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Endoprothetik des oberen Sprunggelenks

Grenzen und Potenziale

Total arthroplasty of the ankle joint

Limitations and potentials

  • Leitthema
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Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Die Endoprothetik des oberen Sprunggelenks hat sich zu einer bewährten Behandlungsoption für Patienten mit fortgeschrittener Arthrose des oberen Sprunggelenks entwickelt. Entscheidend für langfristig gute klinische Resultate und Standzeiten ist die sorgfältige Patientenauswahl unter Berücksichtigung von Indikationen, Kontraindikationen und definierten Prognosefaktoren. Trotz moderner Prothesendesigns bleibt die endoprothetische Versorgung am oberen Sprunggelenk ein komplexes operatives Verfahren, das eines präzisen chirurgischen Vorgehens in einem spezialisierten Zentrum bedarf. Verschiedene Limitierungen sind existent, wie z. B. die Implantationstechnik und Erfahrung des Operateurs, perioperative Komplikationen durch Begleitmedikationen etc. Gegenstand aktueller Forschung ist die Optimierung der Implantatdesigns, Entwicklung personalisierter Operationstechniken, die Verbesserung der Langzeitperformance und die Minimierung perioperativer Komplikationen. Zukünftige Entwicklungen wie die Einführung robotergestützter Chirurgiesysteme und die Integration biologischer Verfahren werden als technologische Perspektiven diskutiert.

Abstract

Total arthroplasty of the ankle joint (TAA) has become an established treatment option for patients with advanced osteoarthritis of the ankle joint. A crucial factor for good long-term clinical results and standing times is careful patient selection, taking the indications, contraindications, and defined prognostic factors into account. Despite modern prosthetic designs, TAA remains a complex surgical procedure that requires precise surgical techniques in a specialized center. Various limitations exist, such as the implantation technique and experience of the surgeon and perioperative complications due to concomitant medications. Current research focuses on the optimization of implant designs, development of personalized surgical techniques, improvement of the long-term performance and minimization of perioperative complications. Future developments, such as the introduction of robot-assisted surgical systems and the integration of biological procedures are also discussed as technological perspectives.

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Literatur

  1. Barg A, Elsner A, Chuckpaiwong B, Hintermann B (2010) Insert position in three-component total ankle replacement. Foot Ankle Int 31(9):754–759. https://doi.org/10.3113/FAI.2010.0754

    Article  PubMed  Google Scholar 

  2. Hermus JPS, van Kuijk SMJ, Spekenbrink-Spooren A, Witlox MA, Poeze M, van Rhijn LW, Arts JJC (2022) Risk factors for total ankle arthroplasty failure: a Dutch arthroplasty register study. Foot Ankle Surg 28(7):883–886. https://doi.org/10.1016/j.fas.2021.12.001

    Article  CAS  PubMed  Google Scholar 

  3. Jaakkola JI, Mann RA (2004) A review of rheumatoid arthritis affecting the foot and ankle. Foot Ankle Int 25(12):866–874. https://doi.org/10.1177/107110070402501205

    Article  PubMed  Google Scholar 

  4. Undén A, Jehpsson L, Kamrad I, Carlsson Å, Henricson A, Karlsson MK, Rosengren BE (2020) Better implant survival with modern ankle prosthetic designs: 1,226 total ankle prostheses followed for up to 20 years in the Swedish ankle registry. Acta Orthop 91(2):191–196. https://doi.org/10.1080/17453674.2019.1709312

    Article  PubMed  PubMed Central  Google Scholar 

  5. van Heiningen J, Vliet Vlieland TP, van der Heide HJ (2013) The mid-term outcome of total ankle arthroplasty and ankle fusion in rheumatoid arthritis: a systematic review. BMC Musculoskelet Disord 14:306. https://doi.org/10.1186/1471-2474-14-306

    Article  PubMed  PubMed Central  Google Scholar 

  6. van der Plaat LW, Haverkamp D (2017) Patient selection for total ankle arthroplasty. Orthop Res Rev 9:63–73. https://doi.org/10.2147/ORR.S115411

    Article  PubMed  PubMed Central  Google Scholar 

  7. Watts DT, Moosa A, Elahi Z, Palmer AJR, Rodriguez-Merchan EC (2022) Comparing the results of total ankle arthroplasty vs tibiotalar fusion (ankle arthrodesis) in patients with ankle osteoarthritis since 2006 to 2020—a systematic review. Arch Bone Jt Surg 10(6):470–479. https://doi.org/10.22038/ABJS.2021.55790.2778

    Article  PubMed  PubMed Central  Google Scholar 

  8. van der Woude D, van der Helm-van Mil AHM (2018) Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis. Best Pract Res Clin Rheumatol 32(2):174–187. https://doi.org/10.1016/j.berh.2018.10.005

