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| <div class="noeditbox">Welcome to [[ Vrije Universiteit Brussel Evidence-based Practice Project| Vrije Universiteit Brussel's Evidence-based Practice project]]. This space was created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox"> | | <div class="noeditbox">Welcome to [[ Texas State University Evidence-based Practice Project| Texas State University's Evidence-based Practice project space]]. This is a wiki created by and for the students in the Doctor of Physical Therapy program at Texas State University - San Marcos. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> |
| '''Original Editor '''- [[User:Sharon Schumacher|Sharon Schumacher]], [[User:Carlos De Coster|Carlos De Coster]] | | '''Original Editor '''- [[User:Jeremy Brady|Jeremy Brady]] |
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| '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | | '''Lead Editors''' - [[User:Jeremy Brady|Jeremy Brady]], [[User:Neha Palsule|Neha Palsule]], [[User:Jorge Solorzano|Jorge Solorzano]], [[User:Tori Westcott|Tori Westcott]], [[User:Dana Williams|Dana Williams]] |
| </div> | | </div> |
| == Search Strategy == | | == Search Strategy == |
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| '''<span lang="EN-US">PubMed</span>'''<span class="apple-converted-space"><span lang="EN-US"> </span></span><span lang="EN-US">(</span>[http://www.ncbi.nlm.nih.gov/pubmed <span lang="EN-US">http://www.ncbi.nlm.nih.gov/pubmed</span>]<span lang="EN-US">)</span>
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| <span lang="EN-US">MeSH
| | == Definition/Description == |
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| *<span lang="EN-US">Complications</span>
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| *<span lang="EN-US">Diagnosis</span>
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| *<span lang="EN-US">Drug therapy</span>
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| *<span lang="EN-US">Epidemiology</span>
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| *<span lang="EN-US">Etiology</span>
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| *<span lang="EN-US">Pathology</span>
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| *<span lang="EN-US">Rehabilitation</span>
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| *<span lang="EN-US">Surgery</span>
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| *<span lang="EN-US">Therapy</span>
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| '''<span lang="EN-US">Medline Plus</span>'''
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| <span lang="EN-US">Used
| | == Clinically Relevant Anatomy == |
| keyword:</span>
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| *<span lang="EN-US">Ankle replacement</span><br>
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| == Definition/Description == | | == Epidemiology /Etiology == |
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| Ankle replacement surgery has been available for over two decades however it is a far less common procedure than hip or knee arthroplasty owing to the less frequent incidence of osteoarthritis ankle pathology. The majority of ankle osteoarthritis is secondary to trauma.<ref>Ankle Replacement Surgery. Annals of the Royal College of Surgeons of England. 2006 July;88(4):417-418</ref><sup></sup>
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| Until relatively recently, ankle joint arthrodesis (fusion) was the gold standard of treatment, but this was not without its complications, e.g. non-union,[[Osteoarthritis|Osteoarthritis]] in the other mid/hind foot joints and stiffness and loss of proprioception<sup><ref>Ankle Replacement Surgery. Annals of the Royal College of Surgeons of England. 2006 July;88(4):417-418</ref></sup>
| | == Characteristics/Clinical Presentation == |
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| <sup> </sup>Total ankle replacement was developed in the 1970's but initially was plagued with high long term failure rates. The older prosthesis loosened or malfunctioned and frequently needed to be removed<sup></sup><ref>[http://www.medicalnewstoday.com/articles/11222.php http://www.medicalnewstoday.com/articles/11222.php]</ref>. In the late 70's Dr. Frank G. Alvine an orthopedic surgeon from Sioux Falls, SD developed the Agility Ankle which was the first FDA approved total ankle implant in use in the United States<ref>[http://www.medicalnewstoday.com/articles/11222.php http://www.medicalnewstoday.com/articles/11222.php]</ref>. Since its introduction the Agility Ankle System has gone through several modifications. Currently the Agility Ankle System is the most widely used ankle prosthesis. With more than 20 years of experience it has the longest followup of any fixed bearing device<sup></sup><ref>Cerrato R, Myerson MS. Total Ankle Replacement:the Agility LP prosthesis. Foot and Ankle Clin. 2008 Sept; 13(3): 485-94.</ref>. | | add text here <br> |
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| On May 29, 2009 the medical news today announced the FDA approved the first mobile bearing device called the Scandinavian Total Ankle Replacement System (STAR). As a condition of FDA approval the company (Small Bone Innovations Inc.) must evaluate the safety and effectiveness of the device during the next eight years<ref>[http://medicalnewstoday.com/printerfriendlynews.php?newsid=151776 http://medicalnewstoday.com/printerfriendlynews.php?newsid=151776]</ref>.
