Skip to main content

Advertisement

SpringerLink
Log in

Thrombembolic complications after total ankle replacement

  • Foot and Ankle (SG Parekh, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

The literature addressing functional outcome and survivorship of prosthesis components is constantly growing. However, the data on thromboprophylaxis and thrombembolic complications in patients who underwent TAR are scarce. A total of 31 studies were included in the systemic literature review. The incidence of thrombembolic complications varied between 0.0 % and 9.8 %. Most commonly, low molecular weight heparin was used as thromboprophylaxis for 6 weeks postoperatively. The incidence of thrombembolic complications was comparable with that of symptomatic deep vein thrombosis in patients with total knee or hip replacement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Demetracopoulos CA, Halloran JP, Maloof P, et al. Total ankle arthroplasty in end-stage ankle arthritis. Curr Rev Musculoskelet Med. 2013. Very recent review highlighting indications, advantages, disadvantages, and clinical outcomes of total ankle arthroplasty in patients with end-stage osteoarthritis.

  2. Easley ME, Adams Jr SB, Hembree WC, et al. Current concepts review: results of total ankle arthroplasty. J Bone Joint Surg Am. 2011;93:1455–68.

    Article  PubMed  Google Scholar 

  3. • Gougoulias N, Khanna A, Maffulli N. How successful are current ankle replacements?: a systematic review of the literature. Clin Orthop Relat Res. 2010;468:199–208. Recent systematic literature review including 13 Level IV studies with a total of 1105 ankle arthroplasties. The overall failure rate was approximately 10% after 5 years with a wide range between 0% and 32%. This review could not support superiority of any implant design.

    Article  PubMed  Google Scholar 

  4. Saltzman CL, Mann RA, Ahrens JE, et al. Prospective controlled trial of STAR total ankle replacement vs ankle fusion: initial results. Foot Ankle Int. 2009;30:579–96.

    Article  PubMed  Google Scholar 

  5. Guyer AJ, Richardson G. Current concepts review: total ankle arthroplasty. Foot Ankle Int. 2008;29:256–64.

    Article  PubMed  Google Scholar 

  6. Mann JA, Mann RA, Horton E. STAR ankle: long-term results. Foot Ankle Int. 2011;32:473–84.

    Article  Google Scholar 

  7. Besse JL, Colombier JA, Asencio J, et al. Total ankle arthroplasty in France. Orthop Traumatol Surg Res. 2010;96:291–303.

    Article  PubMed  Google Scholar 

  8. Goldberg AJ, Sharp RJ, Cooke P. Ankle replacement: current practice of foot & ankle surgeons in the United kingdom. Foot Ankle Int. 2009;30:950–4.

    Article  PubMed  Google Scholar 

  9. Gougoulias N, Maffulli N. History of total ankle replacement. Clin Podiatr Med Surg. 2013;30:1–20.

    Article  PubMed  Google Scholar 

  10. • Valderrabano V, Pagenstert GI, Muller AM, et al. Mobile- and fixed-bearing total ankle prostheses: is there really a difference? Foot Ankle Clin. 2012;17:565–85. Recent review highlighting the currently available total ankle designs. Some advantages of 3-component prosthesis design were observed in biomechanical studies. However, no obvious difference in clinical outcome between 3-component and 2-component prosthesis designs could be identified in the current literature.

    Article  PubMed  Google Scholar 

  11. Espinosa N, Walti M, Favre P, et al. Misalignment of total ankle components can induce high joint contact pressures. J Bone Joint Surg Am. 2010;92:1179–87.

    Article  PubMed  CAS  Google Scholar 

  12. Valderrabano V, Hintermann B, Nigg BM, et al. Kinematic changes after fusion and total replacement of the ankle: part 3: Talar movement. Foot Ankle Int. 2003;24:897–900.

    PubMed  Google Scholar 

  13. Valderrabano V, Hintermann B, Nigg BM, et al. Kinematic changes after fusion and total replacement of the ankle: part 2: movement transfer. Foot Ankle Int. 2003;24:888–96.

    PubMed  Google Scholar 

  14. Valderrabano V, Hintermann B, Nigg BM, et al. Kinematic changes after fusion and total replacement of the ankle: part 1: range of motion. Foot Ankle Int. 2003;24:881–7.

