Although first generation total ankle replacement (TAR) had high failure rates, recent investigations have reported good results of the newer generations of TAR due to advances in implant designs and techniques. Patient selection is critical to performing TAR to obtain promising outcomes and to decrease complication rate. As the current concepts of correcting the accompanying deformity have been established, TAR in moderate to severe varus deformity of the ankle result in favorable outcomes and indications for TAR are expanding. Correction of deformity and hindfoot fusion should be performed in conjunction with TAR if needed. If radiolucency around components or osteolysis is progressive during follow-up, CT should be carried out as a confirmative diagnostic method. TAR is an effective treatment modality alternative to ankle fusion. However, we should recognize that TAR is a demanding procedure, which requires accurate techniques, enough experience, and preoperative plan for a concomitant deformity.
Animals ; Ankle ; Arthroplasty ; Arthroplasty, Replacement, Ankle ; Congenital Abnormalities ; Family Characteristics ; Follow-Up Studies ; Osteolysis ; Patient Selection

With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.
Ankle* ; Arthritis ; Arthrodesis ; Arthroplasty* ; Arthroplasty, Replacement, Ankle ; Magnetic Resonance Imaging ; Multimodal Imaging ; Radiography

PURPOSE: We evaluated the complications and failures after total ankle arthroplasty during at least 2 years short term follow up. MATERIALS AND METHODS: There were 45 cases of 42 patients of HINTEGRA(R) (Newdeal SA, Lyon, France) model from November 2004 to August 2006. Follow up averaged at least 2 year. We evaluated the complications and analyzed the cause of the failures. RESULTS: There were totally 15 cases of complication, 5 cases of medial impingement syndrome, 3 cases of varus malposition, 2 cases of delayed healing of wounds, and each one case of deep peroneal nerve problem, medial malleolus fracture, post-operative deep infection, gouty arthritis pain, and Achilles tendinitis. CONCLUSION: Total ankle arthroplasty had higher complication rate than any other joint arthroplasty, so we need a more meticulous preoperative and peri-operative care.
Animals ; Ankle ; Arthritis, Gouty ; Arthroplasty ; Arthroplasty, Replacement, Ankle ; Follow-Up Studies ; Humans ; Joints ; Peroneal Nerve

PURPOSE: Recently, minimally constrained 3-component total ankle systems have been often performed to address painful ankle arthritis. We report early clinical and radiographic outcome of the total ankle arthroplasty with Mobility system for end-stage ankle arthritis. MATERIALS AND METHODS: Total ankle arthroplasty was performed with Mobility total ankle system in 40 ankles (39 patients) from November 2008 to January 2013. The mean age at surgery was 63.7 years (range, 50-78 years). The mean follow-up duration was 20.8 months (range, 12-56 months). The primary etiology for ankle arthritis was post-traumatic arthritis (26 ankles, 65%). The outcome was assessed based on visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot function score, patient satisfaction and radiographic measurements. RESULTS: There was a significant reduction in VAS pain score from an initial average of 7.7 points (range, 5-10 points) to 2.8 points at the final follow-up (range, 0-7) (p<0.05). The mean AOFAS score improved significantly from 46.8 (range, 15-68) preoperatively to postoperatively 82.4 (range, 63-100) (p<0.05). Eighty-one percent of patients were satisfied with the result. Combined surgeries, such as Achilles tendon percutaneous lengthening, were performed in twenty-one cases of 40 ankles. CONCLUSION: The current short term results of Mobility total ankle arthroplasty showed a quite favorable functional and radiographical outcome with few major complications. However, the long term follow-up study with larger number of cases is needed in the future.
Achilles Tendon ; Ankle* ; Arthritis ; Arthroplasty* ; Arthroplasty, Replacement, Ankle ; Follow-Up Studies ; Foot ; Humans ; Patient Satisfaction

