Clinical Radiographical Outcomes and Complications after a Brand-New Total Ankle Replacement Design through an Anterior Approach: A Retrospective at a Short-Term Follow Up

Massimiliano Mosca, Silvio Caravelli, Emanuele Vocale, Simone Massimi, Davide Censoni, Marco Di Ponte, Mario Fuiano, Stefano Zaffagnini, Massimiliano Mosca, Silvio Caravelli, Emanuele Vocale, Simone Massimi, Davide Censoni, Marco Di Ponte, Mario Fuiano, Stefano Zaffagnini

Abstract

Recently, the progress in techniques and in projecting new prosthetic designs has allowed increasing indications for total ankle replacement (TAR) as treatment for ankle osteoarthritis. This retrospective work comprehended 39 subjects aged between 47 and 79 years old. The patients, observed for at least 12 months (mean follow up of 18.2 ± 4.1 months), have been evaluated according to clinical and radiological parameters, both pre- and post-operatively. The AOFAS and VAS score significantly improved, respectively, from 46.2 ± 4.8 to 93.9 ± 4.1 and from 7.1 ± 1.1 to 0.7 ± 0.5 (p value < 0.05). At the final evaluation, the mean plantarflexion passed from 12.2° ± 2.3° to 18.1° ± 2.4° (p value < 0.05) and dorsiflexion from a pre-operative mean value of 8.7° ± 4.1° to 21.7° ± 5.4° post-operatively (p value < 0.05). This study found that this new total ankle replacement design is a safe and effective procedure for patients effected by end-stage ankle osteoarthritis. Improvements have been demonstrated in terms of range of motion, radiographic parameters and patient-reported outcomes. However, further studies are needed to assess the long-term performance of these prostheses.

Keywords: anterior approach; end-stage osteoarthritis; new design prosthesis; total ankle replacement.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Pre-operative radiographic image in anteroposterior and lateral view (on the left and on the right, respectively) of an arthritic ankle joint, with a slight articular varus deformity (a) and post-operative radiographic results (b).
Figure 1
Figure 1
Pre-operative radiographic image in anteroposterior and lateral view (on the left and on the right, respectively) of an arthritic ankle joint, with a slight articular varus deformity (a) and post-operative radiographic results (b).
Figure 2
Figure 2
Prosthetic components. It is to be noted, the new design silhouette and the fixation system of the talar and tibial components.
Figure 3
Figure 3
Pre-operative clinical picture, with an evident range of motion limitation (a) and post-operative clinical results in terms of movement restoration (b).

References

    1. Valderrabano V., Horisberger M., Russell I., Dougall H., Hintermann B. Etiology of ankle osteoarthritis. Clin. Orthop. Relat. Res. 2009;7:1800–1806. doi: 10.1007/s11999-008-0543-6.
    1. Khlopas H., Khlopas A., Samuel L.T., Ohliger E., Sultan A.A., Chughtai M., Mont M.A. Current Concepts in Osteoarthritis of the Ankle: Review. Surg. Technol. Int. 2019;35:280–294.
    1. Gougoulias N., Maffulli N. History of Total Ankle Replacement. Clin. Podiatr. Med. Surg. 2013;30:1–20. doi: 10.1016/j.cpm.2012.08.005.
    1. Buechel F.F., Pappas M.J., Iorio L.J. New Jersey low contact stress total ankle replacement: Biomechanical rationale and review of 23 cementless cases. Foot Ankle. 1988;8:279–290. doi: 10.1177/107110078800800603.
    1. Kitaoka H.B., Alexander I.J., Adelaar R.S., Nunley J.A., Myerson M.S., Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15:349–353. doi: 10.1177/107110079401500701.
    1. Glazebrook M.A., Arsenault K., Dunbar M. Evidence-Based Classification of Complications in Total Ankle Arthroplasty. Foot Ankle Int. 2009;30:945–949. doi: 10.3113/FAI.2009.0945.
    1. Thomas R., Daniels T.R., Parker K. Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis. J. Bone Jt. Surg. Am. 2006;88:526–535.
    1. Pedowitz D.I., Kane J.M., Smith G.M., Saffel H.L., Comer C., Raikin S.M. Total ankle arthroplasty versus ankle arthrodesis: A comparative analysis of arc of movement and functional outcomes. Bone Jt. J. 2016;98:634–640. doi: 10.1302/0301-620X.98B5.36887.
    1. Singer S., Klejman S., Pinsker E., Houck J., Daniels T. Ankle arthroplasty and ankle arthrodesis: Gait analysis compared with normal controls. Bone Jt. Surg. Am. 2013;95:e191.
    1. Wiewiorski M., Hoechel S., Anderson A.E., Nowakowski A.M., DeOrio J.K., Easley M.E., Nunley J.A., Valderrabano V., Barg A. Computed Tomographic Evaluation of Joint Geometry in Patients with End-Stage Ankle Osteoarthritis. Foot Ankle Int. 2016;7:644–651. doi: 10.1177/1071100716629777.
    1. Nunley J.A., Adams S.B., Easley M.E., DeOrio J.K. Prospective Randomized Trial Comparing Mobile-Bearing and Fixed-Bearing Total Ankle Replacement. Foot Ankle Int. 2019;40:1239–1248. doi: 10.1177/1071100719879680.
    1. Leigheb M., Janicka P., Andorno S., Marcuzzi A., Magnani C., Grassi F. Italian translation, cultural adaptation and validation of the “American Orthopaedic Foot and Ankle Society’s (AOFAS) ankle-hindfoot scale”. Acta Biomed. 2016;87:38–45.
    1. Mosca M., Caravelli S., Vocale E., Maitan N., Grassi A., Massimi S., Fuiano M., Zaffagnini S. Clinical-radiological outcomes and complications after total ankle replacement through a lateral transfibular approach: A retrospective evaluation at a mid-term follow-up. Int. Orthop. 2021;45:437–443. doi: 10.1007/s00264-020-04709-4.
    1. Usuelli F.G., Maccario C., Granata F., Indino C., Vakhshori V., Tan E.W. Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty. Foot Ankle Int. 2019;40:24–33. doi: 10.1177/1071100718798851.
    1. Alsayel F., Alttahir M., Mosca M., Barg A., Herrera-Pérez M., Valderrabano V. Mobile Anatomical Total Ankle Arthroplasty—Improvement of Talus Recentralization. J. Clin. Med. 2021;10:554. doi: 10.3390/jcm10030554.
    1. Deleu P.A., Besse J.L., Naaim A., Leemrijse T., Birch I., Devos Bevernage B., Chèze L. Change in gait biomechanics after total ankle replacement and ankle arthrodesis: A systematic review and meta-analysis. Clin. Biomech. 2020;73:213–225. doi: 10.1016/j.clinbiomech.2020.01.015.

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