Total Ankle Replacement Outcomes in Patients With Prior Distraction Arthroplasty.

Background: Distraction arthroplasty aims to treat ankle osteoarthritis while preserving the native ankle joint, often to prevent or delay ankle arthrodesis or total ankle replacement (TAR). No study to date has explored TAR outcomes in patients who have had prior distraction arthroplasty. Thus, this study described the clinical, radiographic, and patient-reported outcomes for TAR at minimum 2-year follow-up in patients who had undergone prior ankle distraction arthroplasty.

Patient-Specific Instrumentation Does Not Improve Alignment Compared to the Extramedullary Foot Holder for the INBONE II Total Ankle Arthroplasty.

Background: Patient-specific instrumentation (PSI) was developed to improve accuracy and efficiency in implant placement for total ankle arthroplasty (TAA). This study represents the first to measure the accuracy of PSI regarding implant alignment and implant size in the INBONE II total ankle system (Stryker). A secondary goal was to compare radiographic and clinical outcomes between the PSI and that of a matched group of implants performed with standard instrumentation.

Effects of Calcaneal Osteotomies on Gait Kinematics in Simulated Progressive Collapsing Foot Deformity: A Cadaveric Study.

Background: Calcaneal osteotomies are often used to correct hindfoot valgus and forefoot abduction in patients with PCFD. Calcaneal osteotomies are commonly performed to address hindfoot valgus and forefoot abduction present with PCFD. This study compared the dynamic effects of medializing calcaneal osteotomy (MCO) and lateral column lengthening (LCL), after simulated PCFD (sPCFD), on joint kinematics and plantar pressure during simulated gait.

Patient-Reported Outcomes and Revision Risk Following Total Ankle Replacement With and Without Ipsilateral Hindfoot Fusion.

Background: Hindfoot (subtalar, talonavicular, and/or calcaneocuboid) fusion is commonly used to treat arthritis and/or deformity. Some patients undergoing total ankle replacement (TAR) have a history of hindfoot fusion or undergo it concomitantly. This study aims to evaluate Patient-Reported Outcomes Measurement Information System (PROMIS)-based clinical outcomes, revision rates, and radiographic findings of primary TAR with ipsilateral hindfoot fusion at a minimum 2-year follow-up from primary TAR.

Early Periprosthetic Tibial Lucency Following Low-Profile Total Ankle Arthroplasty.

Background: Most modern total ankle arthroplasty (TAA) implants have low-profile designs that minimize tibial resection and use small pegs or posts for fixation. A number of studies have identified concerning rates of lucencies around the tibial components of these implants. In this study, we evaluated a consecutive series of patients receiving an anterior approach low-profile TAA prosthesis to describe the incidence, characteristics, and progression of tibial component lucencies at short-term (minimum 1-year) follow-up.

Postoperative Medial Gutter Impingement Following Primary Total Ankle Arthroplasty: A Retrospective Case-Control Study.

Background: Medial gutter impingement may compromise the results of an otherwise well-fixed total ankle arthroplasty (TAA), but no previous study has assessed predisposing factors. This case-control study sought to investigate potential risk factors and the role of talar component downsizing in decreasing medial impingement.

Methods: A retrospective case-control study with 149 patients was performed.

Outcomes of Total Ankle Replacement.

Total ankle replacement (TAR) is an effective operative treatment of end-stage ankle osteoarthritis (OA) in the appropriate patient, conferring improved kinematic function, decreased stress across adjacent joints, and offering equivalent pain relief in comparison to ankle arthrodesis (AA). It is important to consider patient age, weight, coronal tibiotalar deformity, joint line height, and adjacent joint OA to maximize clinical and patient outcomes. Both mobile-bearing and fixed-bearing implants have demonstrated favorable clinical outcomes, marked improvement in patient-reported outcomes, and good survivorship; however, implant survivorship decreases with longer term follow-up, necessitating constant improvement of primary and revision TAR options.

An evaluation of the total ankle replacement in the modern era: a narrative review.

Background And Objective: Total ankle replacement has become an increasingly popular surgical procedure for treatment of end-stage ankle arthritis. Though ankle arthrodesis has historically been considered the gold standard treatment, advancements in implant design, functional outcomes, and survivorship have made total ankle replacement a compelling alternative. Particularly, in the past 20 years, total ankle replacement has undergone tremendous innovation, and the field of research in this procedure continues to grow.

Postoperative Medial Malleolar Fractures in Total Ankle Replacement Are Associated With Decreased Medial Malleolar Width and Varus Malalignment: A Case-Control Study.

Background: There are limited data regarding risk factors associated with periprosthetic medial malleolar fractures in total ankle arthroplasty (TAA). This case-control study aimed to identify the risk factors and analyze the effect of prophylactic screw fixation in preventing a medial malleolar fracture after TAA.

Methods: A case-control study was conducted on 149 patients who underwent primary TAA.

Defining the Patient Acceptable Symptom State (PASS) for PROMIS After Total Ankle Replacement.

Background: Although patient-reported outcomes (PROs), such as the Patient-Reported Outcomes Measurement Information System (PROMIS), are a key element of evaluating success after total ankle replacement (TAR), many do not explicitly state a key factor of postoperative success: is the patient satisfied with their outcome after TAR? The patient acceptable symptom state (PASS) represents the symptom threshold beyond which patients consider themselves well. This study aimed to establish the PROMIS thresholds for the PASS in a primary cohort of TAR patients.

Methods: This single-institution study included 127 primary TAR patients with preoperative and 2-year postoperative PROMIS scores.

Lessons From Revision Total Ankle Replacement: Tibias Fail Earlier, and Taluses Fail Later (and Fail Again).

