The purpose of this study was to determine the outcomes of revision ankle replacements, using the Invision implant and impaction allograft for massive talar dome defects following primary ankle replacement failure. Outcomes were assessed in terms of bone graft incorporation; improvement in patient reported outcome measures (PROMs); and survivorship of the revision ankle arthroplasty. A retrospective review of prospectively collected data identified eleven patients who had massive bone cysts and underwent revision of a failed primary total ankle replacement to the Invision revision system, combined with impaction grafting using morselized femoral head allograft. These revisions occurred at a single high volume ankle arthroplasty centre. Computed tomography (CT) scans were used to assess bone graft incorporation and the Manchester-Oxford Foot Questionnaire (MOXFQ) and EQ-5D scores were used pre and post operatively to assess PROMs.Objective
Methods
The last decade has seen a considerable increase
in the use of in total ankle arthroplasty (TAA) to treat patients
with end-stage arthritis of the ankle. However, the longevity of
the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment
algorithm for the painful TAA to be used when considering revision
surgery. Cite this article:
Despite the increasing numbers of ankle arthroplasties, there are limited studies on their survival and comparisons between different implants. The primary aim of this study was to determine the failure rates of primary ankle arthroplasties commonly used in the UK. A data linkage study combined National Joint Registry (NJR) data and NHS Digital data. The primary outcome of failure was defined as the removal or exchange of any components of the implanted device. Life tables and Kaplan-Meier survival charts were used to illustrate survivorship. Cox proportional hazards regression models were fitted to compare failure rates between 1 April 2010 and 31 December 2018.Aims
Methods
The National Joint Registry (NJR) was established in 2003, and was extended to include ankle arthroplasty on 1. st. April 2010, and shoulder and elbow arthroplasty in April 2012. The aim of this study was to evaluate the uptake of the NJR for ankle arthroplasty over its first 3 years. This is compared to the first 3 years of hip and knee data, and the first year of shoulder and elbow data. The methods of measuring compliance are also evaluated. NJR compliance is measured by comparing the number of procedures submitted to the NJR, against the number of levies raised through implant sales. This applies to all of the UK, and both independent and NHS providers. However, compliance can also be measured by comparing NJR submissions with data submitted to the Hospital Episode Statistics (HES) database. This only relates to NHS institutions in England. The NJR ankle data was compared to implant data, and adjusted to compare to HES data, to evaluate the different methods of measuring compliance. We also compared these figures with the first 3 years for hip and knee arthroplasties and the first year for shoulder and elbow arthroplasties. Results:. In 2011 there were 493 arthroplasties and the compliance was 64% against industry data. In 2012 there were 590 procedures with compliance improved to 77% against industry data. When adjusting NJR to compare with HES data, the compliance was 87% in 2012., with 507 ankle arthroplasties registered with the NJR and 582 on HES data. The reasons for this discrepancy are discussed. The specific difficulties of capturing
A failed total ankle arthroplasty (TAA) is often associated with
much bone loss. As an alternative to arthrodesis, the surgeon may
consider a custom-made talar component to compensate for the bone
loss. Our aim in this study was to assess the functional and radiological
outcome after the use of such a component at mid- to long-term follow-up. A total of 12 patients (five women and seven men, mean age 53
years; 36 to77) with a failed TAA and a large talar defect underwent
a revision procedure using a custom-made talar component. The design
of the custom-made components was based on CT scans and standard
radiographs, when compared with the contralateral ankle. After the
anterior talocalcaneal joint was fused, the talar component was
introduced and fixed to the body of the calcaneum.Aims
Patients and Methods
We report the incidence and intensity of persistent
pain in patients with an otherwise uncomplicated total ankle replacement
(TAR). Arthroscopic debridement was performed in selected cases
and the clinical outcome was analysed. Among 120 uncomplicated TARs, there was persistent pain with
a mean visual analogue scale (VAS) of 2.7 (0 to 8). The intensity
of pain decreased in 115 ankles (95.8%). Exercise or walking for
more than 30 minutes was the most common aggravating factor (62
ankles, 68.1%). The character of the pain was most commonly described
as dull (50 ankles, 54.9%) and located on the medial aspect of the
joint (43 ankles, 47.3%). A total of seven ankles (5.8%) underwent subsequent arthroscopy.
These patients had local symptoms and a VAS for pain ≥ 7 on exertion.
Impingement with fibrosis and synovitis was confirmed. After debridement,
the median VAS decreased from 7 to 3 and six patients were satisfied.
The median VAS for pain and the American Orthopaedic Foot and Ankle
Society score of the ankles after debridement was similar to that
of the uncomplicated TARs (p = 0.496 and p = 0.066, respectively). Although TAR reduces the intensity of pain, residual pain is
not infrequent even in otherwise uncomplicated TARs and soft-tissue
impingement is the possible cause. Cite this article:
