Fabrice Gaudot

A Controlled, Comparative Study of a Fixed-Bearing Versus Mobile-Bearing Ankle Arthroplasty

Background: Total ankle arthroplasty is available with fixed-bearing (FB) or mobile-bearing (MB) versions, and there is little consensus on the benefits and drawbacks of each type. This study aimed to compare clinical outcomes of statistically paired series of FB and MB versions of the same ankle prosthesis. Methods: The study was a multicenter retrospective comparison between 2 groups: the FB group of 33 consecutive Talaris cases and the MB group of 33 “paired” Salto cases, selected from a database of 313 consecutive cases to statistically match etiology, age, and preoperative American Orthopaedic Foot & Ankle Society (AOFAS) score. All patients were operated upon with the same operative technique and received identical pre- and postoperative clinical and radiographic assessments. The mean follow-up was 24 months for the FB group and 23 months for the MB group. Results: There was no statistical difference between results of the 2 groups in terms of accuracy of positioning, clinical and radiographic mobility, and morbidity. The most recent postoperative AOFAS scores were higher for the FB group than for the MB group (P = .05). Radiolucent lines were observed in 4 FB patients versus 13 MB patients (P = .02). Subchondral cysts were noted in 1 FB patient and in 8 MB patients (P = .01). Conclusion: There was no notable difference in clinical performance of the FB and MB implants with the numbers available. This short-term study demonstrated that FB ankle arthroplasty had results equivalent to, if not better than, MB ankle arthroplasty. Longer follow-up is necessary to determine the success of this new generation of ankle arthroplasty. Level of Evidence: Level III, retrospective case control study.

The Salto Talaris XT Revision Total Ankle Replacement System

The clinical results of total ankle replacement are becoming increasingly consistent and acceptable due to longer surgical experience with these prostheses and improved design features. Survivorship remains a concern, however, and ankle or tibio-talocalcaneal arthrodesis cannot continue to be the sole revision options. The frequency of revision procedures is likely to increase due to the growing number of primary total ankle replacement operations. Revision total ankle replacement is technically challenging and requires special prostheses. We have used the Salto Talaris XT revision ankle prosthesis since 2012. It consists of a tibial component with a long keel and three types of talar component (i.e., flat cut, short stem; flat cut, long stem; and sloped cut, long stem), designed to accommodate the majority of revision total ankle replacement cases. The Salto Talaris XT revision ankle prosthesis is compatible with the Salto Talaris primary total ankle replacement, as the two models are designed with identical articular geometry and have similar surface coating for cementless fixation (outside the United States), as well as fixed-bearing polyethylene insert. This chapter describes the principles of revision total ankle replacement, on which the Salto Talaris XT revision ankle prosthesis system is based, and describes the surgical technique. The clinical performance of this prosthesis appears promising at short-term follow-up, though the ongoing prospective study would yield more accurate and conclusive results in time.

Prothèses totales de chevilles chez les patients de moins de 40 ans – série prospective continue de 33 implants à plus de 2 ans de recul

Introduction La prothese totale de cheville (PTC) est une alternative serieuse a l’arthrodese, mais dont les resultats sont mal connus chez les patients jeunes. En effet, leur demande fonctionnelle et le potentiel de duree de vie des implants sont plus importants. L’objectif de cette etude est d’analyser la survie et le resultat fonctionnel des PTC mises en place chez des patients de moins de 40xa0ans avec un recul minimal de 2xa0ans. Patients et methodes Cette serie prospective continue inclut tous les patients operes dans notre centre depuis 1998 et âges de moins de 40xa0ans le jour de l’implantation de leur prothese. Nous recensons ainsi 31 PTC chez 29 patients, 12 de sexe masculin et 17 de sexe feminin, âges en moyenne de 32,9xa0ans. Resultats Sur les 31 PTC implantees, 26 (83,9xa0%) sont toujours en place au recul moyen de 9,1xa0ans. L’etiologie de destruction articulaire etait principalement post-traumatique (20 cas) ou une maladie inflammatoire (7 patients). Le score AOFAS moyen est passe de 31,9 en preoperatoire a 81,1 au dernier recul, avec un gain moyen par patient de 53,5. Les 5 PTC explantees l’ont ete pour defaut d’ancrage (3 cas), suspicion de sepsis (1 cas), et fracture du talus (1 cas). Tous ont ete repris par arthrodese et 3 etaient porteurs d’une polyarthrite rhumatoide. Discussion Le taux de survie des PTC de cette serie est comparable a celui rapporte dans les principales etudes incluant des patients de tous âges. Chez ces patients jeunes nous nous attendions a observer des complications specifiques liees a leur niveau d’activite plus exigeant. Comparativement aux patients plus âges nous ne notons cependant pas plus de fracture ou usure d’insert, ni plus de defaut d’ancrage. La question du devenir a long terme des articulations sous-talienne et medio-tarsienne reste difficile a trancher dans cette population de patients porteurs d’une maladie inflammatoire poly-articulaire dans 22,5xa0% des cas. Enfin, trois echecs sont survenus chez des patients successifs de cette serie, operes entre 1998 et 2000. L’hypothese se discute d’un lien entre ces echecs et un procede industriel de traitement de surface de l’implant. Ce procede n’est plus utilise a ce jour et l’echec le plus recent de cette etude concerne une PTC posee en 2008. Conclusion L’implantation de protheses de chevilles chez des patients jeunes donne des resultats comparables a ceux obtenus chez l’ensemble des patients a 9,1xa0ans de recul. L’etiologie inflammatoire est probablement surexposee au risque d’echec.