Ankle arthrodesis vs athroplasty and quality of life

NewsBot · Aug 14, 2024

The association of ASA score and outcomes following total ankle arthroplasty
Cody C. Ashy et al
Foot and Ankle Surgery; Volume 30, Issue 6; , August 2024, Pages 488-492

Background
This study seeks to evaluate the relationship between American Society of Anesthesiologist (ASA) score and postoperative outcomes following TAA.

Methods
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2020 to identify 2210 TAA patients. Patients were stratified into low (n = 1328; healthy/mild systemic disease) or high (n = 881; severe/life-threatening systemic disease) ASA score cohorts.

Results
There was no statistically significant difference in complications, readmission, or reoperation rate based on ASA score. Increased ASA score was significantly associated with longer length of stay (low = 1.69 days, high = 1.98 days; p < .001) and higher rate of adverse discharge (low = 95.3 %, high = 87.4 %; p < .001).

Conclusion
Higher ASA scores (3 and 4) were statically significantly associated with increased length of stay and non-home discharge disposition. These findings are valuable for physicians and patients to consider prior to TAA given the increased utilization of resources and cost associated with higher ASA scores.
Click to expand...

NewsBot · Aug 16, 2024

An evaluation of the total ankle replacement in the modern era: a narrative review
Isabel Shaffrey et al
Ann Transl Med. 2024 Aug 1;12(4):71.

Background and objective: Total ankle replacement has become an increasingly popular surgical procedure for treatment of end-stage ankle arthritis. Though ankle arthrodesis has historically been considered the gold standard treatment, advancements in implant design, functional outcomes, and survivorship have made total ankle replacement a compelling alternative. Particularly, in the past 20 years, total ankle replacement has undergone tremendous innovation, and the field of research in this procedure continues to grow. In this review, we aim to summarize the history, evolution, advancements, and future directions of total ankle replacement as described through implant design, indications, surgical procedures, complications, and outcomes.

Methods: Literature searches were conducted in PubMed to identify relevant articles published prior to March 2023 using the following keywords: "total ankle replacement", "total ankle arthroplasty", and "total ankle".

Key content and findings: Total ankle replacement has demonstrated significant improvements in surgical technique, implant design, survivorship, and clinical and functional outcomes in the modern era. The procedure reports high patient satisfaction, low complication rates, and improved functional abilities that challenge the current gold standard treatment for ankle arthritis.

Conclusions: Though there are areas of improvement for total ankle replacement, the procedure demonstrates promising outcomes for patients with end-stage ankle arthritis to improve pain and functional abilities. Research studies continue to explore various the facets of total ankle replacement, including outcomes, risk factors, novel techniques and modalities, and complications, to direct future innovation and to optimize patient results.
Click to expand...

NewsBot · Aug 20, 2024

What is the Total Ankle Arthroplasty Experience of Podiatric Foot and Ankle Surgery Fellows? A National Survey
Ramez Sakkab et al
J Foot Ankle Surg. 2024 Aug 10:S1067-2516(24)00177-7

In 2011, the Council of Podiatric Medical Education, the accrediting body of the American Podiatric Medical Association, approved the conversion of all Podiatric Residencies to 3-year surgical programs. In 2012, there were 12 podiatric fellowships recognized by the American College of Foot and Ankle Surgeons. To date, there are 53 programs listed under the college's website. As podiatric fellowships expand further research is needed to identify advantages and difficulties of fellowship training. One of the most salient topics is Total Ankle Replacement. Our primary aim was to obtain current fellow survey data to formulate improved outcomes of Total Ankle Arthroplasty and enhance our understanding of podiatric reconstructive foot and ankle surgery fellowship training programs. Invitation was administered by email and 73.6% of active reconstructive 2023-24 American College of Foot and Ankle Surgeons post-graduate fellows responded. Fellowship total ankle replacement case volume was significantly greater than residency (p = 0.037). Completion of 0-5 total ankle replacement(s) was 30.8%, and greater than 30 in 17.9% of fellows. Fifty nine percent reported feeling "comfortable" or "very comfortable" with total ankle arthroplasty. Patient specific instrumentation was used in a majority of cases by 66.7% of programs. Over three fourths (79.8%) of fellows stated they planned on performing TAR as an attending surgeon after their fellowship. Despite its limitations, we hope our survey data can aid graduating and previous fellows and add to the body of knowledge for future TAR educational programs and industry involvement. As podiatric fellowships continue to transform, so too must our research efforts to track progress.
Click to expand...

