Current Status of Ankle Arthroplasty

Springer Berlin Heidelberg New York Barcelona Budapest Hong Kong London Milan Paris Singapore Tokyo

HAKON KOFOED (Ed.)

Current Status of Ankle Arthroplasty

With 37 Figures

Springer

Dr. HAKON KOFOED

University Hospital of Copenhagen Orthopaedic Clinic, Frederiksberg Hospital 57 Nordre Fasanvej 2000 Frederiksberg, Denmark

CIP-Data applied for Die Deutsche Bibliothek - CIP-Einheitsaufnahme Current status of ankle arthroplasty: with 26 tables 1 H. Kofoed (ed.). - Berlin; Heidelberg; New York; Barcelona; Budapest; Hong Kong; London; Milan; Singapore; Paris; Tokyo: Springer, 1998

ISBN -13: 978-3-540-64653-2 e-ISBN -13: 978-3-642-72255-4 DOl: 10.1007/978-3-642-72255-4

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Preface

The First International Congress on Ankle Arthroplasty took place in Copen­hagen 20-21 June 1997. Internationally reknowned ankle surgeons from five continents discussed the current status of ankle joint replacement and ar­throdesis. This book contains the proceedings.

Ankle arthroplasty has been in clinical use since 1970, and for lO-IS years was subsequently used as a treatment for painful and degenerated ankle joints. Hip and knee arthroplasty were established as routine methods dur­ing that same period, and arthrodesis of hip and knee became the exception. In the slipstream of these successes, several ankle-prosthesis designs hit the international market.

The initial results were described as promising. The majority of the pa­tients experienced freedom of pain and retained some ankle joint mobility. However, the failure rate of these new implants became too pronounced after a few years of use. There could be several reasons for these mediocre results. Most designs called for rather excessive bone resections. Some prostheses were constrained, relying on the cement fixation in the fatty bone marrow above the subchondral bone level in the tibia. The multi-axial design had to rely on ligament stability. Non-congruent prostheses fared worse than con­gruent designs. The talus component was often placed on top of the talus dome. Thereby, the normal rotational axis of the ankle was changed. Im­pingement syndromes, abnormal gait patterns and, later, prosthesis loosening with gross loss of bone stock made it nearly impossible to perform revisions, and arthrodesis could be difficult to use as salvage procedures.

Subsequently, the treatment with an ankle prosthesis was reduced to very special cases. In retrospect, it would seem that these first attempts to replace the ankle joint were unsuccessful because they did not respect the anatomy, the kinematics, the alignment and the stability of the ankle joint. Ankle ar­throdesis again became the gold standard.

While ankle arthroplasty generally was abandoned by the orthopaedic community, careful studies of normal ankle anatomy kinematics and pre­vious failures resulted in the development of a new generation of ankle pros­theses. These are characterised by preserving bone stock, respecting the nor­mal rotational axis, tibiopedal alignment and by being non-constrained. They also use biological fixation. These attempts to improve ankle prosthesis and their results may not have resulted in the ultimate answer, but they have certainly started a new era and a genuine interest in ankle arthroplasty. It is our hope that these innovations will lead to results for ankle replacements

VI Preface

that are compatible with those of the successful replacements in other weight-bearing joints.

We are extremely grateful to all the contributing authors who, by giving and sharing their expert opinion in this book, have broadened the knowl­edge and the interest in treatment of the painful ankle. We also want to thank Springer-Verlag, Heidelberg, Germany, especially to Mr. Thomas Gunther, for the extremely smooth and most effective handling of this pre­sentation.

HAKON KOFOED Copenhagen, May 1998

Contents

Part I The Basics of Ankle Arthroplasty

Kinematics of the Normal Ankle Joint A. LUNDBERG .................................... 3

2 Why an Ankle Arthroplasty? L. KLENERMAN ................................... 8

3 What Went Wrong with the First Generation of Ankle Arthroplasties? W.A. SOUTER .................................... 10

4 Ankle Arthroplasty: Indications, Alignment, Stability and Gain in Mobility H. KOFOED ....... . .................. . ........... 16

5 Cemented and Uncemented Ankle Endoprosthesis: Clinical and Pedobarographic Results K. TILLMANN, M. SCHIRP, B. SCHAAR and B. FINK. . . . . . . .. 22

