Role of Prosthetic Alignment and Heterotopic Calcifications in Total Ankle Arthroplasty
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Published:
Feb 17, 2023
Keywords:
Alignment, heterotopic calcifications, quality of life
Main Article Content
Abstract
Introduction: The main objective of this work is to evaluate the relationship between the formation of heterotopic calcifications and the alignment parameters of the prosthesis.
Materials and Methods: The population under study comprised 31 patients. The radiographic alignment variables evaluated were alpha and beta angles, the talar center of rotation, and the percentage of posterior coverage of the tibia in the immediate postoperative period and after 2 years. The clinical evaluation variables were: VAS, AOFAS, and the SF-36 questionnaire to evaluate quality of life at the end of follow-up.
Results: The most frequent etiology of osteoarthritis was post-traumatic (67.7%). In the immediate postoperative period, the mean alpha angle was 88.7° (range 82-92.6°; SD± 2.61); the mean beta angle was 84.46° (range 78°, 62-91.40°; SD ±3.59). The alignment of the tibial component in the anteroposterior plane was neutral in 25 patients (80.6%), valgus in 6 (19.4%), and varus in none. At 2 years of follow-up, 96% presented heterotopic calcifications. An improvement was verified both in the AOFAS (pre/post 31.90/80.94) and in the VAS scales (pre/post: 8.7/1.97) (p<0.05).
Conclusions: No relationship was found between heterotopic calcification and worse functional outcomes or pain, except for quality-of-life parameters (SF-36) such as physical condition, emotional limitation, and general health perception, which worsened as the degree of calcifications around the prosthesis increased.
Materials and Methods: The population under study comprised 31 patients. The radiographic alignment variables evaluated were alpha and beta angles, the talar center of rotation, and the percentage of posterior coverage of the tibia in the immediate postoperative period and after 2 years. The clinical evaluation variables were: VAS, AOFAS, and the SF-36 questionnaire to evaluate quality of life at the end of follow-up.
Results: The most frequent etiology of osteoarthritis was post-traumatic (67.7%). In the immediate postoperative period, the mean alpha angle was 88.7° (range 82-92.6°; SD± 2.61); the mean beta angle was 84.46° (range 78°, 62-91.40°; SD ±3.59). The alignment of the tibial component in the anteroposterior plane was neutral in 25 patients (80.6%), valgus in 6 (19.4%), and varus in none. At 2 years of follow-up, 96% presented heterotopic calcifications. An improvement was verified both in the AOFAS (pre/post 31.90/80.94) and in the VAS scales (pre/post: 8.7/1.97) (p<0.05).
Conclusions: No relationship was found between heterotopic calcification and worse functional outcomes or pain, except for quality-of-life parameters (SF-36) such as physical condition, emotional limitation, and general health perception, which worsened as the degree of calcifications around the prosthesis increased.
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How to Cite
Villena, D. S., Valenti, P., Verbner, J., Sotelano, P., Santini Araujo, M. G., Conti, L., Parise, A. C., & Carrasco, M. (2023). Role of Prosthetic Alignment and Heterotopic Calcifications in Total Ankle Arthroplasty. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(1), 33-44. https://doi.org/10.15417/issn.1852-7434.2023.88.1.1637
Section
Clinical Research
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References
1. Overley BD, Beideman TC. Painful osteophytes, ectopic bone, and pain in the malleolar gutters following total
ankle replacement: management and strategies. Clin Podiatr Med Surg 2015;32(4):509-16. https://doi.org/10.1016/j.cpm.2015.06.013
2. Bemenderfer TB, Davis WH, Anderson RB, Wing K, Escudero MI, Waly F, et al. Heterotopic ossification in total
ankle arthroplasty: case series and systematic review. J Foot Ankle Surg 2020;59(4):716-21.
https://doi.org/10.1053/j.jfas.2019.12.003
3. Manegold S, Springer A, Landvoigt K, Tsitsilonis S. Heterotopic ossification after total ankle replacement: The role of prosthesis alignment. Foot Ankle Surg 2017;23(2):122-7. https://doi.org/10.1016/j.fas.2017.02.008
4. Angthong C, Adams SB, Easley ME, Nunley JA. Heterotopic ossification following total ankle replacement: clinical significance and factors affecting its formation. J Surg Orthop Adv 2014;23(4):203-13. PMID: 25785471
5. King CM, Schuberth JM, Christensen JC, Swanstrom KM. Relationship of alignment and tibial cortical coverage to hypertrophic bone formation in Salto Talaris® total ankle arthroplasty. J Foot Ankle Surg 2013;52(3):355-9.
