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Marelie Maritz - One of the best experts on this subject based on the ideXlab platform.
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Mobility Total Ankle Replacement – short term results
2018Co-Authors: I Stead, Marelie MaritzAbstract:IntroductionTotal Ankle Replacement designs continue to evolve, and provide an alternative to Ankle arthrodesis for patients with Ankle arthritis. It has been our practice to offer total Ankle Replacement to selected patients with Ankle arthritis. The purpose of this study was to analyse the short term results of our patients with the Mobility R Total Ankle Replacement (TAR) system.MethodsAll patients who received TAR in our practice from 2004 to 2011 were reviewed. American Orthopaedic Foot and Ankle Scores AOFAS were assessed and compared both preoperatively and at time of follow-up. All complications both intra-operative and post-operatively were noted. Weight bearing X-rays were taken at follow-up, and implant alignment and the presence of lucencies were noted.Results21 patients were evaluated. All showed an improvement in AOFAS scores; however the improvement showed a wide variation. All patients showed an improvement in pain scores. Post-operative Ankle stiffness, specifically dorsi-flexion, was pro...
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Mobility Total Ankle Replacement – short term results
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: I Stead, Marelie MaritzAbstract:Introduction Total Ankle Replacement designs continue to evolve, and provide an alternative to Ankle arthrodesis for patients with Ankle arthritis. It has been our practice to offer total Ankle Replacement to selected patients with Ankle arthritis. The purpose of this study was to analyse the short term results of our patients with the Mobility R Total Ankle Replacement (TAR) system. Methods All patients who received TAR in our practice from 2004 to 2011 were reviewed. American Orthopaedic Foot and Ankle Scores AOFAS were assessed and compared both preoperatively and at time of follow-up. All complications both intra-operative and post-operatively were noted. Weight bearing X-rays were taken at follow-up, and implant alignment and the presence of lucencies were noted. Results 21 patients were evaluated. All showed an improvement in AOFAS scores; however the improvement showed a wide variation. All patients showed an improvement in pain scores. Post-operative Ankle stiffness, specifically dorsi-flexion, was problematic in several patients. Marked prolonged swelling was problematic for many patients. Conclusions Total Ankle Replacement provides a good option for patients with Ankle arthritis. Swelling and post-operative stiffness continue to be a problem, and should be explained to patients. MULTIPLE DISCLOSURES
Victor Valderrabano - One of the best experts on this subject based on the ideXlab platform.
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total Ankle Replacement
Deutsches Arzteblatt International, 2015Co-Authors: Alexej Barg, Matthias D Wimmer, Martin Wiewiorski, Dieter Christian Wirtz, Geert Pagenstert, Victor ValderrabanoAbstract:Osteoarthritis of the Ankle is an increasing issue in the healthcare sector (1, e1, e2). Approximately 1% of the adult population suffers from painful Ankle osteoarthritis (2). The psychological and physical limitations associated with advanced Ankle osteoarthritis are at least as marked as those of patients with osteoarthritis of the knee or hip (2). Degenerative changes of the Ankle, in contrast to osteoarthritis of the knee or hip, are usually posttraumatic (Table 1, eTable 1) (3, e3, e4). Both poorly healed fractures to the lower extremity (4, e5) and repetitive ligament injuries (5) can play a major role. The main causes of secondary osteoarthritis of the Ankle include rheumatic diseases, hemophilia, hemochromatosis, gout, avascular necrosis, and postinfectious states (1, e1). Table 1 Etiology of advanced Ankle osteoarthritis, based on a selection of clinical and epidemiological studies* eTable 1 Etiology of advanced Ankle osteoarthritis, based on a selection of clinical and epidemiological studies* This review article uses the current literature to explain the indications and the absolute and relative contraindications for total Ankle Replacement. It also presents the results of current clinical studies on postoperative functional outcomes and the probability of success of Ankle Replacement surgery.
