Cementless Total Ankle Replacement

Artificial ankle replacement is a controversial procedure. For young people with normal lower and middle joints, they have simple osteoarthritis, ankle pain, limited mobility, etc., and the ankle joint fusion is performed at a suitable position to obtain satisfactory results. It is not advisable to perform artificial joint ankle replacement. Elderly patients (over 60 years old) suffer from sacral arthritis or rheumatoid arthritis. If there is severe hindfoot deformity, it is necessary to perform posterior deformity orthopedic surgery before artificial ankle replacement. If the ankle joint is unstable or the hindfoot deformity is not orthopedic, ankle joint fusion should be performed. Therefore, the indications for the ankle joint are very limited. Some people think that the long-term effect of ankle joint fusion has been found to have frequent foot pain, especially in patients with foot polyarthritis. Therefore, a variety of artificial ankle joints appeared in the early and mid-1970s, and the short-term efficacy success rate can reach 80% to 90%. However, after more clinical application and long-term observation, most of the ankle arthroplasty has a very long-term effect, especially in young patients with simple ankle joint traumatic arthritis. This has led many surgeons to agree with Waring that ankle arthroplasty should not be performed. However, some people are not so pessimistic. They advocate that those who have less activity and who have arthritis in the ankle joint and the subtalar joint are suitable for ankle arthroplasty. Although efforts have been made to address the design of ankle prosthesis, the results of mid- and long-term follow-up of total ankle replacement are not as good as total hip and total knee. Therefore, for the new prosthesis of the ankle joint, only long-term follow-up can be used to determine whether the prosthesis is really higher than the early prosthesis. It is currently believed that axillary joint replacement should not be used only for the treatment of ankle arthritis based on the short-term follow-up results of the reported total ankle arthroplasty. Treatment of diseases: dislocation of the ankle Indication Most non-infected cases with ankle fusion indications can be considered for ankle replacement. Non-cemented artificial total ankle arthroplasty is applicable to: 1. Old ankle fracture and dislocation, leaving severe traumatic arthritis with obvious pain and dysfunction. 2. Rheumatoid arthritis, especially in bilateral sex. 3. Other arthritis such as systemic lupus erythematosus or hemophilic arthritis. 4. Astragalus ischemic necrosis. 5. No history of infection or local infection has been completely controlled for more than 1 year. 6. There are better soft tissue conditions, and the medial and lateral collateral ligaments of the ankle joint are normal. 7. Age is better for middle-aged and older people, but it cannot be used as the main factor for mastering indications. Contraindications 1. Have a history of recent infections. 2. The collateral ligament of the ankle joint is completely broken or muscle spasm and there is obvious ankle instability. 3. Nervous system diseases, such as loss of the distal leg or foot. 4. The deformity is too large to correct. 5. Severe osteoporosis or psoriatic arthritis, ankle replacement should be cautious. Surgical procedure Take the Agility prosthesis as an example. The main steps are as follows: 1. Ankle joint retraction: Under the perspective of C-arm X-ray machine, the first fixation nail is inserted from the inside to the outside through the talar neck parallel to the ankle joint, and the aiming device is inserted parallel to the first nail at the back of the calcaneus. The second nail. Then, perpendicular to the humeral shaft, the other two nails are inserted into the tibia from the inside to the outside parallel to the first nail. Install the tractor and hold the neutral position to retract the ankle joint about 1 cm. 2. Incision: Use the anterior approach to enter between the tibialis anterior and elongate muscles, and pay attention to protect the vascular bundle. The longitudinal incision switch capsule, together with the periosteum, is pushed away to both sides until the joint surface between the talus and the inner and outer iliac crest is fully revealed. A second incision was made at the distal end of the humerus, the anterior iliac ligament was removed, and the lower jaw was loosened with an osteotome. 3. Place the joint fixation device: parallel the humeral shaft to place the extramedullary positioning system, and select the appropriate size module to be placed in the center of the ankle joint under the perspective of the C-arm X-ray machine to ensure the distal radius, the talus, the inner and the outer iliac crest. The internal and external iliac crests generally do not exceed 1/3 of their height. 4. Osteotomy: The bone is cut by the oscillating saw through the module to avoid the internal and external ankle fracture. When preparing the talar bone groove, the module should be parallel to the talus rather than the talar neck. The handle of the module should be parallel to the 2nd toe, so that there is about 20° rotation. 5. Trial mode: Use the osteotome to easily move the sacral joint, put the sacral prosthesis specimen, and insert the prosthesis in the anteroposterior direction. At this time, the humeral prosthesis has an external rotation of about 20°. The talus prosthesis is placed in a mild traction or ankle flexion position, and then the soft tissue balance is judged. If the back extension is less than 10°, do the Achilles tendon extension. After the trial work is completed, the formal prosthesis is placed, and the soft tissue balance needs to be detected, and the loosening adjustment is needed. 6. Lower jaw combined fusion: the lower jaw is combined with the cortex, and the broken bone is added and fixed with 2 screws. Place the drainage and suture the incision. complication 1. Poor wound healing: treatment with skin grafts, blood vessel skin grafts, hyperbaric oxygen chambers, etc. 2. Infection: Superficial infection should be promptly drained and applied antibiotics. Deep infection should be debridement of deep tissue, wound washing, catheter drainage, and application of sensitive antibiotics. If the prosthesis is loose, the prosthesis should be removed, thoroughly debrided, and a phase fusion or delayed prosthesis replacement procedure should be performed. 3. Prosthesis loosening: If the ankle joint is stable and there is no internal or external deformity, it should be repaired, the original prosthesis or bone cement should be taken out, and a new prosthesis should be placed. If looseness is related to joint stability and cannot be overcome by changing the thickness of the prosthesis, ankle arthrodesis should be performed. 4. Pain: Often associated with looseness and infection. The impact between the prosthesis and the tibia is also one of the causes of pain. When the joint is replaced, a suitable prosthesis should be selected for total joint replacement. 5. Internal and external iliac fractures: related to the use of saw blades and improper osteotomy. The fracture without displacement can be fixed with plaster cast for about 8 weeks. If the fracture is displaced, it is impossible to reset or can not maintain the alignment, internal fixation can be added.