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Total ankle replacement in patients with haemophilic arthropathy: Primary arthroplasty and conversion of painful ankle arthrodesis to TAR
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Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
The average VAS pain score decreased significantly from 7.9 ± 1.3 to 0.8 ± 1.2. The average total range of motion increased significantly from 22.9◦ ± 11.8◦ to 40.2◦ ± 11.8◦ . Conclusions: Early results of Zimmer trabecular metal total ankle replacement demonstrated improved patient-reported outcomes and increased ankle motion at a minimum follow-up of one year. In the first 55 consecutive cases the fibular osteotomy required for access to the ankle healed without complications. Painful early loosening due to lack of bony ingrowth required revision in 3 of 55 cases. http://dx.doi.org/10.1016/j.fas.2017.07.222
134 Comparison of fusion and complication rates in patients with primary open ankle arthrodesis A. Barg ∗ , C. Saltzman University of Utah, United States Introduction: Different surgical techniques with various approaches and fixation methods have been described for ankle arthrodesis. Tibiotalar arthrodesis can be performed with or without distal tibiofibular fusion. The objectives of this retrospective study were to compare (1) demographics, (2) surgical techniques, (3) postoperative fusion rates, and (4) postoperative complication rates in patients that underwent primary open tibiotalar arthrodesis with vs. without distal tibiofibular fusion. Methods: Between March 2002 and November 2014, 322 primary open ankle arthrodeses were performed at our institution. There were 183 male and 139 female patients with a mean age of 56.0 ± 14.0 years (18.0–88.8). Both patient groups were compared with regard to demographics, surgical technique, and complication rates. Fusion rate and time to complete osseous fusion were analyzed. The mean time to final follow-up was 36.7 ± 26.7 months (12.0–150.4). Results: Of the 322 patients that underwent primary open ankle arthrodesis, 214 had a combined distal tibiofibular fusion, while 108 did not. Demographics and comorbidities were comparable in both groups. The most common surgical approach used was lateral and anterior in patients with and without distal tibiofibular fusion, respectively (p < 0.001). Autograft and allograft were used significantly less frequently in patients without distal tibiofibular fusion. The rate of osseous union was comparable in both groups with 92.2% and 93.0% (p = 0.675). The incidence of wound and thromboembolic complications was similar in both groups. Conclusions: The rates of osseous union and complication were comparable in both patient groups, with and without distal tibiofibular fusion. http://dx.doi.org/10.1016/j.fas.2017.07.223
135 Total ankle replacement in patients with haemophilic arthropathy: Primary arthroplasty and conversion of painful ankle arthrodesis to TAR A. Barg 1,∗ , T. Bailey 1 , M. Jacxsens 1 , M. Preis 2 1 2
University of Utah, United States Wiesbaden Clinic, Germany
Introduction: In this retrospective study we examined intraoperative and postoperative complications and evaluated the mid-term clinical and radiographic outcomes of total ankle replacement (TAR) in patients with haemophilic arthropathy performed in a private clinic. Methods: Fourteen patients with a mean age of 51.4 ± 10.2 years (range = 32.9–63.7) were treated for end-stage haemophilic ankle arthropathy. Nine procedures were primary arthroplasties, five procedures were conversions of painful ankle arthrodesis to TAR. The mean duration of follow-up was 5.8 ± 2.3 years (range = 2.0–9.2). Component stability and alignment was assessed with weight-bearing radiographs and clinical assessment was performed. Results: One patient sustained an intraoperative medial malleolar fracture. In two patients delayed wound healing was observed. In one patient open arthrolysis was performed due to painful arthrofibrosis. Both components were neutrally aligned. VAS significantly decreased from 8.5 ± 0.9 (range = 8–10) to 1.3 ± 1.6 (range = 0–6). Significant functional improvement including ROM and AOFAS hindfoot score was observed. The summarized components of the SF-36 physical and mental outcomes score significantly improved at the latest follow-up. Complication rates and clinical/radiographic outcomes were comparable in patients with primary TAR and conversion of ankle arthrodesis to TAR. Conclusions: The mid-term results following TAR or a conversion procedure in patients with haemophilic arthropathy performed in a private clinic setting are encouraging. However, for postoperative success, access to an experienced, multidisciplinary team including a hematologist is mandatory. http://dx.doi.org/10.1016/j.fas.2017.07.224
136 Total ankle arthroplasty classification system A. Barg ∗ , C. Saltzman University of Utah, United States Introduction: The objectives of the present study were (1) to describe our classification system in detail, and (2) to assess interobserver and intra-observer reliability. Methods: The classification was developed considering prosthesis design features that have been identified to influence clinical outcome and prosthesis component survivorship in the current literature. The following prosthesis designs have been classified: AES, Agility, BOX, Buechel-Pappas, ESKA, INBONE, HINTEGRA, Mobility, Ramses, Salto, Scandinavian Total Ankle Replacement, TNK, and TM Total Ankle. The inter- and intra-observer reliabilities were determined by calculating the kappa values for the different subgroups. Four observers at different levels of training in foot & ankle surgery were involved: study nurse, 1st & 4th year orthopaedic residents, and an orthopaedic fellow. Kappa values were interpreted according to the definitions of Landis and Koch.
