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Beck DM, Padegimas EM, Pedowitz DI, Raikin SM. Total Ankle Arthroplasty: Comparing Perioperative Outcomes When Performed at an Orthopaedic Specialty Hospital Versus an Academic Teaching Hospital. Foot Ankle Spec 2017; 10:441-448. [PMID: 28800719 DOI: 10.1177/1938640017724543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The number of total ankle arthroplasties (TAAs) performed in the United States has risen significantly in recent years, as has utilization of orthopaedic specialty hospital (OSH) to treat healthy patients undergoing elective surgery. The purpose of this study was to compare postoperative outcomes following TAA at an OSH when compared with a matching population of patients undergoing TAA at an academic teaching hospital (ATH). METHODS We identified all TAA from January 2014 to December 2014 at the OSH and January 2010 to January 2016 at the ATH. Each OSH patient was manually matched with a corresponding ATH patient by clinical variables. Outcomes analyzed were length of stay (LOS), 30-day readmissions, mortality, reoperation, and inpatient rehabilitation utilization. RESULTS There were 40 TAA patients in each group. OSH and ATH patients were similar in age, body mass index, age-adjusted Charlson Comorbidity Index, and gender. Average LOS for TAA at the OSH was 1.28 ± 0.51 compared with 2.03 ± 0.89 (P < .001) at the ATH. There were no OSH patients readmitted within 30 days, compared with 2 ATH patients readmitted (5.0%; P = .15). Two OSH patients (5.0%) and 2 ATH patients (5.0%; P = 1.00) required reoperation. There were no mortalities in either group. There were no OSH patients requiring transfer. CONCLUSIONS Primary TAA performed at an OSH had significantly shorter LOS when compared with a matched patient treated at an ATH with no significant difference in readmission or reoperation rates and may offer a potential source of significant health care savings. LEVELS OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- David M Beck
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (DMB, EMP).,The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (DIP, SMR)
| | - Eric M Padegimas
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (DMB, EMP).,The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (DIP, SMR)
| | - David I Pedowitz
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (DMB, EMP).,The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (DIP, SMR)
| | - Steven M Raikin
- Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (DMB, EMP).,The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (DIP, SMR)
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102
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Current Concepts Regarding Total Ankle Replacement as a Viable Treatment Option for Advanced Ankle Arthritis: What You Need to Know. Clin Podiatr Med Surg 2017; 34:515-527. [PMID: 28867057 DOI: 10.1016/j.cpm.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Much of the current literature suggests that total ankle replacement (TAR) is no longer an inferior or fringe treatment for advanced ankle arthritis compared with ankle fusion, but rather a viable option for recalcitrant arthritic ankle pathology in the correct patient population. In this article, current concepts associated with successful outcomes for TAR are discussed with an emphasis on ankle joint anatomy and biomechanics, preoperative planning and patient selection, understanding pathomechanics and soft tissue balancing, as well as the surgeon's learning curve.
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103
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Abstract
BACKGROUND The decision tree for the operative treatment of end-stage ankle arthritis involves either ankle arthrodesis (AA) or total ankle arthroplasty (TAA). Although both have documented success providing diminished pain, improved patient-centered outcomes, and improved objective measures of function, arthroplasty is unique in its ability to preserve motion at the tibiotalar joint. Arthroplasty procedures are normally thought of as a motion-sparing surgery rather than a motion-producing procedure, which may limit its success in patients with stiff ankles. Our hypothesis was that there would be improvements in parameters of gait even in patients with a low degree of preoperative total sagittal range of motion. METHODS A retrospective review was conducted on patients who underwent total ankle arthroplasty with greater than 1-year follow-up. Seventy-six patients were available who underwent isolated TAA for end-stage ankle arthritis with greater than 1-year follow-up. Patient demographics and preoperative and postoperative gait analyses were evaluated. Using a linear regression model, the effect sizes for the variables of age, gender, BMI, preoperative diagnosis, and preoperative total sagittal range of motion were calculated. Multivariate analysis was used to determine the influence each individual variable had on the many parameters of preoperative gait, postoperative gait, and change in gait after surgery. A post hoc analysis was conducted in which patients were divided into 4 quartiles according to preoperative range of motion. A 1-way analysis of variance (ANOVA) was used to compare improvement in parameters of gait for the 4 subgroups. RESULTS Although a greater degree of preoperative sagittal range of motion was predictive of greater postoperative sagittal range of motion, patients with limited preoperative range of motion experienced a greater overall improvement in range of motion, and clinically meaningful absolute improvements in range of motion, and other parameters of gait. The post hoc analysis demonstrated that patients in the lowest quartile of preoperative motion had both statistically and clinically significant greater improvements across numerous parameters of gait, although the absolute values were lower than in the patients with higher preoperative ROM. Age, gender, BMI, and preoperative diagnosis did not correlate with changes in parameters of gait after total ankle arthroplasty. CONCLUSION Preoperative range of motion was predictive of overall postoperative gait function. On one hand, a low preoperative range of motion resulted in a lower absolute postoperative function. On the other hand, patients with stiff ankles preoperatively had a statistically and clinically greater improvement in function as measured by multiple parameters of gait. This suggests that total ankle arthroplasty can offer clinically meaningful improvement in gait function and should be considered for patients with end-stage tibiotalar arthritis even in the setting of limited sagittal range of motion. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- James W Brodsky
- 1 Baylor University Medical Center, Dallas, TX, USA.,2 University of Texas Southwestern Medical School, Dallas, TX, USA.,3 College of Medicine, Texas A&M University Health Science Center, Bryan, TX, USA
| | | | - Akira Taniguchi
- 4 Department of Orthopaedic Surgery, Nara Medical University, Kashihara-shi, Nara-ken, Japan
| | | | - Yahya Daoud
- 5 Quantitative Sciences and Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX, USA
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104
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Queen RM, Franck CT, Schmitt D, Adams SB. Are There Differences in Gait Mechanics in Patients With A Fixed Versus Mobile Bearing Total Ankle Arthroplasty? A Randomized Trial. Clin Orthop Relat Res 2017; 475:2599-2606. [PMID: 28589334 PMCID: PMC5599399 DOI: 10.1007/s11999-017-5405-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/01/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is an alternative to arthrodesis, but no randomized trial has examined whether a fixed bearing or mobile bearing implant provides improved gait mechanics. QUESTIONS/PURPOSES We wished to determine if fixed- or mobile-bearing TAA results in a larger improvement in pain scores and gait mechanics from before surgery to 1 year after surgery, and to quantify differences in outcomes using statistical analysis and report the standardized effect sizes for such comparisons. METHODS Patients with end-stage ankle arthritis who were scheduled for TAA between November 2011 and June 2013 (n = 40; 16 men, 24 women; average age, 63 years; age range, 35-81 years) were prospectively recruited for this study from a single foot and ankle orthopaedic clinic. During this period, 185 patients underwent TAA, with 144 being eligible to participate in this study. Patients were eligible to participate if they were able to meet all study inclusion criteria, which were: no previous diagnosis of rheumatoid arthritis, a contralateral TAA, bilateral ankle arthritis, previous revision TAA, an ankle fusion revision, or able to walk without the use of an assistive device, weight less than 250 pounds (114 kg), a sagittal or coronal plane deformity less than 15°, no presence of avascular necrosis of the distal tibia, no current neuropathy, age