What is an Ankle Arthroplasty?
Ankle replacement is the replacement of the ankle joint (calf joint) with a prosthetic component composed of polyethylene and metal, and is preferred over ankle arthrodesis (fusion) because range of motion and function are not affected. The main goals of arthroplasty are to
- Replicate ROM of the talocrural joint
- Function well under weight bearing
- Be wear resistent
- Maintain alignment and stability
History of Total Ankle Arthroplasty
Ankle replacement surgery has been performed for over two decades, but due to the low incidence of osteoarthritic ankle lesions, it is far less common than hip or knee replacements. Most ankle osteoarthritis is secondary to trauma. [1]
Until recently, ankle arthrodesis (fusion) was the gold standard of treatment, but this was not without complications such as nonunion osteoarthritis and stiffness and loss of proprioception in other mid/hindfoot joints[2]
Total ankle replacement was developed in the 1970s but was initially plagued by high long-term failure rates. Older prostheses loosen or malfunction and often need to be removed [3]. In the late 70’s, Dr. Frank G. Alvine, a plastic surgeon from Sioux Falls SD, developed the The Agility Ankle was the first FDA-approved total ankle implant for use in the United States [4]. The Agility Ankle System has undergone several revisions since its introduction. Currently, the Agility Ankle System is the most widely used ankle prosthesis. With more than 20 years of Experience it as the longest follow-up of any fixed bearing arrangement [5].
On May 29, 2009, Medical News Today announced that the FDA has approved the first mobile bearing device known as the Scandinavian Total Ankle Replacement System (STAR). As a condition of FDA approval, the company (Small Bone Innovations Inc.) must evaluate the safety and efficacy of the device during trials The next eight years [6].
In a systematic review of the literature published in the Journal of Bone and Joint Surgery in 2007, intermediate outcomes of total ankle arthroplasty appeared to be similar to those of ankle arthrodesis, but data are scarce [7]. In a study comparing reoperation rates after ankle arthrodesis and Total Ankle Arthroplasty SooHoo Zingmond and Ko demonstrated that ankle arthroplasty carries a higher risk of complications compared to ankle arthrodesis, but also has potential advantages in reducing the risk of patients needing subtalar arthrodesis [8 ]. at seven to Knecht Estin Callagham et al conducted a 16-year follow-up of Agility total ankle arthroplasty and concluded that the incidence of radiographic hindfoot arthritis and revision surgery was remarkably low at an average of 9 years after arthroplasty. Encouragement [9].
Although interest in total ankle arthroplasty is increasing, interim clinical results to date are few and often not validated by independent practitioners. Furthermore, no level I or II studies have been published [10].
High levels of patient dissatisfaction with revisions due to both wound looseness and high rates of wound complications were a major problem when surgical total ankle arthroplasty (TAA) was first introduced in 1970 over the years.[11] In 1990, cementless implants were shown to promote bone ingrowth and less proliferation bone removal compared to cement.[11] In addition to the continuous changes in cementlessness, further technological advances over the years have resulted in new surgical techniques for primary arthritis ranging from a two-component system to a 3-dimensional model . . . .
One observational study examined the benefits of prosthetics over arthroscopy showing that individuals with single or multi-arthroplasty who underwent arthroscopy had fewer gait abnormalities and were unaffected less bad on other lower joints. A systematic review provided that in There were 852 individuals who underwent TAA with 78% implant survival at 5 years postoperatively and 77% at 10 years postoperatively and overall there was only 7% remodeling. This provides evidence that the technique produces satisfactory results and should be considered for potentially qualified candidates surgical correction.[13]
The Arthroplasty
Indication for Procedure
There are no well-defined indications for Total Ankle Arthroplasty. Surgery is considered only when conservative treatment has been attempted without any improvement. The surgery is mainly being performed on patients with various neurological disorders. This leads to advanced neuropathological changes crippling pain and loss of toes. The ankle is most commonly affected by post-traumatic arthritis.[14] Total ankle joint replacement is also indicated after failed ankle arthrodesis [15] the ‘ideal’ patient for ankle joint replacement is an elderly person with limited mobility the physical requirements of having good bone stock normal vascular status are immune-suppression and excellent hindfoot-ankle alignment.[16] In general, here are the most common indications for arthritis:
- Primary or posttraumatic osteoarthritis
- Severe rheumatoid arthritis
- Rejected arthrodesis
Indications: According to Saltzman, there is no specific indication for a total ankle arthroplasty.[17] The “ideal” patient who would normally have this procedure is an older person with normal immune system normal vascular status good bone density and a proper hindfoot-ankle alignment without success with conservative treatment modalities. Patients who fail to respond to nonsurgical methods or fail to achieve the results of their toe prostheses are often associated with neuromuscular dysfunction the weakness is satisfied joint.
