Peri-prosthetic bone cysts after total ankle replacement. A systematic review and meta-analysis

Arcângelo, Joana; Guerra-Pinto, Francisco; Pinto, Ana; Grenho, André; Navarro, Alfons; Oliva, Xavier Martín

doi:10.1016/j.fas.2017.11.002

Cited by 38 publications

(41 citation statements)

References 50 publications

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“…Finally, past literature has recognized PPCs in TAR to be a multifactor phenomenon, supporting many possible causes but focusing mainly on histopathological findings. 1,7,8 The relationship between the presence of PPCs and clinical results has very seldom been investigated. 1 It is possible to hypothesize that most PPCs remain underdiagnosed, both because of the frequently used 2D radiographic follow-up postoperatively and because they probably remain clinically latent and asymptomatic until they become large enough to lead to symptoms and implant failure.…”

Section: Discussionmentioning

confidence: 99%

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

et al. 2019

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Background: We investigated the association between hindfoot residual malalignment assessed on weightbearing computed tomography (WBCT) images and the development of periprosthetic cysts (PPCs) after total ankle replacement (TAR). We hypothesized that PPCs would be found predominantly medially in the varus configuration and laterally in the valgus configuration. Methods: Cases of primary TAR with available WBCT imaging of the ankle were included in this retrospective study. The location of the PPC was marked and the following volumes were calculated: total (TCV), medial (MCV), central (CCV), and lateral (LCV) cyst volumes. Hindfoot alignment was measured as Foot and Ankle Offset (FAO), with 95% confidence intervals (95% CIs) calculated to define varus (<95% CI) and valgus (>95% CI) groups. Cyst volumes were compared between these 2 groups. The American Orthopaedic Foot & Ankle Society (AOFAS) score at the time of the WBCT was also retrieved. Receiver operating characteristic (ROC) curves were used to determine FAO thresholds for predicting an increased risk of PPC. Results: Forty-eight TARs (mean follow-up, 44.6 months) were included, 81% of which had at least 1 PPC. The mean FAO was 0.12% (95% CI, –1.12 to 1.36). Patients with greater residual malalignment ( P < .001) and those with longer follow-up ( P < .001) presented with increased TCV. In varus cases, the MCV was greater than the LCV ( P = .042), with a threshold FAO value of −2.75% or less predicting an increased MCV. In valgus cases, the LCV was greater than the MCV ( P = .049), with a FAO threshold value of 4.5% or more predicting an increased LCV. Conclusion: In this series, the PPC volume after primary TAR significantly correlated with postoperative hindfoot malalignment and longer follow-up. Level of Evidence: Level III, retrospective comparative series.

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Section: Discussionmentioning

confidence: 99%

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

et al. 2019

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“…This practice is consistent with local guidelines and other recent publications, including a recently published systematic review and meta-analysis of periprosthetic osteolysis, where 61.9% of the studies (13 of 21) used radiographs as the method for osteolysis detection. 38 Also, most of the publications regarding CT scans and osteolysis suggest that x-rays should be used as a first-line investigation and that CT may be only warranted in patients with radiographic evidence of lucent lesions. [35][36][37] Another limitation of this study is the relatively small sample size of our cohort, especially in the SR group.…”

Section: Discussionmentioning

confidence: 99%

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

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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

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“…The causes of osteolysis following TAR are multiple, ranging from an inflammatory cytokine-cascade response to wear debris, 16,20 mechanical factors such as high joint fluid pressure, implant micro-motion and stress shielding, 1,8,9 and material properties of the implants themselves. 1,22,27 Malpositioning of implants in TAR surgery leads to higher contact pressures and greater shear stress, and can lead to higher rates of osteolysis.…”

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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Peri-prosthetic bone cysts after total ankle replacement. A systematic review and meta-analysis

Abstract: Non-anatomic, mobile-bearing, hydroxyapatite-coated and non tibial-stemmed total ankle replacements are positively associated with more periprosthetic bone cysts.

Cited by 38 publications

References 50 publications

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

3D, Weightbearing Topographical Study of Periprosthetic Cysts and Alignment in Total Ankle Replacement

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

Bone Cysts and Osteolysis in Ankle Replacement

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