Total ankle arthroplasty with combined calcaneal and metatarsal osteotomies for treatment of ankle osteoarthritis with accompanying cavovarus deformities: early results.
ABSTRACT Background: Our study evaluated the short-term clinical and radiographic results of total ankle arthroplasty (TAA) with combined bony reconstructions for treatment of end-stage ankle osteoarthritis with accompanying cavovarus/hindfoot varus deformities. Methods: This study included 8 patients (10 ankles) with ankle osteoarthritis (OA) who were treated by TAA with combined calcaneal and metatarsal osteotomies between September 2004 and June 2010 and were followed an average of 17.9 months (12-43 months). Visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, radiographic measurements, and patient satisfaction were evaluated. Results: The average patient age was 66.2 years (range, 55-76 years). Eighteen bony reconstruction procedures such as lateral sliding calcaneal osteotomy (n = 9) and first metatarsal dorsiflexion osteotomy (n = 4) were performed in addition to TAA. VAS pain score improved from an average of 8.8 (range, 6-10) preoperatively to an average of 2.4 (range, 0-7) (P < .05), and the AOFAS score improved from 36.9 (range, 14-71) preoperatively to 89.3 (range, 68-100) (P < .05). Ninety percent of the patients were satisfied with the results. Radiographically, the tibiocalcaneal angle (TCA) improved from a preoperative average of 19.0 degrees (range, 13-23 degrees) to 0.2 degrees (range, -5.4 to 2.8 degrees), the tibial axis-talar dome angle (TA-TDA) improved from a preoperative average of 15.6 degrees (range, 11.1-18.0 degrees) to 3.3 degrees (range, 1.7-5.6 degrees), and the talar dome-ground surface angle (TD-GSA) improved from a preoperative average of 21.2 degrees (range, 15.4-27.5 degrees) to 5.1 degrees (range, 1.8-10.2 degrees) (P < .05). Conclusion: We found that it was occasionally necessary to perform combined calcaneal and metatarsal osteotomies with TAA in order to successfully treat ankle OA with an accompanying cavovarus/varus deformity. The TD-GSA and TCA were also found to be important radiographic parameters in assessing varus ankles. Level of Evidence: IV, retrospective case series.
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ABSTRACT: Total ankle arthroplasty provides an alternative to arthrodesis for management of ankle arthritis. What is the outcome of total ankle arthroplasty implants currently in use? We conducted a systematic literature search of studies reporting on the outcome of total ankle arthroplasty. We included peer-reviewed studies reporting on at least 20 total ankle arthroplasties with currently used implants, with a minimum followup of 2 years. The Coleman Methodology Score was used to evaluate the quality of the studies. Thirteen Level IV studies of overall good quality reporting on 1105 total ankle arthroplasties (234 Agility, 344 STAR, 153 Buechel-Pappas, 152 HINTEGRA, 98 Salto, 70 TNK, 54 Mobility) were included. Residual pain was common (range, 27%-60%), superficial wound complications occurred in 0% to 14.7%, deep infections occurred in 0% to 4.6% of ankles, and ankle function improved after total ankle arthroplasty. The overall failure rate was approximately 10% at 5 years with a wide range (range, 0%-32%) between different centers. Superiority of an implant design over another cannot be supported by the available data. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.Clinical Orthopaedics and Related Research 08/2009; 468(1):199-208. · 2.79 Impact Factor
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ABSTRACT: Ankle arthroplasty is emerging as an alternative to arthrodesis. Restoring and maintaining proper bony alignment and muscle balance in the limb is essential if there is to be any chance for long-term survival. Deformity can arise above the ankle, in the joint itself, or in the foot. Secondary procedures in the foot and leg, including osteotomies, fusions and muscle balancing, are performed either before or simultaneously with ankle replacement.Foot and Ankle Clinics of North America 01/2003; 7(4):721-36, vi. · 0.84 Impact Factor
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ABSTRACT: The treatment of coronal plane deformity during total ankle arthroplasty is understood poorly. This study tests the hypotheses that preoperative coronal plane malalignment and incongruence of the ankle can be corrected and maintained for 2 years with total ankle replacement, and that factors can be identified that place ankles at risk of having progressive edge-loading develop. Of 86 consecutive patients who had total ankle replacement, 35 had preoperative coronal plane alignment > or =10 degrees. Lateral ligament reconstruction was done in seven patients and superficial deltoid release was done in four patients at the time of ankle replacement. Ankles with talar and tibial deformities improved talar and tibial alignment toward a neutral weightbearing axis postoperatively. Ankles with only a talar deformity improved the talar alignment toward a neutral weightbearing axis postoperatively. No changes in alignment were shown during the subsequent 2 years. Postoperative ankle articulations were congruent. Patients with preoperative incongruent joints are 10 times more likely to have progressive edge-loading develop than patients with congruent joints. Surgeons must be attentive to coronal plane alignment during and after ankle replacement. Longer followup is needed to assess the longevity of the correction and the impact of minor malalignment on implant wear.Clinical Orthopaedics and Related Research 08/2004; · 2.88 Impact Factor