TAR, preoperatively to revision surgery, and at the last follow-up after revision surgery. Computed tomography scans were also analyzed. Results: Ankles with lateral talar translation prior to revision surgery were about 10 times more likely to have valgus tibial implant position ( P = .003). A wide tibiofibular distance at the level of the syndesmosis after index TAR was associated with an increased hindfoot moment arm at revision surgery ( P = .025). Decrease of PI height at revision surgery and a PI fracture were evident in 10 (32%) and 4 (13%) cases, respectively. Talar cyst formation at revision surgery was evident in 12 (39%) cases. Tibiofibular fusion was effective in restoring function of the replaced ankle and providing pain relief. Conclusion: Syndesmotic overload impaired clinical and radiographic outcomes after mobile-bearing TAR. Proper implant positioning and additional realignment procedures may prevent overload of periarticular soft tissue structures after mobile-bearing TAR. Level of Evidence: Level IV, retrospective case series.

Styles APA, Harvard, Vancouver, ISO, etc.

19

Gaugler, Mario, Beat Hintermann et Christine Schweizer. « The Effect of Age in Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 3, n^o 3 (1 juillet 2018) : 2473011418S0005. http://dx.doi.org/10.1177/2473011418s00055.

Texte intégral

Résumé :

Category: Ankle Introduction/Purpose: Over the last decades, total ankle replacement (TAR) emerged as a reliable treatment option in end-stage ankle osteoarthritis (OA) while preserving motion and physiological load. As these are strong arguments for TAR from an active patient’s perspective, it appears obvious that young patients show great interest in it. In the late 90s, 2nd generation implants showed a high revision rate, which has led to great cautiousness for TAR in young and active patients. Despite recently published data on 3rd generation implants showed a comparable outcome within different age groups, the question to debate remains whether TAR is advised in younger patients. The purpose of this study was to compare the clinical outcome and revision rate after TAR in patients younger and older than 50 years. Methods: A consecutive series of 813 primary TARs (3rd generation HINTEGRA, 446 male, 367 female), performed between May 2003 and December 2013, were enrolled. 129 patients (16%) were younger than 50 years and 784 (84%) were older than 50 years at time of surgery. The clinical outcome (AOFAS hindfoot score) and survivorship (revision of a metallic component as endpoint, or ankle fusion) of patients aged <50 years and ≥50 years at the time of surgery were compared. Results: Posttraumatic OA as indication for a TAR was more common in the younger cohort (81 vs. 78%) and the mean follow-up time was slightly longer (5.6 vs. 5.0 years). Younger patients had a significantly lower preoperative AOFAS score (39 vs. 44). Both groups showed an identical clinical improvement that resulted in a lower total AOFAS score (66 vs. 71) in the younger group at last follow-up. Overall, a total of 81 ankles (10%) were revised (13 patients <50 years, 68 patients ≥50 years). In 62 ankles (77%) a revision of a metallic component, in 19 ankles (23%) a conversion to ankle fusion was performed. The estimated 10-year revision rate was 15.7% for patients aged > 50 years and 18.4% for patients aged ≥ 50 years. Conclusion: Beside of the higher incidence of posttraumatic OA in younger cohort, the high activity level and biomechanical demands may lead to a greater subjective limitation, which explains their significantly lower baseline AOFAS score. However, both groups showed similar clinical improvement and overall revision rates. Our findings support and back up recently published data from 3rd generation TARs to be an effective and reliable treatment option in end-stage ankle OA in young patients. However, a long-term follow-up and individual analysis of all failures leading to revision is of high importance.

Styles APA, Harvard, Vancouver, ISO, etc.

20

Ramaskandhan, Jayasree, Anjum Rashid, Simon Kometa et Malik S. Siddique. « Comparison of 5-Year Patient-Reported Outcomes (PROMs) of Total Ankle Replacement (TAR) to Total Knee Replacement (TKR) and Total Hip Replacement (THR) ». Foot & ; Ankle International 41, n^o 7 (5 mai 2020) : 767–74. http://dx.doi.org/10.1177/1071100720918880.

Texte intégral

Résumé :

Background: Total ankle replacement (TAR) is becoming a more common alternative to ankle arthrodesis for the improvement of pain and function in end-stage arthritis of the ankle. The effects of end-stage arthritis of the ankle are similar to those of end-stage hip arthritis. There is a paucity of literature on patient-reported outcome measures (PROMs) following TARs in comparison with total hip replacement (THR) or total knee replacement (TKR). We aimed to study the 1-, 3-, and 5-year outcomes of TAR in comparison with TKR and THR. Methods: PROMs data from patients who underwent a primary THR, TKR, or TAR performed between March 2008 and 2013 over a 5-year period were collected from our hospital patient registry. They were divided into 3 groups based on the type of primary joint replacement. Patient demographics and patient-reported outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], 36-item Short-Form (SF-36) scores, and patient satisfaction scores at follow-up) were compared preoperatively and at the 1-, 3-, and 5-year follow-ups. Results: There were data available on 2672 THR, 3520 TKR, and 193 TAR patients preoperatively. Preoperatively, TAR patients reported statistically significantly higher function scores when compared with THR and TKR patients (40 vs 33; P = .001 [ P < .05] and 40 vs 36; P = .001 [ P < .05]). For SF-36 scores, there was no statistically significant difference between groups for the general health and role emotional components ( P = .171 and .064, respectively [ P > .05]); TAR patients reported similar scores to TKR patients for physical domains at the 3- and 5-year follow-ups ( P > .05), and TAR patients also reported similar scores to both THR and TKR patients for the mental domains ( P > .05). At 5 years postoperatively, TAR patients reported lower scores than THR and TKR patients for function and stiffness. For SF-36 scores, TAR patients reported similar outcomes to THR and TKR patients for mental health components ( P > .05), similar scores to TKR patients for 3 of 4 physical domains ( P < .05), but lower satisfaction rates for activities of daily living (ADL) and recreation when compared with THR ( P < .05). Conclusion: TAR patients had similar outcomes to THR and TKR patients for disease-specific and mental health domains, and lower patient satisfaction rates in terms of pain relief, ADL, and recreation. Further research is warranted including clinical outcomes along with PROMs with a long-term follow-up. Level of Evidence: Level III, retrospective comparative series.

Styles APA, Harvard, Vancouver, ISO, etc.

21

Ruiz, Roxa, Nicola Krähenbühl, Alexej Barg et Beat Hintermann. « Ankle Range of Motion after Total Ankle Replacement with and without Heel Cord Lengthening ». Foot & ; Ankle Orthopaedics 4, n^o 4 (1 octobre 2019) : 2473011419S0036. http://dx.doi.org/10.1177/2473011419s00367.

Texte intégral

Résumé :

Category: Ankle, Ankle Arthritis Introduction/Purpose: Though total ankle replacement (TAR) has become a well-accepted alternative to fusion for treatment of end-stage ankle osteoarthritis (OA), controversy still exists regarding the appropriate indications. In 80% of the cases, trauma accounts for the primary cause of end-stage ankle OA. In these cases, the soft tissue conditions are often poor and the remaining ankle range of motion (ROM) limited. Additionally, performing a heel cord lengthening (HCL) should theoretically increase ankle ROM. However, it remains unclear to which extent a preoperative stiff ankle can become mobile after a TAR, with or without a HCL. The purpose of this study was to assess the gained ROM after TAR in end-stage ankle OA, and whether it is beneficial for patients who additionally underwent a HCL. Methods: Out of 605 primary TAR performed at our institution between 2006 and 2015, 288 ankles (280 patients; age 64.1 [39 – 88]; male, 151; female, 129) were identified with a neutral hindfoot alignment, no degenerative changes or previous fusions of adjacent joints, and no previous ligament reconstruction and tendon transfers at time of TAR. Medial and lateral gutter debridement as well as a complete posterior capsule resection was performed before the prosthesis was inserted. The ankle was then gradually mobilized into dorsiflexion. If a minimum of 10° dorsiflexion could not be obtained, HCL was performed (percutaneous triple hemisection). Postoperatively, the ankle was protected by a walker and weight-bearing was permitted as tolerated. ROM was determined during weight-bearing with the use of a goniometer preoperatively and 2-years postoperatively. Pearson correlation analysis and paired t-test were used for statistical analysis. Results: Out of 288 ankles, 41 (14.2%) underwent additional HCL. Preoperative ROM correlated with the ROM 2-years after TAR, independent whether a HCL was performed (p < 0.01) or not (p < 0.01). ROM for the ankles where no HCL was performed was 35° preoperatively and 34° 2-years postoperatively. For the ankles in which a HCL was performed, it was 28° preoperatively and 28° 2-years postoperatively. Pearson correlation analysis showed that patients with a low ROM preoperatively tended to get more motion after TAR, whereas patients with an extensive preoperative ROM even lost some motion after receiving a TAR system (Figure 1). Conclusion: The data suggests that a HCL procedure has little potential to ameliorate a preoperative low ROM. A TAR system however, may help increase the ROM in patients with little preoperative ROM while in patients with extensive preoperative ROM it may even cause a loss of ROM. The data further suggests that the heel cord contracture is not the only cause of limited motion in end-stage ankle OA, and that whether TAR nor TAR in combination with HCL should be performed with the goal of gaining ROM for the treatment of end-stage OA.

