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The Bone & Joint Journal
Vol. 103-B, Issue 7 | Pages 1270 - 1276
1 Jul 2021
Townshend DN Bing AJF Clough TM Sharpe IT Goldberg A

Aims. This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods. Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results. In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion. The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270–1276


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_11 | Pages 2 - 2
4 Jun 2024
Townshend D Bing A Clough T Sharpe I Blundell C Davenport J Davies H Davis J Dhar S Goldberg A Karski M Hepple S Kakwani R McKinley J Murty A Ragland M Shalaby H Smith R Taylor H
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Introduction. This is a multi-centre, prospective, observational study of 503 INFINITY fixed bearing total ankle arthroplasties. We report the minimum two-year results of this prosthesis which was introduced to the UK Market in 2014 and is now the most used ankle arthroplasty in the National Joint Registry of England and Wales. Methods. Patients were recruited from 11 centres in the United Kingdom between June 2016 and November 2019. Demographic, radiographic, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Foot Ankle Questionnaire and Euroquol 5D-5L) were collected preoperatively, at 6 months, 1 year and 2 years and 5 years. The average age was 67.8 (range 23.9 to 88.5) and average BMI 29.3 (18.9 to 48.0). The COFAS grading system was used to stratify deformity. There were 261 (51.9%) COFAS Type 1, 122 (24.2%) COFAS Type 2, 31 (6.2%) COFAS 3 and 89 (17.7%) COFAS type 4. 38 patients (7.6%) presented with inflammatory arthritis. 99 (19.7%) implantations utilised patient specific instrumentation. Complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts and/or subsidence. Results. The mean follow up was 34.2 months (range 24–64). 15 patients have died, 8 withdrawn and 3 lost to follow up. 8 implants (1.6%) have been revised. According to the Glazebrook classification there were low grade complications in 6.6%, medium grade in 1.4% and high grade in 1.6%. There have been an additional 13 non revision re-operations (2.6%) at the latest follow up. There was a significant (p < 0.01) improvement across all functional outcome scores at a minimum of 2yr follow up. Discussion and conclusion. This large cohort has shown a low early revision rate and high functional outcomes with a low-profile fixed bearing prosthesis


Bone & Joint Research
Vol. 11, Issue 4 | Pages 189 - 199
13 Apr 2022
Yang Y Li Y Pan Q Bai S Wang H Pan X Ling K Li G

Aims

Treatment for delayed wound healing resulting from peripheral vascular diseases and diabetic foot ulcers remains a challenge. A novel surgical technique named ‘tibial cortex transverse transport’ (TTT) has been developed for treating peripheral ischaemia, with encouraging clinical effects. However, its underlying mechanisms remain unclear. In the present study, we explored the potential biological mechanisms of TTT surgery using various techniques in a rat TTT animal model.

Methods

A novel rat model of TTT was established with a designed external fixator, and effects on wound healing were investigated. Laser speckle perfusion imaging, vessel perfusion, histology, and immunohistochemistry were used to evaluate the wound healing processes.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_14 | Pages 15 - 15
1 Dec 2015
Walter R Harries W Hepple S Winson I
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The Zenith. TM. total ankle replacement (Corin, Cirencester) is a mobile-bearing implant based on the Buechal Pappas design. Key features are the simple fully-jigged instrumentation aiming to improve accuracy and reproducibility of implant positioning, cementless calcium phosphate coated surfaces for improved early osseointegration, and titanium nitride-coated bearing surfaces to resist wear. We present early to mid-term survival data for 155 total ankle replacements implanted by three surgeons in our institute. Case records of all patients undergoing Zenith. TM. Total Ankle Replacement by three senior surgeons, including a member of the design team, between 2007 and 2014 were examined. Patients were examined clinically and radiographically annually after the early postoperative period. The primary outcome measure was implant survival. Secondary outcome measures included complication rates, parameters of radiographic alignment, and radiographic evidence of cysts and loosening. One hundred and fifty-five cases were performed for a mixture of primary pathologies, predominantly primary or posttraumatic arthrosis. Mean follow-up was 50 months. Implant survival was 99.0% at 3 years (n=103), 94.0% at 5 years (n=50), and 93.8% at 7 years (n=16). One patient was revised to arthrodesis for aseptic loosening, one arthrodesis was performed for periprosthetic infection with loosening, and one below-knee amputation was performed for chronic pain. Three cases underwent further surgery to address cysts, and 7 malleolar fractures were reported. Medial gutter pain was experienced by 9% of patients. Overall, our data show excellent early and mid-term survivorship for the Zenith. TM. Total Ankle Replacement. Simple fully-jigged instrumentation allows accurate and reproducible implant alignment


