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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Intermediate-term Patient-Reported Outcomes and Radiographic Evaluation Following Intramedullary- vs

Craig C Akoh1, Rishin Kadakia2, Amanda Fletcher3

  • 1Department of Orthopaedic Surgery, Rush Copley Medical Center, Aurora, IL, USA.

Foot & Ankle International
|January 27, 2021
PubMed
Summary

Intramedullary-referenced (IMr) and extramedullary-referenced (EMr) total ankle replacement (TAR) show similar outcomes. Both methods provide comparable alignment, patient satisfaction, and implant survivorship after 5 years.

Keywords:
complicationsextramedullary-referencedimpending failureintramedullary-referencedoutcomessurvivorshiptotal ankle arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Radiology

Background:

  • End-stage tibiotalar osteoarthritis necessitates advanced treatment options.
  • Total ankle replacement (TAR) offers a solution for debilitating ankle arthritis.
  • Comparing referencing methods in TAR is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare radiographic and clinical outcomes of extramedullary-referenced (EMr) versus intramedullary-referenced (IMr) total ankle replacement (TAR).
  • To evaluate implant survivorship and complication rates between EMr and IMr TAR components.
  • To analyze patient-reported outcome scores and radiographic alignment in both TAR groups.

Main Methods:

  • Retrospective comparative study of 340 patients undergoing TAR (105 IMr, 235 EMr) from May 2007 to February 2018.
  • Analysis included patient-reported outcomes, radiographic alignment, concomitant procedures, and complications.
  • Kaplan-Meier survivorship analysis assessed implant reoperation and revision rates over a mean follow-up of 5.3 years.

Main Results:

  • Both IMr and EMr TAR achieved near-neutral postoperative coronal alignment (1.4 vs 1.5 degrees).
  • IMr TAR showed a 2.7 times higher odds of requiring concomitant procedures compared to EMr TAR.
  • Patient-reported outcomes and 5-year implant survivorship were similar between IMr (98.6%) and EMr (97.5%) groups.

Conclusions:

  • IMr and EMr TAR components demonstrate comparable postoperative alignment and patient-reported outcomes.
  • Complication rates and 5-year implant survivorship were similar between the two referencing methods.
  • Both EMr and IMr TAR are effective options for managing end-stage tibiotalar osteoarthritis.