OBJECTIVE: To systematically review the clinical efficacy of total ankle arthroplasty (TAA) and ankle arthrodesis (AA) in the treatment of end-stage ankle arthritis. METHODS: The PubMed, EMBASE and Cochrane Library databases were searched for articles published in the treatment of end-stage ankle arthritis with AA or TAA from the establishment of the database to June 2021. Bias risk tool was used to evaluate the quality of the literature. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS), visual analog scale (VAS), ankle osteoarthritis scale(AOS), gait analysis (pace, frequency, stride), range of motion (ROM), satisfaction, complications and reoperation rate were analyzed by meta-analysis between AA and TAA groups by RevMan 5.3 software. RESULTS: A total of 12 articles were included, including 1 050 patients in the AA group and 3 760 patients in the TAA group, totaling 4 810 patients. Meta-analysis showed that the total score of AOFAS[MD=-3.12, 95%CI(-9.02, 2.96), P=0.31], pain score [MD=1.60, 95%CI(-1.35, 4.54), P=0.29], alignmentl score[MD=-0.04, 95%CI(-0.52, 0.44), P=0.88], VAS[MD=0.10, 95%CI(-0.49, 0.68), P=0.74], and AOS total score [MD=-4.01, 95%CI(-8.28, 0.25), P=0.06], the difference was not statistically significant (P>0.05). The score of AOFAS functional in TAA group was significantly higher than that in TAA group[MD=44.22, 95%CI(-8.01, -0.43), P=0.03]. There was no significant difference in gait analysis between the two groups (P>0.05). Postoperative ROM [MD=-4.93, 95%CI(-6.35, -3.52), P<0.000 01] and change in ROM from preoperative to follow-up[MD=-5.74, 95%CI(-8.88, -2.61), P=0.0003] between two groups, the difference was statistically significant. There was no significant difference in satisfaction between the two groups [OR=1.011, 95%CI(0.46, 2.23), P=0.98]. Complications [OR=1.61, 95%CI(1.26, 2.06), P=0.0002] and non-revision reoperation [OR=1.61, 95%CI(1.17, 2.21), P=0.003] were significantly lower in the TAA group than in the AA group. There was no significant difference in the rate of revision and reoperation(P>0.05) between the two groups [OR=1.02, 95%CI(0.37, 2.78), P=0.97]. CONCLUSION The clinical efficacy of AA is similar to that of TAA, but the non revision reoperation rate and main surgical complications of TAA are significantly reduced. Therefore, further high-quality methodological research and long-term follow-up are needed to confirm this conclusion.
Humans ; Ankle/surgery* ; Ankle Joint/surgery* ; Arthroplasty, Replacement, Ankle ; Treatment Outcome ; Osteoarthritis/surgery* ; Arthrodesis ; Retrospective Studies

Pigmented villonodular synovitis (PVNS) is a rare proliferative disease affecting joint synovium, tendon sheaths, bursae. The usual treatment for PVNS is a surgical excision. If destructive joint lesions have occurred, complete resections must be performed followed by arthrodesis or arthroplasty. We report a case of a pigmented villonodular synovitis involving an ankle joint which was treated by total ankle replacement for recurrence after simple synovectomy.
Animals ; Ankle ; Ankle Joint ; Arthrodesis ; Arthroplasty ; Arthroplasty, Replacement, Ankle ; Joints ; Recurrence ; Synovial Membrane ; Synovitis, Pigmented Villonodular ; Tendons

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.
Ankle Joint ; Ankle* ; Arthroplasty* ; Arthroplasty, Replacement, Ankle ; Dislocations ; Female ; Head ; Humans ; Limb Salvage ; Middle Aged ; Necrosis ; Prostheses and Implants ; Talus ; Transplants