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gait analysis in Ankle osteoarthritis and total Ankle Replacement
Clinical Biomechanics, 2007Co-Authors: Benno M Nigg, Vinzenz Von Tscharner, Beat Goepfert, Darren J Stefanyshyn, Victor Valderrabano, Beat HintermannAbstract:BACKGROUND: Little information is available about gait changes in Ankle osteoarthritis and total Ankle Replacement, and also about total Ankle Replacement patients' rehabilitation in the first year after surgery. METHODS: Thirty subjects were included in this study: 15 unilateral post-traumatic Ankle osteoarthritis patients and 15 age-/gender-matched control subjects. Patients were followed prospectively: preoperatively, at 3, 6, 9, and 12 months after total Ankle Replacement. The clinical-functional level was assessed by the American Orthopaedic Foot and Ankle Society Ankle and the Short-Form-36 health survey score. 3D Ankle-hindfoot kinematic-kinetic analysis was performed using a motion analysis and a two-plate force-platform system. Statistics included repeated measures analysis of variances, independent sample and paired Student's t-tests (significance alpha=0.05). FINDINGS: Compared to normal subjects, Ankle osteoarthritis caused significant reduction of the American Orthopaedic Foot and Ankle Society and Short-Form-36 score. In gait analysis, Ankle osteoarthritis showed a significant deficiency in six of seven spatiotemporal variables, a decrease of the tri-planar Ankle movement, a decrease of the second active maximal vertical and the maximal medial ground reaction force, a reduction of the sagittal and transverse Ankle joint moments, a reduction of the Ankle joint power. Three months after total Ankle Replacement surgery patients experienced a worsening of gait. At 12 months follow-up, all spatiotemporal variables were not different from the normal subjects (full rehabilitation); in six of 11 kinematic and kinetic variables there was a partial rehabilitation. INTERPRETATION: This study provides data for the clinical-biomechanical understanding of the normal, arthritic, and total Ankle Replacement treated Ankle during walking and the first year of rehabilitation.
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sports and recreation activity of Ankle arthritis patients before and after total Ankle Replacement
American Journal of Sports Medicine, 2006Co-Authors: Victor Valderrabano, Markus Knupp, Geert Pagenstert, Monika Horisberger, Beat HintermannAbstract:BackgroundTotal Ankle Replacement is a possible treatment for Ankle arthritis; however, participation in sports after this procedure has not yet been analyzed.HypothesesThere is a significant increase of sports activity after total Ankle Replacement in patients with arthritis. There is a significant correlation between sports activity and American Orthopaedic Foot and Ankle Society hindfoot score in patients after total Ankle Replacement.Study DesignCase series; Level of evidence, 4.MethodsA clinical evaluation was performed preoperatively and at follow-up after total Ankle Replacement in 147 patients (152 Ankles) with Ankle arthritis (mean age, 59.6 years; range, 28-86 years). Ankle arthritis origin, patient satisfaction, range of motion, American Orthopaedic Foot and Ankle Society hindfoot score, radiologic assessment, and rate, level, and type of sports activity were documented at both evaluations. The mean follow-up was 2.8 years (range, 2-4 years).ResultsPreoperative diagnosis was posttraumatic osteo...
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total Ankle Replacement
Foot and Ankle Clinics of North America, 2003Co-Authors: Beat Hintermann, Victor ValderrabanoAbstract:SUMMARY Background: About 1% of adults suffer from painful osteoarthritis of the Ankle. The current literature contains no information on the percentage of such patients who derive long-term relief of symptoms from conservative treatment. Advanced Ankle osteoarthritis can be treated with non-joint-preserving measures, such as total Ankle Replacement and Ankle fusion. Methods: This review is based on selected relevant publications, guidelines from Germany and abroad, and the authors’ personal experience. Results: Before surgery is considered, conservative measures such as physiotherapy and orthopedic aids should be used to the fullest possible extent. No randomized trials have yet been published comparing total Ankle Replacement with Ankle fusion. Total Ankle Replacement with newer types of prosthesis yields good to very good intermediate-term and long-term results, with mean success rates of up to 90% at 10 years (range, 68–100%).
Beat Hintermann - One of the best experts on this subject based on the ideXlab platform.
