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The Science Behind Periprosthetic Aseptic Osteolysis in Total Ankle Replacement

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Primary and Revision Total Ankle Replacement

Abstract

In foot and ankle literature, firm evidence about the etiology, pathophysiology, natural history, and optimal treatments of ankle periprosthetic osteolysis is still lacking. In contrast to osteolysis around hip arthroplasty, factors other than polyethylene debris, such as reaction to necrotic tissue, micromotion at the implant-bone interface, and high fluid pressure may play a key role in osteolysis around total ankle replacement. Annual radiographic surveillance is recommended for early detection and treatment of osteolysis. Computerized tomography showed superiority in both detecting cysts and accurately determining their sizes if compared to standard radiography. The benefit of early surgical intervention in progressive osteolysis may outweigh the risks of catastrophic failure associated with longer conservative management. For total ankle replacement metallic components deemed to be stable, cysts debridement with impaction bone grafting and polyethylene exchange is usually all that is required. If one or both components are deemed to be unstable, component revision is required in addition to cyst debridement and impaction bone grafting. A foot and ankle surgeon who is an expert in both primary and revision total ankle replacement should manage treatment of osteolysis associated with total ankle replacement.

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References

  1. Labek G, Thaler M, Janda W, et al. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg Br. 2011;93(3):293–7.

    Article  CAS  PubMed  Google Scholar 

  2. Harris WH, Schiller AL, Scholler JM, et al. Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am. 1976;58:612–8.

    Article  CAS  PubMed  Google Scholar 

  3. Willert HG. Reactions of the articular capsule to wear products of artificial joint prostheses. J Biomed Mater Res. 1977;11:157–64.

    Article  CAS  PubMed  Google Scholar 

  4. Valderrabano V, Hintermann B, Dick W. Scandinavian total ankle replacement: a 3.7-year average follow up of 65 patients. Clin Orthop. 2004;424:47–56.

    Article  Google Scholar 

  5. Besse JL, Brito N, Lienhart C. Clinical evaluation and radiographic assessment of bone lysis of the AES total ankle replacement. Foot Ankle Int. 2009;30(10):964–75. doi:10.3113/FAI.2009.0964.

    Article  PubMed  Google Scholar 

  6. Bonnin M, Judet T, Colombier JA, et al. Midterm results of the Salto total ankle prosthesis. Clin Orthop Relat Res. 2004;424:6–18.

    Article  Google Scholar 

  7. Hanna RS, Haddad SL, Lazarus ML. Evaluation of periprosthetic lucency after total ankle arthroplasty: helical CT versus conventional radiography. Foot Ankle Int. 2007;28(8):921–6.

    Article  PubMed  Google Scholar 

  8. Kim BS, Knupp M, Zwicky L, Lee JW, Hintermann B. Total ankle replacement in association with hindfoot fusion: outcome and complications. J Bone Joint Surg Br. 2010;92(11):1540–7. doi:10.1302/0301-620X.92B11.24452.

    Article  CAS  PubMed  Google Scholar 

  9. Koivu H, Kohonen I, Sipola E, et al. Severe periprosthetic osteolytic lesions after the Ankle Evolutive System total ankle replacement. J Bone Joint Surg Br. 2009;91(7):907–14. doi:10.1302/0301-620X.91B7.22434.

    Article  CAS  PubMed  Google Scholar 

  10. Rippstein PF, Huber M, Coetzee JC, Naal FD. Total ankle replacement with use of a new three-component implant. J Bone Joint Surg Am. 2011;93(15):1426–35. doi:10.2106/JBJS.J.00913.

    Article  PubMed  Google Scholar 

  11. Schutte BG, Louwerens JW. Short-term results of our first 49 Scandinavian total ankle replacements (STAR). Foot Ankle Int. 2008;29(2):124–7.

    Article  CAS  PubMed  Google Scholar 

  12. Rodriguez D, Bevernage BD, Maldague P, Deleu PA, Tribak K, Leemrijse T. Medium term follow-up of the AES ankle prosthesis: high rate of asymptomatic osteolysis. Foot Ankle Surg. 2010;16(2):54–60. doi:10.1016/j.fas.2009.05.013. Epub 2009 Jul 9.

    Article  PubMed  Google Scholar 

  13. Yoon HS, Lee J, Choi WJ, Lee JW. Periprosthetic osteolysis after total ankle arthroplasty. Foot Ankle Int. 2014;35(1):14–21. doi:10.1177/1071100713509247. Epub 2013 Oct 16.

    Article  PubMed  Google Scholar 

  14. Kohonen I, Koivu H, Pudas T, Tiusanen H, Vahlberg T, Mattila K. Does computed tomography add information on radiographic analysis in detecting periprosthetic osteolysis after total ankle arthroplasty? Foot Ankle Int. 2013;34(2):180–8. doi:10.1177/1071100712460224. Epub 2013 Jan 10.

