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Anatomic total talar prosthesis replacement surgery and ankle arthroplasty: an early case series in Thailand.

Angthong C - Orthop Rev (Pavia) (2014)

Bottom Line: From preoperative to postoperative, VAS-FA score increased from 6.0 to 57.5, and SF-36 score increased from 19.3 to 73.7 in a patient with TPR.This study is the first report of anatomic-metallic TPR which appears to provide satisfactory outcomes for treatment of talar loss at a short-term follow-up.TAR also provides acceptable results for treatment of ankle arthritis at this point.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Thammasat University , Pathum Thani, Thailand.

ABSTRACT
Little is known about specific outcomes and early experiences of total talar prosthesis replacement surgery in the current literature, and ankle arthroplasty in Southeast Asia. This study reported on four patients with talar loss or ankle arthritis. Patients were treated with a custom total talar prosthesis (anatomic-metallic version) replacement (TPR, n=1) or with total ankle replacement (TAR, n=3). Baseline data, including Visual-Analog-Scale Foot and Ankle (VAS-FA) and Quality of Life scores via Short-Form-36 (SF-36), were collected for all patients. Mean follow-up time was 7.6 months. From preoperative to postoperative, VAS-FA score increased from 6.0 to 57.5, and SF-36 score increased from 19.3 to 73.7 in a patient with TPR. Mean VAS-FA scores increased from 51.5±15.6 to 85.7±4.7 (P=0.032), and mean SF-36 scores tended to increase from 65.2±13.3 to 99.3±1.2 (P=0.055) in TAR group. This study is the first report of anatomic-metallic TPR which appears to provide satisfactory outcomes for treatment of talar loss at a short-term follow-up. TAR also provides acceptable results for treatment of ankle arthritis at this point.

No MeSH data available.


Related in: MedlinePlus

Mean ratios (*) of the anteroposterior (length) and medio-lateral (width) dimensions of the trochlea tali (TaALc/TaWc) in the current study (talar prosthesis), and the ratios of the means of the same dimensions reported in Fessy et al. 14 and Stagni et al.13 and Kuo et al. 12 Mean ratios of the individual dimensions are also given above the bars. Abbreviations: TaALc, Trochlea tali central arc length: distance between the most anterior and posterior and proximal points of the trochlea tali, as seen in the sagittal projection of the talus or talar prosthesis (current study); TaWc, Trochlea tali width: width between medial and lateral crests of the talar dome at central location along mediolateral (M/L) axis).
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fig002: Mean ratios (*) of the anteroposterior (length) and medio-lateral (width) dimensions of the trochlea tali (TaALc/TaWc) in the current study (talar prosthesis), and the ratios of the means of the same dimensions reported in Fessy et al. 14 and Stagni et al.13 and Kuo et al. 12 Mean ratios of the individual dimensions are also given above the bars. Abbreviations: TaALc, Trochlea tali central arc length: distance between the most anterior and posterior and proximal points of the trochlea tali, as seen in the sagittal projection of the talus or talar prosthesis (current study); TaWc, Trochlea tali width: width between medial and lateral crests of the talar dome at central location along mediolateral (M/L) axis).

Mentions: There was only one subject, who was male, in the total talar prosthesis replacement (TPR) group. The patient age was 25 years. The cause of his ankle problem was severe traumatic loss of the entire talus (Figure 1C,D). The duration of symptoms before the definitive treatment was approximately 3 months and the follow-up time was 4.6 months. A custom iTalar-M prosthesis was implanted in this patient. This prosthesis was manufactured as a custom-made implant for this patient by the author and colleagues using three-dimensional computed tomography imaging of the contralateral talus with computer graphics, and development with medical grade (stainless steel) (Figure 1G,H). The custom prosthesis in the current study consisted of: i) trochlea tali central arc length (TaALc: a distance between the most anterior and posterior and proximal points of the trochlea tali, as seen in the sagittal projection of the talus or our talar prosthesis) as 35.1 mm; ii) trochlea tali width [TaWc: a width between medial and lateral crests of the talar dome at central location along mediolateral (M/L) axis] as 27.8 mm. These distances were in the ranges of same parameters in the previous studies.12-14 The three-dimensional computer graphics-based talar morphometry with computed tomography was analyzed and compared with the previous studies (Figure 2).12-14 The mean ratio of the anteroposterior (length) and medio-lateral (width) dimensions of the trochlea tali (TaALc/TaWc) of a custom prosthesis in the current study was in the range among the same ratios of previous studies.13,14 These evidences confirmed the anatomic design of total talar prosthesis in the current study. For the operation, the surgical findings revealed that the ankle joint and subtalar joint of this patient had no significant arthritic changes. Then, the author decided to perform the total talar prosthesis replacement for him. The operative time was 230 minutes. From preoperative to postoperative, the VAS-FA score increased from 6.0 to 57.5, the SF-36 score increased from 19.3 to 73.7, the dorsiflexion increased from 0 to 5 degrees, the plan-tarflexion increased from 0 to 16 degrees, and the total ankle motion increased from 0 to 21 degrees. The preoperative and postoperative inversions were 0 and 10 degrees, and the eversions were 0 and 13 degrees. There were no intraoperative or postoperative complications. There was no sign of prosthesis migration at the last follow-up visit for this patient (Figure 1E,F). The patient was able to return to stand and walk as full-weight bearing without gait aid (Figure 3A-E). He was able to mobilize and perform his activity-daily living by himself with more convenience. His quality of life was substantially improved at the latest follow-up period.


