Aims. The Vantage Total Ankle System is a fourth-generation low-profile fixed-bearing implant that has been available since 2016. We aimed to describe our early experience with this implant. Methods. This is a single-centre retrospective review of patients who underwent primary total ankle arthroplasty (TAA) with a Vantage implant between November 2017 and February 2020, with a minimum of two years’ follow-up. Four surgeons contributed patients. The primary outcome was reoperation and revision rate of the Vantage implant at two years. Secondary outcomes included radiological alignment, peri-implant complications, and pre- and postoperative patient-reported outcomes. Results. There were 168 patients (171 ankles) included with a mean follow-up of 2.81 years (2 to 4.6) and mean age of 63.0 years (SD 9.4). Of the ten ankles with implant failure (5.8%), six had loosening of the tibial component. In the remaining four failed implants, one was due to periprosthetic joint infection (PJI), one was due to loosening of the talar component, and two were due to loosening of both the tibial and talar components. Seven patients underwent reoperation: irrigation and debridement for superficial infection (n = 4); bone grafting for cysts (n = 2); and open reduction internal fixation (n = 1). Asymptomatic peri-implant lucency/subsidence occurred in 20.1% of ankles, with the majority involving the tibial component (n = 25). There were statistically significant improvements in PROMs in all domains. Conclusion. Short-term results of this implant demonstrate early survival comparable to the reported survivorship of similar low-profile, non-stemmed implants. Radiological lucency occurred more commonly at the tibial component, and revisions occurred primarily due to loosening of the tibial component. Further research is needed to evaluate longer-term survivorship. Cite this article: Bone Joint J 2023;105-B(10):1099–1107

Introduction. Total ankle arthroplasty (TAA) is an increasingly popular treatment option for patients with end-stage ankle arthritis. However, for most implant systems, failure rates of 10–20% have been reported within the first 10 years after primary TAA. Pain is the primary symptom that indicates failure of TAA but cause of it can be difficult to establish. Methods. All patients who underwent a primary TAA at our center were included in the study. The clinical outcomes were studied for patients requiring a further revision procedure following primary TAA. The reasons for revision surgery and outcomes of surgery were analyzed using appropriate inferential statistical tests. Results. Between 2007 and 2018, 42 primary TAA required revisions in 40 patients. There were 25 men (59.5%) and 15 women (35.7%) with mean age of 57.5 years the time of primary TAA. All patients had undergone primary procedure at a mean duration of 3.5 years previously (range: 3 months to 10 years). Of the total revision procedures, 12/40 (30%) of revisions were carried out due to malalignment, 10/42 (23.8%) due to loosening of the implants or bone subsidence, 5/42 procedures (11.9%) following infection, 4/42 (9.5%) due to polyethylene migration, 1/42 (2.3%) due to fracture and 1/42 (2.3%) due to Charcot arthropathy. In 9/42 (21.4%) cases, imaging showed no objective reason for pain. 50% of patients who underwent revision TAA reported 78.5% satisfaction with results of surgery at 2 years follow up post-operatively. Conclusion. Major reasons for revising primary TAR at our centre are mal-alignment, implant loosening / bone subsidence and suspicion of infection and pain. In-spite of undergoing a complex revision surgery, patients report 78.5% satisfaction from outcomes of surgery

Aims. This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. Methods. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up. Results. A total of 86 patients were evaluated at a mean follow-up of 65.4 months (60 to 90). At five-year follow-up, statistically significant improvements (p < 0.001) were found in the mean American Orthopaedic Foot & Ankle Society Ankle Hindfoot Score (from 33.8 (SD 14.3) to 86.1 (SD 8.8)), visual analogue scale for pain (from 8.5 (SD 1.7) to 1.5 (SD 1.2)), Short Form-12 Physical and Mental Component Scores (from 29.9 (SD 6.7) and 43.3 (SD 8.6) to 47.3 (SD 7.5) and 52.2 (SD 8.0), respectively), and mean ankle dorsiflexion and plantarflexion (from 6.2° (SD 5.5°) and 9.6° (SD 5.8°) to 23.9° (SD 7.7°) and 16.9° (SD 7.2°), respectively). Radiologically, the implants maintained neutral alignment without subsidence. Tibial or talar radiolucency was found in eight patients, but none of these patients was symptomatic. At five-year follow up, 97.7% of implants (95% confidence interval 91.2 to 99.4) were free from revision or removal with 84 implants at risk. We recorded two cases (2.3%) of failure for septic loosening. Conclusion. Transfibular TAA is safe and effective with a high survival rate at mid-term follow-up and satisfactory clinical and radiological results. Further studies are required to determine the long-term performance of these implants. Cite this article: Bone Joint J 2022;104-B(4):472–478