NewsBot · Sep 3, 2024

Increased Activity Level Following Total Ankle Replacement Results in Improved Patient Reported Outcomes
Reka Kovacs, BMedScia reka.kovacs@nhslothian.scot.nhs.uk ∙ Jun Min Leow, MRCS(Ed)b ∙ Mathew Smith, MBChBc ∙ Phui Yuen Wong, MBChBc ∙ Hisham Shalaby, MBBS, FRCS(Orth)b ∙ John McKinley, MBBS, FRCS(Orth)b
Source

While evidence highlights increased activity levels following total ankle replacement (TAR), the correlation between postoperative activity changes and ankle-surgery-specific patient-reported outcomes is unexplored. This retrospective cohort study investigates the effect of activity level changes on patient-reported outcomes, including the Manchester-Oxford Foot Questionnaire (MOXFQ) and patient satisfaction following TAR. Patient records from a single center performing TARs between January 2014 and February 2023 were reviewed alongside patient questionnaires completed preoperatively and at a mean follow-up of 44±31 months postoperatively (range 6-134 months). Activity participation pre- and postoperatively was assessed and correlated with MOXFQ scores. Data from 89 patients was available for analysis (mean age 72.3±8.9 years [range, 48-92]). Postoperatively, 31 patients (35%) increased, 42 (47%) maintained, and 16 (18%) decreased their activity levels. The mean time to return to regular activity was 23.4 weeks. Preoperative MOXFQ scores were similar across all groups (increased: 74.03±14.00; maintained: 73.6±13.9; decreased: 77.0±15.5; p=0.71). All groups showed significant improvements in MOXFQ scores from preoperative to postoperative assessments (p<0.05). Patients with increased activity levels showed greater MOXFQ improvements (-61.6±19.0) compared to those with decreased activity levels (-38.3±26.6) (p<0.01). Following TAR, 82% of patients maintained or increased their activity levels. Patients with increased postoperative activity exhibited superior improvements in MOXFQ scores. These findings underscore the importance of promoting physical activity for optimal outcomes following TAR.
Click to expand...

NewsBot · Sep 25, 2024

Total Ankle Arthroplasty as a Correction Tool for Foot Deformities: Analyzing the Impact on Medial Column Alignment Adaptation Through Weightbearing Computed Tomography
Ben Efrima et al
Foot Ankle Int. 2024 Sep 10

Background: While weightbearing computed tomography (WBCT) has been instrumental in analyzing total ankle arthroplasty (TAA) positioning, there is a notable gap in the literature regarding adaptive changes in the foot's medial column after TAA. This study aims to bridge this gap by comparing preoperative and postoperative alignments of the foot's medial column and analyzing if a correlation exists between TAA coronal alignment correction and medial column alignment adaptation.

Methods: Sixty patients who underwent a lateral approach TAA for end-stage osteoarthritis (OA) between January 2021 and April 2023 were included in this retrospective study. Patients were divided into varus (n = 30) and valgus (n = 30) groups. Preoperative and postoperative WBCT scans were analyzed to measure medial column alignment. Statistical analysis evaluated alignment corrections and correlations.

Results: Both groups showed significant plantarflexion of the second tarsometatarsal (TMT) angle, with a median adaptation of -1 degree (IQR -3, 0; P < .01) in the valgus group and -1 degree (IQR -3, 0; P = .03) in the varus group. The varus group exhibited increased plantarflexion of the first TMT angle (median -1 degree, IQR -1, -2; P = .03). Both groups demonstrated increased adduction of the medial column. The talonavicular coverage angle adaptation averaged 7.2 ± 14 degrees (P < .01) in the valgus and 9 ± 12 degrees (P < .01) in the varus group. The talo-first metatarsal axial angle adaptation was 5 ± 13 degrees (P = .03) in the valgus group and 9.5 ± 15 degrees (P = .08) in the varus group.

Conclusion: WBCT analysis revealed significant medial column adaptation post-TAA in varus and valgus alignments. However, no correlation was found between hindfoot correction and forefoot adaptation, making it challenging to predict the need for additional realignment surgeries. Future studies should explore the relationship between tibiotalar correction and medial column alignment to improve outcomes and the influence of total ankle design on medial column adaptation
Click to expand...