Styles APA, Harvard, Vancouver, ISO, etc.

22

Sokolowski, Marc, Nicola Krähenbühl, Chen Wang, Lukas Zwicky, Christine Schweizer, Tamara Horn Lang et Beat Hintermann. « Secondary Subtalar Joint Osteoarthritis Following Total Ankle Replacement ». Foot & ; Ankle International 40, n^o 10 (22 juillet 2019) : 1122–28. http://dx.doi.org/10.1177/1071100719859216.

Texte intégral

Résumé :

Background:An advantage of total ankle replacement (TAR) compared to ankle fusion is that by maintaining motion, the occurrence of hypermobility of adjacent joints may be prevented. This could affect the development of symptomatic subtalar joint osteoarthritis (OA). The aim of the study was to determine the incidence of subtalar joint fusion and the progression of subtalar joint OA following TAR.Methods:Secondary subtalar joint fusion rate was determined from a cohort of 941 patients receiving primary TAR between 2000 and 2016. The indication for fusion, the time interval from primary TAR to fusion, and the union rate were evaluated. To assess the progression of subtalar joint OA, degenerative changes of the subtalar joint were classified in 671 patients using the Kellgren-Lawrence score (KLS) prior to TAR and at latest follow-up.Results:In 4% (37) of the patients, a secondary subtalar joint fusion was necessary. The indication for fusion was symptomatic OA in 51% (19), hindfoot instability in 27% (10), osteonecrosis of the talus in 19% (7), and cystic changes of the talus in 3% (1) of the patients. Time from primary TAR to subtalar joint fusion due to progressive OA was 5.0 (range, 0.3-10) years and for other reasons 1.6 (range, 0.2-11.6) years ( P = .3). In 68% (456) of the patients, no progression of subtalar joint OA was observed.Conclusion:The incidence of secondary subtalar joint fusion was low. The most common reason for subtalar joint fusion following TAR was symptomatic OA.Level of Evidence:Level IV, case series.

Styles APA, Harvard, Vancouver, ISO, etc.

23

Najefi, Ali-Asgar, Yaser Ghani et Andy Goldberg. « Role of Rotation in Total Ankle Replacement ». Foot & ; Ankle International 40, n^o 12 (12 août 2019) : 1358–67. http://dx.doi.org/10.1177/1071100719867068.

Texte intégral

Résumé :

Background: The importance of total ankle replacement (TAR) implant orientation in the axial plane is poorly understood with major variation in surgical technique of implants on the market. Our aim was to better understand the axial rotational profile of patients undergoing TAR. Methods: In 157 standardized computed tomography (CT) scans of patients with end-stage ankle arthritis planning to undergo primary TAR surgery, we measured the relationship between the knee posterior condylar axis, the tibial tuberosity, the transmalleolar axis (TMA), and the tibiotalar angle. The foot position was measured in relation to the TMA with the foot plantigrade. The variation between the medial gutter line and the line bisecting both gutters was assessed. Results: The mean external tibial torsion was 34.5 ± 10.3 degrees (11.8-62 degrees). When plantigrade, the mean foot position relative to the TMA was 21 ± 10.6 degrees (0.7-38.4 degrees) internally rotated. As external tibial torsion increased, the foot position became more internally rotated relative to the TMA (Pearson correlation, 0.6; P < .0001). As the tibiotalar angle became more valgus, the foot became more externally rotated relative to the TMA (Pearson correlation, −0.4; P < .01). The mean difference between the medial gutter line and a line bisecting both gutters was 4.9 ± 2.8 degrees (1.7-9.4 degrees). More than 51% of patients had a difference greater than 5 degrees. The mean angle between the medial gutter line and a line perpendicular to the TMA was 7.5 ± 2.6 degrees (2.8-13.7 degrees). Conclusion: There was a large variation in rotational profile of patients undergoing TAR, particularly between the medial gutter line and the TMA. Surgeon designers and implant manufacturers should develop consistent methods to guide surgeons toward judging the appropriate axial rotation of their implant on an individual basis. We recommend careful clinical assessment and preoperative CT scans to enable the correct rotation to be determined. Level of Evidence: Level IIc, outcomes research.

Styles APA, Harvard, Vancouver, ISO, etc.

24

Seo, Sang Gyo, Eo Jin Kim, Doo Jae Lee, Kee Jeong Bae, Kyoung Min Lee et Dong Yeon Lee. « Comparison of Multisegmental Foot and Ankle Motion Between Total Ankle Replacement and Ankle Arthrodesis in Adults ». Foot & ; Ankle International 38, n^o 9 (6 juin 2017) : 1035–44. http://dx.doi.org/10.1177/1071100717709564.

Texte intégral

Résumé :

Background: Total ankle replacement (TAR) and ankle arthrodesis (AA) are usually performed for severe ankle arthritis. We compared postoperative foot segmental motion during gait in patients treated with TAR and AA. Methods: Gait analysis was performed in 17 and 7 patients undergoing TAR and AA, respectively. Subjects were evaluated using a 3-dimensional multisegmental foot model with 15 markers. Temporal gait parameters were calculated. The maximum and minimum values and the differences in hallux, forefoot, hindfoot, and arch in 3 planes (sagittal, coronal, transverse) were compared between the 2 groups. One hundred healthy adults were evaluated as a control. Results: Gait speed was faster in the TAR ( P = .028). On analysis of foot and ankle segmental motion, the range of hindfoot sagittal motion was significantly greater in the TAR (15.1 vs 10.2 degrees in AA; P = .004). The main component of motion increase was hindfoot dorsiflexion (12.3 and 8.6 degrees). The range of forefoot sagittal motion was greater in the TAR (9.3 vs 5.8 degrees in AA; P = .004). Maximum ankle power in the TAR (1.16) was significantly higher than 0.32 in AA; P = .008). However, the range of hindfoot and forefoot sagittal motion was decreased in both TAR and AA compared with the control group ( P = .000). Conclusion: Although biomechanical results of TAR and AA were not similar to those in the normal controls, joint motions in the TAR more closely matched normal values. Treatment decision making should involve considerations of the effect of surgery on the adjacent joints. Level of Evidence: Level III, case-control study.

Styles APA, Harvard, Vancouver, ISO, etc.

25

Kvarda, Peter, Laszlo Toth, Tamar Horn-Lang, Roman Susdorf, Roxa Ruiz et Beat Hintermann. « Short-Term Outcomes of a Two-Component Total Ankle Replacement in Revision Arthroplasty ». Foot & ; Ankle Orthopaedics 7, n^o 4 (octobre 2022) : 2473011421S0073. http://dx.doi.org/10.1177/2473011421s00739.

Texte intégral

Résumé :

Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: Given the growing number of primary total ankle replacements (TAR), an increase in the numbers of failed ankles and consecutive revisions might be expected. Achieving a stable and balanced ankle based on stable components while preserving the remaining bone stock as much as possible, are crucial for success in revision TAR. Most reported techniques rely on bulky implants with extended fixation features. Since 2018, we have used a novel 3-component ankle for revision surgery that is converted in situ to a fixed-bearing 2-component ankle once the components have found their position given by the individual anatomy. The purpose of this study was to determine the short-term results of this novel concept in revision TAR. Methods: This single-center retrospective cohort study included 57 patients (57 ankles, mean age 63+-13 years) treated for failed TAR with the semi-constrained HINTERMANN Series H2© (H2) implant between February 2018 and February 2020. Survival analysis was performed and potential risk factors using Cox regression, were assessed. Clinical and radiological outcomes were assessed preoperatively and at the last follow-up. Clinical outcomes included pain on a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot score and patient satisfaction. Radiological outcomes were tibial articular surface angle (TAS), tibiotalar surface angle (TTS), talar tilt angle (TT) in the coronal plane and anteroposterior offset (AP-Offset) ratio in the sagittal plane, as well as signs of radiolucency and/or loosening on plane weightbearing radiographs. Results: The median follow-up was 2 (2.0 to 4.0) years. The cumulative incidence for secondary revision after 1 and 2 years was 5.1% (95%CI 0-11) and 7.4% (0-14) respectively. Four patients needed a secondary revision (three for pain/arthrofibrosis and one for aseptic loosening). While the AOFAS hindfoot score increased from median 54 (range 9-94) to 75 (19-98) (p=0.00001), satisfaction increased from moderate to good (p=0.0017). Radiographically, all components were stable without signs of increased shear-forces in terms of loosening or radiolucency. Conclusion: Obtained results with the novel customized semi-constrained total ankle implant design at short-term are encouraging, with a satisfactory survival rate and acceptable revision rate. The fixation concept without extended fixation features was shown to last against increased shear forces.

Styles APA, Harvard, Vancouver, ISO, etc.

26

Indino, Cristian, Riccardo D’Ambrosi et Federico Giuseppe Usuelli. « Scientific Production and total ankle arthroplasty ». Foot & ; Ankle Orthopaedics 3, n^o 3 (1 juillet 2018) : 2473011418S0026. http://dx.doi.org/10.1177/2473011418s00262.

