Sebastian Lieske

Prospective Study of a Cementless, Mobile-Bearing, Third Generation Total Ankle Prosthesis

Background: The SALTO total ankle prosthesis is a nonce-mented mobile bearing anatomic design characterized by dual Ti-HA coating. This study reviews our results with this prosthesis. Materials and Methods: Between 2001 and 2007, 413 consecutive SALTO prostheses were implanted in our institution in 215 women and 198 men, aged 57.1 ± 11.9 years. At the last visit, 401 implants (47% in the left ankle) were available with a mean followup of 29 (range, 1 to 84) months. Results: Based on the results of the 218 patients with at least 2 years of postoperative followup, the 5-year estimated survivorship, with the primary end-point being implant removal, was 86.6% and ranged from 85.1% in patients with post-traumatic osteoarthritis to 95.6% in those with rheumatoid arthritis. The AOFAS score increased from 50.9 ± 16.8 points preoperatively to 82.2 ± 14 points at followup (mean difference, 31. 1 ± 1.4, 95% confidence interval (C.I.) for the difference, 28. 3 to 33.8, p < 0.001). Visual analog scale for pain decreased from 7.4 ± 1.1 preoperatively to 2.0 ± 2.0 postoperatively (mean difference, −5.4 ± 0.7, 95% C.I. for the difference, −5.6 to −5.2, p < 0.001). Flexion/extension ROM increased from 25.2 ± 14.1 degrees to 33.1 ± 13.6 degrees at the last followup visit (mean difference, 7. 9 ± 0.5 degrees, 95% C.I. for the difference, 4. 3 to 7.2, p < 0.001), while pronation/supination ROM increased from 23.8 ± 13.7 degrees to 25.4 ± 14.5 degrees (mean difference, 1. 6 ± 0.7 degrees, 95% C.I. for the difference, 0. 9 to 2.2, p = 0.005). Conclusion: The SALTO prosthesis provided good clinical and functional results and we believe helps validate the concept of anatomic replacement. Level of Evidence: IV, Retrospective Case Series

[Supramalleolar, subtractive valgus osteotomy of the tibia in the management of ankle joint degeneration with varus deformity].

ZusammenfassungOperationszielZiel der supramalleolären Tibiaosteotomie bei varischer Fehlstellung im oberen Sprunggelenk ist die Verlagerung der Belastung von dem schwer arthrotisch veränderten medialen Gelenkanteil auf den lateralen Abschnitt und somit die Wiederherstellung einer physiologischen Rückfußposition und eines plantigraden Fußauftritts. Damit sollen eine Schmerzreduktion erreicht sowie der Zeitpunkt einer totalendoprothetischen Versorgung bzw. Arthrodese hinausgezögert werden.IndikationenSchmerzhafte, konservativ erfolglos behandelte Varusarthrosen im oberen Sprunggelenk mit > 15° Achsfehlstellung in der tibiotalaren Gelenkachse.KontraindikationenHochgradige, bewegungseinschränkende Arthrosen des oberen Sprunggelenks.Floride Infektionen.Ausgedehnte Knochen- und Weichteildefekte.Osteonekrosen des Talus mit Nekrosebezirken > 50%.OperationstechnikVentraler Zugang über dem oberen Sprunggelenk und supramalleoläre keilförmige Resektion eines zuvor definierten Knochenkeils mit lateraler Basis. In der präoperativen Planung ist die gewünschte Korrektur genau zu berechnen. Nachfolgend lateraler Zugang über der distalen Fibula. Hier Entnahme eines weiter proximal gelegenen Segments aus der Fibula. Nun Schließen der Tibiaosteotomie („closed wedge“) und Osteosynthese der Fibula.ErgebnisseBei 27 Patienten wurde zwischen 2002 und 2006 eine supramalleoläre, valgisierende Osteotomie („closed wedge“) durchgeführt. Präoperativ zeigte sich eine durchschnittliche Varusfehlstellung von 27°, welche postoperativ auf durchschnittlich 6° korrigiert werden konnte.21 Patienten waren bei den Nachuntersuchungen sehr zufrieden, drei Patienten wurden im weiteren Verlauf endoprothetisch und weitere drei Patienten mit einer Arthrodese versorgt.AbstractObjectiveThe aim of supramalleolar osteotomy of the tibia in the management of varus deformity of the upper ankle joint is to shift load bearing away from the severely degenerated medial part of the joint to the lateral part and thus restore physiological alignment of the hindfoot and a plantigrade foot. The intention is to reduce pain and to postpone the need for total endoprosthesis or arthrodesis.IndicationsPainful degeneration of the ankle joint with varus deformity that has proven resistant to conservative treatment, i.e., > 15° axial malalignment of the tibiotalar joint axis.ContraindicationsSevere ankle joint degeneration that restricts movement.Florid infections.Extensive bone and soft-tissue defects.Osteonecrosis of the talus with necrotic regions > 50%.Surgical TechniqueAnterior approach to the upper ankle joint and supramalleolar wedge-shaped resection of a predetermined bone wedge with lateral base. The desired correction is precisely calculated during preoperative planning. Subsequently, lateral approach over the distal fibula. Resection of a more proximal segment from the fibula. Closure of the tibial osteotomy (closed wedge) and osteosynthesis of the fibula.ResultsA supramalleolar valgus osteotomy (closed wedge) was performed in 27 patients from 2002 to 2006. Preoperatively, there was an average varus deformity of 27°, which was corrected to 6° on average postoperatively.21 patients were very satisfied at follow-up, three patients required joint replacement during the later course, and another three patients needed arthrodesis.

