Etiopathogenesis of osteolytic cysts associated with total ankle arthroplasty, a histological study

Wijngaarden, Redmer van; Plaat, Laurens van der; Weme, Rebecca A. Nieuwe; Doets, H. Cornelis; Westerga, Johan; Haverkamp, Daniël

doi:10.1016/j.fas.2015.02.004

Cited by 34 publications

(21 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results are consistent with recent evidence that osteolysis after TAA may be more similar to hip and knee arthroplasty than previously thought, in that it is driven by polyethlyene debris as opposed to local tissue necrosis. 30,31 Limitations Some limitations of our study relate to the multifactorial and complex etiology of osteolysis. We acknowledge that factors such as polyethylene design and wear, 7 micro-motion, 7 genetics, 32,33 stress shielding, 34 and other patient A graph box was estimated for osteolysis compromised zones (OCZ).…”

Section: Discussionmentioning

confidence: 98%

Does Patient-Specific Instrumentation Have a Higher Rate of Early Osteolysis Than Standard Referencing Techniques in Total Ankle Arthroplasty? A Radiographic Analysis

Escudero

Symes

Bemenderfer

et al. 2019

Foot & Ankle Specialist

View full text Add to dashboard Cite

Introduction: Patient-specific instrumentation (PSI) has been developed for total ankle arthroplasty (TAA), with proven benefits. One concern regarding PSI is the need for more soft tissue dissection in order to accurately position the PSI guides, which has the theoretical disadvantage of increased osteolysis. The purpose of our study is to compare the incidence and magnitude of osteolysis for the INFINITY Total Ankle System between PSI and standard referencing (SR) techniques. Methods: Sixty-seven patients who underwent primary TAA using Prophecy (PSI) or SR technique between 2013 and 2015 were reviewed in a retrospective observational study. Osteolysis was assessed on radiographs at 2 years. The incidence was calculated by binomial distribution. The number of zones compromised and the magnitude of osteolysis was calculated using the median as a summary statistic and interquartile range as dispersion statistic. Fisher exact test was used to compare both groups, then a regression model was estimated to calculate the odds ratio for osteolysis. Results: Of the 67 TAAs, 51 were in the PSI group and 16 in the SR group. In the PSI group the incidence, number of compromised zones (CZ), and magnitude was 41% (25%-59%), 1 [1-2], and 2 [2-3], respectively. In the SR group these were 36% (13%-65%), 3 [2-3], and 3 [2-4], respectively. No significant differences were found ( P = .46, P = .12, P = .33). A slightly higher risk of osteolysis was found in the PSI group (odds ratio = 1.33 [0.36-4.83]) ( P = .46). The majority of lesions were in 1 zone with size of 2 to 5 mm (63% for all cohort, 64% PSI, 60% SR). Two cases underwent revision for aseptic loosening, 1 in the SR group and 1 in the PSI group. Conclusion: According to our data, there is no significant difference between PSI and SR in terms of risk, incidence, size and magnitude of osteolysis in the INFINITY Total Ankle System at 2 years. Levels of Evidence: Therapeutic, Level III, Retrospective cohort study

show abstract

Section: Discussionmentioning

confidence: 98%

Does Patient-Specific Instrumentation Have a Higher Rate of Early Osteolysis Than Standard Referencing Techniques in Total Ankle Arthroplasty? A Radiographic Analysis

Escudero

Symes

Bemenderfer

et al. 2019

Foot & Ankle Specialist

View full text Add to dashboard Cite

show abstract

“…An additional eight patients had bone cysts appearing on radiologic studies but remained asymptomatic. Several processes are thought to contribute to cyst formation, such as reaction to PE particles mediated by macrophages, joint fluid pressure especially when the prosthesis does not fully cover the surface after bone resection, stress shielding, micromotion at the bone-implant interface, or even from pre-existing osteoarthritic cysts 48,50 . It has been suggested that cysts are more common when there is delamination of the hydroxyapatite coating in dual-coated prostheses 51 .…”