Part II Current Results of Ankle Arthroplasty

6 The Low Contact Stress/Buechel-Pappas Total Ankle Prosthesis H. C. DOETS ..................................... 29

7 Total Ankle Replacement (LINK S.T.A.R.) for Rheumatoid Arthritis P. L. R. WOOD ............ . ....................... 34

VIII

8 Cementless Ankle Arthroplasty in the United States of America: The Agility Total Ankle Arthroplasty

Contents

S. T. HANSEN JR. .................................. 37

9 Current Results of Ankle Arthroplasty -European Multi-Center Study of Cementless Ankle Arthroplasty F. SCHERNBERG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 41

10 Comparison of Cemented and Cementless Ankle Arthoplasty H. KOFOED ...................................... 47

11 Revision of Different Ankle Prosthesis A. S. CARLSSON ................................... 50

Part III Laboratory Investigations

12 The Fibula Rotates During Motion in the Ankle Joint J. HELWEG and H. KOFOED .......................... 59

13 Kinematic Changes of the Ankle-Joint Complex Caused by Selective Arthrodesis B. HINTERMANN, M. D. BENNO and M. NIGG ............. 64

14 Clinical Study of Total Ankle Arthroplasty Using Gait Analysis (5-Year Follow-Up) S. GIANNINI, F. CATANI, M. G. BENEDETTI and A. LEARDINI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 68

15 The Value of Ankle Prostheses - A Gait Analysis Approach R. G. H. H. NELISSEN, H. C. DOETS and C. MESKERS ........ 72

16 In Vivo Stabilometry of Meniscal-Bearing Ankle Prosthesis E. MAGNUSSEN, L. GARDE and H. KOFOED. . . . . . . . . . . . . .. 78

Part IV Ankle Arthroplasty and Rheumatoid Arthritis

17 First Experience and Early Results with an Uncemented Total Ankle Arthroplasty E. FUNKE, P. RIPPSTEIN and U. MUNZINGER ........ . .... 83

Contents IX

18 Medium-Term Results in Rheumatoid Arthritis with the Bath and Wessex Ankle Prosthesis A. S. CARLSSON, A. HENRICSON, 1. LINDER, J.-A. NILSSON and 1. REDLUND-JOHNELL ........................... 86

19 Ankle Arthroplasty: A Clinical Follow-Up S. SCHILL and H. THABE . . . . . . . . . . . . . . . . . . . . . . . . . . .. 90

20 Cemented Ankle Arthroplasty for Osteoarthritis and Rheumatoid Arthritis - Long-Term Results S. T. SANDBERG and H. KOFOED . . . . . . . . . . . . . . . . . . . . . .. 94

Part V Ankle Arthroplasty and Osteoarthritis

21 Ankle Arthroplasty - The RAMSES Prosthesis G. MENDOLIA ......... . ........ . ........... . .. . .. 99

22 Scandinavian Total Ankle Replacement (LINK S.T.A.R.) Technical Problems and Solutions H. HUBER, R. KELLENBERGER and M. HUBER

23 Our Experience With a Spherical Total Ankle Replacement

106

A. V. VOEGELI .................................... III

24 Medium-Term Results of Cementless Scandinavian Total Ankle Replacement Prosthesis (LINK S.T.A.R.) for Osteoarthritis H. KOFOED ...................................... 116

Part VI Instructional lecture

25 Arthrodesis of the Ankle R.A. MANN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 121

Part VII Miscellaneous About Ankles

26 Long-Term Complications of Ankle Arthrodesis - A Survey S. T. HANSEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 129

27 Bone Mineral Density in the Distal Tibia and in the Os Calcis After Ankle Arthroplasty B. ZERAHN, H. KOFOED and A. BORGWARDT .......... . .. 132

X Contents

28 Comparison of Five Different Scoring Systems for Ankle Arthroplasty N. LEVI and H. KOFOED ............................ 135

29 Patients' Visual Analogue Ankle Scoring A. L. JENSEN and H. KOFOED ......................... 138

30 Radiographic Passive Mobiltiy of Ankle Joints Before and After Ankle Arthroplasty T. ELGAARD and H. KOFOED ......................... 142

