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Recon > Total Ankle Arthroplasty > Flashcards

Total Ankle Arthroplasty Flashcards

1
Q

What is the indication for total ankle arthroplasty

A

Severe painful post-traumatic osteoarthritis

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2
Q

What are some causes of secondary OA

A
  • trauma
  • fractures
  • repetitive ligamentous injuries
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3
Q

What are some causes of primary OA

A
  • misalignment
  • wear and tear
  • aging
  • family history
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4
Q

What percentage of secondary OA is responsible for TAR

A

78-80%

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5
Q

What percentage of primary OA is responsible for TAR

A

10%

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6
Q

What is=s the gold standard for ankle arthritis

A

Ankle arthrodesis

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7
Q

What are some advantages of ankle arthrodesis

A
  • pain relief
  • improved mobility
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8
Q

What are some disadvantages of ankle arthrodesis

A
  • time to healing (12-20 weeks)
  • immobilization
  • muscle atrophy
  • mal union/pseudoarthrosis
  • limitations wit inclines, uneven ground, driving and athletic activities
  • decreased cadence and stride
  • adjacent joint arthritis (STJ)
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9
Q

What are some indications are TAR

A
  • ligamentous integrity
  • hindfoot alignment
  • bone stock
  • vascular status
  • physical demands
  • midfoot/hindfoot arthrosis
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10
Q

What are some absolute contraindications for TAR

A
  • Charcot neuroartropathy
  • active/recent infection
  • AVN of more than 50% of talus
  • hyper mobility
  • uncorrectable ankle mal alignment - eg 50% valgus
  • poor soft issue envelope
  • sensory/motor dysfunction
  • High physical demands
  • absent fibula
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11
Q

What would you look for on physical exam before ankle TAR

A
  • hindfoot stability
  • WB ankle alignment and ROM
  • Assessment of STJ motion
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12
Q

What is the importance of CT scan prior to TAR

A

Evaluate cystic changes/bone stock

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13
Q

If you would like to assess and localize the degenerative changes in adjacent joints for a TAR, what imaging would you use

A

SPECT-CT

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14
Q

What did the 1st generation of TAR implants not respect??

A
  • anatomy
  • kinematics
  • alignment
  • stability
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15
Q

Why did the 1st generation of TAR implants did not work

A
  • excessive bone resections
  • poor cement fixation in fatty bone marrow
  • changed the pronatory-supinatory motion of the ankle
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16
Q

TAR implants were first constrained. What type of joint did the ankle mimic when the implants were constrained

A

Hinge joint

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17
Q

What type of TAR implants were constrained

A
  • TPR
  • ICLH
  • Conaxial
  • Mayo
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18
Q

What was the problem with constrained TAR implants

A

As a hinge joint, it transferred stresses to the bone-cement interface

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19
Q

What type of joint was mimicked with the unconstrained TAR implants

A

Ball-in-socket joint

20
Q

What was the problem with the unconstrained joint TAR implants

A

Unstable, malleolar impingement

21
Q

What were the types of unconstrained TAR implants

A
  • mayo
  • buckholz
  • smith
  • newton
  • irvine
22
Q

What did the next generation of ankle replacements take into consideration

A
  • preserve bone stock
  • respect rotational axis
  • respect ankle alignment
  • semiconstrained
  • biological fixation
23
Q

What are the current FDA-approved TARs

A
  • Tornier Salto-Talaris
  • Stryker S.T.A.R.
  • Wright Medical INBONE II
  • Zimmer Trabecular Metal
  • Depuy Agility - only for Depuy revisions
24
Q

Which TAR implant is customized

A

Wright medical inbone II

25
Q

Purpose/benefits of Wright Medical Inbone II

A
  • fixed bearing
  • primary/revisional ankles
26
Q

What does the Wright Medical Prophecy uses

A
  • 3D printed alignment blocks
  • Pre-operative CT
27
Q

What are the benefits of the Wright Medical Infinity

A
  • fixed bearing
  • primary ankles
28
Q

Which TAR implant is the only FDA approved mobile-bearing device

A

Stryker S.T.A.R.

29
Q

Describe the Stryker STAR

A
  • 3 component design
  • Only FDA approved mobile-bearing device
  • Free-gliding polyethylene meniscus
  • Rotation/gliding between tibia and meniscus
30
Q

Which is the only TAR implant that uses the lateral approach incision

A

Zimmer Trabecular Metal

31
Q

What are some features of the Zimmer Trabecular Metal TAR implant

A
  • lateral approach
  • minimal bone resection
  • titianium cancellous/porous
  • difficulty with balancing in frontal plane
  • arch is supportive
32
Q

Which TAR implant is only used in revisional cases

A

Depuy Agility

33
Q

Which TAR implant relies/relied on distal tib-fib arthrodesis/ syndemosis fusing

A

Depuy Agility

34
Q

Which are you primary TAR implants

A
  • Infinity
  • Salto
  • STAR
  • Zimmer
35
Q

Which TAR implant would you use for revision, obese patients are patients with high deformity

A

Inbone

36
Q

Which TAR implant would you use for adjacent hindfoot DJD

A

STAR

37
Q

Where do you make the incision for TAR implants

A

Between TA and EHL,
Avoid TA sheath - it will bow string

38
Q

Which structures are you retracting laterally in you TAR implant incision

A

Superficial peroneal nerve, NV structures

39
Q

What are some ancillary procedures you’ll have to consider for TAR implant placement

A
  • equinus release
  • calcaneal osteotomy
  • ligamentous reconstruction
  • supramalleolar osteotomy
  • medial column alignment
40
Q

What is the post op course for TAR implant

A
  • layered closure
  • drain vs. incisional VAC
  • NWB/ no ROM x 2 weeks
  • 2-6 weeks NWB
  • Aggressive PT
41
Q

What are the most important ligaments for TARq

A
  • Deep deltoid
  • syndesmosis
42
Q

Why is the syndesmosis important in a TAR

A
  • valgus rotation of talus
  • prevent lateral and anterior talar excursion
43
Q

Why is the syndesmosis important in the TAR

A
  • posterior migration of fibula
  • rotation instability with external rotational forces
44
Q

What are revisional TAR/adjunct procedures

A
  • gutter clean out
  • arthroscopy
  • rebalancing
  • management of loosening and cyst formation
  • polyethylene exchange
  • fusion adjacent joint
45
Q

What are failed TAR options

A
  • Arizona brace
  • infection - antibiotic PMMA spacer
  • conversion to inbone
  • arthrodesis with/without allograft/autograft
  • BKA

Recon (10 decks)

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