https://doi.org/10.1053/j.jfas.2013.01.011
6. Hintermann B, Valderrabano V, Dereymaeker G, Dick W. The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res 2004;(424):57-68. https://doi.org/10.1097/01.blo.0000132462.72843.e8
7. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane
corrective osteotomies. Orthop Clin North Am 1994;25(3):425-65. PMID: 8028886
8. Barg A, Elsner A, Chuckpaiwong B, Hintermann B. Insert position in three-component total ankle replacement.
Foot Ankle Int 2010;31(9):754-9. https://doi.org/10.3113/FAI.2010.0754
9. Choi WJ, Lee JW. Heterotopic ossification after total ankle arthroplasty. J Bone Joint Surg Br 2011;93(11):1508-12. https://doi.org/10.1302/0301-620X.93B11.27641
10. Choi GW, Kim HJ, Yeo ED, Song SY. Comparison of the HINTEGRA and Mobility total ankle replacements. Shortto intermediate-term outcomes. Bone Joint J 2013;95-B(8):1075-82. https://doi.org/10.1302/0301-620X.95B8.31774
11. Jung H-G, Lee S-H, Shin M-H, Lee D-O, Eom J-S, Lee J-S. Anterior heterotopic ossification at the talar neck after
total ankle arthroplasty. Foot Ankle Int 2016;37(7):703-8. https://doi.org/10.1177/1071100716642757
12. Lee K-B, Cho Y-J, Park J-K, Song E-K, Yoon T-R, Seon J-K. Heterotopic ossification after primary total ankle
arthroplasty. J Bone Joint Surg Am 2011;93(8):751-8. https://doi.org/10.2106/JBJS.J.00178
13. Valderrabano V, Hintermann B, Dick W. Scandinavian total ankle replacement: a 3.7-year average followup of 65 patients. Clin Orthop Relat Res 2004;(424):47-56. PMID: 15241143
14. Haytmanek CT, Gross C, Easley ME, Nunley JA. Radiographic outcomes of a mobile-bearing total ankle
replacement. Foot Ankle Int 2015;36(9):1038-44. https://doi.org/10.1177/1071100715583353
15. Kerkhoff YRA, Kosse NM, Metsaars WP, Louwerens JWK. Long-term functional and radiographic outcome of a
mobile bearing ankle prosthesis. Foot Ankle Int 2016;37(12):1292-302. https://doi.org/10.1177/1071100716661477
16. Buechel FF, Buechel FF, Pappas MJ. Ten-year evaluation of cementless Buechel-Pappas meniscal bearing total
ankle replacement. Foot Ankle Int 2003;24(6):462-72. https://doi.org/10.1177/107110070302400603
17. Jung H-G, Shin M-H, Lee S-H, Eom J-S, Lee D-O. Comparison of the outcomes between two 3-component total
ankle implants. Foot Ankle Int 2015;36(6):656-63. https://doi.org/10.1177/1071100715573716
18. Natens P, Dereymaeker G, Abbara M, Matricali G. Early results after four years experience with the S.T.A.R.
uncemented total ankle prosthesis. Acta Orthop Belg 2003;69(1):49-58. PMID: 12666291
19. Wood PLR, Deakin S. Total ankle replacement. The results in 200 ankles. J Bone Joint Surg Br 2003;85(3):334-41. https://doi.org/10.1302/0301-620x.85b3.13849
20. Lee G-W, Seon J-K, Kim N-S, Lee K-B. Comparison of intermediate-term outcomes of total ankle arthroplasty in
patients younger and older than 55 years. Foot Ankle Int 2019;40(7):762-8. https://doi.org/10.1177/1071100719840816
21. Demetracopoulos CA, Adams SB, Queen RM, DeOrio JK, Nunley JA, Easley ME. Effect of age on outcomes in
total ankle arthroplasty. Foot Ankle Int 2015;36(8):871-80. https://doi.org/10.1177/1071100715579717
22. San Giovanni TP, Keblish DJ, Thomas WH, Wilson MG. Eight-year results of a minimally constrained total ankle
arthroplasty. Foot Ankle Int 2006;27(6):418-26. https://doi.org/10.1177/107110070602700606
23. Del Vecchio JJ, Uzair AE, Ghioldi ME. Letter regarding: anterior heterotopic ossification at the talar neck after total ankle arthroplasty. Foot Ankle Int 2017;38(8):930-2. https://doi.org/10.1177/1071100717712986
ankle replacement: management and strategies. Clin Podiatr Med Surg 2015;32(4):509-16. https://doi.org/10.1016/j.cpm.2015.06.013
2. Bemenderfer TB, Davis WH, Anderson RB, Wing K, Escudero MI, Waly F, et al. Heterotopic ossification in total
ankle arthroplasty: case series and systematic review. J Foot Ankle Surg 2020;59(4):716-21.
https://doi.org/10.1053/j.jfas.2019.12.003
3. Manegold S, Springer A, Landvoigt K, Tsitsilonis S. Heterotopic ossification after total ankle replacement: The role of prosthesis alignment. Foot Ankle Surg 2017;23(2):122-7. https://doi.org/10.1016/j.fas.2017.02.008
4. Angthong C, Adams SB, Easley ME, Nunley JA. Heterotopic ossification following total ankle replacement: clinical significance and factors affecting its formation. J Surg Orthop Adv 2014;23(4):203-13. PMID: 25785471
5. King CM, Schuberth JM, Christensen JC, Swanstrom KM. Relationship of alignment and tibial cortical coverage to hypertrophic bone formation in Salto Talaris® total ankle arthroplasty. J Foot Ankle Surg 2013;52(3):355-9.
