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Metal implant shown effective at mid-term follow-up for osteochondral ankle defects
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LAS VEGAS — Metal implants were a promising treatment for defects of the medial talar dome after failed primary surgery and can contribute to improved subscale pain scores during walking, running and stair climbing, according to recently presented data.
Researchers used a 15-mm diameter metal resurfacing inlay implant with 15 different offsets to treat patients with defects of the medial talar dome after failed surgery (HemiCAP; Arthrosurface).
According to Rogier Gerards, MD, PhD-candidate, the use of the implants was associated with statistically significant improvement in the Numeric Rating Scale (NRS) for pain in 24 consecutive patients he and colleagues studied.
“We had patients who had good results, 22 of 24 would undergo the surgery again. If it failed in the future, we could do a joint replacement procedure, as well. This study shows that a metal implant is a promising treatment of an osteochondral defect of the medial talar dome after failed previous surgery,” Gerards said.
Image: Gerards R
Improvement across subscales
The prospective study included 24 consecutive patients with an osteochondral defect of the medial talar dome, with median defects that ranged in diameter from 12 mm to 20 mm. For inclusion in the study, patients had to have persistent pain for a least 1 year after an initial surgery.
Gerards and colleagues assessed patients postoperatively at 2 weeks, 6 weeks, 12 weeks and 1 year and annually thereafter through a median 4-year follow-up. They used the NRS for pain at rest, walking, running and stair walking as the primary outcome of success. Secondary outcomes of success were Foot Ankle Outcome Scores (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, SF-36 scores and radiographic evaluation.
Promising outcomes
The investigators found the NRS scores improved for walking, stair climbing and running in patients treated with an implant. According to the results, preoperative walking scores improved from 6.8 points ± 1.3 points to 3.1 points ± 2.6 points at final follow-up (range, 2 to 5 years).
Investigators reported NRS scores at rest for patients improved from 3.5 ± 2.7 to 2.1 ± 2.2 postoperatively at final follow-up. The difference was not statistically significant (P = .16).
The FAOS improved in four of five subscales (P .01) at final follow-up and preoperative AOFAS scores improved from 62 points median to 85 points median at final follow-up (P < .01).
Investigators noted 19 patients worked preoperatively and they all worked after the surgery. Additionally, 13 patients participated in sports prior to their ankle injuries; 4 patients were able to play sports at final follow-up.
Overall, the investigators observed few complications; however, some patients developed an area of temporary numbness around their scar that resolved within a few months. One patient had a superficial wound infection that was treated with oral antibiotics.
Seven additional surgical procedures were performed in six patients and one patient required a lateral displacement calcaneal osteotomy as additional surgery for an osteochondral ankle defect after 26 months. Nine patients had the screws from their medial malleolus osteotomy removed due to tenderness and one patient had anterior impingement surgery.
“After radiographic assessment, we found no instances of implant loosening,” Gerards said.
Gerards told Orthopaedics Today Europe he and colleagues just learned that one patient of the two who were not satisfied had the implant removed, which was the first time the device was explanted. – by Robert Linnehan
- Reference:
- Gerards R, et al. Paper #741. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2015; Las Vegas.
- For more information:
- Rogier Gerards, MD, PhD, can be reached at Academic Medical Center, Department of Orthopedic Surgery, G4 264 Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; email: r.m.gerards@amc.uva.nl.
Disclosure: Gerards reports no relevant financial disclosures.