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James K Deorio - One of the best experts on this subject based on the ideXlab platform.
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Revision Surgery for Metal Component Failure in Total Ankle Arthroplasty
Foot & Ankle Orthopaedics, 2018Co-Authors: James R. Lachman, Jania Arcia Ramos, Samuel B Adams, Mark E Easley, James A. Nunley, James K DeorioAbstract:Background:Metal component failure in total Ankle Arthroplasty (TAA) is difficult to treat. Traditionally, conversion to an arthrodesis has been advocated. Revision TAA surgery has become more comm...
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Revision Surgery for Metal Component Failure in Total Ankle Arthroplasty
Foot & Ankle Orthopaedics, 2018Co-Authors: James Lachman, Jania Arcia Ramos, Samuel Adams, Mark Easley, James K DeorioAbstract:Category: Ankle Arthritis Introduction/Purpose: Metal component failure in total Ankle Arthroplasty(TAA) is difficult to treat. Traditionally, to an arthrodesis has been advocated. Revision TAA surgery has become more and more common with availability of revision implants and refinement of bone conserving primary implants. It this study, patient reported results and clinical outcomes are analyzed for patients undergoing revision total Ankle Arthroplasty. Methods: We retrospectively reviewed prospectively collected data on 45 patients (cases) with a mean age of 63.7 +/-10.2 years who developed loosening or collapse of either major metal component in the primary total Ankle Arthroplasty. Cases of isolated polyethylene exchange, infection, or extra-articular realignment procedures were excluded. Prospectively collected patient reported outcomes measures including the American Orthopaedic Foot and Ankle Society(AOFAS) hindfoot score, Visual Analog Scale (VAS), Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), and the Foot and Ankle Outcomes Score (FAOS) questionnaires were collected. Clinical data was collected through thorough review of the electronic medical record to identify clinical failure defined as explant and second revision or conversion to arthrodesis or amputation. Results: The causes of failure of primary TAA in this study were aseptic loosening of both components (40%), talar component subsidence/loosening (37.7%), tibial loosening (8.8%), coronal talar subluxation (8.8%) and talar malrotation (2.2%). Twenty-four patients (53.3%) underwent revision of all components, nineteen (42.2%) just the talar and polyethylene components, and two (4.4%) the tibial and polyethylene components. The average time to revision was 5.56 years +/- 5.71 with a follow-up of 3.02 years +/- 1.25 after revision. Ten (22.2%) revision arthroplasties required further surgery; five required conversion to arthrodesis and five required second revision TAA. VAS scores, SF36 scores, SMFA scores, AOFAS Hindfoot scores, and FAOS all improved after revision surgery but took 2 years to reach scores comparable to 1 year after primary TAA. Conclusion: Clinical and patient reported results of revision Ankle Arthroplasty after metal component failure were comparable to those after primary Ankle Arthroplasty. In our series, 22.2% of revision TAAs required a second revision TAA or arthrodesis surgery. Various prosthesis performed similarly when used in revision scenarios. Patients recovered faster from primary Ankle Arthroplasty when compared to revision Ankle Arthroplasty but all scores were comparable by the two-year follow-up visit after revision Arthroplasty surgery.
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Design Rationale for Total Ankle Arthroplasty Systems: An Update
The Journal of the American Academy of Orthopaedic Surgeons, 2018Co-Authors: Christopher E. Gross, Ariel Palanca, James K DeorioAbstract:The design of total Ankle Arthroplasty systems is evolving as a result of findings from longer-term studies. Our understanding of modes of failure has increased, and surgical techniques have become more refined. Currently, five total Ankle Arthroplasty systems are used in the United States. The landscape has changed considerably in the decade since the latest article reviewing total Ankle design was published. Some implants with acceptable intermediate results had much poorer outcomes at 7- to 10-year follow-up. As more research showing mid- to long-term outcomes is published, the design rationale and current outcomes data for each of these implants must be considered.
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Tibiotalar Arthrodesis Conversion to Total Ankle Arthroplasty.
