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The Infinity Total Ankle System: Early Clinical Results with 2- to 4-year Follow-up

DOI:10.1177/2473011418S00382
Authors:
Murray J Penner at University of British Columbia - Vancouver
Murray J Penner
W. Hodges Davis
W. Hodges Davis
W. Hodges Davis
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Thomas Bemenderfer at Carolinas HealthCare System
Thomas Bemenderfer
Feras Waly at University of British Columbia - Vancouver
Feras Waly
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Abstract

Category Ankle Arthritis Introduction/Purpose Background: Increasing interest in 2-component total ankle arthroplasty (TAA) designs and the increased use of TAA overall has led to the development of a new generation of 2-component TAA implants. The first of these to become available was the Infinity Total Ankle System (Wright Medical Technology, Memphis, TN), introduced in 2014. Despite it currently being the most commonly used TAA implant in the UK and among the most commonly used in the USA, published clinical results are lacking. Purpose This study presents the first report of the clinical and radiographic outcomes of the Infinity Total Ankle System with minimum 2 year follow-up Methods The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American sites between 2013 and 2015 were reviewed in a prospective observational study. Demographic, radiographic, and functional outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter. Results The overall implant survival rate was 97% (65 of 67 implants) at mean follow up of 3 years (range 27-47 months). Two cases underwent talar component revision for aseptic loosening. Six of the 67 cases (9%) required a non-revision reoperation. Mean FFI and AOS scores at latest follow up improved from preoperative by 21.6 (p<0.0001) and 34.0 (p<0.0001), respectively. No radiographic loosening of any talar or tibial components was identified in the 65 non-revised cases. Conclusion Early clinical and radiographic outcomes with the Infinity TAA are promising and compare favorably to those reported for both fixed- and mobile-bearing third generation TAA designs, even when used in cases with deformity and increased case complexity.
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AOFAS Annual Meeting 2018 1
The Infinity Total Ankle System: Early Clinical Results with 2- to 4-year Follow-up
Murray Penner, MD, FRCSC, W. Hodges Davis, MD, Thomas Bemenderfer, MD, MBA, Feras Waly, MD, Robert
Anderson, MD
Category: Ankle Arthritis
Keywords: Ankle Replacement, Outcomes, Ankle Arthritis
Introduction/Purpose: Background:
Increasing interest in 2-component total ankle arthroplasty (TAA) designs and the increased use of TAA overall has led to the
development of a new generation of 2-component TAA implants. The first of these to become available was the Infinity Total
Ankle System (Wright Medical Technology, Memphis, TN), introduced in 2014. Despite it currently being the most commonly
used TAA implant in the UK and among the most commonly used in the USA, published clinical results are lacking.
Purpose:
This study presents the first report of the clinical and radiographic outcomes of the Infinity Total Ankle System with minimum 2
year follow-up
Methods: The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American
sites between 2013 and 2015 were reviewed in a prospective observational study. Demographic, radiographic, and functional
outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter.
Results: The overall implant survival rate was 97% (65 of 67 implants) at mean follow up of 3 years (range 27-47 months). Two
cases underwent talar component revision for aseptic loosening. Six of the 67 cases (9%) required a non-revision reoperation.
Mean FFI and AOS scores at latest follow up improved from preoperative by 21.6 (p<0.0001) and 34.0 (p<0.0001), respectively.
No radiographic loosening of any talar or tibial components was identified in the 65 non-revised cases.
Conclusion: Early clinical and radiographic outcomes with the Infinity TAA are promising and compare favorably to those
reported for both fixed- and mobile-bearing third generation TAA designs, even when used in cases with deformity and increased
case complexity.
Foot & Ankle Orthopaedics, 3(3)
DOI: 10.1177/2473011418S00382
©The Author(s) 2018
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Risk Stratification for Revision Surgery Following Total Ankle Replacement
Article
As a result of improved implants Total Ankle Replacement (TAR) is becoming a more reliable option for end stage ankle arthritis. As with any surgery there are numerous complications that can occur intraoperatively and postoperatively with TAR. The primary aim of this study is to use recent data on implants currently on the market to develop a well-defined and comprehensive complication classification system which stratifies risk of subsequent surgery for TAR. A systematic review of studies on TARs from 2013-2018 was performed. Inclusion criteria were studies published between 2013 and August 2018, studies having at least 20 patients, data with at least one-year follow-up and use of implants currently on the market. Studies were excluded if they involved revision cases, case reports, basic science articles and studies published in non-peer-reviewed journals. Sixteen studies fit inclusion criteria involving 3,305 implants. Overall survival of all implants was found to be 93% with a pooled complication rate of 75.6% using criteria for classifying complications by Glazebrook et al. Previously published classification systems did not clearly define complication categories leading to inconsistency in complication reporting and inaccurate complication rates. There are also several complications that are unclassifiable with the classifications developed by Gadd et al and Glazebrook et al. Our proposed updated classification system provides more inclusive tier profiles to capture the complications that can occur with implants currently on the market. Furthermore, this system provides a stratification of risk that these complications pose to ultimate procedure success.
