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Revision total ankle arthroplasty using a total talar prosthesis for failed ankle arthroplasty
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
At 7 years postoperative the result was good in 5 patients and bad in the 2 other requiring arthroplasty. Their age was over 50 years, which may partly explain the failure of mosaicoplasty. Conclusion: The medium-term result of mosaicoplasty for advanced osteochondritis was good. A broader series would better support the results. The long-term outcome remains another point to be studied. http://dx.doi.org/10.1016/j.fas.2017.07.294
206 Revision total ankle arthroplasty using a total talar prosthesis for failed ankle arthroplasty S. Morita 1,∗ , Y. Tanaka 1 , H. Kurokawa 1 , A. Taniguchi 1 , T. Kumai 1 , Y. Takakura 2 1 2
Nara Medical University, Japan Nishinara Central Hospital, Japan
Introduction: Salvage for loosening and sinking of a talar component after total ankle arthroplasty (TAA) is extremely challenging. We have developed total talar prosthesis for the patient with idiopathic necrosis of the talus and obtained excellent results. Therefore, we applicated the prosthesis for revision surgeries. To prove usefulness of this procedure, a retrospective follow-up study was performed. Methods: Ten ankles of 10 patients in whom loosening and sinking of talar component after TAA or TAA combined with the first or second-generation artificial talus from 2006 to 2015 were investigated. There were 7 patients (7 ankles) who needed revision of the tibial components. The mean follow-up period was 31 months (14–98). The mean age at the operation was 69 years old (50–85). For the clinical evaluation, Visual Analog Scale (VAS) and JSSF ankle hindfoot scale were used at just before the operation and the final follow up. Results: The VAS was improved from 6.4 to 3.2. The JSSF ankle hindfoot scale was improved from 59.5 to 86.2. In particular subcategory of pain was improved remarkably from 19 to 34. Conclusion: Tibio-talo-calcaneal arthrodesis is usually adapted for sinking or loosening of talar components after TAA. However it tend to take much time to obtain bone union, remain the leg length discrepancy, and spoil the range of hindfoot motions, that causes severe functional decline. Applying the total talar prosthesis combined with tibial component of TAA could be a useful solution for this condition to relief the pain and restore the ankle function. http://dx.doi.org/10.1016/j.fas.2017.07.295
207 Endoscopic versus open excision of os trigonum for the treatment of posterior ankle impingement syndrome (PAIS) D. Georgiannos ∗ , I. Bisbinas 424 Military General Hospital, Thessaloniki, Greece Introduction: Open surgical excision of the os trigonum has been considered the traditional treatment of posterior ankle impingement syndrome (PAIS), however the endoscopic excision has recently become quite popular. The purpose of our study was to compare the results of endoscopic versus open excision of a symptomatic os trigonum for the treatment of PAIS in athletic population. It was hypothesized that the endoscopic technique was
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superior to open one regarding functional outcomes, pain and the time the athletes returned to training and to previous sports level. Methods: The study was a randomized controlled clinical trial. From 2008 to 2011, 52 athletes underwent a symptomatic os trigonum excision- 26 had an open (group A) and 26 had an endoscopic approach (group B). The AOFAS-hindfoot score and the VAS-FA score were obtained and the time to return to training and to previous sports level was recorded. Results: Patients in group B appeared to have significant improvement of AOFAS-hindfoot score than those in group A. The time to return to training was 9.58 ± 3.98 weeks for group A and 4.58 ± 1.47 weeks for group B. The time to return to previous sports level was 11.54 ± 3.89 weeks for group A and 7.12 ± 2.25 weeks for group B. The overall complication rate was 23% for group A (6 cases) and 3.8% for group B (one case). Conclusion: It is concluded that the endoscopic excision of the os trigonum is a safe and effective treatment option for athletes who need an early return to their previous sports level. http://dx.doi.org/10.1016/j.fas.2017.07.296
208 Osteochondral autologous transplantation versus dorsal closing wedge metatarsal osteotomy for the treatment of Freiberg’s infraction in athletes. Midterm results of a comparative study D. Georgiannos ∗ , I. Bisbinas 424 Military General Hospital, Thessaloniki, Greece Introduction: Dorsiflexion closing wedge metatarsal osteotomy (DCWMO) has been considered the gold standard for the treatment of Freibergs disease. Osteochondral autologous transplantation (OAT) is a well-accepted surgical option for osteochondral lesions of the knee and ankle. The purpose of our study was to compare the results of the DCWMO versus OAT for the treatment of Freiberg’s infraction in athletic population. Methods: This was a prospective, randomized, non-blinded study. Between 2008 and 2013, 27 patients with Freibergs disease were randomly assigned to either the DCWMO (14 patients) or the OAT (13 patients) group. The outcomes collected were: postoperative complications, MTP joint ROM, metatarsal length. The AOFAS-hindfoot and the VAS-FA score were obtained. Results: Mean AOFAS-LMI score was 63.4 ± 14.4 preop and 84.4 ± 5.6 postop (group A) and 62.8 ± 14 and 92 ± 6.9 (group B) respectively. The mean VAS-FA score was improved significantly from 48.1 ± 11.5 to 91.8 ± 9.5 in group A and from 49.9 ± 10.9 to 95.4 ± 4.4 in group B. Shortening of the metatarsals by a mean 1.9 mm in group A, as opposed to lengthening of 0.2 mm in group B. Patients were able to start training at 6 weeks and return to full sport action at 10 weeks (group B), while in group A the time was 8 and 13 weeks respectively. Conclusion: We concluded that the OAT is equal if not superior to the DCWMO. Acceptable clinical results were reported, as well as very low morbidity and early return to sports activities. That makes the OAT procedure a safe, effective and optimal treatment for athletic population suffering Freibergs infraction. http://dx.doi.org/10.1016/j.fas.2017.07.297
