Search Results (44)

Background: Knee arthrodesis markedly alters lower limb biomechanics and creates a challenging scenario when associated with end-stage ankle osteoarthritis. No prior reports have specifically described treatment with total ankle replacement (TAR) in the presence of an ipsilateral fused knee. This study evaluated the feasibility and mid-term outcomes of TAR in this rare condition. Methods: Two patients with post-traumatic end-stage ankle osteoarthritis and long-standing knee arthrodesis underwent TAR using a lateral transfibular approach with a Zimmer Trabecular Metal™ implant. Surgical planning aimed to restore coronal and sagittal alignment. Postoperative management and rehabilitation were specifically adapted to the absence of knee motion, with emphasis on gait re-education. Clinical and radiographic follow-up was performed up to 36 months. Results: At final follow-up, both patients showed substantial pain reduction, improved ankle range of motion, and recovery of a stable, functional gait compatible with knee fusion. Imaging demonstrated well-aligned, stable components without loosening or subsidence. No major complications or reoperations occurred. Conclusions: Lateral transfibular TAR appears feasible and effective for end-stage ankle osteoarthritis in patients with ipsilateral knee arthrodesis, preserving ankle motion and supporting functional ambulation in this complex setting. Full article

Background: Distal tibial fractures (DTFs) are a major cause of post-traumatic osteoarthritis (PTOA). The risk of conversion to total ankle arthroplasty (TAA) or ankle fusion (AF) after DTFs remains unclear, and the current literature provides heterogeneous and often incomplete data. The aim of this systematic review was to evaluate the incidence of TAA and AF following DTF-related PTOA and to explore potential predictors of conversion, including initial treatment strategy. Methods: A systematic review was conducted according to PRISMA guidelines. The PICO framework was applied during the study design and literature search phase to define the research question and eligibility criteria. Studies reporting adult patients with a history of DTFs who later developed PTOA and underwent TAA or AF were included. Descriptive statistics were performed. Study-level proportions of conversion to TAA, AF, or both were analyzed using random-effects meta-analysis with logit transformation. Results: Eight studies comprising 190,383 fractures met the inclusion criteria. Overall, 31,269 patients underwent TAA or AF, corresponding to a conversion rate of 16.4%. The pooled conversion incidence from the random-effects model was 5.6%, with considerable heterogeneity (I² ≈ 100%). When procedures were analyzed separately, the pooled incidence was 0.25% for TAA and 0.76% for AF. Conclusions: The risk of conversion to TAA or AF after DTFs appears to be relatively low, despite the high prevalence of PTOA. The higher conversion rate observed in surgically treated fractures likely reflects the complexity of the initial fracture rather than the failure of surgical management itself. Level IV, systematic review of retrospective studies. Full article

Background: While gravity-assisted ankle stress AP (GAASA) images have proven effective in evaluating deep deltoid ligament injuries, their efficacy in assessing syndesmosis injuries remains unclear. We aimed to investigate the diagnostic performance of GAASA images in detecting syndesmosis injuries. Methods: This study reviewed records of patients aged 16+ with unilateral ankle fractures in a single-center ER from 2022 to 2023. Three orthopedic surgeons evaluated standard AP and lateral X-rays, ankle mortise, and GAASA and bilateral ankle CT images in blinded sessions for syndesmosis injuries. Evaluations were repeated to assess the inter- and intra-rater reliability. Results: A total of 121 patients with suspected syndesmosis injuries were included in this study. The average age of the patients was 49.9 ± 16.6 years. Syndesmosis injuries were present in 32.2% of cases. The inter-observer reliability was the highest for GAASA images (κ = 0.701) and mortise radiographs (κ = 0.735), and lowest for CT images (κ = 0.426). GAASA images had a sensitivity of 82% and specificity of 68%. Mortise images had 55% sensitivity and 81% specificity. GAASA images showed better discriminatory power for syndesmosis injuries compared to mortise and CT images. Conclusions: GAASA images demonstrated superior sensitivity and better negative predictive values in detecting syndesmosis injuries compared to mortise radiographs and CT images. While GAASA may serve as a useful adjunct for evaluating syndesmosis injuries, its interpretation requires careful clinical correlation, and it should not be considered a replacement for standard imaging in all cases. GAASA may be of particular value in emergency or resource-limited settings where CT is not readily available, offering a practical option for ruling out injury in many patients. Full article