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_2 | Pages 33 - 33
1 Jan 2014
Raglan M Taylor A Dhar S
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Introduction:. Total ankle replacement is a recognised treatment for disabling end stage ankle arthritis and an alternative to arthrodesis, although results are not yet comparable to other joint replacements. This has stimulated a constant evolution in design of implants and instrumentation. The Nottingham Foot and Ankle Unit used the STAR until 2005, when it switched to Mobility, due to the perceived advantages of less bone resection, improved instrumentation and potentially less polyethylene insert wear. The aim of this study is to report the unit's results and review the different outcomes between the two ankle replacements used. Methods:. A retrospective analysis of all total ankle replacements carried out by the foot and ankle unit at Nottingham City Hospital between March 1999 and June 2013. Post operative complications, associated reoperations and revisions were recorded. The American Orthopaedic Foot and Ankle Score (AOFAS), Foot Function Index (FFI), European five dimension quality of life scores (EQ-D5) and patient satisfaction was independently assessed at each follow up visit. Other ankle replacements or those performed elsewhere or with less than 12 month follow up were excluded. Results:. 162 Mobility and 148 STARs' were assessed. The mean follow up was 7 years (1–13 yrs,) STAR and 3.5 years (1–8 yrs) Mobility. Post-operative complication rate of 15% STAR and 13% Mobility, associated operation rate of 15% STAR and 10% Mobility with revision rate of 19% STAR at 13 years and 4.3 % Mobility at 8 years. Both STAR and Mobility groups showed improvements in AOFAS, FFI, EQ-D5 and patient satisfaction, but there were no significant differences between the two groups. Conclusion:. This is one of the largest comparative series of total ankle replacements and shows that patient satisfaction, pain and function is improved. The Mobility total ankle replacement had fewer revisions and complications compared to STAR


Bone & Joint Open
Vol. 2, Issue 7 | Pages 503 - 508
8 Jul 2021
Callaghan CJ McKinley JC

Aims

Arthroplasty has become increasingly popular to treat end-stage ankle arthritis. Iatrogenic posterior neurovascular and tendinous injury have been described from saw cuts. However, it is hypothesized that posterior ankle structures could be damaged by inserting tibial guide pins too deeply and be a potential cause of residual hindfoot pain.

Methods

The preparation steps for ankle arthroplasty were performed using the Infinity total ankle system in five right-sided cadaveric ankles. All tibial guide pins were intentionally inserted past the posterior tibial cortex for assessment. All posterior ankles were subsequently dissected, with the primary endpoint being the presence of direct contact between the structure and pin.


The Bone & Joint Journal
Vol. 102-B, Issue 3 | Pages 345 - 351
1 Mar 2020
Pitts C Alexander B Washington J Barranco H Patel R McGwin G Shah AB

Aims

Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion.