Die supramalleoläre, subtraktive, valgisierende Tibiaosteotomie bei Varusarthrose des Sprunggelenks

ZusammenfassungOperationszielZiel der supramalleolären Tibiaosteotomie bei varischer Fehlstellung im oberen Sprunggelenk ist die Verlagerung der Belastung von dem schwer arthrotisch veränderten medialen Gelenkanteil auf den lateralen Abschnitt und somit die Wiederherstellung einer physiologischen Rückfußposition und eines plantigraden Fußauftritts. Damit sollen eine Schmerzreduktion erreicht sowie der Zeitpunkt einer totalendoprothetischen Versorgung bzw. Arthrodese hinausgezögert werden.IndikationenSchmerzhafte, konservativ erfolglos behandelte Varusarthrosen im oberen Sprunggelenk mit > 15° Achsfehlstellung in der tibiotalaren Gelenkachse.KontraindikationenHochgradige, bewegungseinschränkende Arthrosen des oberen Sprunggelenks.Floride Infektionen.Ausgedehnte Knochen- und Weichteildefekte.Osteonekrosen des Talus mit Nekrosebezirken > 50%.OperationstechnikVentraler Zugang über dem oberen Sprunggelenk und supramalleoläre keilförmige Resektion eines zuvor definierten Knochenkeils mit lateraler Basis. In der präoperativen Planung ist die gewünschte Korrektur genau zu berechnen. Nachfolgend lateraler Zugang über der distalen Fibula. Hier Entnahme eines weiter proximal gelegenen Segments aus der Fibula. Nun Schließen der Tibiaosteotomie („closed wedge“) und Osteosynthese der Fibula.ErgebnisseBei 27 Patienten wurde zwischen 2002 und 2006 eine supramalleoläre, valgisierende Osteotomie („closed wedge“) durchgeführt. Präoperativ zeigte sich eine durchschnittliche Varusfehlstellung von 27°, welche postoperativ auf durchschnittlich 6° korrigiert werden konnte.21 Patienten waren bei den Nachuntersuchungen sehr zufrieden, drei Patienten wurden im weiteren Verlauf endoprothetisch und weitere drei Patienten mit einer Arthrodese versorgt.AbstractObjectiveThe aim of supramalleolar osteotomy of the tibia in the management of varus deformity of the upper ankle joint is to shift load bearing away from the severely degenerated medial part of the joint to the lateral part and thus restore physiological alignment of the hindfoot and a plantigrade foot. The intention is to reduce pain and to postpone the need for total endoprosthesis or arthrodesis.IndicationsPainful degeneration of the ankle joint with varus deformity that has proven resistant to conservative treatment, i.e., > 15° axial malalignment of the tibiotalar joint axis.ContraindicationsSevere ankle joint degeneration that restricts movement.Florid infections.Extensive bone and soft-tissue defects.Osteonecrosis of the talus with necrotic regions > 50%.Surgical TechniqueAnterior approach to the upper ankle joint and supramalleolar wedge-shaped resection of a predetermined bone wedge with lateral base. The desired correction is precisely calculated during preoperative planning. Subsequently, lateral approach over the distal fibula. Resection of a more proximal segment from the fibula. Closure of the tibial osteotomy (closed wedge) and osteosynthesis of the fibula.ResultsA supramalleolar valgus osteotomy (closed wedge) was performed in 27 patients from 2002 to 2006. Preoperatively, there was an average varus deformity of 27°, which was corrected to 6° on average postoperatively.21 patients were very satisfied at follow-up, three patients required joint replacement during the later course, and another three patients needed arthrodesis.