Texte intégral

Résumé :

Category: Ankle Arthritis Introduction/Purpose: The purpose of this systematic review was to report clinical outcomes on total ankle replacement (TAR) whose data were extracted from national registers. Methods: A systematic review of the literature, to identify all studies reporting outcomes after total ankle replacement, was performed. Two independent investigators performed the research using MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase and Cochrane Databases (1950 to December 2017). Results: Analysis of the literature included 18 articles from 2007 to 2017. Of these 5 articles performed a comprehensive analysis of the national registers, 5 articles evaluated complications and reasons of failure after TAR, 6 articles made a specific outcome register analysis, one article compared TAR and ankle arthrodesis while the last one analysed the role of TAR in patients with rheumatoid arthritis. Conclusion: Scientific publications extracted from national joint registers for total ankle replacement provide useful but heterogeneous information on implants survivorship, implant models and risk factors. There is still a discrepancy between the data reported by designers in clinical studies and the data reported by the registries. The centralization of registers in specialized hospitals with dedicated surgeons, the use of patient reported outcomes (PROMs) in association with surgeon assessments and periodical publications can improve the development of registries and consequently of the literature in this regard.

Styles APA, Harvard, Vancouver, ISO, etc.

27

Daniels, Timothy R., Shahin Kayum, Ryan M. Khan et Anastasia Sanjevic. « Two-Year Outcomes of Total Ankle Replacement with the Cadence Total Ankle Replacement System ». Foot & ; Ankle Orthopaedics 4, n^o 4 (1 octobre 2019) : 2473011419S0015. http://dx.doi.org/10.1177/2473011419s00156.

Texte intégral

Résumé :

Category: Ankle, Ankle Arthritis Introduction/Purpose: Over the last few decades, total ankle replacement (TAR) emerged as a reliable treatment option in end-stage ankle osteoarthritis (OA) while preserving motion and physiological load. The Cadence™ prosthesis, manufactured by Integra LifeSciences, is a two-component, fixed-bearing implant with minimal tibial and talar resection and has been in clinical use since June 2016. The purpose of this study is to assess the two-year validated clinical outcome scores and radiological parameters of the Cadence™ prosthesis at our hospital. Methods: Thirty-one consecutive patients who received the Cadence™ prosthesis between June 2016 and December 31st, 2016 were enrolled. All patients who underwent a primary TAR with the Cadence™ prosthesis and who had at least two years follow- up were included. All surgeries were performed by a single surgeon with experience in total ankle arthroplasty. At the yearly clinical evaluation, patients were administered the Ankle Osteoarthritis Scale (AOS) and the Short Form Health Survey (SF-36), and their radiological outcomes pre and post-surgery were assessed. Results: Thirty-one patients fulfilled the inclusion criteria. Forty ancillary procedures were performed on twenty-four TAR’s. Radiological analyses showed preoperative talar sagittal translation with 25 anterior, 2 posterior, and 4 neutral. Sagittal translation decreased from an average 3.11 mm to 1.0 mm. Eleven ankles had a perioperative talar Varus and Valgus deformity that was corrected, with neutral alignment in all. At the two-year clinic visit, x-rays showed no lucencies or stress fractures and none of the ankles required revision of metal components. The pre and post-operative pain and disability scores displayed major improvement wherein AOS pain scores decreased -20.28 ± 14.34 points from an average of 47.86 points while AOS disability scores decreased -32.11 ± 22.70 from an average of 57.15 points. Conclusion: The overall outcome of the total ankle arthroplasty with the Cadence™ prosthesis showed excellent clinical and radiological outcomes. Compelling clinical evidence shows that the quality of life, functional measures, and pain in patients suffering from end-stage arthritis significantly improved following surgery with the Cadence™ total ankle replacement system. The semi- constrained design of this two-component implant and utilization of biased polyethylene inserts allowed for correction of the talus in both the sagittal (talar anterior / posterior translation) and coronal planes (talar varus / valgus).

Styles APA, Harvard, Vancouver, ISO, etc.

28

Ahn, Junho, Kshitij Manchanda, Stephen Wallace, Dane K. Wukich, George T. Liu, Michael D. VanPelt, Katherine M. Raspovic et Trapper A. Lalli. « Contemporary Comparison of Short-Term Outcomes after Total Ankle Replacement and Ankle Arthrodesis ». Foot & ; Ankle Orthopaedics 4, n^o 4 (1 octobre 2019) : 2473011419S0008. http://dx.doi.org/10.1177/2473011419s00089.

Texte intégral

Résumé :

Category: Ankle, Ankle Arthritis Introduction/Purpose: During the last twenty years, studies comparing total ankle replacement (TAR) and ankle arthrodesis (AA) appear to demonstrate lower complication rates with TAR than with AA. However, advances in implant technology and surgical techniques have dramatically reduced complication rates. As a result, studies comparing TAR and AA require more patients to detect differences in rare events. Despite this, few epidemiologic studies have been performed examining short-term outcomes after TAR and AA using a contemporary patient population. The purpose of the current study was to compare perioperative outcomes after TAR and AA using patient data from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database between 2012 and 2017. Methods: We reviewed patient data from ACS-NSQIP database collected between 2012 and 2017 using Current Procedural Terminology (CPT) codes 27700 (TAR), 27702 (TAR), 29899 (AA) and 27870 (AA). Patients were then excluded if they were treated for fractures, infections, non-foot or ankle-related conditions or had revision procedures. Patients were also excluded if they were older than 90 years as ACS-NSQIP does not report age above 90 years. The study population included those treated in inpatient and outpatient settings. The main outcomes of interest were readmission and reoperation related to initial surgery, surgical site complications and hospital length of stay (LOS). Predictors of adverse outcomes were evaluated through multivariate regression of patient demographics, comorbidities and treatment characteristics. Results: Out of 1214 patients included in the study, 187 (15.4%) patients were treated with AA, and 1027 (84.6%) underwent TAR. Patients with AA were younger, had higher body-mass index, higher white blood cell count, more often had diabetes mellitus (DM) treated with insulin, received more dialysis treatment, had higher anesthesia risk classification and were treated in the outpatient setting more often than patients with TAR. Among outcomes, AA patients had longer hospital LOS, more deep surgical site infections and more reoperations than TAR patients. Post-operative readmissions were not significant but were higher in AA patients (2.7% vs. 0.9%, p=0.101). Combining these adverse outcomes, multivariate regression revealed that higher anesthesia risk category (p=0.0007), DM (p=0.029) and AA (p=0.049) had positive correlations with adverse outcomes. Conclusion: Ankle arthrodesis appears to be independently associated with perioperative complications compared to TAR, consistent with previous reports. Although complications were rare, patients with DM and higher anesthesia risk seem to be important factors to consider. Interestingly, patients with DM had fewer adverse outcomes with TAR than AA (3.8% vs. 7.4%). The difference was even greater in DM patients treated with insulin (4.3% vs. 13.3%) although only 38 patients had DM controlled with insulin in the cohort. Further studies are needed to identify patient populations at risk of complications, specifically those with DM.

Styles APA, Harvard, Vancouver, ISO, etc.

29

Barg, Alexej, Phinit Phisitkul et Charles Saltzman. « Mobile- vs. Fixed-Bearing Total Ankle Prostheses ». Foot & ; Ankle Orthopaedics 2, n^o 3 (1 septembre 2017) : 2473011417S0001. http://dx.doi.org/10.1177/2473011417s000108.

Texte intégral

Résumé :

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is a well-accepted treatment option in patients with end-stage ankle osteoarthritis. In general, TAR designs can be classified based on their number of components: 2-components (fixed-bearing) vs. 3- components (mobile-bearing). In the U.S. the STAR prosthesis is the only one mobile-bearing TAR with FDA approval. It remains unclear whether 3-component TAR designs have superior clinical outcomes including prosthesis survivorship. Therefore we performed a systematic review and meta-analysis of the available TAR designs to determine prosthesis survivorship and whether there is a statistically significant difference between mobile- and fixed-bearing TAR designs. Methods: We reviewed literature using common data bases. All searches were unlimited. For the search we used the subject heading terms: “ankle”, “replacement”, “arthroplasty”, and “prosthesis”. For meta-analysis a checklist was used as described by Meta-analysis Of Observational Studies in Epidemiology (MOOSE) Group. The quality of included studies was assessed using Coleman’s Methodology Score. The following parameters were reviewed: type of study, inventor bias, number of patients/ankles, mean age with range, gender, etiology of underlying ankle osteoarthritis, average and maximum follow-up, number of TAR failures, and total exposure time. For each study, failure rate was estimated as the number of failures/total exposure years. N-year (here, 5 or 10 years) failure rate was calculated as 1-exp(-N*failure rate). The pooled estimate of failure rate was a weighted average across studies using the inverse variance weighting method. The test for heterogeneity was not significant so fixed effects models were used. Results: In total, 32 studies with 3968 ankles were included into the analysis. Nine studies included 844 fixed-bearing TARs and 23 studies included 3124 mobile-bearing TARs. Patient characteristics were comparable in both study groups. For fixed-bearing TAR, the 5-year and 10-year failure rate was 0.077 and 0.149 with an average annual failure rate of 0.016 (95%CI 0.008-0.025). For mobile-bearing TAR, the 5-year and 10-year failure rate was 0.074 and 0.142with an annual failure rate of 0.015 (95%CI 0.011- 0.020). Two studies with fixed-bearing TAR and six studies with mobile-bearing TAR had inventor bias. The average annual failure rate was comparable in both groups (P = 0.88), with and without inventor bias, 0.013 vs. 0.018 (P = 0.87). Conclusion: We have shown that TAR has an overall failure rate of 0.149 and 0.142 at 10 years in patients with fixed-bearing and mobile-bearing TAR design, respectively. No superiority of one implant design over another can be supported by the available data.

