The purpose of this study was to obtain anatomical measurements of the distal tibia and talus of Korean ankles and to evaluate, based on those measurements, the compatibility of the HINTEGRA prostheses in the context of total ankle replacement (TAR). We measured the length, width, height, and angles of the distal tibia and talus of 51 cadavers and compared these measurements with the corresponding dimensions of the HINTEGRA prostheses. The male ankles were larger than the female ones as was expected, but their overall shapes did not differ, which fact validates use of the prostheses irrespective of patients' sex. The dimensions of the talus itself did not differ significantly from those previously reported for American whites and blacks and South African whites. This might suggest a possibility that the HINTEGRA prostheses, being used in these countries, would be compatible to Korean ankles, too. In fact, the length range of the talar components was generally compatible with those derived from cadaveric measurements of the trochlea. However, the widths of the tibial and talar components were not completely compatible to Korean ankles. Above all, the length of the large-sized tibial components was much longer than the largest ankles, which would confine the choice of prosthesis mainly to small-sized ones for arthroplasty in Korea. Even though these prostheses are currently used, some modifications are needed to extend their usability in Korea, such as shortening and width/length ratio adjustment of the tibial component, and of the talar component accordingly

Background. Total ankle arthroplasty (TAA) with the use of third generation implants has demonstrated favorable clinical results and improved survival. However, few studies have compared the different types of implants. The purpose of this study was to perform a retrospective evaluation of patient outcomes and complications by comparing TAA procedures performed with HINTEGRA versus MOBILITY systems. Methods. Fifty-two consecutively enrolled patients (28 men and 24 women; mean age 64.8 years) underwent TAA using HINTEGRA (21 ankles) or MOBILITY (33 ankles) between September 2004 and July 2012. Visual analog scale (VAS) pain scores and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were determined at each follow-up visit. The radiographs were reviewed to assess component positioning, radiolucency, heterotopic ossification and other factors. Results. The mean follow-up period was 28.3 months in the HINTEGRA group and 32.5 months in the MOBILITY group. VAS decreased from 8.3 to 2.0 for the HINTEGRA group and from 7.9 to 2.7 for the MOBILITY group. The AOFAS score increased from 43.8 to 87.3 for the HINTEGRA group and from 46.6 to 83.7 for the MOBILITY group. Intra- and postoperative malleolar fractures were not noted in the HINTEGRA group, whereas 5 ankles (15.2%) in the MOBILITY group sustained this injury (P=.144). Ankle impingement syndrome was noted in 8 ankles (38.1%) in the HINTEGRA group and 3 (9.1%) in the MOBILITY group (P=.015). However, no significant differences in postoperative osteolysis and neuralgia were noted between the groups. Conclusions. HINTEGRA and MOBILITY implants both exhibited favorable clinical outcome without significant differences. However, in terms of complications, ankle impingement syndrome was significantly more common in the HINTEGRA group, while intraoperative malleolar fracture was observed in only the MOBILITY group

As an alternative to ankle replacement, ankle arthrodesis remains a mainstay in the treatment of end-stage arthritis. Arthroscopic techniques for ankle arthrodesis have more recently been developed, although there has been limited research exploring the cost of arthroscopic (AAA) versus open ankle arthrodesis (OAA), and comparing ankle fusions to replacement (TAA). We hypothesise that resource use after AAA will be lower than that after OAA, and both will be lower than TAA. We performed a retrospective review of a prospectively collected database. The COFAS database was used to identify patients with >2 years of follow up who have undergone AAA, OAA or Hintegra TAA at St Paul's Hospital between 2003–2010. Ninety patients with TAA, 52 with AAA and 56 with OAA met our inclusion criteria. The following data were documented: patient demographics (age, gender, presence of diabetes, inflammatory arthritis or any smoking history), factors related to the index surgery (type of surgery, OR time, length of stay) and factors relating to the post-operative course (number of post-operative clinic visits, OR time for re-operations, length of stay for additional hospital admissions). In terms of the index surgery, AAA required less initial OR time compared to either OAA or TAA. Initial length of hospital stay was significantly longer for both TAA and OAA, compared to AAA. Patients attended more follow-up visits after TAA or OAA compared to after AAA. In terms of additional OR time required, no significant differences were found among the groups. The most common reason for re-operation was infection or wound breakdown (38% of re-operations), followed by removal of hardware (15%). TAA also required significantly more additional days in hospital compared to either OAA or AAA. For all significant comparisons, p < 0.05. For each primary TAA, on average an additional one hour of surgery, three days in hospital and seven clinic visits were required on top of the cost factored for the primary arthroplasty. For each primary AAA, an additional four clinic visits, 23 minutes of revision surgery and one day in hospital were required. For each primary OAA, an average additional five clinic visits, three minutes of OR time, and 0.2 days of additional hospital stay occurred during follow up. Using several measures of resource use, we find that arthroscopic ankle fusions compare favourably to both ankle replacements and open ankle fusions. We also show that resource utilisation measurements can be a useful surrogate for complications, and that resource utilisation can demonstrate the practical implications of complications for patients, surgeons and health care resources