Die Luxation als seltene Komplikation des Oberflächenersatzes am Hüftgelenk

ZusammenfassungIn den 1990er Jahren kam es zu einem Wiederaufleben in der Oberflächenendoprothetik des Hüftgelenks. Die Metall-Metall-Gleitpaarung stellt heute besonders bei jüngeren, aktiven Patienten eine Therapieoption dar. Im Vergleich zu den Totalendoprothesen mit gestielten Hüftschäften bietet der Oberflächenersatz Vorteile, insbesondere in Hinblick auf den femoralen Knochenverlust. Die kurzfristigen Resultate sind sehr gut. In der aktuellen Literatur wird über Revisionsraten von <1% berichtet.Im Vergleich zur konventionellen Hüftendoprothetik stellt die Luxation eine seltene Komplikation dar. Bei konventioneller Versorgung ist mit einer Luxationsrate von 2–5% zu rechnen. In Auswertung der internationalen Literatur ist hier im Vergleich bei der Oberflächenendoprothetik nur eine durchschnittliche Luxationsrate von 0,21% zu finden.AbstractResurfacing of the hip joint experienced a revival in the 1990s. Today metal-on-metal bearing is a therapy option especially for younger, active patients. In comparison to stemmed total hip replacements resurfacing offers advantages, in particular in view of the femoral bone loss. The short-term results are very good. In the current literature revision rates of less than 1% are reported.In comparison to conventional total hip replacement, dislocation is a rare complication. With conventional total hip replacement the dislocation rate is 2–5%. In the international literature the dislocation rate with resurfacing is 0.21%.Resurfacing of the hip joint experienced a revival in the 1990s. Today metal-on-metal bearing is a therapy option especially for younger, active patients. In comparison to stemmed total hip replacements resurfacing offers advantages, in particular in view of the femoral bone loss. The short-term results are very good. In the current literature revision rates of less than 1% are reported. In comparison to conventional total hip replacement, dislocation is a rare complication. With conventional total hip replacement the dislocation rate is 2-5%. In the international literature the dislocation rate with resurfacing is 0.21%.

[Dislocation as a rare complication of resurfacing of the hip joint. Case report and meta-analysis].

ZusammenfassungIn den 1990er Jahren kam es zu einem Wiederaufleben in der Oberflächenendoprothetik des Hüftgelenks. Die Metall-Metall-Gleitpaarung stellt heute besonders bei jüngeren, aktiven Patienten eine Therapieoption dar. Im Vergleich zu den Totalendoprothesen mit gestielten Hüftschäften bietet der Oberflächenersatz Vorteile, insbesondere in Hinblick auf den femoralen Knochenverlust. Die kurzfristigen Resultate sind sehr gut. In der aktuellen Literatur wird über Revisionsraten von <1% berichtet.Im Vergleich zur konventionellen Hüftendoprothetik stellt die Luxation eine seltene Komplikation dar. Bei konventioneller Versorgung ist mit einer Luxationsrate von 2–5% zu rechnen. In Auswertung der internationalen Literatur ist hier im Vergleich bei der Oberflächenendoprothetik nur eine durchschnittliche Luxationsrate von 0,21% zu finden.AbstractResurfacing of the hip joint experienced a revival in the 1990s. Today metal-on-metal bearing is a therapy option especially for younger, active patients. In comparison to stemmed total hip replacements resurfacing offers advantages, in particular in view of the femoral bone loss. The short-term results are very good. In the current literature revision rates of less than 1% are reported.In comparison to conventional total hip replacement, dislocation is a rare complication. With conventional total hip replacement the dislocation rate is 2–5%. In the international literature the dislocation rate with resurfacing is 0.21%.Resurfacing of the hip joint experienced a revival in the 1990s. Today metal-on-metal bearing is a therapy option especially for younger, active patients. In comparison to stemmed total hip replacements resurfacing offers advantages, in particular in view of the femoral bone loss. The short-term results are very good. In the current literature revision rates of less than 1% are reported. In comparison to conventional total hip replacement, dislocation is a rare complication. With conventional total hip replacement the dislocation rate is 2-5%. In the international literature the dislocation rate with resurfacing is 0.21%.