| | == Differential Diagnosis == |
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| In a systematic review of the literature published in the Journal of Bone and Joint Surgery in 2007, the intermediate outcome of total ankle arthroplasty appears to be similiar to that of [[ankle arthrodesis|ankle arthrodesis]] however data was sparse<ref>Haddad SL, Coetzee JC, Estok R. et al. Intermediate and Long-Term Outcomes of Total Ankle Arthroplasy and Ankle Arthrodesis. The Journal of Bone and Joint Surgery (American). 2007;89:1899-1905.</ref>.<sup> </sup>In a study comparing reoperation rates following ankle arthrodesis and total ankle arthroplasty SooHoo, Zingmond and Ko confirmed that ankle replacement is associated with a higher risk of complications as compared with ankle fusion, but also has potential advantages in terms of a decreased risk of the patient requiring subtalar joint fusion<sup></sup><ref>SooHoo NF, Zingmond DS, Ko CY. Comparison of Reoperation Rates Following Ankle Arthrodesis and Total Ankle Arthroplasty. The Journal of Bone and Joint Surgery (American). 2007;89:2143-2149.</ref>. In a seven to sixteen year follow up on the Agility Total Ankle Arthroplasty, Knecht, Estin, Callagham et al concluded that the relatively low rates of radiographic hindfoot arthritis and revision procedures at an average of nine years after the arthroplasty are encouraging<sup></sup><ref>Knecht SI, Estin M, Callaghan JJ et al. The Agility Total Ankle Arthroplasty: Seven to Sixteen-Year Follow-up. The Journal of Bone and Joint Surgery (American). 2004;86:1161-1171.</ref>.
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| Although interest in total ankle replacements is increasing, midterm clinical results to date are few and often have not been validated by independent pratitioners. In addition no level I or II studies have been published<sup></sup><ref>Cracchiolo A 3rd, Deorio JK. Design features of current total ankle replacements: implants and instrumentation. Journal of the American Academy of Orthopedic Surgeons. 2008 Sept:16(9):530-40.</ref>.
| | == Diagnostic Procedures == |
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| == Clinically Relevant Anatomy ==
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| == Indication for Procedure<br> == | | == Outcome Measures == |
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| <span class="Apple-style-span" style="font-family: Verdana, sans-serif; line-height: 18px; font-size: 12px; ">There is no
| | add links to outcome measures here (also see [[Outcome Measures|Outcome Measures Database]]) |
| well-defined indication for a Total Ankle Arthroplasty. Surgery is considered
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| only when conservative treatment has been attempted with no improvement. The
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| operation is mainly being executed in patients who suffer from different types
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| of arthrides. This cause advanced arthritic changes of disabling pain and loss
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| of ankle motion. The ankle is most frequently affected by post-traumatic
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| arthritis.<sup> <ref>MURNAGHAN J.M., WARNOCK D.S., HENDERSON S.A.., ‘Total Ankle Replacement: Early experience with STAR prothesis’, The Ulster Medical Journal, 2005, May, vol. 74, nr. 1, p. 9-13</ref></sup> Total ankle joint replacement is also indicated
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| following unsuccessful ankle arthrodesis <ref>SMITH C.L., L.T., M.S.C., U.S.N., ‘Physical therapy management of patients with total ankle replacement’, Physical Therapy, 1980, March, vol. 60, nr. 8, p. 303-306</ref> the ‘ideal’ patient for
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| ankle joint replacement is an elderly person with the low physical demands who
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| has good bone stock, normal vascular status, no immune-suppression, and
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| excellent hind foot-ankle alignment.<ref>SALTZMAN C.L., MCLFF T.E., BUCKWALTER J.A., BROWN T.D., ‘Total Ankle Replacement revisited’, Journal of Orthopaedic & Sports Physical Therapy, 2000, February, vol.nr. 30(2), p. 56-67</ref></span><br>
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| == Clinical Presentation == | | == Examination == |
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| add text here relating to the clinical presentation of the condition<br> | | add text here related to physical examination and assessment <br> |
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| == Diagnostic Tests ==
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| add text here relating to diagnostic tests for the condition<br>
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| == Medical Management <br> == | | == Medical Management <br> == |
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| == Physical Therapy Management <br> == | | == Physical Therapy Management <br> == |
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| <span class="Apple-style-span" style="font-family: Verdana, sans-serif; line-height: 18px; font-size: 12px; ">As it will be
