Arthroscopic ankle arthrodesis for end-stage haemophilic arthropathy of the ankle

Haemophilia ◽  
2013 ◽  
Vol 20 (1) ◽  
pp. e97-e99 ◽  
Author(s):  
J. F. Baker ◽  
F. Maleki ◽  
J. M. Broderick ◽  
J. McKenna
Keyword(s):  
Ankle Arthrodesis ◽  
Haemophilic Arthropathy ◽  
End Stage

Total Ankle Arthroplasty Survivorship, Complication, and Revision Rates in Patients Younger Than 55 Years

2021 ◽  
pp. 193864002098092
Author(s):  
Devon W. Consul ◽  
Anson Chu ◽  
Travis M. Langan ◽  
Christopher F. Hyer ◽  
Gregory Berlet
Keyword(s):  
Case Series ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Implant Survival ◽  
Ankle Arthritis ◽  
Single Institution ◽  
Retrospective Case ◽  
Ankle Replacement ◽  
End Stage

Total ankle replacement has become a viable alternative to ankle arthrodesis in the surgical management of advanced ankle arthritis. Total ankle replacement has generally been reserved for patients who are older and for those who will have a lower demand on the replacement. The purpose of the current study is to review patient outcomes, complications, and implant survival in patients younger than 55 years who underwent total ankle replacement at a single institution. A single-center chart and radiographic review was performed of consecutive patients who underwent total ankle replacement for treatment of end-stage ankle arthritis. All surgeries were performed by 1 of 5 fellowship-trained foot and ankle surgeons at a single institution. A total of 51 patients met inclusion criteria with a mean follow-up of 31.2 months (SD = 16.2). Implant survival was 94%, There were 7 major complications (13%) requiring an unplanned return to the operating room and 8 minor complications (15%) that resolved with conservative care. The results of this study show that total ankle replacement is a viable treatment option for patients younger than 55 years. Levels of Evidence: A retrospective case series

scholarly journals Is End-Stage Ankle Arthrosis Best Managed with Total Ankle Replacement or Arthrodesis? A Systematic Review

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Robert W. Jordan ◽  
Gurdip S. Chahal ◽  
Anna Chapman
Keyword(s):  
Systematic Review ◽  
Functional Outcome ◽  
Controlled Trial ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Online Databases ◽  
Ankle Replacement ◽  
Comparative Group ◽  
Randomised Controlled ◽  
End Stage

Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes.Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure.Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn.Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.

Validation of the Ankle Osteoarthritis Scale Instrument for Preoperative Evaluation of End-Stage Ankle Arthritis Patients Using Item Response Theory

2019 ◽  
Vol 40 (4) ◽  
pp. 422-429 ◽  
Author(s):  
Guiping Liu ◽  
Alexander C. Peterson ◽  
Kevin Wing ◽  
Trafford Crump ◽  
Alastair Younger ◽  
...  
Keyword(s):  
Item Response Theory ◽  
Item Response ◽  
Ankle Arthrodesis ◽  
Ankle Arthritis ◽  
Response Theory ◽  
Ankle Osteoarthritis ◽  
Differential Item Function ◽  
Ankle Replacement ◽  
End Stage ◽  
Pain Domain

Background: Significant ankle arthritis results in functional limitations and patient morbidity. There is a need to measure symptoms and the impact of interventions on patient’s quality of life using valid and reliable patient-reported measurement instruments. The objective of this research was to validate the Ankle Osteoarthritis Scale instrument in the preoperative setting using factor analysis, item response theory, and differential item function methods. Methods: This research is based on secondary analysis of patients scheduled for ankle arthrodesis or total ankle replacement in Vancouver, Canada. Participants completed the instrument between September 2014 and August 2017. Item response theory was used to estimate item difficulty and discrimination parameters, controlling for study participants’ underlying level of ankle function. Differential item function was examined for sex, age group, and surgery. There were 88 participants. Results: Modification indices suggested that item 10, “walking around the house,” would better fit the pain domain rather than the disability domain. Items in the pain domain displayed a range of discrimination and difficulty. Items in the disability domain exhibited a range of discrimination, though the disability domain had low difficulty. Differential item functioning for sex, age group, and ankle arthrodesis or total ankle replacement appeared to be ignorable. Conclusion: This evaluation of the Ankle Osteoarthritis Scale found the instrument to be a strong measure of the effect of pain and dysfunction among patients with end-stage ankle arthritis, even when removing items 7 and 8, supporting its prior use in numerous clinical studies. Level of Evidence: Level II, prospective comparative study.