Part VIII Instructional Lecture

31 Instructional Lecture. Can the Ankle Joint Be Replaced? Yes H. KOFOED ...................................... 149

Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 155

Contributors

CARLSSON AKE S., Department of Orthopaedics, Malmo University Hospital, S-20502 Malmo, Sweden

DOETS H. C., Slootervaart Zickenhuis, University of Amsterdam, Louwesweg 6, NL-1066 EC-Amsterdam, The Netherlands

ELGAARD TENNA, University Clinic, Department of Radiology, Frederiksberg Hospital, 57 Nordre Fasanvej, DK-2000 Frederiksberg, Denmark

FUNKE EDGAR, Schulthess Klinik, Lengghalde 2, CH-8008 Zurich, Switzerland

GIANNINI S., University of Bologna, 1stituto Orthopedico Rizzoli, 1 via Pupilli, 1-40136 Bologna, Italy

HANSEN SIGVARD T., University of Washington, Department of Orthopaedics, 325 Ninth Avenue, Seattle, WA 98104-2499, USA

HELWEG JEPPE, University Clinic of Orthopaedics, Frederiksberg Hospital, 57 Nordre Fasanvej, DK-2000 Frederiksberg, Denmark

HINTERMANN B., Dept. of Orthopaedics, Kantonspital Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland

HUBER HARRY, Hopitalla Chaux-de-Fonds, Rue de Chasseral20, CH-2300 La Chaux-de-Fonds, Switzerland

JENSEN ALLAN 1., University Clinic of Orthopaedics, Frederiksberg Hospital, 57 Nordre Fasanvej, DK-2000 Frederiksberg, Denmark

KLENERMANN 1., Dept. of Orthopaedics and Accident Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool L693BX, UK

KOFOED HAKON, The University Clinic, Frederiksberg Hospital, University Hospital of Copenhagen, Nordre Fasanvey 57, DK-2000 Frederiksberg, Denmark

XII Contributors

LEVI NILS, Department of Orthopaedics, National University Hospital, Bledgdamsvej 9, DK-2100 Copenhagen, Denmark

LUNDBERG ARNE, Department of Orthopaedics, Huddinge Sjukhus, University of Stockholm, S-1486 Huddinge, Sweden

MAGNUSSEN ERLAND, University Clinic of Orthopaedics, Frederiksberg Hospital, 57 Nordre Fasanvej, DK-2000 Frederiskberg, Denmark

MANN ROGER A., University of San Francisco, Oakland Clinic, 3300 Webster Street, 1200 Oakland, California 94609, USA

MENDOLIA GEORGES, Centre MCD core d'opale, St. Martin, F-62222 Boulogne, France

NELISSEN ROB G. H. H., Academisch Ziekenhuis Leiden, Department of Orthopaedic Surgery, J 11-S, Albinusdreef 2, NL-2300 RC Leiden, Holland

SANDBERG S. T., Clinic of Orthopaedics, Frederiksberg Hospital, 57 Nordre Fasanvej, DK-2000 Frederiksberg, Denmark

SCHERNBERG FRAN90IS, Universite de Reims, Dept. d'Orthopedie, Hopital Maison Blanche, 46 Rue Cognacq-Jay, F-51092 Reims Cedex, France

SCHILL S., Diakonie-Krankenhaus, Ringstra6e 58-60, D-55543 Bad Kreuznach, Germany

SOUTER WILLIAM A., Surgical Arthritis Unit, Princess Margaret Rose, Orthopaedic Hospital, Edinburgh, Scotland, UK

TILLMANN KARL, University of Hamburg, Rheumaklinik Bad Bramstedt, Postfach 1448, D-24572 Bad Bramstedt, Germany

VOEGELI A., VILADOT, University of Barcelona, Hospital San Rafael, Passeig De la Vall D'Hebro 107-110, E-08035 Barcelona, Spain

WOOD PETER L. R., Wrightington Hospital, Hall Lane, Apley Bridge, Wigan, Lancs. WN69EP, UK

ZERAHN Bo, Department of Clinical Physiology, Herlev University Hospital, Herlev Ringvej, DK-2730 Denmark