JBJS essential surgical techniques, 2016Co-Authors: Manuel J. Pellegrini, Samuel B Adams, James K Deorio, James A. Nunley, Adam Schiff, Robin M. Queen, Mark E EasleyAbstract:[Introduction][1] Although conversion of the painful Ankle arthrodesis to total Ankle Arthroplasty remains controversial, this surgical modality has satisfactorily expanded the treatment armamentarium for addressing this pathology. [Indications & Contraindications][2] [Step 1: Preoperative Preparation and Surgical Planning][3] Preoperative preparation and planning is similar to that for a primary total Ankle Arthroplasty, and implants designed for primary Arthroplasty can be used in most patients managed with conversion to total Ankle replacement. [Step 2: Patient Positioning][4] Position the patient as for a primary total Ankle replacement. [Step 3: Remove Hardware and Insert Prophylactic Malleolar Screws][5] Preserve exsanguination time by removing hardware prior to inflating the tourniquet. [Step 4: Recreate the Tibiotalar Joint][6] Recreate the native joint line, which can be relatively easy in selected patients and challenging in others. [Step 5: Set the Optimal Talar Slope][7] Set the optimal talar slope, which can be challenging, particularly when the Ankle arthrodesis is malunited in equinus. [Step 6: Recreate the Medial and Lateral Gutters][8] Because the former medial and lateral articulations between the talus and the malleoli can be difficult to define, use careful surgical technique to avoid compromise of the malleoli and excessive talar resection. [Step 7: Mobilize the Ankle and Use Bone Graft in Defects from Previous Hardware][9] To avoid potential malleolar fractures, mobilize the Ankle only after the prophylactic malleolar screws have been placed; the tibial and talar cuts, completed; the gutters, reestablished; all resected bone, removed; and scar tissue from the posterior aspect of the Ankle, excised; thereafter, conversion total Ankle Arthroplasty is similar to a primary total Ankle replacement, with the exception of potential bone defects where prior hardware was positioned. [Step 8: Talar Preparation][10] Perform the routine steps for primary total Ankle Arthroplasty, often ignoring bone defects from the Ankle arthrodesis hardware, but plan to repair the defects with bone-grafting before implanting the final talar component. [Step 9: Tibial Preparation and Definitive Components][11] Perform tibial preparation in a manner similar to that used for primary total Ankle Arthroplasty. [Results][12] We performed 23 conversion total Ankle arthroplasties in patients who had an Ankle arthrodesis, including those with pain despite successful fusion and those with painful nonunions[9][13]. [Pitfalls & Challenges][14] [Introduction][1] Although conversion of the painful Ankle arthrodesis to total Ankle Arthroplasty remains controversial, this surgical modality has satisfactorily expanded the treatment armamentarium for addressing this pathology. [Indications & Contraindications][2] [Step 1: Preoperative Preparation and Surgical Planning][3] Preoperative preparation and planning is similar to that for a primary total Ankle Arthroplasty, and implants designed for primary Arthroplasty can be used in most patients managed with conversion to total Ankle replacement. [Step 2: Patient Positioning][4] Position the patient as for a primary total Ankle replacement. [Step 3: Remove Hardware and Insert Prophylactic Malleolar Screws][5] Preserve exsanguination time by removing hardware prior to inflating the tourniquet. [Step 4: Recreate the Tibiotalar Joint][6] Recreate the native joint line, which can be relatively easy in selected patients and challenging in others. [Step 5: Set the Optimal Talar Slope][7] Set the optimal talar slope, which can be challenging, particularly when the Ankle arthrodesis is malunited in equinus. [Step 6: Recreate the Medial and Lateral Gutters][8] Because the former medial and lateral articulations between the talus and the malleoli can be difficult to define, use careful surgical technique to avoid compromise of the malleoli and excessive talar resection. [Step 7: Mobilize the Ankle and Use Bone Graft in Defects from Previous Hardware][9] To avoid potential malleolar fractures, mobilize the Ankle only after the prophylactic malleolar screws have been placed; the tibial and talar cuts, completed; the gutters, reestablished; all resected bone, removed; and scar tissue from the posterior aspect of the Ankle, excised; thereafter, conversion total Ankle Arthroplasty is similar to a primary total Ankle replacement, with the exception of potential bone defects where prior hardware was positioned. [Step 8: Talar Preparation][10] Perform the routine steps for primary total Ankle Arthroplasty, often ignoring bone defects from the Ankle arthrodesis hardware, but plan to repair the defects with bone-grafting before implanting the final talar component. [Step 9: Tibial Preparation and Definitive Components][11] Perform tibial preparation in a manner similar to that used for primary total Ankle Arthroplasty. [Results][12] We performed 23 conversion total Ankle arthroplasties in patients who had an Ankle arthrodesis, including those with pain despite successful fusion and those with painful nonunions[9][13]. [Pitfalls & Challenges][14] [1]: #sec-15 [2]: #sec-16 [3]: #sec-19 [4]: #sec-20 [5]: #sec-21 [6]: #sec-22 [7]: #sec-23 [8]: #sec-24 [9]: #sec-25 [10]: #sec-26 [11]: #sec-27 [12]: #sec-28 [13]: #ref-9 [14]: #sec-29