A Survey for End-Stage Ankle Arthritis Treatment: Ankle Arthrodesis Versus Ankle Arthroplasty

2020 ◽  
Vol 59 (2) ◽  
pp. 330-336 ◽  
Author(s):  
Kerry Tai ◽  
Christopher Vannabouathong ◽  
Sohail M. Mulla ◽  
Christina L. Goldstein ◽  
Christopher Smith ◽  
...  
Keyword(s):  
Ankle Arthrodesis ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
End Stage

Nationwide Analysis of Total Ankle Replacement and Ankle Arthrodesis in Medicare Patients: Trends, Complications, and Cost

2020 ◽  
pp. 193864002095018
Author(s):  
William A. Tucker ◽  
Brandon L. Barnds ◽  
Brandon L. Morris ◽  
Armin Tarakemeh ◽  
Scott Mullen ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Complication Rates ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Procedure Cost ◽  
Medicare Patients ◽  
Retrospective Comparative Study ◽  
End Stage

Background Surgical management of end-stage ankle arthritis consists of either ankle arthrodesis (AA) or total ankle replacement (TAR). The purpose of this study was to evaluate utilization trends in TAR and AA and compare cost and complications. Methods Medicare patients with the diagnosis of ankle arthritis were reviewed. Patients undergoing surgical intervention were split into AA and TAR groups, which were evaluated for trends as well as postoperative complications, revision rates, and procedure cost. Results A total of 673 789 patients were identified with ankle arthritis. A total of 19 120 patients underwent AA and 9059 underwent TAR. While rates of AA remained relatively constant, even decreasing, with 2080 performed in 2005 and 1823 performed in 2014, TAR rates nearly quadrupled. Average cost associated with TAR was $12559.12 compared with $6962.99 for AA ( P < .001). Overall complication rates were 24.9% in the AA group with a 16.5% revision rate compared with 15.1% and 11.0%, respectively, in the TAR group ( P < .001). Patients younger than 65 years had both higher complication and revision rates. Discussion TAR has become an increasingly popular option for the management of end-stage ankle arthritis. In our study, TAR demonstrated both lower revision and complication rates than AA. However, TAR represents a more expensive treatment option. Levels of Evidence: Level III: Retrospective comparative study

Outcomes of Total Ankle Replacement, Arthroscopic Ankle Arthrodesis, and Open Ankle Arthrodesis for Isolated Non-Deformed End-Stage Ankle Arthritis

2019 ◽  
Vol 101 (17) ◽  
pp. 1523-1529 ◽  
Author(s):  
Andrea N. Veljkovic ◽  
Timothy R. Daniels ◽  
Mark A. Glazebrook ◽  
Peter J. Dryden ◽  
Murray J. Penner ◽  
...  
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Replacement ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
End Stage

scholarly journals Total ankle arthroplasty and ankle arthrodesis affect the biomechanics of the inner foot differently

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yan Wang ◽  
Duo Wai-chi Wong ◽  
Qitao Tan ◽  
Zengyong Li ◽  
Ming Zhang
Keyword(s):  
Contact Pressure ◽  
Stance Phase ◽  
Peak Stress ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Plantar Pressure Distribution ◽  
Metatarsal Bones ◽  
Biomechanical Parameters ◽  
End Stage

Abstract Ankle arthrodesis and total ankle arthroplasty are the two primary surgeries for treatment of end-stage degenerative ankle arthritis. The biomechanical effects of them on the inner foot are insufficient to identify which is superior. This study compared biomechanical parameters among a foot treated by ankle arthrodesis, a foot treated by total ankle arthroplasty, and an intact foot using computational analysis. Validated finite element models of the three feet were developed and used to simulate the stance phase of gait. The results showed total ankle arthroplasty provides a more stable plantar pressure distribution than ankle arthrodesis. The highest contact pressure, 3.17 MPa, occurred in the medial cuneonavicular joint in the total ankle arthroplasty foot. Neither of the surgeries resulted in contact pressure increase in the subtalar joint. The peak stress in the metatarsal bones was increased in both surgical models, especially the second and third metatarsals. This study enables us to get visual to the biomechanics inside of an intact foot, and feet treated by total ankle arthroplasty and ankle arthrodesis during walking.

scholarly journals The role of orthopaedic surgery in haemophilia: current rationale, indications and results

