Di Iorio Alexandre, Viste Anthony, Fessy Michel Henry, Besse Jean Luc
Centre Hospitalier Universitaire de Lyon, Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Lyon-Sud, FR 69495, Pierre-Bénite, Rhône-Alpes, France.
Medipôle Montagard, Institut de Chirurgie Osseuse, 1139 Chemin du Lavarin, FR 84000, Avignon, Vaucluse, France.
Int Orthop. 2017 Dec;41(12):2525-2533. doi: 10.1007/s00264-017-3605-0. Epub 2017 Sep 4.
AES mobile-bearing total ankle replacement was developed from the Buechel Pappas model. It was withdrawn in 2009, after identification of a higher than expected complication rate. The purpose of the current study was to analyse clinical outcomes, failures and survival of the initial series of 50 AES published in 2009.
In this single-centre continuous prospective study (2003-2006), 50 AES prostheses were included. Pre-operative osteoarthritis was mainly post-traumatic (50%) and secondary to instability (36%). All patients were assessed with clinical and radiographic follow-up at six months, one year, two years and every two to three years thereafter. A CT-scan was systematically performed before procedure, and at two years, five years and ten years. At last follow-up, all patients with TAR had a functional (SF 36, AOFAS) and clinical assessment. All complications or surgical events were analysed.
The mean follow-up was ten ± two years (range, 9-13). The mean AOFAS score was 75 points (range, 26-100). The mean SF 36 score was 69 points (range, 35-97). There was a significant deterioration in AOFAS score at five years and at last follow-up (p < 0.05). Fifteen TARs underwent reoperation for cyst curettage-graft because of development of periprosthetic lesions. Six of them ended up with prosthesis removal-arthrodesis. At the last follow-up, 14 TARs were removed for arthrodesis. Of the 30 prostheses seen at last follow-up, four are awaiting prosthesis removal-arthrodesis and one for cyst curettage-graft. The ten year survivorships free of any prosthesis removal or arthrodesis and free of any reoperation were 68% (95% CI, 55-85) and 57% (95% CI, 44-74), respectively.
Our data suggested a high rate of reoperation. Overall ten year survival was lower than with other designs, particularly due to cyst lesions.
Level IV, prospective case series.
AES活动轴承全踝关节置换术是在Buechel Pappas模型的基础上研发的。该产品于2009年被撤回，因其并发症发生率高于预期。本研究的目的是分析2009年发表的首批50例AES置换术的临床疗效、失败情况及假体生存率。
在这项单中心连续性前瞻性研究（2003 - 2006年）中，纳入了50例AES假体。术前骨关节炎主要为创伤后（50%）和继发于不稳定（36%）。所有患者在术后6个月、1年、2年及此后每2至3年进行临床和影像学随访。术前、术后2年、5年和10年均系统地进行CT扫描。在最后一次随访时，对所有接受全踝关节置换术的患者进行功能（SF 36、美国足踝外科协会评分）和临床评估。分析所有并发症或手术相关事件。
平均随访时间为10±2年（范围9 - 13年）。平均美国足踝外科协会评分为75分（范围26 - 100分）。平均SF 36评分为69分（范围35 - 97分）。在5年和最后一次随访时，美国足踝外科协会评分有显著下降（p < 0.05）。15例全踝关节置换术因假体周围病变发展而接受了囊肿刮除植骨再手术。其中6例最终进行了假体取出并关节融合术。在最后一次随访时，14例全踝关节置换术因关节融合而被取出。在最后一次随访时观察到的30例假体中，4例等待假体取出并关节融合术，1例等待囊肿刮除植骨术。无任何假体取出或关节融合术且无任何再手术的10年假体生存率分别为68%（95%可信区间，55 - 85）和57%（95%可信区间，44 - 74）。
我们的数据表明再手术率较高。总体10年生存率低于其他设计，特别是由于囊肿病变。
IV级，前瞻性病例系列。
Zotero 插件