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Total Ankle Replacement for the Valgus Unstable Osteoarthritic Ankle
Techniques in Foot & Ankle Surgery, 2010Co-Authors: Samuel Brunner, Markus Knupp, Beat HintermannAbstract:Total Ankle Replacement in valgus unstable Ankles is challenging because misalignment of the Ankle, especially in combination with valgus instability, has been identified as a major deteriorating factor for the result of total Ankle Replacement. This article describes a treatment algorithm based on the classification of valgus unstable osteoarthritic Ankles. Three types of valgus unstable Ankles are differentiated with regard to the treatment.
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total Ankle Replacement in association with hindfoot fusion outcome and complications
Journal of Bone and Joint Surgery-british Volume, 2010Co-Authors: Markus Knupp, Lukas Zwicky, Beat HintermannAbstract:We report the clinical and radiological outcome of total Ankle Replacement performed in conjunction with hindfoot fusion or in isolation. Between May 2003 and June 2008, 60 Ankles were treated with total Ankle Replacement with either subtalar or triple fusion, and the results were compared with a control group of 288 Ankles treated with total Ankle Replacement alone.After the mean follow-up of 39.5 months (12 to 73), the Ankles with hindfoot fusion showed significant improvement in the mean visual analogue score for pain (p < 0.001), the mean American Orthopaedic Foot and Ankle Society score (p < 0.001), and the mean of a modified version of this score (p < 0.001). The mean visual analogue pain score (p = 0.304) and mean modified American Orthopaedic Foot and Ankle Society score (p = 0.119) were not significantly different between the hindfoot fusion and the control groups. However, the hindfoot fusion group had a significantly lower mean range of movement (p = 0.009) and a higher rate of posterior focal ...
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insert position in three component total Ankle Replacement
Foot & Ankle International, 2010Co-Authors: Alexej Barg, Andreas Elsner, Bavornrit Chuckpaiwong, Beat HintermannAbstract:Total Ankle Replacement has become a valuable treatment option for end-stage osteoarthritis. The most recent generation of implants comprises a second interface between the polyethylene insert and the tibial prosthetic component. This may permit a better adaptation of position between the implant components and thereby prevent unphysiological loading of Ankle ligaments and reduce polyethylene wear. To date, no available data have evaluated whether the relative position of talar and tibial implant components change over time.
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haemophilic arthropathy of the Ankle treated by total Ankle Replacement a case series
Haemophilia, 2010Co-Authors: Alexej Barg, Andreas Elsner, D Hefti, Beat HintermannAbstract:The standard treatment for end-stage osteoarthritis of the Ankle joint in haemophilic patients has been fusion of the Ankle joint. Total Ankle Replacement is still controversial as a treatment option. The objective of this prospective study was to evaluate the mid-term outcome in patients treated with total Ankle Replacement using an unconstrained three-component Ankle implant. Ten haemophilic Ankles in eight patients (mean age: 43.2 years, range 26.7-57.5) treated with total Ankle Replacement were followed up for a minimum of 2.7 years (mean: 5.6, range 2.7-7.6). The outcome was measured with clinical and radiological evaluations. There were no intra- or peri-operative complications. The AOFAS-hindfoot-score increased from 38 (range 8-57) preoperatively to 81 (range 69-95) postoperatively. All patients were satisfied with the results. Four patients became pain free; in the whole patient cohort pain level decreased from 7.1 (range 4-9) preoperatively to 0.8 (range 0-3) postoperatively. All categories of SF-36 score showed significant improvements in quality of life. In one patient, open Ankle arthrolysis was performed because of painful arthrofibrosis. For patients with haemophilic osteoarthritis of the Ankle joint, total Ankle Replacement is a valuable alternative treatment to Ankle fusion.
