Search

Introduction/Purpose: Current available total ankle replacement constructs offer either proximal projecting pegs (nonstemmed) in various shapes or large stem (stemmed) designs to the superior aspect of the tibia component. Each design offers inherent stability and unique function. Periprosthetic radiolucency can develop post-operatively and lead to adverse effects. However, the incidence and clinical significance of lucency formation amongst stemmed and non-stemmed constructs is poorly understood. Methods: A retrospective radiographic and chart analysis was performed of 256 patients, under a single orthopedic practice, who underwent primary TAA between 2013-2019 with one of 3 total ankle systems. Pre-operative ankle characteristics, intraoperative procedures, as well as post-operative angles, lucency formation, region of lucency formation, and patient outcomes were analyzed. Results: Patients' mean age 65.5 yrs., male n=126 and female n=127, a mean follow-up of 24.3 months for our patient cohort. A total of 149 stemmed and 107 non-stemmed constructs were analyzed. Incidence of periprosthetic tibial lucency formation 33.2%, stemmed implants 10.0%, and 65.4% for non-stemmed implant (p value 0.00001). Conclusion: This paper describes the incidence of periprosthetic formation amongst a stemmed and non-stemmed total ankle arthroplasty cohort. Statistical significance was found when analyzing stemmed vs. non-stemmed incidence of radiolucency formation, this did not correlate with increased incidence of post-operative complications. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Periprosthetic joint infection (PJI) is a devastating complication of arthroplasty. The well known PJI risk factors are useful for identifying high-risk patients but would be even more helpful for clinical decision-making if they are converted to a risk assessment scores. The Mayo Prosthetic Joint Infection Risk Score was based on the data of total hip and knee arthroplasty and has not been validated for application for total ankle arthroplasty. Methods: A series of 398 consecutive cases of total ankle arthroplasty, with minimal follow-up of 6 months, was reviewed for Mayo Periprosthetic Joint Infection Risk Score (Mayo score) and PJI. The patients' Mayo scores and PJI was examined by logistic regression. T-test was performed to compare the Mayo score between the non-infected TAA cases and infected cases. Receiver Operating Characteristic (ROC) was used to identify the critical value of Mayo score for total ankle arthroplasty. Results: There were 12 cases of PJI or 3.0% in the series. Of the 398 patients, the Mayo scores were in the range from -4 to 13 (median 2; interquartile range (IQR) 0-4). Preliminary analysis showed that, by logistic regression, the probability of PJI was increased as increases of the Mayo scores (Fig A). The mean Mayo score of the PJI patients (8.6+-1.8) was significantly greater than the rest of the patients (mean Mayo score 1.9+-3.4; p < .0001). ROC analysis showed that, when a Mayo score was greater than 5, the patient has a high probability of PJI (sensitivity = 100%; specificity = 86.9%; Fig B). Conclusion: This study showed a high correlation between the Mayo score and PJI in total ankle arthroplasty, which is the same trend as in total knee and hip arthroplasty. The preliminary results suggest that strategically focusing on the patients, who have a Mayo score > 5, could be a more efficient approach to prevent PJI after total ankle arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Physical therapy (PT) following total ankle arthroplasty (TAA) is often considered, but guidelines for its use are not standardized. While there may be patient factors that dictate recommendations, establishing a baseline of utilization practices may set the stage for establishing generalizable recommendations. Methods: This retrospective cohort study employed data from the 2010 to 2019 M91Ortho PearlDiver administrative dataset. Those undergoing TAA were identified based on coding, and patient factors were extracted, including: age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which patients' surgery was performed (midwest, northeast, south, west), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, and frequency of PT utilization in the 90-days following TAA were identified as occurring at home or in an outpatient setting. Univariate and multivariate logistic regression analyses allowed the identification of predictive factors for PT utilization. Results: Of 6,563 TAA patients identified, 2788 (42.5%) utilized postoperative PT services. Most services were done as an outpatient (63.4%), compared to at home (6.1%). Weekly utilization