Methods

We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_21 | Pages 10 - 10
1 Apr 2013
Porter K Karia P Szarko M Amin A
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Introduction. Minimally invasive Achilles tendon repair has recently gained popularity amongst foot and ankle surgeons. This study aims to quantify the risk of sural nerve injury when using the Achillon device (Integra), as well as delineate its anatomical relationship to the Achilles tendon. Methods. In 15 cadaveric specimens, the Achilles tendon was transected through a 2cm transverse incision made 4cm proximal to the palpable Achilles tendon insertion point. The Achillon device was inserted beneath the paratenon both proximally and distally and six needle passers mounted with sutures were introduced percutaneously into the tendon (x3 proximal and x3 distal). We dissected around the Achillon jig to determine whether the needle and suture had punctured the sural nerve. We also documented the position of the sural nerve in relation to the Achilles tendon. Results. The mean horizontal distance from the Achilles tendon insertion to the sural nerve was 22.5mm (15.9mm–30.2mm). The mean vertical distance from the Achilles tendon insertion to the point where the sural nerve crosses the lateral border of the tendon was 96.1mm (77.4mm–134.9mm). In 4 out of 15 cadaveric specimens (27%) the sural nerve was punctured. In total, the sural nerve was punctured 6 times (twice in 2 specimens) in 90 needle passes (6.7%). Five out of the 6 punctures occurred when the Achillon device was inserted into the distal tendon portion with the most proximal hole being responsible for 3 of the punctures. Conclusions. The sural nerve displays a highly variable anatomical course and our findings highlight a significant risk of puncture during percutaneous Achilles tendon repair using the Achillon device. More studies are needed to clarify whether this risk equates to a significant clinical problem and whether a change in technique or instrumentation can decrease this risk


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_21 | Pages 11 - 11
1 Apr 2013
Millar T Garg S
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Introduction. Total ankle replacement (TAR) surgery remains a reasonable alternative to arthrodesis in a select group of patients with end stage ankle joint arthritis. We describe the early results of a prospective study of the first 50 Zenith total ankle replacements performed by a single surgeon (SKG). Methods. Demographic details, Visual Analogue Score (VAS) for pain (0, no pain; 10, worst possible pain), AOFAS scores, ‘would have surgery again’ and satisfaction levels were collated, pre-operatively and at their most recent outpatient review. Any post-operative complications were noted. Radiographs were also assessed for evidence of loosening, progressive osteolysis, subsidence and overall alignment of the implant. Results. One patient died at 25 months following surgery from unrelated causes. No patients have been lost to follow up. A review of 50 patients (35 males, 15 females; mean age 65 years, range 44–88 years) with a mean follow up of 30 months (range 11–48) included 48 patients with osteoarthritis and two patients with rheumatoid arthritis. There was one medial malleolar fracture at the time of surgery which required fixation and one fracture of the lateral malleolus which was picked up at the six week review. At their latest review the VAS and AOFAS score had improved significantly and 46 patients were satisfied and 4 patients unsatisfied with the outcome of surgery. One patient has cyst formation around the tibial component but is pain free with a stable implant and does not wish further intervention. The components were satisfactorily aligned in the vast majority of patients. Conclusion. This non-inventor series of the Zenith TAR has shown excellent results in the short term. We feel that the instrumentation allows for more reproducible cuts which appear to be technically easier than with some other designs. However, studies looking at long term results will be necessary


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 4 - 4
1 May 2012
Redfern D
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I consider the term ‘minimally invasive surgery’ (MIS) to represent a wide range of techniques directed at achieving a surgical objective with less collateral tissue damage. The surgeon choosing to employ such techniques may aspire to achieve improved or more consistent outcome for their patients but is this so? What are the complications? In certain areas of surgery the concept of MIS is well established (e.g. knee and ankle arthroscopy). In forefoot surgery the concept has been met with interest but also skepticism. Much of this skepticism pivots around concerns that the loss of direct vision (maintained in arthroscopic techniques) may increase the risk of complications. In other words, there is a concern that due to the loss of direct visualization (replaced by intra-operative xray imaging), any benefit that might arise from the less invasive technique of the operation will be negated by either poorer quality of surgical correction or higher risk of injury to adjacent structures. All surgery is associated with a degree of risk and in considering the complications specifically associated with MIS of the forefoot we must try to separate out those complications related to the specific MIS technique involved and those that are not. In other words, we need to identify whether the complication has occurred as a result of incorrect surgical planning (e.g. wrong choice of osteotomy/flaws in surgical objective), poor execution of the surgical technique, or as a result of the MIS instrumentation/equipment. I will discuss the above in relation to my experience of complications encountered whilst employing minimally invasive surgical techniques in the treatment of forefoot pathology over the last 2 years