Contraindications: Arthroplasty is contraindicated for those with neuroarthropathic degenerative joint disease infection avascular necrosis of the talus osteochondritis dessicans malalignment of the hindfoot-ankle severe benign joint hypermobility syndromes or soft tissue problems or carriers atew sensation or movement in the lower body.[11] In individuals with rheumatoid arthritis (RA), inflammation may occur before symptoms of active swelling and joint damage. During the first and second year of this disease process, structural damage (i.e. joint degeneration) may occur visible X-ray imaging.[18] Patients with diabetes may develop gouty arthritis in the ankle joints. This is due to the metabolism of uric acid into urate crystals that move into the joints.[18]
Patients with RA and diabetes may therefore be candidates for ankle arthroscopy or not depending on the severity of joint damage seen on radiographic imaging.
Common contraindications are:
- Severe talus subluxation Severe valgus or varus deformity
- Substantial osteoporosis
- neurological disease or recurring infections
Preoperative Procedures and Definitive Diagnosis
A weight-bearing A-P and a lateral mortise view of both ankles are required for effective preparation and anticipation, which will be required during surgery. The rearfoot alignment (Cobey/Saltzman) view is critical to assess the ankle and identify any calcaneo-tibial deformities. This is done by having the patient stand elevated and tilting the cassette forward 15 degrees so that the X-rays are perpendicular to the film. This position changes if deformity develops after measuring the distal tibial anterior angle (ADTA). this The ADTA is formed by the mechanical axis of the tibia and the joint orientation line of the ankle in the sagittal plane and measures 80° ± 3° in the normal lower extremity. In the coronal plane, the lateral distal tibial angle (LDTA) tibial-talar angle and calcaneal tibial Alignment should be measured. The LDTA, formed by the articular surface of the distal tibia and the anatomical axis of the tibia, measures 89° ± 3°.29 and, if reduced, indicates varus deformity. The tibial angle (Figure 3C) is defined by the tibia and talus Articular surface of the ankle joint. The joint is defined as inconsistent (unstable) when the tibiotalar angle is >10° [19]. If there is abnormal ADTA or LDTA (sagittal or coronal deformity), measure the center of angular rotation (CORA). CORA is Diaphyseal midline and a line from the middle of the joint perpendicular to the abnormal ADTA or LDTA (Fig. 4). CORA can be at the level of the joint line (usually due to anatomical joint line misalignment or ankle degeneration) or proximally (usually due to tibial deformities/fractures) [19]. So, as you can see, it is important to consider a lot of factors and analyze it from multiple angles, any instability and misalignment of the new prosthesis can lead to excessive wear and even failure [19].
Medical Management
First generation:
Early attempts at ankle prostheses involved gluing a stemmed metal ball into the tibia and a polyethylene cup into the talus. Throughout the 1970s, prostheses evolved to use active components that adhered to the talus. All designs use methyl methacrylate cement, which becomes The defining element of the first generation of prosthetics. [11]
Types:
- Restrained – Increases stability as only dorsiflexion and plantarflexion are allowed. Prosthetic loosening is common due to increased joint torque. [11]
- Unrestrained – Allowing full ROM results in reduced stability, which often results in impingement to the medial and/or lateral ankle.
- Semi-constrained – a combination of constrained and unconstrained models, allowing for greater ROM and internal and external stability. The prosthesis at Imperial College Hospital in London uses concave polyethylene on the tibia and stainless steel components on the talus. [11]
Unfortunately, by the early 1980s, most orthopedic surgeons did not recommend first-generation ankle replacements. Numerous studies have shown cemented wound loosening problems and low patient satisfaction [17][11]. Due to poor results and high Complication Rate Surgeons are beginning to recommend ankle arthrodesis.
Second generation:
Second-generation arthroplasty is cementless and uses bony ingrowth to stabilize the implant. Compared with cemented bone ingrowth prosthesis, bone resection has fewer bone cement complications such as soft tissue damage and bone cement displacement [17].
Surgical Factors:
- Fixation: Ingrowth implants usually have a beaded surface around the bony interface hydroxyapatite layer or a combination of both. Current surgical protocols commonly use the combined fixation technique.[11][17] Between different prostheses, the number of articulating surfaces and components both must be considered.[17][11][20].
