Post on 19-Jul-2018
Ankle Fusion Takedown to Total Joint Arthroplasty
Kaitie Ward R2 WSPMA Annual Conference 04/30/2017
No Disclosures
Literature Review Ankle Arthrodesis= Gold standard for end stage ankle arthritis [1-3]
Poor outcomes persist: [1,2,4,5] Infection Nonunion Malalignment Adjacent joint destruction
Literature Review
Possible secondary interventions: [1,2,4-7] Revision arthrodesis
Extension of the fusion mass
Talar allograft
Amputation
Total ankle arthroplasty (TAA)
Literature Review
Sequelae of ankle arthrodesis Adjacent joint arthritis Subtalar joint
Negatively influence functionality and quality of life [4-6] Decreased rate of successful fusion when compared to non-ankle arthrodesis
[8].
Pantalar joint arthrodesis is frequently poorly tolerated Oxygen consumption equivalent to BKA [3,9,10]
Takedown Fusion to TAA= Additional treatment modality with high patient satisfaction [1-3,5,6].
May be considered in: Absence of infection Appropriate bone quality [1,3]
More favorable outcomes: Definable source of pain Lower metabolic demand Advanced age Shorter duration of primary
fusion Lack of fibular resection
[2,5,6]
Literature Review
Case Series
To present ankle fusion takedown and conversion to arthroplasty as an additional alternative treatment option for unfavorable outcomes of ankle arthrodesis.
Methodology
Retrospective chart review 2009-2015 Mean follow-up=147 months Single surgeon 4 patients Demographics, comorbidities, procedure details, and complications were
evaluated Assessment of ankle ROM, subjective pain levels, weight bearing radiographs
and patient’s activity level
Procedures Ankle arthrodesis takedown and conversion to TAA performed by primary
surgeon in 4 pts Indications:
Ankle nonunion Increasing hindfoot pain Subtalar joint arthritis Decreased function Malunion
Traditional anterior approach Pre-operative imaging Previous joint location Osteotomy placement Sufficient medial and lateral malleoli for stability Implantation of a two-component constrained implant
Results
Age/Sex/ Laterality
Comorbidities Indications Time from Arthrodesis
(Months)
Subtalar Joint
Arthrodesis
Complications Final Follow-Up (Months)
Subjective Results
Objective Results
75/F/L Diabetes mellitus II Rheumatoid
arthritis
Ankle nonunion 11.3 No Superficial wound dehiscence
66.8 No pain Very pleased
Mild swelling Incision healed Ankle ROM- DF
+10°, PF +25°
73/M/R Peptic ulcer disease Hypertension Hyperlipidemia
STJ DJD 144.7 Yes, concurrent Superficial wound dehiscence with
infection
3.9 Mild pain Moderate swelling
Incision healed Ankle ROM- DF
+10°, PF + 25°
53/F/L Gastric ulcers Seizure disorder Osteopenia Chronic Pain Smoker
Ankle nonunion 32.4 Yes, subsequent Hardware irritation 57.4 Not tender over ankle
Mild swelling Incision healed Light touch
sensation decreased
Ankle ROM- DF +0°, PF +20°
60/F/R Fibromyalgia Ankle nonunion 20.2 No STJ arthritis 18.6 Not tender over ankle
Pain and stiffness at STJ
Mild swelling Incision healed STJ ROM-
Limited Ankle ROM- DF
+5°, PF +20°
Average- 65 Average- 52.2 Average- 36.7
Case Example 73 yo M
12 years s/p right ankle arthrodesis
Pre-Operative Ankle Views
Post-Operative Ankle Views
Analysis & Discussion
Complex patient factors for poorly tolerated ankle fusions Lack of consensus for treatment of STJ arthritis STJ pathology at some point in treatment course Salvage vs. fusion Fibular resection
Conclusion
TAA may be utilized as a salvage procedure 4 patients with favorable outcomes
Average final follow-up of 36.7 months
More studies needed Staging vs unstaged?
References
1. Barg A, Hintermann B. Takedown of Painful Ankle Fusion and Total Ankle Replacement Using a 3-Component Ankle Prosthesis. Tech Foot Ankle Surg. 9(4):190-198,2010.
2. Greisberg J, Assal M, Flueckiger G, Hansen ST. Takedown of Ankle Fusion and Conversion to Total Ankle Replacement. Clin Orthop Relat Res. 424:80-88,2004.
3. Raikin, SM, Rampuri V. An Approach to the Failed Ankle Arthrodesis. Foot Ankle Clin. 13(3):401-416,2008. 4. Coester L, Saltzman CL, Leupold J, Pontarelli W. Long-Term Results Following Ankle Arthrodesis for Post-Traumatic
Arthritis. J Bone Joint Surg. 83(2):219-228,2001. 5. Hintermann B, Barg A, Knupp M, Valderrabano V. Conversion of Painful Ankle Arthrodesis to Total Ankle Arthroplasty. J
Bone Joint Surg. 91:850-858,2009.
6. Hintermann B, Barg A, Knupp M, Valderrabano V. Conversion of Painful Ankle Arthrodesis to Total Ankle Arthroplasty-Surgical Technique. J Bone Joint Surg. 92 Suppl 1:55-66,2010.
7. Giannini S, Buda R, Cavallo M, Ruffilli A, Fornasari PM, Vannini F. Conversion of Painful Ankle Arthrodesis to Bipolar Fresh Osteochondral Allograft: Case Report. FAI. 33(8):678-681,2012.
8. Zanolli, DH, Nunley JA, Easley ME. Subtalar Fusion Rate in Patients with Previous Ipsilateral Ankle Arthrodesis. FAI. 36(9):1025-1028,2015.
9. Acosta R, Ushiba J, Cracchiolo A. The Results of a Primary and Staged Pantalar Arthrodesis and Tibiotalocalcaneal Arthrodesis in Adult Patients. FAI. 21(3):82-194, 2000.
10.Pappa JA, Myerson MS. Pantalar and Tibiotalocalcaneal Arthrodesis for Post-Traumatic Osteoarthrosis of the Ankle and Hindfoot. J Bone Joint Surg. 74:1042-1049,1992.
Thank You