Role of Rotation in Total Ankle Replacement

Najefi, Ali-Asgar; Ghani, Yaser; Goldberg, Andy

doi:10.1177/1071100719867068

Cited by 36 publications

(26 citation statements)

References 28 publications

(45 reference statements)

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“…12,15 Despite improvements in preoperative planning tools and instrumentation, restoring the ankle’s axis of rotation by resurfacing the tibial and talar surfaces remains challenging. 7,21,27 Over the past decade, mobile-bearing total ankles were introduced to the market and showed satisfactory outcomes. 2,3,5,9,10,30,33-35 Adding an interface between the polyethylene insert (PI) and the tibial component potentially permits motion between the talus and PI in both the sagittal and coronal planes and may allow rotational motion (axial plane).…”

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confidence: 99%

Syndesmotic Overload in 3-Component Total Ankle Replacement

et al. 2019

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Background: Mobile-bearing total ankle replacement (TAR) potentially enables motion at the tibial implant–polyethylene insert (PI) interface. Such additional freedom of movement may overload periarticular ligaments and subsequently result in coronal translation of the talus. The aim of this study was to assess whether syndesmotic overload affects clinical and radiographic outcomes following mobile-bearing TAR and whether tibiofibular fusion is an effective treatment option. Methods: Thirty-one patients who underwent revision surgery for syndesmotic overload after mobile-bearing TAR were retrospectively analyzed. Clinical and radiographic outcomes were assessed before and after index TAR, preoperatively to revision surgery, and at the last follow-up after revision surgery. Computed tomography scans were also analyzed. Results: Ankles with lateral talar translation prior to revision surgery were about 10 times more likely to have valgus tibial implant position ( P = .003). A wide tibiofibular distance at the level of the syndesmosis after index TAR was associated with an increased hindfoot moment arm at revision surgery ( P = .025). Decrease of PI height at revision surgery and a PI fracture were evident in 10 (32%) and 4 (13%) cases, respectively. Talar cyst formation at revision surgery was evident in 12 (39%) cases. Tibiofibular fusion was effective in restoring function of the replaced ankle and providing pain relief. Conclusion: Syndesmotic overload impaired clinical and radiographic outcomes after mobile-bearing TAR. Proper implant positioning and additional realignment procedures may prevent overload of periarticular soft tissue structures after mobile-bearing TAR. Level of Evidence: Level IV, retrospective case series.

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confidence: 99%

Syndesmotic Overload in 3-Component Total Ankle Replacement

et al. 2019

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“…Apparently, the axial position of the talar and tibial component in TAA remains a major issue. 20 A prosthesis design that is able to combine the advantages of a mobile-bearing and a fixed-bearing total ankle design may enhance implant longevity and simplify TAA. Such a novel design must allow for optimal positioning of the metallic components based on the available bone stock (eg, only minimal talar and tibial resection).…”

Section: Discussionmentioning

confidence: 99%

“…26 No validated method to accurately determine osseous landmarks to reference the ideal position of the implants has yet been described. 20 If the tibial tuberosity is used as a reference for implant positioning, the wide range of tibial torsion considered as normal and possible tibial bowing make proper positioning challenging. 20 In addition, assessment of the prosthesis components' position after TAA is difficult.…”

Section: Discussionmentioning

confidence: 99%

“…20 If the tibial tuberosity is used as a reference for implant positioning, the wide range of tibial torsion considered as normal and possible tibial bowing make proper positioning challenging. 20 In addition, assessment of the prosthesis components' position after TAA is difficult. Since weightbearing CT scans allow a detailed analysis of the hindfoot under physiological load, the use of this novel imaging option is promising for accurate assessment of the prosthesis components after TAA.…”

Section: Discussionmentioning

confidence: 99%

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Axial Rotational Alignment in Mobile-Bearing Total Ankle Arthroplasty