Styles APA, Harvard, Vancouver, ISO, etc.

30

Harnroongroj, Thos, Daniel Sturnick, Scott J. Ellis, Constantine Demetracopoulos et Jonathan Deland. « The Ankle-Hindfoot Kinematics of Current Generation Total Ankle Replacement : A Cadaveric Gait Simulation ». Foot & ; Ankle Orthopaedics 4, n^o 4 (1 octobre 2019) : 2473011419S0020. http://dx.doi.org/10.1177/2473011419s00203.

Texte intégral

Résumé :

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) has developed as a standard treatment option for end-stage ankle arthritis with the primary benefit of pain relief and ankle-hindfoot motion preservation. The current generation of TARs features limited bone resection and improved initial fixation of components to restore physiologic constraint and the anatomic articulation of the ankle. However, the ankle-hindfoot kinematics of current TAR designs compared to the baseline native ankle have not yet been extensively studied. Cadaveric gait simulation is a valuable tool for investigating direct effects of surgical procedures on foot and ankle biomechanics. The objective of this study was to assess whether this current generation TAR system could provide normal ankle-hindfoot kinematics as the baseline native ankle using cadaveric gait simulation. Methods: Eleven mid-tibia cadaveric specimens were secured to a static mounting fixture with a six-degree of freedom robotic platform to simulate gait in native-intact and TAR conditions. A force plate was moved relative to the stationary specimen through an inverse tibial kinematic path calculated from in vivo data while extrinsic tendons were actuated using physiologic loads (Figure 1A). Ankle-hindfoot kinematics were measured from reflective markers attached to bones via surgical pins. TAR was performed using a current generation, fixed-bearing system by a fellowship-trained foot-ankle surgeon using the manufacturer described protocol (PROPHECY Patient-specific instrumentation, Infinity, Wright Medical Technology). Ankle-hindfoot joint kinematics were measured using the same tibial kinematic inputs and muscle forces as the intact condition. Non-parametric, bias-corrected bootstrapping was used to calculate 95% confidence intervals to compare motion between intact and total ankle replacement. Results: Analyses demonstrated no significant difference in average ankle-hindfoot joint kinematics between the intact and TAR conditions (Figure 1B). The result was consistent for the ankle, subtalar, and talonavicular joints, in each plane of motion. Conclusion: These findings demonstrate that the current generation of fixed-bearing TAR can recreate normal ankle-hindfoot kinematics patterns seen in normal ankles. Restoring ankle kinematics can be a significant factor in slowing down the progression of adjacent joint arthritis in the foot. However, it is still inconclusive whether ankle-hindfoot kinematics can be restored in patients with long standing ankle arthritis, and this should be addressed in future studies.

Styles APA, Harvard, Vancouver, ISO, etc.

31

Reddy, Sudheer, Lane Koenig, Berna Demiralp, Jennifer T. Nguyen et Qian Zhang. « Assessing the Utilization of Total Ankle Replacement in the United States ». Foot & ; Ankle International 38, n^o 6 (1 mars 2017) : 641–49. http://dx.doi.org/10.1177/1071100717695111.

Texte intégral

Résumé :

Background: Total ankle arthroplasty (TAR) has been shown to be a cost-effective procedure relative to conservative management and ankle arthrodesis. Although its use has grown considerably over the last 2 decades, it is less common than arthrodesis. The purpose of this investigation was to analyze the cost and utilization of TAR across hospitals. Methods: Our analytical sample consisted of Medicare claims data from 2011 and 2012 for Inpatient Prospective Payment System hospitals. Outcome variables of interest were the likelihood of a hospital performing TAR, the volume of TAR cases, TAR hospital costs, and hospital profit margins. Data from the 2010 Cost Report and Medicare inpatient claims were utilized to compute average margins for TAR cases and overall hospital margins. TAR cost was calculated based on the all payer cost-to-charge ratio for each hospital in the Cost Report. Nationwide Inpatient Sample data were used to generate descriptive statistics on all TAR patients across payers. Results: Medicare participants accounted for 47.5% of the overall population of TAR patients. Average implant cost was $13 034, accounting for approximately 70% of the total all-payer cost. Approximately, one-third of hospitals were profitable with respect to primary TAR. Profitable hospitals had lower total costs and higher payments leading to a difference in profit of approximately $11 000 from TAR surgeries between profitable and nonprofitable hospitals. No difference was noted with respect to length of stay or number of cases performed between profitable and nonprofitable hospitals. TAR surgeries were more likely to take place in large and major teaching hospitals. Among hospitals performing at least 1 TAR, the margin on TAR cases was positively associated with the total number of TARs performed by a hospital. Conclusion: There is an overall significant financial burden associated with performing TAR with many health systems failing to demonstrate profitability despite its increased utilization. While additional factors such as improved patient outcomes may be driving utilization of TAR, financial barriers may exist that can affect utilization of TAR across health systems. Level of Evidence: Level III, comparative study

Styles APA, Harvard, Vancouver, ISO, etc.

32

Tan, Jin Aun, Mohd Yazid Bajuri, Juzaily Fekry Leong, Levin Kb et Azammuddin Alias. « TOTAL ANKLE REPLACEMENT FOR TREATMENT OF AVASCULAR NECROSIS OF THE TALUS ». Asian Journal of Pharmaceutical and Clinical Research 11, n^o 8 (7 août 2018) : 1. http://dx.doi.org/10.22159/ajpcr.2018.v11i8.25602.

Texte intégral

Résumé :

Avascular necrosis (AVN) of talus is a well-known complication following talar neck fracture that leads to osteoarthritis of the ankle joint. Tibiotalar fusion is the gold standard of treatment in end-stage ankle osteoarthritis with predictable good outcome. With the introduction of newer generation of total ankle replacement (TAR), it is gaining popularity as an alternative treatment in selected cases of ankle joint osteoarthritis secondary to AVN talus. We present here a case of ankle joint osteoarthritis secondary to AVN talus in a 30-year-old female in which a TAR was performed. We wish to highlight that TAR can be done in ankle joint osteoarthritis with AVN talus in properly selected cases.

Styles APA, Harvard, Vancouver, ISO, etc.

33

Nunley, James, Samuel Adams, James DeOrio et Mark Easley. « Prospective Randomized Trial Comparing Mobile-bearing and Fixed-bearing Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 3, n^o 3 (1 juillet 2018) : 2473011418S0009. http://dx.doi.org/10.1177/2473011418s00093.

Texte intégral

Résumé :

Category: Ankle Arthritis Introduction/Purpose: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported longterm for MB-TAR and at intermediate-to-longterm follow-up for newer generation FB-TAR. Although comparisons between the two total ankle designs have been reported, to our knowledge, no investigation has compared the two designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: This investigation was approved by our institution’s IRB committee. Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65, range 35 to 85) were enrolled; demographic comparison between the two cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees or extensive talar dome wear pattern (“flat top talus”). Prospective patient-reported outcomes, physical exam and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score (VAS), short form 36 (SF-36), foot and ankle disability index (FADI), short musculoskeletal functional assessment (SMFA) and AOFAS ankle-hindfoot score. Surgeries were performed by non-design team orthopaedic foot and ankle specialists with total ankle replacement expertise. Statistically analysis was performed by a qualified statistician. Results: At average follow-up of 4.5 years (range 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, one had died, 4 were withdrawn after enrolling but prior to surgery and 4 were lost to follow-up. In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up. There was no statistically significant difference in improvement in clinical outcomes between the two groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FB-TAR, respectively. Re-operations were performed in 8 MB-TAR and 3 FB-TAR, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: For the first time, with a high level of evidence, our study confirms that patient reported and clinical outcomes are favorable for both designs and that there is no significant difference in clinical improvement between the two implants. The incidence of lucency/cyst formation was similar for MB-TAR and FB-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not correlate with radiographic findings. Re-operations were more common for MB-TAR and in the majority of cases were to relieve impingement or treat cysts rather than revise or remove metal implants.

Styles APA, Harvard, Vancouver, ISO, etc.

34

Nunley, James A., Samuel B. Adams, Mark E. Easley et James K. DeOrio. « Prospective Randomized Trial Comparing Mobile-Bearing and Fixed-Bearing Total Ankle Replacement ». Foot & ; Ankle International 40, n^o 11 (27 septembre 2019) : 1239–48. http://dx.doi.org/10.1177/1071100719879680.

