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Bipolar Fresh Osteochondral Allografting of the Tibiotalar Joint

Bugbee, William D. MD; Khanna, Gaurav MD; Cavallo, Marco MD; McCauley, Julie C. MPHc; Görtz, Simon MD; Brage, Michael E. MD

Journal of Bone & Joint Surgery - American Volume: 6 March 2013 - Volume 95 - Issue 5 - p 426–432
doi: 10.2106/JBJS.L.00165
Scientific Articles

Background: Tibiotalar arthritis in the young, active patient is a debilitating condition with limited treatment options. Bipolar tibiotalar fresh osteochondral allograft transplantation was conceived as a possible alternative to arthrodesis and arthroplasty. We reported our experience with bipolar ankle osteochondral allografts for the treatment of tibiotalar joint arthritis.

Methods: Between 1999 and 2008, we performed bipolar ankle allografts in eighty-eight ankles (eighty-four patients). Eighty-six ankles (eighty-two patients) had a minimum follow-up duration of two years. The mean patient age was forty-four years and 52% of the patients were male. Evaluation included frequency and type of reoperations, the Olerud-Molander Ankle Score, pain, function, and patient satisfaction. Radiographs were evaluated for graft healing, joint space narrowing, and graft collapse.

Results: The mean duration of follow-up was 5.3 years (range, two to eleven years). Thirty-six (42%) of the eighty-six ankles that had undergone allograft had further surgery since implantation. Of the eighty-six ankles, twenty-five ankles (29%) had undergone graft-related reoperations and were considered clinical failures (ten underwent revision allografts, seven underwent arthrodeses, six underwent conversions to total ankle arthroplasty, and two underwent below-the-knee amputations) and eleven ankles (13%) had had reoperations that were not necessarily related to the graft (e.g., implant removal, debridement, synovectomy, or distraction). Survivorship of the osteochondral allograft was 76% at five years and 44% at ten years. The mean Olerud-Molander Ankle Score was 61 points at the time of the latest follow-up. The majority of patients reported satisfaction (92%) with osteochondral allograft transplantation and less pain (85%) and improved function (83%) after the procedure.

Conclusions: Transplantation of a fresh bipolar ankle osteochondral allograft for the treatment of tibiotalar arthritis resulted in acceptable outcomes in this difficult population, with most patients having improved objective and subjective outcome measures. Subjective satisfaction was high in spite of the 29% clinical failure rate. Osteochondral allograft failure did not limit further surgical options. We concluded that transplantation of a bipolar ankle allograft is a useful alternative in carefully selected patients with advanced tibiotalar arthritis.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Division of Orthopaedic Surgery, Scripps Clinic, 10666 North Torrey Pines Road, MS116, La Jolla, CA 92037. E-mail address for W.D. Bugbee:

2Department of Orthopaedic Surgery, Kaiser Permanente, 1011 Baldwin Park Boulevard, Baldwin Park, CA 91706

3II Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Via G.C. Pupilli 1, Bologna 40136, Italy

4Shiley Center for Orthopaedic Research & Education at Scripps Clinic, 11025 North Torrey Pines Road, Suite 200, MS 126, La Jolla, CA 92037

5Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson Street, San Diego, CA 92103

6Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Harborview Medical Center, 3325 Ninth Avenue, Box 359799, Seattle, WA 98104

Copyright 2013 by The Journal of Bone and Joint Surgery, Incorporated
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