Section: Discussionmentioning

confidence: 99%

The Salto total ankle arthroplasty — Clinical and radiological outcomes at five years

Koo

Liddle

Pastides

et al. 2019

Foot and Ankle Surgery

View full text Add to dashboard Cite

Aims: Modern designs of total ankle arthroplasty (TAA) have the potential to treat symptomatic ankle OA without adversely affecting ankle biomechanics. We present the mid-term results of a modern, mobile-bearing TAA design. Methods: TAA was performed in 50 consecutive patients (55 ankles) in an independent, prospective, single-centre series. Implant survival, patientreported outcome measures (PROMs) and radiographic outcomes are presented at a mean of five years (range 2-10.5 years). Results: A total of three patients (four ankles) died and two (two ankles) were lost to follow-up. Three TAAs were revised for aseptic loosening (in two cases) or infection. Two further patients underwent reoperations, one for arthroscopic debridement of anterolateral synovitis and one for grafting of an asymptomatic tibial cyst. With all-cause revision as an endpoint, implant survival was 93.3% at five to ten years (95% CI 80.5%-97.8%). If reoperations are included this falls to 90.2% (95% CI 75.6%-96.3%) at five years. No other patient demonstrated radiographic evidence of loosening or subsidence. PROMs and satisfaction were excellent at latest follow-up. Conclusion: At five years, the outcomes for this design of TAA in this series were excellent, and were similar to those of previously published series from the designer centre.

show abstract

“…A recent study by von Wijngaarden et al. ( 2015 ) indicated that polyethylene is not the cause of osteolysis in failed TAA. Dalat et al.…”

mentioning

confidence: 98%

Ballooning osteolysis in 71 failed total ankle arthroplasties

et al. 2016

View full text Add to dashboard Cite

Background and purposeAseptic loosening is a major cause of failure in total ankle arthroplasty (TAA). In contrast to other total joint replacements, large periarticular cysts (ballooning osteolysis) have frequently been observed in this context. We investigated periprosthetic tissue responses in failed TAA, and performed an element analysis of retrieved tissues in failed TAA.Patients and methodsThe study cohort consisted of 71 patients undergoing revision surgery for failed TAA, all with hydroxyapatite-coated implants. In addition, 5 patients undergoing primary TAA served as a control group. Radiologically, patients were classified into those with ballooning osteolysis and those without, according to defined criteria. Histomorphometric, immunohistochemical, and elemental analysis of tissues was performed. Von Kossa staining and digital microscopy was performed on all tissue samples.ResultsPatients without ballooning osteolysis showed a generally higher expression of lymphocytes, and CD3+, CD11c+, CD20+, and CD68+ cells in a perivascular distribution, compared to diffuse expression. The odds of having ballooning osteolysis was 300 times higher in patients with calcium content >0.5 mg/g in periprosthetic tissue than in patients with calcium content ≤0.5 mg/g (p < 0.001).InterpretationThere have been very few studies investigating the pathomechanisms of failed TAA and the cause-effect nature of ballooning osteolysis in this context. Our data suggest that the hydroxyapatite coating of the implant may be a contributory factor.

show abstract

Etiopathogenesis of osteolytic cysts associated with total ankle arthroplasty, a histological study

Cited by 34 publications

References 31 publications

Does Patient-Specific Instrumentation Have a Higher Rate of Early Osteolysis Than Standard Referencing Techniques in Total Ankle Arthroplasty? A Radiographic Analysis

Does Patient-Specific Instrumentation Have a Higher Rate of Early Osteolysis Than Standard Referencing Techniques in Total Ankle Arthroplasty? A Radiographic Analysis

The Salto total ankle arthroplasty — Clinical and radiological outcomes at five years

Ballooning osteolysis in 71 failed total ankle arthroplasties

Contact Info

Product

Resources

About