- Components:
- Articulating surfaces: Current designs vary as to the articulations to be reconstructed. Resurfacing can occur at the superior tibiotalar joint superior and medial articulations or at the medial lateral and superior joints.[11] Identifying patients who will benefit most from each surgery is ongoing.[17]
Design components:
- 2 component implants include a tibial and a talar articulating component. Syndesmosis fusion may also be combined with implants to reconstruct the medial and lateral recesses of the ankle and convert the ankle from a 3-bone joint to a 2-bone joint. Known features: Agility Salto Talaris Eclipse INBONE
- Advantages: reduced shear and torsion of the prosthesis[21] syndesmosis reduces shear force and increases the bony support of the tibial component[17].
- Disadvantages: excised bone with increased probability of soft tissue damage leads to accelerated polyethylene waste and possibility of syndesmosis fusion failure.[17]
2 Component Ankle Replacement NhwɛsoɔSalto TalarisAgility
- 3 component implants include a “mobile bearing” of polyethylene between the tibial plate and talar component. Known brands: Buechel-Pappas Scandinavian Total Ankle Replacement (STAR) Mobility HINTEGRA
- Advantages: low polyethylene wear rates allow multiplanar motion[11] increased congruency minimal bony resection[17][21]
- Disadvantage: mobile bearing part may provoke surgery involving significant abnormal ligamentous stress due to malalignment of axis of rotation[17][11].
3 Component Ankle Replacement ExamplesSTARBuechel Pappas
Both component configurations allow for semiconstrained motion specifically allowing some inversion and eversion during sagittal plane ankle motion. U.S. The Food and Drug Administration (FDA) has approved four ingredients for the 2 products. The STAR was recommended for FDA approval on 2008.[22][21] There is insufficient evidence of the life expectancy of current prostheses.[21]
Surgical Procedure
To operate, the patient is positioned supine with the hips slightly elevated and a tourniquet applied to the proximal thigh to prevent intraoperative bleeding. A 10-cm incision is then made in the middle of the joint to expose the normal anatomical features. Once upon a time. structures have exposed the vital muscles and tendons to protect and ensure integrity and reduce surgical complications these include; muscles tibialis anterior and extensor hallucis longus. This is also to achieve proper talocrural alignment and soft tissue balance to ensure that the prosthesis can achieve plantar grade in position. It is also important to excavate and repair any osteoblasts or other factors that may be causing bone irregularities. It is based on a natural angle with more talocrural joint (varus or valgus) bone medially or laterally may ot beyi this may also occur if the joint is deep or shallow as it may need to be reduced or raised[19].
Once the joints are straightened and the bones are in good alignment, the new material is tested to ensure rull ROM and stability have occurred. If dorsiflexion is restricted and not due to malalignment, then achilles tendon length is equally important and occurs as instability in inversion or eversion the ligaments are reconstructed. Persistent malalignment may occur and may require different corrective procedures such as subtalar fusion depending on severity and repairability[19].
Alternate Option:
Ankle Arthrodesis
Ankle arthrodesis or fusion was the recommended surgical procedure after failure of first-generation ankle arthroplasty. The procedure involves cutting the superficial cartilage of the joint to reshape the talus and tibia and fuse the bones together. As a result the ankle joint doesn’t allowing no movement. The goal of ankle arthrodesis is pain relief.[23][20] Unfortunately, ankle immobility can lead to increased stress on the knee and hind leg and in addition, increased motion on the hind leg that can develop into arthritis.[11] Other complications with fusion include speed adjacent joints impair its functional limitations.[21]
[24]
Outcome Measures
- Foot and Ankle Disability Index
- Foot Function Index (FFI)
- Foot and Ankle Ability Measure (FAAM)
Physical Therapy Management
As will be explained in the pre-operative and post-operative phases, a multidisciplinary team involving the patient plays an important role in the pre- and post-operative arrangements, which may involve physiotherapists, occupational therapists, discharge nurses, nurses, healthcare personnel assistant and doctor. Both the preoperative and postoperative phases are integral to the patient’s progress and the preoperative should not be overlooked as it is easy to focus on the postoperative.
Pre-Operative Phase
One of the main tasks of the team prior to surgery is to educate the patient on what to expect before and after surgery as this will give the patient the opportunity to prepare mentally, ensuring a smooth transition from short-term goals to long-term goals but also aids in control and Reduce postoperative pain [25] (evidence level 3B)
Both ROM muscle strength gait and deviation will be recorded for comparison before and after joint replacement surgery and as much as possible to ensure that the patient is at optimal strength prior to surgery. For a safe and easy transition, it is important for patients to learn how to walk with crutches so they can Perform ADL as soon as possible after arthroplasty, but also with the understanding that they will not be weight bearing after arthroplasty [26]. (Level of Evidence 4)
As with all procedures under general anesthesia, there are common pulmonary postoperative complications (PPC’s) that need to be managed and risk reduced, which can also be explained at this stage.