Implantation einer Sprunggelenktotalendoprothese vom Typ Salto 2

AIM OF SURGERY Operative treatment of advanced primary and secondary arthritis of the ankle was carried out with the aim of achieving pain-free movement and retention of mobility. INDICATIONS Surgery is indicated when conservative therapy is no longer sufficient for treatment of arthritis of the ankle with painful limited movement, sufficient bony joint conditions and correctable instability or axis malpositioning. CONTRAINDICATIONS Surgery is not recommended with general surgical or anesthesiological contraindications, rampant infections, severe disturbances of peripheral perfusion, bony defects in areas relevant for anchoring, unstable soft tissue conditions, talus necrosis >30 %, manifest osteoporosis and severe non-correctable instability or malpositioning. OPERATION TECHNIQUE Tibial and talar bone resection was carried out via ventral access to the ankle through an incision and if present, soft tissue correction of instability after insertion of test components. Cement-free implantation of the original implants followed by subtle reconstruction of the extensor retinaculum and layer for layer closure of the wound. ADDITIONAL INTERVENTIONS Additional measures were necessary on the periarticular soft tissues, the hindfoot and lower leg due to movement restrictions, instability and axis malpositioning which could be carried out in a one or two stage procedure depending on the extent and morphology. RESULTS Between February 2009 and February 2010 a total of 115 patients (52 % with posttraumatic arthritis) received a cement-free implantation with a Salto 2 prosthesis. Additional corrective interventions were carried out in the presence of varus and valgus deformities. The degree of movement for dorsal extension and plantar flexion could be increased by an average of 8.3°. The interventions resulted in a significant reduction in pain from an average preoperative visual analogue pain scale (VAS) score of 7.8 (range 5-10) to an average postoperative score of 1.9 (range 0-6.1).

Using the Oxford Foot Model to determine the association between objective measures of foot function and results of the AOFAS Ankle-Hindfoot Scale and the Foot Function Index: a prospective gait analysis study in Germany

Objective After cross-cultural adaption for the German translation of the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS-AHS) and agreement analysis with the Foot Function Index (FFI-D), the following gait analysis study using the Oxford Foot Model (OFM) was carried out to show which of the two scores better correlates with objective gait dysfunction. Design and participants Results of the AOFAS-AHS and FFI-D, as well as data from three-dimensional gait analysis were collected from 20 patients with mild to severe ankle and hindfoot pathologies. Kinematic and kinetic gait data were correlated with the results of the total AOFAS scale and FFI-D as well as the results of those items representing hindfoot function in the AOFAS-AHS assessment. With respect to the foot disorders in our patients (osteoarthritis and prearthritic conditions), we correlated the total range of motion (ROM) in the ankle and subtalar joints as identified by the OFM with values identified during clinical examination ‘translated’ into score values. Furthermore, reduced walking speed, reduced step length and reduced maximum ankle power generation during push-off were taken into account and correlated to gait abnormalities described in the scores. An analysis of correlations with CIs between the FFI-D and the AOFAS-AHS items and the gait parameters was performed by means of the Jonckheere-Terpstra test; furthermore, exploratory factor analysis was applied to identify common information structures and thereby redundancy in the FFI-D and the AOFAS-AHS items. Results Objective findings for hindfoot disorders, namely a reduced ROM, in the ankle and subtalar joints, respectively, as well as reduced ankle power generation during push-off, showed a better correlation with the AOFAS-AHS total score—as well as AOFAS-AHS items representing ROM in the ankle, subtalar joints and gait function—compared with the FFI-D score. Factor analysis, however, could not identify FFI-D items consistently related to these three indicator parameters (pain, disability and function) found in the AOFAS-AHS. Furthermore, factor analysis did not support stratification of the FFI-D into two subscales. Conclusions The AOFAS-AHS showed a good agreement with objective gait parameters and is therefore better suited to evaluate disability and functional limitations of patients suffering from foot and ankle pathologies compared with the FFI-D.

