CT Scan Assessment and Functional Outcome of Periprosthetic Bone Grafting After Total Ankle Arthroplasty at Medium-term Follow-up

Naude, Jaco; Saragas, Nikiforos Pandelis; Ferrao, Paulo N. F.

doi:10.1177/10711007211064612

Cited by 8 publications

(5 citation statements)

References 63 publications

(177 reference statements)

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“…There is still limited understanding of the appropriate management strategy for them, and their natural history over time. 4,18 Overall, there was statistically significant and clinically meaningful improvement in clinical outcomes for all 5 subdomains of the FAOS survey preoperatively to 5 years postoperatively. Our findings also demonstrate that the improvement in clinical outcomes achieved at 2 years was maintained at 5 years (meeting statistical significance but likely not a threshold for meaningful clinical significance).…”

Section: Discussionmentioning

confidence: 90%

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Midterm Clinical Outcomes, Radiographic Outcomes, and Survivorship of the Infinity Total Ankle Arthroplasty

Shaffrey,

O’Malley,

Henry

et al. 2023

Foot Ankle Int.

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Background: The Infinity Total Ankle Arthroplasty (Stryker, Mahwah, NJ) is a low-profile fixed-bearing implant first introduced in 2014. Although the short-term survivorship (2-4 years follow-up) and complication rates of the Infinity TAA have been reported, there are limited midterm outcome reports. The aim of this study was to describe the survivorship and clinical outcomes of a single-center experience with the Infinity implant at minimum 5-year follow-up. Methods: Retrospective review of 65 ankles that underwent primary total ankle arthroplasty (TAA) with the Infinity implant was conducted. Mean clinical follow-up was 6.5 years (range, 5.0-8.0). Preoperative and postoperative radiographs were measured to assess tibiotalar alignment, periprosthetic lucencies, and cysts. Preoperative, 2-year, and 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscores were compared to assess midterm clinical outcomes. Survivorship assessment was determined by removal of 1 or both metallic implant components. Results: Survivorship of the implant was 93.8% at final follow-up. There were 4 revisions: 2 for tibial implant loosening, 1 for talar loosening, and 1 for loosening of both components. Three of the 4 revisions occurred within the first 2 years following implantation, and the last failure occurred at 7 years postoperatively. There were 11 reoperations in 10 (15%) ankles and 3 wound complications. There were 17 ankles (26.2%) with radiographic abnormalities around the implants, including 14 cases with tibial component lucencies and 4 cases of periimplant cysts. FAOS outcome measurement showed general stability between 2 and 5 years and substantial improvement from preoperative status. Conclusion: To date this study is the largest midterm report on the Infinity total ankle prosthesis, with 65 implants at a mean follow-up of 6.5 years. We found good midterm implant survivorship, and patients experienced significant improvements in FAOS outcome scores and radiographic alignment at final follow-up. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 90%

“…There is still limited understanding of the appropriate management strategy for them, and their natural history over time. 4,18…”

Section: Discussionmentioning

confidence: 99%

Midterm Clinical Outcomes, Radiographic Outcomes, and Survivorship of the Infinity Total Ankle Arthroplasty

Shaffrey,

O’Malley,

Henry

et al. 2023

Foot Ankle Int.

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“…In terms of osteolysis treatment, bone grafting for the osteolytic lesions currently has been known as the only effective treatment for osteolysis without implant. 9 10 28 29) However, it does not invariably yield satisfactory results. 30) Therefore, there is a need for adjunct biological strategies to enhance bone grafting outcomes and proactively prevent osteolysis.…”

Section: Discussionmentioning

confidence: 99%

The Role of Receptor Activator of Nuclear Factor-κB Ligand/Osteoprotegerin Ratio in Synovial Fluid as a Potential Marker for Periprosthetic Osteolysis Following Total Ankle Arthroplasty

