Stresses in the ankle joint and total ankle replacement design

Kakkar, Rahul; Siddique, Malik

doi:10.1016/j.fas.2011.02.002

Cited by 51 publications

(36 citation statements)

References 38 publications

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“…This was supported by the fact that even in the older age group, no significant differences between males and females were observed appreciating that osteoporosis primarily affects postmenopausal women [32]. Third, there were no cases with osteoarthritis (OA) in the study group although the most common indications for implantation of total ankle arthroplasty are posttraumatic arthritis and primary OA [30]. The impact of OA on subchondral bone is well established, especially in the femoral head and the proximal tibia.…”

Section: Discussionsupporting

confidence: 50%

“…Nonetheless, to create a large bone-implant interface, parts of the subchondral bone plate are resected and bone regions deeper to the subchondral bone plate are responsible for implant stabilization. Hence, next to the accepted influence of implant design and surgical technique on implant survival, mechanically sufficient bone stock is needed for long-term total ankle arthroplasty survival [30]. Accordingly, the age-related changes of bone deeper to the subchondral lamella might influence the long-term stability of the total ankle arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

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Bone Microarchitecture of the Talus Changes With Aging

Krause

Rupprecht

Mumme

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Fractures of the talus in the elderly are rare and usually result from high-impact injuries, suggesting only minor age-related bone structure changes. However, total ankle replacement failures with age often result from talar subsidence, suggesting age-related bone loss in the talus. Despite a number of histological analyses of talar microarchitecture, the effects of age and sex on talar microarchitecture changes remain poorly defined.Questions/purposes The aim of this study was to analyze changes or differences in the trabecular microarchitecture of the talus with regard to (1) age and (2) sex. Methods Sixty human tali were harvested from 30 patients at autopsy of three different age groups (20-40, 41-60, 61-80 years). The specimens were analyzed by radiography, micro-CT, and histological analysis. Given that there was no difference between the left and right talus, static histomorphometric parameters were assessed in three regions of interest of the right talus only (body, neck, head; n = 30). Results The talar body, neck, and head were affected differently by age-related changes. The greatest loss of bone volume with age was seen in the talar body (estimate: À0.239; 95% confidence interval [CI], À0.365 to À0.114; p \ 0.001). In the talar neck (estimate: À0.165; 95% CI, À0.307 to À0.023; p = 0.025), bone loss was only moderate and primarily was the result of reduction in trabecular thickness (estimate: À1.288; 95% CI, À2.449 to À0.127; p = 0.031) instead of number (estimate: À0.001; 95% CI, À0.005 to À0.003; p = 0.593). Bone structure changes were independent of sex. Conclusions Age-related bone structure changes predominantly occur in the talar body, which poses a potential risk factor for total ankle replacement loosening. The moderate changes in the talar neck might explain the persistent low incidence of talar neck fractures with age.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Bone Microarchitecture of the Talus Changes With Aging

Krause

Rupprecht

Mumme

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…TAR may prevent the transfer of such stresses [57]. Although TAR has been attributed with high rates of loosening, less constrained designs with multiaxial motion may offer improved results [58]. The most recent systematic review by Jordan et al does not show convincing differences in outcomes for ankle arthrodesis and TAR [59].…”

Section: Typementioning

confidence: 99%

Hindfoot fusion in haemophilic arthropathy: 6‐year mean follow‐up of 41 procedures performed in 28 adult patients

et al. 2016

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“…8 Kakkar et al reported that improper alignment of the prosthesis may result in excessive eccentric loads, potentially contributing to bone overload, leading them to conclude that proper implant positioning was likely important for long-term implant durability. 14 In addition, the reduced area of the ankle joint combined with ankle loads of up to 500% body weight during walking increase the need for accurate tibiotalar alignment to reduce implant wear and possible associated osteolysis. 27 Previous studies identified the high impact on implant contact pressures associated with translation or congruency discrepancies of the implants.…”

mentioning

confidence: 99%

Total Ankle Arthroplasty Accuracy and Reproducibility Using Preoperative CT Scan-Derived, Patient-Specific Guides

et al. 2014

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We have further demonstrated that final implant position is successfully guided by these patient-specific guides, with reproducibility of tibial component placement falling within 2 degrees of the intended target. This level of reproducibility suggests a promise for this technology, and it is hoped this level of accuracy will become the benchmark for the next generation of total ankle arthroplasty.

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Stresses in the ankle joint and total ankle replacement design

Cited by 51 publications

References 38 publications

Bone Microarchitecture of the Talus Changes With Aging

Bone Microarchitecture of the Talus Changes With Aging

Hindfoot fusion in haemophilic arthropathy: 6‐year mean follow‐up of 41 procedures performed in 28 adult patients

Total Ankle Arthroplasty Accuracy and Reproducibility Using Preoperative CT Scan-Derived, Patient-Specific Guides

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