Background/Objectives: Total ankle replacement (TAR) is considered an effective solution for end-stage ankle arthritis. New-generation implants have shown promising intermediate clinical outcomes and are available in two main designs: fixed-bearing and mobile-bearing prostheses. The aims of this study are to compare both prosthetic systems, focusing on (i) the revision rate for major complications, including conversion to arthrodesis, revision of components, and below-knee amputation; (ii) minor complications requiring additional surgery; and (iii) providing a comprehensive overview of total ankle replacement. Methods: A systematic review of the literature was conducted using the main databases. The inclusion criteria were patients aged 18 years or older and individuals who had undergone total ankle arthroplasty. Case reports, case series, original articles, and systematic reviews were excluded from the final selection. The pooled incidence of events was reported using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Results: A total of 33 studies, pooling data from 3652 observations and identifying 635 events, met the inclusion criteria. Relevant demographic and surgical data were systematically extracted and analyzed. A meta-analysis of comparable data revealed revision and failure risks for both prosthesis types. No statistically significant differences in complication rates were observed between fixed-bearing and mobile-bearing prostheses. Conclusions: Both fixed-bearing and mobile-bearing prostheses are viable options for treating ankle arthritis, demonstrating an intermediate risk of complications over short, medium, and long-term follow-ups. Full article

Background: Klippel–Trenaunay syndrome (KTS) is a congenital vascular malformation syndrome characterized by low-flow vascular anomalies, including venous malformation (VM) and lymphatic involvement. These anomalies may lead to limb asymmetry due to soft tissue and/or bone overgrowth. Compression therapy using elastic garments is considered a conservative and minimally invasive first-line treatment option for KTS. However, the benefits of compression therapy for low-flow vascular malformations, particularly limb VMs, have not been sufficiently evaluated. This prospective, multi-center study assessed the efficacy and safety of compression therapy for KTS with VM. Methods: After measuring the affected limb, a custom-made elastic garment providing 30 mmHg of compression was manufactured (THUASNE, France). A total of 20 patients (7 male, 13 female; mean age: 10.9 years) underwent compression therapy for 26 weeks at four nationwide institutions in Japan. The primary outcome was the change in lower limb circumference. Secondary outcomes included pain, modified Rankin Scale (mRS) score, body water content, vital signs, changes in garment elasticity, and adverse events. Results: All 20 patients completed the study. At the study endpoint, the circumference ratio of the affected to unaffected limbs was significantly reduced at the superior end of the tibial tuberosity (p = 0.02) and the thinnest part of the ankle (p < 0.001). The elastic force of the garment declined by approximately 50% over 26 weeks. No serious adverse events related to the intervention were reported. Conclusions: Compression therapy using a custom-made elastic garment appears to be a safe and effective approach for managing limb overgrowth in patients with KTS and VM. To maintain the therapeutic effect, garment replacement is recommended at least every six months. Full article

Background: The anterior approach to the ankle addresses many pathologies. The orthoplastic anteromedial incisional approach to the ankle courses between the anterior tibial and posterior tibial angiosomes. There are various modalities that can be used in evaluating the integrity of these angiosomes before surgical intervention. Methods: A retrospective review of 23 patients using the anteromedial ankle approach in either total talus replacement or total ankle replacement was performed from January 1, 2016, through August 31, 2021. Surgical intervention occurred from January 29, 2016, through January 10, 2019, and follow-up was through August 2021. Results: Patients were evaluated based on medical history, postoperative week of suture or staple removal, incision complications, and time at which full weightbearing began. Smoking history was also documented. Eighteen patients healed uneventfully, and some of these patients had a smoking history, a history of type 2 diabetes mellitus, or both. Conclusion: A preoperative evaluation of vascular supply is necessary to determine the healing potential of this approach. Atraumatic handling of the soft-tissue envelope is imperative to aid in wound healing and optimize the postoperative course. The orthoplastic anteromedial ankle incisional approach is a possible alternative option for an anterior ankle incision if adequate vascular status is determined to be present before surgical intervention. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/23-090) Full article

