Revision of STAR total ankle replacement to hybrid AES–STAR total ankle replacement—A report of two cases

Kharwadkar, N.; Harris, N.

doi:10.1016/j.fas.2008.06.003

Cited by 26 publications

(11 citation statements)

References 14 publications

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Section: (Original) Clinical Research Articlementioning

confidence: 99%

“…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 after failed TAR and primary ankle arthrodesis.…”

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confidence: 99%

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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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Section: (Original) Clinical Research Articlementioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2014

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“…Their 5 patients with revision TAR had more pain than their 9 patients who were revised with fusion. Kharwadkar and Harris (2009) reported good short-term results of revision TAR in 2 cases. Hintermann et al (2013) analyzed 117 cases where each failed primary TAR was revised with a similar type of prosthesis, and all by the same surgeon.…”

Section: Discussionmentioning

confidence: 97%

Poor prosthesis survival and function after component exchange of total ankle prostheses

Kamrad¹,

Henricsson²,

Karlsson³

et al. 2015

Acta Orthopaedica

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Background and purpose In failed total ankle replacements (TARs), fusion is often the procedure of preference; the outcome after exchanging prosthetic components is debated. We analyzed prosthetic survival, self-reported function, and patient satisfaction after component exchange.Patients and methods We identified patients in the Swedish Ankle Registry who underwent exchange of a tibial and/or talar component between January 1, 1993 and July 1, 2013 and estimated prosthetic survival by Kaplan-Meier analysis. We evaluated the patient-reported outcome measures (PROMs) SEFAS, EQ-5D, EQ-VAS, SF-36, and patient satisfaction by direct questions.Results 69 patients underwent revision TAR median 22 (0–110) months after the primary procedure. 24 of these failed again after median 26 (1–110) months. Survival analysis of revision TAR showed a 5-year survival rate of 76% and a 10-year survival of 55%. 29 patients with first revision TAR in situ answered the PROMs at mean 8 (1–17) years after revision and had the following mean scores: SEFAS 22, SF-36 physical 37 and mental 49, EQ-5D index 0.6, and EQ-VAS 64. 15 of the patients were satisfied, 5 were neither satisfied nor dissatisfied, and 9 were dissatisfied.Interpretation Revision TAR had a 10-year survival of 55%, which is lower than the 10-year survival of 74% for primary TAR reported from the same registry. Only half of the patients were satisfied. Future studies should show which, if any, patients benefit from revision TAR and which patients should rather be fused directly.

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“…38 Given the functional limitations of arthrodesis, revision TAA has emerged as a viable alternative, with promising outcomes recently reported in the literature. 20,21,39 Fully informing patients of the risks and benefits of each intervention and tailoring treatment to their desires and needs is paramount.…”

Section: Surgical Managementmentioning

confidence: 99%

Evaluation and Management of the Painful Total Ankle Arthroplasty

Hsu

Haddad

Myerson

2015

Journal of the American Academy of Orthopaedic Surgeons

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Total ankle arthroplasty (TAA) is an increasingly popular treatment option for patients with end-stage ankle arthritis. Although improved short- and long-term clinical and radiographic outcomes have been achieved with TAA, revision surgery may be necessary in the setting of aseptic loosening, subsidence, impingement, arthrofibrosis, or infection. Factors such as patient selection, implant design, and surgical technique can all contribute to TAA failure. Treatment of patients with a painful TAA is complex and requires careful consideration of symptom history, workup, and nonsurgical and surgical treatment options. Surgical management of failed TAA includes arthrodesis, revision surgery, or below-knee amputation.

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Revision of STAR total ankle replacement to hybrid AES–STAR total ankle replacement—A report of two cases

Cited by 26 publications

References 14 publications

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

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

Poor prosthesis survival and function after component exchange of total ankle prostheses

Evaluation and Management of the Painful Total Ankle Arthroplasty

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