    Article  PubMed  Google Scholar 

  15. Kobayashi A, Minoda Y, Kadoya Y, Ohashi H, Takaoka K, Saltzman CL. Ankle arthroplasties generate wear particles similar to knee arthroplasties. Clin Orthop Relat Res. 2004;(424):69–72.

    Google Scholar 

  16. Kobayashi A, Freeman MAR, Bonefield W, et al. Number of polyethylene particles and osteolysis in total joint replacements. J Bone Joint Surg. 1997;79B:844–8.

    Article  Google Scholar 

  17. Fevang BT, Lie SA, Havelin LI, et al. 257 ankle arthroplasties performed in Norway between 1994 and 2005. Acta Orthop. 2007;78:575–83.

    Article  PubMed  Google Scholar 

  18. Font-Rodriguez DE, Scuderi GR, Insall JN. Survival ship of cemented total knee arthroplasty. Clin Orthop. 1997;345:79–86.

    Article  Google Scholar 

  19. Koivu H, Mackiewicz Z, Takakubo Y, Trokovic N, Pajarinen J, Konttinen YT. RANKL in the osteolysis of AES total ankle replacement implants. Bone. 2012;51(3):546–52. doi:10.1016/j.bone.2012.05.007. Epub 2012 May 14.

    Article  CAS  PubMed  Google Scholar 

  20. Arafah O, Penner MJ. Is polyethylene particulate debris present in osteolytic cysts in total ankle replacement? [Abstract]. Poster presentation (e-102) at the IFFAS/AOFAS 2014 meeting, Chicago.

    Google Scholar 

  21. Dalat F, Barnoud R, Fessy MH, Besse JL, French Association of Foot Surgery AFCP. Histologic study of periprosthetic osteolytic lesions after AES total ankle replacement. A 22 case series. Orthop Traumatol Surg Res. 2013;99(6 Suppl):S285–95. doi:10.1016/j.otsr.2013.07.009. Epub 2013 Aug 23.

    Article  CAS  PubMed  Google Scholar 

  22. Vaupel Z, Baker E, Baker KC, et al. Analysis of retrieved agility total ankle arthroplasty systems. Foot Ankle Int. 2009;30(9):815–23.

    Article  PubMed  Google Scholar 

  23. Pyevich MT, Saltzman CL, Callaghan JJ, Alvine FG. Total ankle arthroplasty: a unique design. Two to twelve-year follow-up. J Bone Joint Surg Am. 1998;80(10):1410–20.

    Article  CAS  PubMed  Google Scholar 

  24. Knecht SI, Estin M, Callaghan JJ, et al. The Agility total ankle arthroplasty. Seven to sixteen-year follow-up. J Bone Joint Surg Am. 2004;86-A(6):1161–71.

    Article  PubMed  Google Scholar 

  25. Burton L, Paget D, Binder NB, et al. Orthopedic wear debris mediated inflammatory osteolysis is mediated in part by NALP3 inflammasome activation. J Orthop Res. 2013;31(1):73–80.

    Article  CAS  PubMed  Google Scholar 

  26. Gallo J, Slouf M, Goodman SB. The relationship of polyethylene wear particle size, distribution and number: a possible factor explaining the risk of osteolysis after hip arthroplasty. J Biomed Mater Res B Appl Biomater. 2010;94(1):171–7.

    PubMed  Google Scholar 

  27. Goodman S. Wear particulate and osteolysis. Orthop Clin North Am. 2005;36(1):41–8.

    Article  PubMed  Google Scholar 

  28. Hozack WJ, Mesa JJ, Carey C, Rothman RH. Relationship between polyethylene wear, pelvic osteolysis, and clinical symptomatology in patients with cementless acetabular components. A framework for decision making. J Arthroplasty. 1996;11:769–72.

    Article  CAS  PubMed  Google Scholar 

  29. Ishikawa SN, Murphy GA, Richardson EG. The effect of cigarette smoking on hindfoot fusions. Foot Ankle Int. 2002;23:996–8.

    Article  PubMed  Google Scholar 

  30. Kim BS, Lee JW. Total ankle replacement for the varus unstable osteoarthritic ankle. Tech Foot Ankle Surg. 2010;9(4):157–64.

    Article  Google Scholar 

  31. Trincat S, Kouyoumdjian P, Asencio G. Total ankle arthroplasty and coronal plane deformities. Orthop Traumatol Surg Res. 2012;98(1):75–84.

    Article  CAS  PubMed  Google Scholar 

  32. Haskell A, Mann RA. Ankle arthroplasty with preoperative coronal plane deformity: short term result. Clin Orthop Relat Res. 2004;424:98–103.

    Article  Google Scholar 

  33. Leung S, Naudie D, Kitamura N, Walde T, Engh CA. Computed tomography in the assessment of periacetabular osteolysis. J Bone Joint Surg. 2005;87-A:592–7.