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conversion of tibiotalar arthrodesis to total Ankle Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2015Co-Authors: Manuel J. Pellegrini, Samuel B Adams, James K Deorio, James A. Nunley, Adam Schiff, Robin M. Queen, Mark E EasleyAbstract:Background: Conversion of Ankle arthrodesis to total Ankle Arthroplasty remains controversial. Although satisfactory outcomes have been published, not all foot and Ankle surgeons performing total Ankle Arthroplasty have embraced this modality. Methods: Twenty-three total Ankle arthroplasties were performed in patients who had undergone a prior or an attempted Ankle arthrodesis. The mean age at surgery was fifty-nine years (range, forty-one to eighty years), and the mean duration of follow-up was 33.1 months (minimum, twelve months). Indications for the procedure were symptomatic adjacent hindfoot arthritis (twelve patients) or symptomatic tibiotalar or subtalar nonunion (eleven) after tibiotalocalcaneal arthrodesis. We performed concomitant surgical procedures in eighteen Ankles (78%), with the most common procedure being prophylactic malleolar fixation (70%). We prospectively evaluated clinical outcomes using the Short Form-36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), and visual analog scale (VAS) for pain and assessed initial weight-bearing radiographs and those made at the most recent follow-up evaluation. Results: The mean VAS pain score (and standard deviation) improved from 65.7 ± 21.8 preoperatively to 18.3 ± 17.6 at the most recent follow-up evaluation (p < 0.001), with five patients being pain-free (VAS score = 0). The mean SMFA bother and function indexes improved from 55 ± 22.9 and 46.7 ± 12.6 preoperatively to 30.6 ± 22.7 and 25.4 ± 17.4 at the most recent follow-up visit (p = 0.001 and p < 0.001, respectively). The mean SF-36 total score improved from 37.7 ± 19.3 to 56.4 ± 23.1 (p = 0.002). The implant survival rate was 87%. Four (20%) of the tibial components and fourteen (70%) of the talar components that were not revised exhibited initial settling and then were seen to be stabilized radiographically without further change in implant position. Three total Ankle replacements (13%) showed progressive talar subsidence, prompting revision. Ten patients (43%) had minor complications not requiring repeat surgery. Conclusions: Short-term follow-up after conversion of Ankle arthrodesis to total Ankle Arthroplasty demonstrated pain relief and improved function in a majority of patients. Patients who undergo this surgery frequently require concomitant procedures; we recommend prophylactic malleolar fixation when performing conversion total Ankle Arthroplasty. The rate of complications, particularly talar component settling and migration, is cause for concern. We do not recommend the procedure for Ankle arthrodeses that included distal fibulectomy. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Samuel B Adams - One of the best experts on this subject based on the ideXlab platform.
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Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage:
Foot & Ankle Orthopaedics, 2020Co-Authors: Daniel J. Cunningham, Sean P. Ryan, Samuel B AdamsAbstract:Category:Ankle Arthritis; Ankle; DiabetesIntroduction/Purpose:Total Ankle Arthroplasty (TAA) results in improved patient outcomes and preserved range of motion for patients with end-stage arthritis...
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Revision Surgery for Metal Component Failure in Total Ankle Arthroplasty
Foot & Ankle Orthopaedics, 2018Co-Authors: James R. Lachman, Jania Arcia Ramos, Samuel B Adams, Mark E Easley, James A. Nunley, James K DeorioAbstract:Background:Metal component failure in total Ankle Arthroplasty (TAA) is difficult to treat. Traditionally, conversion to an arthrodesis has been advocated. Revision TAA surgery has become more comm...
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Total Ankle Arthroplasty with Simultaneous Versus Secondary Hindfoot Arthrodesis
Foot & Ankle Orthopaedics, 2018Co-Authors: Michel A. Taylor, Mark E Easley, James A. Nunley, Selene G. Parekh, Elizabeth A. Cody, Samuel B AdamsAbstract:Category:Ankle ArthritisIntroduction/Purpose:Total Ankle Arthroplasty (TAA) for Ankle arthritis leads to a more normal gait pattern compared to Ankle arthrodesis, prompting many to hypothesize that...
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Tibiotalar Arthrodesis Conversion to Total Ankle Arthroplasty.