Post-Operative Phase
It is important to ensure that the risk of PPC is reduced and respiratory physiotherapy is available at this early stage Cough deep breathing exercises and early mobilization are essential to reduce atelectasis and restore the levator muscles as quickly as possible.
Atelecatsis occurs in 90% of anesthetized patients resulting in 16-20% reduction in functional residual capacity which is why alveoli often collapse resulting in increased work of respiratory hypoxia reducing compliance V/Q mismatch and risk of pneumonia ].(Evidence level 5)T(Level of evidence 5)here is a 9% chance of developing pneumonia and here exercise interventions are important in reducing the overall incidence of these complications[29].(Level of evidence 5)
IT IS IMPORTANT TO KNOW YOUR OWN HOSPITAL/SURGEON’S GUIDELINES FOLLOWING ANY ARTHROPLASTY OR INJURY AND THE FOLLOWING SHOULD BE USED FOR MEASURING DIAGNOSIS AND CONSIDERING SOME EXERCISE/MINOR PROTOCOLS
THIS SHOULD NOT BE USED AS A REPLACEMENT TO THE SURGENS PROTOCOL
THIS IS A PROTOCOL OF THE ROYAL NATIONAL ORTHOPEDIC HOSPITAL NHS TRUST[30] using the best available evidence[31][32][33][34][35][36]
As can be expected after any surgical procedure, pain and inflammation must be controlled. This is especially true after hip replacement as pain and inflammation can persist for up to 12 months after surgery.[37] The surrounding tissue may be damaged during surgery and can cause range of mobility and energy.[38][39][40] Damage to joint proprioceptors during capsule dissection can lead to disturbances of both static and dynamic balance.[41][42] These factors can lead to gait disability and decreased mobility efficiency.[43] Walking posture and walking corrections deficiencies become the target of treatment once the patient moves independently.
Physical Therapy Goals:
- Decrease pain
- Decrease inflammation
- Increase strength
- Increase range of motion
- Improve dynamic and static balance
- Improve proprioception
- Proper independent ambulation
Assessment
- Method of injury or cause of disease
- Date of surgery and type of implant
- Auxiliary device with weight bearing mode of operation
- Controlled ankle motion (CAM) walker/walking boot
- Functional impairment/assistance with ADLs/adptive equipment
- Pain/ Symptom history: Location duration type intensity (VAS) factors that exacerbate and relieve 24-hour symptom behavior
- Current/Pat Relevant Medical History: Lower extremity or other injuries with upper extremity issues that may restrict ability to walk with AD and comorbid diagnoses
- Current/previously identified chemicals
- Diagnostic tests
- Sleep disturbance
- Barriers to learning
- Social/occupational history
- Patient’s goals
- Repetition of vocation/avocation and associated actions
- Living environment
Relevant Tests & Measures:
- Observation/examination/palpation: Skin and incision examination edema muscle atrophy
- Circulation: Dorsal pedal pulse
- Sensory and proprioception testing
- Range of motion and Muscle length: The average postoperative arc of motion (dorsifexion and plantarfexion) is 23°[44][45] .
- Muscle strength
- Posture: Increased pronation/supination in postural ability to maintain weight bearing posture
- Determine the need and adequacy of auxiliary and adaptive equipment
- Balance: Static and dynamic postural balance unilateral balance on one unaffected side (especially if the patient is still unable to bear weight).[44] Patient may exhibit dynamic postural imbalance as less confident in ankle strategy and deficit of motor control ability[41].