Texte intégral

Résumé :

Background: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported long term for MB-TAR and at intermediate- to long-term follow-up for newer generation FB-TAR. Although comparisons between the 2 total ankle designs have been reported, to our knowledge, no investigation has compared the 2 designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes, and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65 years, range 35-85 years) were enrolled; a demographic comparison between the 2 cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees, or extensive talar dome wear pattern (“flat-top talus”). Prospective patient-reported outcomes, physical examination, and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score, Short Form 36, Foot and Ankle Disability Index, Short Musculoskeletal Functional Assessment, and American Orthopaedic Foot & Ankle Society ankle-hindfoot score. Surgeries were performed by a nondesign team of orthopedic foot and ankle specialists with total ankle replacement expertise. Statistical analysis was performed by a qualified statistician. At average follow-up of 4.5 years (range, 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, 1 had died, 4 were withdrawn after enrolling but prior to surgery, and 4 were lost to follow-up. Results: In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up with no statistically significant difference between the 2 groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FH-TAR, respectively. Reoperations were performed in 8 MB-TARs and 3 FH-TARs, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: With a high level of evidence, our study found that patient-reported and clinical outcomes were favorable for both designs and that there was no significant difference in clinical improvement between the 2 implants. The incidence of lucency/cyst formation was similar for MB-TAR and FH-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not necessarily correlate with radiographic findings. Reoperations were more common for MB-TAR and, in most cases, were to relieve impingement or treat cysts rather than revise or remove metal implants. Level of Evidence: Level I, prospective randomized study.

Styles APA, Harvard, Vancouver, ISO, etc.

35

Usuelli, Federico, Andrea Pantalone, Camilla Maccario, Matteo Guelfi et Vincenzo Salini. « Sports and Recreational Activities following Total Ankle Replacement ». Joints 05, n^o 01 (mars 2017) : 012–16. http://dx.doi.org/10.1055/s-0037-1601408.

Texte intégral

Résumé :

Purpose In literature, there is a controversy regarding whether patients who have undergone total ankle replacement (TAR) can participate in sports and recreational activities. The purpose of this study was to report change in sports activity level after TAR. Methods A retrospective study was performed, enrolling 76 patients with symptomatic end-stage ankle arthritis who underwent TAR from May 2011 to October 2014. Patients were mainly males (44/76; 58%) and 56 years old on average (range: 22.3–79.6 years) at the time of surgery. They were treated with mobile-bearing prosthesis implanted with an anterior approach. Patients were evaluated preoperatively and 12 months postoperatively. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, the visual analog scale (VAS) pain score, and the 12-Item Short Form Health Survey (SF-12) – physical component summary (PCS) and mental component summary (MCS). Activity level was assessed with the University of California at Los Angeles (UCLA) activity scale. Results At 12 months postoperatively, statistically significant increase was reported for AOFAS scores (from 32.8 ± 12.7 preoperatively to 72.6 ± 13.3; p < 0.001), SF-12 PCS (from 34.3 ± 5.1 preoperatively to 45.4 ± 6.4; p < 0.001), and SF-12 MCS (from 39.8 ± 7.5 preoperatively to 51.4 ± 6.1; p < 0.001). A statistically significant decrease was detected in VAS pain score (from 8.7 ± 1.6 preoperatively to 2.2 ± 1.6; p < 0.001). The UCLA activity levels increased significantly from 2.4 ± 0.8 to 6.3 ± 2.3 (p < 0.001). Conclusion Pain and function significantly improved in patients affected by ankle osteoarthritis, who underwent TAR, at 1-year follow-up. In addition, activity level showed a significant increase respect to preoperative condition. Level of Evidence Level IV, retrospective case series.

Styles APA, Harvard, Vancouver, ISO, etc.

36

Maccario, Camilla, Ettore Vulcano, Cristian Indino, Luigi Manzi et Federico Giuseppe Usuelli. « Age-Related Outcome of Mobile-Bearing Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 2, n^o 3 (1 septembre 2017) : 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000271.

Texte intégral

Résumé :

Category: Ankle, Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is becoming increasingly popular amongst patients with end-stage ankle arthritis. This is in part related to the advances in design, technology, and technique that have improved TAR longevity. The ideal candidate for a TAR is not fully clear. For a long time patients over age 50 years, body mass index (BMI) under 30 kg/m2, and with low functional demands represented selection criteria for many patients. However, these criteria were based off a very limited number of scientific studies on older TAR designs. The aim of this study is to investigate clinical and radiographic outcome in patients of 50 years or less versus patients over 50 years undergoing a Hintegra® total ankle replacement (Integra, Plainsboro, NJ). Methods: This study includes 70 consecutive patients who underwent primary TAR from May 2011 to April 2014. The cohort was divided into 2 groups: the young group (YG) with age less than or equal to 50 years, and the older group (OG) with age above 50 years. Patients were assessed clinically and radiologically preoperatively and at 6, 12 and 24 months postoperatively. Results: A significant increase in the AOFAS and SF-12 and decrease in VAS scores was seen in both groups between preoperative and final followup (p < 0.001). There was a statistically significant difference between the YG and OG for the AOFAS score at final follow-up. The YG had significantly greater improvement compared to the OG (p = 0.046). In addition radiographic results showed no statistically significant difference in the coronal and sagittal alignment between the 2 groups. The mean postoperative angles in either study group demonstrated significant improvements compared to the preoperative alignment. Conclusion: This study demonstrates that total ankle arthroplasty is an effective short-term treatment for young, active patients with symptomatic end-stage ankle arthritis. Our findings are in disagreement with the widespread theory that ankle replacement is a more reliable treatment in the elderly

Styles APA, Harvard, Vancouver, ISO, etc.

37

Sabour, Andrew, Ram Alluri et Eric Tan. « A National Comparison of Total Ankle Replacement Versus Arthrodesis. Is There a Paradigm Shift ? » Foot & ; Ankle Orthopaedics 2, n^o 3 (1 septembre 2017) : 2473011417S0003. http://dx.doi.org/10.1177/2473011417s000344.

Texte intégral

Résumé :

Category: Ankle, Ankle Arthritis, Diabetes Introduction/Purpose: Total ankle replacement (TAR) and tibiotalar arthrodesis (TTA) are both utilized in the surgical management of ankle osteoarthritis. Over the past decade, foot and ankle surgeons have broadened the indications for TAR, and subsequently have performed less TTA. Currently, no studies exist evaluating the epidemiological, pre-operative, and temporal trends between TTA and TAR. The purpose of this study was to compare nationwide trends of TAR and TTA in the treatment of ankle osteoarthritis. Methods: The Nationwide Inpatient Sample (NIS) from 2007 to 2013 was used to extract data on patients over 50 years of age who underwent either primary TAR or TTA. Patients who underwent both procedures or revision procedures were excluded. Univariate and multivariate analysis were performed to assess for differences in temporal, demographic, and primary diagnosis trends between TAR and TTA. Results: 15,060 patients underwent TAR and 35,096 underwent TTA between 2007 and 2013. Patients undergoing TTA had significantly more comorbidities (2.17 vs 1.55, P<0.001). Temporal analysis demonstrated a significant 15% increase every 3 years in TAR performed from 2007 (14%) to 2013 (45%) (Figure 1) (P<0.001). Multivariate analysis comparing TAR and TTA demonstrated that in patients with a primary diagnosis of post-traumatic osteoarthritis, the odds of having a TAR in 2013 was 12 times higher than in 2007 (P<0.05). Similar increases in TAR utilization was demonstrated in patients with primary osteoarthritis (4.93 times) and rheumatoid arthritis (3.12 times) (P<0.001). Analysis of comorbid diagnoses revealed that patients with diabetes, hypertension, or CAD were 4.66 times more likely to have a TAR in 2013 compared to 2007 (P<0.001). Conclusion: Over the past decade the indications for TAR have increased, and foot and ankle surgeons are performing TAR with greater frequency. This has been most evident in patients undergoing TAR for post-traumatic arthritis and rheumatoid arthritis. Foot and ankle surgeons still prefer to perform TAR in patients with fewer comorbidities compared to TTA. However, as technology has advanced and surgeons have become more facile with the technique, patients with specific comorbidities are undergoing TAR at a significantly higher annual incidence.

Styles APA, Harvard, Vancouver, ISO, etc.

38

Harnroongroj, Thos, Amelia Hummel, Carolyn Sofka, Scott J. Ellis, Jonathan Deland et Constantine Demetracopoulos. « The “Joint Line Height Ratio” Assessing the Ankle Joint Line Level Before and After Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 4, n^o 4 (1 octobre 2019) : 2473011419S0020. http://dx.doi.org/10.1177/2473011419s00202.