JBJS essential surgical techniques, 2016Co-Authors: Manuel J. Pellegrini, Samuel B Adams, James K Deorio, James A. Nunley, Adam Schiff, Robin M. Queen, Mark E EasleyAbstract:[Introduction][1] Although conversion of the painful Ankle arthrodesis to total Ankle Arthroplasty remains controversial, this surgical modality has satisfactorily expanded the treatment armamentarium for addressing this pathology. [Indications & Contraindications][2] [Step 1: Preoperative Preparation and Surgical Planning][3] Preoperative preparation and planning is similar to that for a primary total Ankle Arthroplasty, and implants designed for primary Arthroplasty can be used in most patients managed with conversion to total Ankle replacement. [Step 2: Patient Positioning][4] Position the patient as for a primary total Ankle replacement. [Step 3: Remove Hardware and Insert Prophylactic Malleolar Screws][5] Preserve exsanguination time by removing hardware prior to inflating the tourniquet. [Step 4: Recreate the Tibiotalar Joint][6] Recreate the native joint line, which can be relatively easy in selected patients and challenging in others. [Step 5: Set the Optimal Talar Slope][7] Set the optimal talar slope, which can be challenging, particularly when the Ankle arthrodesis is malunited in equinus. [Step 6: Recreate the Medial and Lateral Gutters][8] Because the former medial and lateral articulations between the talus and the malleoli can be difficult to define, use careful surgical technique to avoid compromise of the malleoli and excessive talar resection. [Step 7: Mobilize the Ankle and Use Bone Graft in Defects from Previous Hardware][9] To avoid potential malleolar fractures, mobilize the Ankle only after the prophylactic malleolar screws have been placed; the tibial and talar cuts, completed; the gutters, reestablished; all resected bone, removed; and scar tissue from the posterior aspect of the Ankle, excised; thereafter, conversion total Ankle Arthroplasty is similar to a primary total Ankle replacement, with the exception of potential bone defects where prior hardware was positioned. [Step 8: Talar Preparation][10] Perform the routine steps for primary total Ankle Arthroplasty, often ignoring bone defects from the Ankle arthrodesis hardware, but plan to repair the defects with bone-grafting before implanting the final talar component. [Step 9: Tibial Preparation and Definitive Components][11] Perform tibial preparation in a manner similar to that used for primary total Ankle Arthroplasty. [Results][12] We performed 23 conversion total Ankle arthroplasties in patients who had an Ankle arthrodesis, including those with pain despite successful fusion and those with painful nonunions[9][13]. [Pitfalls & Challenges][14] [Introduction][1] Although conversion of the painful Ankle arthrodesis to total Ankle Arthroplasty remains controversial, this surgical modality has satisfactorily expanded the treatment armamentarium for addressing this pathology. [Indications & Contraindications][2] [Step 1: Preoperative Preparation and Surgical Planning][3] Preoperative preparation and planning is similar to that for a primary total Ankle Arthroplasty, and implants designed for primary Arthroplasty can be used in most patients managed with conversion to total Ankle replacement. [Step 2: Patient Positioning][4] Position the patient as for a primary total Ankle replacement. [Step 3: Remove Hardware and Insert Prophylactic Malleolar Screws][5] Preserve exsanguination time by removing hardware prior to inflating the tourniquet. [Step 4: Recreate the Tibiotalar Joint][6] Recreate the native joint line, which can be relatively easy in selected patients and challenging in others. [Step 5: Set the Optimal Talar Slope][7] Set the optimal talar slope, which can be challenging, particularly when the Ankle arthrodesis is malunited in equinus. [Step 6: Recreate the Medial and Lateral Gutters][8] Because the former medial and lateral articulations between the talus and the malleoli can be difficult to define, use careful surgical technique to avoid compromise of the malleoli and excessive talar resection. [Step 7: Mobilize the Ankle and Use Bone Graft in Defects from Previous Hardware][9] To avoid potential malleolar fractures, mobilize the Ankle only after the prophylactic malleolar screws have been placed; the tibial and talar cuts, completed; the gutters, reestablished; all resected bone, removed; and scar tissue from the posterior aspect of the Ankle, excised; thereafter, conversion total Ankle Arthroplasty is similar to a primary total Ankle replacement, with the exception of potential bone defects where prior hardware was positioned. [Step 8: Talar Preparation][10] Perform the routine steps for primary total Ankle Arthroplasty, often ignoring bone defects from the Ankle arthrodesis hardware, but plan to repair the defects with bone-grafting before implanting the final talar component. [Step 9: Tibial Preparation and Definitive Components][11] Perform tibial preparation in a manner similar to that used for primary total Ankle Arthroplasty. [Results][12] We performed 23 conversion total Ankle arthroplasties in patients who had an Ankle arthrodesis, including those with pain despite successful fusion and those with painful nonunions[9][13]. [Pitfalls & Challenges][14] [1]: #sec-15 [2]: #sec-16 [3]: #sec-19 [4]: #sec-20 [5]: #sec-21 [6]: #sec-22 [7]: #sec-23 [8]: #sec-24 [9]: #sec-25 [10]: #sec-26 [11]: #sec-27 [12]: #sec-28 [13]: #ref-9 [14]: #sec-29