Background: Tibiotalocalcaneal (TTC) arthrodesis using talar allografts has emerged as a viable surgical option for managing complex hindfoot pathologies, including post-traumatic avascular necrosis (AVN), infection-related complications, and failed total ankle replacement (TAR). These conditions present significant therapeutic challenges due to extensive bone loss and joint instability. Previous reports have focused on TTC arthrodesis using talar allografts, highlighting its potential to provide enhanced structural support. This study aims to further evaluate the efficacy and safety of this surgical approach by assessing union, clinical outcomes, and complications in a diverse patient population. Methods: This retrospective study reviewed 11 patients who underwent TTC arthrodesis with talar allograft between January 2020 and November 2022. The study cohort included patients with post-traumatic AVN, infection-related complications, and failed TAR. Preoperative and postoperative evaluations included X-rays, computed tomography scans, and functional outcome scores such as the Visual Analog Scale (VAS) and the Foot and Ankle Outcome Score (FAOS). Results: This study included 11 patients who underwent surgical treatment between January 2020 and November 2022, with a minimum follow-up of 24 months and a mean follow-up of 33.45 months (range, 24–50 months). Successful arthrodesis was observed in nine patients, yielding a success rate of 82%. Significant improvements in functional outcomes were noted, including marked reductions in pain and enhanced activity levels, as evaluated by VAS and FAOS scores. Two patients demonstrated radiographic nonunion (one tibiotalar, one subtalar), but both remained asymptomatic and did not require revision surgery. No other complications such as infection, wound issues, or thromboembolism were observed. Immediate postoperative radiographs confirmed appropriate allograft alignment and placement. Conclusions: TTC arthrodesis using structural talar allografts may be a viable and safe option for managing severe hindfoot pathology, potentially resulting in satisfactory fusion rates and clinical outcomes. Full article

Ankle osteoarthritis (OA) is a degenerative condition that impacts quality of life. Total ankle replacement (TAR) represents a significant advancement in orthopedic surgery. Objectives: The purpose was to provide an overview of the indications, outcomes, and complications of anterior and lateral surgical approaches in TAR, as well as return to sport following surgery. Methods: The PubMed, MEDLINE, Scopus, and Cochrane Central databases were searched. The keywords used were “total ankle arthroplasty”, “total ankle replacement”, “ankle anterior approach”, “ankle lateral approach”, “outcomes”, “return to sport”, and “complications”, and the search included articles published from 2014 to 2024. Results: Successful functional outcomes, return to athletic activity, and return to the previous level of sports performance after surgery have been reported at rates of over 60%. The anterior approach restores the normal tibial slope but presents a high risk of wound-healing complications and medial malleolar fractures. The lateral approach allows an anatomic placement of the implant, but it is associated with fibular complications and a high risk of revision surgery. Return to sport is feasible in low-impact sports such as cycling, swimming, and dancing. Conclusions: The anterior and lateral approaches for TAR yielded satisfactory functional outcomes and rates of return to athletic activity. Different intra- and post-operative complications and revision surgery should be managed properly to optimize outcomes. Full article

Background: Technological advancements have made three-dimensional printing prevalent in orthopedic surgery. It facilitates the production of customized implants and tailored patient instruments, enhancing surgical planning and results. This review focuses on the uses and effectiveness of patient-specific products manufactured using three-dimensional printing in ankle surgery. Methods: A search of databases—PubMed, Embase, Cochrane Library, and Google Scholar—yielded 41 articles for review. Results: Total talus replacement offers a viable alternative to standard treatments like arthrodesis and total ankle arthroplasty. Custom implants and patient-specific instrumentation in total ankle arthroplasty procedures guarantee a tailored fit and accurate alignment. For arthrodesis, three-dimensional printing enables the production of cages, effectively solving issues associated with conventional bone grafts, such as poor bone quality, significant defects, and nonunion. Additionally, patient-specific instrumentation facilitates the swift and accurate placement of Kirschner wires at the correct sites. When performing supramalleolar osteotomy, patient-specific instrumentation leads to shorter operation times, reduced blood loss, and less radiation exposure. Conclusions: Three-dimensional printing is increasingly employed in ankle surgeries, and as technology advances, it is anticipated to become critical for addressing complex ankle issues. Full article

Tarsal tunnel syndrome (TTS) is defined as an entrapment neuropathy from compression of the tibial nerve and/or distal terminal nerves in the tarsal tunnel, the medial foot, and/or ankle. While the incidence of TTS following a total knee replacement (TKR) could not be found, we present the case of a 78-year-old white female who developed symptoms of TTS 2 weeks after a left knee replacement. The history, examination, imaging, and electrodiagnostic (EDX) studies were consistent with the diagnosis of left-sided TTS. After a course of conservative care failed to alleviate her symptoms, the patient underwent nerve decompression surgery for the affected nerves. Her pain score prior to the surgery was 5 out of 10 when walking, and 10 out of 10 at night. Immediately after surgery, her pain at its worst was 3 out of 10, and soon thereafter she reported no pain whatsoever (0 out of 10). All TTS-related symptoms subsequently resolved. This case presents an unusual extrinsic cause of TTS, highlights the need for a thorough history when diagnosing TTS, and contributes to the scientific community’s knowledge of knee complications and possible etiologies of TTS. Full article