End-stage ankle arthritis (ESAA) is a debilitating disease that does not affect all individuals equally. Gender differences have been identified in patients with end-stage hip and knee arthritis and have stimulated research to explain these findings. The present study was undertaken to examine if gender has a significant effect on pre-operative disability and post-operative outcomes in patients with ESAA. Patients undergoing ankle arthrodesis (AA) or total ankle replacement (TAR) with minimum 2-year follow-up were identified in the Canadian Orthopaedic Foot and Ankle Society prospective ankle reconstruction database. Demographic data, revision data, patient satisfaction questionnaires, and outcome data using the Ankle Osteoarthritis Scale (AOS) and Short-form 36 (SF-36) health survey were collected. TAR: 384 patients were included, with 198 females and 186 males. Patient BMI, comorbidities, and duration of follow-up were similar between groups. Males were slightly older at the time of surgery (65.1 vs 62.4 years, p=0.01)). The most common etiology was post-traumatic arthritis for both genders, however females had a higher rate of rheumatoid arthritis (17% vs 5%, p=0.001). Implant types included STAR, Hintegra, and Mobility, and were similar between groups. Preoperatively females had higher rates of pain and disability, demonstrated by lower SF-36 physical component scores (PCS) (31.0 vs 34.5, p<0.001), and higher AOS pain (54.7 vs 51.1, p=0.05) and AOS disability scores (66.5 vs 59.6, p<0.001). Postoperatively, both groups had significant improvement in PCS, AOS pain, and AOS disability scores. Females, however, continued to demonstrate lower PCS scores (38.3 vs 41.9, p<0.001) and higher AOS disability (31.0 vs 25.8, p=0.02) than males. Regression analysis found that preoperative PCS, gender, age, and arthritis etiology all had a significant impact on postoperative PCS scores, with preoperative PCS scores having the largest impact. Preoperative AOS pain and disability scores had the largest impact on postoperative AOS pain and disability scores, respectively. Gender had no significant impact on AOS pain and disability scores postoperatively. Patient satisfaction was similar between males and females postoperatively. Secondary surgery was performed in 13.6% of females and 16.1% of males. Five males and five females underwent revision to arthrodesis. In patients with ESAA, females tend to have higher pre-operative levels of pain and disability compared to males, which persists post-operatively. This is consistent with the hip and knee arthroplasty literature. This finding may be due to females undergoing surgery at more advanced disease states, arthritis etiology, referral bias, or treatment bias. Both males and females have significant and similar degrees of improvement in pain and disability scores after TAR, and reoperation rates and patient satisfaction rates are similar despite the apparent disparity in outcomes

