Heterotopic Ossification in Total Ankle Arthroplasty: Case Series and Systematic Review |
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| Affiliation: | 1. Surgeon, Carolinas Medical Center, Department of Orthopaedic Surgery, Charlotte, NC;2. Surgeon, OrthoCarolina Research Institute, Charlotte, NC;3. Surgeon, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada;4. Surgeon, Department of Orthopaedic Surgery, University of Tabuk, Tabuk, Saudi Arabia;1. Senior Registrar, Department of Orthopedic Surgery and Traumatology, Kolding Hospital, a part of Lillebaelt Hospital, Kolding, Denmark;2. Consultant and Associate Professor, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark;3. Consultant and Associate Professor, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark;4. Associate Professor, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark;5. Consultant, Department of Orthopedic Surgery and Traumatology, Kolding Hospital, a part of Lillebaelt Hospital, Kolding, Denmark;1. Orthopaedic Surgeon, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan;2. Professor, Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, Japan;3. Lecturer, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan;4. Professor, Department of Health Sciences, Hokkaido Chitose College of Rehabilitation, Chitose, Hokkaido, Japan;5. Professor, Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan;6. Professor, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan;1. Assistant Professor, Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, Ulsan, South Korea;2. Orthopedic Surgeon, Department of Orthopaedic Surgery, GangNeung Asan Hospital, University of Ulsan, College of Medicine, Ulsan, South Korea;1. Fellowship Director, Florida Orthopedic Foot and Ankle Center, Sarasota, FL;2. Fellow, Florida Orthopedic Foot and Ankle Center, Sarasota, FL;3. Fellow, Longview Orthopedic Clinic Association, Longview, TX |
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| Abstract: | Heterotopic ossification after total ankle arthroplasty (TAA) is a known sequela and has been reported to contribute to reduced range of motion and poor functional outcomes. However, conflicting results have been reported in the literature. The present study documents the incidence of heterotopic ossification for a novel fourth-generation fixed-bearing 2-component prosthesis and reports a systematic review of the literature. We reviewed the incidence and functional outcome of consecutively enrolled patients who underwent primary Infinity TAA between 2013 and 2015 in a prospective observational study. Preoperative and postoperative radiographic and functional outcome data were collected. A systematic review was also conducted investigating all published studies between 1998 and 2018 reporting the incidence of heterotopic ossification after TAA. The incidence of heterotopic ossification was 70.5% in the 61 patients who underwent primary TAA in the case series. There was no association between heterotopic ossification and American Orthopaedic Foot and Ankle Society (AOFAS) score, foot function index (FFI), visual analogue scale (VAS), and ankle osteoarthritis scale (AOS). Sixteen studies on 1339 TAA implants were included. The overall incidence of heterotopic ossification after TAA was 66.0% at average 3.6 years (range 22.2% to 100%). Four studies (299 ankles) did not address functional outcomes. Eleven studies (960 ankles) reported no association between heterotopic ossification and functional outcomes. One study (80 ankles) reported a statistically significant difference in range of motion (7°) and AOFAS score (7 points). In conclusion, although the incidence of heterotopic ossification after TAA is considerable, there is insufficient literature to suggest that heterotopic ossification after TAA impacts range of motion or functional outcome. |
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