NewsBot · Sep 28, 2024

The Influence of Resilience on Outcomes After Total Ankle Arthroplasty
Joseph A S McCahon et al
Foot Ankle Spec. 2024 Sep 18

Background: Resiliency is the ability to recover from stressful events and has been shown to correlate with patient outcomes following certain orthopaedic procedures. The purpose of this study was to determine the relationship between resiliency and outcomes following TAA.

Methods: A retrospective analysis of patients undergoing primary TAA between April 2015 and September 2022 was performed (N = 83). Data included demographics, comorbidities, complications, preoperative and postoperative visual analog scale (VAS) pain and Foot and Ankle Ability Measure (FAAM) functional scores, Brief Resilience Scale (BRS) scores, and surgical satisfaction. Patients were defined as having low resilience (LR), normal resilience (NR), or high resilience (HR) based on a BRS score of <3, 3-4.30, and >4.3, respectively.

Results: High resilience patients had significantly higher postoperative FAAM ADL, Sports, and Overall scores as well as a significantly greater increase from preoperative scores compared with LR and NR patients. Low resilience patients had significantly lower FAAM Sports and Overall scores compared with normal and high resilience patients. BRS scores positively correlated with postoperative FAAM scores. We found no difference in satisfaction or VAS between the 3 cohorts. Multivariate regression analysis identified BRS scores to be an independent predictor for greater changes in FAAM scores following TAA.

Conclusion: Although functional improvements following TAA are expected, patients with higher resilience at baseline are more likely to experience greater improvements in functional outcomes following surgery.
Click to expand...

NewsBot · Oct 13, 2024

Gait stability improves following unilateral total ankle arthroplasty
Martin Barylak et al
J Orthop Res. 2024 Oct 10

End-stage ankle arthritis is often treated surgically by total ankle arthroplasty (TAA) due to its potential to improve gait through increased joint range of motion and reduce pain. However, TAA's effect on gait stability is not well understood. This study explores the impact of TAA on gait stability, measured by Margin of Stability (MoS), in 148 patients with end-stage ankle arthritis. Kinematic data were collected pre-operatively, at 1-year post-op, and at 2-years post-op and the MoS was determined at heel strike and midstance for the anteroposterior (MoSAP) and mediolateral (MoSML) directions. A linear mixed effects model including gait speed as a factor was used to assess the effects of limb, session, and their interaction on outcome measures. A significant interaction (p < 0.002) between limb (surgical, nonsurgical) and session (pre-op, 1-year post-op, 2-years post-op) was identified for each MoS variable of interest. Cumulatively, our results suggest that the nonsurgical limb, MoSAP at heel strike and MoSML at midstance improved (increased) as time from surgery increased. These results suggest patients developed a compensatory movement pattern to navigate surgical limb single support. TAA reduces this compensation improving side-to-side symmetry, while not fully restoring symmetry by 2-years post-op. These results indicate that TAA could improve gait stability in patients with end-stage ankle arthritis, but further work is needed to understand the impact of TAA on altering fall risk.
Click to expand...

NewsBot · Nov 11, 2024

A Systematic Review of Outcomes of Total Ankle Arthroplasty with INBONE II
Cody C Ashy et al
Foot and Ankle Surgery; 6 November 2024

Background
This study systematically reviews the literature and reports on outcomes of total ankle arthroplasty (TAA) with the INBONE II fixed-bearing implant.
Methods
PubMed, SCOPUS and CINAHL were searched for clinical studies reporting INBONE II specific outcomes from database inception through July 13th, 2024, according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines.
Results
Seven primary TAA studies and 4 revision TAA studies were included with 406 and 114 patients respectively. Survivorship was 96.5% (mean follow-up 44.8 months) and 93.9% (mean follow-up=37.3 months) for primary and revision TAA, respectively. The mean reoperation rate was 11.4% with a 3.2% rate of major complications for primary TAA. Meanwhile, the reoperation rate was 9.1% with a major complication rate of 12.2% for revision TAA.
Conclusions
Primary and revision TAA with this implant results in over 93% survival at mid-term follow-up with an acceptable complication rate, supporting its continued use.
Click to expand...

