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

Cody, Elizabeth; Bejarano-Pineda, Lorena; Lachman, James R.; Taylor, Michel; Gausden, Elizabeth B.; DeOrio, James K.; Easley, Mark E.; Nunley, James A.

doi:10.1177/1071100718806474

Cited by 77 publications

(89 citation statements)

References 38 publications

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“…27,29,30,39 In contrast to other prosthesis designs, survivorship of the Salto Talaris implant was observed to be comparable to that of previously published studies with similar durations of follow-up. 1,6,33 While we cannot claim that this implant is superior to other available implants on the market, our results do demonstrate the continued durability of this particular implant with mid-to long-term follow-up. A recent systematic review comparing outcomes of TAA and arthrodesis over the past decade reported that despite having a lower postoperative complication rate, TAA was associated with an increased rate of reoperations.…”

Section: Discussionmentioning

confidence: 49%

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

et al. 2020

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Background: The Salto Talaris is a fixed-bearing implant first approved in the US in 2006. While early surgical outcomes have been promising, mid- to long-term survivorship data are limited. The aim of this study was to present the survivorship and causes of failure of the Salto Talaris implant, with functional and radiographic outcomes. Methods: Eighty-seven prospectively followed patients who underwent total ankle arthroplasty with the Salto Talaris between 2007 and 2015 at our institution were retrospectively identified. Of these, 82 patients (85 ankles) had a minimum follow-up of 5 (mean, 7.1; range, 5-12) years. The mean age was 63.5 (range, 42-82) years and the mean body mass index was 28.1 (range, 17.9-41.2) kg/m2. Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Preoperative, immediate, and minimum 5-year postoperative AP and lateral weightbearing radiographs were reviewed; tibiotalar alignment (TTA) and the medial distal tibial angle (MDTA) were measured to assess coronal talar and tibial alignment, respectively. The sagittal tibial angle (STA) was measured; the talar inclination angle (TIA) was measured to evaluate for radiographic subsidence of the implant, defined as a change in TIA of 5 degrees or more from the immediately to the latest postoperative lateral radiograph. The locations of periprosthetic cysts were documented. Preoperative and minimum 5-year postoperative Foot and Ankle Outcome Score (FAOS) subscales were compared. Results: Survivorship was 97.6% with 2 revisions. One patient underwent tibial and talar component revision for varus malalignment of the ankle; another underwent talar component revision for aseptic loosening and subsidence. The rate of other reoperations was 21.2% ( n = 18), with the main reoperation being exostectomy with debridement for ankle impingement ( n = 12). At final follow-up, the average TTA improved 4.4 (± 3.8) degrees, the average MDTA improved 3.4 (± 2.6) degrees, and the average STA improved 5.3 (± 4.5) degrees. Periprosthetic cysts were observed in 18 patients, and there was no radiographic subsidence. All FAOS subscales demonstrated significant improvement at final follow-up. Conclusions: We found the Salto Talaris implant to be durable, consistent with previous studies of shorter follow-up lengths. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at a minimum 5-year follow-up. Level of Evidence: Level IV, retrospective case series.

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Section: Discussionmentioning

confidence: 49%

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

et al. 2020

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“…Interestingly, if we had considered only the peak axial force during level walking as has been done by previous investigators, 5,6 the results would have been smaller peak micromotions (Table 3) and smaller amounts of bone at risk of failure (Table 4) We found that the fixation design played an important role in the magnitude of the maximum peak micromotion: the stem design had four to five times larger values (874-1125 µm) than the three spikes and keel designs, for which the peak micromotion was both smaller and similar to one another (~54-140 µm). Moreover, the distribution of micromotion at the instant of the maximum peak micromotion was also dependent on the fixation design: for the three spikes design, the highest micromotion was located posteriorly; for the keel, the highest micromotion was located anteriorly; and the stem design showed a concentric pattern around the stem.…”

Section: Resultsmentioning

confidence: 99%

Biomechanical evaluation of total ankle arthroplasty. Part II: Influence of loading and fixation design on tibial bone–implant interaction

Gonzalez

Steineman

Sturnick

et al. 2020

Journal Orthopaedic Research

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Finite element (FE) models to evaluate the burden placed on the interaction between total ankle arthroplasty (TAA) implants and the bone often rely on peak axial forces. However, the loading environment of the ankle is complex, and it is unclear whether peak axial forces represent a challenging scenario for the interaction between the implant and the bone. Our goal was to determine how the loads and the design of the fixation of the tibial component of TAA impact the interaction between the implant and the bone. To this end, we developed a framework that integrated robotic cadaveric simulations to determine the ankle kinematics, musculoskeletal models to determine the ankle joint loads, and FE models to evaluate the interaction between TAA and the bone. We compared the bone-implant micromotion and the risk of bone failure of three common fixation designs for the tibial component of TAA: spikes, a stem, and a keel. We found that the most critical conditions for the interaction between the implant and the bone were dependent on the specimen and the fixation design, but always involved submaximal forces and large moments. We also found that while the fixation design influenced the distribution and the peak value of bone-implant micromotion, the amount of bone at risk of failure was specimen dependent. To account for the most critical conditions for the interaction between the implant and the bone, our results support simulating multiple specimens under complex loading profiles that include multiaxial moments and span entire activity cycles.

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“…Regarding alignment, studies have been published focusing on the relationship between TAR malalignment and failure of the implant. 12,26 However, no direct correlation between radiographic residual malalignment and onset of PPC has been demonstrated so far.…”

Section: Introductionmentioning

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

Cited by 77 publications

References 38 publications

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

Radiographic and Clinical Outcomes of the Salto Talaris Total Ankle Arthroplasty

Biomechanical evaluation of total ankle arthroplasty. Part II: Influence of loading and fixation design on tibial bone–implant interaction

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

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