Implantation of a Salto 2 total ankle prosthesis

AIM OF SURGERY Operative treatment of advanced primary and secondary arthritis of the ankle was carried out with the aim of achieving pain-free movement and retention of mobility. INDICATIONS Surgery is indicated when conservative therapy is no longer sufficient for treatment of arthritis of the ankle with painful limited movement, sufficient bony joint conditions and correctable instability or axis malpositioning. CONTRAINDICATIONS Surgery is not recommended with general surgical or anesthesiological contraindications, rampant infections, severe disturbances of peripheral perfusion, bony defects in areas relevant for anchoring, unstable soft tissue conditions, talus necrosis >30 %, manifest osteoporosis and severe non-correctable instability or malpositioning. OPERATION TECHNIQUE Tibial and talar bone resection was carried out via ventral access to the ankle through an incision and if present, soft tissue correction of instability after insertion of test components. Cement-free implantation of the original implants followed by subtle reconstruction of the extensor retinaculum and layer for layer closure of the wound. ADDITIONAL INTERVENTIONS Additional measures were necessary on the periarticular soft tissues, the hindfoot and lower leg due to movement restrictions, instability and axis malpositioning which could be carried out in a one or two stage procedure depending on the extent and morphology. RESULTS Between February 2009 and February 2010 a total of 115 patients (52 % with posttraumatic arthritis) received a cement-free implantation with a Salto 2 prosthesis. Additional corrective interventions were carried out in the presence of varus and valgus deformities. The degree of movement for dorsal extension and plantar flexion could be increased by an average of 8.3°. The interventions resulted in a significant reduction in pain from an average preoperative visual analogue pain scale (VAS) score of 7.8 (range 5-10) to an average postoperative score of 1.9 (range 0-6.1).

Implantation einer Sprunggelenktotalendoprothese vom Typ Salto 2@@@Implantation of a Salto 2 total ankle prosthesis

AIM OF SURGERY Operative treatment of advanced primary and secondary arthritis of the ankle was carried out with the aim of achieving pain-free movement and retention of mobility. INDICATIONS Surgery is indicated when conservative therapy is no longer sufficient for treatment of arthritis of the ankle with painful limited movement, sufficient bony joint conditions and correctable instability or axis malpositioning. CONTRAINDICATIONS Surgery is not recommended with general surgical or anesthesiological contraindications, rampant infections, severe disturbances of peripheral perfusion, bony defects in areas relevant for anchoring, unstable soft tissue conditions, talus necrosis >30 %, manifest osteoporosis and severe non-correctable instability or malpositioning. OPERATION TECHNIQUE Tibial and talar bone resection was carried out via ventral access to the ankle through an incision and if present, soft tissue correction of instability after insertion of test components. Cement-free implantation of the original implants followed by subtle reconstruction of the extensor retinaculum and layer for layer closure of the wound. ADDITIONAL INTERVENTIONS Additional measures were necessary on the periarticular soft tissues, the hindfoot and lower leg due to movement restrictions, instability and axis malpositioning which could be carried out in a one or two stage procedure depending on the extent and morphology. RESULTS Between February 2009 and February 2010 a total of 115 patients (52 % with posttraumatic arthritis) received a cement-free implantation with a Salto 2 prosthesis. Additional corrective interventions were carried out in the presence of varus and valgus deformities. The degree of movement for dorsal extension and plantar flexion could be increased by an average of 8.3°. The interventions resulted in a significant reduction in pain from an average preoperative visual analogue pain scale (VAS) score of 7.8 (range 5-10) to an average postoperative score of 1.9 (range 0-6.1).

Allgemeine Operationstechnik der Sprunggelenksendoprothetik

Die vorliegende OP-Anleitung soll einige praktische Tipps fur die Implantation einer Sprunggelenksendoprothese aufzeigen. Aufgrund der Vielfalt der zurzeit auf dem Markt erhaltlichen Prothesentypen ist es nicht moglich, fur jeden einzelnen Prothesentyp eine detaillierte OP-Beschreibung vorzunehmen. Deshalb werden wir uns auf einige aus unserer Sicht wesentliche Operationsschritte beschranken, die uns aus unserer Erfahrung (nach uber 1,000 Prothesenimplantationen am Sprunggelenk) mit vier verschiedenen Prothesentypen relevant erscheinen.