Misalignment of Total Ankle Components Can Induce High Joint Contact Pressures

Espinosa, Norman; Wälti, Michael; Favre, Philippe; Snedeker, Jess G.

doi:10.2106/jbjs.i.00287

Cited by 173 publications

(108 citation statements)

References 24 publications

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“…Clinical and biomechanical studies have demonstrated that alignment and position of prosthesis components may affect biomechanical properties of the replaced ankle and clinical outcomes including range of motion [52][53][54][55].…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Barg

Saltzman

2014

Curr Rev Musculoskelet Med

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A variety of surgical procedures are utilized for management of ankle osteoarthritis. The most common etiology in patients with ankle osteoarthritis is post-traumatic often resulting in asymmetric ankle osteoarthritis with concomitant valgus or varus deformity. A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, jointpreserving surgery holds the potential to be a superior treatment option than joint-sacrificing procedures including total ankle replacement or ankle arthrodesis. This review is designed to describe indications and contraindications for single-stage supramalleolar realignment surgery. Complications associated with this type of surgery and postoperative outcome are highlighted using recent literature.

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Section: Indications and Contraindicationsmentioning

confidence: 99%

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Barg

Saltzman

2014

Curr Rev Musculoskelet Med

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“…2,6,7,10,17,21,24,34,37 While contemporary TAR designs, reveal superior and more reliable overall clinical outcomes and low revision rates, 2,11,13,21,27,36 the long-term results are still not yet predictable and do not match those in total kneeand total hip arthroplasty. 1,3,5,17,19,25,32 With an increasing number of patients undergoing TAR the number of patients who will need a revision operation will rise.…”

Section: (Original) Clinical Research Articlementioning

confidence: 99%

Inferior Results of Salvage Arthrodesis After Failed Ankle Replacement Compared to Primary Arthrodesis

et al. 2014

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BACKGROUND: Up to now, there has been no evidence that salvage arthrodesis would perform inferior when compared with primary ankle arthrodesis. The purpose of this study was to compare their clinical and radiographic results. METHODS: A retrospective analysis was performed using 2 validated scores and assessment of radiographic union by comparing 23 patients who underwent salvage ankle arthrodesis (group SA = salvage arthrodesis) after failed total ankle replacement with 23 matched patients who received primary ankle arthrodesis (group PA = primary arthrodesis). The mean follow-up period was 38 (range 16-92) months in group SA and 56 (23-94) months in group PA. RESULTS: Complete union was achieved in 17 patients (74%) after a mean time of 50 (13-114) weeks in group SA and in 16 patients (70%) after a mean time of 23 (10-115) weeks in group PA. The SF-36 score averaged 48 points (7-80) in SA and 66 points (14-94; P = .006) in group PA. In group SA the mean FFI was 57% (22-82) for pain and 71% (44-98) for function. In group PA significantly better results for pain with 34% (0-88; P = .002) and function with 48% (1-92; P = .002) were found. CONCLUSION: Salvage arthrodesis led to impaired life quality and reduced function combined with significantly higher pain when compared with primary ankle arthrodesis. These findings can be used to counsel our patients preoperatively. LEVEL OF EVIDENCE: Level III, retrospective case series. (Original) Clinical Research ArticleThere is an ongoing debate whether to choose total ankle replacement (TAR) or ankle arthrodesis in the surgical treatment of symptomatic end-stage ankle osteoarthritis. 2,6,7,10,17,21,24,34,37 While contemporary TAR designs, reveal superior and more reliable overall clinical outcomes and low revision rates, 2,11,13,21,27,36 the long-term results are still not yet predictable and do not match those in total kneeand total hip arthroplasty. 1,3,5,17,19,25,32 With an increasing number of patients undergoing TAR the number of patients who will need a revision operation will rise. Neglected misalignment, medial or lateral gutter impingement, component loosening, polyethylene displacement and progressive wear, infection and persistent pain are potential factors that ultimately led to revision operation. 4,30,38 It sounds logical that-whenever possible-the implant should be salvaged and retained. This can be achieved by adding surgeries (eg, osteotomies, ligament reconstructions) 2,6,7,10,12,21,24,35,37 or simple component exchange. 2,9,11,18,20,21,23,27,29,31,36,39 However, there will always be patients who are not amenable to this kind of treatment and conversion to an arthrodesis can be considered.While several studies investigated the radiographic and clinical outcomes after primary ankle arthrodesis, there is a paucity of reports available in the literature that deal with salvage arthrodesis after failed TAR. 2,3,[6][7][8]10,17,21,24,34,37 To the best of our knowledge there has been no comparative analysis performed to assess salvage arthrodesis aft...

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“…Most current finite element models of TAR are limited to the intra-articular aspects or to the prosthetic components (Anderson et al, 2006(Anderson et al, , 2010Reggiani et al, 2006;Espinosa et al, 2010;Barg et al, 2011). Therefore, the goal of this study was to develop and validate a finite element model of TAR, for future testing of hypotheses related to clinical issues.…”

Section: Introductionmentioning

confidence: 99%

Development and experimental validation of a finite element model of total ankle replacement

Terrier

Larrea

Guerdat

et al. 2014

Journal of Biomechanics

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a b s t r a c tTotal ankle replacement remains a less satisfactory solution compared to other joint replacements. The goal of this study was to develop and validate a finite element model of total ankle replacement, for future testing of hypotheses related to clinical issues. To validate the finite element model, an experimental setup was specifically developed and applied on 8 cadaveric tibias. A non-cemented press fit tibial component of a mobile bearing prosthesis was inserted into the tibias. Two extreme anterior and posterior positions of the mobile bearing insert were considered, as well as a centered one. An axial force of 2 kN was applied for each insert position. Strains were measured on the bone surface using digital image correlation. Tibias were CT scanned before implantation, after implantation, and after mechanical tests and removal of the prosthesis. The finite element model replicated the experimental setup. The first CT was used to build the geometry and evaluate the mechanical properties of the tibias. The second CT was used to set the implant position. The third CT was used to assess the bone-implant interface conditions. The coefficient of determination (R-squared) between the measured and predicted strains was 0.91. Predicted bone strains were maximal around the implant keel, especially at the anterior and posterior ends. The finite element model presented here is validated for future tests using more physiological loading conditions.

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Misalignment of Total Ankle Components Can Induce High Joint Contact Pressures

Cited by 173 publications

References 24 publications

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Single-Stage Supramalleolar Osteotomy for Coronal Plane Deformity

Inferior Results of Salvage Arthrodesis After Failed Ankle Replacement Compared to Primary Arthrodesis

Development and experimental validation of a finite element model of total ankle replacement

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