Total Ankle Replacement

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  • The Effect of Age in Total Ankle Replacement
    SAGE Publishing, 2018
    Co-Authors: Mario Gaugler, Beat Hintermann, Christine Schweizer Msc
    Abstract:

    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

  • Complications, Reoperations, and Postoperative Outcomes of Simultaneous Supramalleolar Osteotomy and Total Ankle Replacement in Misaligned Osteoarthritic Ankles in Comparison to Total Ankle Replacement Alone
    SAGE Publishing, 2018
    Co-Authors: Anne-constance Franz, Manja Deforth Msc, Christine Schweizer Msc, Lukas Zwicky Msc, Beat Hintermann
    Abstract:

    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] 96° [n=1], or tibial lateral surface angle [TLS]

  • Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement
    SAGE Publishing, 2017
    Co-Authors: Manja Deforth Msc, Markus Knupp, Lukas Zwicky, Nicola Krähenbühl, Beat Hintermann
    Abstract:

    Category: Ankle Introduction/Purpose: A key for success in Total Ankle Replacement is a balanced Ankle joint. If the tibial component is misaligned, the ligamentous structures, the malleoli and the tendons may be overused, which, may lead to pain and impairment during gait. A misaligned tibial component can be revised using a corrective bone resection and re-insertion of a new component or using a corrective osteotomy of the distal tibia above the stable implant. The aim of this study was to review a series of patients, in whom a corrective supramalleolar osteotomy was performed to realign a misaligned tibial component in Total Ankle Replacement. Methods: Twenty-two patients (nine male; 13 female; mean age, 62.6 years; range, 44.7 – 80.0) were treated with a supramalleolar osteotomy to correct a painful dysbalanced Ankle, following a varus implanted tibial component. Following radiological and clinical outcomes were recorded preoperatively and at the follow-up examination within the first 24 months: the tibial anterior surface angle (TAS), the tibial lateral surface angle (TLS), patient’s pain measured with the Visual Analogue Scale (VAS), the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score, range of motion (ROM) of the Ankle and patient’s satisfaction. Furthermore, postoperative complications were reviewed. Results: The TAS changed on average from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively (p < 0.0001), the AOFAS score increased from 46 ± 14 to 66 ± 16 points (p < .0001) and the VAS pain score decreased from 5.8 ± 1.9 to 3.3 ± 2.4 (p < .001). No statistical difference was found in the TLS and the range of motion. The osteotomy healed in 19 patients (86%), re-osteosynthesis was successful in the remaining three patients. In one of these three patients, a chronic infection of the Ankle joint led to a below-knee amputation. Fifteen patients (68%) were (very) satisfied, four (18%) moderately satisfied and three (14 %) patients were not satisfied with the obtained postoperative result. Conclusion: The supramalleolar osteotomy was found to be an efficient alternative to correct the misaligned tibial component in Total Ankle Replacement. Pain could be successfully addressed in the majority of the patients. The treatment of a malpositioned, well anchored tibial component with a supramalleolar osteotomy, instead of exchanging the tibial component, allows preservation of the bone stock. However, non-union should be mentioned as a possible complication of this surgery. Nonetheless, this method might be a feasible treatment option, especially for younger patients

  • hintegra Total Ankle Replacement survivorship analysis in 684 patients
    Journal of Bone and Joint Surgery American Volume, 2013
    Co-Authors: Alexej Barg, Markus Knupp, Lukas Zwicky, Heath B. Henninger, Beat Hintermann
    Abstract:

