Midterm Outcomes of a Fixed-Bearing Total Ankle Arthroplasty With Deformity Analysis

Harston, Andrew; Lazarides, Alexander L.; Adams, Samuel B.; DeOrio, James K.; Easley, Mark E.; Nunley, James A.

doi:10.1177/1071100717731853

Cited by 42 publications

(33 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Seven studies scored no stars for the item “outcome of interest,” 14,15,31,32,34,37,38 6 studies scored no stars for the item “comparability of cohorts,” 4,14,20,31,37,38 and 3 studies scored 1 of 2 stars for this item. 13,15,34 For the other items of the checklist, where a maximum of 1 star could be obtained, 2 studies did not obtain a star. One study received no star for the item “representativeness,” 34 and the other study received no star for the item “long enough follow-up.” 14…”

Section: Resultsmentioning

confidence: 99%

Influence of Preoperative Tibiotalar Alignment in the Coronal Plane on the Survival of Total Ankle Replacement: A Systematic Review

Keijzer

Joling²,

Sierevelt³

et al. 2019

Foot Ankle Int.

View full text Add to dashboard Cite

Background: It remains controversial whether significant preoperative tibiotalar varus and valgus deformity should be contraindications for total ankle replacement (TAR). The primary aim of this systematic review was to analyze the influence of preoperative tibiotalar varus and valgus alignment on the survival of TAR. Methods: The databases MEDLINE and Embase were searched from onset through September 2018. Two authors performed study selection and data extraction using a predefined data extraction tool. Implant survival in the alignment groups was reported as “revisions per 100 component years.” Additional procedures, complications, and revisions were also reported. Assessment of the methodological quality was performed using the Newcastle-Ottawa Scale (NOS). Results: In total, 17 studies were considered eligible, in which a total of 1692 TARs were included from 1627 patients. The weighted mean follow-up was 52.4 (range, 1-147) months. The neutral alignment group included 711 TARs, the varus group included 545 TARs, and the valgus group included 332 TARs. Total revisions were 52, 37, and 36 in the preoperative tibiotalar neutral, varus, and valgus alignment groups, respectively. Revisions per 100 observed component years were 1.6, 1.7, and 2.5 in the preoperative tibiotalar neutral, varus, and valgus alignment groups, respectively. A total of 129 complications and 447 additional procedures were reported in 601 TARs. Conclusion: There was a strong indication that preoperative varus alignment in the coronal plane had a comparable implant survival to neutral alignment. Preoperative valgus alignment demonstrated a more negative influence on implant survival. Level of evidence: Level III, systematic review.

show abstract

Section: Resultsmentioning

confidence: 99%

Influence of Preoperative Tibiotalar Alignment in the Coronal Plane on the Survival of Total Ankle Replacement: A Systematic Review

Keijzer

Joling²,

Sierevelt³

et al. 2019

Foot Ankle Int.

View full text Add to dashboard Cite

show abstract

“…Case series of MB-TAR and FB-TAR suggest favorable outcomes for both implant types. 3,4,6,9,11,13,18,21,26 Current FB-TAR designs, including the Salto Talaris, only gained traction over the past decade, prompted by the FDA’s restriction on MB-TAR in the United States. By the time the STAR was introduced to the US market in 2009, FB-TAR was established an alternative to MB-TAR.…”

Section: Discussionmentioning

confidence: 99%

“…There are relatively high reoperation rates in both groups, but most address impingement or cyst formation without the need to remove the metal implants. 3,4,6,9,11,14,21 Case series are important in understanding anticipated outcomes of both designs but fail to compare MB-TAR and FB-TAR with a high level of evidence.…”

Section: Discussionmentioning

confidence: 99%

“…Successful outcomes and satisfactory implant survivorship are reported at long-term follow-up for MB-TAR 6,9,14,21 and at intermediate- to long-term follow-up for newer generation FB-TAR. 11,13,18,26 Comparisons between MB-TAR and FB-TAR have been reported, but these nonrandomized cohort studies and systematic reviews fail to determine whether the MB-TAR design features confer an advantage over those of the fixed-bearing design. Gaudot et al 10 published a retrospective case-controlled study of mobile-bearing Salto and fixed-bearing Salto Talaris total ankle replacements.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Prospective Randomized Trial Comparing Mobile-Bearing and Fixed-Bearing Total Ankle Replacement