Background: This comprehensive systematic review aims to explore and discuss existing treatment modalities for infections in total ankle arthroplasty (TAA), providing insights that may contribute to the establishment of a “standard of care” for these challenging cases. The study analyses the intricate landscape of infected TAA, addressing gaps in the current literature and emphasizing the need to refine treatment strategies. With the reported incidence of periprosthetic joint infection after TAA surpassing rates observed in total hip and knee replacements, the research navigates through various treatment modalities, underscoring the lack of a universally accepted standard of care. Methods: In this systematic review, following PRISMA guidelines, PubMed, Scopus, and Google Scholar, we identified 15 papers addressing the management strategies for infected TAA (162 infected ankle arthroplasty cases).These databases were chosen for their extensive coverage, strong relevance to the research topic, and ease of access, ensuring a thorough and focused retrieval of pertinent literature on the treatment of infected ankle prostheses. The review involved the identification and evaluation of articles providing insights into complications, treatment outcomes, and risk factors. Extracted data were summarized and reported. A descriptive analysis was performed, and when feasible, a statistical analysis was conducted. Results: Treatment modalities included irrigation and debridement (48.8%), revision total ankle arthroplasty (36.3%), primary arthrodesis (7.9%), spacer arthroplasty (4.5%), and primary amputation (3.9%). Complication rates varied, with 46.5% for irrigation and debridement, 20% for two-stage revision, 7.14% for primary arthrodesis, and 25% for spacer arthroplasty. Conclusions: The rising prevalence of TAA underscores the need for a definitive treatment protocol due to severe complications. This review emphasizes careful patient selection and accurate diagnosis. Irrigation and debridement are effective for acute infections, while two-stage revision is a valid alternative for chronic infections. High-quality randomized controlled trials are important for establishing an evidence-based treatment protocol. Full article

Background/Objectives: Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) uses preoperative three-dimensional imaging to create cutting blocks tailored to patient anatomy. However, there is debate regarding the additional benefits of PSI in terms of improved alignment or functional outcomes compared to using conventional instruments. Although PSI design has undergone continuous development, the improvements have not been incorporated. Therefore, the aim of this study was to compare the surgical time and radiological outcomes between advanced-design PSI and conventional instruments. Methods: We conducted a retrospective review of 328 patients who underwent primary TKAs using PSI for osteoarthritis and compared them with 328 matched patients who underwent TKA performed with conventional instruments during the same period (March 2023 to August 2024). We compared the surgical time and component alignment between the advanced-design PSI group and the conventional instrument group. Results: The average surgical time was significantly shorter in the advanced-design PSI group (47.6 ± 12.4 min) compared to the conventional instrument group (59.2 ± 14.2 min, p < 0.05). The advanced PSI design group had a significantly lower occurrence of outliers in hip–knee–ankle alignment (7%) compared to the conventional instrument group (36.3%). This trend was also observed in femoral coronal alignment, tibial coronal alignment, and femoral sagittal alignment. Conclusions: The use of advanced-design PSI demonstrated significantly reduced surgical time and improved alignment compared to conventional instruments. This highlights that proper design is a key factor for PSI to achieve superior biomechanical effects. Our study shows that advanced-design PSI technology has the potential to replace conventional instruments in TKA, though further research is required to determine its clinical outcomes and economic benefits. Full article