    Article  Google Scholar 

  34. Resnick D, Fix CF, Trudell D. Bone and joint imaging. 2nd ed. Philadelphia: W. B. Saunders; 1996.

    Google Scholar 

  35. Puri L, Wixson R, Stern SH, Kohli J, Hendrix RW, Stuberg D. Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty. J Bone Joint Surg. 2002;84-A:609–14.

    Article  PubMed  Google Scholar 

  36. Balter S, Zanzonico P, Reiss GR, Moses JW. Radiation is not the only risk. AJR Am J Roentgenol. 2011;196(4):762–7. doi:10.2214/AJR.10.5982.

    Article  PubMed  Google Scholar 

  37. Biswas D, Bible JE, Bohan M, et al. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am. 2009;91:1882–9.

    Article  PubMed  Google Scholar 

  38. Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, Ron E, Sachs RK, Samet JM, Setlow RB, Zaider M. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A. 2003;100:13761–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Saha S, Burke C, Desai A, Vijayanathan S, Gnanasegaran G. Review article. SPECT-CT: applications in musculoskeletal radiology. Br J Radiol. 2013;86(1031):20120519.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Knupp M, Pagenstert GI, Barg A, Bolliger L, Easley M, Hintermann B. SPECT-CT compared with conventional imaging modalities for the assessment of the varus and valgus malaligned hindfoot. J Orthop Res. 2009;27:1461–6.

    Article  PubMed  Google Scholar 

  41. Rippstein PF, Huber M, Naal FD. Management of specific complications related to total ankle arthroplasty. Foot Ankle Clin. 2012;17(4):707–17. doi:10.1016/j.fcl.2012.08.010. Epub 2012 Oct 23.

    Article  PubMed  Google Scholar 

  42. Jonck JH, Myerson MS. Revision total ankle replacement. Foot Ankle Clin. 2012;17(4):687–706. Epub 2012 Sep 18.

    Article  PubMed  Google Scholar 

  43. Bonnin M, Gaudot F, Laurent J-R, et al. The Salto total ankle arthroplasty: survivorship and analysis of failures at 7 to 11 years. Clin Orthop Relat Res. 2011;469(1):225–36.

    Article  PubMed  Google Scholar 

  44. Prissel MA, Roukis TS. Management of extensive tibial osteolysis with the Agility™ total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. J Foot Ankle Surg. 2014;53(1):101–7. doi:10.1053/j.jfas.2013.10.008.

    Article  PubMed  Google Scholar 

  45. Restrepo C, Ghanem E, Houssock C, et al. Isolated polyethylene exchange versus acetabular revision for polyethylene wear. Clin Orthop Relat Res. 2009;467:194–8.

    Article  PubMed  Google Scholar 

  46. Maloney WJ, Herzwurm P, Paprosky W, et al. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as part of a total hip replacement. J Bone Joint Surg Am. 1997;79:1628–34.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedic (49), College of Medicine, King Khalid University Hospital/King Saud University, 7805, Riyadh, 11472, Saudi Arabia

    Orfan Arafah MBBS, FRSC(C)

  2. Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada

    Murray J. Penner MD, BMechEng, FRCSC

  3. Department of Orthopaedics, St. Paul’s Hospital, Vancouver Coastal Health Authority and Providence Health Care, 1000-1200 Burrard Street, Vancouver, BC, Canada, V6Z 2C7

    Murray J. Penner MD, BMechEng, FRCSC

Authors
  1. Orfan Arafah MBBS, FRSC(C)
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  2. Murray J. Penner MD, BMechEng, FRCSC
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Corresponding author

Correspondence to Murray J. Penner MD, BMechEng, FRCSC .

Editor information

Editors and Affiliations

  1. Gundersen Health System, La Crosse, Wisconsin, USA

    Thomas S. Roukis

  2. Orthopedic Foot and Ankle Center, Westerville, Ohio, USA

    Gregory C. Berlet

  3. Wisconsin Foot and Ankle Institute, Marshfield, Wisconsin, USA

    Christopher Bibbo

  4. Orthopedic Foot and Ankle Center, Westerville, Ohio, USA

    Christopher F. Hyer

  5. Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada

    Murray J. Penner

  6. Foot and Ankle Center Karlsruhe, Karlsruhe, Germany

    Markus Wünschel

  7. Atlantic Foot & Ankle Center of Chesapeake, Chesapeake, Virginia, USA

    Mark A. Prissel

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Arafah, O., Penner, M.J. (2016). The Science Behind Periprosthetic Aseptic Osteolysis in Total Ankle Replacement. In: Roukis, T., et al. Primary and Revision Total Ankle Replacement. Springer, Cham. https://doi.org/10.1007/978-3-319-24415-0_16

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  • DOI: https://doi.org/10.1007/978-3-319-24415-0_16

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-24413-6

  • Online ISBN: 978-3-319-24415-0

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