Chamnanni Rungprai, M.D.

Transcription

1 Comparison Outcomes of Total Ankle Replacement with and without Achilles tendon lengthening 1,2 Chamnanni Rungprai, M.D. Co-authors 1 Phinit Phisitkul, M.D. 1 John E. Femino M.D. 1 Annunziato Amendola, M.D. 1 University Of Iowa Hospital and Clinic, Iowa, USA 2 Phramongkutklao hospital and college of medicine, Bangkok, Thailand AOFAS 2015 Annual Meeting eposter

2 NO CONFLICT TO DISCLOSE Comparison Outcomes of Total Ankle Replacement with and without Achilles tendon lengthening Chamnanni Rungprai, M.D. My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Introduction Preexisting ankle equinus contracture is an important determinant for postoperative motion and can alter biomechanics of ankle joint after total ankle replacement. 1-5 Simultaneous total ankle replacement with Achilles tendon lengthening is considered when intraoperative ankle dorsiflexion is inadequate. However, there was no current literature demonstrated the outcomes of patients with Achilles tendon lengthening and comparing patients with or without Achilles tendon lengthening. The purpose of this study was to compare the functional outcomes and complications between total ankle replacement with and without Achilles tendon lengthening. Hypothesis: Patients who underwent total ankle with Achilles tendon lengthening should have comparable functional outcomes and complications as same as without Achilles tendon lengthening.

4 Materials and methods Retrospective chart review with prospectively collected outcomes of 212 consecutive patients (221 legs) who were diagnosed with end-staged ankle arthritis and underwent total ankle replacement surgery with Achilles tendon lengthening or gastrocnemius lengthening (110 patients/ 112 legs; percutaneous triple hemisection (Hoke technique) 77 patients / 79 legs and endoscopic gastrocnemius recession (EGR) (33 patients / 33 legs) between January 1997 and December The minimum follow up to be included in the study was 6 months (mean, 62.0 months; range, 6 to 162 months for without Achilles tendon lengthening; mean, 30.5 months; range, 6 to 133 months for Hoke technique, mean, 16.7 months; range, 6 to 43 months for EGR). The primary outcome was Foot Function Index (FFI), Short Form-36 (SF-36), Visual Analogue Scale (VAS), ankle dorsiflexion. The secondary outcomes included operative time and complications. Pair t-test, independent t-test, Wilcoxon Rank Sum Test, and Chisquare test were used to assess the outcomes and complications.

5 Surgical technique A B * A B C D C D C D E Figure 1: Endoscopic gastrocnemius recession (EGR) was performed by two portals technique (1A). The gastrocnemius aponeurosis is identified (1B), retrograde knife was used to release aponeurosis (1C). The gastrocnemius muscle after complete release the gastrocnemius aponeurosis (1D). Figure 2: EGR is performed before the total ankle replacement if the patient has severe equinus contracture, otherwise, it should be performed after the total ankle replacement. Anterior approach is used for total ankle replacement (2A), Posteromedial portal of EGR (2A, * ) and ankle dorsiflexion after EGR (2B). Post-operative radiography in AP, Lateral, and mortis view of the ankle joint (2D-2E).

6

7

8

9 Results Both total ankle replacement with or without Achilles tendon lengthening demonstrated significant improvement of functional outcomes (p < 0.05 all). However, total ankle replacement with or without Achilles tendon lengthening were comparable in term of improvement of functional outcomes (p > 0.05 all). For complication, limited ankle dorsiflexion may caused Implant subsidence and polyethylene fracture or wearing in total ankle without Achilles tendon lengthening. Among the Achilles tendon lengthening procedures, Hoke technique showed significant weakness of plantar flexion.

10 Discussion Limitations Retrospective design, and therefore no randomization was used in the methods. Some patients were lost to follow-up and some did not response to the questionnaires, resulting in approximately fifty percent of patients available to be analyzed at final follow-up. Limited follow-up time and need 5- and 10-year follow-up in future study. Strengths Consecutive case collection. Relatively large number of subject. Systematically collected outcome data using validated assessment methods. All surgeries were performed by the same group of fellowship-trained orthopaedic foot and ankle surgeons. Lack of specific instruments to measure the ankle range of motion.

11 Conclusion Total ankle replacement with and without Achilles tendon lengthening demonstrated significant improvement in terms of outcomes as measured with the FFI, SF-36, VAS, and ankle dorsiflexion. Total ankle replacement with Hoke technique demonstrated significantly weakness of plantar flexion when compared to without Achilles tendon release. Total ankle replacement without Achilles tendon lengthening demonstrated implants and polyethylene complications than with Achilles tendon lengthening. Future prospective investigation is important.

12 Reference: 1. DiGiovanni CW, Kuo R, Tejwani N, Price R, Hansen ST Jr, Cziernecki J, Sangeorzan BJ. Isolated gastrocnemius tightness. J Bone Joint Surg Am. 2002; 84-A: DiDomenico LA, Adams HB, Garchar D. Endoscopic gastrocnemius recession for the treatment of gastrocnemius equinus. J Am Podiatr Med Assoc Jul- Aug;95(4): Saxena A, Widtfeldt A. Endoscopic gastrocnemius recession: preliminary report on 18 cases. J Foot Ankle Surg. 2004; Sep-Oct;43(5): Baumann JU, Koch HG. Ventrale aponeurotische Verl angerung des Musculus gastrocnemius. Operat Orthop Traumatol 1989;1: Phisitkul P, Rungprai C, Femino JE, Arunakul M, Amendola A. Endoscopic Gastrocnemius Recession for the Treatment of Isolated Gastrocnemius Contracture: A Prospective Study on 320 Consecutive Patients. Foot Ankle Int May 21. pii: Abdulmassih S, Phisitkul P, Femino JE, Amendola A. Triceps surae contracture: implications for foot and ankle surgery. J Am Acad Orthop Surg Jul;21(7): doi: /JAAOS