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The purpose of this study was to compare complication rates of total ankle replacement in 2 groups of patients based on their body mass index (BMI). The total cohort was divided into 2 groups based on BMI. Group 1 included patients with a BMI ≤30 kg/m2. Group 2 included patients with a BMI >30 kg/m2. Available charts were reviewed for patients who underwent primary total ankle arthroplasty. Patient demographics, BMI, prosthesis used, concomitant procedures, and intraoperative and postoperative complications were recorded. Ninety-seven patients met the inclusion criteria and underwent total ankle replacement between March 2012 and July 2016. Mean follow-up was 26.3 (range 12 to 62) months. Mean age was 66.4 (range 23 to 85) years. Mean BMI was 29.6 (range 20.6 to 49.5) kg/m2. Forty-three males and 54 females were included. There were 53 patients in group 1 (BMI ≤30 kg/m2) and 44 patients in group 2 (BMI >30 kg/m2). Total complication rates for group 1 and 2 were 18.9% (10 of 53) and 11.4% (5 of 44), respectively. There were a total of 10 minor complications and 5 major complications. There was no statistical difference between the groups (p = .308) in terms of complication rates. All patients underwent at least 1 concomitant procedure at the time of the index ankle replacement. We found that total ankle replacement can be safely utilized in patients with a BMI >30 kg/m2. In the present study, there was no statistical significance in complication rates in the 2 groups.

Total ankle replacement can be a viable option for patients with end-stage ankle arthritis associated with coronal plane deformity. With proper ankle balancing, a well-aligned ankle implant can be maintained over time and provide successful patient outcomes. The purpose of this study was to evaluate radiographic and subjective outcomes in patients with ankle arthritis along with coronal plane deformity who underwent total ankle arthroplasty with a 3-piece mobile-bearing implant. Our primary inclusion criterion was patients who demonstrated more than 5° of tibiotalar coronal deformity in either varus or valgus direction. Sixty-three consecutive patients who underwent total ankle replacement were reviewed. Of these, 25 (39.7%) met the inclusion criteria. Sixteen (64%) patients had a varus deformity (Group 1) and 9 (36%) had valgus deformity (Group 2) preoperatively. Alignment was evaluated radiographically at 5 different intervals: preoperative, immediate postoperative, and 6, 12, and 36 months postoperative. In patients with varus deformity, the mean tibiotalar angle was 12.6°, 0.8°, 1.0°,1.0°, and 0.8° for preoperative, immediate postoperative, and 6, 12, and 36 months, respectively. The same measurements and intervals for patients with valgus deformity were found to be 10.3°, 1.4°, 1.6°, 1.4°, and 1.4°. A statistically significant difference was observed in preoperative and postoperative coronal plane deformity. This correction was maintained at final follow-up visit. American Orthopaedic Foot and Ankle Society scores and visual analogue scale scores were recorded as well, and statistically significant improvements in preoperative and postoperative scores were found (p < .001). In conclusion, coronal plane deformity correction of the ankle can be accomplished and maintained in total ankle replacement procedures with proper soft tissue balancing and osseous procedures as indicated.

Bone marrow aspirate has been used for the adjunctive treatment of numerous pathologic conditions in orthopedics. Viable cells are found in aspiration from many different anatomic regions of the body. Concentration of these cells has been shown to improve healing due to the increased number of certain important cells. This article discusses the mechanisms involved and reviews the literature.

Traditionally, total ankle replacement has been reserved for elderly patients with low physical demands. With nearly 80% of end-stage ankle arthritis being secondary to prior trauma, patients may require a replacement at a much younger rate than primary hip and knee arthritis. Historical accounts of implant failure and high revision rates in younger patients have been reported in the literature. With increasing technology and surgeon experience, implants are being used in younger patients with significantly fewer complications than early reports. In this retrospective review, we evaluated the patient-reported outcome measures and implant complications in three age subsets in arthroplasty patients; Group 1:55 years-old, Group 2: 55-70 years-old, and Group 3:70 years-old. In our study, mean postoperative American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores were 75.5 for group 1, 79.7 for group 2, and 86.9 for group 3, which improved from preoperative scores of 50, 52.4, and 53.8, respectively. Mean postoperative Foot Function Index (FFI) scores were 10 for group 1, 23.9 for group 2, and 12.3 for group 3, which improved from 59.4, 62.8, and 47.6 preoperatively, respectively. The overall complication rate was found to be 11.2%. The complication rate for group 1 was 18%, the complication rate for group 2 was 11.6%, and the complication rate was 9.4% for group 3. The differences in patient AOFAS hindfoot, FFI scores, and complication rates between the groups were not found to be statistically significant. Our results show that patients younger than age 55 years have similar complication rates and reported satisfaction scores to patients 55 years of age and older.

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The purpose of this study was to compare wound complication rates after total ankle replacement in 3 groups of patients based on tobacco status. The total cohort was divided into 3 groups based on tobacco history. Group 1 included patients who were actively tobacco users. Group 2 included patients with a history of tobacco user. Group 3 served as the control group and included patients who had never used tobacco. Available charts were reviewed for patients who underwent primary total ankle arthroplasty by 1 surgeon. Patient demographics, tobacco history, and postoperative wound complications were recorded. A total of 114 patients with tobacco history were available for follow-up and were included in this study, which ranged from March 2012 to July 2017. Group 1 included 11 active smokers. Group 2 included 38 former smokers, and group 3 had a total of 65 never smokers included. The average follow-up was 28 months for group 1 (range 10-55 months), 34.1 months for group 2 (range 12-60 months), and 32.8 months for group 3 (range 11-60 months). The wound complication rate was noted to be statistically significant when comparing active smokers to never smokers using Fisher’s exact test ( P = .0223). When comparing former smokers with never smokers, the difference in wound complication rate did not reach statistical significance ( P = 0.7631). All patients underwent at least 1 concomitant procedure at the time of initial ankle replacement. Our findings show that total ankle replacement wound healing complication rates are significantly higher in active tobacco users. There was no significant difference in wound healing complications when comparing former tobacco users versus never tobacco users. Levels of Evidence: Level III: Retrospective comparative study