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conversion of tibiotalar arthrodesis to total Ankle Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2015Co-Authors: Manuel J. Pellegrini, Samuel B Adams, James K Deorio, James A. Nunley, Adam Schiff, Robin M. Queen, Mark E EasleyAbstract:Background: Conversion of Ankle arthrodesis to total Ankle Arthroplasty remains controversial. Although satisfactory outcomes have been published, not all foot and Ankle surgeons performing total Ankle Arthroplasty have embraced this modality. Methods: Twenty-three total Ankle arthroplasties were performed in patients who had undergone a prior or an attempted Ankle arthrodesis. The mean age at surgery was fifty-nine years (range, forty-one to eighty years), and the mean duration of follow-up was 33.1 months (minimum, twelve months). Indications for the procedure were symptomatic adjacent hindfoot arthritis (twelve patients) or symptomatic tibiotalar or subtalar nonunion (eleven) after tibiotalocalcaneal arthrodesis. We performed concomitant surgical procedures in eighteen Ankles (78%), with the most common procedure being prophylactic malleolar fixation (70%). We prospectively evaluated clinical outcomes using the Short Form-36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), and visual analog scale (VAS) for pain and assessed initial weight-bearing radiographs and those made at the most recent follow-up evaluation. Results: The mean VAS pain score (and standard deviation) improved from 65.7 ± 21.8 preoperatively to 18.3 ± 17.6 at the most recent follow-up evaluation (p < 0.001), with five patients being pain-free (VAS score = 0). The mean SMFA bother and function indexes improved from 55 ± 22.9 and 46.7 ± 12.6 preoperatively to 30.6 ± 22.7 and 25.4 ± 17.4 at the most recent follow-up visit (p = 0.001 and p < 0.001, respectively). The mean SF-36 total score improved from 37.7 ± 19.3 to 56.4 ± 23.1 (p = 0.002). The implant survival rate was 87%. Four (20%) of the tibial components and fourteen (70%) of the talar components that were not revised exhibited initial settling and then were seen to be stabilized radiographically without further change in implant position. Three total Ankle replacements (13%) showed progressive talar subsidence, prompting revision. Ten patients (43%) had minor complications not requiring repeat surgery. Conclusions: Short-term follow-up after conversion of Ankle arthrodesis to total Ankle Arthroplasty demonstrated pain relief and improved function in a majority of patients. Patients who undergo this surgery frequently require concomitant procedures; we recommend prophylactic malleolar fixation when performing conversion total Ankle Arthroplasty. The rate of complications, particularly talar component settling and migration, is cause for concern. We do not recommend the procedure for Ankle arthrodeses that included distal fibulectomy. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Nikolaus Böhler - One of the best experts on this subject based on the ideXlab platform.
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Outcome after total Ankle Arthroplasty—results and findings from worldwide Arthroplasty registers
International orthopaedics, 2013Co-Authors: Gerold Labek, Svilen Todorov, Liviu Iovanescu, Christian Ioan Stoica, Nikolaus BöhlerAbstract:Purpose The data currently available concerning total Ankle Arthroplasty (TAA) does not allow valid conclusions in several clinically relevant areas. Total Ankle Arthroplasty imposes special requirements on the methodology of data collection, evaluation, publication and the assessment of register data.
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outcome after total Ankle Arthroplasty results and findings from worldwide Arthroplasty registers
International Orthopaedics, 2013Co-Authors: Gerold Labek, Svilen Todorov, Liviu Iovanescu, Christian Ioan Stoica, Nikolaus BöhlerAbstract:Purpose The data currently available concerning total Ankle Arthroplasty (TAA) does not allow valid conclusions in several clinically relevant areas. Total Ankle Arthroplasty imposes special requirements on the methodology of data collection, evaluation, publication and the assessment of register data.
Mark E Easley - One of the best experts on this subject based on the ideXlab platform.