Background. The literature on the outcome of revision total ankle arthroplasty (TAA) remains limited. We aim to report the clinical and radiological outcomes of revision TAA at a high-volume centre in the UK. Methods. Retrospective review of 28 patients that underwent 29 revision TAA procedures using INBONE II prosthesis. Demographic, radiological, and patient reported outcome measures data were analysed. Results. The mean (range) duration from primary TAA to revision was 87.5 (16–223) months. The main indication for the revision was aseptic loosening of the primary TAA (82.8%). Additional procedures were required in 75.9% of patients. At mean (range) follow-up of 40 (24- 60) months, the infection, re-operation, and implant survival rates were 6.9%, 6.9% and 96.5% respectively. A significant postoperative improvement in the component alignment radiographic measures was observed. Osteolysis, subsidence, loosening and heterotopic ossification rates were comparable to other reports and did not influence the clinical outcome. A significant improvement was observed in the MOXFQ (all domains) and the EQ-5D (three domains) at 24 months postoperatively. Conclusions. Revision TAA using INBONE II was associated with good short-term survival and improvement in the postoperative scores at 2 years. Maintenance of the postoperatively improved alignment was documented at follow up. The relatively high survival rate in this series supports the notion that revision TAA is a satisfactory option for failed primary TAA

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

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

Aims

The Cartiva synthetic cartilage implant (SCI) entered mainstream use in the management of first metatarsophalangeal joint (MTPJ) arthritis following the positive results of large trials in 2016. Limited information is available on the longer-term outcomes of this implant within the literature, particularly when independent from the originator. This single-centre cohort study investigates the efficacy of the Cartiva SCI at up to five years.

Aims

The purpose of this study was to assess the success rate and functional outcomes of bone grafting for periprosthetic bone cysts following total ankle arthroplasty (TAA). Additionally, we evaluated the rate of graft incorporation and identified associated predisposing factors using CT scan.

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Implant failure has become more common as the number of primary total ankle arthroplasties (TAAs) performed has increased. Although revision arthroplasty has gained attention for functional preservation, the long-term results remain unclear. This study aimed to assess the long-term outcomes of revision TAA using a mobile-bearing prosthesis in a considerably large cohort; the risk factors for failure were also determined.

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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.

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We report the medium-term outcomes of a consecutive series of 118 Zenith total ankle arthroplasties (TAAs) from a single, non-designer centre.

Background. Revision total ankle arthroplasty (TAA) can be extremely challenging due to bone loss and deformity. We present the results examining the preliminary indications and short term outcomes for the use of the Salto XT revision prosthesis. Material and methods. We conducted an IRB approved prospective review revision TAA performed in two institutions using the Salto XT. There were 40 patients (24 females and 16 males with an average age of 65 years (45–83), who had undergone previous TAA (Agility 27, Salto 4, STAR 4, Buechal Pappas 1), and 4 patients who underwent staged procedures for infection. The primary indications for the revision were loosening and subsidence (34), malalignment (17), cyst formation (8), infection (4). Results. Severe bone loss of the talus (30) and distal tibia (5) caused by erosion or cysts (8) were treated with cancellous bone graft (33), cement (7), or a combination (12). A press fit of the tibial component was obtained in 25 cases, and of the talus in 17. The talar component was seated directly onto the calcaneus in 4 cases supplemented anteriorly by cancellous bone graft. Patients were followed up for an average of 24.2 months (range 12–36 months). The overall complication rate was 25%. An 85% survivorship of the revision TAA was achieved (4 cases of postoperative infection and 2 cases of implant loosening). At the last follow-up visit, the remaining 34 implants were stable and none had loosened nor failed. Conclusion. Revision ankle replacement with bone loss is a technically challenging procedure with acceptable outcomes for the patient but an 85% survivorship even in the short term. We noted the complexity yet feasibility of performing revision TAA, and determined that the stability of the prosthesis was important. The short term survivorship indicates a likely higher rate of failure in the longer term

Aims

The purpose of this study is to examine the adductus impact on the second metatarsal by the nonosteotomy nonarthrodesis syndesmosis procedure for the hallux valgus deformity correction, and how it would affect the mechanical function of the forefoot in walking. For correcting the metatarsus primus varus deformity of hallux valgus feet, the syndesmosis procedure binds first metatarsal to the second metatarsal with intermetatarsal cerclage sutures.