older than 35 years, no history of a talar neck fracture, or an avascular talus. Of the 144 eligible patients, 40 consented to participate in our randomized trial. These 40 patients were randomly assigned to either the fixed (n = 20) or mobile bearing implant group (n = 20). Walking speed, bilateral peak dorsiflexion angle, peak plantar flexion angle, sagittal plane ankle ROM, peak ankle inversion angle, peak plantar flexion moment, peak plantar flexion power during stance, peak weight acceptance, and propulsive vertical ground reaction force were analyzed during seven self-selected speed level walking trials for 33 participants using an eight-camera motion analysis system and four force plates. Seven patients were not included in the analysis owing to cancelled surgery (one from each group) and five were lost to followup (four with fixed bearing and one with mobile bearing implants). A series of effect-size calculations and two-sample t-tests comparing postoperative and preoperative increases in outcome variables between implant types were used to determine the differences in the magnitude of improvement between the two patient cohorts from before surgery to 1 year after surgery. The sample size in this study enabled us to detect a standardized shift of 1.01 SDs between group means with 80% power and a type I error rate of 5% for all outcome variables in the study. RESULTS This randomized trial did not reveal any differences in outcomes between the two implant types under study at the sample size collected. In addition to these results, effect size analysis suggests that changes in outcome differ between implant types by less than 1 SD. Detection of the largest change score or observed effect (propulsive vertical ground reaction force [Fixed: 0.1 ± 0.1; 0.0-1.0; Mobile: 0.0 ± 0.1; 0.0-0.0; p = 0.0.051]) in this study would require a future trial to enroll 66 patients. However, the smallest change score or observed effect (walking speed [Fixed: 0.2 ± 0.3; 0.1-0.4; Mobile: 0.2 ± 0.3; 0.0-0.3; p = 0.742]) requires a sample size of 2336 to detect a significant difference with 80% power at the observed effect sizes. CONCLUSIONS To our knowledge, this is the first randomized study to report the observed effect size comparing improvements in outcome measures between fixed and mobile bearing implant types. This study was statistically powered to detect large effects and descriptively analyze observed effect sizes. Based on our results there were no statistically or clinically meaningful differences between the fixed and mobile bearing implants when examining gait mechanics and pain 1 year after TAA. LEVEL OF EVIDENCE Level II, therapeutic study.
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Affiliation(s)
- Robin M Queen
- Kevin P. Granata Biomechanics Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech, 230 Norris Hall, Blacksburg, VA, 24061, USA.
| | | | - Daniel Schmitt
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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105
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Abstract
The role of the surgeon learning curve in total ankle replacement (TAR) has produced contradictory results. It is important for a new surgeon to know what clinical and radiological parameters are considered reliable and ideal. It is clear that exposure to a high-volume center will increase the reliability of a new surgeon approaching TAR. Implant choice may be influenced by surgeon training, and the debate of mobile versus fix-bearing prosthesis is still open. Anterior versus lateral approach is still an open debate, with any hypothetical advantages given by the direct vision on the center of rotation to be proven.
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Affiliation(s)
| | - Camilla Maccario
- C.A.S.C.O. Foot and Ankle Unit- IRCCS Galeazzi, via Riccardo Galeazzi 4, Milano 20161, Italy; Universita' degli Studi di Milano, via Festa del Perdono, 7, Milano 20122, Italy
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106
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Abstract
Reoperation rates are higher in total ankle arthroplasties (TAAs) compared with ankle arthrodesis. Infection rates for primary TAAs are 1.4% to 2.4%. The survival rate of TAA is approximately 75% to 90% at 10 years. Arc of motion is maintained with TAAs compared with ankle arthrodesis. Ankle arthrodesis increases arc of motion through the talonavicular joint. Several factors are strong reasons to favor ankle fusion rather than TAA. TAA and ankle arthrodesis are effective treatments of end-stage ankle arthritis but the choice must be tailored to individual patients.
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Affiliation(s)
- Joel Morash
- QE2 Health Science Center, Halifax Infirmary (Room 4867), 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.
| | - David M Walton
- Beaumont Orthopedics, Michigan Orthopedic Institute, Royal Oak, MI 21601, USA
| | - Mark Glazebrook
- QE2 Health Science Center, Halifax Infirmary (Room 4867), 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada
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107
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Abstract
End-stage ankle arthritis produces severe functional disability, quantifiable by gait abnormalities. In all categories of gait parameters, total ankle arthroplasty (TAA) satistically significantly improves function, compared to patients' preoperative function. There are increases in step length, cadence and velocity; in sagittal plane motion of the ankle, as well has hip and knee motion, and in ankle power and moment. These functional gait improvements correspond to clinical improvements of pain relief and satisfaction. Although these improvements fail to reach the functional performance of healthy controls, the improvement over preoperative function is clinically meaningful and statistically significant.
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108
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Lawton CD, Butler BA, Dekker RG, Prescott A, Kadakia AR. Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. J Orthop Surg Res 2017; 12:76. [PMID: 28521779 PMCID: PMC5437567 DOI: 10.1186/s13018-017-0576-1] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/04/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The surgical treatment of end-stage tibiotalar arthritis continues to be a controversial topic. Advances in surgical technique and implant design have lead to improved outcomes after both ankle arthrodesis (AA) and total ankle arthroplasty (TAA), yet a clear consensus regarding the most ideal form of treatment is lacking. In this study, the outcomes and complications following AA and TAA are compared in order to improve our understanding and decision-making for care and treatment of symptomatic tibiotalar arthritis. METHODS Studies reporting on outcomes and complications following TAA or AA were obtained for review from the PubMed database between January 2006 and July 2016. Results from studies reporting on a minimum of 200 total ankle arthroplasties or a minimum of 80 ankle arthrodesis procedures were reviewed and pooled for analysis. All studies directly comparing outcomes and complications between TAA and AA were also included for review. Only studies including modern third-generation TAA implants approved for use in the USA (HINTEGRA, STAR, Salto, INBONE) were included. RESULTS A total of six studies reporting on outcomes following TAA and five reporting on outcomes following AA met inclusion criteria and were included for pooled data analysis. The adjusted overall complication rate was higher for AA (26.9%) compared to TAA (19.7%), with similar findings in the non-revision reoperation rate (12.9% for AA compared to 9.5% for TAA). The adjusted revision reoperation rate for TAA (7.9%) was higher than AA (5.4%). Analysis of results from ten studies directly comparing TAA to AA suggests a more symmetric gait and less impairment on uneven surfaces after TAA. CONCLUSIONS Pooled data analysis demonstrated a higher overall complication rate after AA, but a higher reoperation rate for revision after TAA. Based on the existing literature, the decision to proceed with TAA or AA for end-stage ankle arthritis should be made on an individual patient basis.
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Affiliation(s)
- Cort D Lawton
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Bennet A Butler
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Robert G Dekker
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Adam Prescott
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Anish R Kadakia
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA. .,Department of Orthopedic Surgery, Feinberg School of Medicine, Foot and Ankle Orthopedic Fellowship, Northwestern University - Northwestern Memorial Hospital, Chicago, IL, USA. .,, 676 North Saint Clair, Suite 1350, Chicago, IL, 60611, USA. .,, 259 East Erie, 13th Floor, Chicago, IL, 60611, USA.