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Total Ankle Replacement in association with hindfoot fusion
The Journal of Bone and Joint Surgery. British volume, 2010Co-Authors: B. S. Kim, Markus Knupp, Lukas Zwicky, J. W. Lee, Beat HintermannAbstract:We report the clinical and radiological outcome of total Ankle Replacement performed in conjunction with hindfoot fusion or in isolation. Between May 2003 and June 2008, 60 Ankles were treated with total Ankle Replacement with either subtalar or triple fusion, and the results were compared with a control group of 288 Ankles treated with total Ankle Replacement alone. After the mean follow-up of 39.5 months (12 to 73), the Ankles with hindfoot fusion showed significant improvement in the mean visual analogue score for pain (p > 0.001), the mean American Orthopaedic Foot and Ankle Society score (p > 0.001), and the mean of a modified version of this score (p > 0.001). The mean visual analogue pain score (p = 0.304) and mean modified American Orthopaedic Foot and Ankle Society score (p = 0.119) were not significantly different between the hindfoot fusion and the control groups. However, the hindfoot fusion group had a significantly lower mean range of movement (p = 0.009) and a higher rate of posterior focal osteolysis (p = 0.04). Both groups showed various complications (p = 0.131) and failure occurring at a similar rate (p = 0.685). Subtalar or triple fusion is feasible and has minimal adverse effects on Ankles treated with total Ankle Replacement up to midterm follow-up. The clinical outcome of total Ankle Replacement when combined with hindfoot fusion is comparable to that of Ankle Replacement alone. Thus, hindfoot fusion should be performed in conjunction with total Ankle Replacement when indicated
I Stead - One of the best experts on this subject based on the ideXlab platform.
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Mobility Total Ankle Replacement – short term results
2018Co-Authors: I Stead, Marelie MaritzAbstract:IntroductionTotal Ankle Replacement designs continue to evolve, and provide an alternative to Ankle arthrodesis for patients with Ankle arthritis. It has been our practice to offer total Ankle Replacement to selected patients with Ankle arthritis. The purpose of this study was to analyse the short term results of our patients with the Mobility R Total Ankle Replacement (TAR) system.MethodsAll patients who received TAR in our practice from 2004 to 2011 were reviewed. American Orthopaedic Foot and Ankle Scores AOFAS were assessed and compared both preoperatively and at time of follow-up. All complications both intra-operative and post-operatively were noted. Weight bearing X-rays were taken at follow-up, and implant alignment and the presence of lucencies were noted.Results21 patients were evaluated. All showed an improvement in AOFAS scores; however the improvement showed a wide variation. All patients showed an improvement in pain scores. Post-operative Ankle stiffness, specifically dorsi-flexion, was pro...
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Mobility Total Ankle Replacement – short term results
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: I Stead, Marelie MaritzAbstract:Introduction Total Ankle Replacement designs continue to evolve, and provide an alternative to Ankle arthrodesis for patients with Ankle arthritis. It has been our practice to offer total Ankle Replacement to selected patients with Ankle arthritis. The purpose of this study was to analyse the short term results of our patients with the Mobility R Total Ankle Replacement (TAR) system. Methods All patients who received TAR in our practice from 2004 to 2011 were reviewed. American Orthopaedic Foot and Ankle Scores AOFAS were assessed and compared both preoperatively and at time of follow-up. All complications both intra-operative and post-operatively were noted. Weight bearing X-rays were taken at follow-up, and implant alignment and the presence of lucencies were noted. Results 21 patients were evaluated. All showed an improvement in AOFAS scores; however the improvement showed a wide variation. All patients showed an improvement in pain scores. Post-operative Ankle stiffness, specifically dorsi-flexion, was problematic in several patients. Marked prolonged swelling was problematic for many patients. Conclusions Total Ankle Replacement provides a good option for patients with Ankle arthritis. Swelling and post-operative stiffness continue to be a problem, and should be explained to patients. MULTIPLE DISCLOSURES
Mark S Myerson - One of the best experts on this subject based on the ideXlab platform.
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Revision Total Ankle Replacement.