Anatomic total talar prosthesis replacement surgery and ankle arthroplasty: an early case series in Thailand.

Angthong C - Orthop Rev (Pavia) (2014)

Mean ratios (*) of the anteroposterior (length) and medio-lateral (width) dimensions of the trochlea tali (TaALc/TaWc) in the current study (talar prosthesis), and the ratios of the means of the same dimensions reported in Fessy et al. 14 and Stagni et al.13 and Kuo et al. 12 Mean ratios of the individual dimensions are also given above the bars. Abbreviations: TaALc, Trochlea tali central arc length: distance between the most anterior and posterior and proximal points of the trochlea tali, as seen in the sagittal projection of the talus or talar prosthesis (current study); TaWc, Trochlea tali width: width between medial and lateral crests of the talar dome at central location along mediolateral (M/L) axis).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195992&req=5

fig002: Mean ratios (*) of the anteroposterior (length) and medio-lateral (width) dimensions of the trochlea tali (TaALc/TaWc) in the current study (talar prosthesis), and the ratios of the means of the same dimensions reported in Fessy et al. 14 and Stagni et al.13 and Kuo et al. 12 Mean ratios of the individual dimensions are also given above the bars. Abbreviations: TaALc, Trochlea tali central arc length: distance between the most anterior and posterior and proximal points of the trochlea tali, as seen in the sagittal projection of the talus or talar prosthesis (current study); TaWc, Trochlea tali width: width between medial and lateral crests of the talar dome at central location along mediolateral (M/L) axis).
Mentions: There was only one subject, who was male, in the total talar prosthesis replacement (TPR) group. The patient age was 25 years. The cause of his ankle problem was severe traumatic loss of the entire talus (Figure 1C,D). The duration of symptoms before the definitive treatment was approximately 3 months and the follow-up time was 4.6 months. A custom iTalar-M prosthesis was implanted in this patient. This prosthesis was manufactured as a custom-made implant for this patient by the author and colleagues using three-dimensional computed tomography imaging of the contralateral talus with computer graphics, and development with medical grade (stainless steel) (Figure 1G,H). The custom prosthesis in the current study consisted of: i) trochlea tali central arc length (TaALc: a distance between the most anterior and posterior and proximal points of the trochlea tali, as seen in the sagittal projection of the talus or our talar prosthesis) as 35.1 mm; ii) trochlea tali width [TaWc: a width between medial and lateral crests of the talar dome at central location along mediolateral (M/L) axis] as 27.8 mm. These distances were in the ranges of same parameters in the previous studies.12-14 The three-dimensional computer graphics-based talar morphometry with computed tomography was analyzed and compared with the previous studies (Figure 2).12-14 The mean ratio of the anteroposterior (length) and medio-lateral (width) dimensions of the trochlea tali (TaALc/TaWc) of a custom prosthesis in the current study was in the range among the same ratios of previous studies.13,14 These evidences confirmed the anatomic design of total talar prosthesis in the current study. For the operation, the surgical findings revealed that the ankle joint and subtalar joint of this patient had no significant arthritic changes. Then, the author decided to perform the total talar prosthesis replacement for him. The operative time was 230 minutes. From preoperative to postoperative, the VAS-FA score increased from 6.0 to 57.5, the SF-36 score increased from 19.3 to 73.7, the dorsiflexion increased from 0 to 5 degrees, the plan-tarflexion increased from 0 to 16 degrees, and the total ankle motion increased from 0 to 21 degrees. The preoperative and postoperative inversions were 0 and 10 degrees, and the eversions were 0 and 13 degrees. There were no intraoperative or postoperative complications. There was no sign of prosthesis migration at the last follow-up visit for this patient (Figure 1E,F). The patient was able to return to stand and walk as full-weight bearing without gait aid (Figure 3A-E). He was able to mobilize and perform his activity-daily living by himself with more convenience. His quality of life was substantially improved at the latest follow-up period.

Bottom Line: From preoperative to postoperative, VAS-FA score increased from 6.0 to 57.5, and SF-36 score increased from 19.3 to 73.7 in a patient with TPR.This study is the first report of anatomic-metallic TPR which appears to provide satisfactory outcomes for treatment of talar loss at a short-term follow-up.TAR also provides acceptable results for treatment of ankle arthritis at this point.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Faculty of Medicine, Thammasat University , Pathum Thani, Thailand.

ABSTRACT
Little is known about specific outcomes and early experiences of total talar prosthesis replacement surgery in the current literature, and ankle arthroplasty in Southeast Asia. This study reported on four patients with talar loss or ankle arthritis. Patients were treated with a custom total talar prosthesis (anatomic-metallic version) replacement (TPR, n=1) or with total ankle replacement (TAR, n=3). Baseline data, including Visual-Analog-Scale Foot and Ankle (VAS-FA) and Quality of Life scores via Short-Form-36 (SF-36), were collected for all patients. Mean follow-up time was 7.6 months. From preoperative to postoperative, VAS-FA score increased from 6.0 to 57.5, and SF-36 score increased from 19.3 to 73.7 in a patient with TPR. Mean VAS-FA scores increased from 51.5±15.6 to 85.7±4.7 (P=0.032), and mean SF-36 scores tended to increase from 65.2±13.3 to 99.3±1.2 (P=0.055) in TAR group. This study is the first report of anatomic-metallic TPR which appears to provide satisfactory outcomes for treatment of talar loss at a short-term follow-up. TAR also provides acceptable results for treatment of ankle arthritis at this point.

No MeSH data available.


Related in: MedlinePlus