Total ankle replacement through a lateral approach: surgical tips

Abstract

Purpose: Recently, the Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR) was developed to be used through a lateral transfibular approach. The purpose of this paper is to describe the surgical technique and early outcomes of the TAR via the lateral approach using the Zimmer TM TARs. Methods: Sixty-seven patients underwent primary TAR using the Zimmer TM TAR between May 2013 and May 2015. Patients were clinically evaluated preoperatively and postoperatively at six and twelve months and annually using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores, visual analogue scale (VAS) pain score, and the Short Form Health Survey (SF-12) questionnaire. The minimum follow-up was 12 months. Results: The mean AOFAS hindfoot score increased from 32.8 preoperatively to 85.0 at the latest follow-up (p-value < 0.001). The mean VAS pain score decreased from 8.0 to 2.0 at the latest follow-up (p-value < 0.001). The Physical and Mental Health Composite Scale scores (PCS and MCS) of the SF-12 passed from a mean value of 30.2 preoperatively to 43.1 (p-value < 0.001) and from a mean value of 44.6 to 53.5 at the latest follow-up (p-value < 0.001), respectively. Conclusions: We present our surgical tips and the early results of this prosthetic design which are encouraging. They could be useful as an adjunct to the manufacturer’s surgical technique guidance for surgeons who utilize these implants.

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

“…In conclusion, in consideration of the early results of this prosthesis reported in previous studies 16,17 , and of the functional and postoperative pain scores reported in this article, the treatment of ankle osteoarthritis with TAR via lateral transfibular approach can provide reliable pain relief and improvements in range of motion and functional outcomes.…”

“…Recently, a novel TAR implant was designed to be performed via the lateral transfibular approach that results in an ideal visualization of the center of rotation and curved resections that allow for sparing bone cuts 16 ; moreover, this approach permits the implantation of components perpendicular to the bone trabeculae, thus limiting the shear forces at the level of the bone-implant interface 16 . This prosthesis consists of a fixed-bearing implant; an alignment coordinate system guides the bone resections and facilitates addressing both coronal and sagittal deformities 17 . The early results of ankle arthroplasty using this TAR implant have been published 12,16,17,18 .…”

“…This prosthesis consists of a fixed-bearing implant; an alignment coordinate system guides the bone resections and facilitates addressing both coronal and sagittal deformities 17 . The early results of ankle arthroplasty using this TAR implant have been published 12,16,17,18 . The aim of the present paper is to present our preoperative, operative, and postoperative protocols for the treatment of the osteoarthritis of the ankle with TAR via the lateral approach.…”

“…Moreover, the osteotomy technique presented in our protocol usually allows for a stable fixation with screws alone, thus dramatically decreasing the need for further hardware removal due to plate discomfort, even if it makes the fibular reflection more complicated. Another limitation is that, though some studies regarding the results of TAR with lateral transfibular approach have already been published, the encouraging results of this technique must be confirmed by long-term follow-up studies 12,16,17,18 .…”

The early functional results after total ankle replacement

“…Zbog lošijih rezultata, kao i posljedica do kojih dovodi ukočenje gležnja na okolne zglobove 17,18 , danas se kod sve većeg broja pacijenata odlučujemo na ugradnju TEP-a gležnja 10,11 . Razlog je tome i u proizvodnji novih, kvalitetnijih modela endoproteza, kao i u razvoju jednostavnijih kirurških tehnika ugradnje TEP-a gležnja 19 . Rezultati funkcije gležnja nakon ugradnje TEP-a mogu se ispitati različitim standardiziranim ispitnim metodama čija je svrha da se dobiveni rezultati mogu kvalitetno vrednovati i uspoređivati.…”