Texte intégral

Résumé :

Category: Ankle Arthritis Introduction/Purpose: n important principle of joint replacement is to restore the joint line to its native level. Previous studies have demonstrated a correlation between clinical outcomes and our ability to restore the joint in total knee arthroplasty. To date, there has been no study to assess restoration of joint height in total ankle replacement (TAR). In addition, there is no accepted method for assess joint line height in patients who undergo TAR. The objective of this study is to develop a reliable radiographic ankle joint line level measurement. Additionally, the measure will be used to evaluate and compare ankle joint line levels seen on pre-TAR, post-TAR, and non-arthritic contralateral ankle radiographs. Methods: One hundred and twelve primary TAR patients with weightbearing preoperative (pre-TAR) and 1-year postoperative (post-TAR) anteroposterior (AP) ankle radiographs were retrospectively reviewed. Patients with bilateral disease, concomitant malleolar osteotomy, and component subsidence were excluded. Two raters measured the vertical intermalleolar distance (VIMD, Figure 1) and the vertical joint line distance (VJLD, Figure 1) for all radiographs (pre-TAR, post-TAR, and contralateral normal ankle) on two separate occasions. The measurement ”joint line height ratio” was calculated as the ratio of the VJLD to the VIMD (Figure 1). Reliability was assessed using intraclass correlation coefficients (ICCs). Pearson correlation test was used to assess the level of correlation between the VJLD and the VIMD. The comparisons of pre-TAR, non-arthritic contralateral ankle, and post- TAR “joint line height ratio” were performed using paired t-tests and considered significantly different if p < 0.05. Results: Inter/intra-rater reliabilities of all measurements were excellent (r>0.9). Pearson correlation test demonstrated strong positive correlations of VIMD and VJLD with r 0.809 for pre-TAR and r 0.756 for post-TAR, p<0.001. Mean(SD) VIMDs for pre- TAR, non-arthritis contralateral ankle, and post-TAR were 17.91(4.79), 18.96(4.67) and 17.37(4.76) mm. Mean(SD) VJLDs for pre- TAR, non-arthritis contralateral ankle, and post-TAR were 26.49(4.64), 25.47(4.12) and 26.70(5.31) mm. Additionally, mean(SD) ”joint line height ratio” for pre-TAR, non-arthritic contralateral, and post-TAR ankle radiographs were 1.54(0.31), 1.39(0.26) and 1.62(0.49). The “joint line height ratio” of pre- and post-TAR was significantly higher compared to non-arthritic contralateral ankle (p 0.0001 and < 0.0001), respectively. No significant difference in ”joint line height ratio” was found between pre- and post-TAR(p = 0.15). Conclusion: The “joint line height ratio” was a reliable tool for assessing the ankle joint line pre and post-TAR. End-stage ankle arthritis leads to an elevated joint line compared to non-arthritic ankle. The joint line level after TAR was preserved to that measured before TAR, but not restored compared to the non-arthritic contralateral ankle. When performing TAR, joint line level restoration should be evaluated compared to the contralateral non-arthritic ankle radiograph. The amount of tibial cut should be minimized as much as possible to prevent further bone loss and ankle joint line elevation.

Styles APA, Harvard, Vancouver, ISO, etc.

39

Saito, Guilherme Honda, Natalie Nielsen, Austin Sanders, Scott Ellis, Carolyn Sofka et Constantine Demetracopoulos. « TL 18052 - Sagittal tibiotalar alignment in fixed-bearing total ankle replacement ». Scientific Journal of the Foot & ; Ankle 13, Supl 1 (11 novembre 2019) : 66S. http://dx.doi.org/10.30795/scijfootankle.2019.v13.1008.

Texte intégral

Résumé :

Introduction: Implant positioning is critical in total ankle replacement (TAR). However, the effect of sagittal tibiotalar alignment on functional outcomes in fixed-bearing TAR remains unclear. Furthermore, no studies comparing different fixed-bearing implants with respect to the anteroposterior position of the talar component have been performed to date. Methods: A retrospective analysis of 71 primary TARs in a single center was performed. Prostheses included were the INBONE II® (Wright Medical, Memphis, TN) and the Salto Talaris (Integra LifeSciences, Plainsboro, NJ). Radiographic measurements of the tibial-axis-to-talus ratio (T-T ratio) and the anteroposterior offset ratio (AP offset ratio) were performed preoperatively and postoperatively, respectively. Foot and Ankle Outcome Scores (FAOS) and SF-12 MCS and PCS scales were evaluated preoperatively and 2 years postoperatively. Results: Postoperative sagittal tibiotalar alignment was neutral in 39 ankles and anterior in 32 ankles. No significant differences were observed between groups with respect to clinical outcome scores. Patients with a Salto Talaris prosthesis had a greater AP offset ratio (0.12 ± 0.05) than patients with an INBONE II® implant (0.05 ± 0.04) (P < .01); however, this increased translation did not correlate with the outcome scores. Conclusion: At the 2-year follow-up, the INBONE II® TAA showed a more neutral sagittal alignment compared with the Salto Talaris prosthesis. However, no correlation between the postoperative AP offset ratio and functional outcome scores was observed with the use of the two fixed-bearing TAR. Further studies with longer follow-ups are needed to determine if the difference in sagittal alignment may have an effect on functional outcomes in the long-term.

Styles APA, Harvard, Vancouver, ISO, etc.

40

Ratnasamy, Philip P., Michael J. Gouzoulis, Alexander J. Kammien, Irvin Oh et Jonathan N. Grauer. « Home and Outpatient Physical Therapy Utilization Following Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 7, n^o 4 (octobre 2022) : 247301142211461. http://dx.doi.org/10.1177/24730114221146175.

Texte intégral

Résumé :

Background: Physical therapy (PT) following total ankle replacement (TAR) is often considered, but guidelines for its use are not standardized. Although patient factors may dictate recommendations, this retrospective cohort study aims to characterize baseline utilization practices to set the stage for establishing generalizable recommendations. Methods: TAR patients were identified from the 2010-2019 M91 Ortho PearlDiver data set based on administrative coding. Patient factors were extracted, including age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which patients’ surgery was performed (Midwest, Northeast, South, West), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, and frequency of home or outpatient PT utilization in the 90 days following TAR were identified. Inpatient PT was not captured. Univariate and multivariate logistic regression analyses allowed identification of predictive factors for PT utilization. Results: Of 5412 TAR patients identified, postoperative PT services were used by 2453 (45.3%). Most PT was outpatient (38.3% of the study population) compared to home (4.1% of the study population). Weekly utilization of PT was greatest in the first week following surgery (17.7% of PT visits) and thereafter followed a roughly bell-shaped curve, with utilization greatest at 7 weeks following surgery (14.9% of PT visits). Independent predictors of PT utilization following TAR included having surgery performed in the Midwest (relative to the South, OR 1.37, P < .0001), Northeast (OR 1.20, P = .0217), or West (OR 1.26, P < .0021) and having commercial (relative to Medicare, OR 1.87, P < .0001) or Medicaid insurance (OR 1.46, P = .0239). Conclusion: Of 5412 TAR patients, 42.5% used PT within 90 days of surgery. PT utilization was highest in the first and seventh weeks following surgery, and demographic predictors of PT use were defined. Through identification of timing and predictors of PT utilization following TAR, PT care pathways may be better defined. Level of Evidence: Level III, retrospective cohort study.

Styles APA, Harvard, Vancouver, ISO, etc.

41

Silvestri, Claudia A. Di, Riccardo D’Ambrosi, Camilla Maccario, Cristian Indino et Federico Giuseppe Usuelli. « Severe Ankle Varus Malalignment Management with a Fix-Bearing Total Ankle Replacement Implant ». Foot & ; Ankle Orthopaedics 5, n^o 4 (1 octobre 2020) : 2473011420S0019. http://dx.doi.org/10.1177/2473011420s00194.

Texte intégral

Résumé :

Category: Ankle Arthritis; Ankle Introduction/Purpose: Despite Total ankle replacement (TAR) is currently considered a safe procedure and an optimal alternative to ankle fusion in end-stage ankle arthritis, still the precise indications and the limits of TAR are a highly controversial topic. Coronal malalignment correction with TAR is also a widely debated point. Purpose of this work was to confront two patient groups undergoing Total Ankle Replacement (a group of patients with a pre-operative ankle varus misalignment on coronal plane, versus a group of patients with neutral pre-operative ankle alignment) comparing clinical and radiographic results, complications and survival rate of the implant. Methods: 171 patients, all affected by end-stage ankle arthritis and all treated with total ankle replacement with fix-bearing Trabecular Metal Total Ankle System (Zimmer-Biomet, Warsaw IN, USA), were divided in two groups. Group ‘A’ included 159 patients having a normal alignment or a slight valgus or valgus misalignment within 10°. Group ‘B’ included 12 patients with a pre- operative varus malalignment >10°. Each patient of the study was evaluated, clinically and radiologically, before and after surgery, and subsequently at 6 and 12 months follow-up, then once every year. Clinical evaluation comprised some score: visual analogue scale (VAS); American Foot and Ankle Society Score (AOFAS); and the Short Form (SF)-12 Quality of Life, in both of its ‘physical’ (PCS) and ‘mental’ (MCS) components. Radiological evaluated parameters were: tibio-talar surface angle (TTS), lateral distal tibial angle (LDTA-α), and anterior distal tibial angle (ADTA-β). Complications and implant survival rate were evaluated for both groups. Results: At a mean follow up of 2,75 years (range 2.09-5.66 years), improvement was found in all clinical and radiological evaluated parameters of two groups, without statistically significant differences between two groups at last follow-up. In group A most frequent reported complication was the presence of a fibular symptomatic hardware. Major complication were a deep arthroplasty infection and a 3 months post-operative ankle fracture-dislocation/periprostethic fracture. In group B there were 2 delayed wound healing, and one case of loosening of correction. No significant difference in complication and revision rate comparison between two groups was founded. Conclusion: Mid-term results reported in the present show that in patients with varus greater than 10 ° it is possible to obtain a post-operative alignment similar to pre-operative neutral ankles and that the complication rate is not greater. Despite this, is Authors opinion that major and complex misalignment should be approached by skilled surgeons, with an adequate learning curve experience, with a wide range of cases and in highly specialized centers.

