Joint-Preserving Surgery in Varus Ankle Osteoarthritis.

Ankle deformity is a disabling condition especially if concomitant with osteoarthritis (OA). Varus ankle OA is one of the most common ankle OA deformities. This deformity usually leads to unequal load distribution in the ankle joint and decreases joint contact surface area, leading to a progressive degenerative arthritic situation. Varus ankle OA might have multiple causative factors, which might present as a single isolated factor or encompassed together in a single patient. The etiologies can be classified as post-traumatic (e.g., after fractures and lateral ligament instability), degenerative, systemic, neuromuscular, congenital, and others. Treatment options are determined by the degree of the deformity and analyzing the pathology, which range from the conservative treatments up to surgical interventions. Surgical treatment of the varus ankle OA can be classified into two categories, joint-preserving surgery (JPS) and joint-sacrificing surgery (JSS) as total ankle arthroplasty and ankle arthrodesis. JPS is a valuable treatment option in varus ankle OA, which should not be neglected since it has showed a promising result, optimizing biomechanics and improving the survivorship of the ankle joint.

Two-Staged Revision Total Ankle Arthroplasty Surgery with Primary Total Ankle Arthroplasty System: A Case Report.

CASE: Case of a 2-staged revision surgical technique for the treatment of an aseptic total ankle arthroplasty (TAA) loosening: first surgery: removal of the loosened and painful TAA Scandinavian Total Ankle Replacement, with exclusion of infection, and reconstruction of the large bone defect (bone-defect downsizing surgery); proof of successful ankle bone reconstruction by CT-scan imaging; second surgery: implantation of a primary VANTAGE TAA (ankle reconstruction with new primary TAA). CONCLUSION: The present case shows the management of a failed TAA with bone defect by performing a 2-step surgical approach: removal of loosened TAA with simultaneous bone stock restoration and then implantation of a new primary TAA. This concept is a possible alternative to a post-TAA ankle arthrodesis or to the use of a TAA revision system.

Mobile Anatomical Total Ankle Arthroplasty-Improvement of Talus Recentralization.

INTRODUCTION: Total ankle arthroplasty (TAA) is becoming a more frequent treatment option for end-stage ankle osteoarthritis (OA) as outcomes measures are improving. However, there is concern that malalignment of TAA can result in premature failure of the implant. One of the malalignment issues is the talar sagittal malposition. However, a consensus on the significance of the sagittal translation of the talus in TAA is yet to be established. The aim of this study was, therefore, to clarify whether talus OA subluxation is normalized after the implantation of a mobile TAA. METHODS: Forty-nine consecutive patients with symptomatic end-stage ankle OA underwent 50 cementless three-component mobile-bearing VANTAGE TAA with 21 right ankles (42%) and 29 left ankles (58%). Clinical and radiographic outcomes were assessed: Clinical variables: American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score (0-100), visual analogue scale (VAS, 0-10), and ankle range of motion (ROM). Radiological variables: medial distal tibial articular angle (mDTAA), anterior distal tibial articular angle (aDTAA) and lateral talar station (LTS). RESULTS: The clinical results showed the mean improvement in AOFAS hindfoot score from 42.12 ± SE 2.42 (Range: 9-72) preoperatively, to 96.02 ± SE 0.82 (Range: 78-100) at a mean follow-up of 12 months, with a highly statistically significant difference (p < 0.00001). Pain score (VAS) was 6.70 ± SE 0.28 (Range 0-10) preoperatively, and 0.26 ± SE 0.12 (Range: 0-3) at 12-month follow-up, with a highly statistically significant difference (p < 0.00001). ROM measurements preoperatively showed a mean of 22.55° ± SE 1.51° (Range: 0-50°), which showed a statistically significant improvement (p < 0.0001) to 45.43° ± SE 1.56° (Range: 25-60°) 12 months postoperatively. The radiological analyses revealed the following results: On the coronal view, the mDTAA preoperatively was 88.61 ± SE 0.70 (Range: 78.15-101.10), which improved to 89.46 ± SE 0.40 (Range: 81.95-95.80) at 12 months (not statistically significant-p = 0.94). On the sagittal view, the preoperative values of the aDTAA showed 82.66 ± SE 0.84 (Range: 70.35-107.47), which improved to 88.98 ± SE 0.47 (Range: 82.83-96.32) at 12 months postoperatively, with a highly statistically significant difference between preoperative and 12-months values (p < 0.00001). The mean LTS values for all patients were 3.95 mm ± SE 0.78 (Range: -11.52 to 13.89) preoperatively and 1.14 mm ± SE 0.63 (Range: -10.76 to 11.75) at 12 months, with a statistically significant difference between preoperative and 12-month follow-up (p = 0.01). The review of the radiological TAA osteointegration at 12 months showed no cases of loosening of the implanted TAAs. Two cases (4%) showed a radiolucency and one case (2%) a cyst on the tibial component; no cases had a change on the talar component. No TAA complication/revision surgeries were documented. CONCLUSION: In the present study, the lateral talar station of anteriorly subluxated ankles showed a significant improvement, i.e., physiological centralization of the talus, in the postoperative period when a mobile-bearing TAA was performed. The anterior/posterior congruency between the talar component and the mobile polyethylene insert of the mobile-bearing VANTAGE TAA allows the sagittal translation of the talus relative to the flat tibial component, reducing the prosthesis strain and failure.

Arthrodesis of a Varus Ankle.

Patients with varus ankle deformity and concomitant osteoarthritis experience severe disabling pain that affects their daily activity of living. Most cases rarely respond to nonoperative treatment. One surgical option is corrective ankle arthrodesis. Unfortunately, this corrective surgery is challenging and might not be possible as a purely isolated procedure. Corrective ankle arthrodesis for varus ankle is performed with different surgical approaches and techniques, using different methods of fixations. The goal of surgery is to create a pain-free, stable, and plantigrade ankle, hindfoot, and foot. Both the foot and ankle must be correctly aligned in the optimal position for proper locomotion.