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Published in: International Orthopaedics 2/2021

01-02-2021 | Osteoarthrosis | Original Paper

Clinical-radiological outcomes and complications after total ankle replacement through a lateral transfibular approach: a retrospective evaluation at a mid-term follow-up

Authors: Massimiliano Mosca, Silvio Caravelli, Emanuele Vocale, Nicolò Maitan, Alberto Grassi, Simone Massimi, Mario Fuiano, Stefano Zaffagnini

Published in: International Orthopaedics | Issue 2/2021

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Abstract

Purpose

Degenerative ankle arthropathy is a debilitating and increasingly widespread condition with worsening of quality of life. In last years, total ankle replacement has increased indications, thanks to advances in surgical technique, materials and design that provided new solutions for surgeons. The purpose of this study is to evaluate the effectiveness of total ankle replacement (TAR), implanted using a trans-fibular lateral approach in patients with high-grade degenerative arthropathy, in terms of clinical, functional and radiological outcomes and possible complications.

Methods

This retrospective study included 73 patients, aged between 47 and 79 years (mean age 61.7 ± 14.2 years), who underwent trans-fibular total ankle arthroplasty. All patients were followed up for at least two years post-operatively with mean follow-up 31.2 ± 8.1 months and have been evaluated clinically and radiographically both pre-operatively and post-operatively.

Results

Patients demonstrated a significant improvement in average AOFAS score, SF-36 score and VAS scale. Average plantarflexion improved from 9.9° ± 4.2 to 18.4° ± 6.3 and dorsiflexion from pre-operative mean value of 6.8° ± 5.8 to 17.2° ± 3.1 post-operative. Complications recorded in our series were 16 (21.9%), specifically 2 major complications and 14 minor complications.