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109
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Usuelli FG, Maccario C, D'Ambrosi R, Surace MF, Vulcano E. Age-Related Outcome of Mobile-Bearing Total Ankle Replacement. Orthopedics 2017; 40:e567-e573. [PMID: 28358975 DOI: 10.3928/01477447-20170327-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 02/03/2023]
Abstract
The aim of this study was to investigate clinical and radiographic outcomes in patients 50 years and younger vs patients older than 50 years undergoing total ankle replacement. Seventy consecutive patients who underwent primary total ankle replacement were included in this retrospective study. Patients were assessed clinically and radiographically. There was a statistically significant difference between the 2 groups for the American Orthopaedic Foot & Ankle Society score at final follow-up. The younger group had significantly greater improvement compared with the older group. Total ankle arthroplasty is an effective treatment for young, active patients with symptomatic end-stage ankle arthritis. [Orthopedics. 2017; 40(3):e567-e573.].
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110
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Sabine K, Sascha A, Peter B, Clemens M, Michel C, Hans-Joerg T. Comparative study of outcomes after ankle arthrodesis shows higher complication rates in cases operated upon by general orthopaedic surgeons. INTERNATIONAL ORTHOPAEDICS 2017; 41:1163-1168. [PMID: 28417165 DOI: 10.1007/s00264-017-3459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 03/20/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION A functional assessment of 38 patients after ankle arthrodesis for the evaluation of the necessity of surgeons-specialisation was carried out by means of clinical evaluation and gait analysis after an average follow up of 30 months. METHODS Scores were used to grade ankle function. Gate analysis was examined to determine the effect of arthrodesis on the ankle in relation to the surgeons' experience. Under conditions of normal daily living, we found significant differences in life quality between patients operated upon by experts in orthopaedic foot and ankle surgery (group A) and patients operated by general orthopaedic surgeons (group B). RESULTS All patients in group A had orthograde stance. Wrong screw positioning and a failed neutral tibio-talar position were the main problems in group B. Due to this, the re-operation rate was 10%. CONCLUSION Our findings may have implications for surgical training programs and for regionalisation of complex surgical procedures.
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Affiliation(s)
- Krenn Sabine
- 1st Department - Sports Clinic, Orthopaedic Hospital Speising, Vienna, Austria. .,Orthopaedic Hospital Speising Vienna, Speisingerstraße 109, 1130, Vienna, Austria.
| | - Albers Sascha
- Fußzentrum Vienna, Alserstraße 43, 1080, Vienna, Austria
| | - Bock Peter
- Orthopaedic Hospital Speising Vienna, Speisingerstraße 109, 1130, Vienna, Austria
| | - Mansfield Clemens
- Orthopaedic Hospital Speising Vienna, Speisingerstraße 109, 1130, Vienna, Austria
| | - Chraim Michel
- Orthopaedic Hospital Speising Vienna, Speisingerstraße 109, 1130, Vienna, Austria
| | - Trnka Hans-Joerg
- Orthopaedic Hospital Speising Vienna, Speisingerstraße 109, 1130, Vienna, Austria.,Fußzentrum Vienna, Alserstraße 43, 1080, Vienna, Austria
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111
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Lateef S, Golightly YM, Renner JB, Jordan JM, Nelson AE. A Cross-sectional Analysis of Radiographic Ankle Osteoarthritis Frequency and Associated Factors: The Johnston County Osteoarthritis Project. J Rheumatol 2017; 44:499-504. [PMID: 28202744 PMCID: PMC5468490 DOI: 10.3899/jrheum.161076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Because there are no epidemiologic data regarding the frequency of ankle osteoarthritis (OA) in a general population, we sought to analyze this disabling condition in a large, well-characterized, community-based cohort of older individuals. METHODS Cross-sectional data, including ankle radiographs, were from the most recent data collection (2013-2015) of the Johnston County OA Project. Radiographic ankle OA (rAOA) was defined as a Kellgren-Lawrence arthritis grading scale of ≥ 2 on weight-bearing lateral and mortise radiographs. The presence of pain, aching, or stiffness in the ankles as well as history of ankle injury (limiting ability to walk for at least 2 days) were assessed. Chi-square statistics (categorical variables) and Student t tests (continuous variables) were used to compare all participant characteristics by rAOA status. Joint-based logistic regression models with generalized estimating equations were used to examine associations of rAOA and covariates of interest [age, body mass index (BMI), sex, race, ankle symptoms, and injury history]. RESULTS Of 864 participants with available data, 68% were women, 34% were African American, with a mean age of 72 years and BMI of 31 kg/m2. Nearly 7% of this sample had rAOA. Increasing age, high BMI, history of ankle injury, and presence of ankle symptoms were all independently associated with greater odds of having rAOA; no significant differences were seen by sex or race. CONCLUSION The frequency of rAOA was higher than estimates generally quoted in the literature. While injury was an important contributor, other factors such as age, BMI, and symptoms were also significantly associated with rAOA.
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Affiliation(s)
- Shahmeer Lateef
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Yvonne M Golightly
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Jordan B Renner
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Joanne M Jordan
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Amanda E Nelson
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA.
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine.
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Wagener J, Gross CE, Schweizer C, Lang TH, Hintermann B. Custom-made total ankle arthroplasty for the salvage of major talar bone loss. Bone Joint J 2017; 99-B:231-236. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0504.r2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 09/23/2016] [Indexed: 12/14/2022]
Abstract
Aims A failed total ankle arthroplasty (TAA) is often associated with much bone loss. As an alternative to arthrodesis, the surgeon may consider a custom-made talar component to compensate for the bone loss. Our aim in this study was to assess the functional and radiological outcome after the use of such a component at mid- to long-term follow-up. Patients and Methods A total of 12 patients (five women and seven men, mean age 53 years; 36 to77) with a failed TAA and a large talar defect underwent a revision procedure using a custom-made talar component. The design of the custom-made components was based on CT scans and standard radiographs, when compared with the contralateral ankle. After the anterior talocalcaneal joint was fused, the talar component was introduced and fixed to the body of the calcaneum. Results At a mean follow-up of 6.9 years (1 to 13), 11 ankles were stable with no radiological evidence of loosening. Only one was lost to follow-up. The mean arc of movement was 21° (10° to 35°). A total of nine patients (75%) were satisfied or very satisfied with the outcome, two (17%) were satisfied but with reservations and one (8%) was not satisfied. All but one patient had an improvement in the American Orthopaedic Foot and Ankle Society hindfoot score (p = 0.01). Just one patient developed deep infection, leading to arthrodesis. Conclusion A custom-made talar component yielded satisfactory results with regard to function, stability and satisfaction. This should encourage the use of such components as an alternative to arthrodesis of the ankle in patients with a failed TAA. Cite this article: Bone Joint J 2017;99-B:231–6.