Styles APA, Harvard, Vancouver, ISO, etc.

42

Le, Vu (Brian), Mario Escudero, Murray Penner, Kevin Wing, Alastair Younger, Andrea Veljkovic et Maximiliano Barahona. « Radiographic Analysis of Total Ankle Replacements ». Foot & ; Ankle Orthopaedics 3, n^o 3 (1 juillet 2018) : 2473011418S0007. http://dx.doi.org/10.1177/2473011418s00074.

Texte intégral

Résumé :

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacements (TAR) are an increasingly common treatment for end-stage ankle arthritis but evidence on optimal alignment is not as well-established as in the hip and knee arthroplasty literature. Many believe that restoration of coronal and sagittal alignment is critical, while others suggest malalignment within a certain range has no impact on failure (Braito et al. 2015). There is controversy on the ideal TAR component positioning to minimize failure and requiring revision surgery. In this study we examine 9 radiographic measures of TARs, 6 of which have previously been described for TARs, 1 commonly used on preoperative ankles, and 2 novel measures on a database of 146 TARs to identify predictors of TAR re-operation. Methods: A retrospective review was performed on the Canadian Orthopaedic Foot and Ankle Society (COFAS) database of ankle arthritis, selecting for all total ankle replacements done at a single institution by one of three fellowship-trained foot and ankle surgeons between September 2004 and June 2015. Those with complete series of anteroposterior and lateral standing ankle radiographs both preoperative and postoperative, and minimum of 1 year of follow-up were included. Measurements were performed on the postoperative radiographs and included: coronal and sagittal distal tibial component angles, talar center migration, talar tilt angle, lateral talar station, tibial axis-talus ratio, talar component gamma angle, anterior and posterior tibial component overhang and underhang. Standard descriptive statistical methods were used to analyze the data. Results: Of a total of 296 TARs, 146 were included and 14 TARs failed (9.6%), defined as requiring re-operation, 8 of which were metal-component revisions (5%). The TARs were stratified into those with measurements within previously published normal values and those that fall outside that range. Time to failure ranged from 1.4 to 9.6 years. Our preliminary data analysis showed that TARs with coronal distal tibial component angles between 87-93 degrees demonstrated an odds ratio of 0.11 for re-operation compared with those beyond that range, p=0.003. TARs with talar tilt angles of 0 degrees demonstrated an odds ratio of 0.24 for re-operation compared with those whose talar tilt was not zero, p=0.02. Conclusion: Post-operative coronal alignment of TARs, namely distal tibial component angle and talar tilt, appear to be associated with TAR-reoperation. Specifically, if the measurements are within previously described normal limits, the odds ratio for re-operation is low and statistically significant. Further data analysis is underway and may demonstrate more parameters of significance in predicting TAR failure.

Styles APA, Harvard, Vancouver, ISO, etc.

43

Ratnasamy, Philip P., Alexander J. Kammien, Michael J. Gouzoulis, Irvin Oh et Jonathan N. Grauer. « Emergency Department Visits Within 90 Days of Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 7, n^o 4 (octobre 2022) : 247301142211342. http://dx.doi.org/10.1177/24730114221134255.

Texte intégral

Résumé :

Background: Total ankle replacement (TAR) utilization in the United States has steeply increased in recent decades. Emergency department (ED) visits following TAR impacts patient satisfaction and health care costs and warrant exploration. Methods: This retrospective cohort study utilized the 2010 to 2019 M91Ortho PearlDiver data set to identify TAR patients with at least 90 days of follow-up. PearlDiver contains billing claims data across all sites of care throughout the United States for all indications for care. Patient factors extracted included age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which surgery was performed, insurance plan, and postoperative hospital length of stay. Ninety-day postoperative ED visit incidence, timing, frequency, and primary diagnoses were identified and compared to 1-year postoperative ED visit baseline data. Univariate and multivariate logistic regression analyses were used to determine risk factors for ED visits. Results: Of 5930 TAR patients identified, ED visits within 90 days were noted for 497 (8.4%) patients. Of all ED visits, 32.0% occurred within 2 weeks following surgery. Multivariate analysis revealed several predictors of ED utilization: younger age (odds ratio [OR] 1.35 per decade decrease), female sex (OR 1.20), higher ECI (OR 1.32 per 2-point increase), TAR performed in the western US (OR 1.34), and Medicaid coverage (OR 2.70; 1.71-4.22 relative to Medicare) ( P < .05 each). Surgical site issues comprised 78.0% of ED visits, with surgical site pain (57.0%) as the most common problem. Conclusion: Of 5930 TAR patients, 8.4% returned to the ED within 90 days of surgery, with predisposing demographic factors identified. The highest incidence of ED visits was in the first 2 postoperative weeks, and surgical site pain was the most common reason. Pain management pathways following TAR should be able to be adjusted to minimize the occurrence of postoperative ED visits, thereby improving patient experiences and decreasing health care utilization/costs. Level of Evidence: Level III, retrospective cohort study.

Styles APA, Harvard, Vancouver, ISO, etc.

44

Smyth, Niall A., John G. Kennedy, Lew C. Schon, Javad Parvizi et Amiethab A. Aiyer. « Risk Factors for Periprosthetic Joint Infection Following Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 4, n^o 4 (1 octobre 2019) : 2473011419S0040. http://dx.doi.org/10.1177/2473011419s00400.

Texte intégral

Résumé :

Category: Ankle, Ankle Arthritis Introduction/Purpose: A major complication of total ankle replacement (TAR) is a periprosthetic joint infection (PJI). The reported rate of this complication ranges between 2.4 – 8.9%. Identifying preoperative patient characteristics that correlate with an increased risk of PJI is of great interest to orthopaedic surgeons, as this may assist with appropriate patient selection. The purpose of this study is to systematically review the literature to identify risk factors that are associated with PJI following TAR. Methods: Utilizing the terms “(risk factor OR risk OR risks) AND (infection OR infected) AND (ankle replacement OR ankle arthroplasty)” we searched the PubMed/MEDLINE electronic databases. Using the PRISMA guidelines, studies were selected for inclusion if they assessed clinical risk factors for developing a PJI following TAR. In addition, the reference lists of included studies were also reviewed and compared to the collected studies to ensure that no pertinent papers were omitted. The quality of the included studies was then assessed using the American Academy of Orthopaedic Surgeons Clinical Practice Guideline and Systematic Review Methodology. Recommendations were made using the overall strength of evidence. Results: Eight studies met the inclusion criteria, totaling 12,704 patients who underwent a TAR. A limited strength of recommendation can be made that the following preoperative patient characteristics correlate with an increased risk of PJI following TAR: inflammatory arthritis, prior ankle surgery, age greater than 65 years, body mass index less than 19, peripheral vascular disease, chronic lung disease, hypothyroidism, and low preoperative AOFAS hindfoot scores. There is conflicting evidence in the literature regarding the effect of obesity, tobacco use, diabetes, and duration of surgery. Conclusion: Several risk factors were identified as having an association with PJI following TAR. These factors may alert surgeons that a higher rate of PJI is possible. However, because of the low level of evidence of reported studies, only a limited strength of recommendation can be ascribed to regard these as risk factors for PJI at this time.

Styles APA, Harvard, Vancouver, ISO, etc.

45

Najefi, Ali-Asgar, et Andrew Goldberg. « The Role of Axial Rotation in Total Ankle Replacement ». Foot & ; Ankle Orthopaedics 3, n^o 3 (1 juillet 2018) : 2473011418S0009. http://dx.doi.org/10.1177/2473011418s00090.

Texte intégral

Résumé :

Category: Ankle Arthritis Introduction/Purpose: The importance of implant orientation in the axial rotational plane is ill understood. No Total ankle replacement (TAR) implant deals specifically with rotation as part of the surgical technique. Preoperative computed tomography (CT) scan–derived patient-specific plans and guides (PROPHECY, Wright Medical Technology, Memphis, TN) have been developed for TAR scanning the knee and ankle for the purposes of patient specific instrumentation. The objectives of this study were to establish the range and relationship between the transtibial axis at the knee, the tibial tuberosity, and the transmalleolar axis using these CT scans in an adult population with ankle arthritis. Methods: 150 CT Scans of patients with end stage ankle osteoarthritis undergoing Psi, we measured the relationship between the transtibial axis, the tibial tuberosity and the transmalleolar axis (Figure 1). All CT scans were analysed using the Solidworks software (Dassault Systèmes). Varus or valgus arthritis, tibiotalar angle and presence of deformity was also recorded. Results: The mean difference in the axial plane between the transmalleolar axis and the tibial tuberosity was 17.9 ± 9.3 degrees externally rotated. There was a large range which was between -5 and 53 degrees of external rotation. The mean foot angle was 15.4 ± 11.1 degrees relative to the implant position. All planned implant positions were mean 1.0 ± 1.8 degrees (range -3.8 – 1.7 degrees) internally rotated to the transmalleolar axis. Varus or valgus ankle arthritis did not correlate with rotation of the tibial axis (p=0.4). Conclusion: There is a wide variation in rotational alignment of the tibia, which cannot be accurately assessed clinically or using plain radiographs. Surgical techniques that reference the tibial tuberosity to plan component alignment can be misleading and lead to implant malalignment. We recommend routine preoperative CT scanning prior to ankle replacement surgery and recommend research to assess the effects of axial rotation of implant performance and survival.

