Imaging of Ankle Replacements

LiMarzi, Gary M.; Fursevich, Dzmitry; Cole, James; Wasyliw, Christopher; Bancroft, Laura W.

doi:10.1055/s-0034-1396769

Cited by 9 publications

(13 citation statements)

References 22 publications

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“…3 In addition, the talar inclination angle (TIA) was measured on the immediately postoperative and latest follow-up lateral radiographs to evaluate for radiographic subsidence of the implant, defined as a change in TIA of 5 degrees or more from the immediately to the latest postoperative lateral radiograph. 2,11,23,32…”

Section: Methodsmentioning

confidence: 99%

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

et al. 2020

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Background: The Salto Talaris is a fixed-bearing implant first approved in the US in 2006. While early surgical outcomes have been promising, mid- to long-term survivorship data are limited. The aim of this study was to present the survivorship and causes of failure of the Salto Talaris implant, with functional and radiographic outcomes. Methods: Eighty-seven prospectively followed patients who underwent total ankle arthroplasty with the Salto Talaris between 2007 and 2015 at our institution were retrospectively identified. Of these, 82 patients (85 ankles) had a minimum follow-up of 5 (mean, 7.1; range, 5-12) years. The mean age was 63.5 (range, 42-82) years and the mean body mass index was 28.1 (range, 17.9-41.2) kg/m2. Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Preoperative, immediate, and minimum 5-year postoperative AP and lateral weightbearing radiographs were reviewed; tibiotalar alignment (TTA) and the medial distal tibial angle (MDTA) were measured to assess coronal talar and tibial alignment, respectively. The sagittal tibial angle (STA) was measured; the talar inclination angle (TIA) was measured to evaluate for radiographic subsidence of the implant, defined as a change in TIA of 5 degrees or more from the immediately to the latest postoperative lateral radiograph. The locations of periprosthetic cysts were documented. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Results: Survivorship was 97.6% with 2 revisions. One patient underwent tibial and talar component revision for varus malalignment of the ankle; another underwent talar component revision for aseptic loosening and subsidence. The rate of other reoperations was 21.2% ( n = 18), with the main reoperation being exostectomy with debridement for ankle impingement ( n = 12). At final follow-up, the average TTA improved 4.4 (± 3.8) degrees, the average MDTA improved 3.4 (± 2.6) degrees, and the average STA improved 5.3 (± 4.5) degrees. Periprosthetic cysts were observed in 18 patients, and there was no radiographic subsidence. All FAOS subscales demonstrated significant improvement at final follow-up. Conclusions: We found the Salto Talaris implant to be durable, consistent with previous studies of shorter follow-up lengths. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at a minimum 5-year follow-up. Level of Evidence: Level IV, retrospective case series.

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Section: Methodsmentioning

confidence: 99%

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

et al. 2020

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“…However, a change in angulation by 5 degrees or more is generally accepted as significant. 1,11,17,22 This is the first paper to demonstrate specific inclination angles of the TAA talar component associated with concerning radiographic outcomes.…”

Section: Discussionmentioning

confidence: 84%

“…A decrease in TCI angle or DTAA of 5 degrees or more between the postoperative and last available follow-up radiographs was considered clinically important, as per accepted convention, 1,11,17,22 and considered as anterior radiographic talar subsidence for this study.…”

Section: Methodsmentioning

confidence: 99%

Impact of Sagittal Talar Inclination on Total Ankle Replacement Failure

Escudero

Symes

et al. 2019

Foot Ankle Int.

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Background: Restoration of ankle alignment is important in total ankle arthroplasty (TAA), but sagittal alignment of the talar component is less studied than coronal sagittal. Little has been published on the importance of sagittal talar alignment in TAA. The radiographic talar component inclination was hypothesized to be predictive of TAA survival, subsidence, and functional outcomes. Methods: A retrospective review of the Vancouver End-Stage Ankle Arthritis Database was performed on all TAAs at a single center over 11 years utilizing 1 of 2 implants. Talar component inclination (TCI) angles were measured and standard descriptive statistics were completed with a survival analysis. Inter- and intraobserver reliability were determined. Postoperative TCI angles were analyzed against several definitions of TAA survival and patient-reported outcome measures from the database. A total of 109 TAAs satisfied inclusion and exclusion criteria. Results: A postoperative talar component inclination angle greater than 22 degrees was associated with talar component anterior subsidence, defined as a change in that angle of 5 degrees or more between postoperative and last available radiographs. This was still significant after adjusting for confounders: age, gender, body mass index, and presence of inflammatory arthritis. All measured angles had good inter- and intraobserver reliability. Conclusion: Surgeons should avoid dorsiflexing the talar prosthesis during TAA, which hypothetically diminishes the ankle critical dorsiflexion range. This may cause anterior talar undercoverage in terminal dorsiflexion and may edge load the talar prosthesis, predisposing to anterior subsidence. Elevated TCI was a simple and reliable radiographic measurement to predict long-term TAA outcome due to predictable anterior subsidence of the talar prosthesis. Level of Evidence: Level III, retrospective comparative series.

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“…Imaging after total ankle arthroplasty (TAA) typically consists of serial weightbearing radiographs to assess implant alignment and fixation. 46 With an incidence of 5% to 6%, aseptic loosening is one of the most common complications following TAA and often requires revision arthroplasty or arthrodesis. 5,83 Radiographs may demonstrate periprosthetic lucency in up to 98% of patients, though the majority of these lesions are not clinically significant and may be expected due to stress shielding with some implants.…”

Section: Clinical Uses In Orthopedic Foot and Ankle Surgerymentioning

confidence: 99%

“…5,83 Radiographs may demonstrate periprosthetic lucency in up to 98% of patients, though the majority of these lesions are not clinically significant and may be expected due to stress shielding with some implants. 22,46 CT has been shown to be a far more accurate tool in the evaluation of periprosthetic osteolysis and is recommended in any patient with suspected loosening. 32,41,93 Metal artifacts may obscure lesions on CT, but their effect can be minimized with specialized imaging protocols.…”

Section: Clinical Uses In Orthopedic Foot and Ankle Surgerymentioning

confidence: 99%

Nuclear Medicine for the Orthopedic Foot and Ankle Surgeon

et al. 2020

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Nuclear medicine has been widely applied as a diagnostic tool for orthopedic foot and ankle pathology. Although its indications have diminished with improvements in and the availability of magnetic resonance imaging, nuclear medicine still has a significant and valuable role. The present article offers a comprehensive and current review of the most common nuclear imaging modalities for the orthopedic foot and ankle surgeon. Methods discussed include bone scintigraphy, gallium citrate scintigraphy, labeled-leukocyte scintigraphy, and single-photon emission computed tomography (SPECT). We review the indications and utility of these techniques as they pertain to specific foot and ankle conditions, including osteomyelitis, stress fractures, talar osteochondral lesions, complex regional pain syndrome, oncology, plantar fasciitis, and the painful total ankle arthroplasty. We conclude with a discussion of our approach to nuclear medicine with illustrative cases. Level of Evidence: Level V, expert opinion.

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Imaging of Ankle Replacements

Cited by 9 publications

References 22 publications

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

Impact of Sagittal Talar Inclination on Total Ankle Replacement Failure

Nuclear Medicine for the Orthopedic Foot and Ankle Surgeon

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