- Functional mobility
- American Orthopedic Foot and Ankle Association ankle-hindfoot score[46] Outcome measures
- Self-selected normal walking speed[47]
- Assess safety in mobility
- Gait Assessment[44]
Initial Rehab 0-4 Weeks
Restrictions:
- Non-weight bearing 2/52 with a back slab
- Below knee POP at 2/52 and start carrying full weight in this POP
- POP removed in 4/52 and aircast boot was considered
- Elevation
- As a sedentary job return to work on 4/52 as long as it is raised and secured
Goals:
- Safe and independent movement with walking aids
- Independent with exercise programme
- Know monitoring and protection
Treatment:
- POP
- Pain-relief
- POLICE
- Basic circulatory exercises
- Mobility
Progress when:
From POP absolute weight bear any complications and then referred to physiotherapy from patients
Recovery Rehab 4 weeks – 3 months
Restrictions:
- There is no resistance for up to 3 months if any muscles are transferred
- No stretching tendons if transferred
Goals:
- Independent from aircast boot
- Achieve full ROM
Treatment:
- Pain relief, swelling management
- Counseling teaching postural counseling monitoring difficulties pacing
- Gait re-education
- Exercises –> PROMAAROM AROM light strengthening core stability balance/proprioception stretching
- Hydrotherapy
- Orthotics
- Manual therapy –> SSTM’s mobilisations
Progress when:
Full ROM independent mobile neutral footrest in position
Intermediate Rehab 12 weeks – 6 months
Restrictions:
- None
Goals:
- Independent with no aids
- Normal footwear
- Grade 5 strength
- Grade 4 strength in tendons transferred
Treatment:
- Pain relief, swelling management
- Counseling teaching postural counseling monitoring difficulties pacing
- Gait re-education
- Exercises –> PROMAAROM AROM light strengthening core stability balance/proprioception stretching
- Hydrotherapy
- Orthotics
- Manual therapy –> SSTM’s mobilisations
Progress when:
Normal independent footwear with no support Pain control strength 5/5 (4/5 if muscle transfer)
Final Rehab 6 months – 1 year
Goals:
- Back to slow no/little impact sports
- Grade 5 strength in transferred tendons
Treatment:
- Maximise function
- End stage exercise balance with proprioception and sport specificity
- Manual therapy
Muscles to Consider
Here is an unfinished list of some of the main muscles in the foot and leg consider these in your preparation and diagnosis. Some muscles may have migrated or stretched and now require specific realignment because proprioceptive function may now have changed.
Posterior Compartment – Superficial
- Gastrocnemius
- Plantaris
- Soleus
Posterior Compartment – Deep
- Popliteus
- Flexor Hallucis Longus
- Flexor Digitorum Longus
- Tibialis Posterior
Lateral Compartment
- Peroneus Longus
- Peroneus Brevis
Anterior Compartment
- Tibialis Anterior
- Extensor Hallucis Longus
- Extensor Digitorum Longus
- Peroneus Tertius
Sample Exercises
Balance c perturbationBall tossPosition of touch
Gyinabea kwanSeated rocker boardDF therabandAnkle eversionDF stretchAnkle PF
Additional Information
After the operation it is important for the patient to maintain movement and daily activities. But there is still discussion among doctors about when a patient should resume physical activity. There are some that allow exercise immediately after surgery. But some say it is it is considered preferable to wait until satisfactory growth of bone as determined by radiographs. But it’s the doctor’s job to try to improve: the patient’s ROM in the ankle controls the ROM in the hip and knee to increase muscle strength through exercises for the Gluteus The Maximus Quadriceps femoris muscle is the muscle responsible for the flexion of the femur[48]. Postoperative mobilization begins early with rapid progression until normal activities are resumed.[49] The goal is to achieve 10° of dorsal flexion and 30° of plantar flexion. For patients with virtually no movement in the ankle, any movement is progress.[50]
In the early postoperative period it is important that the incision heals and the implant becomes securely anchored to the bone bed this will be done using a non-weight below knee immobilizer. This is maintained until a satisfactory skeleton is formed in growth. [51] no. Another goal is to. ROM of the ankle and check hip and knee ROM.
After a few months, the patient should make an appointment with the doctor. Here X-ray scans will be done to check for complications such as: joint cuts to check for bone damage; the next most common procedures are extra-articular procedures for axial misalignments and component replacement.[52]
Prognosis & Outcome
Outcome of ankle arthroplasty and pain function implant survival and complications. There are many studies looking at implant survival and report rates of about 67-94% at 5 years[53][54][55] and 75% at ten years[53] with reasonable ability relies on it.
A systematic review of medium- and long-term outcomes of arthritis and arthritis by Haddal et al[56] had interesting results. It reviewed 49 primary studies in 1262 patients and used the AOFAS score (Americal Orthopedic Foot and Ankle Society). This score is out of 100 (0=worst 100=best) broken down into 8 parts of pain activity walking distance walking height gait abnormality sagittal mobility hindfoot mobility ankle hindfoot mobility and alignment. The score has mixed dimensions and the objective component of the score is difficult to render reliable between therapists[57].