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Revision Surgery for Metal Component Failure in Total Ankle Arthroplasty
Foot & Ankle Orthopaedics, 2018Co-Authors: James R. Lachman, Jania Arcia Ramos, Samuel B Adams, Mark E Easley, James A. Nunley, James K DeorioAbstract:Background:Metal component failure in total Ankle Arthroplasty (TAA) is difficult to treat. Traditionally, conversion to an arthrodesis has been advocated. Revision TAA surgery has become more comm...
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Total Ankle Arthroplasty with Simultaneous Versus Secondary Hindfoot Arthrodesis
Foot & Ankle Orthopaedics, 2018Co-Authors: Michel A. Taylor, Mark E Easley, James A. Nunley, Selene G. Parekh, Elizabeth A. Cody, Samuel B AdamsAbstract:Category:Ankle ArthritisIntroduction/Purpose:Total Ankle Arthroplasty (TAA) for Ankle arthritis leads to a more normal gait pattern compared to Ankle arthrodesis, prompting many to hypothesize that...
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Total Ankle Arthroplasty: A Critical Analysis Review.
JBJS reviews, 2018Co-Authors: Elizabeth A. Cody, Daniel J. Scott, Mark E EasleyAbstract:Total Ankle Arthroplasty has become an accepted alternative to Ankle arthrodesis for end-stage Ankle arthritis, with usage increasing considerably over the past decade.Recent publications have shown good early to intermediate-term outcomes and high patient satisfaction. Patients with large coronal p
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Tibiotalar Arthrodesis Conversion to Total Ankle Arthroplasty.
JBJS essential surgical techniques, 2016Co-Authors: Manuel J. Pellegrini, Samuel B Adams, James K Deorio, James A. Nunley, Adam Schiff, Robin M. Queen, Mark E EasleyAbstract:[Introduction][1] Although conversion of the painful Ankle arthrodesis to total Ankle Arthroplasty remains controversial, this surgical modality has satisfactorily expanded the treatment armamentarium for addressing this pathology. [Indications & Contraindications][2] [Step 1: Preoperative Preparation and Surgical Planning][3] Preoperative preparation and planning is similar to that for a primary total Ankle Arthroplasty, and implants designed for primary Arthroplasty can be used in most patients managed with conversion to total Ankle replacement. [Step 2: Patient Positioning][4] Position the patient as for a primary total Ankle replacement. [Step 3: Remove Hardware and Insert Prophylactic Malleolar Screws][5] Preserve exsanguination time by removing hardware prior to inflating the tourniquet. [Step 4: Recreate the Tibiotalar Joint][6] Recreate the native joint line, which can be relatively easy in selected patients and challenging in others. [Step 5: Set the Optimal Talar Slope][7] Set the optimal talar slope, which can be challenging, particularly when the Ankle arthrodesis is malunited in equinus. [Step 6: Recreate the Medial and Lateral Gutters][8] Because the former medial and lateral articulations between the talus and the malleoli can be difficult to define, use careful surgical technique to avoid compromise of the malleoli and excessive talar resection. [Step 7: Mobilize the Ankle and Use Bone Graft in Defects from Previous Hardware][9] To avoid potential malleolar fractures, mobilize the Ankle only after the prophylactic malleolar screws have been placed; the tibial and talar cuts, completed; the gutters, reestablished; all resected bone, removed; and scar tissue from the posterior aspect of the Ankle, excised; thereafter, conversion total Ankle Arthroplasty is similar to a primary total Ankle replacement, with the exception of potential bone defects where prior hardware was positioned. [Step 8: Talar Preparation][10] Perform the routine steps for primary total Ankle Arthroplasty, often ignoring bone defects from the Ankle arthrodesis hardware, but plan to repair the defects with bone-grafting before implanting the final talar component. [Step 9: Tibial Preparation and Definitive Components][11] Perform tibial preparation in a manner similar to that used for primary total Ankle Arthroplasty. [Results][12] We performed 23 conversion total Ankle arthroplasties in patients who had an Ankle arthrodesis, including those with pain despite successful fusion and those with painful nonunions[9][13]. [Pitfalls & Challenges][14] [Introduction][1] Although conversion of the painful Ankle arthrodesis to total Ankle Arthroplasty remains controversial, this surgical modality has satisfactorily expanded the treatment armamentarium for addressing this pathology. [Indications & Contraindications][2] [Step 1: Preoperative Preparation and Surgical Planning][3] Preoperative preparation and planning is similar to that for a primary total Ankle Arthroplasty, and implants designed for primary Arthroplasty can be used in most patients managed with conversion to total Ankle replacement. [Step 2: Patient Positioning][4] Position the patient as for a primary total Ankle replacement. [Step 3: Remove Hardware and Insert Prophylactic Malleolar Screws][5] Preserve exsanguination