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Mid-term (5–10 year) results of the Salto Talaris total ankle arthroplasty
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
155 Return to sport and physical activities after total ankle replacement: Mobile and fixed bearing C. Indino 1,∗ , L. Manzi 1 , C. Maccario 1,2 , R. D’Ambrosi 1,2 , C.E. Gross 3 , F.G. Usuelli 1 1
IRCCS Galeazzi Milano, Italy Università degli Studi di Milano, Italy 3 Department of Orthopaedics, Medical University of South Carolina, United States 2
Introduction: Patients often request total ankle replacement (TAR) not only for pain relief but also to participate in physical activities. This study aimed to assess and compare participation in physical activities 12 months after TAR with either mobile- or fixed-bearing prosthesis. Methods: Between May 2011 and January 2015, 117 primary TARs were performed (77 Hintegra, 40 Zimmer Trabecular Metal Total Ankle). Pain and function were assessed using AOFAS, VAS, SF-12 scores obtained preoperatively, 6, and 12 months postoperatively. Activity levels were determined using the Halasi ankle activity scale and the UCLA score obtained preoperatively and 12 months after surgery. Results: All patients had a significant improvement of AOFAS, VAS and SF-12 scores. The Halasi activity scale and UCLA score were 4.2 and 6.6 respectively for the fix-bearing group and 3.7 and 6.3 for the mobile-bearing 12 months after surgery. Jogging, dancing, and skiing represented the most practiced sports. Fix-bearing prosthesis had a quicker recovery and better functional outcomes within the first 6 months after the operation. At one year, there was not a significant difference in return to sport and physical activities between patients treated with a mobile-bearing implant and a fix-bearing implant. Conclusion: At one year, both the fixed and mobile bearing had significant improvements in functional and recreational scores, with neither proving superior. Further studies on the durability and complications of prostheses, as well as patient activity and return to specific sports and activities after surgery are needed to reach activity guidelines based on stronger levels of evidence. http://dx.doi.org/10.1016/j.fas.2017.07.244
156 Mid-term (5–10 year) results of the Salto Talaris total ankle arthroplasty J. Nunley ∗ , J. DeOrio, M. Easley, M. Stewart, S. Adams Duke University, United States The Salto Talaris ankle replacement is a modern fixed-bearing implant. The goal of this study is to report the midterm clinical results of patients who underwent ankle replacement with this prosthesis. Methods: Patients with a minimum of 5-year up to 10-year follow-up were prospectively enrolled in this study. Follow-up examinations were annually. Patients rated pain using the visual analog score (VAS) and reported their functional level using the (AOFAS) ankle-hindfoot scores, SMFA, and SF-36. Preoperative and postoperative radiographs were reviewed for component loosening. Criteria for failure were defined as undergoing revision requiring exchange or removal of the metallic components. Results: Between March 2007 and February 2012, 106 patients met the criterion. Of these, 71 patients (mean age, 62.5 years) had
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a minimum follow-up of 5 years (range 60–115 months, mean 81.4 months). Average outcome for the VAS was 11.7 (preop: 70.1). Significant improvements were seen in the SMFA, AOFAS anklehindfoot score, and the SF-36. Survivorship was 95.8% with two patients undergoing revision arthroplasty for aseptic loosening and a third patient scheduled for revision for a chronic wound infection. 12 patients (17%) required a total of 15 additional surgical procedures on the ipsilateral ankle or hindfoot. Conclusion: Patients who underwent total ankle arthroplasty with the Salto Talaris prosthesis have continued to show significant improvements in pain and functional outcomes at mid-term follow-up. This has shown to be an effective treatment option with durable results for patients with end-stage ankle arthritis. http://dx.doi.org/10.1016/j.fas.2017.07.245
157 4–10 year outcomes of INBONE I total ankle arthroplasty with deformity analysis J. Nunley ∗ , J. DeOrio, M. Easley, S. Adams, A. Harston Duke University, United States This study compares the mid-term outcomes of patients with and without preoperative coronal plane deformity who underwent ankle replacement with the INBONE I prosthesis. Methods: From May 2007 to September 2011, patients who underwent an INBONE I TAR were prospectively enrolled. Assessments preoperatively and at yearly follow-ups using the VAS for pain, the (AOFAS) ankle- hindfoot score, the SMFA, and the SF-36. Patients were grouped according to coronal plane tibiotalar alignment (preoperative coronal plane malalignment of >10◦ and <10◦ deformity). Results: 155 prosthesis were implanted in 151 patients. Minimum 4 year follow-up (48–113 months) average 67. Significant (p < 0.05) improvement in the VAS, AOFAS, SMFA, and SF-36 scores were seen. Forty-five patients (29%) had 49 additional surgeries for impingement, loosening/subsidence, malalignment, ligament instability, polyethylene exchange, and/or infection. There were 14 implant failures with overall survivorship of 90.3%. There was no statistically significant difference in outcomes between patients with coronal plane deformity >10◦ (47.7%) and <10◦ (42.3%). Patients with >10◦ had fewer reoperations (19 vs. 30) and fewer revisions (5 vs. 9) when compared to patients with <10◦ deformity. Conclusion: Patients who underwent INBONE I total ankle arthroplasty demonstrated significant improvement in pain and patient-reported outcomes at a mean of 5.7 years post-operatively. The patients with preoperative coronal plane tibiotalar deformity had similar pain relief, function, and need for additional surgeries and revisions. http://dx.doi.org/10.1016/j.fas.2017.07.246
