A novel approach for joint line restoration in revision total ankle arthroplasty based on the three-dimensional registration of the contralateral tibia and fibula.

PURPOSE: The use of total ankle arthroplasty (TAA) is increasing over time, as so will the need for revision TAAs in the future. Restoration of the ankle joint line (JL) in revision TAA is often difficult due to severe bone loss. This study analyzed the accuracy of a three-dimensional (3D) registration of the contralateral tibia and fibula to restore the ankle joint line (JL) and reported side-to-side differences of anatomical landmarks. METHODS: 3D triangular surface models of 96 paired lower legs underwent a surface registration algorithm for superimposition of the mirrored contralateral lower leg onto the original lower leg to approximate the original ankle JL using a proximal, middle and distal segment. Distances of the distal fibular tip, anterior and posterior medial colliculus to the JL were measured and absolute side-to-side differences reported. Anterior lateral distal tibial angle (ADTA) and lateral distal tibial angle (LDTA) were measured. RESULTS: Mean JL approximation was most accurate for the distal segment (0.1 ± 1.4 mm (range: -3.4 to 2.8 mm)) and middle segment (0.1 ± 1.2 mm (range: -2.8 to 2.5 mm)) compared to the proximal segment (-0.2 ± 1.6 mm (range: -3.0 to 4.9 mm)) (p = 0.007). Distance of the distal fibular tip, the anterior, and posterior medial colliculus to the JL, ADTA and LDTA yielded no significant side-to-side differences (n.s.). CONCLUSION: 3D registration of the contralateral tibia and fibula reliably approximated the original ankle JL. The contralateral distal fibular tip, anterior and posterior medial colliculi, ADTA and LDTA can be used reliably for the planning of revision TAA with small side-to-side differences reported. LEVEL OF EVIDENCE: IV.

Mid- to long-term results of total ankle replacement in patients with haemophilic arthropathy: A 10-year follow-up.

INTRODUCTION: Haemophilic ankle arthropathy is caused by recurrent spontaneous joint haemorrhaging and leads to pain, deformity and loss of function. In the presence of advanced articular deterioration, therapeutic options are confined to either arthroplasty or arthrodesis, the latter still being referred to as the procedure of choice. However, total ankle replacement (TAR) has recently gained acceptance as an alternative. AIM: To investigate the mid- to long-term results of TAR in haemophilic ankle arthropathy. MATERIALS AND METHODS: Seventeen TARs in 14 male patients (mean age: 43 years [range, 27.4-57.6]), implanted between 1998 and 2012, were retrospectively analysed. Implant survival was estimated using Kaplan-Meier analysis. Haemophilic/viral status, complications and revision surgeries were recorded. Follow-up assessment of 12 TARs was performed 9.6 years (range, 3.3-17.8) postoperatively, including clinical examination, pain and satisfaction scales, the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and the SF-36. Radiographic evaluation of pre- and follow-up radiographs was conducted. RESULTS: Estimated implant survival was 94% at 5, 85% at 10 and 70% at 15 years, respectively. Three cases required revision surgery. At follow-up, 9.6 years (range, 3.3-17.8) postoperatively, the level of satisfaction was 76% (range, 50-100) and of pain 2/10 (range, 0-6) on the VAS. Range of motion had increased significantly (P = .037). The SF-36 summary scores were comparable to those of a matched standard population. The AOFAS hindfoot score averaged 81 points (range, 73-90). All radiographs revealed component loosening or periprosthetic radiolucency. CONCLUSION: Total ankle replacement in the presence of advanced haemophilic arthropathy is a viable treatment option with favourable mid-/long-term results, maintaining mobility of the ankle joint.

[Complex reconstruction in Charcot arthropathy using the Ilizarov ring fixator]. / Komplexe Rekonstruktionen bei Charcot-Arthropathie mittels Ilizarov-Ringfixateur.

BACKGROUND: From the foot surgeon's point of view, the surgical treatment of Charcot neuro-osteopathy is considered challenging. Conservative treatment using plaster and orthoses is used to treat Charcot arthropathy, especially in the acute stage of a treatment strategy. Surgical treatment using the Ilizarov ring fixator is established for the correction of residual misalignments and also in the acute stage. Advantages of the ring fixator are great stability of the apparatus, low loading of the soft tissues caused by foreign material, and possible long-term treatment. OBJECTIVES: The aim of this work is to explain the indication, planning of correction, assembly of Ilizarov ring fixator, and the postoperative treatment with respect to the literature and the authors' experience. The aim of treatment with the Ilizarov ring fixator is a plantigrade, resilient, ulcer-free foot. Treatment is lengthy for both the affected patients and the attending orthopedic surgeon, and great attention is required to achieve the desired corrections and a good result for the patient. DISCUSSION: According to the literature and the authors' experience, the results indicate that the Ilizarov ring fixator represents a viable method for the preservation of the affected limb in patients with Charcot neuro-osteopathy. The assembly of the apparatus must follow the principles of Ilizarov in order to avoid failure. Corrective osseous and soft tissue interventions require a detailed preoperative analysis.

[Arthrodesis and endoprostheses of the ankle joint: indications, techniques and pitfalls]. / Arthrodese und Endoprothese des oberen Sprunggelenks: Indikationen, Techniken und Fallstricke.

If adequate conservative measures for the treatment of end-stage ankle osteoarthritis have failed, surgery may be taken into consideration. After exorbitant failure rates in the beginning of total ankle replacement, nowadays this kind of treatment has regained lot of interest and has become a viable alternative to ankle fusion. The correct indication and a precise explanation of the surgical procedure, outcomes and potential complications provide a solid base for future success.Currently, there is no doubt that total ankle replacement has become an important player in the treatment of symptomatic and debilitating end-stage ankle arthritis. With increasing number of patients who undergo total ankle replacement the experience with this kind of procedure increases too. As a consequence several surgeons have started to stretch indications favoring total ankle replacement. However, it must be mentioned here, despite progress in terms of improved anatomical and biomechanical understanding of the hindfoot and improved surgical techniques and instruments, total ankle replacement and ankle fusion remain challenging and difficult procedures. We provide a review article including an overview of the relevant techniques. This article should serve as rough guide for surgeons and help in decision-making regarding total ankle replacement and ankle fusion.

[Ankle arthrodesis after failed total ankle replacement]. / Sprunggelenkarthrodese nach gescheiterter Endoprothesenimplantation.

Despite recent anatomical and biomechanical improvements the longevity of current total ankle replacements remains limited. Once total ankle replacement has failed conversion into ankle arthrodesis provides a viable option and should therefore be considered. However, due to the massive bone loss, precarious soft tissues and in order to preserve leg length, this kind of surgical treatment is considered to be technically demanding with potential impairment of the quality of life and decreased global foot and ankle function as well. The present article focuses on salvage ankle arthrodesis after failed total ankle replacement and seeks to provide a usable treatment algorithm.