Volume and Distribution of Periprosthetic Bone Cysts in the Distal Tibia and Talus before Early Revision of Total Ankle Arthroplasty

Abstract

Periprosthetic osteolysis is a common complication following total ankle arthroplasty (TAA). However, understanding of osteolysis volume and distribution is still evolving, undermining efforts to reduce the incidence of osteolysis via bone remodeling. We obtained data on the characteristics of osteolysis developing within the distal tibia and talus after TAA. Three-dimensional computed tomography (3D-CT) reconstructions of 12 patients who underwent HINTEGRA TAA were performed. We identified 27 volumes of interest (VOIs) in the tibia and talus and used statistical methods to identify the characteristics of osteolysis in the VOIs. The osteolysis volume was significantly larger in the talus than in the tibia (162.1 ± 13.6 and 54.9 ± 6.1 mm3, respectively, p = 0.00). The extent of osteolysis within the peri-prosthetic region was greater than within other regions (p < 0.05). Particularly, in the talus, the region around the talar pegs exhibited 24.2 ± 4.5% more osteolysis than any other talar region (p = 0.00). Our results may suggest that extensive osteolysis within the peri-prosthetic region reflects changes in stress flow and distribution, which vary according to the design and placement of the fixation components. This is the first study to report 3D osteolysis patterns after TAA. Careful planning of TAA design improvements may reduce the incidence of osteolysis. Our results will facilitate the further development of TAA systems.

Incidence of Patterns of Bony Modification of Neck of the Talus

“…These are caused by talar facets variations in terms of shape and orientation [27]. Another study reported prevalence of medial and lateral extension of 11% and 8% respectively [28]. Medial extension was seen in 61% cases as reported by Al-Jabri et al [29].…”

Use of Femoral Head Allograft for Extended Bone Loss in Revision Total Ankle Arthroplasty

“…However, besides additional bone loss, it may convert the bone-implant interface along its stem to vertical shear forces. Furthermore, delayed or missing osseointegration can result in subsidence and further bone loss [15][16][17] . Alternatively, the use of bone cement has been proposed and may be critical for younger patients 18 .…”

“…In cases of large ballooning cyst formation and progressive bone loss including the malleoli, it is worth considering whether the reconstruction of the bony structures enables sufficient osseointegration of the revised standard components or whether other salvage options, such as arthrodesis or use of intramedullary fixation, are required. However, the latter may carry an increased risk of further bone loss and debilitating loss of function 10,[13][14][15][16][17][18] .…”