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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
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Algorithm for Management of Periprosthetic Ankle Fractures
Alexander L Lazarides1, Tyler J Vovos1, Gireesh B Reddy1
11 Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA.
Foot & Ankle International
|March 1, 2019
Summary
Management of periprosthetic fractures after total ankle replacement (TAR) is challenging. Stable fractures often need fixation, while talus fractures indicate unstable implants requiring revision TAR surgery or arthrodesis.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Radiology
Background:
- Periprosthetic fractures around total ankle replacements (TARs) have limited evidence regarding management and outcomes.
- Developing a management algorithm for these complex fractures is crucial.
Purpose of the Study:
- To develop an algorithm for managing patients with postoperative periprosthetic fractures around a TAR.
- To analyze factors influencing implant stability and treatment outcomes.
Main Methods:
- Retrospective analysis of 32 patients with TAR between 2007-2017 experiencing periprosthetic fractures >4 weeks post-surgery.
- Radiographic and intraoperative assessment of implant stability.
- Univariate and multivariate analyses to identify outcome predictors.
Main Results:
- Most fractures occurred at the medial malleolus (62.5%); 75% had stable implants.
- Talus fractures invariably had unstable implants, necessitating revision TAR surgery (100%).
- Fracture location (talus), shorter time to fracture, and implant type predicted instability. Implant stability correlated with revision surgery need. Nonoperative treatment led to failure.
Conclusions:
- Stable periprosthetic fractures around TARs typically require operative fixation.
- Immobilization management resulted in high rates of re-intervention.
- Talus fractures necessitate revision TAR surgery or arthrodesis.
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