Background:. There is little knowledge about wear performance of total ankle arthroplasties (TAR). However, revisions rates are high for TAR [1] and wear associated revisions are frequent [2]. Therefore, the aim of this study is . (1). To test the wear behavior of a TAR using a biomechanically valid testing scenario. (2). To test the influence of an alternative ceramic tibial component. (3). To test the long term wear performance of TAR. Material and Methods:. In the first part of this study the HINTEGRA (Smith & Nephew) TAR has been used for wear testing. Wear testing was performed on a modified AMTI knee simulator. Level walking according to a previous described testing standard [see abstract: Development of a force controlled testing scenario for total ankle replacements] has been used. Level walking was simulated in three clinical relevant situations, first simulating the reduced loading after implantation, secondly simulating an increasing range of motion and at last a loading pattern orientating at the loadings in the native/healthy joint. Every simulation was run for 3 million cycles, resulting in 9 million total cycles. In the second part of this study the metal tibial plateau was replaced by a ceramic tibial component (Biolox® Delta, CeramTec). Simulation was run, as described above, for additional 9 million cycles. Termed as a long term test, in total 18 million cycles of testing are performed. Results:. When simulating level walking with loadings assumed after implantation a wear rate of 19.5 ± 1,49 mg/Mc has been determined. Increasing the range of motion lead to a wear rate of 18.0 ± 2,56 mg/Mc and simulating loading as assumed in a healthy joint, a wear rate of 23.8 ± 1,47 mg/Mc was determined. When replacing the metal tibial component by a ceramic tray the wear rate decreased between 20–30% dependent on the tested scenario. No delamination occurred during 18 millon cycles of testing. Conclusion:. In this study, high wear rates for TAR were determined. Compared to standardized wear testing of total knee replacements in our laboratory the wear rate of TAR was approximately 2.5 times increased. Ceramics seem to be an option to decrease the wear rate. The high wear rate of the polyethylene may be a factor contributing to the high revision rates seen in TARs

Purpose. To investigate the effect of obesity on functional outcome following total ankle arthroplasty. Method. We identified 43 obese patients (46 ankles) (BMI > 30kg/m2), using a prospectively collected database of total ankle arthroplasties. Inclusion criteria included: (a) Post-traumatic or inflammatory arthritis; (b) Minimum two-year follow-up, (c) Coronal plane deformity less than 10 degrees. Exclusion criteria: (a) Co-morbidity affecting physical function; (b) Recent total joint arthroplasty. American Orthopaedic Foot and Ankle Society (AOFAS), Ankle Osteoarthritis Scale (AOS) and SF-36 questionnaires were used preoperatively and at latest follow-up. Revision was defined as any intervention requiring replacement of part or whole of the prosthesis. A control group of non-obese individuals (BMI 18.5–29.9kg/m2) was devised matching for age within 10 years, gender, diagnosis, implant and length of follow-up (within 1 year). From the original group of 46 ankles, we matched 28 ankles, thereby constructing two groups for comparison (matched obesity and control). Results. From the original obesity group (n=46, mean BMI 34.7, age 65.1 years and follow-up 3.5 years), four patients were lost to follow-up. There were 10 revisions (21.7%) including five for liner exchange, four full component and one revision to fusion. Statistically significant (p<0.001) improvements were detected with all outcome measures (AOFAS, AOS and SF-36). In the matched obesity and control groups we used 11 STAR, 11 Mobility and six Hintegra implants. Delayed wound healing affected one patient in each group. In the matched obesity group (mean BMI 35), there were six revisions (three liner exchange, three full component) (21.4%), at a mean of 3.2 years. One patient was lost to follow-up (known to be revised). Statistically significant improvements were noted with all outcome measures. In the control group (mean BMI 26.1), there were three revisions (two liner exchange and one full component) (10.7%), at a mean of 2.3 years. All patients were followed-up. Statistically significant improvements were associated with all outcome measures except the mental component summary of the SF-36 (52.2 to 54, p=0.37). The same score pre-operatively was lower in the matched obesity group (45 vs. 52.2, p=0.193). Overall, no difference was found in mean outcome score improvement between groups. In the matched obesity group, the mean pre-operative AOS pain score was higher (58.8 vs. 46.5) (p=0.016), as was the preoperative AOS disability score (68.4 vs. 58.5) (p=0.082). The mean post-operative AOS pain and disability scores were also higher, although not reaching significance (p=0.096 and p=0.241 respectively). Conclusion. Obesity is associated with greater functional and psychological preoperative burden, although the overall improvement in functional outcome is comparable to non-obese matched controls. Obese patients can expect a significantly higher revision rate (21.4% vs 10.7%) within five years of surgery