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Affiliation(s)
- J. Wagener
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - C. E. Gross
- Medical University of South Carolina, Department
of Orthopaedic Surgery, Charleston, South
Carolina, USA
| | - C. Schweizer
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - T. Horn Lang
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
| | - B. Hintermann
- Clinic of Orthopaedic Surgery, Kantonsspital
Baselland, CH-4410 Liestal, Switzerland
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D'Ambrosi R, Usuelli F, Indino C, Manzi L, Maccario C, Gross C. Sport and physical activities in total ankle replacement: Mobile- and fix-bearing. ARCHIVES OF TRAUMA RESEARCH 2017; 6:31. [DOI: 10.4103/atr.atr_14_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Gribble PA, Bleakley CM, Caulfield BM, Docherty CL, Fourchet F, Fong DTP, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, Verhagen EA, Vicenzino BT, Wikstrom EA, Delahunt E. Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med 2016; 50:1496-1505. [PMID: 27259753 DOI: 10.1136/bjsports-2016-096189] [Citation(s) in RCA: 308] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 02/06/2023]
Abstract
Lateral ankle sprains (LASs) are the most prevalent musculoskeletal injury in physically active populations. They also have a high prevalence in the general population and pose a substantial healthcare burden. The recurrence rates of LASs are high, leading to a large percentage of patients with LAS developing chronic ankle instability. This chronicity is associated with decreased physical activity levels and quality of life and associates with increasing rates of post-traumatic ankle osteoarthritis, all of which generate financial costs that are larger than many have realised. The literature review that follows expands this paradigm and introduces emerging areas that should be prioritised for continued research, supporting a companion position statement paper that proposes recommendations for using this summary of information, and needs for specific future research.
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Affiliation(s)
- Phillip A Gribble
- University of Kentucky, College of Health Sciences, Lexington, Kentucky, USA
| | - Chris M Bleakley
- Department of Life and Health Sciences, Ulster University, Jordanstown, Carrickfergus, UK
| | - Brian M Caulfield
- University College Dublin, Insight Centre for Data Analytics, Dublin, Ireland
| | - Carrie L Docherty
- Indiana University, School of Public Health, Bloomington, Indiana, USA
| | | | - Daniel Tik-Pui Fong
- National Centre for Sport and Exercise Medicine-East Midlands, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Jay Hertel
- Departments of Kinesiology and Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Claire E Hiller
- University of Sydney, College of Health, Sydney, New South Wales, Australia
| | - Thomas W Kaminski
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Patrick O McKeon
- Department of Exercise and Sport Sciences, Ithaca College, Ithaca, New York, USA
| | | | - Evert A Verhagen
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Bill T Vicenzino
- University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Queensland, Australia
| | - Erik A Wikstrom
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eamonn Delahunt
- University College Dublin, School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
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Pedowitz DI, Kane JM, Smith GM, Saffel HL, Comer C, Raikin SM. Total ankle arthroplasty versus ankle arthrodesis. Bone Joint J 2016; 98-B:634-40. [DOI: 10.1302/0301-620x.98b5.36887] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/13/2015] [Indexed: 11/05/2022]
Abstract
Aims Few reports compare the contribution of the talonavicular articulation to overall range of movement in the sagittal plane after total ankle arthroplasty (TAA) and tibiotalar arthrodesis. The purpose of this study was to assess changes in ROM and functional outcomes following tibiotalar arthrodesis and TAA. Patients and Methods Patients who underwent isolated tibiotalar arthrodesis or TAA with greater than two-year follow-up were enrolled in the study. Overall arc of movement and talonavicular movement in the sagittal plane were assessed with weight-bearing lateral maximum dorsiflexion and plantarflexion radiographs. All patients completed Short Form-12 version 2.0 questionnaires, visual analogue scale for pain (VAS) scores, and the Foot and Ankle Ability Measure (FAAM). Results In all, 41 patients who underwent TAA and 27 patients who underwent tibiotalar arthrodesis were enrolled in the study. The mean total arc of movement was 34.2° (17.0° to 59.1°) with an average contribution from the talonavicular joint of 10.5° (1.2° to 28.8°) in the TAA cohort. The average total arc of movement was 24.3° (6.9° to 44.3°) with a mean contribution from the talonavicular joint of 22.8° (5.6° to 41.4°) in the arthrodesis cohort. A statistically significant difference was detected for both total sagittal plane movement (p = 0.00025), and for talonavicular motion (p < 0.0001). A statistically significant lower VAS score (p = 0.0096) and higher FAAM (p = 0.01, p = 0.019, respectively) was also detected in the TAA group. Conclusion TAA preserves more anatomical movement, has better pain relief and better patient-perceived post-operative function compared with patients undergoing fusion. The relative increase of talonavicular movement in fusion patients may play a role in the outcomes compared with TAA and may predispose these patients to degenerative changes over time. Take home message: TAA preserves more anatomic sagittal plane motion and provides greater pain relief and better patient-perceived outcomes compared with ankle arthrodesis. Cite this article: Bone Joint J 2016;98-B:634–40.
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Affiliation(s)
- D. I. Pedowitz
- Rothman Institute, 925
Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
| | - J. M. Kane
- Baylor University Medical Center, 3500
Gaston Ave, Dallas, TX 75246, USA
| | - G. M. Smith
- Allegheny General Hospital, 320
E North Ave, Pittsburgh, PA
15212, USA
| | - H. L. Saffel
- Marshall University, 1600
Medical Center Dr, Huntington, WV 25701, USA
| | - C. Comer
- Sidney Kimmel Medical College at Thomas
Jefferson University, 1020 Walnut Street, Philadelphia, PA
19107, USA
| | - S. M. Raikin
- Rothman Institute, 925
Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
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Chang SH, Yasui T, Taketomi S, Matsumoto T, Kim-Kaneyama JR, Omiya T, Hosaka Y, Inui H, Omata Y, Yamagami R, Mori D, Yano F, Chung U, Tanaka S, Saito T. Comparison of mouse and human ankles and establishment of mouse ankle osteoarthritis models by surgically-induced instability. Osteoarthritis Cartilage 2016; 24:688-97. [PMID: 26596790 DOI: 10.1016/j.joca.2015.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/04/2015] [Accepted: 11/08/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Prevalence of ankle osteoarthritis (OA) is lower than that of knee OA, however, the molecular mechanisms underlying the difference remain unrevealed. In the present study, we developed mouse ankle OA models for use as tools to investigate pathophysiology of ankle OA and molecular characteristics of ankle cartilage. DESIGN We anatomically and histologically examined ankle and knee joints of C57BL/6 mice, and compared them with human samples. We examined joints of 8-week-old and 25-month-old mice. For experimental models, we developed three different ankle OA models: a medial model, a lateral model, and a bilateral model, by resection of respective structures. OA severity was evaluated 8 weeks after the surgery by safranin O staining, and cartilage degradation in the medial model was sequentially examined. RESULTS Anatomical and histological features of human and mouse ankle joints were comparable. Additionally, the mouse ankle joint was more resistant to cartilage degeneration with aging than the mouse knee joint. In the medial model, the tibiotalar joint was markedly affected while the subtalar joint was less degenerated. In the lateral model, the subtalar joint was mainly affected while the tibiotalar joint was less altered. In the bilateral model, both joints were markedly degenerated. In the time course of the medial model, TdT-mediated dUTP nick end labeling (TUNEL) staining and Adamts5 expression were enhanced at early and middle stages, while Mmp13 expression was gradually increased during the OA development. CONCLUSION Since human and mouse ankles are comparable, the present models will contribute to ankle OA pathophysiology and general cartilage research in future.