    PubMed  Google Scholar 

  15. Glazebrook MA, Arsenault K, Dunbar M. Evidence-based classification of complications in total ankle arthroplasty. Foot Ankle Int. 2009;30:945–9.

    Article  PubMed  Google Scholar 

  16. Conti SF, Wong YS. Complications of total ankle replacement. Clin Orthop Relat Res. 2001;391:105–14.

    Article  PubMed  Google Scholar 

  17. DiDomenico LA, Anania MC. Total ankle replacements: an overview. Clin Podiatr Med Surg. 2011;28:727–44.

    Article  PubMed  Google Scholar 

  18. Jackson MP, Singh D. Total ankle replacement. Curr Orthop. 2003;17:292–8.

    Article  Google Scholar 

  19. Lechler P, Grifka J. Kock FX [Ankle arthroplasty: indications and current state]. Orthopadie. 2011;40:561–70.

    Article  CAS  Google Scholar 

  20. Steck JK, Anderson JB. Total ankle arthroplasty: indications and avoiding complications. Clin Podiatr Med Surg. 2009;26:303–24.

    Article  PubMed  Google Scholar 

  21. Valderrabano V, Pagenstert GI, Hintermann B. Total ankle replacement - three–component prosthesis. Tech Foot and Ankle. 2005;2:84–90.

    Google Scholar 

  22. DiDomenico LA, Treadwell JR, Cain LZ. Total ankle arthroplasty in the rheumatoid patient. Clin Podiatr Med Surg. 2010;27:295–311.

    Article  PubMed  Google Scholar 

  23. Mayle Jr RE, DiGiovanni CW, Lin SS, et al. Current concepts review: venous thromboembolic disease in foot and ankle surgery. Foot Ankle Int. 2007;28:1207–16.

    Article  PubMed  Google Scholar 

  24. Mizel MS, Temple HT, Michelson JD, et al. Thromboembolism after foot and ankle surgery. A multicenter study. Clin Orthop Relat Res. 1998;348:180–5.

    Article  PubMed  Google Scholar 

  25. Solis G, Saxby T. Incidence of DVT following surgery of the foot and ankle. Foot Ankle Int. 2002;23:411–4.

    PubMed  Google Scholar 

  26. Conti SF, Wong YS. Complications of total ankle replacement. Foot Ankle Clin. 2002;7:791–807.

    Article  PubMed  Google Scholar 

  27. Gadgil A, Thomas RH. Current trends in thromboprophylaxis in surgery of the foot and ankle. Foot Ankle Int. 2007;28:1069–73.

    Article  PubMed  Google Scholar 

  28. Voleti PB, Donegan DJ, Kim TW, et al. Level of evidence: does it change the rate of publication and time to publication of American Academy of Orthopaedic Surgeons presentations? J Bone Joint Surg Am. 2013;95:e2.

    PubMed  Google Scholar 

  29. Bardelli M, Scoccianti G. Uncemented total ankle arthroplasty in post-traumatic osteoarthritis: 3- to 7-year follow-up. J Orthop Traumatol. 2006;7:93–6.

    Article  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  31. Barg A, Henninger HB, Knupp M, et al. Simultaneous bilateral total ankle replacement using a 3-component prosthesis: outcome in 26 patients followed for 2–10 years. Acta Orthop. 2011;82:704–10.

    Article  PubMed  Google Scholar 

  32. • Barg A, Henninger HB, Hintermann B. Risk factors for symptomatic deep-vein thrombosis in patients after total ankle replacement who received routine chemical thromboprophylaxis. J Bone Joint Surg Br. 2011;93:921–7. The only available clinical study specifically addressing the incidence of postoperative symptomatic deep-vein thrombosis and the risk factors of deep vein thrombosis in 665 patients with total ankle replacement. The incidence of symptomatic deep vein thrombosis was 3.9%. Following statistically significant independent risk factors have been identified: previous venous thrombembolic event, obesity, and postoperative non-weight-bearing.

