Change in Bone Mineral Density after Total Ankle Replacement: Two Year Follow Up (original) (raw)
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Total ankle replacement. Review and critical analysis of the current status
Foot and Ankle Surgery, 1996
Therapy resistant ankle pain and the disadvantages of ankle arthrodesis lead to the development of numerous ankle joint prostheses. When considering all ankle joint endoprosthetic developments since 1970, two different kinds of prosthesis can be distinguished. (i) Two component prostheses which can be further classified as constrained, semiconstrained and nonconstrained and (ii) three component prostheses with a free gliding core (multiaxial systems). After encouraging short term results in the 1970s and early 1980s, disappointing long term results led to disuse of most of the previously developed prostheses. The two most frequent complications were aseptic loosening and wound healing. Aseptic loosening can result from large bone resection (tibial 8-16 mm and talar ca 7 mm) which lead to a fixation of soft cancellous bone which is not able to resist the forces acting on the anchoring systems. Besides bone resection, the geometry of an ankle joint replacement also plays an important part in aseptic loosening. This is clearly shown by the results from constrained design where the highest loosening rates occur in ankle joint prosthesis. The nonconstrained systems and multiaxial systems with free gliding core both showed lower loosening rates, but because of an unphysiologically large range of motion they are associated with stability problems. Constrained designs neglect the anatomical and biomechanical characteristics of the ankle joint leading to an unphysiological unidimensional range of motion as, regarding the anatomy and biomechanics of the ankle joint, it is evident that the ankle joint is not a real hinge joint. The curvatures of the talus and the tibial surfaces show varying radii. The radii of the talus are described as counter-rotating spiral radii and the tibial as a unform radius. These anatomical characteristics allow axial vertical rotation in the ankle joint as well as extension and flexion. In future, the incorporation of more anatomical characteristics should be taken into account when designing a new ankle joint replacement, in particular the counterrotating spiral radii of the talus. As well as incorporating anatomical curvatures into the design of an ankle joint system it is also necessary to reduce the bone resections to achieve lower loosening rates and thus better results.
The Journal of bone and joint surgery. American volume, 2014
The popularity of total ankle replacement as a treatment for end-stage arthritis continues to grow. The purpose of this study was to assess changes in ankle kinetics and kinematics from a preoperative time point through two years postoperatively in patients who had received either a fixed-bearing or a mobile-bearing implant.METHODS: Ninety patients who received a primary total ankle replacement (forty-nine mobile-bearing and forty-one fixed-bearing) were examined. Three-dimensional joint mechanics and ground reaction forces were measured during level walking preoperatively and one and two years postoperatively. Patient-reported and functional outcomes were also collected. Data were analyzed with use of a 3 × 2 repeated-measures analysis of variance (ANOVA) to determine significant differences between implant types and across time (α = 0.05).RESULTS: No significant difference was observed in the ankle motion or step time between implant types or across time. However, there was a grea...
Clinical biomechanics (Bristol, Avon), 2016
Gait analysis after total ankle replacement and ankle arthrodesis is usually measured barefoot. However, this does not reflect reality. The purpose of this study was to compare patients barefoot and with footwear. We compared 126 patients (total ankle replacement 28, ankle arthrodesis 57, and tibiotalocalcaneal arthrodesis 41) with 35 healthy controls in three conditions (barefoot, standardized running, and rocker bottom shoes). Minimum follow-up was 2 years. We used dynamic pedobarography and a light gate. relative midfoot index, forefoot maximal force, walking speed. The relative midfoot index decreased in all groups from barefoot to running shoes and again to rocker bottom shoes (p<0.001). The forefoot maximal force increased wearing shoes (p<0.001), but there was no difference between running and rocker bottom shoes. Walking speed increased by 0.06m/s with footwear (p<0.001). Total ankle replacement and ankle arthrodesis were equal in running shoes but both deviated fro...
