{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:25:35Z","timestamp":1784546735639,"version":"3.55.0"},"reference-count":15,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2015,3,13]],"date-time":"2015-03-13T00:00:00Z","timestamp":1426204800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[2015,8]]},"abstract":"\n Background:<\/jats:title>\n This series reviews the clinical and radiographic outcomes of patients who underwent total ankle replacement (TAR) using first- and second-generations of a modern fixed-bearing prosthesis utilizing a modular intramedullary stem.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A consecutive series of first- and second-generation primary TARs with modular intramedullary stems were identified. Clinical outcome data were collected prospectively\u2014including visual analog scale for pain, American Orthopaedic Foot & Ankle Society hindfoot-ankle, Short Musculoskeletal Function Assessment, and Short Form\u201336 scores. Preoperative coronal plane deformity and correction of deformity after TAR were assessed. Complications, subsequent procedures, and failure rates were compared. A total of 193 first- and 56 second-generation patients were identified with a mean follow-up of 3.7 and 2.1 years, respectively.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Clinical outcome data reflected significant improvements at 1 year postoperatively, and improvements were maintained at 2-year follow-up for each group. Improvement in visual analog scale scores were significantly better in the second-generation group at 1 year postoperatively, but this was not maintained at 2 years. Mean coronal tibiotalar angles for ankles with preoperative varus or valgus deformities were significantly improved. Correction was maintained until final follow-up, with no significant differences in deformity improvement between groups. The rate of reoperation at 2 years postoperatively on the affected foot or ankle subsequent to the index ankle replacement for patients in the first-generation group (18.5%) was higher compared to the second-generation group (15.9%), but the time until reoperation was not statistically significant ( P = .376). The implant failure rate was higher in the first-generation group (6.0%) compared to the second-generation group (2.6%) at 2 years postoperatively, but the time until failure was not significantly different ( P = .295).<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Patients who underwent TAR with a first- or second-generation fixed-bearing prosthesis with an intramedullary tibial component demonstrated significant improvements in all measures of pain and function with sustained improvements in coronal plane alignment. The second-generation prosthesis demonstrated slightly better improvements at 1 year and was associated with lower reoperation and implant failure rates.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n Level II, comparative series.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/1071100715576568","type":"journal-article","created":{"date-parts":[[2015,3,13]],"date-time":"2015-03-13T22:25:41Z","timestamp":1426285541000},"page":"881-890","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":70,"title":["Comparison of First- and Second-Generation Fixed-Bearing Total Ankle Arthroplasty Using a Modular Intramedullary Tibial Component"],"prefix":"10.1177","volume":"36","author":[{"suffix":"Jr","given":"John S.","family":"Lewis","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia L.","family":"Green","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Samuel B.","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Easley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K.","family":"DeOrio","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Nunley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2015,3,13]]},"reference":[{"key":"bibr1-1071100715576568","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.01386"},{"key":"bibr2-1071100715576568","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000132407.75881.a0"},{"key":"bibr3-1071100715576568","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.00126"},{"key":"bibr4-1071100715576568","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200709000-00002"},{"key":"bibr5-1071100715576568","doi-asserted-by":"publisher","DOI":"10.1177\/107110079401500701"},{"key":"bibr6-1071100715576568","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000132414.41124.06"},{"key":"bibr7-1071100715576568","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2011.0473"},{"key":"bibr8-1071100715576568","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2009.0579"},{"key":"bibr9-1071100715576568","doi-asserted-by":"publisher","DOI":"10.1177\/1938640012473148"},{"key":"bibr10-1071100715576568","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199909000-00006"},{"key":"bibr11-1071100715576568","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000131246.79993.ec"},{"key":"bibr12-1071100715576568","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000132245.18548.09"},{"key":"bibr13-1071100715576568","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.85B3.13849"},{"key":"bibr14-1071100715576568","first-page":"958","volume":"92","author":"Wood 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