    PubMed  CAS  Google Scholar 

  33. Barg A, Knupp M, Anderson AE, et al. Total ankle replacement in obese patients: component stability, weight change, and functional outcome in 118 consecutive patients. Foot Ankle Int. 2011;32:925–32.

    Article  PubMed  Google Scholar 

  34. Barg A, Knupp M, Henninger HB, et al. Total ankle replacement using HINTEGRA, an unconstrained, three-component system: surgical technique and pitfalls. Foot Ankle Clin. 2012;17:607–35.

    Article  PubMed  Google Scholar 

  35. Barg A, Zwicky L, Knupp M, et al. HINTEGRA total ankle replacement: survivorship analysis in 684 patients. J Bone Joint Surg Am. 2013;95:1175–83.

    Article  PubMed  Google Scholar 

  36. Besse JL, Brito N, Lienhart C. Clinical evaluation and radiographic assessment of bone lysis of the AES total ankle replacement. Foot Ankle Int. 2009;30:964–75.

    Article  PubMed  Google Scholar 

  37. Bleazey ST, Brigido SA, Protzman NM. Perioperative complications of a modular stem fixed-bearing total ankle replacement with intramedullary guidance. J Foot Ankle Surg. 2013;52:36–41.

    Article  PubMed  Google Scholar 

  38. Clement RC, Krynetskiy E, Parekh SG. The Total ankle arthroplasty learning curve with third-generation implants: a single surgeon's experience. Foot Ankle Spec. 2013;6:263–70.

    Article  PubMed  Google Scholar 

  39. Dhawan R, Turner J, Sharma V, et al. Tri-component, mobile bearing, total ankle replacement-mid-term functional outcome and survival. J Foot Ankle Surg. 2012.

  40. Gallardo J, Lagos L, Bastias, et al. Continuous popliteal block for postoperative analgesia in total ankle arthroplasty. Foot Ankle Int. 2012;33:208–12.

    Article  PubMed  Google Scholar 

  41. Haskell A, Mann RA. Perioperative complication rate of total ankle replacement is reduced by surgeon experience. Foot Ankle Int. 2004;25:283–9.

    PubMed  Google Scholar 

  42. Hintermann B. Die STAR-Sprunggelenkprothese: Kurz- und mittelfristige Erfahrungen. Orthopadie. 1999;28:792–803.

    CAS  Google Scholar 

  43. Hintermann B, Valderrabano V. Endoprothetik am oberen Sprungelenk. Z ärztl Fortbild Qual sich (ZaeFQ). 2001;95:187–94.

    CAS  Google Scholar 

  44. Hintermann B, Valderrabano V, Knupp M, et al. Die HINTEGRA-Sprunggelenkprothese: Kurz- und mittelfristige Erfahrungen. Orthopädie. 2006;35:533–45.

    Article  CAS  Google Scholar 

  45. Hobson SA, Karantana A, Dhar S. Total ankle replacement in patients with significant pre-operative deformity of the hindfoot. J Bone Joint Surg Br. 2009;91:481–6.

    PubMed  CAS  Google Scholar 

  46. Karantana A, Hobson S, Dhar S. The Scandinavian total ankle replacement: survivorship at 5 and 8 years comparable to other series. Clin Orthop Relat Res. 2010;468:951–7.

    Article  PubMed  Google Scholar 

  47. Karantana A, Martin GJ, Shandil M, et al. Simultaneous bilateral total ankle replacement using the S.T.A.R.: a case series. Foot Ankle Int. 2010;31:86–9.

    Article  PubMed  Google Scholar 

  48. Knecht SI, Estin M, Callaghan JJ, et al. The Agility total ankle arthroplasty. Seven to 16-year follow-up. J Bone Joint Surg Am. 2004;86-A:1161–71.

    PubMed  Google Scholar 

  49. Kokkonen A, Ikavalko M, Tiihonen R, et al. High rate of osteolytic lesions in medium-term followup after the AES total ankle replacement. Foot Ankle Int. 2011;32:168–75.

    Article  PubMed  Google Scholar 

  50. Kumar A, Dhar S. Total ankle replacement: early results during learning periods. Foot Ankle Surg. 2007;13:19–23.

    Article  Google Scholar 

  51. Lee KB, Cho SG, Hur CI, et al. Perioperative complications of HINTEGRA total ankle replacement: our initial 50 cases. Foot Ankle Int. 2008;29:978–84.