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Affiliation(s)
- Song Ho Chang
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - T Yasui
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - S Taketomi
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - T Matsumoto
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - J R Kim-Kaneyama
- Department of Biochemistry, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan.
| | - T Omiya
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Y Hosaka
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - H Inui
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Y Omata
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - R Yamagami
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - D Mori
- Bone and Cartilage Regenerative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - F Yano
- Bone and Cartilage Regenerative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - U Chung
- Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - S Tanaka
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - T Saito
- Sensory & Motor System Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Bone and Cartilage Regenerative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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What Is the Impact of Comorbidities on Self-rated Hand Function in Patients With Symptomatic Trapeziometacarpal Arthritis? Clin Orthop Relat Res 2015; 473:3477-83. [PMID: 26290344 PMCID: PMC4586244 DOI: 10.1007/s11999-015-4507-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The thumb trapeziometacarpal joint is one of the most common sites of arthritic degeneration prompting specialty care. Surgical treatment algorithms are based on radiographic arthritic progression. However, the pain and disability attributable to trapeziometacarpal arthritis do not correlate with arthritic stage, and depression has independently predicted poorer self-rated hand function both at baseline and after treatment in patients' atraumatic hand conditions. QUESTIONS/PURPOSES (1) Does thumb trapeziometacarpal osteoarthritis impact both self-perceived general health and hand function? (2) Do depression and other comorbid conditions differentially impact patient-rated hand function based on the presence or absence of symptomatic trapeziometacarpal arthritis? (3) How do disease-specific, patient demographics and comorbid conditions impact self-reported hand function in patients with trapeziometacarpal osteoarthritis? METHODS This cross-sectional study compared patients with symptomatic trapeziometacarpal osteoarthritis (n = 47) with matched control subjects without a symptomatic hand condition (n = 47). All participants self-reported medical (including depression) and musculoskeletal comorbidities and completed the SF-36 and the Michigan Hand Questionnaire (MHQ). Bivariate statistical analyses contrasted the patients with trapeziometacarpal osteoarthritis to control subjects. Linear regression modeling determined the impact of subject demographic data, comorbidity burden, and examination findings on total MHQ scores in patients with trapeziometacarpal arthritis. RESULTS Patients with scored trapeziometacarpal osteoarthritis indicated poorer perceived general health on the SF-36 categories of limitations resulting from physical health (52 ± 29 versus 71 ± 31, mean difference 19 [95% confidence interval {CI}, 7-31], p = 0.003) and limitations resulting from emotional problems (50 ± 27 versus 67 ± 50, mean difference 17 [95% CI, 3-33], p = 0.022) compared with control subjects. Self-reported depression was associated with worse hand function (total MHQ score) in patients with trapeziometacarpal arthritis (69 ± 20 versus 49 ± 22: mean difference -20 [95% CI, -5 to-36], p = 0.012) but not in control patients (90 ± 13 versus 84 ± 20: mean difference -5 [95% CI, -8 to 19], p = 0.404). In multivariate modeling, depression (β -20, [95% CI, -5 to -34], p = 0.009) and upper extremity comorbidities (β -25, [95% CI, -10 to -40], p = 0.002) were both associated with reduced total MHQ scores in patients with trapeziometacarpal osteoarthritis, and those factors accounted for 34% of the variance in the MHQ score. CONCLUSIONS When interpreting patient-rated hand disability in patients presenting with symptomatic trapeziometacarpal osteoarthritis, scores should be interpreted after accounting for the presence of depression and upper extremity comorbidities. LEVEL OF EVIDENCE Level III, prognostic study.
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Witteveen AGH, Hofstad CJ, Kerkhoffs GMMJ. Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle. Cochrane Database Syst Rev 2015; 2015:CD010643. [PMID: 26475434 PMCID: PMC9254328 DOI: 10.1002/14651858.cd010643.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The cause of ankle osteoarthritis (OA) is usually trauma. Patients are relatively young, since ankle trauma occurs at a relatively young age. Several conservative treatment options are available, evidence of the benefits and harms of these options are lacking. OBJECTIVES To assess the benefits and harms of any conservative treatment for ankle OA in adults in order to provide a synthesis of the evidence as a base for future treatment guidelines. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2014, issue 9), MEDLINE (Ovid) (1946 up to 11 September 2014), EMBASE (1947 to September 2014), PsycINFO (1806 to September 2014), CINAHL (1985 to September 2014), PEDro (all years till September 2014), AMED until September 2014, ClinicalTrials.gov, Current Controlled Trials, The Dutch Register. To identify potentially relevant studies we screened reference lists in retrieved review articles and trials. SELECTION CRITERIA We considered randomised or controlled clinical trials investigating any non-surgical intervention for ankle OA for inclusion. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS No other RCT concerning any other conservative treatment besides the use of hyaluronic acid (HA) for ankle OA was identified. Six randomised controlled trials (RCTs) were included.A total of 240 participants diagnosed with ankle OA were included in this review. The primary analysis included three RCTs (109 participants) which compared HA to placebo. One study compared HA to exercise therapy, one compared HA combined with exercise therapy to an intra-articular injection of botulinum toxin and one compared four different dosages of HA.Primary analysis: a pooled analysis of two trials (45 participants) found that the Ankle Osteoarthritis Scale (AOS) total score (measuring pain and physical function) was reduced by 12% (95% CI -24% to -1%) at six months (mean difference (MD) -12.53 (95% CI -23.84 to -1.22) on a scale of 0 to 100; number needed to treat for an additional beneficial outcome (NNTB) = 4 (95% CI 2 to 205); this evidence was graded as low quality, due to limitations in study design (unclear risk of selection bias for two studies and unclear risk for attrition bias for one study) and imprecision of results: a small population size (45 participants). It is not known if a mean difference of 12.53 points on a 100 point scale is clinically relevant. No minimal important clinical difference is known for this score. Pain and function outcomes were not reported separately. Radiographic joint structure changes were not investigated. For the mean quality of life at six months (two trials; 45 participants) no meta-analysis could be performed due to missing data. No serious adverse events (SAEs) were noted and no participants withdrew because of an adverse event. There were a few adverse events (AEs) 5/63 (8%) in the HA group and 2/46 (4%) in the placebo group. The Peto odds ratio (Peto OR) to have an adverse event was 2.34 higher compared to the control group (95% CI 0.45 to 12.11). This evidence is inconclusive because of a wide CI and a small number of events.For comparing HA to exercise therapy (30 participants) the results for pain on a Visual Analogue Scale (VAS 0 to 10) at 12 months are inconclusive (MD 0.70, 95% CI -2.54 to 1.14). The American Orthopedic Foot and Ankle Society score (AOFAS score) was 13.10 points (MD) higher in favour of HA (95% CI 2.97 to 23.23) on a scale of 0 to 100. The evidence was graded as low. No adverse events were found. Radiographic structure changes were not measured; no participants withdrew due to AEs; no SAEs were found.For the comparison of HA injection combined with exercise therapy to an intra-articular injection of botulinum toxin A (BoNT-A) (75 participants), the outcome of the AOS pain score of the affected joint at six months is inconclusive (MD 0.10, 95% CI -0.42 to 0.62). The physical function (the AOS disability score) at six months is inconclusive (MD 0.20, 95% CI -0.34 to 0.74). The same number of AEs were found in both groups; HA 2/37 (5.9%), BoNT-A 2/38 (5.8%) (risk ratio (RR) 1.03, 95% CI 0.15 to 6.91). Radiographic changes were not examined, no SAEs were found and no participants withdrew because of an AE. The evidence was graded as low.The RCT comparing four different dosing schedules for HA (26 participants) showed the best median decrease in pain on walking VAS (on a scale of 0 to 100) for 3 x 1 ml at 27 weeks with a median decrease of 30. Physical function, radiographic changes and quality of life were not measured.Twenty-seven percent of all participants had AEs, most of them in the 2ml group (57% in this group). No participants withdrew due to an AE and no SAEs were noted.Overall the quality of the evidence showed some serious limitations. The evidence was graded low for the primary analysis comparing HA to placebo. This was based on a limitation in design and implementation: sample sizes were small (45 to 92 participants) and and imprecision in results: there was an unclear risk of bias for several items concerning the three studies used in the meta analysis. AUTHORS' CONCLUSIONS Currently, there is insufficient data to create a synthesis of the evidence as a base for future guidelines for ankle OA. Since the aetiology of ankle OA is different, guidelines that are currently used for hip and knee OA may not be applicable for ankle OA. Simple analgesics as recommended for hip and knee OA seem however a reasonable first step to treat ankle OA. It is unclear if there is a benefit or harm for HA as treatment for ankle OA compared to placebo at six months based on a low quality of evidence. Inconclusive results were found comparing HA to other treatments. HA can be conditionally recommended if patients have an inadequate response to simple analgesics. It remains unclear which patients (age, grade of ankle OA) benefit the most from HA injections and which dosage schedule should be used.