Lee,

Song,

Han

et al. 2024

Clin Orthop Surg

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Background Periprosthetic osteolysis is a prevalent complication following total ankle arthroplasty (TAA), implicating various cytokines in osteoclastogenesis as pivotal in this process. This study aimed to evaluate the relationship between osteolysis and the concentrations of osteoclastogenesis-related cytokines in synovial fluid and investigate its clinical value following TAA. Methods Synovial fluid samples from 23 ankles that underwent revision surgery for osteolysis following TAA were analyzed as the osteolysis group. As a control group, we included synovial fluid samples obtained from 23 ankles during primary TAA for osteoarthritis. The receptor activator of nuclear factor-κB ligand (RANKL)/osteoprotegerin (OPG) ratio in these samples was quantified using sandwich enzyme-linked immunosorbent assay techniques, and a bead-based multiplex immunoassay facilitated the detection of specific osteoclastogenesis-related cytokines. Results RANKL levels averaged 487.9 pg/mL in 14 of 23 patients in the osteolysis group, with no detection in the control group’s synovial fluid. Conversely, a significant reduction in OPG levels was observed in the osteolysis group ( p = 0.002), resulting in a markedly higher mean RANKL/OPG ratio (0.23) relative to controls ( p = 0.020). Moreover, the osteolysis group had increased concentrations of various osteoclastogenesis-related cytokines (tumor necrosis factor-α, interleukin [IL]-1β, IL-6, IL-8, IP-10, and monocyte chemotactic protein-1) in the synovial fluid relative to the control group. Conclusions Our results demonstrated that periprosthetic osteolysis was associated with osteoclastogenesis activation through an elevated RANKL/OPG ratio following TAA. We assume that RANKL and other osteoclastogenesis-related cytokines in the synovial fluid have clinical value as a potential marker for the development and progression of osteolysis following TAA.

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“…We appreciate the interest in our article 1 and take note of the concerns that have been brought up. Management of periprosthetic cysts after total ankle arthroplasty is an unresolved topic with lacking evidence and clear-cut guidelines.…”

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confidence: 99%

Response to “Letter Regarding: CT Scan Assessment and Functional Outcome of Periprosthetic Bone Grafting After Total Ankle Arthroplasty at Medium-term Follow-up”

Naude¹,

Saragas²,

Ferrao³

2022

Foot Ankle Int.

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We appreciate the interest in our article 1 and take note of the concerns that have been brought up. Management of periprosthetic cysts after total ankle arthroplasty is an unresolved topic with lacking evidence and clear-cut guidelines.Although our indication for bone grafting cysts larger than 1.75 cm 3 may seem arbitrary, we went through a process to decide on this size. We started reviewing all the available literature regarding bone grafting of periprosthetic cysts (which is sparse) and found most papers to recommend grafting of cysts larger than 10 mm. Cysts larger than one-third of the bone implant interface (which is small on the talar side) have been correlated with TAA failure in the literature. Lundeen et al more recently published on periprosthetic bone grafting and used 15 mm as an indication for surgery. Taking these factors into consideration, we decided that cysts with a minimum of 15 mm (1.5 cm) or more importantly a minimum volume of 1.75 cm 3 (ellipsoid formula using 1.5 cm in all 3 axes) in size would be a safe indication for bone grafting. As this is a cubic value, the value increases significantly with minimal change in the dimensions (20-mm cyst equates to 4.16 cm 3 ), which is part of the reason for us having a seemingly large mean cyst size of 8.16 cm 3 . By using 15 mm in our study, we were also able to standardize and compare results with other studies.To say that as a specialty we are plagued by arbitrary guidelines that persists for decades is not fair. It is the very lack of guidelines regarding the best management of periprosthetic cysts that prompted the authors to initiate this study. Currently, albeit with small numbers, these guidelines are a steppingstone for further research in this difficult and complex problem. Our management protocol of periprosthetic cysts in this study followed sound orthopaedic principles with good outcomes and thus can guide other surgeons in managing this pathology until further research better defines and standardizes these guidelines. As the term suggests, these are merely to guide management and not dictum. Many surgeons around the world work in solo practices. They do not have the benefit and privilege of being part of a specialized center with numerous colleagues in the same subspeciality to discuss complex pathologies and decide on appropriate management. These surgeons rely on current available literature to help them decide on appropriate management. The onus is on us to continue researching these difficult pathologies, rather than rely on decades old evidence, so as to provide the best evidencebased guidelines that will improve our patient care.We agree fully that the current study has low numbers (which we mentioned as a limitation), making it difficult to draw strong conclusions. We do though need a starting point. Giving a recommendation that is well defined, easily measurable, accurate, and repeatable by all surgeons is a good starting point. One of the aims with this article is to inspire further research that will guide surgeons in the b...

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CT Scan Assessment and Functional Outcome of Periprosthetic Bone Grafting After Total Ankle Arthroplasty at Medium-term Follow-up

Cited by 8 publications

References 63 publications

Midterm Clinical Outcomes, Radiographic Outcomes, and Survivorship of the Infinity Total Ankle Arthroplasty

Midterm Clinical Outcomes, Radiographic Outcomes, and Survivorship of the Infinity Total Ankle Arthroplasty

The Role of Receptor Activator of Nuclear Factor-κB Ligand/Osteoprotegerin Ratio in Synovial Fluid as a Potential Marker for Periprosthetic Osteolysis Following Total Ankle Arthroplasty

Response to “Letter Regarding: CT Scan Assessment and Functional Outcome of Periprosthetic Bone Grafting After Total Ankle Arthroplasty at Medium-term Follow-up”

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