    Article  PubMed  Google Scholar 

  52. Magnan B, Facci E, Bartolozzi P. Traumatic loss of the talus treated with a Talar body prosthesis and total ankle arthroplasty. A case report. J Bone Joint Surg Am. 2004;86:1778–82.

    PubMed  Google Scholar 

  53. Pagenstert G, Hintermann B. Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure. BMC Musculoskelet Disord. 2011;12:233.

    Article  PubMed  Google Scholar 

  54. Rippstein PF, Huber M, Coetzee JC, et al. Total ankle replacement with use of a new three-component implant. J Bone Joint Surg Am. 2011;93:1426–35.

    Article  PubMed  Google Scholar 

  55. Rzesacz EH, Gossé F. Die Versorgung der posttraumatischen Arthrose des oberen Sprunggelenks durch die S.T.A.R.-Sprunggelenkprothese. Oper Orthop Traumatol. 2007;19:527–46.

    Article  PubMed  Google Scholar 

  56. Saltzman CL, Kadoko RG, Suh JS. Treatment of isolated ankle osteoarthritis with arthrodesis or the total ankle replacement: a comparison of early outcomes. Clin Orthop Surg. 2010;2:1–7.

    Article  PubMed  Google Scholar 

  57. Valderrabano V, Hintermann B. HINTEGRA-Sprunggelenkprothese: Präliminäre Resultate der ersten 125 Fälle. Fuss Sprungg. 2004;2:7–16.

    Article  Google Scholar 

  58. van der Heide HJ, Schutte B, Louwerens JW, et al. Total ankle prostheses in rheumatoid arthropathy: outcome in 52 patients followed for 1–9 years. Acta Orthop. 2009;80:440–4.

    Article  PubMed  Google Scholar 

  59. Vienne P. Agility total ankle replacement. Tech Foot and Ankle. 2005;4:62–8.

    Article  Google Scholar 

  60. Kofoed H. Cylindrical cemented ankle arthroplasty: a prospective series with long-term follow-up. Foot Ankle Int. 1995;16:474–9.

    Article  PubMed  CAS  Google Scholar 

  61. Patsalis T. Die AES-Sprunggelenksprothese: Indikation, Technik und erste Ergebnisse. Fuss Sprungg. 2004;2:38–44.

    Article  Google Scholar 

  62. Alvine FG. The Agility ankle replacement: the good and the bad. Foot Ankle Clin. 2002;7:737–53.

    Article  PubMed  Google Scholar 

  63. Buechel Sr FF, Buechel Jr FF, Pappas MJ. Ten-year evaluation of cementless Buechel-Pappas meniscal bearing total ankle replacement. Foot Ankle Int. 2003;24:462–72.

    PubMed  Google Scholar 

  64. Deorio JK. INBONE total ankle arthroplasty. Semin Arthro. 2010;21:288–94.

    Article  Google Scholar 

  65. Rippstein PF. Clinical experiences with three different designs of ankle prostheses. Foot Ankle Clin. 2002;7:817–31.

    Article  PubMed  Google Scholar 

  66. Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban vs enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med. 2008;358:2776–86.

    Article  PubMed  CAS  Google Scholar 

  67. Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban vs enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med. 2008;358:2765–75.

    Article  PubMed  CAS  Google Scholar 

  68. Elsner A, Schiffer G, Jubel A, et al. The venous pump of the first metatarsophalangeal joint: clinical implications. Foot Ankle Int. 2007;28:902–9.

    Article  PubMed  Google Scholar 

  69. Oishi CS, Grady-Benson JC, Otis SM, et al. The clinical course of distal deep venous thrombosis after total hip and total knee arthroplasty, as determined with duplex ultrasonography. J Bone Joint Surg Am. 1994;76:1658–63.

    PubMed  CAS  Google Scholar 

  70. Theodorou SJ, Theodorou DJ, Kakitsubata Y. Sonography and venography of the lower extremities for diagnosing deep vein thrombosis in symptomatic patients. Clin Imaging. 2003;27:180–3.

