Poor outcomes of fusion with Trabecular Metal implants after failed total ankle replacement: Early results in 11 patients

Autor: Jean-Luc Besse, Michel-Henry Fessy, Sylvain Aubret, L Merlini
Přispěvatelé: Service de chirurgie orthopédique et traumatologique, Université Clermont Auvergne, CHU Clermont-Ferrand, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Service de Chirurgie Orthopédique et Traumatologique [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
medicine.medical_treatment
CHEVILLE
Bone Nails
Iliac crest
0302 clinical medicine
Medicine
Orthopedics and Sports Medicine
Treatment Failure
Aged
80 and over
030222 orthopedics
ANKLE FUSION
Subtalar Joint
[SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph]
Prostheses and Implants
Middle Aged
3. Good health
REVISION
medicine.anatomical_structure
TRABECULAR METAL
Female
Bone Plates
Adult
Reoperation
medicine.medical_specialty
Arthrodesis
Ankle replacement
Nonunion
Ilium
Arthroplasty
Replacement
Ankle
03 medical and health sciences
BIOMECANIQUE
Subtalar joint
Humans
TANTALUM
Aged
Retrospective Studies
TOTAL ANKLE REPLACEMENT
business.industry
Retrospective cohort study
030229 sport sciences
medicine.disease
Surgery
Radiography
Implant
Ankle
business
Ankle Joint
Follow-Up Studies
Zdroj: Orthopaedics and Traumatology-Surgery and Research
Orthopaedics and Traumatology-Surgery and Research, Elsevier, 2018, 104 (2), pp. 231-237. ⟨10.1016/j.otsr.2017.11.022⟩
ISSN: 1877-0568
DOI: 10.1016/j.otsr.2017.11.022⟩
Popis: Introduction One of the reasons for revision of total ankle replacement (TAR) implants is loosening due to subchondral cysts. Reconstruction and fusion of the ankle is often the first choice for revision procedures due to the large bone defects, which are typically filled with autograft and/or allograft. Filling the defect with a trabecular metal tantalum implant is a potential alternative given the biomechanical properties of this component. Hypothesis Using tantalum as a spacer provides primary stability and contributes to fusion of the ankle joint after removal of failed TAR implants. Methods Eleven patients underwent arthrodesis an average of 6.9 years after TAR. The mean height of the bone defect was 32 mm. It was filled with a specially designed quadrangular implant (Trabecular Metal™, Zimmer/Biomet) combined with an iliac crest graft. Ten patients underwent tibio-talo-calcaneal (TTC) arthrodesis fixed with an angled retrograde nail and one patient underwent talocrural arthrodesis fixed with two plates (anterolateral and anteromedial). The clinical, functional (AOFAS and SF36 scores) and radiological (plain X-rays and CT scan) outcomes were determined. Results At a mean follow-up of 19.3 months, the mean total AOFAS score was 56 (21–78) and the mean SF36 score was 60.5 (19–84). One patient was lost to follow-up and four patients still had pain. The tantalum implant was integrated in six patients. Five patients achieved fusion of the subtalar joint and 8 achieved fusion of the talocrural joint. Three patients required surgical revision. Discussion Our hypothesis was not confirmed. The clinical outcomes after more than 1 year of follow-up are disappointing, as was the large number of nonunion cases and the lack of tantalum integration. These technical failures can be explained by insufficient construct stability and/or insufficient implant porosity. Level of Evidence IV (retrospective cohort study).
Databáze: OpenAIRE
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