NewsBot · Nov 14, 2024

Obesity is highly associated with a non-home discharge following total ankle arthroplasty
Edgar Sy et al
J Foot Ankle Surg. 2024 Nov 11

Studies have shown that non-home discharge following orthopedic procedures is associated with a higher risk of 30-day complications and significantly increases medical costs. The purpose of this study was to identify risk factors for being discharged to a non-home destination following total ankle arthroplasty (TAA). We included patients undergoing TAA from the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) between 2014 and 2019. TAA was identified using CPT codes 27702, 27703 and 27704. Logistic regression models were used to assess the association between discharge location (home versus non-home) and a series of exposure variables (e.g., patient demographics, patient health characteristics, and operative factors). A total of 1,704 patients were included, experiencing a 3.6% short term complication rate (61/1,704). 8.5% of the population were discharged to a non-home destination. In the final adjusted model, patients who were older [OR 1.11; 95%CI 1.08, 1.13], female [OR 2.94; 95%CI 2.04, 4.34], obese [OR 1.93; 95%CI 1.29, 2.89], had surgery in an inpatient setting [OR 5.73; 95%CI 1.78, 18.46], and ASA class IV [OR 10.65; 95%CI 1.03, 110.61] were at greater risk for a non-home discharge. People living with obesity experienced a nearly 2x greater likelihood of being discharged to a non-home destination after TAA despite their preoperative functional (e.g., ASA class) and metabolic status (i.e., diabetes). Opportunities to mitigate this risk will be needed to lessen the financial burden of TAA surgery as a growing number of obese patients become eligible for TAA in the US.
Click to expand...

NewsBot · Nov 15, 2024

Long-term Outcomes After Total Ankle Arthroplasty: A Systematic Review
Michael S Lee et al
Foot Ankle Orthop. 2024 Nov 8;9(4)

Background: Total ankle arthroplasty has emerged as a treatment to successfully treat ankle arthritis. Recent studies have reported more than 40 000 total ankle arthroplasties (TAAs) being performed between 2009 and 2019 in the United States. Although recent studies have reported favorable patient-reported outcomes at short- and midterm follow-up, there is a paucity of aggregate literature reporting on long-term patient-reported outcomes (PROs) after TAA. The purpose of this review is to report an aggregate of literature on minimum 10-year patient-reported outcomes after TAA.

Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were queried in June 2024. Primary research articles were included if they reported minimum 10-year PROs or satisfaction for patients who underwent primary TAA and were written in English. Survivorship was reported based on implant failure, which was determined uniquely by each study.

Results: Eight studies met the inclusion criteria. A total of 595 ankles with a range of average ages from 51 to 73.7 years were included in the study with follow-up ranging from a minimum of 10 years to a minimum of 20 years. Six of the 8 studies reported average follow-up ranging from 11.9 to 15.8 years. Two of the 8 studies reported significant improvement in PROs following surgery. Survivorship at a minimum of 10-year follow-up ranged from 66% to 94.4%. Average time to implant failure ranged from 4.6 to 13.8 years.

Conclusion: Patients undergoing primary TAA were reported to have generally improved PROs at minimum 10- year follow-up. However, they demonstrated variable rates of survivorship ranging from 66% to 94.4%. Of those experiencing implant failure, average time to failure ranged from 4.6 to 13.8 years. Survivorship should be interpreted with caution because of varying definitions between studies. Further studies should seek to standardize the definition of survivorship and reporting of PROs to allow for effective analysis of heterogeneity.
Click to expand...

Ankle arthrodesis vs athroplasty and quality of life

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Ankle arthrodesis

Advice please: Orthotic prescription after ankle arthrodesis

Complications following ankle arthrodesis - help please

ankle arthrodesis and back pain

The 100 Most Impactful Articles in Foot and Ankle Surgery

The Complexities of Self-Harm in Foot & Ankle Surgery

Relationship between ankle and hip movement strategies

Share This Page

Ankle arthrodesis vs athroplasty and quality of life

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Ankle arthrodesis

Advice please: Orthotic prescription after ankle arthrodesis

Complications following ankle arthrodesis - help please

ankle arthrodesis and back pain

The 100 Most Impactful Articles in Foot and Ankle Surgery

The Complexities of Self-Harm in Foot & Ankle Surgery

Relationship between ankle and hip movement strategies

Share This Page

Useful Searches