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
The average VAS pain score decreased significantly from 7.9 ± 1.3 to 0.8 ± 1.2. The average total range of motion increased significantly from 22.9◦ ± 11.8◦ to 40.2◦ ± 11.8◦ . Conclusions: Early results of Zimmer trabecular metal total ankle replacement demonstrated improved patient-reported outcomes and increased ankle motion at a minimum follow-up of one year. In the first 55 consecutive cases the fibular osteotomy required for access to the ankle healed without complications. Painful early loosening due to lack of bony ingrowth required revision in 3 of 55 cases. http://dx.doi.org/10.1016/j.fas.2017.07.222
134 Comparison of fusion and complication rates in patients with primary open ankle arthrodesis A. Barg ∗ , C. Saltzman University of Utah, United States Introduction: Different surgical techniques with various approaches and fixation methods have been described for ankle arthrodesis. Tibiotalar arthrodesis can be performed with or without distal tibiofibular fusion. The objectives of this retrospective study were to compare (1) demographics, (2) surgical techniques, (3) postoperative fusion rates, and (4) postoperative complication rates in patients that underwent primary open tibiotalar arthrodesis with vs. without distal tibiofibular fusion. Methods: Between March 2002 and November 2014, 322 primary open ankle arthrodeses were performed at our institution. There were 183 male and 139 female patients with a mean age of 56.0 ± 14.0 years (18.0–88.8). Both patient groups were compared with regard to demographics, surgical technique, and complication rates. Fusion rate and time to complete osseous fusion were analyzed. The mean time to final follow-up was 36.7 ± 26.7 months (12.0–150.4). Results: Of the 322 patients that underwent primary open ankle arthrodesis, 214 had a combined distal tibiofibular fusion, while 108 did not. Demographics and comorbidities were comparable in both groups. The most common surgical approach used was lateral and anterior in patients with and without distal tibiofibular fusion, respectively (p < 0.001). Autograft and allograft were used significantly less frequently in patients without distal tibiofibular fusion. The rate of osseous union was comparable in both groups with 92.2% and 93.0% (p = 0.675). The incidence of wound and thromboembolic complications was similar in both groups. Conclusions: The rates of osseous union and complication were comparable in both patient groups, with and without distal tibiofibular fusion. http://dx.doi.org/10.1016/j.fas.2017.07.223
135 Total ankle replacement in patients with haemophilic arthropathy: Primary arthroplasty and conversion of painful ankle arthrodesis to TAR A. Barg 1,∗ , T. Bailey 1 , M. Jacxsens 1 , M. Preis 2 1 2
University of Utah, United States Wiesbaden Clinic, Germany
Introduction: In this retrospective study we examined intraoperative and postoperative complications and evaluated the mid-term clinical and radiographic outcomes of total ankle replacement (TAR) in patients with haemophilic arthropathy performed in a private clinic. Methods: Fourteen patients with a mean age of 51.4 ± 10.2 years (range = 32.9–63.7) were treated for end-stage haemophilic ankle arthropathy. Nine procedures were primary arthroplasties, five procedures were conversions of painful ankle arthrodesis to TAR. The mean duration of follow-up was 5.8 ± 2.3 years (range = 2.0–9.2). Component stability and alignment was assessed with weight-bearing radiographs and clinical assessment was performed. Results: One patient sustained an intraoperative medial malleolar fracture. In two patients delayed wound healing was observed. In one patient open arthrolysis was performed due to painful arthrofibrosis. Both components were neutrally aligned. VAS significantly decreased from 8.5 ± 0.9 (range = 8–10) to 1.3 ± 1.6 (range = 0–6). Significant functional improvement including ROM and AOFAS hindfoot score was observed. The summarized components of the SF-36 physical and mental outcomes score significantly improved at the latest follow-up. Complication rates and clinical/radiographic outcomes were comparable in patients with primary TAR and conversion of ankle arthrodesis to TAR. Conclusions: The mid-term results following TAR or a conversion procedure in patients with haemophilic arthropathy performed in a private clinic setting are encouraging. However, for postoperative success, access to an experienced, multidisciplinary team including a hematologist is mandatory. http://dx.doi.org/10.1016/j.fas.2017.07.224
136 Total ankle arthroplasty classification system A. Barg ∗ , C. Saltzman University of Utah, United States Introduction: The objectives of the present study were (1) to describe our classification system in detail, and (2) to assess interobserver and intra-observer reliability. Methods: The classification was developed considering prosthesis design features that have been identified to influence clinical outcome and prosthesis component survivorship in the current literature. The following prosthesis designs have been classified: AES, Agility, BOX, Buechel-Pappas, ESKA, INBONE, HINTEGRA, Mobility, Ramses, Salto, Scandinavian Total Ankle Replacement, TNK, and TM Total Ankle. The inter- and intra-observer reliabilities were determined by calculating the kappa values for the different subgroups. Four observers at different levels of training in foot & ankle surgery were involved: study nurse, 1st & 4th year orthopaedic residents, and an orthopaedic fellow. Kappa values were interpreted according to the definitions of Landis and Koch.