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Current Updates in Total Ankle Arthroplasty, An Issue of Foot and Ankle Clinics of North America, E-Book

Current Updates in Total Ankle Arthroplasty, An Issue of Foot and Ankle Clinics of North America, E-Book

J. Chris Coetzee

(2017)

Additional Information

Abstract

This issue of Foot and Ankle Clinics will include articles on the following: Ankle replacement vs, arthrodesis; Osteolysis; coronal plane malalignment in total ankle arthroplasty; salvage of failed total ankle arthroplasty with anterior translation of the talus; malalignment of the foot or leg; use of tendon transfers; management of the failed long-stemmed custom agility total ankle arthroplasty; and many more articles surrounding foot and ankle arthroplasty.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Current Updates in TotalAnkle Arthroplasty\r i
Copyright\r ii
Editorial Advisory Board iii
Contributors v
CONSULTING EDITOR v
EDITOR v
AUTHORS v
Contents ix
Preface ix
Kinematics and Function of Total Ankle Replacements Versus Normal Ankles ix
Ankle Arthrodesis Versus Total Ankle Arthroplasty ix
Osteolysis in Total Ankle Replacement: How Does It Work? ix
Total Ankle Replacement in the Presence of Talar Varus or Valgus Deformities\r ix
Current Update in Total Ankle Arthroplasty: Salvage of the Failed Total Ankle Arthroplasty with Anterior Translation of the ... x
Malalignment Correction of the Lower Limb Before, During, and After Total Ankle Arthroplasty x
Revision of Stemmed Agility Implants x
Management of Talar Component Subsidence x
Soft Tissue Reconstruction After Total Ankle Arthroplasty xi
How To Diagnose and Treat Infection in Total Ankle Arthroplasty xi
Dealing with the Stiff Ankle: Preoperative and Late Occurrence xi
Experience with Navigation in Total Ankle Arthroplasty. Is It Worth the Cost? xi
Is There Anything to Learn from a National Joint Registry? xii
Pearls and Pitfalls for a Surgeon New to Ankle Replacements xii
FOOT AND ANKLE CLINICS\r xiii
FORTHCOMING ISSUES xiii
September 2017 xiii
December 2017 xiii
March 2018 xiii
RECENT ISSUES xiii
March 2017 xiii
December 2016 xiii
September 2016 xiii
Preface xv
Kinematics and Function of Total Ankle Replacements Versus Normal Ankles 241
Key points 241
INTRODUCTION 241
BIOMECHANICS AND ANATOMY 242
CLINICAL OUTCOMES 242
GAIT ANALYSIS 243
Temporal Spatial Parameters of Gait 243
Kinematic Parameters of Gait 244
Kinetic Parameters of Gait 244
THE DEBATE: MOBILE-BEARING VERSUS FIXED-BEARING IMPLANTS 245
SUMMARY 246
REFERENCES 246
Ankle Arthrodesis Versus Total Ankle Arthroplasty 251
Key points 251
INTRODUCTION 251
ANKLE ARTHRODESIS 252
Contraindications 252
Technique 252
Outcomes 256
Pain relief 256
Union rates 256
Gait biomechanics 256
Periarticular degeneration 256
ANKLE ARTHROPLASTY 256
Indications and Contraindications 257
Survivorship 257
Comorbidities 259
Smoking 259
Clinical Outcomes 259
Infections 260
Postoperative Range of Motion 260
SUMMARY 260
REFERENCES 263
Osteolysis in Total Ankle Replacement 267
Key points 267
INTRODUCTION 267
CONTEMPORARY TOTAL ANKLE REPLACEMENT DESIGNS 268
OSTEOLYSIS IN TOTAL ANKLE REPLACEMENT 268
QUESTIONING POLYETHYLENE DEBRIS–INDUCED PERIPROSTHETIC OSTEOLYSIS 268
THEORIES TO EXPLAIN PERIPROSTHETIC OSTEOLYSIS 269
The Role of Polyethylene Wear 269
Rate of Wear and Joint Size 270
The Role of Micromotion 270
The Role of Fluids 272