Jbjs Essential Surgical Techniques, 2015Co-Authors: Mark S Myerson, Amiethab Aiyer, J. Kent EllingtonAbstract:[Introduction][1] The technique for revision total Ankle Replacement described in this article addresses the subsidence and loosening that occur when an Agility total Ankle Replacement fails. [Step 1: Indications and Contraindications][2] The main indications for revision total Ankle arthroplasty include loosening and subsidence of the talar component, with no limit to the extent of subsidence or loss of talar bone stock as neither precludes use of a revision system, particularly when a flat cut on the talus can be made. [Step 2: Anterior Incision and Joint Exposure][3] Make the incision employing the prior anterior midline incision, create full-thickness flaps of tissue to diminish the risk of wound dehiscence, and completely expose and debride the joint as this is critical to revising the total Ankle Replacement correctly. [Step 3: Remove the Talar Component and Polyethylene][4] Remove the talar component, which is rarely difficult as it is usually loose. [Step 4: Remove the Tibial Component][5] When removing the tibial component, it is critical to preserve as much of the anterior tibial cortex as possible to provide support for the revision tibial component. [Step 5: Make the Tibial Bone Cut][6] Tibial cuts can be made proximal or distal to tibial osseous defects. [Step 6: Make the Talar Bone Cut][7] It is preferable to use a cutting block for the talus that attaches to the tibial guide. [Step 7: Managing Loosening and Cavitary Defects][8] If there is substantial bone loss around the tibia after component removal, consider impaction bone-grafting, as better bone quality makes it is easier to obtain a press fit and allow immediate weight-bearing. [Step 8: Place Trial Components][9] Size the tibia and talus and subsequently insert the tibial and talar trials and polyethylene simultaneously. [Step 9: Cementing Technique][10] In revision settings, manual cement insertion is important because there is no medullary canal to work around. [Results][11] We previously reported the outcomes of revision of failed Agility total Ankle Replacements (DePuy, Warsaw, Indiana) in forty-one patients. [Pitfalls & Challenges][12] [Introduction][1] The technique for revision total Ankle Replacement described in this article addresses the subsidence and loosening that occur when an Agility total Ankle Replacement fails. [Step 1: Indications and Contraindications][2] The main indications for revision total Ankle arthroplasty include loosening and subsidence of the talar component, with no limit to the extent of subsidence or loss of talar bone stock as neither precludes use of a revision system, particularly when a flat cut on the talus can be made. [Step 2: Anterior Incision and Joint Exposure][3] Make the incision employing the prior anterior midline incision, create full-thickness flaps of tissue to diminish the risk of wound dehiscence, and completely expose and debride the joint as this is critical to revising the total Ankle Replacement correctly. [Step 3: Remove the Talar Component and Polyethylene][4] Remove the talar component, which is rarely difficult as it is usually loose. [Step 4: Remove the Tibial Component][5] When removing the tibial component, it is critical to preserve as much of the anterior tibial cortex as possible to provide support for the revision tibial component. [Step 5: Make the Tibial Bone Cut][6] Tibial cuts can be made proximal or distal to tibial osseous defects. [Step 6: Make the Talar Bone Cut][7] It is preferable to use a cutting block for the talus that attaches to the tibial guide. [Step 7: Managing Loosening and Cavitary Defects][8] If there is substantial bone loss around the tibia after component removal, consider impaction bone-grafting, as better bone quality makes it is easier to obtain a press fit and allow immediate weight-bearing. [Step 8: Place Trial Components][9] Size the tibia and talus and subsequently insert the tibial and talar trials and polyethylene simultaneously. [Step 9: Cementing Technique][10] In revision settings, manual cement insertion is important because there is no medullary canal to work around. [Results][11] We previously reported the outcomes of revision of failed Agility total Ankle Replacements (DePuy, Warsaw, Indiana) in forty-one patients. [Pitfalls & Challenges][12] [1]: #sec-13 [2]: #sec-14 [3]: #sec-15 [4]: #sec-16 [5]: #sec-17 [6]: #sec-18 [7]: #sec-19 [8]: #sec-20 [9]: #sec-21 [10]: #sec-22 [11]: #sec-23 [12]: #sec-25
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management of failures of total Ankle Replacement with the agility total Ankle arthroplasty