The average AOFAS score was 78.2 points in patients treated with total ankle arthroplasties and 75.6 points for those treated arthroscopically. Meta-analytic mean results showed that 38% of patients treated with total ankle arthroplasty had excellent results 30.5% had excellent results 5.5% had fair results results and 24% had negative results. In the arthrodesis group, the corresponding ratios were 31% 37% 13% and 13%, respectively. Five-year implant survival was 78% and 10-year survival was 77%. The conversion rate after total ankle arthroplasty was 7% with the primary reason for conversion that it is fading and/or declining (28%). The conversion rate after ankle arthrodesis was 9% with the main reason for conversion being nonunion (65%). One percent of all patients who underwent ankle arthroscopy required a below-the-knee amputation compared with 5% in the ankle the arthrodesis group. Their conclusions were based on these findings
the results of total ankle arthroplasty appear to be similar to those of ankle arthrodesis; but data were limited. Comparative studies are needed to strengthen these conclusions[56].
References
- ↑ Ankle Replacement Surgery. Annals of the Royal College of Surgeons of England. 2006 July;88(4):417-418
- ↑ Ankle Replacement Surgery. Annals of the Royal College of Surgeons of England. 2006 July;88(4):417-418
- ↑ http://www.medicalnewstoday.com/articles/11222.php
- ↑ http://www.medicalnewstoday.com/articles/11222.php
- ↑ Cerrato R, Myerson MS. Total Ankle Replacement:the Agility LP prosthesis. Foot and Ankle Clin. 2008 Sept; 13(3): 485-94.
- ↑ http://medicalnewstoday.com/printerfriendlynews.php?newsid=151776
- ↑ Haddad SL, Coetzee JC, Estok R. et al. Intermediate and Long-Term Outcomes of Total Ankle Arthroplasy and Ankle Arthrodesis. The Journal of Bone and Joint Surgery (American). 2007;89:1899-1905.
- ↑ SooHoo NF, Zingmond DS, Ko CY. Comparison of Reoperation Rates Following Ankle Arthrodesis and Total Ankle Arthroplasty. The Journal of Bone and Joint Surgery (American). 2007;89:2143-2149.
- ↑ Knecht SI, Estin M, Callaghan JJ et al. The Agility Total Ankle Arthroplasty: Seven to Sixteen-Year Follow-up. The Journal of Bone and Joint Surgery (American). 2004;86:1161-1171.
- ↑ Cracchiolo A 3rd, Deorio JK. Design features of current total ankle replacements: implants and instrumentation. Journal of the American Academy of Orthopedic Surgeons. 2008 Sept:16(9):530-40.
- ↑ Jump up to:11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 11.11 11.12 Cook R.A., O’Malley M.J. Total Ankle Arthroplasty. Orthop Nurs. 2001;20(4): 30-37.
- ↑ Doets, C., Brand, R., Nelissen, R. Total Ankle Arthroplasty in Inflammatory Joint Disease with Use of Two Mobile-Bearing Designs. The Journal of Bone and Joint Surgery. 2006;88:1274-1284.
- ↑ Haddad, S. et all. Arthroplasty vs Arthrodesis: Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis A Systematic Review of the Literature. The Journal of Bone and Joint Surgery. 2007;89:1899-1905.
- ↑ MURNAGHAN J.M., WARNOCK D.S., HENDERSON S.A.., ‘Total Ankle Replacement: Early experience with STAR prothesis’, The Ulster Medical Journal, 2005, May, vol. 74, nr. 1, p. 9-13
- ↑ SMITH C.L., L.T., M.S.C., U.S.N., ‘Physical therapy management of patients with total ankle replacement’, Physical Therapy, 1980, March, vol. 60, nr. 8, p. 303-306
- ↑ SALTZMAN C.L., MCLFF T.E., BUCKWALTER J.A., BROWN T.D., ‘Total Ankle Replacement revisited’, Journal of Orthopaedic & Sports Physical Therapy, 2000, February, vol.nr. 30(2), p. 56-67
- ↑ Jump up to:17.0 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 Saltzman, C.L., McIff, T.E., Buckwalter, J.A., Brown, T.D. Total Ankle Replacement Revisited. JOSPT. 2000;30: 56-67.
- ↑ Jump up to:18.0 18.1 Goodman, C., Snyder, T. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th ed. St. Louis: Saunders Elsevier, 2009.
- ↑ Jump up to:19.0 19.1 19.2 19.3 19.4 Bonasia DE. Dettoni F. Femino JE. Phisitkul P. Germano M. Amendola A. Total Ankle Replacement: When, Why and How? The Iowa Orthopaedic Journal 2010(30)119-130
- ↑ Jump up to:20.0 20.1 Gill. LH. Challenges in Total Ankle Arthroplasty. Foot Ankle Int. 2004;25(4):195-207.