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported long term for MB-TAR and at intermediate- to long-term follow-up for newer generation FB-TAR. Although comparisons between the 2 total ankle designs have been reported, to our knowledge, no investigation has compared the 2 designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes, and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65 years, range 35-85 years) were enrolled; a demographic comparison between the 2 cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees, or extensive talar dome wear pattern (“flat-top talus”). Prospective patient-reported outcomes, physical examination, and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score, Short Form 36, Foot and Ankle Disability Index, Short Musculoskeletal Functional Assessment, and American Orthopaedic Foot & Ankle Society ankle-hindfoot score. Surgeries were performed by a nondesign team of orthopedic foot and ankle specialists with total ankle replacement expertise. Statistical analysis was performed by a qualified statistician. At average follow-up of 4.5 years (range, 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, 1 had died, 4 were withdrawn after enrolling but prior to surgery, and 4 were lost to follow-up. Results: In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up with no statistically significant difference between the 2 groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FH-TAR, respectively. Reoperations were performed in 8 MB-TARs and 3 FH-TARs, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: With a high level of evidence, our study found that patient-reported and clinical outcomes were favorable for both designs and that there was no significant difference in clinical improvement between the 2 implants. The incidence of lucency/cyst formation was similar for MB-TAR and FH-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not necessarily correlate with radiographic findings. Reoperations were more common for MB-TAR and, in most cases, were to relieve impingement or treat cysts rather than revise or remove metal implants. Level of Evidence: Level I, prospective randomized study.

show abstract

“…Our decision to include multiple different implant systems in the present study stems from the fact that all 4 implant systems have had good results reported in the recent literature, with midterm survival rates higher than 90%. 6,9,13,18,30 Both mobile- and fixed-bearing implants were included because no study has shown a difference between the two in terms of survival rates or outcomes. By including multiple different implant systems and multiple surgeons, we felt that our findings on predictors of failure would be more generalizable.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Failure of Total Ankle Arthroplasty With a Minimum Five Years of Follow-up

et al. 2018

Self Cite

View full text Add to dashboard Cite

Background: As the popularity of total ankle arthroplasty (TAA) increases and indications expand, surgeons require a better understanding of which patient factors are associated with implant failure. In this study, we aimed to use a large total ankle database to identify independent risk factors for implant failure at mid- to long-term follow-up. Methods: A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 5 years’ follow-up. The primary outcome was revision, defined as removal of one or both metal components; failures due to infection were excluded. Patient and clinical factors analyzed included age, sex, body mass index (BMI), smoking status, presence of diabetes, indication for TAA, implant, tourniquet time, and presence of ipsilateral hindfoot fusion. Preoperative coronal deformity and sagittal talar translation were assessed, as were postoperative coronal and sagittal tibial component alignment. Univariable and multivariable analyses were performed to identify predictors of implant failure. After excluding 5 ankles that failed because of deep infection, 533 ankles with a mean 7 (range, 5-11) years of follow-up met the inclusion criteria. Four implants were used: INBONE I, INBONE II, STAR, and Salto-Talaris. Results: Thirty-four ankles (6.4%) were revised or removed a mean 4 (range, 1-9) years postoperatively. The only independent predictors of failure were the INBONE I prosthesis and ipsilateral hindfoot fusion ( P = .006 and P = .023, respectively). Conclusions: This is among the largest studies to analyze the relationship between TAA failure rates and multiple different patient, operative, and radiographic factors. Of note, age, BMI, and amount of deformity were not associated with higher failure rates. Only patients with ipsilateral hindfoot fusion or who received the INBONE I prosthesis were at significantly higher risk of implant failure. Level of Evidence: Level III, retrospective cohort study.

show abstract

Midterm Outcomes of a Fixed-Bearing Total Ankle Arthroplasty With Deformity Analysis

Abstract: Level III, comparative study.

Cited by 42 publications

References 30 publications

Influence of Preoperative Tibiotalar Alignment in the Coronal Plane on the Survival of Total Ankle Replacement: A Systematic Review

Influence of Preoperative Tibiotalar Alignment in the Coronal Plane on the Survival of Total Ankle Replacement: A Systematic Review

Prospective Randomized Trial Comparing Mobile-Bearing and Fixed-Bearing Total Ankle Replacement

Risk Factors for Failure of Total Ankle Arthroplasty With a Minimum Five Years of Follow-up

Contact Info

Product

Resources

About