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Chỉnh hình hiện đại mắt cá chân

Thế hệ đầu tiên thiết kế arthroplaty tổng số mắt cá chân đã có biến chứng không thể chấp nhận được và tỷ lệ thất bại cao so với mắt cá chân arthrodesis. Bộ phận giả gần đây đã khuyến khích các kết quả trung gian bởi vì các kỹ thuật phẫu thuật tinh chế và thiết kế được cải thiện. | Perspectives on Modern Orthopaedics Total Ankle Arthroplasty Mark E. Easley MD Christopher J. Vertullo MBBS FRACS W. Christopher Urban MD and James A. Nunley MD Abstract First-generation total ankle arthroplaty designs had unacceptably high complication and failure rates compared with ankle arthrodesis. More recent prosthe-ses have had encouraging intermediate results because of refined surgical techniques and improved designs. Mobile-bearing designs theoretically offer less wear and loosening through full conformity and minimal constraint. The less complex fixed-bearing designs avoid bearing dislocation and the potential for added wear from a second articulation. Four second-generation designs have demonstrated reasonable functional outcomes the Scandinavian Total Ankle Replacement the Agility Ankle the Buechel-Pappas Total Ankle Replacement and the TNK ankle. Intermediate results are promising but should be interpreted with care. J Am Acad Orthop Surg 2002 10 157-167 Introduced in the 1970s total ankle arthroplasty TAA had unacceptably high complication rates compared with ankle arthrodesis the standard for surgical management of advanced ankle arthrosis. Interest has been renewed based on two factors. The first is experience gained with refined surgical techniques and the second is improved elements of implant design derived from hip and knee arthroplasty applied to the ankle. More recent less constrained designs require less bone resection and have enhanced fixation. These factors combined with a greater awareness of soft-tissue management component alignment and ligament balancing have resulted in promising intermediate results. The long-term outcome of ankle arthrodesis is currently being examined especially regarding the development of disabling adjacent hindfoot arthrosis. However the renewed interest in second-generation TAA remains tempered by the poor history of earlier prostheses the difficulty of perfecting the surgical technique troublesome .