Styles APA, Harvard, Vancouver, ISO, etc.

46

Manzi, Luigi, Cristian Indino, Christopher Gross, Riccardo D’Ambrosi et Federico Giuseppe Usuelli. « Hindfoot alignment in total ankle replacement at 2 year follow-uo ». Foot & ; Ankle Orthopaedics 3, n^o 3 (1 juillet 2018) : 2473011418S0033. http://dx.doi.org/10.1177/2473011418s00333.

Texte intégral

Résumé :

Category: Ankle Arthritis Introduction/Purpose: End-stage ankle osteoarthritis frequently involves multiplanar malalignment both tibio-talar and subtalar joint. Restoration of the correct position of the tibial and the talar component and of the hindfoot is mandatory for the long-term survival of total ankle replacement. Since patients with ankle osteoarthritis often present concomitant hindfoot deformity, radiographic references are needed to describe deformities. However, the possible compensatory mechanisms of these linked joints are not well known.The aim of this study is to show if there is any difference regarding hindfoot position at 6 months, 1 year and 2 years follow-up. Methods: The study included 68 ankles who underwent Total Ankle Replacment through a later transfibuklar approach between May 2013 and December 2015. The main indications for TAR were: post-traumatic (55 patients, 80.9%) and reumathoid arthritis (5 patients, 7.4%). In these patients the hindfoot view angle was measured 6, 12 and 24 months postoperatively. Furthermore, clinical outcomes were recorded. Patients who underwent hindfoot/midfoot fusions were excluded. Results: The mean hindfoot alignment angle (HAV) was 0.4±0.0 pre-operatively and 0.1±6.2, 0.7±6.2, 1.2±7.0 at 6, 12 and 24 months postoperatively. There was no statistically significant difference in the HAV between follow-up. A statistically significant improvement in clinical scores (AOFAS, VAS and SF.12) was found at each follow-up. The main complications were: 6 hardware removal for intollerance (8,8%), 3 delayed wound healing (4,4%), 1 medial impingement (1,5%). Conclusion: Regarding the hindfoot alignment angle, TAA through a lateral approach showed a good reliability. Furthermore, hindfoot alignment remains stable over time.

Styles APA, Harvard, Vancouver, ISO, etc.

47

Usuelli, Federico G., Camilla Maccario, Cristian Indino, Luigi Manzi, Fausto Romano et Christopher E. Gross. « Evaluation of Hindfoot Alignment After Fixed- and Mobile-Bearing Total Ankle Prostheses ». Foot & ; Ankle International 41, n^o 3 (9 décembre 2019) : 286–93. http://dx.doi.org/10.1177/1071100719891160.

Texte intégral

Résumé :

Background: End-stage ankle arthritis can involve malalignment of the ankle in both the coronal and sagittal planes. Up to 33% to 44% of patients who present for total ankle replacement (TAR) 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 changed over time. Specifically, we measured coronal and sagittal alignment of both the ankle and hindfoot complex. Methods: A retrospective study was performed on 2 independent groups of patients undergoing 2 different systems for total ankle replacement: Zimmer (lateral approach, fixed-bearing) and Hintegra (anterior approach, mobile bearing). Specific demographic data and radiographic data were measured. Within-group comparisons were performed using 1-way repeated measures ANOVA, analyzing the temporal course of clinical data within the Hintegra and Zimmer groups. Results: At the ankle joint, as measured by the α and β angles ( P > .05), the position of the components remained relatively similar in both the fixed- and mobile-bearing TAR at 24-month follow-up. The sagittal alignment, as measured by the TT (tibiotalar) ratio, demonstrated a posterior shifting of the talus in the mobile bearing group ( P = .036). Although the fixed- and mobile-bearing TAR had both significant hindfoot alignment improvement between the preoperative radiographs and at 24 months, over time, the fixed-bearing ankle had a significant increase in both the hindfoot alignment view angle and hindfoot alignment distance ( P < .001), suggesting a possible dynamism of the hindfoot in the fixed-bearing TAR. Conclusion: The lateral-approach fixed and anterior approach mobile-bearing implants maintained coronal and sagittal alignment in the short term; the temporal course of the lateral approach fixed-bearing ankle showed an increase in the valgus positioning of the hindfoot. The anterior approach mobile-bearing implant maintained its hindfoot alignment over the course of the study. Level of Evidence: Level III, case-control study.

Styles APA, Harvard, Vancouver, ISO, etc.

48

Conlin, Catherine, Ellie Pinsker, Ryan Khan et Timothy R. Daniels. « Experiences of Living with Bilateral Total Ankle Replacement and Ankle Arthrodesis : A Qualitative Study from a Patient Perspective ». Foot & ; Ankle Orthopaedics 4, n^o 4 (1 octobre 2019) : 2473011419S0014. http://dx.doi.org/10.1177/2473011419s00148.

Texte intégral

Résumé :

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) and ankle arthrodesis are both effective treatments for end-stage ankle arthritis, however differences in treatment outcomes may be better understood using a qualitative inquiry among individuals who have undergone both procedures. The purpose of this study was to investigate patients’ experiences and impressions of living with bilateral TAR and ankle arthrodesis. Methods: The sample consisted of 10 patients, selected purposively from a larger cohort, who could speak English and had a TAR on one side and ankle arthrodesis on the contralateral side. All procedures were completed by a single experienced surgeon. Semi-structured interviews were conducted at least one year after completion of the most recent procedure (TAR or arthrodesis). Qualitative data analysis was performed in accordance with a descriptive phenomenological theoretical approach, from which codes and themes were derived. Results: Interviews revealed advantages and disadvantages associated with both TAR and ankle arthrodesis from the patients’ perspective. Two overarching domains in which differences between their TARs and ankle fusions emerged: psychological and musculoskeletal. Within these domains, concepts of vigilance (as previously described by Pinsker) and strategizing the use of one ankle over the other emerged as themes that unified nearly all patients. Specific differences between the two procedures with respect to stability versus flexibility were commonly identified. Overall, patients preferred their TAR. Conclusion: This study provides insight into the lived experiences of a unique group of patients who have both an ankle arthrodesis and TAR. Patients evaluated the impact of TAR and ankle arthrodesis on their lives and overwhelmingly favoured TAR. The findings of this study can help clinicians to better counsel patients on expectations after TAR and ankle arthrodesis, and may aid researchers improve patient-report measurement instruments to better capture the outcomes that are important to patients.

Styles APA, Harvard, Vancouver, ISO, etc.

49

Putra, A. M. S., Muhamad Noor Harun et Syahrom Ardiyansyah. « Study of Wear Prediction on Total Ankle Replacement ». Advanced Materials Research 845 (décembre 2013) : 311–15. http://dx.doi.org/10.4028/www.scientific.net/amr.845.311.

Texte intégral

Résumé :

Pre-clinical experimental wear testing is very effective to evaluate new ankle replacement in the aspect of design and material used. However, both cost and time can be one of the constraints factors, particularly in the early stage of design or analysis. Numerical method has been addressed as an alternative to predict wear on ankle replacement. The computational wear simulation has been widely used on the hip and knee but very less found in study related to wear analysis of the ankle. The purpose of this research is to develop computational simulation to predict wear on total ankle replacement (TAR). Three dimensional (3D) models of the right ankle TAR were developed using BOX total ankle replacement model. Mobile bearing device was developed consisting of three components tibial, bearing and talar. Each component has different design and purposes representing its physiological behaviour of the ankle. The ankle load applied was based on the joint reaction force profile at the ankle joint. This is to determine the distribution of contact stress on the meniscal bearing surfaces contact with talar component for 25 discrete instant during stance phase of gait cycle. The sliding distance was obtained from predominates motion of plantar/dorsi flexion. The computed linear wear depth and cumulative volumetric wear were 0.01614 mm per million cycles and 30.5 mm3, respectively. The values obtained were proven to be consistent with the previous in vitro result.

Styles APA, Harvard, Vancouver, ISO, etc.

50

Jordan, Robert W., Gurdip S. Chahal et Anna Chapman. « Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis ? A Systematic Review ». Advances in Orthopedics 2014 (2014) : 1–9. http://dx.doi.org/10.1155/2014/986285.

Texte intégral

Résumé :

Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes.Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure.Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn.Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.

Styles APA, Harvard, Vancouver, ISO, etc.

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

Créez une référence correcte selon les styles APA, MLA, Chicago, Harvard et plusieurs autres