Background: Ankle arthritis is a common degenerative disease that progresses as cartilage damage in the lower tibia and upper talus progresses, resulting in loss of joint function. In addition to typical arthritis, there is also structural bone loss in the talus due to diseases such as talar avascular necrosis. Total talus replacement surgery is the procedure of choice in end-stage ankle arthritis and consists of a tibial, talar component and an insert. However, in cases of severe cartilage and bone damage to the talar bone with less damage to the tibial cartilage, a talar component hemiarthroplasty may be considered. Although the application of total talus replacement surgery using ceramics has been studied, reports on the application of metal 3D printing technology are limited. We aimed to investigate the feasibility of partial talar components using ceramic and titanium 3D printing technology in terms of biocompatibility and stability through animal experiments. Methods: Preoperative 3D CT was acquired and converted to STL files to fabricate a partial talus component for ankle hemiarthroplasty using ceramic and titanium. Six minipigs with an average age of 17 months were implanted with three ceramic (C-group) and three titanium talar components (T-group) in the hind limb ankle joint. The surgery was performed under anesthesia in a sterile operating room and was performed by two experienced foot and ankle specialist orthopedic surgeons. Blood analysis and CT were performed before surgery and every month for 3 months after surgery to assess the extent of inflammatory response and physical stability, sacrifices were performed 3 months after surgery, and H&E staining and micro-CT analysis were performed to compare histological biocompatibility. A grading score was calculated to semi-quantitative assess and compare the two groups. Results: In the postsurgical evaluation, blood analysis revealed that both groups had increased white blood cell counts on the postoperative day after surgery. The white blood cell count increased more in the titanium group (1.85-fold) than in the ceramic group (1.45-fold). After 3 months, all values normalized. During the study, CT analysis confirmed that all artificial samples were displaced from their initial positions. In micro-CT analysis, the adhesive tissue score of the ceramic artificial sample was better than that of the titanium sample (average threshold = 3027.18 ± 405.92). In histologic and grading scores for the inflammatory reactions, the average inflammation indices of the ceramic and titanium groups were 2.0 and 1.21, respectively. Also, the average grade score confirmed based on the results of fibrous tissue proliferation and new blood vessels was 18.4 in the ceramic application group and 12.3 in the titanium application group. Conclusions: In conclusion, both titanium and ceramics have excellent biocompatibility for artificial joints, and ceramic materials can be used as novel artificial joints. Further research on the strength and availability of these ceramics is required. Full article

Talar avascular necrosis (AVN) is a devastating condition that frequently follows type III and IV talar neck fractures. As 60% of the talus is covered by hyaline cartilage, its vascular supply is limited and prone to trauma, which may eventually lead to AVN development. Early detection of AVN (Hawkins sign, MRI) is crucial, as it may prevent the development of the irreversible stages III and IV of AVN. Alertness is advised regarding non-obvious conditions that may cause this complication (sub chondroplasty, systemic lupus erythematosus, diabetes mellitus). Although, in stages I–II, AVN may be treated with non-surgical procedures (ESWT therapy, non-weight bearing) or joint-sparing techniques (core drilling, bone marrow aspirate injections), stages III–IV require more advanced procedures, such as joint-sacrificing procedures (hindfoot arthrodesis/ankle arthrodesis), or replacement surgery, including total talar replacement (TTR) or combined total ankle replacement (TAR). The advancement of 3D-printing technology and increased access to implant manufacturing are contributing to a rise in the production rates of third-generation total talar prostheses. As a result, there is a growing frequency of alloplasty procedures and combined total ankle replacement (TAR) surgeries. By performing TTR as opposed to deses, the operator avoids (i) delayed union, (ii) a shortening of the limb, (iii) a lack of mobility, and (iv) the stiffening of adjacent joints, which are the main disadvantages of joint-sacrificing procedures. Simultaneously, TTR and combined TAR offer (i) a brief period of weight-bearing restriction, (ii) quick pain relief, and (iii) preservation of the length of the limb. Here, we summarize the most up-to-date knowledge regarding AVN diagnosis and treatment, with a special focus on the role of TTR. Full article

Total ankle arthroplasty (TAA) is a motion-preserving treatment for end-stage ankle arthritis. An effective tool for analyzing these implants’ mechanical performance and longevity in silico is finite element analysis (FEA). An FEA in ABAQUS was used to statically analyze the mechanical behavior of the ultra-high-molecular-weight polyethylene (UHMWPE) bearing component at varying dorsiflexion/plantarflexion ankle angles and axial loading conditions during the stance phase of the gait cycle for a single cycle. The von Mises stress and contact pressure were examined on the articulating surface of the bearing component in two newly installed fixed-bearing TAA implants (Wright Medical INBONE II and Exactech Vantage). Six different FEA models of variable ankle compressive load levels and ankle angle positions, for the varying subphases of the stance phase of the gait cycle, were created. The components in these models were constrained to be conducive to the bone–implant interface, where implant loosening occurs. Our results showed that the von Mises stress and contact pressure distributions increased as the compressive load increased. The highest stress was noted at dorsiflexion angles > 15°, in areas where the UHMWPE liner was thinnest, at the edges of the talar and UHMWPE components, and during the terminal stance phase of the gait cycle. This static structural analysis highlighted these failure regions are susceptible to yielding and wear and indicated stress magnitudes that are in agreement (within 25%) with those in previous static structural TAA FEAs. The mechanical wear of the UHMWPE bearing component in TAA can lead to aseptic loosening and peri-implant cyst formation over time, requiring surgical revision. This study provides ankle replacement manufacturers and orthopedic surgeons with a better understanding of the stress response and contact pressure sustained by TAA implants, which is critical to optimizing implant longevity and improving patient care. Full article