At 7 years postoperative the result was good in 5 patients and bad in the 2 other requiring arthroplasty. Their age was over 50 years, which may partly explain the failure of mosaicoplasty. Conclusion: The medium-term result of mosaicoplasty for advanced osteochondritis was good. A broader series would better support the results. The long-term outcome remains another point to be studied. http://dx.doi.org/10.1016/j.fas.2017.07.294
206 Revision total ankle arthroplasty using a total talar prosthesis for failed ankle arthroplasty S. Morita 1,∗ , Y. Tanaka 1 , H. Kurokawa 1 , A. Taniguchi 1 , T. Kumai 1 , Y. Takakura 2 1 2
Nara Medical University, Japan Nishinara Central Hospital, Japan
Introduction: Salvage for loosening and sinking of a talar component after total ankle arthroplasty (TAA) is extremely challenging. We have developed total talar prosthesis for the patient with idiopathic necrosis of the talus and obtained excellent results. Therefore, we applicated the prosthesis for revision surgeries. To prove usefulness of this procedure, a retrospective follow-up study was performed. Methods: Ten ankles of 10 patients in whom loosening and sinking of talar component after TAA or TAA combined with the first or second-generation artificial talus from 2006 to 2015 were investigated. There were 7 patients (7 ankles) who needed revision of the tibial components. The mean follow-up period was 31 months (14–98). The mean age at the operation was 69 years old (50–85). For the clinical evaluation, Visual Analog Scale (VAS) and JSSF ankle hindfoot scale were used at just before the operation and the final follow up. Results: The VAS was improved from 6.4 to 3.2. The JSSF ankle hindfoot scale was improved from 59.5 to 86.2. In particular subcategory of pain was improved remarkably from 19 to 34. Conclusion: Tibio-talo-calcaneal arthrodesis is usually adapted for sinking or loosening of talar components after TAA. However it tend to take much time to obtain bone union, remain the leg length discrepancy, and spoil the range of hindfoot motions, that causes severe functional decline. Applying the total talar prosthesis combined with tibial component of TAA could be a useful solution for this condition to relief the pain and restore the ankle function. http://dx.doi.org/10.1016/j.fas.2017.07.295
207 Endoscopic versus open excision of os trigonum for the treatment of posterior ankle impingement syndrome (PAIS) D. Georgiannos ∗ , I. Bisbinas 424 Military General Hospital, Thessaloniki, Greece Introduction: Open surgical excision of the os trigonum has been considered the traditional treatment of posterior ankle impingement syndrome (PAIS), however the endoscopic excision has recently become quite popular. The purpose of our study was to compare the results of endoscopic versus open excision of a symptomatic os trigonum for the treatment of PAIS in athletic population. It was hypothesized that the endoscopic technique was
69
superior to open one regarding functional outcomes, pain and the time the athletes returned to training and to previous sports level. Methods: The study was a randomized controlled clinical trial. From 2008 to 2011, 52 athletes underwent a symptomatic os trigonum excision- 26 had an open (group A) and 26 had an endoscopic approach (group B). The AOFAS-hindfoot score and the VAS-FA score were obtained and the time to return to training and to previous sports level was recorded. Results: Patients in group B appeared to have significant improvement of AOFAS-hindfoot score than those in group A. The time to return to training was 9.58 ± 3.98 weeks for group A and 4.58 ± 1.47 weeks for group B. The time to return to previous sports level was 11.54 ± 3.89 weeks for group A and 7.12 ± 2.25 weeks for group B. The overall complication rate was 23% for group A (6 cases) and 3.8% for group B (one case). Conclusion: It is concluded that the endoscopic excision of the os trigonum is a safe and effective treatment option for athletes who need an early return to their previous sports level. http://dx.doi.org/10.1016/j.fas.2017.07.296
208 Osteochondral autologous transplantation versus dorsal closing wedge metatarsal osteotomy for the treatment of Freiberg’s infraction in athletes. Midterm results of a comparative study D. Georgiannos ∗ , I. Bisbinas 424 Military General Hospital, Thessaloniki, Greece Introduction: Dorsiflexion closing wedge metatarsal osteotomy (DCWMO) has been considered the gold standard for the treatment of Freibergs disease. Osteochondral autologous transplantation (OAT) is a well-accepted surgical option for osteochondral lesions of the knee and ankle. The purpose of our study was to compare the results of the DCWMO versus OAT for the treatment of Freiberg’s infraction in athletic population. Methods: This was a prospective, randomized, non-blinded study. Between 2008 and 2013, 27 patients with Freibergs disease were randomly assigned to either the DCWMO (14 patients) or the OAT (13 patients) group. The outcomes collected were: postoperative complications, MTP joint ROM, metatarsal length. The AOFAS-hindfoot and the VAS-FA score were obtained. Results: Mean AOFAS-LMI score was 63.4 ± 14.4 preop and 84.4 ± 5.6 postop (group A) and 62.8 ± 14 and 92 ± 6.9 (group B) respectively. The mean VAS-FA score was improved significantly from 48.1 ± 11.5 to 91.8 ± 9.5 in group A and from 49.9 ± 10.9 to 95.4 ± 4.4 in group B. Shortening of the metatarsals by a mean 1.9 mm in group A, as opposed to lengthening of 0.2 mm in group B. Patients were able to start training at 6 weeks and return to full sport action at 10 weeks (group B), while in group A the time was 8 and 13 weeks respectively. Conclusion: We concluded that the OAT is equal if not superior to the DCWMO. Acceptable clinical results were reported, as well as very low morbidity and early return to sports activities. That makes the OAT procedure a safe, effective and optimal treatment for athletic population suffering Freibergs infraction. http://dx.doi.org/10.1016/j.fas.2017.07.297