Fixed and mobile-bearing total ankle prostheses: Effect on tibial bone strain
Clinical Biomechanics, 2017
Background Total ankle replacement is associated to a high revision rate. To improve implant survival, the potential advantage of prostheses with fixed bearing compared to mobile bearing is unclear. The objective of this study was to test the hypothesis that fixed and mobile bearing prostheses are associated with different biomechanical quantities typically associated to implant failure. Methods With a validated finite element model, we compared three cases: a prosthesis with a fixed bearing, a prosthesis with a mobile bearing in a centered position, and a prosthesis with mobile bearing in an eccentric position. Both prostheses were obtained from the same manufacturer. They were tested on seven tibias with maximum axial compression force during walking. We tested the hypothesis that there was a difference of bone strain, bone-implant interfacial stress, and bone support between the three cases. We also evaluated, for the three cases, the correlations between bone support, bone strain and bone-implant interfacial stress. Findings There were no statistically significant differences between the three cases. Overall, bone support was mainly trabecular, and less effective in the posterior side. Bone strain and bone-implant interfacial stress were strongly correlated to bone support. Interpretations Even if slight differences are observed between fixed and mobile bearing, it is not enough to put forward the superiority of one of these implants regarding their reaction to axial compression. When associated to the published clinical results, our study provides no argument to warn surgeons against the use of two-components fixed bearing implants.
Total ankle replacement : comparison of the outcomes of STAR and Mobility
Acta orthopaedica Belgica, 2020
Total Ankle Replacement is a recognised treatment for end-stage ankle arthritis and an alternative to arthrodesis. This study reviews a single centre series of prospectively collected outcome measures to determine whether the Mobility performs better than the Scandinavian ankle replacement. The primary outcome measure was the survivorship. Secondary outcome measures consisted of complications and international scoring systems. 147 Scandinavian and 162 Mobility ankle replacements were reviewed at a mean follow up of 12.4 and 7.7 years respectively. The revision rate, which included liner exchange, component exchange or removal of implant was at 7 years 12.3% (18) for Scandinavian and 5.2% (8) for Mobility. The complication rate was 16.5% (22) for Scandinavian compared to 9.9 % (15) for Mobility. The results of our unit compare favourably with previous published studies. In this study the Mobility has been shown to have more favourable results at 7 years compared to the Scandinavian.
Total Ankle Arthroplasty Survival and Risk Factors for Failure
Foot & Ankle International, 2019
Background: Total ankle arthroplasty (TAA) is an increasingly selected treatment for end-stage ankle arthritis; however, failure and revision of the tibial and talar components remains an issue. Although multiple risk factors have been shown to contribute to early component revision, no study has looked at combining such risk factors into a predictive model that could potentially decrease revision rates and improve implant survival. This study aimed to develop a predictive model for TAA failure based on patient characteristics, patient-reported outcomes (PROs), and immediate postoperative radiographs. Methods: A retrospective review of a single-site ankle arthritis database was conducted. All patients with current-generation ankle replacements including the Hintegra and Infinity prostheses implanted between 2004 and 2015 and with complete postoperative radiographs taken between 6 and 12 weeks postoperatively were included. Eight coronal and sagittal radiographic parameters were asse...
The open orthopaedics journal, 2014
Numerous studies have shown reduction of periprosthetic bone mineral density (BMD) after hip replacement. The effect on the whole limb, however, is still unexplored. This study's objective was to analyse the postoperative development of BMD and muscle strength of the limb after total hip replacement (THR) and to determine links between these parameters. 55 patients, who underwent THR, were included. Depending on therapeutic indication, either an uncemented stem (Group A, n=30) or a cemented stem (Group B, n=25) has been implanted. In the limbs, the measurement of BMD using DEXA and the maximum isometric muscle strength, detected by a leg press, were undertaken preoperatively and after 3, 6 and 12 months. A total of 12 patients (Group A: n = 6, Group B: n = 6) were excluded due to reasons which were not relevant to the study. So, the results refer to the data of 43 patients. In Group A (uncemented, n = 24), a significant decrease of BMD on the operated extremity was seen after 3,...