Get PDF Total Ankle Arthroplasty: Historical Overview, Current Concepts and Future Perspectives

Free download. Book file PDF easily for everyone and every device. You can download and read online Total Ankle Arthroplasty: Historical Overview, Current Concepts and Future Perspectives file PDF Book only if you are registered here. And also you can download or read online all Book PDF file that related with Total Ankle Arthroplasty: Historical Overview, Current Concepts and Future Perspectives book. Happy reading Total Ankle Arthroplasty: Historical Overview, Current Concepts and Future Perspectives Bookeveryone. Download file Free Book PDF Total Ankle Arthroplasty: Historical Overview, Current Concepts and Future Perspectives at Complete PDF Library. This Book have some digital formats such us :paperbook, ebook, kindle, epub, fb2 and another formats. Here is The CompletePDF Book Library. It's free to register here to get Book file PDF Total Ankle Arthroplasty: Historical Overview, Current Concepts and Future Perspectives Pocket Guide.
Total Ankle Arthroplasty. Historical Overview, Current Concepts and Future Perspectives. Authors: Hintermann, Beat. Free Preview.
Table of contents

• Revista Médica Clínica Las Condes
• Total Ankle Arthroplasty
• Cushing/Whitney Medical Library
• CNA - 全踝+全距骨假体 - Google Patents

Anzahl Seiten der Print-Ausgabe: Seiten. Vom gleichen Autor Beat Hintermann. Endoprothetik des Sprunggelenks. Total Ankle Arthroplasty Increasing success of arthroplasty of joints like the hip and knee along with concerns about the long-term outcomes of ankle arthrodesis has renewed interest in ankle arthroplasty. The new implants have been designed with attention to reproducing Total Ankle Arthroplasty. A 6-part questionnaire general data; TAR experience; TAR indications and revision practice; radiologic assessment and follow-up; number of ankle arthrodeses and TARs in and was sent out as part of the three AFCP newsletters in contact list of surgeons, of whom in France , with five systematic email reminders to email addresses and five individual email or postal reminders to 50 surgeons.

They were strongly specialized in foot surgery Living cartilage bestows on the ankle joint properties of adaptive congruence varying with load. TAR fails to restore this, apart from a play of mechanical tolerance, to adapt to very high stress four to five times body-weight during walking. Joint mechanics becomes more complex under loading variable instantaneous axes , losing mobility and becoming more stable, with the fibulotalar joint coming into play. TAR should enable transfer of movement and stability, dissipating rotational movement.

The surgeon needs to be able to align, center, mobilize and stabilize, and perform the requisite associated corrective procedures preoperative planning, ancillary precision , to avoid excessive stress with consequent risk of complications stiffening or instability, and wear inducing inflammatory granuloma and subsequent osteolysis and implant migration.

While frontal dome-type geometry would not seem to be recommended, the verdict on cylindrical or conical profiles is still open. Solutions based on elastic tightening of the tibiofibular mortise remain to be found. Bone anchorage surface shape and cover hydroxyapatite is important for osseointegration; cementing is no longer recommended. The implant should be monoblock; a superstructure on the tibial side seems to be needed to ensure long-term anchorage.

TAR should now be seen as a good biomechanic compromise, partially restoring function and normalizing gait parameters. New designs and materials will doubtless emerge. Indications and complementary procedures are intrinsically determined by clinical and, above all, radiological assessment. The ankle is a suspended joint, part of the articular chain of the lower limb and therefore governed above by the mechanical axis of the latter and below by the helicoid torsion of the foot. It acts like a hinge joint transmitting homokinetic rotation. This determines the morphology and orientation of the talus and bimalleolar mortise.

Feet loaded, one after the other. Metal landmarks on either side of heel: either two coins or metal wire ring. Heel raised 1. AP view, with ray in second space axis. From the tips of the two malleoli, a line is drawn down perpendicular to the ground, and distances from the ground are measured on the healthy and pathologic sides. If the difference between the medial and lateral malleoli is identical on both sides, there is no malleolar or diaphyseal malunion high fibular fracture not to be overlooked. If the difference between sides exceeds 3 mm, explore for medial or lateral malleolar or diaphyseal malunion, to determine millimetric correction to perform.

• Wen ti bu da: Out of the Gate.
• TOTAL ANKLE ARTHROPLASTY: BRAZILIAN EXPERIENCE WITH THE HINTEGRA PROSTHESIS!
• Total Ankle Replacement Revisited!

Trace a parallelogram between the medial and lateral metal landmarks and the medial and lateral summits of the talus. Mark the midpoints of the superior and inferior bases, and draw a line between the two.