time by removing hardware prior to inflating the tourniquet. [Step 4: Recreate the Tibiotalar Joint][6] Recreate the native joint line, which can be relatively easy in selected patients and challenging in others. [Step 5: Set the Optimal Talar Slope][7] Set the optimal talar slope, which can be challenging, particularly when the Ankle arthrodesis is malunited in equinus. [Step 6: Recreate the Medial and Lateral Gutters][8] Because the former medial and lateral articulations between the talus and the malleoli can be difficult to define, use careful surgical technique to avoid compromise of the malleoli and excessive talar resection. [Step 7: Mobilize the Ankle and Use Bone Graft in Defects from Previous Hardware][9] To avoid potential malleolar fractures, mobilize the Ankle only after the prophylactic malleolar screws have been placed; the tibial and talar cuts, completed; the gutters, reestablished; all resected bone, removed; and scar tissue from the posterior aspect of the Ankle, excised; thereafter, conversion total Ankle Arthroplasty is similar to a primary total Ankle replacement, with the exception of potential bone defects where prior hardware was positioned. [Step 8: Talar Preparation][10] Perform the routine steps for primary total Ankle Arthroplasty, often ignoring bone defects from the Ankle arthrodesis hardware, but plan to repair the defects with bone-grafting before implanting the final talar component. [Step 9: Tibial Preparation and Definitive Components][11] Perform tibial preparation in a manner similar to that used for primary total Ankle Arthroplasty. [Results][12] We performed 23 conversion total Ankle arthroplasties in patients who had an Ankle arthrodesis, including those with pain despite successful fusion and those with painful nonunions[9][13]. [Pitfalls & Challenges][14] [1]: #sec-15 [2]: #sec-16 [3]: #sec-19 [4]: #sec-20 [5]: #sec-21 [6]: #sec-22 [7]: #sec-23 [8]: #sec-24 [9]: #sec-25 [10]: #sec-26 [11]: #sec-27 [12]: #sec-28 [13]: #ref-9 [14]: #sec-29
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conversion of tibiotalar arthrodesis to total Ankle Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2015Co-Authors: Manuel J. Pellegrini, Samuel B Adams, James K Deorio, James A. Nunley, Adam Schiff, Robin M. Queen, Mark E EasleyAbstract:Background: Conversion of Ankle arthrodesis to total Ankle Arthroplasty remains controversial. Although satisfactory outcomes have been published, not all foot and Ankle surgeons performing total Ankle Arthroplasty have embraced this modality. Methods: Twenty-three total Ankle arthroplasties were performed in patients who had undergone a prior or an attempted Ankle arthrodesis. The mean age at surgery was fifty-nine years (range, forty-one to eighty years), and the mean duration of follow-up was 33.1 months (minimum, twelve months). Indications for the procedure were symptomatic adjacent hindfoot arthritis (twelve patients) or symptomatic tibiotalar or subtalar nonunion (eleven) after tibiotalocalcaneal arthrodesis. We performed concomitant surgical procedures in eighteen Ankles (78%), with the most common procedure being prophylactic malleolar fixation (70%). We prospectively evaluated clinical outcomes using the Short Form-36 (SF-36), Short Musculoskeletal Function Assessment (SMFA), and visual analog scale (VAS) for pain and assessed initial weight-bearing radiographs and those made at the most recent follow-up evaluation. Results: The mean VAS pain score (and standard deviation) improved from 65.7 ± 21.8 preoperatively to 18.3 ± 17.6 at the most recent follow-up evaluation (p < 0.001), with five patients being pain-free (VAS score = 0). The mean SMFA bother and function indexes improved from 55 ± 22.9 and 46.7 ± 12.6 preoperatively to 30.6 ± 22.7 and 25.4 ± 17.4 at the most recent follow-up visit (p = 0.001 and p < 0.001, respectively). The mean SF-36 total score improved from 37.7 ± 19.3 to 56.4 ± 23.1 (p = 0.002). The implant survival rate was 87%. Four (20%) of the tibial components and fourteen (70%) of the talar components that were not revised exhibited initial settling and then were seen to be stabilized radiographically without further change in implant position. Three total Ankle replacements (13%) showed progressive talar subsidence, prompting revision. Ten patients (43%) had minor complications not requiring repeat surgery. Conclusions: Short-term follow-up after conversion of Ankle arthrodesis to total Ankle Arthroplasty demonstrated pain relief and improved function in a majority of patients. Patients who undergo this surgery frequently require concomitant procedures; we recommend prophylactic malleolar fixation when performing conversion total Ankle Arthroplasty. The rate of complications, particularly talar component settling and migration, is cause for concern. We do not recommend the procedure for Ankle arthrodeses that included distal fibulectomy. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Jong Keun Seon - One of the best experts on this subject based on the ideXlab platform.
