Salto Talaris total ankle arthroplasty: Early clinical results from eighty-one consecutive patients by a single surgeon

Transcription

1 Salto Talaris total ankle arthroplasty: Early clinical results from eighty-one consecutive patients by a single surgeon Kurt Hofmann, MD, Zabrina Shabin, MD, Eric Ferkel, MD, Jeffrey Jockel, MD, Mark Slovenkai, MD

2 Disclosures Salto Talaris total ankle arthroplasty: Early clinical results from eighty-one consecutive patients by a single surgeon Kurt Hofmann, MD My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Demographics September 2007 June consecutive patients Primary outcome Need for revision or resection arthroplasty Average age: 64.6 years (35-85) Average BMI: 29.5 ( ) Average follow up: 45.2 months (24-81)

4 Demographics Gender (Male/Female) 32/46 Side (Right/Left) 46/35 Diabetics 3 Immunosuppressed 12 Diagnosis Tobacco Use Current 12 Former 9 Never 56 Osteoarthritis 35 Posttraumatic arthritis 32 Rheumatoid arthritis 9 Psoriatic arthritis 1

5 Concurrent Procedures Removal of hardware 10 Percutaneous TAL 8 Exostectomy 7 Brostrom 6 Subtalar fusion 5 Talonavicular fusion 3 ORIF medial malleolus 3 Other* 8 *One each: revision Brostrom, triple fusion, 1 st metatarsal osteotomy, calcaneal osteotomy, ORIF fibula, ORIF posterior malleolus, soft tissue biopsy, excision of talar bone cyst

6 Results Average LOS: 2.2 days (1-5) 25.6% discharged on POD #1 1 mortality in follow up period Unrelated to TAR recovery (MVC) 2 revisions of metal components 1 tibia and 1 talus Average of 35.5 months after index procedure 97.5% survival rate 0 resection arthroplasty

7 Results Range of Motion Pre-op 1 year post-op p Dorsiflexion Plantarflexion * Total * Coronal deformity correction (time to final XR: 22.6 months)

8 Final XR results 30% displayed some amount of lysis Primarily around the tibial component Average of 1.0 mm ( ) 2 additional patients displayed talar subsidence Both were asymptomatic Radiographic lysis did not correlate with revision surgery or poor outcomes Pre-op coronal deformity did not correlate with development of radiographic lysis

9 Additional Procedures Procedure Number Gutter debridement 17 Ankle synovectomy 6 Removal of hardware (not TAR) 4 ORIF medial malleolus 3 Superficial I&D 3 Tendo-Achilles lengthening 2 Tenolysis 2 Subtalar fusion 2 Revision TAR 2-17 total patients (21.0%) -Average time to additional procedure: 18.5 months (1-51)

10 Outcomes AOFAS Ankle-Hindfoot Scale Pain 31.4 ± 8.0 Function 39.3 ± 10.3 Alignment 8.9 ± 2.5 Total 79.6 ± 16.2 VAS: 1.9 ± 2.1 Short Musculoskeletal Functional Assessment Function Index 18.6 ± 14.7 Bother Index 19.0 ± 14.8 Foot and Ankle Disability Index 80.0 ± 15.8

11 Conclusions Largest cohort with longest follow up reported 97.5% survival rate Equivalent to prior studies Significant increase in ROM Radiographic lysis previously reported in prior studies Not correlated with need for revision or poor outcomes Outcomes data shows overall good to excellent results

12 References Bonnin, M., Gaudot, F., Laurent, J. R., Ellis, S., Colombier, J. A., & Judet, T. (2011). The salto total ankle arthroplasty: Survivorship and analysis of failures at 7 to 11 years. Clinical Orthopaedics and Related Research, 469(1), Bonnin, M., Judet, T., Colombier, J. A., Buscayret, F., Graveleau, N., & Piriou, P. (2004). Midterm results of the salto total ankle prosthesis. Clinical Orthopaedics and Related Research, (424)(424), Cracchiolo, A.,3rd, & Deorio, J. K. (2008). Design features of current total ankle replacements: Implants and instrumentation. The Journal of the American Academy of Orthopaedic Surgeons, 16(9), Gougoulias, N. E., Khanna, A., & Maffulli, N. (2009). History and evolution in total ankle arthroplasty. British Medical Bulletin, 89, Grunfeld, R., Aydogan, U., & Juliano, P. (2014). Ankle arthritis: Review of diagnosis and operative management. The Medical Clinics of North America, 98(2), Nodzo, S. R., Miladore, M. P., Kaplan, N. B., & Ritter, C. A. (2014). Short to midterm clinical and radiographic outcomes of the salto total ankle prosthesis. Foot & Ankle International, 35(1), Schweitzer, K. M., Adams, S. B., Viens, N. A., Queen, R. M., Easley, M. E., Deorio, J. K., et al. (2013). Early prospective clinical results of a modern fixed-bearing total ankle arthroplasty. The Journal of Bone and Joint Surgery.American Volume, 95(11), Zaidi, R., Cro, S., Gurusamy, K., Siva, N., Macgregor, A., Henricson, A., et al. (2013). The outcome of total ankle replacement: A systematic review and meta-analysis. The Bone & Joint Journal, 95-B(11),