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXII | Pages 24 - 24
1 May 2012
Saltzman C
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Technique, inducations, complications and early outcomes with posterior ankle and subtalar arthroscopy. A. ANKLE ARTHROSCOPY: Tips and Pearls on Avoiding Complications. a. Introduction. i. understanding of the anatomy of the foot and ankle is critical to safe performance of arthroscopic procedures and prevention of complications. ii. understanding of the surface and intra-articular anatomy of the ankle/subtalaar region is essential. iii. topographical anatomy serves as a guide to the successful placement of arthroscopic portals in the ankle. iv. neurovascular and tendinous structures are most at risk. b. Indications for Posterior/Subtalar Arthroscopy. i. Posterior ankle/ST Impingement. ii. OLT Ankle (usually posteromedial). iii. Assist operative reduction of calc or post mal fractures. iv. Arthrodesis ankle/ST or both. c. Portals. i. Know the anatomy, use blunt dissection, minimize re-entry. ii. Preoperative plan for access, pathology, visualization. d. Prone Position. a. Posteromedial. b. Posterolateral. c. Accessory posterolateral. e. Set-up/instrumentation. i. Positioning -. ii. posterior, prone. iii. Distraction- non-invasive vs invasive (trans-calcaneal thin wire). iv. Equipment - general set-up/instruments. - scopes (4.0 for outside joint or fusions; 2.7 otherwise). - irrigation/pump (run at lowest flow possible). f. Tips on Avoiding Complications. i. Patient selection and education. ii. Careful preoperative planning, evaluation. iii. Know/respect your anatomy. iv. Meticulous portal placement/care. v. Limit operative time/distension/tissue damage. vi. Use mini C-arm to monitor. vii. Plan, plan and plan, if you are prepared, all will work out. viii. Rehabilitation protocol and follow up


The Bone & Joint Journal
Vol. 101-B, Issue 1 | Pages 47 - 54
1 Jan 2019
Clough T Bodo K Majeed H Davenport J Karski M

Aims

We report the long-term clinical and radiological outcomes of a consecutive series of 200 total ankle arthroplasties (TAAs, 184 patients) at a single centre using the Scandinavian Total Ankle Replacement (STAR) implants.

Patients and Methods

Between November 1993 and February 2000, 200 consecutive STAR prostheses were implanted in 184 patients by a single surgeon. Demographic and clinical data were collected prospectively and the last available status was recorded for further survival analysis. All surviving patients underwent regular clinical and radiological review. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scoring system. The principal endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan–Meier survival curves were generated with 95% confidence intervals and the rate of failure calculated for each year.


The Bone & Joint Journal
Vol. 98-B, Issue 9 | Pages 1202 - 1207
1 Sep 2016
Jeyaseelan L Chandrashekar S Mulligan A Bosman HA Watson AJS

Aims

The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus.

Patients and Methods

We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction.

The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51).


The Bone & Joint Journal
Vol. 98-B, Issue 5 | Pages 634 - 640
1 May 2016
Pedowitz DI Kane JM Smith GM Saffel HL Comer C Raikin SM

Aims

Few reports compare the contribution of the talonavicular articulation to overall range of movement in the sagittal plane after total ankle arthroplasty (TAA) and tibiotalar arthrodesis. The purpose of this study was to assess changes in ROM and functional outcomes following tibiotalar arthrodesis and TAA.

Patients and Methods

Patients who underwent isolated tibiotalar arthrodesis or TAA with greater than two-year follow-up were enrolled in the study. Overall arc of movement and talonavicular movement in the sagittal plane were assessed with weight-bearing lateral maximum dorsiflexion and plantarflexion radiographs. All patients completed Short Form-12 version 2.0 questionnaires, visual analogue scale for pain (VAS) scores, and the Foot and Ankle Ability Measure (FAAM).