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Affiliation(s)
| | - Cheriel J Hofstad
- Sint MaartenskliniekDepartment of Human Movement Science, and Department of Research, Development and EducationPO Box 9011NijmegenNetherlands6500 GM
| | - Gino MMJ Kerkhoffs
- Academic Medical CenterDepartment of Orthopaedic SurgeryMeibergdreef 9AmsterdamNetherlands1105 AZ
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Vaughan P, Gordon D, Goldberg A, Cullen N, Singh D. Patient satisfaction and function after bilateral ankle arthrodeses. Foot Ankle Surg 2015; 21:160-3. [PMID: 26235853 DOI: 10.1016/j.fas.2014.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/21/2014] [Accepted: 11/03/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The optimum way to manage patients with bilateral ankle arthritis (AA) is unclear. METHODS This review was performed to report the midterm satisfaction and functional outcome of a series of patients who have undergone bilateral staged ankle arthrodesis. RESULTS Eight patients, median age 68.5 yrs (range 59-80) were followed-up for a median of 58.5 months (range 24-100). All fusions united in a median time of 12.8 weeks (range 10-19) Their median AOFAS hindfoot score was 79.5 (range 71-90). Six patients (75%) were very satisfied, one was satisfied, and the other neither satisfied nor dissatisfied. Two patients developed symptomatic subtalar arthritis requiring subtalar fusion. CONCLUSIONS This is the first study to report the outcome of bilateral AA independent to that of unilateral AA. Bilateral AA appears to give patients a good functional result with high patient reported satisfaction into the medium term.
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Affiliation(s)
- Philip Vaughan
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK.
| | - David Gordon
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
| | - Andy Goldberg
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
| | - Nick Cullen
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
| | - Dishan Singh
- Foot & Ankle Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK
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Abstract
Subtalar joint arthrodesis is a commonly performed procedure for the correction of hindfoot deformity and/or the relief of pain related to osteoarthritis. The purpose of the present study was to provide preoperative and intraoperative objective radiographic parameters to improve the accuracy and long-term success of realignment arthrodesis of the subtalar joint. We retrospectively reviewed the data from 16 patients, 11 male (57.9%) and 8 female (42.1%) feet, who had undergone realignment subtalar joint arthrodesis. A total of 19 fusions were performed in 9 (47.4%) right and 10 (52.6%) left feet, with a mean follow-up period of 2 (range 1 to 4.8) years. The mean age at surgery was 54.5 (range 14 to 77) years. Statistically significant improvement in radiographic alignment was found in the anteroposterior talo-first metatarsal angle (p = .002), lateral talo-first metatarsal angle (p < .001), tibial-calcaneal angle (p < .001), and tibial-calcaneal distance (p < .001). A positive correlation was observed between the tibial-calcaneal angle and tibial-calcaneal distance (r = 0.825, p < .001). The statistically significant improvement in tibial-calcaneal alignment, in both angulation and distance, support our conclusions that proper realignment of the calcaneus to vertical and central under the tibia will lead to short-term success and, likely, long-term success of subtalar joint arthrodesis.
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Affiliation(s)
- Matthew J Hentges
- Clinical Fellow, Foot and Ankle Deformity Correction Fellowship, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Martin G Gesheff
- Research Program Manager, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Bradley M Lamm
- Head of Foot and Ankle Surgery, Director, Foot and Ankle Deformity Correction Fellowship, and Chief of the Limb Preservation Program, International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD.
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Mani SB, Do H, Vulcano E, Hogan MV, Lyman S, Deland JT, Ellis SJ. Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle. Bone Joint J 2015; 97-B:662-7. [DOI: 10.1302/0301-620x.97b5.33940] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The foot and ankle outcome score (FAOS) has been evaluated for many conditions of the foot and ankle. We evaluated its construct validity in 136 patients with osteoarthritis of the ankle, its content validity in 37 patients and its responsiveness in 39. Data were collected prospectively from the registry of patients at our institution. All FAOS subscales were rated relevant by patients. The Pain, Activities of Daily Living, and Quality of Life subscales showed good correlation with the Physical Component score of the Short-Form-12v2. All subscales except Symptoms were responsive to change after surgery. We concluded that the FAOS is a weak instrument for evaluating osteoarthritis of the ankle. However, some of the FAOS subscales have relative strengths that allow for its limited use while we continue to seek other satisfactory outcome instruments. Cite this article: Bone Joint J 2015; 97-B:662–7.
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Affiliation(s)
- S. B. Mani
- Hospital for Special Surgery, 535
East 70th Street, New York, 10021, USA
| | - H. Do
- Hospital for Special Surgery, 535
East 70th Street, New York, 10021, USA
| | - E. Vulcano
- Hospital for Special Surgery, 535
East 70th Street, New York, 10021, USA
| | - M. V. Hogan
- Hospital for Special Surgery, 535
East 70th Street, New York, 10021, USA
| | - S. Lyman
- Hospital for Special Surgery, 535
East 70th Street, New York, 10021, USA
| | - J. T. Deland
- Hospital for Special Surgery, 535
East 70th Street, New York, 10021, USA
| | - S. J. Ellis
- Hospital for Special Surgery, 535
East 70th Street, New York, 10021, USA
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de Luca K, Parkinson L, Pollard H, Byles J, Blyth F. How is the experience of pain measured in older, community-dwelling people with osteoarthritis? A systematic review of the literature. Rheumatol Int 2015; 35:1461-72. [PMID: 25869349 DOI: 10.1007/s00296-015-3268-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 04/04/2015] [Indexed: 12/11/2022]
Abstract
The objective of the study was to perform a systematic review to identify and appraise outcome measures and measures of pain that are used to assess the experience of pain by older people with osteoarthritis, and to assess whether these measures are effective at capturing the multidimensional nature of the experience of this pain. A systematic review of five electronic databases from January 1996 to March 2013 was done. Inclusion criteria were cohort/observational and cross-sectional studies; specific diagnosis of OA; employed outcome measures of pain and/or health and/or quality of life which included questions about pain; and considered older adults. Articles were reviewed for methodological quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. A total of 14 publications met the inclusion criteria, and 11 discrete studies were included in the review. The studies used 21 different outcome measures, utilizing 13 measures of pain. Sensory, affective and cognitive dimensions of pain were captured by the measures, albeit studies predominantly measured intensity or severity alone. Measures of pain used in epidemiological studies do not adequately capture the multidimensional nature of the experience of pain in osteoarthritis. There is a fraught complexity in the multidimensionality of the experience of pain in osteoarthritis, and studies exploring osteoarthritis pain in older people should attempt to capture this multidimensionality by employing multiple valid and reliable outcome measures that capture specific dimensions of the pain experience.