    Article  PubMed  Google Scholar 

  9. Reina-Bueno M, Munuera-Martínez PV, Pérez-García S, Vázquez-Bautista MDC, Domínguez-Maldonado G, Palomo-Toucedo IC (2021) Foot pain and morphofunctional foot disorders in patients with rheumatoid arthritis: a multicenter cross-sectional study. Int J Environ Res Public Health 18(9):5042. https://doi.org/10.3390/ijerph18095042

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ng SY, Crevoisier X, Assal M (2012) Total ankle replacement for rheumatoid arthritis of the ankle. Foot Ankle Clin 17(4):555–564. https://doi.org/10.1016/j.fcl.2012.08.004 (Erratum in: Foot Ankle Clin. 2013 Mar;18(1):xiii)

    Article  PubMed  Google Scholar 

  11. Anastasio AT, Patel PS, Farley KX, Kadakia R, Adams SB (2021) Total ankle arthroplasty and ankle arthrodesis in rheumatic disease patients: an analysis of outcomes and complications using the national inpatient sample (NIS) database. Foot Ankle Surg 27(3):321–325. https://doi.org/10.1016/j.fas.2020.07.006

    Article  PubMed  Google Scholar 

  12. Raikin SM, Sandrowski K, Kane JM, Beck D, Winters BS (2017) Midterm outcome of the agility total ankle arthroplasty. Foot Ankle Int 38(6):662–670. https://doi.org/10.1177/1071100717701232

    Article  PubMed  Google Scholar 

  13. Stadler C, Stöbich M, Ruhs B, Kaufmann C, Pisecky L, Stevoska S, Gotterbarm T, Klotz MC (2022) Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis. Arch Orthop Trauma Surg 142(12):3697–3704. https://doi.org/10.1007/s00402-021-03946-5

    Article  CAS  PubMed  Google Scholar 

  14. Clough TM, Ring J (2021) Total ankle arthroplasty. Bone Joint J 103(4):696–703. https://doi.org/10.1302/0301-620X.103B4.BJJ-2020-0758.R1

    Article  PubMed  Google Scholar 

  15. Mann JA, Mann RA, Horton E (2011) STARTM ankle: long-term results. Foot Ankle Int 32(5):473–484. https://doi.org/10.3113/FAI.2011.0473

    Article  Google Scholar 

  16. SooHoo NF, Zingmond DS, Ko CY (2007) Comparison of reoperation rates following ankle arthrodesis and total ankle arthroplasty. J Bone Joint Surg Am 89(10):2143–2149. https://doi.org/10.2106/JBJS.F.01611

    Article  PubMed  Google Scholar 

  17. Dekker TJ, Walton D, Vinson EN, Hamid KS, Federer AE, Easley ME, DeOrio JK, Nunley JA, Adams SB Jr. (2017) Hindfoot arthritis progression and arthrodesis risk after total ankle replacement. Foot Ankle Int 38(11):1183–1187. https://doi.org/10.1177/1071100717723130

    Article  PubMed  Google Scholar 

  18. Cardoso DV, Veljkovic A (2022) General considerations about foot and ankle arthrodesis. Any way to improve our results? Foot Ankle Clin 27(4):701–722. https://doi.org/10.1016/j.fcl.2022.08.007

    Article  PubMed  Google Scholar 

  19. Walley KC, Arena CB, Juliano PJ, Aynardi MC (2019) Diagnostic criteria and treatment of acute and chronic periprosthetic joint infection of total ankle arthroplasty. Foot Ankle Orthop 4(2):2473011419841000. https://doi.org/10.1177/2473011419841000

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ting NT, Della Valle CJ (2017) Diagnosis of periprosthetic joint infection—an algorithm-based approach. J Arthroplasty 32(7):2047–2050. https://doi.org/10.1016/j.arth.2017.02.070

    Article  PubMed  Google Scholar 

  21. Krenn V, Morawietz L, Kienapfel H, Ascherl R, Matziolis G, Hassenpflug J, Thomsen M, Thomas P, Huber M, Schuh C, Kendoff D, Baumhoer D, Krukemeyer MG, Perino G, Zustin J, Berger I, Rüther W, Poremba C, Gehrke T (2013) Erweiterte Konsensusklassifikation. Histopathologische Klassifikation von Gelenkendoprothesen-assoziierten Erkrankungen. Z Rheumatol 72(4):383–392. https://doi.org/10.1007/s00393-012-1099-0

    Article  CAS  PubMed  Google Scholar 

  22. Steck JK, Schuberth JM, Christensen JC, Luu CA (2017) Revision total ankle arthroplasty. Clin Podiatr Med Surg 34(4):541–564. https://doi.org/10.1016/j.cpm.2017.05.010

    Article  PubMed  Google Scholar 

  23. Albrecht K, Poddubnyy D, Leipe J et al (2022) Perioperativer Umgang mit der Therapie von Patienten mit entzündlich rheumatischen Erkrankungen. Z Rheumatol 81:212–224. https://doi.org/10.1007/s00393-021-01140-x

