Emerging Insights With The Ankle Implant Arthroplasty

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What You Should Know About The Buechel-Pappas Total Ankle Replacement

It is worthy to mention the Buechel-Pappas (BP) Total Ankle Replacement, the leader of the second-generation devices utilized in the U.S. during the early 1980s. Developed by Frederick Buechel, MD, and Michael Pappas, MD, it was the first mobile-bearing device used in ankle arthroplasty.8 Its design was based off a low contact stress (LCS) device originally named the “New Jersey” or “Cylindrical” TAR.

The BP total ankle involves the use of a rotationally unconstrained, deep sulcus, meniscal-bearing device meant to eliminate high contact stresses during inversion and eversion. The ultra high-molecular weight polyethylene piece then articulates with a flat-stemmed tibial component and a biconcave trochlear talar component. The creators of the implant have reported long-term survivorship of the ankle implant at 93.5 percent at 10 years.20 The BP ankle device never received approval from the FDA and is no longer available for use in the U.S.

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Author(s): 
Robert W. Mendicino, DPM, FACFAS, Alan R. Catanzariti, DPM, FACFAS, and Kyle S. Peterson, DPM

   Dr. Mendicino is the Chairman of the Division of Foot and Ankle Surgery at the Western Pennsylvania Hospital in Pittsburgh. He is a Fellow and Past President of the American College of Foot and Ankle Surgeons.

   Dr. Catanzariti is the Director of Residency Training in the Division of Foot and Ankle Surgery at The Western Pennsylvania Hospital in Pittsburgh. He is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Peterson is a second-year resident in the Division of Foot and Ankle Surgery at the Western Pennsylvania Hospital in Pittsburgh.

References

1. Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res. 2009; 467(7):1800-06.
2. Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J. 2005; 25:44-46.
3. Coester LM, Saltman CL, Leapold J, Pontarelli W. Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am. 2001; 83-A(2):219-228.
4. Kennedy JG, Hodgkins CW, et al. Outcomes after standardized screw fixation technique of ankle arthrodesis. Clin Orthop Relat Res. 2006; 447(6):112-118.
5. Morgan CD, Henke JA, et al. Long-term results of tibiotalar arthrodesis. J Bone Joint Surg Am. 1985; 67(4):546-550.
6. Haddad SL, Coetzee JC, Estok R, et al. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis: a systematic review of the literature. J Bone Joint Surg Am. 2007; 89(9):1899-1905.
7. Lord G, Marotte JH. Total ankle prosthesis. Technique and 1st results. Apropos of 12 cases. Rev Chir Orthop Reparatrice Appar Mot. 1973; 59(2):139-51.
8. Gougoulias NE, Khanna A, Maffuli N. History and evolution in total ankle arthroplasty. Br Med Bull. 2009; 89:111-151.
9. Bolton-Maggs BG, Sudlow RA, Freeman MA. Total ankle arthroplsty. A long-term review of the London Hospital experience. J Bone Joint Surg Br. 1985; 67(5):785-90.
10. Guyer AJ, Richardson G. Current concepts review: total ankle arthroplasty. Foot Ankle Int. 2008; 29(2):256-64.
11. Cracchiolo A, DeOrio JK. Design features of current total ankle replacements: Implants and Instrumentation. J Am Acad Orthop Surg. 2008; 16(9):530-40.
12. Pyevich, MT, Saltzman CL, et al. Total ankle arthroplasty : a unique design : two to twelve year follow-up. J Bone Joint Surg Am. 1998; 80(10):1410-1420.
13. Mann JA, Mann RA, Horton E. STAR Ankle: Long-term results. Foot Ankle Int. 2011; 32(5):473-83.
14. Knecht SI, Estin M, et al. The Agility total ankle arthroplasty. Seven to sixteen-year follow-up. J Bone Joint Surg Am. 2004; 86(6):1161-71.
15. Mendicino RW, Catanzariti AR, Shadrick DL. The STAR Total Ankle Replacement. Foot Ankle Quart. 2010; 21(4):157-66.
16. Steck JK, Anderson JB. Total ankle arthroplasty: indications and avoiding complications. Clin Podiatr Med Surg. 2009; 26(2):303-24.
17. Wood PLR, Deakin S. Total ankle replacement. The results in 200 ankles. J Bone Joint Surg Br. 2003; 85-B(3):334-41.
18. Henricson A, Skoog A, Carlsson A. The Swedish Ankle Arthroplasty Register: an analysis of 531 arthroplasties between 1993 and 2005. Acta Orthop. 2007; 78(5):569-74.
19. Courville XF, Hecht PJ, Tosteson AN. Is total ankle arthroplasty a cost-effective alternative to ankle fusion? Clin Orthop Relat Res. 2011; 469(6):1721-27.
20. Buechel FF Sr, Buechel FF Jr, Pappas MJ. Ten-year evaluation of cementless Buechel-Pappas meniscal bearing total ankle replacement. Foot Ankle Int. 2003; 24(6):462-72.

   For further reading, see “Inside Insights On Ankle Replacement Surgery” in the March 2008 issue of Podiatry Today.

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