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Affiliation(s)
- Katie de Luca
- Research Centre for Gender Health and Ageing, University of Newcastle, 18 Palm Court South West Rocks, Callaghan, NSW, 2431, Australia,
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123
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Nguyen MP, Pedersen DR, Gao Y, Saltzman CL, Amendola A. Intermediate-term follow-up after ankle distraction for treatment of end-stage osteoarthritis. J Bone Joint Surg Am 2015; 97:590-6. [PMID: 25834084 PMCID: PMC4372990 DOI: 10.2106/jbjs.n.00901] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of end-stage ankle osteoarthritis remains challenging, especially in young patients. Initial reports have shown early benefits of joint distraction for the treatment of ankle osteoarthritis. We report the five to ten-year results of a previously described patient cohort following ankle distraction surgery. METHODS All thirty-six patients who had undergone ankle distraction surgery between December 2002 and October 2006 were contacted. Patients were evaluated by a clinical investigator and completed the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) surveys. Radiographs as well as computed tomography and magnetic resonance imaging scans of the ankles were obtained at the follow-up visits. RESULTS Twenty-nine patients (81%) were followed for a minimum of five years (mean and standard deviation, 8.3 ± 2.2 years). Sixteen (55%) of the twenty-nine patients still had the native ankle joint whereas thirteen patients (45%) had undergone either ankle arthrodesis or total ankle arthroplasty. Positive predictors of ankle survival included a better AOS score at two years (hazard ratio [HR] = 0.048, 95% confidence interval [CI] = 0.0028 to 0.84, p = 0.04), older age at surgery (HR = 0.91, 95% CI = 0.83 to 0.99, p = 0.04), and fixed distraction (HR = 0.094, 95% CI = 0.017 to 0.525, p < 0.01). Radiographs and advanced imaging revealed progression of ankle osteoarthritis at the time of final follow-up. CONCLUSIONS Ankle function following joint distraction declines over time. Patients should be well informed of the commitment that they must make during the treatment period as well as the long-term results after surgery.
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Affiliation(s)
- Mai P. Nguyen
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.P. Nguyen: . E-mail address for D.R. Pedersen: . E-mail address for Y. Gao: . E-mail address for A. Amendola:
| | - Douglas R. Pedersen
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.P. Nguyen: . E-mail address for D.R. Pedersen: . E-mail address for Y. Gao: . E-mail address for A. Amendola:
| | - Yubo Gao
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.P. Nguyen: . E-mail address for D.R. Pedersen: . E-mail address for Y. Gao: . E-mail address for A. Amendola:
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address:
| | - Annunziato Amendola
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for M.P. Nguyen: . E-mail address for D.R. Pedersen: . E-mail address for Y. Gao: . E-mail address for A. Amendola:
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Santos ALG, Demange MK, Prado MP, Fernandes TD, Giglio PN, Hintermann B. Cartilage lesions and ankle osteoarthrosis: review of the literature and treatment algorithm. Rev Bras Ortop 2014; 49:565-72. [PMID: 26229863 PMCID: PMC4487502 DOI: 10.1016/j.rboe.2014.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022] Open
Abstract
The main etiology of ankle osteoarthrosis is post-traumatic and its prevalence is highest among young individuals. Thus, this disease has a great socioeconomic impact and gives rise to significant losses of patients' quality of life. The objective of its treatment is to eliminate pain and keep patients active. Therefore, the treatment should be staged according to the degree of degenerative evolution, etiology, joint location, systemic condition, bone quality, lower-limb alignment, ligament stability and age. The treatment algorithm is divided into non-surgical therapeutic methods and options for surgical treatment. Joint preservation, joint replacement and arthrodesis surgical procedures have precise indications. This article presents a review on this topic and a proposal for a treatment algorithm for this disease.
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Affiliation(s)
- Alexandre Leme Godoy Santos
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Marco Kawamura Demange
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Marcelo Pires Prado
- Orthopedics and Rehabilitation Center, Hospital do Coração, São Paulo, SP, Brazil
| | - Tulio Diniz Fernandes
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Pedro Nogueira Giglio
- Institute of Orthopedics and Traumatology, School of Medicine, University of São Paulo (USP), São Paulo, SP, Brazil
| | - Beat Hintermann
- Department of Orthopedics, Kantonsspital, Liestal, Switzerland
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125
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Lesão de cartilagem e osteoartrose do tornozelo: revisão da literatura e algoritmo de tratamento. Rev Bras Ortop 2014. [DOI: 10.1016/j.rbo.2013.10.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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126
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Abstract
BACKGROUND Chronic polyarthritis is the second most common cause regarding the etiology of upper ankle osteoarthritis after posttraumatic degenerative changes. Patient mobility is limited by this painful disease. Besides conservative treatment options, replacement of the upper ankle joint is an operative therapeutic option in eligible candidates which provides very good results. OBJECTIVES Besides epidemiological data, clinic presentation, diagnostic tools, treatment options and management of postoperative complications for patients with ankle osteoarthritis, this article presents the results of midterm outcome after total ankle replacement. MATERIAL AND METHODS The retrospective results of 44 patients after total ankle arthroplasty are presented. RESULTS After an average follow-up of 53 months (range 20-98 months) the majority of results were good or excellent with respect to pain relief. CONCLUSION Total ankle replacement is a good option for treating osteoarthritis of the ankle joint in rheumatoid arthritis when attention is paid to the eligibility of the patients.
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127
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Is end-stage ankle arthrosis best managed with total ankle replacement or arthrodesis? A systematic review. Adv Orthop 2014; 2014:986285. [PMID: 25215242 PMCID: PMC4158286 DOI: 10.1155/2014/986285] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/12/2014] [Indexed: 12/11/2022] Open
Abstract
Introduction. End-stage ankle osteoarthritis is a debilitating condition. Traditionally, ankle arthrodesis (AA) has been the surgical intervention of choice but the emergence of total ankle replacement (TAR) has challenged this concept. This systematic review aims to address whether TAR or AA is optimal in terms of functional outcomes. Methods. We conducted a systematic review according to PRISMA checklist using the online databases Medline and EMBASE after January 1, 2005. Participants must be skeletally mature and suffering from ankle arthrosis of any cause. The intervention had to be an uncemented TAR comprising two or three modular components. The comparative group could include any type of ankle arthrodesis, either open or arthroscopic, using any implant for fixation. The study must have reported at least one functional outcome measure. Results. Of the four studies included, two reported some significant improvement in functional outcome in favour of TAR. The complication rate was higher in the TAR group. However, the quality of studies reviewed was poor and the methodological weaknesses limited any definitive conclusions being drawn. Conclusion. The available literature is insufficient to conclude which treatment is superior. Further research is indicated and should be in the form of an adequately powered randomised controlled trial.
