Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Replacement Using a Transfibular Approach
Early Clinical and Radiographic Outcomes of Trabecular Metal Total Ankle Replacement Using a Transfibular Approach
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DOI：
10.2106/jbjs.17.00018
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发表时间：
2018-03-21
影响因子：
5.3
通讯作者：
Gililland, Jeremy
中科院分区：
文献类型：
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作者：
Barg, Alexej;Bettin, Clayton C.;Gililland, Jeremy
背景：在过去的20年里，全踝关节置换术作为终末期踝关节骨性关节炎患者的一种治疗方案得到了更广泛的接受。然而，目前尚缺乏采用外侧经腓骨入路进行全踝关节置换术的文献报道。方法：2012年10月至2014年12月，54例患者(男29例，女25例；平均年龄67.0岁)采用Zimmer小梁金属全踝植入物进行了55例初次全踝关节置换术。临床评估，包括疼痛评估和测量踝关节活动范围，在手术前和最近一次随访时进行。使用负重X线片来确定胫骨和距骨部件的角度对齐，并分析骨-种植体界面。对术中和术后并发症、翻修手术和存活率进行评估。结果：随访24个月，植入物存活率为93%。由于无菌性松动，一个胫骨假体有3次翻修。在55例中，有10例在随访期间进行了二次手术。平均随访时间26.6+/-4.2个月。在腓骨愈合方面，没有观察到延迟愈合或不愈合。平均视觉模拟评分(VAS)疼痛评分显著下降，从7.9+/-1.3降至0.8+/-1.2。平均总活动度从22.9度+/-12.7度增加到40.2度+/-11.8度。结论：在至少2年的随访期内，使用Zimmer小梁金属植入物和外侧经腓骨入路的全踝关节置换术的早期结果改善了患者的预后，增加了踝关节的活动度。在55例连续病例中，进入脚踝所需的腓骨截骨术治愈，无并发症。55例中有3例因缺乏骨性生长而导致疼痛的早期松动需要翻修。
Background: In the last 2 decades, total ankle replacement has gained greater acceptance as a treatment option in patients with end-stage ankle osteoarthritis. However, there is a lack of literature on total ankle replacement using a lateral transfibular approach. Therefore, we sought to report early clinical and radiographic results for a patient cohort treated with total ankle replacement using a lateral transfibular approach, performed by a single surgeon.Methods: From October 2012 to December 2014, 55 primary total ankle arthroplasties using the Zimmer Trabecular Metal Total Ankle implant were performed in 54 patients (29 male and 25 female; mean age, 67.0 years). Clinical assessment, including pain evaluation and measurement of ankle range of motion, was conducted preoperatively and at the latest follow-up. Weight-bearing radiographs were used to determine angular alignment of the tibial and talar components and to analyze the bone-implant interface. Intraoperative and postoperative complications, revision surgeries, and survivorship were evaluated.Results: Implant survival was 93% at 24 months of follow-up. There were 3 revisions of a tibial component due to aseptic loosening. In 10 of the 55 cases, a secondary procedure was performed during follow-up. The mean follow-up duration was 26.6 +/- 4.2 months. No delayed union or nonunion was observed for fibular healing. The average visual analog scale (VAS) pain score decreased significantly, from 7.9 +/- 1.3 to 0.8 +/- 1.2. The average total range of motion increased significantly, from 22.9 degrees +/- 12.7 degrees to 40.2 degrees +/- 11.8 degrees.Conclusions: Early results of total ankle replacement using the Zimmer trabecular metal implant and the lateral transfibular approach demonstrated improved patient-reported outcomes and increased ankle motion at a minimum follow-up of 2 years. In the 55 consecutive cases, the fibular osteotomy required for access to the ankle healed without complications. Painful early loosening due to lack of osseous ingrowth required revision in 3 of 55 cases.