https://doi.org/10.1053/j.jfas.2013.01.011
6. Hintermann B, Valderrabano V, Dereymaeker G, Dick W. The HINTEGRA ankle: rationale and short-term results of 122 consecutive ankles. Clin Orthop Relat Res 2004;(424):57-68. https://doi.org/10.1097/01.blo.0000132462.72843.e8
7. Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A. Deformity planning for frontal and sagittal plane
corrective osteotomies. Orthop Clin North Am 1994;25(3):425-65. PMID: 8028886
8. Barg A, Elsner A, Chuckpaiwong B, Hintermann B. Insert position in three-component total ankle replacement.
Foot Ankle Int 2010;31(9):754-9. https://doi.org/10.3113/FAI.2010.0754
9. Choi WJ, Lee JW. Heterotopic ossification after total ankle arthroplasty. J Bone Joint Surg Br 2011;93(11):1508-12. https://doi.org/10.1302/0301-620X.93B11.27641
10. Choi GW, Kim HJ, Yeo ED, Song SY. Comparison of the HINTEGRA and Mobility total ankle replacements. Shortto intermediate-term outcomes. Bone Joint J 2013;95-B(8):1075-82. https://doi.org/10.1302/0301-620X.95B8.31774
11. Jung H-G, Lee S-H, Shin M-H, Lee D-O, Eom J-S, Lee J-S. Anterior heterotopic ossification at the talar neck after
total ankle arthroplasty. Foot Ankle Int 2016;37(7):703-8. https://doi.org/10.1177/1071100716642757
12. Lee K-B, Cho Y-J, Park J-K, Song E-K, Yoon T-R, Seon J-K. Heterotopic ossification after primary total ankle
arthroplasty. J Bone Joint Surg Am 2011;93(8):751-8. https://doi.org/10.2106/JBJS.J.00178
13. Valderrabano V, Hintermann B, Dick W. Scandinavian total ankle replacement: a 3.7-year average followup of 65 patients. Clin Orthop Relat Res 2004;(424):47-56. PMID: 15241143
14. Haytmanek CT, Gross C, Easley ME, Nunley JA. Radiographic outcomes of a mobile-bearing total ankle
replacement. Foot Ankle Int 2015;36(9):1038-44. https://doi.org/10.1177/1071100715583353
15. Kerkhoff YRA, Kosse NM, Metsaars WP, Louwerens JWK. Long-term functional and radiographic outcome of a
mobile bearing ankle prosthesis. Foot Ankle Int 2016;37(12):1292-302. https://doi.org/10.1177/1071100716661477
16. Buechel FF, Buechel FF, Pappas MJ. Ten-year evaluation of cementless Buechel-Pappas meniscal bearing total
ankle replacement. Foot Ankle Int 2003;24(6):462-72. https://doi.org/10.1177/107110070302400603
17. Jung H-G, Shin M-H, Lee S-H, Eom J-S, Lee D-O. Comparison of the outcomes between two 3-component total
ankle implants. Foot Ankle Int 2015;36(6):656-63. https://doi.org/10.1177/1071100715573716
18. Natens P, Dereymaeker G, Abbara M, Matricali G. Early results after four years experience with the S.T.A.R.
uncemented total ankle prosthesis. Acta Orthop Belg 2003;69(1):49-58. PMID: 12666291
19. Wood PLR, Deakin S. Total ankle replacement. The results in 200 ankles. J Bone Joint Surg Br 2003;85(3):334-41. https://doi.org/10.1302/0301-620x.85b3.13849
20. Lee G-W, Seon J-K, Kim N-S, Lee K-B. Comparison of intermediate-term outcomes of total ankle arthroplasty in
patients younger and older than 55 years. Foot Ankle Int 2019;40(7):762-8. https://doi.org/10.1177/1071100719840816
21. Demetracopoulos CA, Adams SB, Queen RM, DeOrio JK, Nunley JA, Easley ME. Effect of age on outcomes in
total ankle arthroplasty. Foot Ankle Int 2015;36(8):871-80. https://doi.org/10.1177/1071100715579717
22. San Giovanni TP, Keblish DJ, Thomas WH, Wilson MG. Eight-year results of a minimally constrained total ankle
arthroplasty. Foot Ankle Int 2006;27(6):418-26. https://doi.org/10.1177/107110070602700606
23. Del Vecchio JJ, Uzair AE, Ghioldi ME. Letter regarding: anterior heterotopic ossification at the talar neck after total ankle arthroplasty. Foot Ankle Int 2017;38(8):930-2. https://doi.org/10.1177/1071100717712986