Simultaneous bilateral total ankle replacement using a 3-component prosthesis

Figures & data

Table 1. Description of surgery in 26 patients with simultaneous bilateral TAR

Patient no.	Case no.	Side	Diagnosis	Tourniquet time (min)	Operative time (min)	Additional surgery
1	1	left	rheumatoid	71	114
	2	right	rheumatoid	57
2	3	left	posttraumatic	55	125	PATL ^b
	4	right	posttraumatic	80		PATL ^b
3	5	left	rheumatoid	88	169
	6	right	rheumatoid	102
4	7	left	rheumatoid	84	170
	8	right	rheumatoid	107
5	9	left	hemophilia	112	191	PATL ^b
	10	right	hemophilia	103		PATL ^b
6	11	left	gout	86	177
	12	right	gout	113
7	13	left	rheumatoid	95	181	PATL ^b
	14	right	rheumatoid	103		PATL ^b
8	15	left	rheumatoid	68	116	PATL ^b
	16	right	rheumatoid	59		PATL ^b
9	17	left	posttraumatic	89	155	lateral lig. reconstruction
	18	right	posttraumatic	91		lateral lig. reconstruction
10	19	left	rheumatoid	75	119
	20	right	rheumatoid	61
11	21	left	gout	101	193	MDCO ^c , double-hindfoot ADd, lateral lig. reconstruction
	22	right	gout	116		MDCO ^c , MTP-I arthrodesis, peroneus longus to peroneus brevis tendon transfer, lateral lig. reconstruction
12	23	left	hemochromatosis	69	173
	24	right	hemochromatosis	125		supramalleolar osteotomy, PATL ^b
13	25	left	gout	121	213	subtalar arthrodesis, lateral lig. reconstruction
	26	right	gout	118		subtalar arthrodesis
14	27	left	posttraumatic	59	110
	28	right	posttraumatic	65
15	29	left	rheumatoid	78	136
	30	right	rheumatoid	69
16	31	left	rheumatoid	66	168
	32	right	rheumatoid	123		re-arthrodesis talonavicular, tibialis anterior tendon reconstruction
17	33	left	posttraumatic	72	121	PATL ^b
	34	right	posttraumatic	64
18	35	left	rheumatoid	110	209	medial lig. reconstruction
	36	right	rheumatoid	125
19	37	left	posttraumatic	106	187	MDCO ^c, lateral lig. reconstruction
	38	right	posttraumatic	101		MDCO ^c
20	39	left	posttraumatic	89	164	dorsiflexion osteotomy of first metatarsal, peroneus longus to peroneus brevis tendon transfer, lateral lig. reconstruction, PATL ^b
	40	right	posttraumatic	95		dorsiflexion osteotomy of first metatarsal, peroneus longus to peroneus brevis tendon transfer, lateral lig. reconstruction
21	41	left	rheumatoid	94	172	double-hindfoot AD ^d , PATL ^b
	42	right	rheumatoid	99		double-hindfoot AD ^d , PATL ^b
22	43	left	posttraumatic	124 ^a	232	lateral lig. reconstruction
	44	right	posttraumatic	137 ^a		peroneus longus to peroneus brevis tendon transfer, lateral lig. reconstruction
23	45	left	posttraumatic	60	115
	46	right	posttraumatic	69
24	47	left	rheumatoid	72	122	PATL ^b
	48	right	rheumatoid	75		PATL ^b
25	49	left	posttraumatic	75	126
	50	right	posttraumatic	79
26	51	left	rheumatoid	85	149	PATL ^b
	52	right	rheumatoid	74		PATL ^b
mean (SD)				89 (22)	159 (35)

^a patient with additional bilateral total knee replacement.

^b PATL: percutaneous Achilles tendon lengthening.

^c MDCO: medial displacement calcaneal osteotomy.

^d double-hindfoot AD: subtalar and talonavicular arthrodesis.

Figure 1. Angular measurements of prosthesis component positioning. α-angle (panel A) and β-angle (panel B) were measured between the longitudinal axis of the tibia and the articular surface of the tibial component in the AP and lateral views, respectively. γ-angle (C) was measured between a line drawn through the anterior shield and the posterior edge of the talar component and a line drawn along the center of the talar neck on the lateral view.

Table 2. Postoperative complications and revision surgeries in 26 patients with simultaneous bilateral TAR

Case no. ^a	Postoperative complications	Surgery	Time of surgery ^b (years)	Results	Follow-up ^c (years)
5	aseptic loosening of both components	revision of both components (HINTEGRA)	6.7	both components are radiographically stable	2.4
6	aseptic loosening of both components	revision of both components (HINTEGRA), medial ligamentoplasty	6.2	both components are radiographically stable	2.9
11	aseptic loosening of talar component	revision of talar component (HINTEGRA), exchange of inlay	4.7	both components are radiographically stable	3.4
12	aseptic loosening of both components	revision of both components (HINTEGRA)	4.7	both components are radiographically stable	3.4
20	medial impingement	medial debridement	1.1	significant pain relief (VAS 2)	3.5
25	progressive hindfoot valgus deformity	medial displacement calcaneal osteotomy	2.5	normal hindfoot alignment	0.8

^a Cases 5–50 have been reported previously (Barg et al. 2010b).

^b since the primary surgery (TAR).

^c after the revision surgery.

Figure 2. Kaplan-Meier survival curve with revision for aseptic loosening of the tibial and/or talar component as endpoint.

Figure 3. Preoperative (gray) and postoperative (black) quality of life for all patients assessed with the SF-36. Mean (SD). p < 0.001 for all pre- and postoperative comparisons.

Barg A, Knupp M, Hintermann B. Simultaneous bilateral versus unilateral total ankle replacement: A patient-based comparison of pain relief, quality of life and functional outcome. J Bone Joint Surg (Br) 2010b; 92 (12): 1659-63.

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