Journal of Bone and Joint Surgery American Volume, 2013Co-Authors: Kent J Ellington, Sanjeev Gupta, Mark S MyersonAbstract:Background: Few studies have focused on treatment following failed total Ankle Replacement. The purpose of this study was to report the outcomes of patients undergoing revision total Ankle Replacement and to propose a talar component subsidence grading system that may be helpful in making decisions regarding how to revise failed total Ankle Replacements in the future. Methods: A retrospective review was performed of fifty-three patients who underwent revision total Ankle Replacement and had been followed for a minimum of two years. Patients were assessed radiographically and with outcome scores. The rates of conversion to amputation or fusion were also assessed. Results: The mean follow-up period was 49.1 months after the revision arthroplasty. The average time from primary total Ankle Replacement to revision was fifty-one months. Forty-one of the fifty-three patients (77%) were available for follow-up. The revision arthroplasty had been converted to an arthrodesis in five of the forty-one patients, and two additional patients had undergone amputation. The most common indication for revision total Ankle Replacement was talar subsidence (63%; twenty-six of forty-one). Twenty-two patients (54%) had a subtalar arthrodesis performed at the time of the revision arthroplasty, with nineteen of those having a custom-designed long-stem talar component placed simultaneously. The mean radiographic measurements of component position did not change significantly postoperatively. The mean postoperative scores for the thirty-four patients with a retained total Ankle Replacement were: 4.4 of 10 possible points on a visual analog pain scale (VAS), 65 of 100 possible points on the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, 93.5 of 100 possible points on the Short-Form 12 (SF-12), 137.9 of 204 possible points on the Revised Foot Function Index (FFI-R), and 64 of 180 possible points on the Ankle Osteoarthritis Scale (AOS). The mean arc of motion radiographically was 18° preoperatively and 23° postoperatively, with all improvement occurring in plantar flexion. A lesser amount of preoperative talar subsidence was a significant predictor of a good outcome based on the AOFAS hindfoot score (p < 0.03) and the AOS (p < 0.01) score. Conclusions: Revision arthroplasty may be considered as an alternative to arthrodesis when treating patients with a failed Agility total Ankle implant. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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revision total Ankle Replacement
Foot and Ankle Clinics of North America, 2012Co-Authors: Jacques Jonck, Mark S MyersonAbstract:: This review of the current literature regarding total Ankle Replacement (TAR) revision surgery focuses on the causes for implant failure, how to deal with the clinical dilemmas of pain and stiffness following TAR, the management of asymptomatic peri-implant cyst formation, and the management of the distal tibia and talus during revision surgery.
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Planning Correction of the Varus Ankle Deformity with Ankle Replacement
Foot and Ankle Clinics of North America, 2011Co-Authors: Mark S MyersonAbstract:: Ankle Replacement in the presence of a varus deformity is an evolving field. Although the initial results were disappointing, numerous advances in the understanding of the condition and operative techniques have been made. More recent reports show good short-term results, especially when adjunctive procedures are combined, not only to achieve a neutral alignment but also the restore lateral ligamentous stability. As a result, it is possible to correct varus deformities of 20° or more with Ankle Replacement. It is likely that, with a reliable correction of alignment and balance, that the long-term results of Ankle Replacement in significant varus deformity will be promising.
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primary and revision total Ankle Replacement using custom designed prostheses
Foot and Ankle Clinics of North America, 2008Co-Authors: Mark S MyersonAbstract:With means for better mechanical stability and fixation, custom prostheses have improved our capabilities in salvaging failed total Ankle Replacements. Even in the primary total Ankle Replacement setting, previous contraindications due to suboptimal bony support may be adequately bypassed, and more patients may benefit from having a custom prosthesis. Accurate preoperative imaging and templating will ensure proper dimensions of the custom prosthesis. Intraoperative adjuncts such as screws, plates, and bone grafts will help address unexpected bone defects, coexisting adjacent joints arthritis, and other hindfoot and midfoot deformities. In this article, the authors discuss the history and problems of total Ankle Replacement failures, the surgical technique, and tips and pitfalls when using custom Replacement prostheses.