    Article  CAS  PubMed  Google Scholar 

  24. Adams SB Jr, Spritzer CE, Hofstaetter SG, Jakoi AM, Pietrobon R, Nunley JA 2nd, Easley ME (2007) Computer-assisted tibia preparation for total ankle arthroplasty: a cadaveric study. Int J Med Robot 3(4):336–340. https://doi.org/10.1002/rcs.163 (Int J Med Robot. 2008 Jun;4(2):19)

    Article  PubMed  Google Scholar 

  25. Stauffer TP, Kim BI, Grant C, Adams SB, Anastasio AT (2023) Robotic technology in foot and ankle surgery: a comprehensive review. Sensors 23(2):686. https://doi.org/10.3390/s23020686

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hsu AR, Davis WH, Cohen BE, Jones CP, Ellington JK, Anderson RB (2015) Radiographic outcomes of preoperative CT scan-derived patient-specific total ankle arthroplasty. Foot Ankle Int 36(10):1163–1169. https://doi.org/10.1177/1071100715585561

    Article  PubMed  Google Scholar 

  27. Umbel BD, Hockman T, Myers D, Sharpe BD, Berlet GC (2022) Accuracy of CT-derived patient-specific instrumentation for total ankle arthroplasty: the impact of the severity of preoperative varus ankle deformity. Foot Ankle Spec. https://doi.org/10.1177/19386400211068262

    Article  PubMed  Google Scholar 

  28. Sagherian BH, Claridge RJ (2019) The use of tantalum metal in foot and ankle surgery. Orthop Clin North Am 50(1):119–129. https://doi.org/10.1016/j.ocl.2018.08.006

    Article  PubMed  Google Scholar 

  29. Wąsik J, Stołtny T, Pasek J, Szyluk K, Pyda M, Ostałowska A, Kasperczyk S, Koczy B (2019) Effect of total ankle arthroplasty and ankle arthrodesis for ankle osteoarthritis: a comparative study. Med Sci Monit 25:6797–6804. https://doi.org/10.12659/MSM.915574

    Article  PubMed  PubMed Central  Google Scholar 

  30. https://dgrh.de/Start/Publikationen/Empfehlungen/Therapie-bei-besonderen-Situationen/Perioperatives-Management.html. Zugegriffen: 21. Juli 2023

Weiterführende Literatur

  1. Barg A, Wimmer MD, Wiewiorski M, Wirtz DC, Pagenstert GI, Valderrabano V (2015) Total ankle replacement. Dtsch Ärztebl Int 112(11):177–184. https://doi.org/10.3238/arztebl.2015.0177

    Article  PubMed  PubMed Central  Google Scholar 

  2. Foran IM, Vafek EC, Bohl DD, Lee S, Hamid KS (2022) Quality assessment of modern total ankle arthroplasty clinical outcomes research. J Foot Ankle Surg 61(1):7–11. https://doi.org/10.1053/j.jfas.2021.05.011

    Article  PubMed  Google Scholar 

  3. Lawton CD, Butler BA, Dekker RG 2nd, Prescott A, Kadakia AR (2017) Total ankle arthroplasty versus ankle arthrodesis—a comparison of outcomes over the last decade. J Orthop Surg Res 12(1):76. https://doi.org/10.1186/s13018-017-0576-1

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mazzotti A, Arceri A, Zielli S, Bonelli S, Viglione V, Faldini C (2022) Patient-specific instrumentation in total ankle arthroplasty. World J Orthop 13(3):230–237. https://doi.org/10.5312/wjo.v13.i3.230

    Article  PubMed  PubMed Central  Google Scholar 

  5. Park JS, Mroczek KJ (2011) Total ankle arthroplasty. Bull NYU Hosp Jt Dis 69(1):27–35

    PubMed  Google Scholar 

  6. Kraal T, van der Heide HJ, van Poppel BJ, Fiocco M, Nelissen RG, Doets HC (2013) Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease. Bone Joint J 95(12):1656–1661. https://doi.org/10.1302/0301-620X.95B12.32146

    Article  PubMed  Google Scholar 

  7. Adams SB, Steele JR, Demetracopoulos CA, Nunley JA, Easley ME, DeOrio JK (2020) Results of tibia and fibula osteotomies performed concomitant to total ankle replacement. Foot Ankle Int 41(3):259–266. https://doi.org/10.1177/1071100719892221

    Article  PubMed  Google Scholar 

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  1. Orthopädische Universitätsklinik, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland

    Alexander Sandomirski, Jana Johanshon,  Christoph Lohmann & Jan Lietz

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Correspondence to Christoph Lohmann.

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A. Sandomirski, J. Johanshon, C. Lohmann und J. Lietz geben an, dass kein Interessenkonflikt besteht.

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Sandomirski, A., Johanshon, J., Lohmann, C. et al. Endoprothetik des oberen Sprunggelenks. Z Rheumatol 82, 852–858 (2023). https://doi.org/10.1007/s00393-023-01422-6

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