Background: The literature on survivorship and outcomes after revision total ankle replacement (TAR) in the modern era is limited. This study aimed to describe the timing to revision and survivorship after revision TAR. We hypothesized that tibial-sided failures would occur earlier after the primary TAR, and secondary revisions after failure of revision TAR would occur more due to talar-sided failures than tibial-sided failures.

Influence of Isolated Talonavicular and Subtalar Joint Arthrodesis on Hindfoot Kinematics and Range of Motion During Cadaveric Gait Simulation.

Background: Isolated subtalar and talonavicular joint arthrodeses have been associated with adjacent joint arthritis and altered hindfoot kinematics during simplified loading scenarios. However, the effect on kinematics during dynamic activity is unknown. This study assessed changes in subtalar and talonavicular kinematics after isolated talonavicular (TN) and subtalar (ST) arthrodesis, respectively, during stance simulations.

Safety of Same-Day Discharge Following Total Ankle Arthroplasty: A Retrospective Cohort Analysis.

Background: Joint replacement procedures have traditionally been performed in an inpatient setting to minimize complication rates. There is growing evidence that total ankle arthroplasty (TAA) can safely be performed as an outpatient procedure, with the potential benefits of decreased health care expenses and improved patient satisfaction. Prior studies have not reliably made a distinction between outpatient TAA defined as length of stay <1 day and same-day discharge.

Discrepancies Between Intraoperative and Postoperative Ankle Motion Measured for Anterior-Approach Total Ankle Arthroplasty.

Background: Although intraoperative ankle motion serves as a foundational reference for anticipated motion after surgery and guides the addition of procedures to enhance ankle motion in total ankle arthroplasty (TAA), the relationship between intraoperative and postoperative ankle motion remains unclear. This study aimed to investigate the discrepancy between intraoperative and postoperative ankle range of motion (ROM) following TAAs using the anterior-approach, fixed-bearing systems.

Methods: This study retrospectively reviewed 67 patients (67 ankles) who underwent primary TAA at a single institution.

Effects of Travel Distance on Complications and Outcomes in Total Ankle Arthroplasty.

Owing to the last decade's increase in the number of total ankle arthroplasty (TAA) procedures performed annually, there is a concern that the disproportionate distribution of orthopaedic surgeons who regularly perform TAA may impact complications and/or patient satisfaction. This study examines patient-reported outcomes and complications in TAA patients who had to travel for surgery compared to those treated locally. This is a single-center retrospective review of 160 patients undergoing primary TAA between January 2016 and December 2018, with mean age 65 (range: 59-71) years, mean body mass index (BMI) 28.

Radiographic Analysis of Valgus Ankle Deformity With or Without Medial Longitudinal Arch Collapse.

Background: Establishing a surgical plan for ankle deformities necessitates a comprehensive understanding of the deforming forces involved, and the morphology of the ankle deformity plays an important role as well. Valgus tibiotalar tilt development has mostly been described in patients with a low medial longitudinal arch, as seen in progressive collapsing foot deformity (PCFD). However, some valgus ankles demonstrate no radiographic evidence of a collapsed medial arch.

Implant Choice May Reduce the Risk of Early Mechanical Failure in Total Ankle Replacement.

Background: Total ankle replacements (TARs) have rapidly advanced in terms of volume, technique, design, and indications. However, TARs are still at risk for early mechanical failure and revision. Prior studies have investigated potential risk factors for failure, but have been limited to smaller series or older implants.

Outcomes of Total Ankle Arthroplasty After Reoperation due to Gutter Impingement.

Gutter impingement is one of the most common causes of subsequent surgery after total ankle arthroplasty (TAA). Although gutter debridement has been reported to resolve preoperative symptoms early on, persistent pain after surgery, recurrence, and poor functional outcome scores have been described in patients who have undergone reoperation for gutter debridement. The cause of gutter impingement after TAA is multifactorial, and a better understanding of its causes and optimal surgical techniques for intervention is needed.

Early Survivorship, Clinical and Radiographic Outcomes of a Modular Augmented Revision Total Ankle Arthroplasty System.

Background: As the number of total ankle arthroplasties (TAAs) performed annually increases, there is increased demand for modular revision implants. There is limited early survivorship and clinical outcome data for the INVISION Total Ankle Arthroplasty System (Wright Medical Technology/Stryker). This study aims to determine early implant survivorship, complications, and radiographic and patient-reported outcomes (PROs) of the INVISION implant in the revision setting.

Midterm Clinical Outcomes, Radiographic Outcomes, and Survivorship of the Infinity Total Ankle Arthroplasty.

Background: The Infinity Total Ankle Arthroplasty (Stryker, Mahwah, NJ) is a low-profile fixed-bearing implant first introduced in 2014. Although the short-term survivorship (2-4 years follow-up) and complication rates of the Infinity TAA have been reported, there are limited midterm outcome reports. The aim of this study was to describe the survivorship and clinical outcomes of a single-center experience with the Infinity implant at minimum 5-year follow-up.

Evaluating Failure Mechanisms for Total Talus Replacement: Contemporary Review.

Background: As total talus replacement (TTR) grows in popularity as a salvage option for talar collapse, a critical evaluation of the complications associated with this procedure is indicated.

Methods: In this review of the literature, we present a patient report and provide a review of several complications seen after TTR, including ligamentous instability, infection, and adjacent joint osteoarthritis, which we have encountered in our practice.

Results: Total talus replacement has the potential to reduce pain and preserve range of motion.

Influence of Joint Line Level on Clinical Outcomes and Range of Motion in Total Ankle Arthroplasty.

Background: Ankle arthritis leads to an elevated joint line compared to the nonarthritic ankle, as measured by the "joint line height ratio" (JLHR). Previous work has shown that the JLHR may remain elevated after total ankle arthroplasty (TAA). However, the clinical impact of this has yet to be determined.