TY - JOUR
T1 - Metal Resurfacing Inlay Implant for Osteochondral Talar Defects After Failed Previous Surgery: A Midterm Prospective Follow-up Study
AU - Vuurberg, Gwendolyn
AU - Reilingh, Mikel L.
AU - van Bergen, Christiaan J. A.
AU - van Eekeren, Inge C. M.
AU - Gerards, Rogier M.
AU - van Dijk, C. Niek
PY - 2018
Y1 - 2018
N2 - Background: Treatment of osteochondral talar defects (OCDs) after failed previous surgery is challenging. Promising short-term results have been reported with use of a metal resurfacing inlay implant. Purpose: To evaluate the midterm clinical effectiveness of the metal implant for OCDs of the medial talar dome after failed previous surgery. Study Design: Case series; Level of evidence, 4. Methods: We prospectively studied all patients who met the inclusion criteria and received a metal resurfacing inlay implant between 2007 and 2014. The primary outcome measure was implant survival, as measured by reoperation rate. Secondary outcome measures were numeric rating scales for pain at rest and during walking, running, and stair climbing; the Foot and Ankle Outcome Score (FAOS); the American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale; the 36-Item Short Form Health Survey (SF-36); return to work and sports; and radiographic evaluation. Results: This study included 38 patients with a mean age of 39 years (SD, ±13 years) and a mean follow-up of 5.1 years (SD, ±1.5 years). Two patients (5%) underwent revision surgery by means of an ankle arthrodesis (2 and 6 years postoperatively). In 8 patients, computed tomography scanning was conducted to assess postoperative complaints. These scans showed impression of the tibial plafond (n = 4), a small tibial cyst (<2.5 mm; n = 1), and cyst formation around the implant screw (n = 4). A total of 21 reoperations were performed, including medial malleolar screw removal (n = 12), arthroscopic removal of bony anterior impingement (n = 7), and calcaneal realignment osteotomy (n = 2). All secondary outcome measures improved significantly, apart from pain at rest, the FAOS symptoms subscale, and the SF-36 mental component scale. The mean time for return to sport was 4.1 months (SD, ±3 months), and 77% of patients resumed sporting activities postoperatively. Only 1 patient did not return to work postoperatively. Radiographs at final follow-up showed cyst formation (n = 2), subchondral periprosthetic radiolucency (n = 2), and non-preexisting joint space narrowing (n = 2). Conclusion: This study shows that the metal implant is an effective technique when assessed at midterm follow-up for OCDs of the medial talar dome after failed previous surgery.
AB - Background: Treatment of osteochondral talar defects (OCDs) after failed previous surgery is challenging. Promising short-term results have been reported with use of a metal resurfacing inlay implant. Purpose: To evaluate the midterm clinical effectiveness of the metal implant for OCDs of the medial talar dome after failed previous surgery. Study Design: Case series; Level of evidence, 4. Methods: We prospectively studied all patients who met the inclusion criteria and received a metal resurfacing inlay implant between 2007 and 2014. The primary outcome measure was implant survival, as measured by reoperation rate. Secondary outcome measures were numeric rating scales for pain at rest and during walking, running, and stair climbing; the Foot and Ankle Outcome Score (FAOS); the American Orthopaedic Foot and Ankle Society Ankle Hindfoot Scale; the 36-Item Short Form Health Survey (SF-36); return to work and sports; and radiographic evaluation. Results: This study included 38 patients with a mean age of 39 years (SD, ±13 years) and a mean follow-up of 5.1 years (SD, ±1.5 years). Two patients (5%) underwent revision surgery by means of an ankle arthrodesis (2 and 6 years postoperatively). In 8 patients, computed tomography scanning was conducted to assess postoperative complaints. These scans showed impression of the tibial plafond (n = 4), a small tibial cyst (<2.5 mm; n = 1), and cyst formation around the implant screw (n = 4). A total of 21 reoperations were performed, including medial malleolar screw removal (n = 12), arthroscopic removal of bony anterior impingement (n = 7), and calcaneal realignment osteotomy (n = 2). All secondary outcome measures improved significantly, apart from pain at rest, the FAOS symptoms subscale, and the SF-36 mental component scale. The mean time for return to sport was 4.1 months (SD, ±3 months), and 77% of patients resumed sporting activities postoperatively. Only 1 patient did not return to work postoperatively. Radiographs at final follow-up showed cyst formation (n = 2), subchondral periprosthetic radiolucency (n = 2), and non-preexisting joint space narrowing (n = 2). Conclusion: This study shows that the metal implant is an effective technique when assessed at midterm follow-up for OCDs of the medial talar dome after failed previous surgery.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85048022772&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29624081
U2 - https://doi.org/10.1177/0363546518764916
DO - https://doi.org/10.1177/0363546518764916
M3 - Article
C2 - 29624081
SN - 0363-5465
VL - 46
SP - 1685
EP - 1692
JO - American journal of sports medicine
JF - American journal of sports medicine
IS - 7
ER -