    Background: Total Ankle Replacement is increasingly recommended for patients with end-stage Ankle osteoarthritis. We analyzed the survivorship of 722 arthroplasties performed with one type of three-component Total Ankle prosthesis. Methods: Seven hundred and seventy-nine primary Total Ankle arthroplasties (741 patients) were performed between May 2000 and July 2010 with use of the HINTEGRA three-component prosthesis. A logistic multiple regression model was used to identify independent risk factors for prosthesis failure in 684 patients (722 Ankles). The mean time to final follow-up (and standard deviation) was 6.3 ± 2.9 years. Results: Seven hundred and twenty-two Ankles (684 patients) were available for survivorship analysis at the latest follow-up. The overall survival rates were 94% and 84% after five and ten years, respectively. Sixty-one Ankles had a revision arthroplasty (twenty-seven both components, thirteen the tibial component only, and fourteen the talar component only) or were converted to a fusion (seven Ankles).There were no polyethylene failures. There were no amputations. The generation category of the prosthesis, the cause of Ankle osteoarthritis, and the age of the patient were identified as independent risk factors for prosthesis failure. Conclusions: The midterm survivorship of the HINTEGRA implant was comparable with that of other third-generation Total Ankle Replacements. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • simultaneous bilateral Total Ankle Replacement using a 3 component prosthesis outcome in 26 patients followed for 2 10 years
    Acta Orthopaedica, 2011
    Co-Authors: Alexej Barg, Markus Knupp, Heath B. Henninger, Beat Hintermann
    Abstract:

    Background and purpose Total Ankle Replacement is an established surgical procedure in patients with end-stage Ankle osteoarthritis. We analyzed complications and medium-term results in patients wi...

Alexej Barg - One of the best experts on this subject based on the ideXlab platform.

  • early clinical and radiographic outcomes of trabecular metal Total Ankle Replacement using a transfibular approach
    Journal of Bone and Joint Surgery American Volume, 2018
    Co-Authors: Alexej Barg, Charles L Saltzman, Clayton C Bettin, Albert H Burstein, Jeremy M Gililland
    Abstract:

    Background In the last 2 decades, Total Ankle Replacement has gained greater acceptance as a treatment option in patients with end-stage Ankle osteoarthritis. However, there is a lack of literature on Total Ankle Replacement using a lateral transfibular approach. Therefore, we sought to report early clinical and radiographic results for a patient cohort treated with Total Ankle Replacement using a lateral transfibular approach, performed by a single surgeon. Methods From October 2012 to December 2014, 55 primary Total Ankle arthroplasties using the Zimmer Trabecular Metal Total Ankle implant were performed in 54 patients (29 male and 25 female; mean age, 67.0 years). Clinical assessment, including pain evaluation and measurement of Ankle range of motion, was conducted preoperatively and at the latest follow-up. Weight-bearing radiographs were used to determine angular alignment of the tibial and talar components and to analyze the bone-implant interface. Intraoperative and postoperative complications, revision surgeries, and survivorship were evaluated. Results Implant survival was 93% at 24 months of follow-up. There were 3 revisions of a tibial component due to aseptic loosening. In 10 of the 55 cases, a secondary procedure was performed during follow-up. The mean follow-up duration was 26.6 ± 4.2 months. No delayed union or nonunion was observed for fibular healing. The average visual analog scale (VAS) pain score decreased significantly, from 7.9 ± 1.3 to 0.8 ± 1.2. The average Total range of motion increased significantly, from 22.9° ± 12.7° to 40.2° ± 11.8°. Conclusions Early results of Total Ankle Replacement using the Zimmer trabecular metal implant and the lateral transfibular approach demonstrated improved patient-reported outcomes and increased Ankle motion at a minimum follow-up of 2 years. In the 55 consecutive cases, the fibular osteotomy required for access to the Ankle healed without complications. Painful early loosening due to lack of osseous ingrowth required revision in 3 of 55 cases. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • Total Ankle Replacement
    Deutsches Arzteblatt International, 2015
    Co-Authors: Alexej Barg, Matthias D Wimmer, Martin Wiewiorski, Dieter Christian Wirtz, Geert Pagenstert, Victor Valderrabano
    Abstract:

    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.