PURPOSE: This study aims to identify the effectiveness of the medial cortical line for attaining a more accurate tibial component alignment in proximal tibial resection using an extramedullary alignment rod. MATERIALS AND METHODS: The study examined 100 cases of total knee arthroplasty performed from December 2013 to February 2014 in a retrospective manner. On a preoperative anteroposterior (AP) radiograph of the entire tibia, we identified the medial cortical line that runs parallel to the tibial anatomical axis and passes the medial tibial spine, and measured the point where the medial cortical line crosses between the medial malleolus and the lateral malleolus in the ankle joint. RESULTS: The preoperative AP radiograph of the tibia showed the medial cortical line passing the point 40.4%±0.8% medial to the distance from the medial malleolus to the lateral malleolus including the skin thickness in the ankle joint. When the proximal tibial resection was performed with the extramedullary tibial cutting guide aligned with the medial cortical line, the tibial component angle averaged 0.7°±0.3° varus and the alignment accuracy of the tibial component within 0°±3° varus amounted to 97.0%. CONCLUSIONS: The use of the medial cortical line in proximal tibial resection with an extramedullary tibial cutting guide allowed for relatively accurate alignment of the tibial component.
Ankle Joint ; Arthroplasty ; Arthroplasty, Replacement, Knee ; Knee ; Retrospective Studies ; Skin ; Spine ; Tibia

PURPOSE: Ankle fusion that is operated on severe ankle arthritis has its weakness in that normal walking is impossible, even though the result is pretty good. As a alternative choice, total ankle replacement pursues the longer survivorship with material improvement. However, it is not yet known how much range of motion is possible after the replacement, or how it has changed overtime. Therefore, we need an analyzation for that. MATERIALS AND METHODS: A retrospective review of sixty-seven patients undergoing STAR total ankle replacement at our institution between 1998 and 2002 was conducted. Of those, twenty-six (39%) had complete sets of full dorsiflexion and plantar flexion lateral radiographs both between "immediate" postop and at a minimum of 2-years follow-up and no revision procedure during that time. The mean age of these patients was 63.2 years when the surgery was done; the etiology of arthrosis was 21(81%) post-traumatic/degenerative, 4 rheumatoid and 1 psoriatic. RESULTS: Average "immediate" ankle range of motion was 15.9 degrees, and total foot (non-ankle) motion was 20.6 degrees. At one, two, and three years the average ankle and total foot ranges of motion were 17.4 degrees, 17.6 degrees, 15.6 degrees and 21.0 degrees, 22.0 degrees, 21.2 degrees respectively. Statistically there was no significant difference between "immediate" postop motion and one to three years postop (all p>0.05). CONCLUSION: The range of motion after the STAR total ankle replacement is maintained from the "immediate" postoperative range of motion, but not increased, in the 1-3 year post replacement period.
Ankle ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Ankle* ; Follow-Up Studies ; Foot ; Humans ; Range of Motion, Articular ; Retrospective Studies ; Survival Rate ; Walking

PURPOSE: We report the clinical and radiographic result of ligament reconstruction using plantaris and total ankle replacement in end-stage ankle arthritis with ankle instability. MATERIALS AND METHODS: The study is based on the 9 cases among total 48 patients of end-stage ankle arthritis that were treated with total ankle prosthesis and ligament reconstruction from 2007 to 2009 at least 12 months follow-up. We evaluated the VAS (Visual analogue scale) pain score, AOFAS (American orthopedic foot and ankle society) score and radiographic measurements. RESULTS: Average age was 59.4 years (53~67 years) old. VAS pain score improved from preoperative average 8.2+/-0.9 (range, 7~10) to 2.7+/-1.7 (range, 0~6) and the AOFAS score improved from 46.4+/-14.6 points (range, 23~69) to 80.1+/-9.3 points (range, 65~95) at final follow-up. Anterior draw test improved 15.2+/-3.4 mm (range, 12~23 mm) to 8.8+/-2.6 mm (range, 6~13mm),varus stress test improved from 13.9+/-4.6degrees (range,10-18degrees) to 6.2+/-4.7degrees (range,2-18degrees) at final follow up. CONCLUSION: Plantaris ligament reconstruction is good option as part of the management of ankle instability with end-stage ankle arthritis. We achieved good clinical and radiographic results.
Animals ; Ankle ; Arthritis ; Arthroplasty ; Arthroplasty, Replacement, Ankle ; Exercise Test ; Follow-Up Studies ; Foot ; Humans ; Ligaments ; Orthopedics ; Prostheses and Implants