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 6 | Pages 807 - 810
1 Jun 2010
Sansone V Morandi A Dupplicato P Ungaro E

There are few reports of the surgical treatment for late stage Freiburg’s disease with flattening of the metatarsal head and osteoarthritis. We describe the results of the surgical treatment of ten consecutive patients with advanced stage Freiburg’s disease (Smillie’s stage V), using a technique that has not been published previously.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 1 | Pages 61 - 65
1 Jan 2010
Morgan SS Brooke B Harris NJ

We present the outcomes in 38 consecutive patients who had total ankle replacement using the Ankle Evolution System with a minimum follow-up of four years. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and regular standardised anteroposterior and lateral weight-bearing radiographs were obtained. Patient satisfaction and complications were recorded and the survival of the implants was demonstrated by the Kaplan-Meier method.

The mean follow-up was for 57.8 months (48 to 80). The cumulative survival rate at six years was 94.7% (95% confidence interval 80.3 to 98.7). The mean total AOFAS score was 88.1 (53 to 100). The mean score for pain was 35.8 (20 to 40). Ten patients presented with edge-loading of whom nine had corrective surgery. Two ankles were revised, one to an arthrodesis and the other to replace the tibial component. Nine patients showed radiological evidence of osteolysis. They had minimal non-progressive symptoms and further surgery was not undertaken. Nevertheless, the concerns about osteolysis led to the implant being withdrawn by the manufacturer.

The medium-term results of the ankle evolution system ankle replacement are satisfactory with high patient satisfaction, but the rate of osteolysis is of some concern. The long-term benefit of this procedure has yet to be determined.


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 10 | Pages 1322 - 1325
1 Oct 2009
El-Gafary KAM Mostafa KM Al-adly WY

Charcot osteoarthropathy of the foot is a chronic and progressive disease of bone and joint associated with a risk of amputation. The main problems encountered in this process are osteopenia, fragmentation of the bones of the foot and ankle, joint subluxation or even dislocation, ulceration of the skin and the development of deep sepsis. We report our experience of a series of 20 patients with Charcot osteoarthropathy of the foot and ankle treated with an Ilizarov external fixator. The mean age of the group was 30 years (21 to 50). Diabetes mellitus was the underlying cause in 18 patients. Five had chronic ulcers involving the foot and ankle. Each patient had an open lengthening of the tendo Achillis with excision of all necrotic and loose bone from the ankle, subtalar and midtarsal joints when needed. The resulting defect was packed with corticocancellous bone graft harvested from the iliac crest and an Ilizarov external fixator was applied. Arthrodesis was achieved after a mean of 18 weeks (15 to 20), with healing of the skin ulcers. Pin track infection was not uncommon, but no frame had to be removed before the arthrodesis was sound.

Every patient was able to resume wearing regular shoes after a mean of 26.5 weeks (20 to 45).


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 11 | Pages 1457 - 1461
1 Nov 2008
Lee K Chung J Song E Seon J Bai L

We describe the surgical technique and results of arthroscopic subtalar release in 17 patients (17 feet) with painful subtalar stiffness following an intra-articular calcaneal fracture of Sanders’ type II or III. The mean duration from injury to arthroscopic release was 11.3 months (6.4 to 36) and the mean follow-up after release was 16.8 months (12 to 25). The patient was positioned laterally and three arthroscopic portals were placed anterolaterally, centrally and posterolaterally. The sinus tarsi and lateral gutter were debrided of fibrous tissue and the posterior talocalcaneal facet was released. In all, six patients were very satisfied, eight were satisfied and three were dissatisfied with their results. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved from a mean of 49.4 points (35 to 66) pre-operatively to a mean of 79.6 points (51 to 95). All patients reported improvement in movement of the subtalar joint. No complications occurred following operation, but two patients subsequently required subtalar arthrodesis for continuing pain.

In the majority of patients a functional improvement in hindfoot function was obtained following arthroscopic release of the subtalar joint for stiffness and pain secondary to Sanders type II and III fractures of the calcaneum.