Alignment and technique in total ankle arthroplasty

Greisberg, Justin; Hansen, Sigvard T.; DiGiovanni, Chris

doi:10.1053/j.oto.2003.11.002

Cited by 9 publications

(7 citation statements)

References 4 publications

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“…Inadequate correction of alignment in the coronal, sagittal, or axial planes and failure to address soft tissue imbalances increase the risk of failure of total ankle replacement (TAR). 8,11,24 Indeed, the failure rates of TAR are twice as high as those in total hip and knee replacements. 16 In the preoperative assessment of alignment, typically standard anteroposterior and lateral weightbearing radiographs are used to evaluate lower limb alignment and plan the position of TAR in the coronal and sagittal planes.…”

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confidence: 99%

Role of Rotation in Total Ankle Replacement

2019

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

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confidence: 99%

Role of Rotation in Total Ankle Replacement

2019

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“…However, a suboptimal placement of the prosthesis will lead to early failure (Greisberg et al 2004). The results for patients with degeneration due to osteoarthritis do not differ from those suffering from rheumatoid arthritis (Kofoed and Sorensen 1998); furthermore, age does not seem to affect the outcome (Kofoed and Lundberg-Jensen 1999).…”

Section: Discussionmentioning

confidence: 99%

“…Especially patients with rheumatoid arthritis may already have subtalar degeneration when they present with ankle pain, making ankle arthrodesis a less appealing treatment. Secondary procedures to the foot, and especially the subtalar joint, are often part of the surgical plan and are performed either before or simultaneously with ankle replacement ( Greisberg et al 2004 ).…”

Section: Discussionmentioning

confidence: 99%

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Total ankle prostheses in rheumatoid arthropathy

Heide

Schutte²,

Louwerens³

et al. 2009

Acta Orthopaedica

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Background and purpose The first generations of total ankle replacements (TARs) showed a high rate of early failure. In the last decades, much progress has been made in the development of TARs, with the newer generation showing better results. We evaluated TARs implanted with rheumatoid arthritis (RA) or juvenile inflammatory arthritis (JIA) as indication.Patients and methods 58 total ankle prostheses (Buechel-Pappas and STAR type) were implanted in patients with RA (n = 53) or JIA (n = 5) in 54 patients (4 bilateral). After a mean follow-up of 2.7 (1–9) years, all patients were reviewed by two orthopedic surgeons who were not the surgeons who performed the operation. Standard AP and lateral radiographs were taken and a Kofoed ankle score was obtained; this is a clinical score ranging from 0–100 and consists of sub-scores for pain, disability, and range of motion.Results 2 patients died of unrelated causes. Of the 52 patients who were alive (56 prostheses), 51 implants were still in place and showed no signs of loosening on the most recent radiographs. The mean Kofoed score at follow-up was 73 points (SD 16, range 21–92). 4 patients showed a poor result (score < 50) with persistent pain for which no obvious reason could be found. 5 implants were removed, 4 because of infection and 1 because of aseptic loosening.Interpretation Medium-term results of the STAR and BP types of TAR in RA were satisfactory. The main reason for failure of the implant was infection.

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“…After implantation of the final prosthesis components, the position of the hindfoot and the heel were checked and if the ankle remained in valgus, a medial sliding calcaneal osteotomy was performed. 111 Haskell and Mann 92 presented short-term results of 86 patients who underwent STAR with a mean follow-up of 2 years. Thirty-five of 86 patients had a preoperative coronal plane deformity of more than 10 (25 patients with varus deformity and 10 patients with valgus deformity).…”

Section: Literature Review: Tar Experience In Patients With Valgus Dementioning

confidence: 99%

Treatment of the Arthritic Valgus Ankle

Barg

Pagenstert

Leumann

et al. 2012

Foot and Ankle Clinics

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The ankle joint is part of a biomechanical hindfoot complex. Approximately 1% of the world's adult population is affected by ankle osteoarthritis (AO). Trauma is the primary cause of ankle OA, often resulting in varus or valgus deformities. Only 50% of patients with end-stage ankle OA have a normal hindfoot alignment. The biomechanics and morphology of the arthritic valgus ankle is reviewed in this article and therapeutic strategies, including joint preserving and nonpreserving modalities are presented. Pitfalls are discussed and the literature is reviewed regarding outcomes in patients with valgus deformity who underwent total ankle replacement.

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Alignment and technique in total ankle arthroplasty

Cited by 9 publications

References 4 publications

Role of Rotation in Total Ankle Replacement

Role of Rotation in Total Ankle Replacement

Total ankle prostheses in rheumatoid arthropathy

Treatment of the Arthritic Valgus Ankle

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