2019 ◽  
Vol 4 (5) ◽  
pp. 165-173 ◽  
Author(s):  
E. Carlos Rodríguez-Merchán
Keyword(s):  
Coagulation Factor ◽  
Primary Prophylaxis ◽  
Venous Access ◽  
Arthroscopic Synovectomy ◽  
Haemophilic Arthropathy ◽  
Musculoskeletal Problems ◽  
Minor Injuries ◽  
End Stage ◽  
Immature Skeleton

The musculoskeletal problems of haemophilic patients begin in infancy when minor injuries lead to haemarthroses and haematomas. Early continuous haematological primary prophylaxis by means of the intravenous infusion of the deficient coagulation factor (ideally from cradle to grave) is of paramount importance because the immature skeleton is very sensitive to the complications of haemophilia: severe structural deficiencies may develop quickly. If primary haematological prophylaxis is not feasible due to expense or lack of venous access, joint bleeding will occur. Then, the orthopaedic surgeon must aggressively treat haemarthrosis (joint aspiration under factor coverage) to prevent progression to synovitis (that will require early radiosynovectomy or arthroscopic synovectomy), recurrent joint bleeds, and ultimately end-stage osteoarthritis (haemophilic arthropathy). Between the second and fourth decades, many haemophilic patients develop articular destruction. At this stage the main possible treatments include arthroscopic joint debridement (knee, ankle), articular fusion (ankle) and total joint arthroplasty (knee, hip, ankle, elbow).Cite this article: EFORT Open Rev 2019;4:165-173. DOI: 10.1302/2058-5241.4.180090

scholarly journals Effect of Type 1 and Type 2 Diabetes Mellitus on Complication and Reoperation Rates of Ankle Arthrodesis and Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0049
Author(s):  
William Tucker ◽  
Brandon Morris ◽  
Armin Tarakemeh ◽  
Scott Mullen ◽  
Paul Schroeppel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Independent Risk Factor ◽  
Surgical Intervention ◽  
Ankle Arthrodesis ◽  
Diabetic Patients ◽  
Ankle Arthritis ◽  
End Stage ◽  
Reoperation Rates

Category: Diabetes Introduction/Purpose: Diabetes mellitus (DM) poses a risk for increased rate of complications in many orthopaedic procedures, especially in patients undergoing elective arthroplasty procedures. Treatment of end-stage ankle arthritis includes both arthroplasty and arthrodesis. Current literature provides minimal guidance regarding outcomes of total ankle replacement (TAR) or ankle arthrodesis (AA) in diabetic patients. The authors of this study utilized a large database to compare rates of postoperative complications and reoperations of diabetic patients undergoing surgical management of ankle arthritis to rates seen in non-diabetic patients. Methods: Using the PearlDiver Technologies, Inc. database, Medicare patients diagnosed with ankle arthritis using ICD-9 codes were identified from 2005 to 2014. Patients were then sorted as diabetic or non-diabetic. Diabetic patients were then further stratified into Type 1 diabetes (T1DM) and Type 2 diabetes (T2DM). Type 2 diabetics requiring insulin (T2ID) and not requiring insulin (T2NID) were also isolated. Patients were identified who underwent either AA or TAR utilizing ICD-9 procedure and CPT codes. These groups were evaluated for postoperative complications and reoperation rates. Chi-Squared testing was used to determine significance. Multivariate analysis was performed to determine whether diabetes represents an independent risk factor. Results: 1477 diabetic patients underwent TAR and 5399 underwent AA versus 3900 TAR and 7838 AA in nondiabetics. Diabetics undergoing AA experienced complications at 32.2%, reoperations at 30.8%, and revisions at 18.7% versus 13.3%, 22.3%, and 19.2% respectively in patients without diabetes(P<0.05). In diabetics undergoing TAR, the complication rate was 21.6% and reoperation rates were 16.9% versus 12.5% and 13% respectively in their non-diabetic counterparts(P<0.05). Revision rates were similar. Patients with T1DM had more reoperations and complications in both TAR and AA compared to those with T2DM (P<0.05). In both surgical groups, Patients with T2ID had more complications and reoperations than those with T2NID(P<0.05). Multivariate analysis revealed diabetes as an independent risk factor for complication and reoperation in AA but only complication in TAR(P <0.05). Conclusion: Patients with a diagnosis of diabetes mellitus experienced higher complication and total reoperation rates when undergoing either TAR or AA. T1DM appears to impart a greater risk of surgical complication and repeat surgical intervention than does T2DM. However when insulin is required in T2DM, complication and reoperation rates are similar to those of T1DM. Patient selection for surgical management of end-stage ankle arthritis should incorporate diabetic type and insulin dependency when considering surgical intervention.

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