of PT was greatest in the first week following surgery (17.7% of those who utilized PT) and thereafter followed a roughly bell-shaped curve of utilization with the greatest incidence at seven weeks following surgery (14.9% of those who utilized PT). Multivariate analysis identified multiple predictors of PT utilization following TAA, including: older age (odds ratio [OR] 1.23 per decade increase, p < 0.0001), higher ECI (OR 1.03 per 2-point increase, p = 0.0383), having surgery performed in the midwest, northeast, or western US (relative to the South OR 1.43, p < 0.0001; 1.20, p = 0.0109; and 1.32, p < 0.0001, respectively), and having commercial or Medicaid insurance coverage (relative to Medicare OR 1.96, p < 0.0001 and 1.62, p = 0.0006, respectively). Conclusion: Of 6,563 TAA patients, 42.5% utilized PT within 90 days of surgery. PT utilization was highest in the first- and seventh weeks following surgery, and demographic predictors of PT use were defined. Through identification of timing and predictors of PT utilization following TAA, algorithms for PT usage may be better defined and consistently employed. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Emergency department (ED) visits following total ankle arthroplasty (TAA) may impact patient satisfaction and healthcare cost. Elucidating the timing of and risk factors for ED visits in this patient population might help facilitate targeted risk reduction strategies. Methods: This retrospective cohort study utilized data from the 2010 to 2019 M91Ortho PearlDiver administrative dataset to identify patients who underwent TAA with at least 90 days of follow-up. Patient factors were extracted including: age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which their procedure was performed (midwest, northeast, south, west), and insurance plan (commercial, Medicaid, Medicare). The incidence, timing, frequency, and primary diagnoses for 90-day postoperative ED visits were identified and interpreted in the context of one-year postoperative ED visit baseline data. Univariate and multivariate logistic regression analyses were used to determine risk factors for such ED visits. Results: Of 7,600 TAA patients identified, 743 (9.8%) visited the ED within 90 days of their procedure. Of those who visited the ED, one ED visit was reported for 571 patients, two for 117 patients, three for 26 patients, and four or more visits for 29 patients. 37.2% of all ED visits occurred within two weeks following surgery; weekly visits returned to within 0.5% of the population baseline by three weeks after surgery. 90-day readmissions were identified for 289 patients (3.80%) of the cohort. Multivariate analysis revealed several predictors of ED utilization following TAA: younger age (odds ratio (OR) 1.40 per decade decrease), female sex (OR 1.18), higher ECI (OR 1.36 per 2-point increase), and Medicaid coverage (OR 2.74; 1.92-3.90 relative to Medicare) (p < 0.05 each). Regarding reasons for ED visits, surgical site issues were identified for 74.4%, with the most common reason being surgical site pain (60.4%). Conclusion: Of 7,600 TAA patients, 9.8% returned to the ED within 90 days of surgery, with predisposing demographic actors identified. The highest incidence for these ED visits was in the first two postoperative weeks, with surgical site pain being the most common reason. By identifying the timing, predisposing factors, and reasons for ED visits following TAA, targeted care pathways should be able to be adjusted to minimize their occurrence, improve patient experience, and minimize health care utilization/costs. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Total ankle replacement (TAR) is an effective procedure to help patients with end-stage osteoarthritis regain mobility and function. While previous studies have suggested that pre-operative factors such as stress or depression may influence the success of TAR, there is limited literature investigating this relationship. The goal of this study is to evaluate differences in functional and pain outcomes following TAR from patients with high and average PROMIS depression scores. Methods: Patients enrolled in the Orthopaedic Foot and Ankle Outcomes Research (OFAR) platform who underwent total ankle replacement were retrospectively analyzed. Patients were included if they had PROMIS outcomes collected both pre- and 12- months post-operatively. Patients were grouped as 'no/low depression' if they scored below 60 on the PROMIS depression scale, and 'high depression' if they scored greater than or equal to 60 (one standard deviation from the population mean). Statistical differences were evaluated non-parametrically using Wilcoxon rank tests and