  • hintegra Total Ankle Replacement survivorship analysis in 684 patients
    Journal of Bone and Joint Surgery American Volume, 2013
    Co-Authors: Alexej Barg, Markus Knupp, Lukas Zwicky, Heath B. Henninger, Beat Hintermann
    Abstract:

    Background: Total Ankle Replacement is increasingly recommended for patients with end-stage Ankle osteoarthritis. We analyzed the survivorship of 722 arthroplasties performed with one type of three-component Total Ankle prosthesis. Methods: Seven hundred and seventy-nine primary Total Ankle arthroplasties (741 patients) were performed between May 2000 and July 2010 with use of the HINTEGRA three-component prosthesis. A logistic multiple regression model was used to identify independent risk factors for prosthesis failure in 684 patients (722 Ankles). The mean time to final follow-up (and standard deviation) was 6.3 ± 2.9 years. Results: Seven hundred and twenty-two Ankles (684 patients) were available for survivorship analysis at the latest follow-up. The overall survival rates were 94% and 84% after five and ten years, respectively. Sixty-one Ankles had a revision arthroplasty (twenty-seven both components, thirteen the tibial component only, and fourteen the talar component only) or were converted to a fusion (seven Ankles).There were no polyethylene failures. There were no amputations. The generation category of the prosthesis, the cause of Ankle osteoarthritis, and the age of the patient were identified as independent risk factors for prosthesis failure. Conclusions: The midterm survivorship of the HINTEGRA implant was comparable with that of other third-generation Total Ankle Replacements. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  • simultaneous bilateral Total Ankle Replacement using a 3 component prosthesis outcome in 26 patients followed for 2 10 years
    Acta Orthopaedica, 2011
    Co-Authors: Alexej Barg, Markus Knupp, Heath B. Henninger, Beat Hintermann
    Abstract:

    Background and purpose Total Ankle Replacement is an established surgical procedure in patients with end-stage Ankle osteoarthritis. We analyzed complications and medium-term results in patients wi...

  • the effect of three component Total Ankle Replacement malalignment on clinical outcome pain relief and functional outcome in 317 consecutive patients
    Journal of Bone and Joint Surgery American Volume, 2011
    Co-Authors: Alexej Barg, Andreas Elsner, Andrew E Anderson, Beat Hintermann
    Abstract:

    Total Ankle Replacement has become an increasingly popular treatment for patients with end-stage Ankle osteoarthritis. The surgery is technically demanding and generally performed by only experienced foot and Ankle surgeons. An important complication of Total Ankle Replacement is malposition of the talar component. The biomechanical effect of malposition has been reported; however, the functional outcomes of patients with varying degrees of talar component malposition have not. The purpose of this study was to assess the influence of talar component malposition on postoperative pain relief and functional outcome.

James A. Nunley - One of the best experts on this subject based on the ideXlab platform.

Victor Valderrabano - One of the best experts on this subject based on the ideXlab platform.

  • Total Ankle Replacement
    Deutsches Arzteblatt International, 2015
    Co-Authors: Alexej Barg, Matthias D Wimmer, Martin Wiewiorski, Dieter Christian Wirtz, Geert Pagenstert, Victor Valderrabano
    Abstract:

    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.

  • clinical relevance of hindfoot alignment view in Total Ankle Replacement
    Foot & Ankle International, 2010
    Co-Authors: Arno Frigg, Benno M Nigg, Victor Valderrabano, Laura Hinz, Iain Russell
    Abstract:

    Background: Alignment is instrumental for success and long-term survival of Total Ankle Replacement (TAR). At this point in TAR, only coronal alignment in the region of the tibiotalar joint or abov...

  • gait analysis in Ankle osteoarthritis and Total Ankle Replacement
    Clinical Biomechanics, 2007
    Co-Authors: Benno M Nigg, Vinzenz Von Tscharner, Beat Goepfert, Darren J Stefanyshyn, Victor Valderrabano, Beat Hintermann
    Abstract:

    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.

  • sports and recreation activity of Ankle arthritis patients before and after Total Ankle Replacement
    American Journal of Sports Medicine, 2006
    Co-Authors: Victor Valderrabano, Markus Knupp, Geert Pagenstert, Monika Horisberger, Beat Hintermann
    Abstract:

    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...