- ↑ Jump up to:21.0 21.1 21.2 21.3 21.4 Guyer, A.J., Richardson, E.G. Current Concepts Review: Total Ankle Arthroplasty. Foot Ankle Int. 2008;29(2): 256-264.
- ↑ Cracchiolo A. III, Deorio, J.K. Design features of current total ankle replacements: implants and instrumentation. J Am Acad Orthop Surg. 2008;16(9):530-540.
- ↑ Pfeiff C. The Scandinavian Total Ankle Replacement (STAR). Orthop Nurs. 2006; 25(1): 30-33.
- ↑ Anterior Ankle Fusion Surgery Animation. Available from: https://www.youtube.com/watch?v=yfip1QIlWXs
- ↑ Grawe JS. Mirow L. Bouchard R. Lindig M. Huppe M. Impact of preoperative patient education on postoperative pain in consideration of individual coping style. Schmerz 2010;24(6):575-86
- ↑ SMITH C.L., L.T., M.S.C., U.S.N., ‘Physical therapy management of patients with total ankle replacement’, Physical Therapy, 1980, March, vol. 60, nr. 8, p. 303-306
- ↑ Neligan, Patrick. Anesthesiology Clin. 2013:30; 495-511
- ↑ Neligan, Patrick. Anesthesiology Clin. 2013:30; 495-511
- ↑ Tusman, Gerardo, et al. Curr Opin Anesthesiol 2012:25;1-10
- ↑ Royal National Orthopaedic Hospital NHS Trust. Physiotherapy Rehabilitation Guidelines – Total Ankle Replacement Surgery. [ONLINE] available from: http://www.rnoh.nhs.uk/sites/default/files/downloads/physiotherapy_rehabilitation_guidelines_-_total_ankle_replacement_surgery.doc accessed [26/05/2014]
- ↑ Ali et al. Intermediate results of Buechel Pappas unconstrained total ankle replacement for osteoarthritis. The journal of foot and ankle surgery. 2007;46(1):16-20
- ↑ Buechel at al. Twenty-year evaluation of cementless mobile-bearing total ankle replacements. clinical othopaedics and related research. 2004;424:19-26
- ↑ Coetzee J. Caatro M. Accurate measurement of ankle range of motion after total ankle arthroplasty. Clinical orthopaedics and related research. 2004 27-31
- ↑ Conti S. Wong YS. Complications of total ankle replacements. Clinical orthopaedics and related research. 2001;391:105-114
- ↑ Knecht et al. The agility of total ankle arthroplasty. The journal of bone and joint surgery. 2004 1161-1171
- ↑ Kontis et al. The management of failed ankle replacement. The jounrla of bone and joint surgery. 2006 1039-1047
- ↑ Lagaay PM, Schuberth JM. Analysis of Ankle Range of Motion and Functional Outcome Following Total Ankle Arthoplasty. The Journal of Foot and Ankle Surgery. 2010: Iss. 49, 147-151.
- ↑ Gougoulias N, Khanna A, Maffulli N. How Successful are Current Ankle Replacements?: A Systematic Review of the Literature. Clinical Orthopaedics and Related Research. Clin Orthop Relat Res. Jan 2010: 199-208.
- ↑ Buechel FF Sr, Buechel FF Jr, Pappas MJ. Twenty- year evaluation of cementless mobile-bearing total ankle replacements. Department of Orthopaedic Surgery New Jersey Medical School. Jul 2004: 19-26.
- ↑ Bonnin M, Judet T, Colombier JA, Buscayret JA, Graveleau N, Piriou P. Midterm results of the Salto Total Ankle Prosthesis. Clin Orthop Relat Res. Jul 2004: 6-18.
- ↑ Jump up to:41.0 41.1 Lee KB, Park YH, Song EK, Yoon TR, Jung KI. Static and dynamic postural balance after successful mobile-bearing total ankle arthroplasty. Arch Phys Med Rehabil. Apr 2010: 519-522.
- ↑ Culham EG, Westlake KP, Wu Y. Sensory-specific balance training in older adults: effect on position, movement, and velocity sense at the ankle. Phys Ther. May 2007: 560-568.
- ↑ Detrembleur C. Leemrijse T. The effects of total ankle replacement on gait disability: analysis of energetic and mechanical variables. Gait Posture. Feb 2009. 270-274.
- ↑ Jump up to:44.0 44.1 44.2 C. Nüesch, V. Valderrabano, C. Huber, V. von Tscharner, and G. Pagenstert, “Gait patterns of asymmetric ankle osteoarthritis patients,” Clin. Biomech., vol. 27, no. 6, pp. 613–618, 2012.
