Outcomes Following Cyst Curettage and Bone Grafting for the Management of Periprosthetic Cystic Evolution After AES Total Ankle Replacement

Besse, Jean-Luc; Lienhart, Christophe; Fessy, Michel‐Henri

doi:10.1016/j.cpm.2012.10.005

Cited by 37 publications

(23 citation statements)

References 15 publications

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“…UHMWPE malalignment leading to excessive wear and aseptic osteolysis has been reported most commonly with the Scandinavian Total Ankle ReplacementÔ system (52,53). The use of the hydroxyapatite coating has been implicated as the major cause of the severe aseptic osteolysis seen with the Ankle Evolutive System Ò (Transysteme-JMT Implants, Nimes, France) (54)(55)(56)(57)(58) that was subsequently withdrawn from use in 2012 (http://www.mhra.gov.uk/home/groups/dts-bs/documents/ medicaldevicealert/con174792.pdf). Similarly, a recent long-term follow-up of 77 Scandinavian Total Ankle ReplacementÔ prostheses with hydroxyapatite coating revealed a 70.7% survival (i.e., no metallic component revision) at 10 years, which had declined to 45.6% at 14 years (59).…”

Section: Discussionmentioning

confidence: 98%

Incidence of Revision After Primary Implantation of the Salto® Mobile Version and Salto Talaris™ Total Ankle Prostheses: A Systematic Review

Roukis

Elliott

2015

The Journal of Foot and Ankle Surgery

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Section: Discussionmentioning

confidence: 98%

Incidence of Revision After Primary Implantation of the Salto® Mobile Version and Salto Talaris™ Total Ankle Prostheses: A Systematic Review

Roukis

Elliott

2015

The Journal of Foot and Ankle Surgery

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“…Yoon et al 35 reported no evidence of progression of osteolytic lesions after 8 revisions with bone graft treatment. However, Besse et al 4 analyzed a series of 50 TARs for which 20 revision procedures with bone cyst curettage and grafting were performed. At a mean follow-up of 32 months, 79% functional and 92% radiologic failure rate was reported and 28% were converted to arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

Bone Cysts and Osteolysis in Ankle Replacement

2020

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Background: Total ankle replacements (TARs) have higher rates of osteolysis than hip or knee replacements. It is unclear whether this is a pathologic immunologic process in response to wear debris, or expansion of pre-existing osteoarthritic bone cysts. We aimed to determine the incidence of bone cysts in patients with end-stage ankle arthritis prior to surgery and review the literature on bone cysts and osteolysis in relation to TAR. Methods: This is a descriptive/prevalence study in which all patients with end-stage ankle arthritis underwent plain radiographic imaging and computed tomographic (CT) scans prior to TAR surgery. Their imaging was assessed for the presence of cysts, measured on sagittal, axial, and coronal slices of the CT scan at the widest diameter. All cysts that would be removed as a result of the bone resection for the implant were excluded using digital analysis software. We assessed 120 consecutive patients with mean age of 63.4 years. Results: Seventeen patients (14%) did not have any bone cysts based on CT images. Ten patients (8%) had cysts that would have been completely removed by surgery, leaving 93 patients for analysis (78%). In 60% of these cases, the cysts were not seen on the plain radiographs. In 39 patients (33%), the cysts were greater than 5 mm in size. The medial (36%) and lateral malleoli (33%) were the most common location for the cysts (mean diameter 4.6±2.0 and 4.2±2.3 mm, respectively). Conclusion: Bone cysts outside of the resection margins for a TAR were present in 78% of patients with ankle arthritis prior to undergoing surgery. In 30% of cases, cysts were greater than 5 mm in size. In 60% of cases, the cysts were not seen on plain radiographs. Preoperative 3-dimensional imaging can provide a foundation to observe and quantify cyst presence, expansion, and time of onset in the postoperative setting. Level of Evidence: Level IIc, diagnostic/prevalence study.

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“…Because the predominant location of the cysts is the tibia, fixation of the tibial component has been suspected. 3 Given the difference in total ankle design systems and the rate of cyst formation, stem design and the varied methods to improve bony ingrowth or ongrowth (hydroxyapatite, sprayed titanium metal, etc) may be relevant factors. Bonin et al 4 hypothesized that some of these cysts could have evolved from osteoarthritic cysts that pre-dated implantation of the device.…”

Section: Discussionmentioning

confidence: 99%

“…It is unclear if these crystal deposits were unrelated or a causative agent. Currently, our institution has started prescribing oral bisphosphonates when confronted with a patient who has a bone cyst larger than 1.0 cm 3 .…”

Section: Discussionmentioning

confidence: 99%