    Article  PubMed  Google Scholar 

  71. Lieberman JR, Hsu WK. Prevention of venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am. 2005;87:2097–112.

    Article  PubMed  Google Scholar 

  72. Garino JP, Lotke PA, Kitziger KJ, et al. Deep venous thrombosis after total joint arthroplasty. The role of compression ultrasonography and the importance of the experience of the technician. J Bone Joint Surg Am. 1996;78:1359–65.

    PubMed  CAS  Google Scholar 

  73. Warwick DJ, Whitehouse S. Symptomatic venous thromboembolism after total knee replacement. J Bone Joint Surg Br. 1997;79:780–6.

    Article  PubMed  CAS  Google Scholar 

  74. White RH, Henderson MC. Risk factors for venous thromboembolism after total hip and knee replacement surgery. Curr Opin Pulm Med. 2002;8:365–71.

    Article  PubMed  Google Scholar 

  75. Hull RD, Raskob GE. Prophylaxis of venous thromboembolic disease following hip and knee surgery. J Bone Joint Surg Am. 1986;68:146–50.

    PubMed  CAS  Google Scholar 

  76. Lotke PA, Steinberg ME, Ecker ML. Significance of deep venous thrombosis in the lower extremity after total joint arthroplasty. Clin Orthop Relat Res. 1994;299:25–30.

    PubMed  Google Scholar 

  77. Kim YH. The incidence of deep vein thrombosis after cementless and cemented knee replacement. J Bone Joint Surg Br. 1990;72:779–83.

    PubMed  CAS  Google Scholar 

  78. Healy B, Beasley R, Weatherall M. Venous thromboembolism following prolonged cast immobilization for injury to the tendo Achillis. J Bone Joint Surg Br. 2010;92:646–50.

    Article  PubMed  CAS  Google Scholar 

  79. Pearse EO, Caldwell BF, Lockwood RJ, et al. Early mobilization after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br. 2007;89:316–22.

    PubMed  CAS  Google Scholar 

  80. Prandoni P. How I, treat venous thromboembolism in patients with cancer. Blood. 2005;106:4027–33.

    Article  PubMed  CAS  Google Scholar 

  81. Blom JW, Doggen CJ, Osanto S, et al. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 2005;293:715–22.

    Article  PubMed  CAS  Google Scholar 

  82. Jameson SS, Augustine A, James P, et al. Venous thromboembolic events following foot and ankle surgery in the English National Health Service. J Bone Joint Surg Br. 2011;93:490–7.

    PubMed  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Alexej Barg declares that he has no conflict of interest. Katharina Barg declares that she has no conflict of interest. Stefan W. Schneider declares that he has no conflict of interest. Geert Pagenstert declares that he has no conflict of interest. Marcel Gloyer declares that he has no conflict of interest. Heath B. Henninger declares that he has no conflict of interest. Victor Valderrabano declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Orthopaedic Department, University Hospital of Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland

    Alexej Barg, Geert Pagenstert & Marcel Gloyer

  2. Department of Orthopaedic Surgery and Osteoarthritis Research Center Basel, University Hospital of Basel, 4031, Basel, Switzerland

    Victor Valderrabano

  3. Department of Internal Medicine, Clinic Ibbenbüren, 49477, Ibbenbüren, Germany

    Katharina Barg

  4. Department of Dermatology, Venerology, and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany

    Stefan W. Schneider

  5. Department of Orthopaedics,Harold K. Dunn Orthopaedic Research Laboratory, University of Utah, Salt Lake City, UT, 84108, USA

    Heath B. Henninger

Authors
  1. Alexej Barg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katharina Barg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefan W. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Geert Pagenstert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcel Gloyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Heath B. Henninger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Victor Valderrabano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexej Barg.

Additional information

Alexej Barg and Katharina Barg contributed equally to this review work. This review was performed by Katharina Barg in the fulfillment of the thesis requirements for the Medical Degree (MD).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barg, A., Barg, K., Schneider, S.W. et al. Thrombembolic complications after total ankle replacement. Curr Rev Musculoskelet Med 6, 328–335 (2013). https://doi.org/10.1007/s12178-013-9186-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-013-9186-7

Keywords

Search

Navigation