Individual Factors: Genetics 273
SUMMARY 273
REFERENCES 273
Total Ankle Replacement in the Presence of Talar Varus or Valgus Deformities 277
Key points 277
INTRODUCTION 277
CLASSIFICATION OF DEFORMITY 278
PREOPERATIVE ASSESSMENT 280
History and Physical Examination 280
Diagnostic Imaging 282
VARUS DEFORMITY 284
Medial Release 284
Intra-Articular Deformity Correction 286
Tendoachilles Lengthening 289
Extra-Articular Deformity Correction 289
Malleolar Osteotomy 289
First Metatarsal Osteotomy 289
Supramalleolar Osteotomy 290
Calcaneal Osteotomy 290
Tendon Transfers 291
Lateral Ligament Reconstruction 292
Hindfoot Arthrodesis 292
VALGUS DEFORMITY 293
Intra-Articular Deformity 293
Deltoid Ligament Insufficiency 293
Lateral Ligament Reconstruction 296
Hindfoot Arthrodesis 296
Pes Planovalgus Reconstruction 296
Malleolar Osteotomy 296
Syndesmotic Stabilization 297
Supramalleolar Osteotomy 297
THE PING-PONG ANKLE 297
THE ROLE OF STAGING 299
SUMMARY 299
REFERENCES 299
Current Update in Total Ankle Arthroplasty 301
Key points 301
INTRODUCTION 301
CLINICAL EXAMINATION 303
PREOPERATIVE INVESTIGATIONS 304
OPERATIVE MANAGEMENT 304
Preparation 304
Procedures with Retention of Both Components 304
Procedure: equinus deformity 305
Procedure: lateral ligament reconstruction 305
Procedure: distal tibial osteotomy 305
Revision of the Talar Component Alone 305
Procedure: tibial component revision 305
Revision of Both Components 306
Procedure: revision both components 306
Outcomes 309
SUMMARY 309
REFERENCES 309
Malalignment Correction of the Lower Limb Before, During, and After Total Ankle Arthroplasty 311
Key points 311
INTRODUCTION 311
CLINICAL EVALUATION 313
TREATMENT AND CONSIDERATION OF DEFORMITY 315
DEFORMITY PROXIMAL TO THE ANKLE JOINT 316
DEFORMITY OF THE FOOT DISTAL TO THE ANKLE 318
CONSIDERATIONS WHEN PERFORMING ADJUNCTIVE PROCEDURES 322
INTRAOPERATIVE CONSIDERATIONS 324
Varus Ankle 324
Valgus Ankle 327
Recurvatum 331
Procurvatum 332
Multiplanar 334
AVOIDING POSTOPERATIVE DISASTER 336
SUMMARY 338
REFERENCES 338
Revision of Stemmed Agility Implants 341
Key points 341
INTRODUCTION 341
BACKGROUND 342
SURGICAL TECHNIQUE 347
OUTCOMES 355
SUMMARY 359
REFERENCES 359
Management of Talar Component Subsidence 361
Key points 361
INTRODUCTION 361
CAUSE OR RISK FACTORS FOR SUBSIDENCE 362
Component Migration 362
Osteolysis 362
Component Design Factors 363
Increasing of Talar Surface Coverage: Agility/Agility LP 363
Improvement of Talar Component Articulating Design: INBONE I/INBONE II 363
Blood Supply of the Talus 364
Avascular Necrosis of the Talus 365
Malalignment 365
TREATMENT OF TALAR COMPONENT SUBSIDENCE 366
Revision Total Ankle Arthroplasty or Arthrodesis 366
Treating Talar Component Subsidence with Revision Total Ankle Arthroplasty: Surgical Tips and Techniques 367
TYPICAL CASES 371
Case 1: Conversion Agility to Salto XT 371
Case 2: Both Tibial Side and Talar Side Subsidence 380
Case 3: Severe Talar Component Subsidence 381
Case 4: Talar Component Subsidence and Polyethylene Fracture 383
Case 5: Revision with Long-stemmed Custom Prosthesis 384
SUMMARY 385
REFERENCES 385
Soft Tissue Reconstruction After Total Ankle Arthroplasty 391
Key points 391
INTRODUCTION 391
PREVENTATIVE MEASURES 392
Continuous External Tissue Expander 392
Negative Pressure Wound Therapy 393
Postoperative Considerations 393
MANAGEMENT OF WOUND COMPLICATIONS 394
Negative Pressure Wound Therapy, Dermal Regeneration Matrix, and Skin Grafts 394
