Total Ankle Arthroplasty for the Treatment of Symptomatic Nonunion following Tibiotalar Fusion W I L L I A M P. H U N T I N G T O N, M. D. W. H O D G E S D A V I S, M. D. R O B E R T B. A N D E R S O N, M. D. A O F A S A N N U A L M E E T I N G J U L Y 1 7-2 0, 2 0 1 3 H O L L Y W O O D, F L O R I D A
Disclosures William P. Huntington, M.D. My final disclosure is in the final AOFAS program book I have no potential conflicts of interest with this presentation W. Hodges Davis, M.D. My final disclosure is in the final AOFAS program book I have a potential conflict of interest with this presentation due to: Wright Medical: Consultant and royalties Robert B. Anderson, M.D. My final disclosure is in the final AOFAS program book I have a potential conflict of interest with this presentation due to: Wright Medical: Consultant and royalties
Rationale/Background Ankle Arthrodesis Mainstay of treatment for end stage ankle arthritis Non-union rates: as high as 40% in some series Revision arthrodesis is no piece of cake Complication rates 23-60% Revision non-union rates of up to 23% Significant long term sequelae after ankle arthrodesis Abnormal gait patterns/difficulty with uneven surfaces Development of adjacent joint arthritis and need for further surgeries
Rationale/Background Total ankle arthroplasty has been proposed as a treatment option for the failed ankle arthrodesis Hinterman et al JBJS Am 2009 Greisberg et al Clin Orthop Rel Res 2004 Advantages Restore pain-free ankle range of motion Negate the long term sequelae seen with ankle arthrodesis Purpose of present study: Evaluate the short-term outcomes associated with the take down of symptomatic nonunions of ankle arthrodeses and conversion to a fixed bearing, intramedullary total ankle arthroplasty Propose that total ankle arthroplasty is a viable salvage option for the treatment of symptomatic nonunions following tibiotalar fusion.
Methods 5 patients retrospectively identified who underwent takedown of an aseptic, symptomatic nonunion of an ankle fusion and converted to a total ankle arthroplasty Indications for arthrodesis: 2 post-traumatic OA, 2 RA, 1 1 OA Average age at conversion: 62.2 years old Average time between fusion and conversion: 1.7 years Prospectively evaluated at a minimum of 12 months from conversion (average follow-up: 21.3 months) INBONE total ankle replacement (Wright Medical Technologies, Inc. Arlington, TN ) Fixed bearing implant Intramedullary implant
Methods Evaluation Clinical evaluation AOFAS ankle-hindfoot score Foot Function Index Patient satisfaction and VAS pain levels Radiographic evaluation Assessed for tibio-talar loosening and talar subsidence according to criteria proposed by Hintermann et al Clin Orthop Rel Res 2004 Complications
Results Complications: No intraoperative complications requiring additional procedures 1 post-op complication: wound excoriation that resolved with local wound care AOFAS ankle-hindfoot score Average: 82.6 Range: 66-90 Foot Function Index Average: 28.2% Range: 7-49% VAS pain levels Average: 31.1/100 Range: 16.2-44.3
Results 4/5 very satisfied or satisfied with surgery 1 dissatisfied patient has rheumatoid arthritis and takes daily narcotics because of her disease 5/5 would have the operation again No evidence of tibial/talar loosening or talar subsidence in any case at final follow-up No additional procedures have been required
Conclusions Total ankle arthroplasty with a fixed bearing, intramedullary implant for a symptomatic nonunion of an ankle arthrodesis is a viable treatment option that provides reliable short-term results
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