  • scandinavian Total Ankle Replacement a 3 7 year average followup of 65 patients
    Clinical Orthopaedics and Related Research, 2004
    Co-Authors: Victor Valderrabano, Beat Hintermann, W Dick
    Abstract:

    The purpose of the current prospective study was to determine the midterm results of 68 Total Ankle Replacements with the Scandinavian Total Ankle Replacement (S.T.A.R.) prosthesis. The 65 patients (34 women and 31 men; mean age at surgery, 56.1 years [range, 22–85 years]) were assessed clinically a

Anders Henricson - One of the best experts on this subject based on the ideXlab platform.

  • good outcome scores and high satisfaction rate after primary Total Ankle Replacement
    Acta Orthopaedica, 2017
    Co-Authors: Ilka Kamrad, Anders Henricson, Håkan Magnusson, Ake Carlsson, Magnus Karlsson, Bjorn E Rosengren
    Abstract:

    Background and purpose — Total Ankle Replacement (TAR) is gaining popularity for treatment of end-stage Ankle arthritis. Large patient-centered outcome studies are, however, few. Here, we report da...

  • outcome after salvage arthrodesis for failed Total Ankle Replacement
    Foot & Ankle International, 2016
    Co-Authors: Ilka Kamrad, Anders Henricson, Håkan Magnusson, Ake Carlsson, Bjorn E Rosengren
    Abstract:

    In cases with Total Ankle Replacement (TAR) failure, a decision between revision TAR and salvage arthrodesis (SA) must be made. In a previous study, we analyzed revision TAR and found low functional outcome and satisfaction. The aims of the current study were to analyze SA concerning failure rate and patient-related outcome measures (PROMs).

  • use of a trabecular metal implant in Ankle arthrodesis after failed Total Ankle Replacement
    Acta Orthopaedica, 2010
    Co-Authors: Anders Henricson, Urban Rydholm
    Abstract:

    Background and purpose Arthrodesis after failed Total Ankle Replacement is complicated and delayed union, nonunion, and shortening of the leg often occur—especially with large bone defects. We investigated the use of a trabecular metal implant and a retrograde intramedullary nail to obtain fusion.Patients and methods 13 patients with a migrated or loose Total Ankle implant underwent arthrodesis with the use of a retrograde intramedullary nail through a trabecular metal Tibial Cone. The mean follow-up time was 1.4 (0.6–3.4) years.Results At the last examination, 7 patients were pain-free, while 5 had some residual pain but were satisfied with the procedure. 1 patient was dissatisfied and experienced pain and swelling when walking. The implant-bone interfaces showed no radiographic zones or gaps in any patient, indicating union.Interpretation The method is a new way of simplifying and overcoming some of the problems of performing arthrodesis after failed Total Ankle Replacement.

  • use of a trabecular metal implant in Ankle arthrodesis after failed Total Ankle Replacement
    Acta Orthopaedica, 2010
    Co-Authors: Anders Henricson, Urban Rydholm
    Abstract:

    Background and purpose Arthrodesis after failed Total Ankle Replacement is complicated and delayed union, nonunion, and shortening of the leg often occur—especially with large bone defects. We inve...

  • secondary surgery after Total Ankle Replacement the influence of preoperative hindfoot alignment
    Foot and Ankle Surgery, 2007
    Co-Authors: Anders Henricson, Perhenrik Agren
    Abstract:

    The aim of this study was to evaluate the need for secondary surgery in Total Ankle Replacement (TAR) in Ankles with hindfoot malalignment. Methods: One hundred and ninety-six Ankles (186 patients) underwent Ankle arthroplasty. The mean follow up was 4.2 years. Preoperative hindfoot alignment was measured and revisions or reoperations were analysed. Results: There were 41 revisions (21%). The most common reasons for revision were instability (13), aseptic loosening (11) and technical errors (8). In the preoperative varus group the revision rate was 31% and in the valgus and neutral groups 17%, respectively. The results improved with time and experience. Conclusion: The demands in the TAR procedure are much higher in preoperatively varus malaligned Ankles and the need to accomplish alignment at the prime operation is crucial. The surgery is challenging and has a long learning curve and should be performed by experienced foot and Ankle surgeons.

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