Background. Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint (MTPJ) of the great toe, which can result in significant pain and stiffness. Treatment using joint replacement, either by means of hemiarthroplasty or total arthroplasty of the metatarsophalangeal joint is becoming an increasingly popular option for patients with severe disease. Aim. To evaluate mid-term functional and radiological outcomes of a widely used first generation resurfacing arthroplasty system in the treatment of hallux rigidus. Method. Prospective review of patients from 2009 onwards. All patients were operated on by the senior author using the same first generation hemiarthroplasty prosthesis (HemiCAP®, Arthrosurface, USA) and surgical technique. Radiological and clinical outcomes were assessed at 3, 6, 12 and 24 months post-operatively. Patients were assessed pre- and post-operatively on an outpatient basis for MTPJ range of motion as well as outcomes using AOFAS and visual analogue scale scores. Results. 20 prostheses in 19 patients over a two year period. Mean follow-up was 18 months (range 12–24). Mean AOFAS score improved from 38.66 pre-operatively to 74.93 at 12 months post-operatively. Mean VAS score improved from 9.95 pre-operatively to 4.05 post-operatively. There was radiological subsidence in one patient. 5 patients (26%) required revision to arthrodesis due to ongoing pain and stiffness. Conclusion. Despite significant improvements in functional scores and positive radiological outcomes in most patients, we have seen high revision rates with this first generation prosthesis due to ongoing pain and stiffness. Since this study, there has been a redesign of this implant with the addition of a dorsal flange, but the first generation prosthesis still remains in use. Following our results, we have discontinued our use of this product in favour of either the newer generation hemiarthroplasty or total arthroplasty system for patients with severe hallux rigidus

Introduction:. We report the outcomes of salvage procedures in total ankle replacement (TAR) in a single surgeon series. Methods:. This study was a retrospective review of patients who had undergone salvage procedures with tibio-talo-calcaneal (TTC) fusion for failed TAR over a period from 1999–2013 in a single centre. In this period, 317 TAR were performed of which 11 have failed necessitating conversion to TTC fusion. Clinical documentation and radiographs were reviewed for cause of failure, type of graft for fusion, time to radiological/clinical union and complications including further surgeries. Results:. The causes of failure of the TAR were pain from instability/impingement in 8, fracture in one, subsidence of the talar component in one and infection in one. From the group of 11 patients, 8 patients went onto union at a mean of 10 months (7–14). All 8 patients had femoral head structural allografts to maintain limb length for the procedure and 3 required a secondary procedure to dynamise the nail. 2 patients with femoral head structural allografts developed infections necessitating removal of the graft and conversion to an external fixator of which one united and the other developed a painless fibrous union. 1 patient developed non-union with progressive deformity of the ankle resulting in a Symes amputation. Conclusions:. From our series of patients we have demonstrated that failure of TAR requiring salvage procedures is a relatively rare event (3.5%). The use of TTC fusion is successful in the majority of patients and the use of femoral head structural allografts allows preservation of leg length with good rates of union

Aims

Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°.

Introduction:. Prompted by the success of hip and knee arthroplasty, total ankle replacement (TAR) has become increasingly popular as a treatment for end stage arthritic complaints of the ankle. Glazebrook et al proposed a three grade classification of complications to assist prediction of early implant failure. We have compared the experience of a tertiary referral centre in the UK to Glazebrook's proposed system. Method:. A retrospective review of the Sheffield Foot and Ankle Unit TAR database was performed from 1995 to 2010. All complications were recorded and categorised using Glazebrook's proposed system. Glazebrook described eight main complications of increasing severity. Low grade complications; Post operative bone fracture, Intra-operative bone fracture and wound healing problems were very unlikely to lead to revision. Medium grade complications; technical error and subsidence, lead to failure < 50% of the time. High grade complications; deep infection, aseptic loosening and implant failure lead to revision > 50% of the time. Results:. 217 TAR were implanted in 198 patients with a minimum follow up of 30 months. The complication rate was 23% with a revision rate of 17%. All complications recorded in our study except intraoperative bone fracture and wound healing had a failure rate of at least 50%. Conclusion:. The proposed classification system of Glazebrook et al was the first step towards an international system of classifying TAR complications. Most complications associated with TAR have a significant impact on the lifespan of a TAR. Glazebrook et al's proposed three tier system did not reliably reflect our experience. We would categorise complications as either high or low risk for early failure of TAR

Aims

Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR.

Total ankle replacement (TAR) is increasingly offered as an alternative to ankle fusion for the management of severe ankle arthritis. As with all other types of joint arthroplasty, there are risks involved and complications that occur; these increase with case complexity. We present the complications and management from a single-centre series. Since 2006, we have performed 150 Mobility TARs with up to 4 years' follow-up. We have excluded 16 that are part of a separate RCT and 10 with less than 3 months' follow-up. 124 TARs were included in our study (117 patients). Three ankles (2.4%) had superficial wound infections treated successfully with antibiotics. One ankle (0.8%) required an arthroscopic washout and debridement but the implant was retained. 11 ankles (8.9%) had a periprosthetic fracture: One was intraoperative; 10 were postoperative (2 fixed). Four patients (3.2%) developed CRPS. One ankle required fusion surgery (following subsidence of the talar component) with another one pending revision (ligament instability causing implant displacement). No patient had a symptomatic deep vein thrombosis or thromboembolic event. Our figures are comparable with other series. Our complication rate has not changed significantly over time. Our results, at present, suggest that most complications (98%) with the Mobility TAR can be satisfactorily managed without having a detrimental effect on the implant. There have been proven and promising results with total ankle replacement. However, there is a significant complication rate that must be made clear to the patient via informed consent; the rate still remains higher than for hip and knee arthroplasty

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