Total Ankle Arthroplasty With Anatomic Lateral Ankle Stabilization (ATLAS) in Moderate and Severe Pre-operative Varus Alignment
Article
The purpose of the present study was to assess the early clinical and radiographic outcomes for patients who underwent TAA and Anatomic Lateral Ankle Stabilization (ATLAS) using synthetic graft for instability in moderate and severe preoperative varus alignment. Seven ankles with moderate or severe varus alignment underwent TAA with a 3rd generation prothesis (INBONE-2) and ATLAS using synthetic graft between September 2018 and February 2019 at a single institution, and were at least 1 year postoperative (mean 13.3 months, range 12-15). Medical records and charts were reviewed for revisions, reoperations, and complications. Weightbearing radiographs were assessed using tibiotalar alignment parameters preoperatively, and during the latest follow-up. Survivorship for INBONE-2 with ATLAS was 100%; recurrent instability was not observed. Symptomatic talonavicular joint arthritis was recorded for a single patient 12 months postoperatively; no revisions, or reoperations were performed. Coronal alignment improved significantly from 17.7 ± 9.3 (range, 10.1-33.6) to 2.3 ± 1.2 (range, 0.9-4.4) degrees (p<0.006), and all ankles achieved neutral alignment in a single stage. Regarding sagittal alignment, 2 ankles (28.5%) were translated anteriorly and the rest were neutral (71.5%) preoperatively. Significant posterior translation was observed and during the latest follow-up, 4 ankles were neutral (57.1%) and 3 posterior (42.9%) (p<0.009). Satisfactory outcomes were observed at a minimum of 1-year follow-up for patients with moderate or severe varus alignment who underwent TAA with INBONE-2 and ATLAS. ATLAS may afford advantages over previously described repair techniques. Comparative studies between the Brostrum-Gould and ATLAS are warranted.
Total Ankle Arthroplasty Survivorship: A Meta-analysis
Article
The gold standard for management of end-stage ankle arthritis was previously ankle arthrodesis; however, improvements in total ankle replacements are making this a more viable treatment option. The primary aim of this meta-analysis was to evaluate the survivorship of total ankle replacement implants currently in use. An extensive search strategy initially captured 20,842 citations that were evaluated for relevance. Abstract screening produced 97 articles to be read in entirety, of which 10 articles studying 1963 implants met all prospective inclusion criteria for analysis. Overall survivorship of all implants was 93.0% (95% confidence interval, 85.2-96.9) using a random effect model. There was significant heterogeneity between the studies (Q = 131.504). Meta-regression identified an inverse relationship between survivorship and study follow-up duration (p < .0001). Furthermore, age (p = .36) and implant type (fixed-bearing [95.6%, 95% confidence interval, 85.9-98.7] versus mobile-bearing ]89.4%, 95% confidence interval, 79.6%-94.8%]) did not have a statistically significant impact on survivorship, p = .213. However, patients with higher preoperative functional scores had improved survivorship (p = .001). Complications were inconsistently reported with varied definitions. In order of reported frequency, complications were classified into technical error (28.15%), subsidence (16.89%), implant failure (13.28%), aseptic loosening (6.3%), intraoperative fracture (5.67%), wound problems (4.3%), deep infection (1%), and postoperative fracture (0.0001%). Overall study quality was low, with only 10% being prospective and 90% from nonregistry data. The results from this meta-analysis revealed a promising overall survivorship of current implants in use for total ankle replacement; however higher quality studies with standardized outcomes measures are needed.
Total Ankle Replacement Options
Article
  • Oct 2019
Total ankle arthroplasty has been in development for more than 40 years. Although early designs were experimental with high failure rates, current implants are significantly improved, showing promising functional results and clinical outcomes. Total ankle replacement designs are split into mobile-bearing and fixed-bearing designs. When deciding whether to perform ankle arthroplasty, many factors need to be considered to determine if the patient is suitable and which implant is the best fit for patient and surgeon. Many prostheses are available in the United States today and the purpose of this article is to outline options for foot and ankle surgeons.
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