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| explained in the Pre-Op and Post-Op the physician has a big role in making the
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| arrangements before and after the surgery. Before the surgery the main job for
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| the physician is to educate the patient about what will happen before, during
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| and after the surgery. The physician will evaluate: the ROM from the patient,
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| muscle strength, gait and deviations. For ergonomic reasons it is important
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| that the patient learns how to walk with crutches so he still can perform
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| ADL’s. After the surgery it is important that the patient keeps moving and
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| performing his daily activities. However there is still discussion between
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| physicians about when the patient should start again with exercising. There are
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| some that allow exercise immediately after surgery. But some say it is
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| considered best to wait until there is a satisfactory bony in growth as shown
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| radio graphically. However it’s the job of the physician to try to improve:<span style="mso-spacerun:yes"> </span>the patient’s ROM of the ankle, maintain the ROM in the hip and knee, increase the muscle strength with exercise for the Gluteus Maximus, Quadriceps femoris muscles and the muscles that are responsible for dorsal flexion and the plantar flexion of the ankle. Postoperative mobilization begins early, with rapid progression to resumption of normal activities.<ref>SMITH C.L., L.T., M.S.C., U.S.N., ‘Physical therapy management of patients with total ankle replacement’, Physical Therapy, 1980, March, vol. 60, nr. 8, p. 303-306.</ref><sup> </sup>The goal is to obtain 10° of dorsal flexion and 30° of plantar flexion. For patients who have almost no motion in their ankle is any motion an improvement.<ref>SALTZMAN C.L., MCLFF T.E., BUCKWALTER J.A., BROWN T.D., ‘Total Ankle Replacement revisited’, Journal of Orthopaedic & Sports Physical Therapy, 2000, February, vol.nr. 30(2), p. 56-67</ref></span> <br>
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| == Pre-Op ==
| | == Key Research == |
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| <span class="Apple-style-span" style="font-family: Verdana, sans-serif; line-height: 18px; font-size: 12px;">Before the
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| surgery, the most important role is intended for the physical therapist and the
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| doctor. It is important that they orients the patient to the procedure and
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| explain what they want to achieve with the treatment. The patient will be
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| evaluated on his range of motion, muscle strength, ability to perform ADL, gait
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| pattern and deviations. The patient will be given deep-breathing and coughing
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| exercises. The physician will also give bilateral isometric contraction
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| exercises for the Gluteus Maximus and the Quadriceps femoris muscles but also
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| isotonic ankle exercise for planter flexion and dorsal flexion for not affected
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| leg. For ergonomic reasons the patient needs to learn how to transfer from the
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| bed to a chair without weight bearing on the affected ankle. He also needs to
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| walk with Lofstrand crutches.<ref>SMITH C.L., L.T., M.S.C., U.S.N., ‘Physical therapy management of patients with total ankle replacement’, Physical Therapy, 1980, March, vol. 60, nr. 8, p. 303-306</ref></span>
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| <span class="Apple-style-span" style="font-family: Verdana, sans-serif; font-weight: normal; line-height: 18px; font-size: 12px;">In early
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| postoperative period it is important that the incision heals and the implant
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| becomes solidly fixed to the bony bed to do this they will use a below knee
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| non-weight bearing immobilization. This is maintained until there is
