Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Replacement Using a Transfibular Approach

Barg, Alexej; Bettin, Clayton C.; Burstein, Albert H.; Saltzman, Charles L.; Gililland, Jeremy M.

doi:10.2106/jbjs.17.00018

Cited by 53 publications

(35 citation statements)

References 48 publications

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“…Radiolucent lines are a cause for concern after TAR. Barg et al reported a high rate of radiolucent lines in the tibial and talar-implant interface of 34.5% and 12.7% respectively [24]. Interestingly, we observed radiolucent lines in 10% of the patients.…”

Section: Discussionmentioning

confidence: 40%

Early clinical and radiological evaluation in patients with total ankle replacement performed by lateral approach and peroneal osteotomy

Bianchi

Martinelli

Hosseinzadeh

et al. 2019

BMC Musculoskelet Disord

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Background The Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR) is a recent ankle arthroplasty approved for use in the United States and Europe. Many of the studies reporting the results of this implant are provided by surgeons involved at least in the initial design of the implant under study. The aim of this study is to describe the early clinical and radiological outcomes in patients who underwent this procedure performed by non-designer surgeons. Methods A total of thirty consecutive patients underwent total ankle replacement with a Zimmer TM TAR surgery between July 2013 to January 2016.All clinical assessments were collected pre- and post-operatively with minimum follow-up of 12 months for each patient using the American Orthopedic Foot and Ankle (AOFAS) score, the Foot Function Index (FFI) and a visual analogue scale (VAS) for pain. Radiographic outcomes included ankle orientation assessed with angle “α”,“β” and “γ” according to Wood. Furthermore, the anteroposterior offset ratio was measured in weight-bearing lateral ankle radiographs at the last follow-up. Results The mean preoperative FFI-pain (FFI-P) value was 53.67, the FFI-disability (FFI-D) was 64.19. At the last follow-up visit, the FFI-P and FFI-D was 16.95 and 20.76 respectively ( p <0.01 for the both scales). Preoperatively, the mean VAS for pain and AOFAS score was 7.81 and 40.95 respectively, and at the last follow-up 2.29 and 86.38 ( p <0.01 for the both scales). The mean angle calculated using Wood and Deakin’s method were “α”= 89.02°, “β”= 85.11 and “γ”= 27.54 post-operatively. At the last follow-up the same values were respectively 89.43, 85.18 and 29.94. At the last follow-up, the mean offset ratio was 0.06 (range 0.003/-0.17). Conclusions These early results show high levels of patient satisfaction, and we are encouraged to continue with lateral approach total ankle arthroplasty.

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Section: Discussionmentioning

confidence: 40%

Early clinical and radiological evaluation in patients with total ankle replacement performed by lateral approach and peroneal osteotomy

Bianchi

Martinelli

Hosseinzadeh

et al. 2019

BMC Musculoskelet Disord

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“…Furthermore, the medial border of the talar dome had a smaller radius of curvature than that of lateral border [10, 11]. And these observations have been copied in the design of some ankle systems [12–14]. However, the concept of the fixed rotation axis of the talocrural joint contradicted with the coupled behavior of ankle joint complex, and several later results in vitro or vivo [4, 15–18].…”

Section: Introductionmentioning

confidence: 99%

Talar Dome Investigation and Talocrural Joint Axis Analysis Based on Three-Dimensional (3D) Models: Implications for Prosthetic Design

Zhao

Huang

Zhang

et al. 2019

BioMed Research International

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Ankle joint kinematics is mainly stabilized by the morphology of the talar dome and the articular surface of tibiofibular mortise as well as the medial and lateral ligament complexes. Because of this the bicondylar geometry of talus dome is believed to be crucial for ankle implant design. However, little data exist describing the precise anatomy of the talar dome and the talocrural joint axis. The aim of this study is to document the anatomy of the talar dome and the axis of the talocrural joint using three-dimensional (3D) computed tomographic (CT) modeling. Seventy-one participants enrolled for CT scanning and 3D talar model reconstruction. All the ankles were held in a neutral position during the CT scanning. Six points on the lateral and medial crest of the talar dome were defined. The coordinate of the six points; radii of lateral-anterior (R-LA), lateral-posterior (R-LP), medial-anterior (R-MA), and medial-posterior (R-MP) sections; and inclination angle of the talar dome were measured, and the inclination and deviation angles of the talocrural joint axis were determined. The mean values of R-LA, R-LP, R-MA, and R-MP were 19.23 ± 2.47 mm, 18.76 ± 2.90 mm, 17.02 ± 3.49 mm, and 22.75 ± 3.04 mm. The mean inclination angle of the talar dome was 9.86 ± 3.30 degrees. Gender variation was found in this parameter. The mean inclination and deviation angles were 8.60 ± 0.07 and 0.76 ± 0.69 degrees for the dorsiflexion axis and −7.34 ± 0.07 and 0.09 ± 0.18 degrees for the plantarflexion axis. Bilateral asymmetries between the medial and lateral crest of the talar dome were found, which resulted in different dorsiflexion and plantarflexion axes of the talocrural joint. Currently, no ankle implants replicate this talar anatomy, and these findings should be considered in future implant designs.

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“…Short-term clinical follow-up (range 24.0-39.8 months) of the Zimmer TM Ankle, introduced in 2012, has not revealed any occurrences of polyethylene fracture for 55 TAAs performed by a single surgeon. 5 A single revision of the TM Ankle has been reported in the published literature; an analysis of that case attributed the cause of revision to component malpositioning. 13 There are also limited laboratory data to support the use of HXLPE in the ankle.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Total Ankle Arthroplasty Using Highly Crosslinked Ultrahigh-Molecular-Weight Polyethylene Subjected to Physiological Loading

et al. 2019

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Background: Highly crosslinked polyethylene (HXLPE) was developed for its superior wear properties in comparison to conventional polyethylene (CPE). Concern over fatigue resistance has prevented widespread adoption of HXLPE for use in total ankle arthroplasty (TAA). The aim of this study was to determine whether HXLPE has sufficient fatigue strength for total ankle arthroplasty under simulated physiologically relevant motion profiles and loading in the ankle. Methods: Physiologic load and motion profiles representative of walking gait were incorporated into a computational model of a semiconstrained, fixed-bearing TAA to determine the loading state with highest stresses in the HXLPE bearing. Subsequent fatigue testing to 10 million cycles (Mc) at 5600 N was performed to assess bearing strength. Results: Peak stresses in the bearing were predicted at peak axial load and peak dorsiflexion during gait, occurring near heel off. All samples withstood 10 Mc of fatigue loading at that orientation without polyethylene bearing fracture. Conclusion: HXLPE had sufficient fatigue strength to withstand 10 Mc of loading at more than 5 times body weight at the point of peak stresses during simulated gait in total ankle arthroplasty. Clinical Relevance: HXLPE may be mechanically strong enough to withstand the in vivo demands of the ankle. Improvements in wear afforded by HXLPE can be obtained without compromising sufficient polyethylene strength properties in total ankle arthroplasty.

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Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Replacement Using a Transfibular Approach

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 53 publications

References 48 publications

Early clinical and radiological evaluation in patients with total ankle replacement performed by lateral approach and peroneal osteotomy

Early clinical and radiological evaluation in patients with total ankle replacement performed by lateral approach and peroneal osteotomy

Talar Dome Investigation and Talocrural Joint Axis Analysis Based on Three-Dimensional (3D) Models: Implications for Prosthetic Design

Evaluation of Total Ankle Arthroplasty Using Highly Crosslinked Ultrahigh-Molecular-Weight Polyethylene Subjected to Physiological Loading

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