Name: treatment of ankle osteoarthritis with total ankle replacement through a lateral transfibular approach
Uploaded: 2018-01-24T14:00:00
Description: Watch this Scientific Journal Video about Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach at JoVE.com

The procedures are performed using the Zimmer Trabecular Metal Total Ankle prosthesis (Zimmer, Warsaw, IN).

All methods described have been approved by our institutional review board and the local ethics committee and they have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
1. Preoperative Radiographic Evaluation
<ol>
	<li>Perform weight bearing radiographs of the ankle and the foot with antero-posterior, lateral, and rearfoot alignment views (Saltzman&#39;s view30).</li>
	<li>Perform a convent...

We reported the methods and protocol we use performing TAR with lateral transfibular approach. The absolute contraindications for TAR are talar avascular necrosis involving more than 50% of the bone-stock, acute or active infection with or without osteomyelitis, diabetic syndrome with polyneuropathy, high anesthesiologic risks, neuromuscular disorders, peripheral vascular disease, and neuroarthropathy (Charcot arthropathy of the midfoot or hindfoot)19,42. The rel...

The most frequent etiology of ankle osteoarthritis is the post-traumatic origin. In fact, it is often secondary to traumatic injuries that typically affect young patients1,2. Ankle osteoarthritis influences patients&#39; quality of life to the same degree as hip osteoarthritis and even more than knee osteoarthritis3. Ankle fusion has been considered the gold-standard for the treatment of ankle osteoarthritis, but some studies show that it confers augmented stress and increased risk of osteoarthritis of the adjacent joints4,5,6,7; furthermore, there still exist a number of complications associated with ankle fusion, such as equinus or talipes deformity and painful non-union8,9. With the evolution of surgical techniques and implant designs, total ankle replacement (TAR) has become an excellent alternative to ankle fusion for a surgeon with a proper learning-curve10,11,12.
TAR allows the preservation of ankle range of motion and protects from adjacent joint degeneration13. The anterior approach permits an optimal visualization of the coronal alignment; at the same time, this approach is inclined to wound-healing complications14,15. Recently, a novel TAR implant was designed to be performed via the lateral transfibular approach that results in an ideal visualization of the center of rotation and curved resections that allow for sparing bone cuts16; moreover, this approach permits the implantation of components perpendicular to the bone trabeculae, thus limiting the shear forces at the level of the bone-implant interface16. This prosthesis consists of a fixed-bearing implant; an alignment coordinate system guides the bone resections and facilitates addressing both coronal and sagittal deformities17. The early results of ankle arthroplasty using this TAR implant have been published 12,16,17,18. The aim of the present paper is to present our preoperative, operative, and postoperative protocols for the treatment of the osteoarthritis of the ankle with TAR via the lateral approach.
Patient selection starts with a careful clinical examination and history. A medical history of inflammatory or vascular disease, neuropathy or neurologic disease and complicated diabetes may modify the indication. Poor soft tissue envelope of the ankle should be carefully evaluated because it may compromise the wound healing: skin and subcutaneous soft-tissue may already have been compromised from injury or previous surgery. The use of drugs that may influence healing must be considered. Muscle and tendon function, ankle and hindfoot alignment, and ankle range of motion should be evaluated: a detailed examination can indicate whether accessory procedures are needed at the time of surgery19.
We suggest always discussing the expectations of the patient concerning the outcomes of the procedure and the need for compliance with post-operative care. TAR is indicated for patients with an ankle joint disease due to post-traumatic, rheumatoid, or primary arthritis not responsive to conservative options that include physical therapy, activity modification, and non-steroidal anti-inflammatory drugs19. Also, lateral ankle instability may represent a cause of joint degeneration defined as ligamentous posttraumatic ankle osteoarthritis20. In addition, secondary osteoarthritis can be associated with systemic diseases: avascular necrosis of the talus, gout, hemophilia, post-infectious arthritis, and hereditary hemochromatosis21,22,23,24.
During the preoperative consultation, we routinely record the following clinical and functional scores: American Orthopaedic Foot &#38; Ankle Society (AOFAS) ankle and hindfoot score25,26,27, 12-Item Short Form Health Survey27,28, and Visual Analogue scale (VAS) pain score29.

<table border="0" cellpadding="0" cellspacing="0" width="880">
	<tbody>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Zimmer Total Ankle</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">82-0175-162-00</td>
			<td style="width:327px;">Total Ankle Replacement</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Calcaneus pin</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-040-00</td>
			<td>Trans-calcaneal pin</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">4.0 mm Pin</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-040-04</td>
			<td>Talar pin</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">5.0 mm Pin</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-040-05</td>
			<td>Tibial pins</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">1.6 mm k-wire</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-040-01</td>
			<td>1.6 mm Kirschner wire</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Moonray BlueLIne Dual</td>
			<td style="width:204px;">SIMAD</td>
			<td style="width:179px;"></td>
			<td>Mobile C-arm</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Pre-Cut Guide Drill</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-059-00</td>
			<td>Precutting bone drill</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Bur</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;">00-4501-076-00</td>
			<td>Bone resection burr</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Micro 100 Drill</td>
			<td style="width:204px;">Conmed Corporation</td>
			<td style="width:179px;">5053-009</td>
			<td>Pneumatic handpieces</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">3.5 mm ULS screws</td>
			<td style="width:204px;">Zimmer, Inc.</td>
			<td style="width:179px;"></td>
			<td>Fibular fixation screws</td>
		</tr>
		<tr height="22">
			<td height="22" style="height:22px;width:172px;">Matlab version 2008</td>
			<td style="width:204px;">The MathWorks Inc.</td>
			<td style="width:179px;"></td>
			<td>Statistical software</td>
		</tr>
	</tbody>
</table>

treatment of ankle osteoarthritis with total ankle replacement through a lateral transfibular approach

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior approach. Recently, the lateral transfibular approach to the ankle has gained popularity since a new TAR implant was designed to be performed via this approach that results in an ideal visualization of the center of rotation of the ankle and curved resections that allow for sparing bone cuts. The aim of the present paper is to present our preoperative, operative, and postoperative protocols for the treatment of the osteoarthritis of the ankle with TAR via lateral approach. We present our preoperative clinical and radiographic protocol. In addition, we describe our surgical technique with some technical tips. Finally, we report our follow-up schedule that includes the collection of clinical, functional, and radiographic data. The results of this procedure are encouraging: TAR through a lateral transfibular approach provides reliable pain relief and improvements in functional outcomes in patients with ankle osteoarthritis.

We collected the results of a consecutive series of 114 patients (114 ankles) who underwent TAR via lateral transfibular approach between May 2013 and July 2016. All operative procedures were carried out by the senior author.
Data were analyzed with a statistical software (see Table of Materials). The ANOVA and kappa tests were performed40,41. For k-scor...

Watch this Scientific Journal Video about Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach at JoVE.com

Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach

We present our preoperative, operative, and postoperative protocols for the treatment of osteoarthritis of the ankle with total ankle replacement via lateral transfibular approach.

Total ankle replacement (TAR) is a valid option for the treatment of ankle osteoarthritis. The traditional surgical approach for TAR is the anterior ...

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