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| satisfactory bony in growth.<sup> </sup></span><span class="Apple-style-span" style="font-weight: normal; font-size: 13px;"><ref>SALTZMAN C.L., MCLFF T.E., BUCKWALTER J.A., BROWN T.D., ‘Total Ankle Replacement revisited’, Journal of Orthopaedic &amp;amp; Sports Physical Therapy, 2000, February, vol.nr. 30(2), p. 56-67</ref></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif; font-weight: normal; line-height: 18px; font-size: 12px;"><sup>. </sup></span><span class="Apple-style-span" style="font-family: Verdana, sans-serif; font-weight: normal; line-height: 18px; font-size: 12px;">The first 2 weeks the physician’s
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| most important job is to help the patient maintain doing ADL activities, with
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| crutches on a safe way. The second goal is to control the swelling and pain.
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| It’s important that the patient rests and keeps his affected limb elevated
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| above the heart.</span>
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| <span lang="EN-US">After 2 weeks
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| the cast will be replaced by a short leg boot. At this moment the patient goes
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| back to the hospital for a first post-operative visit to the doctor.</span>
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| <span lang="EN-US">The main goal
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| for the physician is to increase the ROM of the ankle and maintain the hip and
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| the knee ROM.</span>
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| <span lang="EN-US">However there
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| is still discussion between physicians about when the patient should start
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| again with exercising. There are some that allow exercise immediately after
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| surgery. But some say it is considered best to wait until there is a
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| satisfactory bony in growth as shown radio graphically.</span>
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| <span lang="EN-US">From here on it
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| is important that the patient maintain his ROM from his ankle, knee and hip. He
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| will be giving exercise to improve the strength of the Gluteus Maximus,
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| Quadriceps and the muscles that are responsible for dorsal flexion and plantar
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| flexion of the ankle.<ref>SMITH C.L., L.T., M.S.C., U.S.N., ‘Physical therapy management of patients with total ankle replacement’, Physical Therapy, 1980, March, vol. 60, nr. 8, p. 303-306.</ref></span>
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| <span class="Apple-style-span" style="font-family: Verdana, sans-serif; font-weight: normal; line-height: 18px; font-size: 12px;">After a few
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| months the patient needs to make an appointment with the doctor. Here they will
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| take X-ray scans to see if there are no complications like: joint debridement
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| for osseous impingement; the next most common procedures were extra-articular
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| procedures for axial misalignments and component replacements.</span><span class="Apple-style-span" style="font-weight: normal; font-size: 13px;"><ref>ADRIENNE A. SPIRT, MATHIEU ASSAL, SIGVARD T. HANSEN Jr., ‘Complications and Failure After Total Ankle Arthroplasty’, The Journal of Bone and Joint Surgery, 2004, June, vol. 86-A, nr. 6, p.1172-1178</ref></span>
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| == Key Research == | |
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| add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> | | add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br> |
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| == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == |
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| <rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1lg0RU4SkRVBqMFj5d-bSyy2dkWVinKpajNeDAG9Bmj8Xqj5o|charset=UTF-8|short|max=10</rss> </div><br> | | see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]] |
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| | <rss>Feed goes here!!|charset=UTF-8|short|max=10</rss> |
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| | == References == |
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| == References ==
| | see [[Adding References|adding references tutorial]]. |
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| <references /><br> | | <references /> |
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| [[Category:Vrije_Universiteit_Brussel_Project|Template:VUB]] [[Category:Ankle]] [[Category:Articles]] [[Category:EIM_Residency_Project]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Procedures]] | | [[Category:Texas_State_University_EBP_Project]] |