Mann-Whitney U tests. Results: 36 patients who underwent TAR met inclusion criteria for analysis. Based on pre-operative PROMIS depression scores, 28 patients were categorized 'no/low depression' (ND), and 8 were categorized as 'high depression' (HD). Both groups showed significant improvement in PROMIS physical function and PROMIS pain interference at 12-months. While the HD group had a significantly higher baseline PROMIS pain interference (65.8) compared to the ND group (58.4, p < 0.05), there was no significant difference between the two groups at 12-months (50.5 vs. 47.6, respectively). Similarly, while there was a significant difference in PROMIS depression score pre-operatively between HD and ND (62.5 vs. 48.3, p < 0.05), there was no significant difference 12- months post-operatively (52.5 vs. 45.8). Conclusion: Our data suggests that patients with high pre-operative PROMIS depression scores may have worse baseline physical function and pain interference compared to other patients but see greater overall improvement after total ankle arthroplasty. Patients in the 'high depression' group also showed a significant improvement in PROMIS depression score 12- months post-operatively. Additional investigation of large, non-commercial outcomes databases, such as OFAR, may also help determine which surgical interventions impact mental health outcomes [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Total ankle arthroplasty is a notoriously challenging operation typically reserved for well-resourced academic tertiary care facilities. Limited studies support its safety in a community hospital setting, while outcomes in a county hospital setting have not been previously described. Demonstrating that TAA can be performed effectively and safely in broader hospital settings is critical given the importance of access to care, the prevalence of tibiotalar arthritis, and known efficacy of TAA for pain management, ankle stability, and preservation of functional ambulation. The purpose of this study was to investigate the differences in post-operative complications, revision rates, and implant survival of TAA performed in the community versus county hospital setting. Methods: A total of 189 patients that underwent TAA between January 2014 and May 2021 were retrospectively evaluated. 149 cases (79%) were performed in a community hospital setting, and 40 cases (21%) were performed in a county hospital setting. Surgeries were completed by a single fellowship-trained surgeon utilizing the same Stryker STAR implant for all cases. Patient demographics, postoperative complications, and revision surgery profiles were collected with a mean follow-up of 22.3 +- 21.1 months. Logistic regression was used to analyze the relationships between complications and osteoarthritis etiology, age, smoking history, diabetes, obesity, and hospital setting. Categorical variables were compared with Chi-square tests, means were compared with a two-tailed Student's t-test, and implant survival was assessed with a Kaplan-Meier analysis. Significance was defined as p<.05 for all statistical analyses. Results: Controlling for osteoarthritis etiology and patient demographics, TAA performed in the county setting was a significant predictor of aseptic loosening (b=2.25, SE=1.01, p=.025; OR=9.5, 95% CI: 1.3-68.1) and posterior tibial tendon (PTT) dysfunction (b=2.76, SE=1.3, p=.034; OR=16, 95% CI: 1.2-204). Rate of aseptic loosening was significantly higher in the county as compared to the community setting (10% vs. 1.3%) (p=.006), as was PTT dysfunction (10% vs. 0.7%) (p=.001). All other complications were comparable between settings (p>.05) (Figure 1). At 7 years, TAA survival with any reoperation as an endpoint was comparable between community (88.6%) and county (87.5%) settings (p=.872), with no difference in mean time to reoperation between community (11.2 months) and county (22.3 months) settings (p=.25). With explant surgery as an endpoint, survival was similarly comparable between community (97.3%) and county (95%) settings (p=.677). Overall mean time to explant surgery was 24.4 months with no difference between settings (p=.10). Conclusion: Total ankle arthroplasty has a similar reoperation rate and implant survival in community and county hospital settings. Our mid-term results compare favorably with outcomes reported from academic tertiary care facilities and suggest that total ankle arthroplasty is an effective intervention across hospital settings when performed by an experienced surgeon. However, certain complications, including symptomatic aseptic loosening and PTT dysfunction, were found to be more common when performed in the county hospital setting. Future studies are necessary to investigate the impact of the increased complication rate on long-term outcomes of total ankle arthroplasty in the county hospital setting. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: A relatively frequent need for secondary surgery is an important consideration when treating end-stage ankle arthritis with total ankle arthroplasty (TAA). Despite a significant reported rate of non-revision reoperation after TAA, it is uncertain if these subsequent procedures have an impact on the longer term outcomes. It is imperative to know whether patients undergoing reoperation after TAA would have comparable functional ability compared to those with uncomplicated TAA in order to optimize patient outcomes when faced with complications after TAA. This study aimed to compare minimum five-year functional outcomes of patients who had undergone reoperation after TAA to those who did not require reoperation. Methods: Seventy-six ankles (74 patients) who underwent TAA with the Salto Talaris fixed bearing system between 2007 to 2014 were allocated into two groups based on presence (n=16) or absence of reoperation (n=60). Reoperations included all secondary procedures after index TAA, excluding revision surgeries requiring removal or exchange of the original prosthesis. The foot and ankle outcome score (FAOS) at preoperative and minimum five-year follow-up was compared between the groups. Additionally, improvements in FAOS subscales were compared. Preoperative deformity, postoperative implant alignment, number of periprosthetic cysts, and subsidence between groups were compared using standard weightbearing radiographs. A subgroup analysis was performed to compare clinical and radiographic outcomes of gutter impingement patients to those of uncomplicated group. Results: The most common cause of reoperation was gutter impingement (n=11), followed by stress fracture of the medial malleolus (n=2), tarsal tunnel syndrome (n=1), periprosthetic cyst (n=1), and infection (n=1). In comparison to the nonreoperation group, all FAOS subscales except for the Sports and Recreational Activities subscale were significantly lower in the reoperation group at final follow-up. The reoperation group exhibited significantly less improvement in the Pain, Symptoms, and Quality of Life subscales at final follow-up (p<0.05, Figure 1). There were no statistical differences in the radiographic parameters between both groups. In a subgroup analysis, all FAOS subscales at final follow-up were significantly lower in the gutter debridement patient group. There was significantly less improvement in the Pain, Symptoms, and QoL subscales in the gutter debridement patient group compared to the non-reoperation group (p<0.05 in all three subscales). Postoperative radiograph showed no differences between groups. Conclusion: Patients who underwent reoperation after TAA demonstrated inferior functional outcomes at mid-term follow-up. At the time of the primary TAA, an emphasis should be placed on carefully examining and preventing possible causes of reoperation to achieve favorable patient outcomes. Additionally, when faced with performing a reoperation following TAA, a thorough evaluation to determine the underlying cause of the reoperation should be performed to guide treatment. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: High-dose opioid prescriptions in osteoarthritis (OA) increase the risk of overdose and chronic opioid dependence, which is associated with worse perioperative outcomes in total joint arthroplasty (TJA). The purpose of this study was to determine the (1) incidence and (2) identify independent risk factors for receiving high-dose initial opioid prescriptions in OA patients. Methods: A retrospective chart review was performed to evaluate initial outpatient opioid prescriptions for OA in opioid-naïve adult patients at a single academic institution between 2013 and 2020. Patients with prior surgery or opioid prescriptions were excluded. Patient demographic data, medical comorbidities, Charlson Comorbidity Index (CCI) scores, and prescription metadata were recorded. High-dose prescriptions were defined as daily oral morphine equivalents (OME/d) >=50. Univariate analysis and multivariate logistic regression were used to identify independent predictors for high-risk opioid prescriptions. Results: A total of 1,527 patients were identified with an initial opioid prescription for OA, with 21.5% of patients receiving high-dose prescriptions. The majority of high-dose prescriptions (>=50 OME/d) were given oxycodone (56.1%), while low-dose prescriptions (<50 OME/d) were more commonly prescribed hydrocodone-acetaminophen (34.2%) and tramadol (32.5%). Using multivariate logistic regression, patient factors that are independently associated with high-dose prescriptions include decreased age, decreased BMI, white race, and non-orthopaedic encounters. Comorbid factors that were independently predictive of high-dose prescriptions include hip OA, higher CCI scores, and depression. (Table 1) Conclusion: Independent predictors for high-dose initial opioid prescriptions in OA include younger age, decreased BMI, white race, non-orthopaedic encounters, hip OA, higher CCI scores, and depression. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: The utilization of total ankle arthroplasty (TAA) has increased over the past decade to include bilateral TAAs. The risk-benefit profiles of simultaneous versus staged joint arthroplasty continues to be debated in the literature. There are limited case series reporting outcomes after bilateral TAA with no previous comparison of simultaneous versus staged TAA. It is important to study patients with bilateral pathology as they represent a unique population often with a differing arthritis etiology and an overall more debilitating condition. Thus, we aim to compare bilateral simultaneous versus staged TAAs including perioperative complications and patient reported outcome measures (PROMs). Methods: We performed a comparative cohort study of patients who underwent primary TAA from 2007 to 2019 at a single academic center. Inclusion criteria were primary bilateral TAA performed in simultaneous or staged fashion in patients over 18 years of age. Exclusion criteria were patients with less than two-years follow-up and those with previous tibiotalar arthrodesis or infection. Patient demographics, comorbidities, perioperative complications, and PROMs were collected. PROMs included preoperative and postoperative visual analog scale (VAS) for pain, the Short Form-36 (SF-36) Health Survey, the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Short Musculoskeletal Function Assessment (SMFA) bother and function sub-scores. Bivariate tests of significance were used to compare variables between the two cohorts. Results: Fifty patients were included with an average clinical follow-up was 52.2 (+-27.3; range 24-109) months. The mean time between staged TAA surgeries was 17.5 months (+-20.1, range 3-74). The mean age was 64.3 (+-10.6, range 21-76) years with 32 (64.0%) men. Many patients had primary osteoarthritis (n=28, 56.0%). Both cohorts experienced improvement in all PROMs at one year, which were maintained at final follow-up with no significant between-group differences (p >0.05). There were no differences in perioperative complication rates with similar overall complications (22.0% vs. 24.0%; p=0.7788) and reoperations (6.0% vs 5.0%; p=0.7354) between the simultaneous and staged cohorts, respectively. The two-year and five-year reoperation-free survival were 96.0% and 90.0% for the staged cohort and 94.0% and 88.0% for the simultaneous cohort, respectively (p=0.4612) Both cohorts had 100% failure-free survival up to eight-years postoperative. One patient in the simultaneous cohort required metal component revision at eight years postoperative. Conclusion: The results of bilateral simultaneous TAA, including patient reported outcomes, perioperative complications, and component survival are comparable to patients undergoing staged TAA. When performed under surgeon expertise in appropriately selected patients, we advocate that simultaneous bilateral TAA is a safe and effective method for the treatment of bilateral end-stage ankle osteoarthritis. Potential benefits of simultaneous TAA warranting further investigation include decreased anesthesia events, surgery time, tourniquet time, length of hospitalization, recovery and rehabilitation time, and overall cost. Future investigations will include dedicated analyses of radiographic outcomes and cost comparisons between these two cohorts. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Radionuclide bone scintigraphy in combination with computed tomography (CT) has been used to evaluate painful total hip and knee arthroplasties, and has also been used in the evaluation of the painful total ankle arthroplasty (TAA). Increased tracer uptake around implants may indicate loosening, but uptake characteristics of bone-seeking radiopharmaceuticals in asymptomatic total ankle patients have not been clarified. While findings of increased metabolic activity may prompt surgical intervention, there has been no work performed to define when postoperatively periprosthetic activity normalizes, if at all. In this study, we plan to establish normative data on 18F sodium fluoride (18F-NaF) positron emission tomography/CT (PET/CT) uptake ratios around TAA implants at various time intervals after surgery in asymptomatic TAA patients. Methods: The majority of the arthroplasty literature has investigated use of SPECT/CT performed with 99mTc-labeled bisphosphonates. However, data suggest that 18F-NaF PET/CT may be superior for this indication, with more favorable pharmacokinetics and similar sensitivity to detect aseptic loosening. In the present study, asymptomatic patients who underwent TAA with a modern fixed-bearing TAA prosthesis (either the Wright Infinity Adaptis or Exactech Vantage prosthesis) for posttraumatic arthritis were eligible for inclusion. Patients with ipsilateral hindfoot fusion and with any periprosthetic lucencies or cysts were excluded. Patients were enrolled at one of four time intervals following TAA: 6, 12, 18, or 24 months. Standard uptake values were measured at the bone-implant interface for the tibial and talar components on static PET, in regions of interest defined on axial CT scan slices. Periprosthetic bone blood flow (K1) and bone turnover (flux) were assessed at each time interval in each periprosthetic region using dynamic PET. Results: Sixteen asymptomatic patients underwent PET/CT: 4 patients at 6 months postoperatively, 6 at 12 months, and 6 at 24 months. We are currently still in data collection and at this time only 2 patients at 18 months have completed the scan, therefore their data were excluded. The average age was 65 years (range, 55 to 80) and 6 patients were female (38%), with individual patient data shown in the Table. Talar K1 and flux both appeared to increase from 6 to 12 months, and decrease between 12 and 24 months, although there was no statistically significant difference between timepoints. Overall tibial K1 and flux appeared to decrease slightly from 6 to 12 months, and stayed relatively stable between 12 and 24 months, again with no significant difference between timepoints (Figure). Conclusion: There is currently no normative data to help guide interpretation of radionuclide bone scintigraphy for the painful TAA. The present study utilizing 18F-NaF PET/CT scans demonstrates that even in asymptomatic patients, periprosthetic bone blood flow and bone turnover remain elevated up to 24 months following modern fixed-bearing TAA. Not only do these values remain elevated at 24 months, but we found that there does not appear to be any significant decrease in either measurement over time from 6 to 24 months postoperatively. Our findings suggest that radionuclide bone scintigraphy should be cautiously interpreted when performed within 2 years of TAA. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Aim of this study is to identify reliable anatomical landmarks of the posterior tibial neurovascular bundle during Total Ankle Replacement (TAR) to minimise the risk of iatrogenic injury. Secondary aim is to identify if there is associated translation of the bundle when anterior translation of the talus is present. Methods: A radiological landmark protocol was devised to create a consistent method for measuring the relations of the bundle to the tibia, talus and medial gutter line when measured at levels mimicking those of resection undertaken in TAR. Analysis between patients with and without anterior subluxation was undertaken. Results: Total of 42 ankles were reviewed with 38% patient having anterior translation of the talus. At the tibiotalar joint, the bundle lies less than 5mm lateral to the medial gutter line and less than 8mm posterior to the posterior tibia. The same measurements at 10mm superior to the tibiotalar joint are less than 8mm and less than 6.5mm respectively. At 5mm distal to the dome of the talus, the bundle is less than 4mm lateral to the medial gutter line and between 8.4-16.0mm posterior to the posterior talus. The bundle to posterior tibia distance does not increase in the sagittal plane for patients with anterior subluxation of the talus. Conclusion: This study provides relevant guidance for surgeons to use intraoperatively when undertaking tibial and talus resections in TAR to identify their relations to the vulnerable neurovascular structures. The measurements of this study indicate for the first time that there is not an increased risk of iatrogenic injury during bone resection at the tibia in patients with anterior subluxation of the talus. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Total ankle arthroplasty (TAA) is an alternative to ankle arthrodesis for the treatment of end-stage arthritis while maintaining greater ankle motion and functionality. Early generation implants had unacceptably high complication rates. Increasing experience of foot and ankle surgeons with the procedure and newer third-generation designs have the potential to offer better outcomes; however, the literature has shown that articles written by design surgeons presents biased results. Therefore, the purpose of this study is to compare the reported outcomes between studies conducted by design and non-design surgeons. Methods: A comprehensive search of MEDLINE for all articles published between 1996 and 2021 was conducted with a minimum two-year follow-up. Two reviewers evaluated each study to determine whether it was eligible for inclusion and abstracted the data of interest. Meta-analytic pooling of group results across studies was performed, including patient-reported outcome measures (PROMs) (i.e., AOFAS, FFI, SF-36). Fifty-two implant groups met inclusion criteria, of which eight were authored by a design surgeon. In total, 4,693 subjects were included with a mean age of 59.89 years and mean BMI of 27.77 kg/m2. Statistical analysis between articles of design and non-design surgeons was performed using two-tailed Student t-test. Results: Overall, at mean follow-up of 68.91 months, the reoperation rate was 25.2% (design=23.5%, non-design=25.5%, p=.843), revision rate was 9.3% (design=9.0%, non-design=9.4%, p=.935), and conversion to arthrodesis rate was 5.0% (design=2.5%, nondesign=5.5%, p=.243). According to the COFAS Reoperations Coding System (CROCS), the majority of reoperations were not around the ankle (Code 1: 76.65%). Mean postoperative plantarflexion (p=.007) and mean preoperative dorsiflexion (p=.006) were significantly greater among non-design surgeons' reports. There was no difference in any pre- or postoperative PROM between groups. The implant survival rate at one, two, five, and ten years was 97.7% (design=98.5%, non-design=97.6%, p=.732), 96.5% (design=97.0%, non-design=96.4%, p=.865), 92.1% (design=96.4%, non-design=91.3%, p=.865), and 79.2% (design=87.9%, nondesign=76.3%, p=.070), respectively (Table 1). Conclusion: In the reporting of TAAs, design surgeons do not appear to be biased. Although reoperation, revision, and conversion to arthrodesis rates were worse among non-design surgeons, this was not significant. Similarly, implant survival was reportedly better for design surgeons, but this was not significant either. However, there was greater implant survival in the design surgeon group at ten years, as compared to non-design surgeons, with a p-value approaching statical significance. Overall, there was no obvious evidence of bias in TAA studies comparing design vs non-design surgeons in studies of TAA implants. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: As the popularity of total ankle arthroplasty (TAA) increases and indications expand, surgeons require a better understanding of which factors are associated with the outcome. In this study, we evaluate the early clinical and radiologic outcomes of the Salto mobile bearing 3-component total ankle prosthesis. Methods: TAA was performed in 119 consecutive ankles (117 patients) by a single surgeon using 3-component Salto total ankle implant from June 2014 to May 2020. A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 1-year follow-up. All patients were followed up at two weeks, six weeks, three months, six months, at one year and yearly thereafter. Clinical outcome scoring was done pre-operatively and post-operatively. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Post-operative coronal, sagittal alignment of the component were evaluated with radiographs. Results: The average follow-up was 22.1 months (range, 12-79). Mean VAS pain score decreased from 6.7 (range, 3-10) preoperatively to 1.7 (range, 0-8) at last follow-up (p < 0.05). AOFAS score increased from 49.3 (range 8-85) to 85.1 (range 31-100) at last follow-up (p < 0.05). Eighty eight percent of the patients was satisfied with the surgical results at the last follow-up. There were 9 cases (7%) with complication. 1 case had low grade infection, 6 cases had wound marginal necrosis, and 2 cases had acute periprosthetic infection that was managed by irrigation and debridement without replacing the implants. Post-operative radiographic angles checked serially and significantly changed from preoperative status (p < 0.05). Conclusion: The TAA series using single Salto 3-componenet implant showed favorable radiologic and clinical outcomes. Also, the radiologic parameters showed statistically significant improvement. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Despite the increasing numbers of ankle replacements that are being performed there are still limited studies on the survival of ankle replacements and which factors influence survivorship comparisons between different implants. The primary aim of this study is to link NJR data with NHS digital data to determine the true failure rates of ankle replacements and to determine the risk factors for failure of total ankle replacements Methods: A data linkage study combined National Joint Registry Data and NHS Digital data. The primary outcome of failure is defined as the removal or exchange of any components of the implanted device inserted during ankle replacement surgery. Life tables and Kaplan Meier survival charts demonstrated survivorship. Cox proportional hazards regression models with the Breslow method used for ties were fitted to compare failure rates. Results: 5,562 primary ankle replacement were recorded on the NJR between 1st April 2010 and 31st December 2018. The unadjusted 1-year survivorship of ankle replacements was 98.8% (95% CI 98.4%-99.0the 5-year survival in 2725 patients was 90.2% (95% CI 89.2%-91.1) and the 10-year survival in 199 patients was 86.2% (95% CI 84.6%-87.6%). In univariate cox regression models age, BMI, ASA, Charlson co-morbidity score, indication for surgery were significantly associated with an increased risk of failure. In multivariate cox regression models only age (HR 0.956, 95% CI 0.942-0.970), BMI (HR 1.032, 95% CI 1.006-1.059) and indication (HR 0.880, 95% CI 0.799-0.968) were associated with an increased risk of failure. Conclusion: Ankle replacements have been demonstrated to have higher failure rates in younger patients, those with an increased BMI, and those with osteoarthritis. These findings should be taken into account when deciding which patients should undergo an ankle replacement and in counselling them on the likely survivorship of their ankle replacement [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Proper prosthetic alignment for Total Ankle Arthroplasty (TAA) surgery has proven to improve implant survival and prevent complications. Unfortunately, most of the previously published data present information from non weightbearing computed tomography (WBCT) scans or lack a correlation of the effects of TAA on hindfoot. To the author's knowledge, subtalar joint behavior after TAA is not completely understood. Therefore, the aim of this study is to assess subtalar joint alignment correction after TAA, and its correlation with the tibiotalar alignment correction using WBCT scan. Methods: After obtaining IRB approval, our prospectively collected surgical database was queried for patients undergoing TAA for end stage ankle osteoarthritis. Patients were included if they had preoperative WBCT scan and underwent TAA using an Infinity Prosthesis with standard instrumentation. Patients were excluded if supramalleolar osteotomy, calcaneal osteotomy or revision surgery had been performed. Twenty patients met the inclusion/exclusion criteria. All patients were brought back to the clinic for WBCT scan and to sign informed consent for the specific needs of this study. Eight coronal radiographic parameters were assessed pre and postoperatively on WBCT imaging. Three fellowship-trained musculoskeletal radiologists realized all measurements in two time-frames separated for one month each. Cohen's inter and intraclass coefficients were calculated to estimate the amount of agreement that occurred by chance. Results: Median age was 62 years (range 50-69), 37.5% female patients, median IMC 28 (range 25-33), 10 right feet. Good to excellent intraobserver (ICC 0.89, 0.75, 0.90) and interobserver (ICC 0.82) reliability were reported. Tibiotalar axis changed in 80% of patients, subtalar axis in 100% and hindfoot axis in 80%. Preoperative WBCT scan measurement showed median Medial Distal Tibial Angle (MDTA) of 93.6° (range 83.5°-105°) and median Talo-Calcaneal Angle (TCA) of 6.1° (range -2.4°-20.9°). Postoperative WBCT scan measurement showed median MDTA of 91.0° (range 82.6°-97.5°) and median TCA of 9.0° (range 0.8°-15.7°). There was no correlation between the lower tibial platform axis (TAS) and subtalar or hindfoot axis. The change in the upper talus platform axis (TTS) showed a direct correlation with the change in the hindfoot axis (p <0.05). The change in joint congruence (TTAC) showed a direct correlation with change in subtalar axis (p <0.01). Conclusion: This is the first study that assesses subtalar joint alignment correction after TAA and its correlation with the tibiotalar alignment correction using WBCT scan. Tibiotalar alignment is often corrected after TAA. Subtalar joint axis and hindfoot axis change after TAA in response to tibiotalar axis, and this change occurs in the same direction as the tibiotalar correction. Future studies should focus on studying the cause of this lack of compensation. [ABSTRACT FROM AUTHOR]