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preliminary outcomes of primary stemmed talus ankle replacement

Rationale for Primary Stemmed Talus Ankle Replacement. General consensus regarding increased rates of failure of the talar component compared to the tibial component.Kopp et al. 45% subsidence, 2/3 of which involved the talar componentSpirt et al. Inability to salvage an ankle replacement secondary to talar subsidenceKnecht et al. Expressed concern regarding the longevity of the talar component.

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preliminary outcomes of primary stemmed talus ankle replacement

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    1. Preliminary Outcomes of Primary Stemmed Talus Ankle Replacement Ferras Zeni, M.D. Sigvard Hansen, M.D.

    2. Rationale for Primary Stemmed Talus Ankle Replacement General consensus regarding increased rates of failure of the talar component compared to the tibial component. Kopp et al. 45% subsidence, 2/3 of which involved the talar component Spirt et al. Inability to salvage an ankle replacement secondary to talar subsidence Knecht et al. Expressed concern regarding the longevity of the talar component

    3. Our Study Retrospective Review 37 patients 27 female: 10 male 21 right: 16 left Minimum two year follow up Etiology Post-traumatic 60% Rheumatoid arthritis 14% CMT 11% Other (polio, PTTI, primary OA) 15%

    4. Indications

    5. Operative Technique Template Talar body size (sizes 1-6) Talar body can be augmented based on extent of bone loss Stem length

    6. Operative Technique Initial tibial and talar cuts identical to nonstemmed arthroplasty Custom jig allows for accurate placement of the guide wire in both the sagital and axial planes Guide wire is then overdrilled using cannulated ACL reamer

    7. Stem Insertion

    8. Complications 9/37 patients underwent reoperation (24%) Two patients awaiting reoperation No infections (one delayed wound healing) One tibial component revision associated with intraoperative medial malleolar fracture No talar component revisions

    9. Most Common Reasons for Reoperation Malalignment 6/37 (16%) 5/6 patients had preoperative malalignment Relative risk 3.6 (p=.25) Syndesmotic nonunion 3/37 (8%) Comparable to previously reported rates

    10. Other Reasons for Reoperation

    11. Factors Associated with Reoperation

    12. Conclusion Eliminates complications relative to talar subsidence 24% reoperation rate Malalignment is the most common reason for revision Likely related to loss of the accommodative function of the subtalar joint There is a trend towards reoperation in patients less than 55, post traumatic etiology and patients with preoperative malalignment, but this did not reach statistical significance.

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