Local Flaps 396
Reverse sural flap 396
Propeller flaps 397
Bipedicle flaps 399
Free tissue transfer 399
POSTOPERATIVE MANAGEMENT 400
Skin Graft or Dermal Substitute Application 400
Local Adjacent Tissue Transfer 400
Free Tissue Transfer 400
SUMMARY 402
REFERENCES 403
How To Diagnose and Treat Infection in Total Ankle Arthroplasty 405
Key points 405
INTRODUCTION 406
EPIDEMIOLOGY AND RISK FACTORS 406
DIAGNOSIS 407
Definition of Periprosthetic Ankle Infection 407
History and Clinical Examination 407
Imaging 409
Laboratory Tests 409
Arthrocentesis and Synovial Fluid Analysis 410
Frozen Section and Sonication 411
TREATMENT ALGORITHM 412
TREATMENT OF WOUND ISSUES 412
Wound Healing Complications 412
Superficial Wound Necrosis 414
TREATMENT OF PERIPROSTHETIC INFECTION 414
Classification of Periprosthetic Joint Infection 414
Early Periprosthetic Infection 415
Antimicrobial therapy 415
Irrigation and debridement with or without polyethylene exchange 415
Deep Late Chronic Infection/Late Hematogenous Infection 415
Revision ankle arthroplasty 415
Cement spacer as a definitive treatment 417
Conversion to ankle arthrodesis 419
Below-the-knee amputation 419
REFERENCES 419
Dealing with the Stiff Ankle 425
Key points 425
INTRODUCTION 425
PREOPERATIVE STIFF ANKLE 426
Indications and Contraindications for Total Ankle Replacement 426
Preoperative Planning 432
Clinical examination 432
Radiographic evaluation 432
Surgical Strategies 432
Anterior osteophytes 432
Posterior osteophytes 433
Mild posterior soft tissue contracture 433
Severe posterior soft tissue contracture (fixed equinus) 433
Tendon contracture 435
Surgical Technique 436
Complications 437
Postoperative Management 437
THE STIFF ANKLE AFTER TOTAL ANKLE REPLACEMENT 438
Indications and Contraindications for Revision 438
Preoperative Planning 439
Clinical examination 439
Radiographic evaluation 439
Differential diagnosis 439
Surgical Strategies 441
Arthroscopic surgery 441
Anterior impingement/stiffness 441
Posterior (and anterior) impingement/stiffness 441
Component loosening and/or malpositioning 441
Surgical Technique 441
Complications 448
Postoperative Management 448
RESULTS 448
SUMMARY 449
ACKNOWLEDGMENTS 449
REFERENCES 449
Experience with Navigation in Total Ankle Arthroplasty. Is It Worth the Cost? 455
Key points 455
REFERENCES 462
Is There Anything to Learn from a National Joint Registry? 465
Key points 465
INTRODUCTION 465
DEMOGRAPHICS OF NATIONAL REGISTRIES 465
WHY HAVE A REGISTRY? 466
The Generalizability Cascade 466
Monitoring the Performance of Implants 467
Monitoring Trends 468
Overall 468
Registry specific 468
Implant specific 468
What Registries Can Tell About Revision 468
Preoperative demographics 468
Failure mode 469
Failure of specific implants 469
Evaluation of revisions 470
Provision of surgeon’s specific data 471
PROBLEMS WITH REGISTRIES 471
Culture 471
The Funding and Control 471
Overinterpretation 472
Revision Compliance—Can the data be trusted? 472
SUMMARY 473
REFERENCES 473
Pearls and Pitfalls for a Surgeon New to Ankle Replacements 477
Key points 477
INTRODUCTION 477
DISCUSSION 478
The Surgeon 478
THE PATIENT 479
Patient Expectations 479
Patient Selection 479
Bone 480
Age 480
Deformity 480
ANKLE REPLACEMENT 482
Anterior Approach 482
Lateral Approach 483
Mobile and Fix Bearing 484
Mobile bearing 485
Fix bearing 485
SUMMARY 485
REFERENCES 486
Index 491