et al. 2020

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Background: The presence of an interface between the tibial component and the polyethylene insert (PI) in mobile-bearing total ankle arthroplasty (TAA) may allow the talus to adapt its axial position according to the patient’s anatomy. However, little is known about differences of the axial talar rotation between patients following mobile-bearing TAA. Therefore, the aim of this study was to assess the relative axial rotation between the talar and tibial component intraoperatively and after a minimum follow-up of 3 years following mobile-bearing TAA. Methods: The relative axial rotation between the talar and the tibial component was measured intraoperatively in a cohort of 58 patients who underwent mobile-bearing TAA. In addition, it was measured on weightbearing computed tomography (CT) scans in 48 patients after a mean of 6.3 (3.0-16.3) years following mobile-bearing TAA. The pre- and postoperative alignment of the ankle joint/tibial component and hindfoot assessed on conventional radiographs was correlated with the intra- and postoperatively determined relative axial rotation of the talar and tibial component. Results: The mean intra- and postoperative axial talar component position was 1.7 (range, 14 internal to 14 external) and 1.4 (range, 12 internal to 20 external) degrees toward internal when compared to the tibial component ( P = .960). The preoperative sagittal alignment of the distal tibia correlated with the intraoperatively determined relative axial rotation between the talar and the tibial component ( P = .019). Conclusion: The wide range of the relative axial rotation between the tibial and talar component suggests that it is crucial to allow the talus to intraoperatively find a position that corresponds to the patient’s individual anatomy. The fact that the range of axial rotation was similar after a minimum of 3 years measured under weightbearing conditions suggests that structural changes of the osteoarthritic ankle may be the main determining factors for the axial rotational position of the talus. Our findings improve current understanding of proper implant position during TAA. In addition, the current study provides a reliable method to assess the postoperative axial position of the prosthesis components. The high interindividual variability of the relative rotation between the tibial and talar component in the axial plane suggests that axial malpositioning following TAA may be a more common issue than currently expected. Our findings may help to improve the assessment of patients with persistent pain following TAA. Level of Evidence: Level III, comparative series.

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“…referencing. [4][5][6][7] Axial plane alignment, however, is difficult to determine on conventional radiographs. Moreover, because of a large variation in the rotational profile of patients undergoing TAR, the tibial tuberosity was shown to be an unreliable bony landmark for intraoperative referencing.…”

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confidence: 99%

Talar neck angle correlates with tibial torsion—Guidance for 3D and 2D measurements in total ankle replacement

Flury

Viehöfer

Hoch

et al. 2020

Journal Orthopaedic Research

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Axial plane alignment of the talar component in total ankle arthroplasty is poorly understood and remains a major issue, especially since malpositioning results in increased peak pressure and rotational torque. Further profound knowledge regarding individual anatomy of the talus and its relation to proximal and distal osseous structures is therefore needed. Therefore, three-dimensional (3D) surface models of 50 lower extremities were generated using computed tomography data of patients without ankle osteoarthritis. The talus neck torsion was measured using a novel 3D measurement method. Then, tibial torsion and subtalar joint axis orientation were measured and correlated to the talus neck torsion. Moreover, a 2D measurement method of the talus neck torsion was developed. A statistically significant correlation was found between external tibia torsion and medial talus neck torsion, as well as talus neck axis and subtalar joint axis in the transversal and frontal plane. The novel defined 3D measurement methods indicated excellent inter-rater and intra-rater reliability. The 2D measurement method of the talus neck torsion was in good agreement with the 3D method. The results showed that the rotational profiles of the tibia, talus, and adjacent joints are interconnected, which should be considered in total ankle replacement (TAR). Clinical relevance: This study improves the overall understanding of the talar anatomy, as well as its relationship to adjacent osseous structures. The novel 2D measurement method of the talus neck torsion might improve talar component positioning in the axial plane corresponding to the patient's individual anatomy, and therefore improve the survival rate of TAR. K E Y W O R D S extramedullary referencing, talar neck torsion, total ankle replacement 1 | INTRODUCTION Osteoarthritis of the ankle is an increasing issue with about 1% of the adult population affected. 1 For end-stage osteoarthritis, total ankle replacement (TAR) represents an evolving method of treatment. The failure rates of TAR, however, are more than twice as high as the rates after total hip and knee replacements. 2 Reasons might be an insufficient consideration of the anatomy as well as the limited predictability due to the use of conventional radiographs for planning of the prosthesis. 3 In coronal and sagittal planes, component positioning is ensured with preoperative weight-bearing radiographs and intraoperative extramedullary

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Role of Rotation in Total Ankle Replacement

Cited by 36 publications

References 28 publications

Syndesmotic Overload in 3-Component Total Ankle Replacement

Syndesmotic Overload in 3-Component Total Ankle Replacement

Axial Rotational Alignment in Mobile-Bearing Total Ankle Arthroplasty

Talar neck angle correlates with tibial torsion—Guidance for 3D and 2D measurements in total ankle replacement

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