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heterotopic ossification after primary total Ankle Arthroplasty
Journal of Bone and Joint Surgery American Volume, 2011Co-Authors: Jukwon Park, Eunkyoo Song, Taekrim Yoon, Jong Keun SeonAbstract:Background: Heterotopic ossification following lower-limb joint Arthroplasty is a challenging clinical problem. No comprehensive study has been conducted on heterotopic ossification after total Ankle Arthroplasty, to our knowledge. The purpose of this study was to evaluate the prevalence and location of heterotopic ossification after primary total Ankle Arthroplasty, predisposing factors, and effects on clinical outcomes, and to develop a method of classification. Methods: Eighty Ankles in eighty patients with a primary total Ankle Arthroplasty were followed for a mean (and standard deviation) of 31.9 ± 11.3 months (range, twenty-four to sixty-five months). The prevalence and location of heterotopic ossification, predisposing factors, and outcomes were analyzed, and a method of classification was developed. Results: Twenty (25%) of the eighty Ankles demonstrated postoperative heterotopic ossification, with the majority of the cases in the posterior aspect of the Ankle. The heterotopic ossification was Class I in four cases (20%); Class II, in five (25%); Class III, in four (20%); and Class IV, in seven (35%). Symptomatic heterotopic ossification was reported in eight patients (10%), and two required surgical resection because of intractable pain. Ankles that developed heterotopic ossification had significantly longer operative times, less postoperative motion, and lower American Orthopaedic Foot & Ankle Society Ankle-hindfoot scores at the six, twelve, and twenty-four-month follow-up examinations (p < 0.05 for all). Conclusions: This study demonstrates that the prevalence of heterotopic ossification following primary total Ankle Arthroplasty is considerable, and that heterotopic ossification is associated with reduced Ankle motion and a poor clinical outcome at a mean of two years postoperatively. Care is needed to attempt to reduce the occurrence of heterotopic ossification. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
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Total Ankle Arthroplasty outcome comparison for post-traumatic and primary osteoarthritis.
Foot & ankle international, 2010Co-Authors: Long-bin Bai, Eunkyoo Song, Taekrim Yoon, Keun-bae Lee, Jong Keun SeonAbstract:Background: Mobile-bearing total Ankle Arthroplasty designs have achieved good clinical results for the treatment of Ankle osteoarthritis. However, no direct comparison of the outcomes of total Ankle Arthroplasty has been made between posttraumatic and primary osteoarthritis. The purpose of the present study was to compare the clinical and radiographic outcomes of total Ankle Arthroplasty in patients with posttraumatic and primary osteoarthritis. Materials and Methods: The HINTEGRA total Ankle Arthroplasty was carried out in 65 patients (67 Ankles) with symptomatic Ankle osteoarthritis. Group A included 37 patients (37 Ankles) with post-traumatic osteoarthritis, whereas Group B included 28 patients (30 Ankles) with primary osteoarthritis. Patients were assessed clinically and radiographically at a mean followup of 38 months. Results: No significant differences were found between the two study groups in terms of American Orthopaedic Foot and Ankle Society Ankle-hindfoot scales, range of motion, or radiogra...
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Cementless total Ankle Arthroplasty in diabetic neuropathic arthropathy
Diabetic Medicine, 2008Co-Authors: Keun-bae Lee, Sang-gwon Cho, Jong Keun SeonAbstract:Background Neuropathic arthropathy (Charcot joint) is a progressive degenerative disease of a joint that may lead to severe deformity and dysfunction and it is now recognized that diabetes is the leading cause of Charcot joint. When the Ankle is involved and conservative treatment fails arthrodesis has commonly been performed, whereas Arthroplasty has previously been considered to be contraindicated. A total Ankle Arthroplasty in Charcot Ankle has not been previously reported. Case report We report the case of a 45-year old, diabetic woman with unilateral Charcot Ankle. Conclusions The woman successfully completed a rehabilitation programme and, 2 years after total Ankle Arthroplasty, achieved independence.