Revision Total Ankle Arthroplasty Using a Novel Modular Fixed-Bearing Revision Ankle System.

Rebecca Martin, Michael Dean, Rajesh Kakwani, An Murty, Ian Sharpe, David Townshend
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Abstract

Introduction: Large bone defects such as those encountered after failed total ankle replacement have previously been a relative contraindication to revision ankle replacement due to inadequate bone stock. We describe our experience and patient reported outcomes with a modular ankle replacement system with tibial and talar augments.

Methods: This is a retrospective case series analysis of patients who underwent a total ankle replacement using the INVISION system across 2 centers between 2016 and 2022. Patients completed the Manchester-Oxford Foot Questionnaire (MOXFQ), Ankle Osteoarthritis Scale (AOS), and EQ-5D pre-operatively and then post-operatively at 6 months, 1 year, 2 years, 3 years, and 5 years. Medical records were reviewed for complications and re-operations. X-rays were reviewed for lucencies and alignment.

Results: A total of 17 patients were included in the study; 14 men and 3 women with an average age at the time of surgery of 67.9 years (range 56-80 years). The average follow-up post-operatively was 40.5 months (range 7-78) at the time of this study. The indication for surgery was revision of failed total ankle replacement (TAR) in 16 and revision of failed ankle fusion in 1. An augmented tibia was used in 13, an augmented talus in 13, and both augmented tibia and talus in 9 cases. There were no early surgical complications. One patient required debridement and implant retention for late deep infection. No implants have been revised. The average MOXFQ score improved by 19.3 points at most recent follow-up. The average AOS score improved by 25.2 points.

Conclusion: The early results of a modular augmented ankle arthroplasty system have shown satisfactory patient outcomes with a low complication and re-operation rate and present another option for patients with larger bone defects. This is a small series, and a larger series with long-term follow-up would be beneficial.

Levels of evidence: Level IV: Case series.

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使用新型模块化固定轴承翻修踝关节系统的翻修全踝关节置换术。
导言:大块骨缺损(如全踝关节置换术失败后出现的骨缺损)是翻修踝关节置换术的相对禁忌症,原因是骨量不足。我们介绍了使用胫骨和距骨增量的模块化踝关节置换系统的经验和患者报告结果:这是一项回顾性病例系列分析,研究对象是2016年至2022年期间在两个中心接受INVISION系统全踝关节置换术的患者。患者术前填写曼彻斯特-牛津足部问卷(MOXFQ)、踝关节骨关节炎量表(AOS)和EQ-5D,术后分别填写6个月、1年、2年、3年和5年的问卷。对并发症和再次手术的病历进行审查。对X光片进行检查,以确定是否有裂隙和对位:共有 17 名患者参与了研究,其中男性 14 人,女性 3 人,手术时的平均年龄为 67.9 岁(56-80 岁不等)。在本研究中,术后平均随访时间为 40.5 个月(7-78 个月)。手术指征为全踝关节置换术(TAR)失败后翻修的有16例,踝关节融合术失败后翻修的有1例,其中13例使用了增强型胫骨,13例使用了增强型距骨,9例同时使用了增强型胫骨和距骨。没有早期手术并发症。一名患者因晚期深度感染需要清创并保留植入物。没有人对植入物进行过修整。在最近的随访中,MOXFQ平均得分提高了19.3分。AOS平均得分提高了25.2分:模块化增量踝关节置换系统的早期结果显示,患者的治疗效果令人满意,并发症和再次手术率较低,为骨缺损较大的患者提供了另一种选择。这只是一个小规模的系列研究,更大规模的系列研究和长期随访将更有益处:四级:病例系列。
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