155 Return to sport and physical activities after total ankle replacement: Mobile and fixed bearing C. Indino 1,∗ , L. Manzi 1 , C. Maccario 1,2 , R. D’Ambrosi 1,2 , C.E. Gross 3 , F.G. Usuelli 1 1
IRCCS Galeazzi Milano, Italy Università degli Studi di Milano, Italy 3 Department of Orthopaedics, Medical University of South Carolina, United States 2
Introduction: Patients often request total ankle replacement (TAR) not only for pain relief but also to participate in physical activities. This study aimed to assess and compare participation in physical activities 12 months after TAR with either mobile- or fixed-bearing prosthesis. Methods: Between May 2011 and January 2015, 117 primary TARs were performed (77 Hintegra, 40 Zimmer Trabecular Metal Total Ankle). Pain and function were assessed using AOFAS, VAS, SF-12 scores obtained preoperatively, 6, and 12 months postoperatively. Activity levels were determined using the Halasi ankle activity scale and the UCLA score obtained preoperatively and 12 months after surgery. Results: All patients had a significant improvement of AOFAS, VAS and SF-12 scores. The Halasi activity scale and UCLA score were 4.2 and 6.6 respectively for the fix-bearing group and 3.7 and 6.3 for the mobile-bearing 12 months after surgery. Jogging, dancing, and skiing represented the most practiced sports. Fix-bearing prosthesis had a quicker recovery and better functional outcomes within the first 6 months after the operation. At one year, there was not a significant difference in return to sport and physical activities between patients treated with a mobile-bearing implant and a fix-bearing implant. Conclusion: At one year, both the fixed and mobile bearing had significant improvements in functional and recreational scores, with neither proving superior. Further studies on the durability and complications of prostheses, as well as patient activity and return to specific sports and activities after surgery are needed to reach activity guidelines based on stronger levels of evidence. http://dx.doi.org/10.1016/j.fas.2017.07.244
156 Mid-term (5–10 year) results of the Salto Talaris total ankle arthroplasty J. Nunley ∗ , J. DeOrio, M. Easley, M. Stewart, S. Adams Duke University, United States The Salto Talaris ankle replacement is a modern fixed-bearing implant. The goal of this study is to report the midterm clinical results of patients who underwent ankle replacement with this prosthesis. Methods: Patients with a minimum of 5-year up to 10-year follow-up were prospectively enrolled in this study. Follow-up examinations were annually. Patients rated pain using the visual analog score (VAS) and reported their functional level using the (AOFAS) ankle-hindfoot scores, SMFA, and SF-36. Preoperative and postoperative radiographs were reviewed for component loosening. Criteria for failure were defined as undergoing revision requiring exchange or removal of the metallic components. Results: Between March 2007 and February 2012, 106 patients met the criterion. Of these, 71 patients (mean age, 62.5 years) had
53
a minimum follow-up of 5 years (range 60–115 months, mean 81.4 months). Average outcome for the VAS was 11.7 (preop: 70.1). Significant improvements were seen in the SMFA, AOFAS anklehindfoot score, and the SF-36. Survivorship was 95.8% with two patients undergoing revision arthroplasty for aseptic loosening and a third patient scheduled for revision for a chronic wound infection. 12 patients (17%) required a total of 15 additional surgical procedures on the ipsilateral ankle or hindfoot. Conclusion: Patients who underwent total ankle arthroplasty with the Salto Talaris prosthesis have continued to show significant improvements in pain and functional outcomes at mid-term follow-up. This has shown to be an effective treatment option with durable results for patients with end-stage ankle arthritis. http://dx.doi.org/10.1016/j.fas.2017.07.245
157 4–10 year outcomes of INBONE I total ankle arthroplasty with deformity analysis J. Nunley ∗ , J. DeOrio, M. Easley, S. Adams, A. Harston Duke University, United States This study compares the mid-term outcomes of patients with and without preoperative coronal plane deformity who underwent ankle replacement with the INBONE I prosthesis. Methods: From May 2007 to September 2011, patients who underwent an INBONE I TAR were prospectively enrolled. Assessments preoperatively and at yearly follow-ups using the VAS for pain, the (AOFAS) ankle- hindfoot score, the SMFA, and the SF-36. Patients were grouped according to coronal plane tibiotalar alignment (preoperative coronal plane malalignment of >10◦ and <10◦ deformity). Results: 155 prosthesis were implanted in 151 patients. Minimum 4 year follow-up (48–113 months) average 67. Significant (p < 0.05) improvement in the VAS, AOFAS, SMFA, and SF-36 scores were seen. Forty-five patients (29%) had 49 additional surgeries for impingement, loosening/subsidence, malalignment, ligament instability, polyethylene exchange, and/or infection. There were 14 implant failures with overall survivorship of 90.3%. There was no statistically significant difference in outcomes between patients with coronal plane deformity >10◦ (47.7%) and <10◦ (42.3%). Patients with >10◦ had fewer reoperations (19 vs. 30) and fewer revisions (5 vs. 9) when compared to patients with <10◦ deformity. Conclusion: Patients who underwent INBONE I total ankle arthroplasty demonstrated significant improvement in pain and patient-reported outcomes at a mean of 5.7 years post-operatively. The patients with preoperative coronal plane tibiotalar deformity had similar pain relief, function, and need for additional surgeries and revisions. http://dx.doi.org/10.1016/j.fas.2017.07.246