the STAR system, the Salto Talaris Total Ankle Prosthesis, ..
Between 1996 and 2004, 58 total ankle prostheses were implanted in 54 patients with RA or JIA (53 and 5 TARs, respectively; 4 bilateral) at the Radboud University Nijmegen Medical Center and Sint Maartenskliniek, both in Nijmegen, the Netherlands. 48 implants were placed in women, and 10 in men. Mean age at the time of operation was 55 (27–82) years. All patients were operated by experienced senior orthopedic surgeons (JWL, MdWM) using the same technique.
the Buechel-Pappas Total Ankle Replacement, and;
Patients and methods 58 total ankle prostheses (Buechel-Pappas and STAR type) were implanted in patients with RA (n = 53) or JIA (n = 5) in 54 patients (4 bilateral). After a mean follow-up of 2.7 (1–9) years, all patients were reviewed by two orthopedic surgeons who were not the surgeons who performed the operation. Standard AP and lateral radiographs were taken and a Kofoed ankle score was obtained; this is a clinical score ranging from 0–100 and consists of sub-scores for pain, disability, and range of motion.
The standard treatment for end-stage arthritis of the ankle joint due to rheumatoid arthritis (RA) has been an ankle fusion. In the last decades, much progress has been made in the development of total ankle replacements (TARs). Most TARs are implanted in patients with RA and posttraumatic arthritis. The first generations of TARs were implants with 2 parts, one inserted in the distal tibia and one placed on top of the talus. These implants showed a high rate of early failure, especially early loosening. The current TARs consist of three components, a metal implant placed in the distal tibia, a metal component in the talus, and a polyethylene insert in-between. These implants allow a certain amount of gliding and rotation, whereas the previous more constrained prostheses behaved as a hinge.
The Salto Total Ankle Prosthesis with its lateral ..
Total ankle replacement in RA showed good medium-term results in our series, similar to those in a recently published meta-analysis (). Early and especially late infection of the prosthesis is a major threat. The high incidence of peroperative fractures did not influence the outcome. It is important to recognize that complications such as peroperative fracture do not necessarily lead to a poor outcome; on the other hand, the absence of complications or radiographic findings does not guarantee a good clinical result. In many studies regarding the medium- or long-term results of endoprostheses, the endpoint has been revision for any reason. Failure may also be defined as patient dissatisfaction with the result of the procedure, regardless of the symptoms or physical findings ().
generation total ankle prosthesis.
Two chronic infections occurred, the first was the above-mentioned patient with a wound-healing problem over a fracture. Initially, the wound appeared to heal well but after a few weeks the patient developed a deep infection, which was treated by removal of the implant and fusion of the ankle, 6 months after the index operation. Another late infection was seen 4 years after implantation of the TAR; this patient had an ipsilateral infected total knee replacement. Both the infected knee prosthesis and the TAR could not be treated adequately with antibiotics and several surgical debridements, and she underwent an above-knee amputation.
Feldman: The implant is the Buechel-Pappas total ankle replacement
The second phase of implants began in the 1980s with the introduction of modern TARs, like the Buechel-Pappas Total Ankle Replacement (Endotec, South Orange, NJ) in the USA and the Scandinavian Total Ankle Replacement (STAR; Waldemar Link, Hamburg, Germany) in Europe. In 1992, the Agility Total Ankle System prosthesis (DePuy, Warsaw, IN), designed by Dr. Frank Alvine, was the first ankle implant to receive FDA approval. At the end of this phase, almost all TARs were semi-constrained, cementless (with minimal bone resection required), and using porous coatings to encourage bone ingrowth. Tibial metal-backed, polyethylene inserts and large contact areas on the tibia and talus became common features as well.
Modular total ankle prosthesis apparatuses and methods:
The Salto Talaris Total Ankle Prosthesis is a fixed bearing ankle replacement is a cobalt-chrome device which is based on the Salto mobile-bearing ankle prosthesis. The bone fixation surface is plasma sprayed. A clinical trial is recruiting at the time of writing. 1 One early...