Revista Médica Clínica Las Condes

Nine TARs were implanted for sequelae of osteochondritis dissecans or localized talar necrosis mean postoperative score, Contra-indications for TAR may be absolute or relative Table 1 , and are associated with high risk of infection history of ankle osteoarthritis or exposed open fracture , cutaneous risk factors multiple scarring, thin or poor-quality skin graft , or severe bone defect or ligament laxity. Post-traumatic arthritis raises specific problems due to associated periarticular lesions. The preoperative check-up is essential, to assess difficulties and risks: CT analysis of deformity, bone capital and neighboring joints; biological analysis, bone-scan and possibly bone biopsy, to assess infectious risk; and arteriography or angio-MRI, to assess arterial status.

Where cutaneous status is poor, the opinion of a plastic surgeon may be sought. Several difficulties requiring specific surgery are to be considered Table 2. In rheumatoid arthritis, tibiotarsal arthritis is seldom isolated and management is global.

Certain points are to be highlighted: frequent associated subtalar or talonavicular arthritis, frequent involvement of other lower-limb joints, skin and bone fragility, and elevated infection risk due to multiple treatment. The terrain should also be taken into account in planning treatment, as prolonged periods of non-weight-bearing or cast or splint immobilization are badly tolerated.

The Castaing technique is completely insufficient here: Emslie-Vidal ligament plasty provides much greater stability. The study concerned two series of patients in whom gait was analyzed in the lab Brussels: Gait Laboratory of the Rehabilitation Unit of the Catholic University of Leuven, Pr. Twenty-one patients were analyzed on objective criteria. Patients walked at spontaneous speed on a standard treadmill, fitted with stress gauges to measure the horizontal, lateral and vertical reaction forces of the foot on the ground. Gait analysis was performed before and 6 months and 1 year after surgery.

The variables assessed in the respective studies were: gait parameters, kinematics, dynamic variables, energy cost and mechanical work.

The comparative study of arthritis patients performed at Garches found the arthrodesis group to show a longer pace than preoperatively, at the cost of gait symmetry, while the implant group showed improved symmetry and reduced limping, without improved pace length or walking speed.

The knee joint showed no postoperative change in mean amplitude, which remained near-normal Leuwen data. TAR distinctly improved mean total work, which was significantly reduced postoperatively, approximating normal values. As reported by Doets et al. Analysis of the present literature by no means answers all of the questions raised by the current third-generation concept of TAR. A round-table provided the opportunity to draw up the methodology for the analysis of a multicenter series regardless of implant type.

The inclusion questions to be addressed were: Which implant? Which surgeons? What database? It was decided not to individualize respective results on each of the four types of implant. The form comprised five rubrics: — Patient information. Implant revisions by arthrodesis were centralized in the same way. The procedure proved efficient, with usable files collected in less than 6 months.

It could be adapted to a prospective study comparing arthrodesis vs.

The round-table series Table 3 comprised TARs left, right in patients 37 bilateral; female, male; mean age, The cases of talar necrosis and osteochondritis were not severe and were operated on at the arthritis stage; extensive talar necrosis counted as a contra-indication.

DF was 1. Mean tibiotalar radiologic amplitude was The approach, although not specifically reported, but was generally anterior. Implantation details were not reported, being specific to the type of implant and to the center.

Thirty-one of the 57 defective implantations concerned imprecise positioning 16 cases of frontal and 10 of sagittal malalignment, and five of poor talar positioning. Bearing stability issues concerned 14 ankles four cases of frontal instability, 10 of sagittal centering. Nine implants showed immediate tibial radiolucency and three talar components were oversized. There was malleolar fracture in 53 cases 35 medial, 18 lateral , secondary either to component oversizing or to a faulty surgical movement, requiring longer immobilization but without impact on the final result: FU score There were six cracked pilons due to tibial component impaction, one talar neck fracture, five cases of peroperative bearing instability, three defective implant fixations two talar, one tibial and two cases of tendon sectioning.

There were no vascular lesions. Postoperative management immobilization time, type of contention, weight-bearing in the various centers was not studied. Three patients underwent revision for skin problems. There was no significant correlation between cutaneous complication and vascular status. The remaining complications comprised seven early infections, with four deep infections requiring revision, and six sensorineural complications hypoesthesia or neuroma in the approach superficial peroneal nerve.

Implantation automatic posterior capsulectomy as part of the tibial section corrected some of this. In cases, Achilles lengthening was performed percutaneous, four open, 11 gastrocnemius lengthenings. The procedure proved very effective peroperatively, but sometimes induced prolonged pain or loss of force.