Conclusions

This study found that trans-fibular total ankle replacement is a safe and effective option for patients with ankle osteoarthritis, resulting in improvement of patient-reported outcomes, range of motion, and radiographic parameters. However, further studies are required to determine long-term performance of these implants.
Literature
1.
go back to reference Felson DT (1995) The epidemiology of osteoarthritis: prevalence and risk factors. In: Kuettner KE, Goldberg VM (eds) Osteoarthritis disorders. American Academy of Orthopaedic Surgeons, Rosemont, pp 13–24 Felson DT (1995) The epidemiology of osteoarthritis: prevalence and risk factors. In: Kuettner KE, Goldberg VM (eds) Osteoarthritis disorders. American Academy of Orthopaedic Surgeons, Rosemont, pp 13–24
2.
go back to reference Peyron JG (1984) The epidemiology of osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HJ (eds) Osteoarthritis. Diagnosis and treatment. WB Saunders, Philadelphia, pp 9–27 Peyron JG (1984) The epidemiology of osteoarthritis. In: Moskowitz RW, Howell DS, Goldberg VM, Mankin HJ (eds) Osteoarthritis. Diagnosis and treatment. WB Saunders, Philadelphia, pp 9–27
3.
go back to reference Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467(7):1800–1806CrossRef Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B (2009) Etiology of ankle osteoarthritis. Clin Orthop Relat Res 467(7):1800–1806CrossRef
4.
go back to reference Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353CrossRef Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15:349–353CrossRef
5.
go back to reference Coester LM, Saltzman CL, Leupold J, Pontarelli W (2001) Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am 83-A(2):219–228CrossRef Coester LM, Saltzman CL, Leupold J, Pontarelli W (2001) Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am 83-A(2):219–228CrossRef
6.
go back to reference Thomas R, Daniels TR, Parker K (2006) Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis. J Bone Joint Surg Am 88(3):526–535PubMed Thomas R, Daniels TR, Parker K (2006) Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis. J Bone Joint Surg Am 88(3):526–535PubMed
7.
go back to reference Easley ME, Vertullo CJ, Urban WC, Nunley JA (2002) Total ankle arthroplasty. J Am Acad Orthop Surg 10(3):157–167CrossRef Easley ME, Vertullo CJ, Urban WC, Nunley JA (2002) Total ankle arthroplasty. J Am Acad Orthop Surg 10(3):157–167CrossRef
8.
go back to reference Bonasia DE, Dettoni F, Femino JE, Phisitkul P, Germano M, Amendola A (2010) Total ankle replacement: why, when and how? Iowa Orthop J 30:119–130PubMedPubMedCentral Bonasia DE, Dettoni F, Femino JE, Phisitkul P, Germano M, Amendola A (2010) Total ankle replacement: why, when and how? Iowa Orthop J 30:119–130PubMedPubMedCentral
9.
go back to reference Pedowitz DI, Kane JM, Smith GM, Saffel HL, Comer C, Raikin SM (2016) Total ankle arthroplasty versus ankle arthrodesis: a comparative analysis of arc of movement and functional outcomes. Bone Jt J 98-B(5):634–640CrossRef Pedowitz DI, Kane JM, Smith GM, Saffel HL, Comer C, Raikin SM (2016) Total ankle arthroplasty versus ankle arthrodesis: a comparative analysis of arc of movement and functional outcomes. Bone Jt J 98-B(5):634–640CrossRef
10.
go back to reference Singer S, Klejman S, Pinsker E, Houck J, Daniels T (2013) Ankle arthroplasty and ankle arthrodesis: gait analysis compared with normal controls. J Bone Joint Surg Am 95(24):e191(1-10)CrossRef Singer S, Klejman S, Pinsker E, Houck J, Daniels T (2013) Ankle arthroplasty and ankle arthrodesis: gait analysis compared with normal controls. J Bone Joint Surg Am 95(24):e191(1-10)CrossRef
11.
go back to reference Tan EW, Maccario C, Talusan PG, Schon LC (2016) Early complications and secondary procedures in transfibular total ankle replacement. Foot Ankle Int 37(8):835–841CrossRef Tan EW, Maccario C, Talusan PG, Schon LC (2016) Early complications and secondary procedures in transfibular total ankle replacement. Foot Ankle Int 37(8):835–841CrossRef
12.
go back to reference Usuelli FG, Indino C, Maccario C, Manzi L, Salini V (2016) Total ankle replacement through a lateral approach: surgical tips. SICOT-J 2:38CrossRef Usuelli FG, Indino C, Maccario C, Manzi L, Salini V (2016) Total ankle replacement through a lateral approach: surgical tips. SICOT-J 2:38CrossRef
13.
go back to reference Hsu AR, Haddad SL, Myerson MS (2015) Evaluation and management of the painful total ankle arthroplasty. J Am Acad Orthop Surg 23:272–282CrossRef Hsu AR, Haddad SL, Myerson MS (2015) Evaluation and management of the painful total ankle arthroplasty. J Am Acad Orthop Surg 23:272–282CrossRef
14.
go back to reference Saltzman CL, Mann RA, Ahrens JE, Amendola RB, Berlet GC, Brodsky JW et al (2009) Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int 30(7):579–596CrossRef Saltzman CL, Mann RA, Ahrens JE, Amendola RB, Berlet GC, Brodsky JW et al (2009) Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int 30(7):579–596CrossRef
15.
go back to reference Henricson A, Knutson K, Lindahl J, Rydholm U (2010) The AES total ankle replacement: a mid-term analysis of 93 cases. Foot Ankle Surg 16:61–64CrossRef Henricson A, Knutson K, Lindahl J, Rydholm U (2010) The AES total ankle replacement: a mid-term analysis of 93 cases. Foot Ankle Surg 16:61–64CrossRef
16.
go back to reference Hurowitz EJ, Gould JS, Fleisig GS, Fowler R (2007) Outcome analysis of agility total ankle replacement with prior adjunctive procedures: two to six year follow-up. Foot Ankle Int 28:308–312CrossRef Hurowitz EJ, Gould JS, Fleisig GS, Fowler R (2007) Outcome analysis of agility total ankle replacement with prior adjunctive procedures: two to six year follow-up. Foot Ankle Int 28:308–312CrossRef
17.
go back to reference Usuelli FG, Indino C, Maccario C, Manzi L, Liuni FM, Vulcano E (2019) Infections in primary total ankle replacement: anterior approach versus lateral transfibular approach. Foot Ankle Surg 25:19–23CrossRef Usuelli FG, Indino C, Maccario C, Manzi L, Liuni FM, Vulcano E (2019) Infections in primary total ankle replacement: anterior approach versus lateral transfibular approach. Foot Ankle Surg 25:19–23CrossRef
18.
go back to reference Kessler B, Sendi P, Graber P, Knupp M, Zwicky L, Hintermann B et al (2012) Risk factors for periprosthetic ankle joint infection: a case-control study. J Bone Joint Surg Am 94-A:1871–1876CrossRef Kessler B, Sendi P, Graber P, Knupp M, Zwicky L, Hintermann B et al (2012) Risk factors for periprosthetic ankle joint infection: a case-control study. J Bone Joint Surg Am 94-A:1871–1876CrossRef
19.
go back to reference Usuelli FG, Maccario C, Granata F, Indino C, Vakhshori C, Tan EW (2019) Clinical and radiological outcomes of trans-fibular total ankle arthroplasty. Foot Ankle Int 40(1):24–33CrossRef Usuelli FG, Maccario C, Granata F, Indino C, Vakhshori C, Tan EW (2019) Clinical and radiological outcomes of trans-fibular total ankle arthroplasty. Foot Ankle Int 40(1):24–33CrossRef
20.
go back to reference Barg A, Bettin CC, Burstein AH, Saltzman CL, Gililland J (2018) Early clinical and radiographic outcomes of trabecular metal total ankle replacement using a transfibular approach. J Bone Joint Surg Am 100(6):505–515CrossRef Barg A, Bettin CC, Burstein AH, Saltzman CL, Gililland J (2018) Early clinical and radiographic outcomes of trabecular metal total ankle replacement using a transfibular approach. J Bone Joint Surg Am 100(6):505–515CrossRef
21.
go back to reference DeVries JG, Derksen TA, Scharer BM, Limoni R (2017) Perioperative complications and initial alignment of lateral approach total ankle replacement. J Foot Ankle Surg 56:996–1000CrossRef DeVries JG, Derksen TA, Scharer BM, Limoni R (2017) Perioperative complications and initial alignment of lateral approach total ankle replacement. J Foot Ankle Surg 56:996–1000CrossRef
22.
go back to reference Clough TM, Alvi F, Majeed H (2018) Total ankle arthroplasty: what are the risks? A guide to surgical consent and a review of the literature. J Bone Joint Surg (Br) 100-B:1352–1358CrossRef Clough TM, Alvi F, Majeed H (2018) Total ankle arthroplasty: what are the risks? A guide to surgical consent and a review of the literature. J Bone Joint Surg (Br) 100-B:1352–1358CrossRef
Metadata
Title
Clinical-radiological outcomes and complications after total ankle replacement through a lateral transfibular approach: a retrospective evaluation at a mid-term follow-up
Authors
Massimiliano Mosca
Silvio Caravelli
Emanuele Vocale
Nicolò Maitan
Alberto Grassi
Simone Massimi
Mario Fuiano
Stefano Zaffagnini
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 2/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-020-04709-4

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