- ↑ San Giovanni T.P., Keblish D.J., Thomas W.H., Wilson M.G. Eight-year results of a minimally constrained total ankle arthroplasty. Foot Ankle Int. 2006;27(6):418-426
- ↑ Valderrabano V., Nigg B.M., von Tscharner V., Frank C.B., Hintermann B. Total ankle replacement in ankle osteoarthritis: an analysis of muscle rehabilitation. Foot Ankle Int. 2007;28(2):281-291.
- ↑ Dyrby C., Chou L.B., Andriacchi T.P., Mann R.A. Functional evaluation of the Scandinavian Total Ankle Replacement. Foot Ankle Int.2004;25(6):377-381.
- ↑ SMITH C.L., L.T., M.S.C., U.S.N., ‘Physical therapy management of patients with total ankle replacement’, Physical Therapy, 1980, March, vol. 60, nr. 8, p. 303-306.
- ↑ SMITH C.L., L.T., M.S.C., U.S.N., ‘Physical therapy management of patients with total ankle replacement’, Physical Therapy, 1980, March, vol. 60, nr. 8, p. 303-306.
- ↑ SALTZMAN C.L., MCLFF T.E., BUCKWALTER J.A., BROWN T.D., ‘Total Ankle Replacement revisited’, Journal of Orthopaedic & Sports Physical Therapy, 2000, February, vol.nr. 30(2), p. 56-67
- ↑ SALTZMAN C.L., MCLFF T.E., BUCKWALTER J.A., BROWN T.D., ‘Total Ankle Replacement revisited’, Journal of Orthopaedic & Sports Physical Therapy, 2000, February, vol.nr. 30(2), p. 56-67
- ↑ ADRIENNE A. SPIRT, MATHIEU ASSAL, SIGVARD T. HANSEN Jr., ‘Complications and Failure After Total Ankle Arthroplasty’, The Journal of Bone and Joint Surgery, 2004, June, vol. 86-A, nr. 6, p.1172-1178
- ↑ Jump up to:53.0 53.1 Haddad, S.L.; Coetzee, J.C.; Estok, R.; Fahrbach, K.; Banel, D.; Nalysnyk, L. (2007). “Intermediate and Long-Term Outcomes of Total Ankle Arthroplasty and Ankle Arthrodesis. A Systematic Review of the Literature”. Journal of Bone and Joint Surgery 89A (9): 1899–905
- ↑ Stengel, Dirk; Bauwens, Kai; Ekkernkamp, Axel; Cramer, Jörg (2005). “Efficacy of total ankle replacement with meniscal-bearing devices: a systematic review and meta-analysis”. Archives of Orthopaedic and Trauma Surgery 125 (2): 109–19
- ↑ Gougoulias, Nikolaos; Khanna, Anil; Maffulli, Nicola (2009). “How Successful are Current Ankle Replacements? All though most total ankle replacement are successful by reducing pain and improving mobility there is a very high possibility that the pain may be ten times worse. There have been several cases where the doctors have recommended amputation to resolve the issue of pain that was not there prior to the total ankle replacement. : A Systematic Review of the Literature”. Clinical Orthopaedics and Related Research 468: 199–208.
- ↑ Jump up to:56.0 56.1 Haddad SL, Coetzee JC, Estok R, Fahrbach K, Banel D, Nalysnyk L. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am. 2007 Sep;89(9):1899-905.
- ↑ Madeley NJ1, Wing KJ, Topliss C, Penner MJ, Glazebrook MA, Younger AS.Responsiveness and validity of the SF-36, Ankle Osteoarthritis Scale, AOFAS Ankle Hindfoot Score, and Foot Function Index in end stage ankle arthritis. Foot Ankle Int. 2012 Jan;33(1):57-63
- ↑ Dr Selene Parekh Ankle Replacement Surgery https://www.youtube.com/channel/UCxqRUzmxviIRrz3MBt6Xxew [Accessed 24/05/2014]
- ↑ Dr Selene Parekh Ankle Replacement Surgery https://www.youtube.com/channel/UCxqRUzmxviIRrz3MBt6Xxew [Accessed 24/05/2014]
- ↑ Dr Selene Parekh Ankle Replacement Surgery https://www.youtube.com/channel/UCxqRUzmxviIRrz3MBt6Xxew {Accessed 24/05/2014]
- ↑ Total Ankle Replacement Surgery educational video. Available from https://www.youtube.com/watch?v=JGjyRJNWAbA [Accessed 24/05/2014]fckLR|}