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128
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Queen RM, Butler RJ, Adams SB, DeOrio JK, Easley ME, Nunley JA. Bilateral differences in gait mechanics following total ankle replacement: a two year longitudinal study. Clin Biomech (Bristol, Avon) 2014; 29:418-22. [PMID: 24565529 DOI: 10.1016/j.clinbiomech.2014.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 11/26/2013] [Accepted: 01/27/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following total ankle replacement (TAR) patients demonstrate improvements in gait. The purpose of this study was to assess the changes in gait symmetry from a pre-operative assessment through two years following TAR. METHODS Seventy-eight patients who received a primary TAR and had no contralateral pain were examined. Three-dimensional joint mechanics and ground reaction forces were collected during seven walking trials pre-operatively, and 1 and 2-years post-operatively. Data was analyzed using a 2×3 repeated measures ANOVA to determine significant differences between limbs and across time points (α=0.05). FINDINGS Walking speed improved from pre-operative to each post-operative time point (P<.001; ES=1.5). Peak dorsiflexion was not changed across time or between sides, however, the dorsiflexion angle at heel strike was increased on the nonsurgical side (P=0.049; ES=0.32). Peak plantar flexion moment (P<.001; ES=.80), stance (P<.001; ES=.29) and step time (P<.001; ES=.41) were improved from pre-op to 1year post-surgery on the surgical side. Step (P<.001; ES=1.2) and stride length (P<.001; ES=1.2) demonstrated improvements across all time points, while the weight acceptance (P<.001; ES=.27) and propulsion ground reaction forces (P<.001; ES=.22) showed improvements between pre-op and 1year post-op. INTERPRETATION The results of the study indicate that the patients are able to walk faster and demonstrate an improvement in gait symmetry; however, this improvement does not return the patient to a symmetric walking pattern by 2years post-TAR.
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Affiliation(s)
- Robin M Queen
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3956, Durham, NC 27710, USA; Michael W. Krzyzewski Human Performance Research Laboratory, DUMC 3435, Duke University Medical Center, Durham, NC 27710, USA.
| | - Robert J Butler
- Michael W. Krzyzewski Human Performance Research Laboratory, DUMC 3435, Duke University Medical Center, Durham, NC 27710, USA; Division of Physical Therapy, Department of Community and Family Medicine, 2200 West Main St., Durham, NC 27705, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3956, Durham, NC 27710, USA
| | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3956, Durham, NC 27710, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3956, Durham, NC 27710, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3956, Durham, NC 27710, USA
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129
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Gribble PA, Delahunt E, Bleakley CM, Caulfield B, Docherty CL, Fong DTP, Fourchet F, Hertel J, Hiller CE, Kaminski TW, McKeon PO, Refshauge KM, van der Wees P, Vicenzino W, Wikstrom EA. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Athl Train 2014; 49:121-7. [PMID: 24377963 PMCID: PMC3917288 DOI: 10.4085/1062-6050-49.1.14] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant or patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalize this evidence to the target patient population. Therefore, there is a need to provide standards for patient or participant selection criteria in research focused on CAI with justifications using the best available evidence. The International Ankle Consortium provides this position paper to present and discuss an endorsed set of selection criteria for patients with CAI based on the best available evidence to be used in future research and study designs. These recommendations will enhance the validity of research conducted in this clinical population with the end goal of bringing the research evidence to the clinician and patient.
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Affiliation(s)
| | | | | | | | | | | | - François Fourchet
- Aspire Health Centre, National Sports Medicine Programme (NSMP), Doha, Qatar
| | - Jay Hertel
- The University of Virginia, Charlottesville
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130
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Demetracopoulos CA, Halloran JP, Maloof P, Adams SB, Parekh SG. Total ankle arthroplasty in end-stage ankle arthritis. Curr Rev Musculoskelet Med 2013; 6:279-84. [PMID: 23893255 DOI: 10.1007/s12178-013-9179-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recent advancements in ankle prosthesis design, combined with improved surgical techniques for correction of coronal plane deformity and ligamentous balancing, have led to a resurgence of interest in total ankle arthroplasty for the treatment of end-stage ankle arthritis. Although ankle arthrodesis has long been considered the gold standard treatment for ankle arthritis, recent studies have shown that patients who undergo total ankle replacement have equivalent pain relief and improved function, when compared with patients with an ankle fusion. The purpose of this review is to summarize the indications, advantages, disadvantages, and clinical outcomes of some of the more commonly used modern prostheses for total ankle arthroplasty.
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131
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Gribble PA, Delahunt E, Bleakley C, Caulfield B, Docherty C, Fourchet F, Fong DTP, Hertel J, Hiller C, Kaminski T, McKeon P, Refshauge K, van der Wees P, Vicenzino B, Wikstrom E. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med 2013; 48:1014-8. [PMID: 24255768 DOI: 10.1136/bjsports-2013-093175] [Citation(s) in RCA: 244] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
While research on chronic ankle instability (CAI) and awareness of its impact on society and health care systems has grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalise this evidence to the target patient population. Therefore, there is a need to provide standards for patient/participant selection criteria in research focused on CAI with justifications using the best available evidence. The International Ankle Consortium provides this position paper to present and discuss an endorsed set of selection criteria for patients with CAI based on the best available evidence to be used in future research and study designs. These recommendations will enhance the validity of research conducted in this clinical population with the end goal of bringing the research evidence to the clinician and patient.
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Affiliation(s)
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | | | - Brian Caulfield
- School of Physiotherapy, University College Dublin, Dublin, UK
| | | | | | - Daniel Tik-Pui Fong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Jay Hertel
- Kinesiology Program, University of Virginia, Charlottesville, Virginia, USA
| | - Claire Hiller
- Department of Physiotherapy, University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Kaminski
- Department of Health, Nutrition and Exercise Sciences, University of Delaware, Newark, New Jersey, USA
| | - Patrick McKeon
- Department of Rehabilitation Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Kathryn Refshauge
- Department of Physiotherapy, University of Sydney, Sydney, New South Wales, Australia
| | | | - Bill Vicenzino
- Department of Physiotherapy, University of Queensland, Brisbane, Queensland, Australia
| | - Erik Wikstrom
- University of North Carolina, Charlotte, North Carolina, USA
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132
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Kraus VB, Worrell TW, Renner JB, Coleman RE, Pieper CF. High prevalence of contralateral ankle abnormalities in association with knee osteoarthritis and malalignment. Osteoarthritis Cartilage 2013; 21:1693-9. [PMID: 23867580 PMCID: PMC3795812 DOI: 10.1016/j.joca.2013.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 07/03/2013] [Accepted: 07/09/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate ankle joint abnormalities in a knee osteoarthritis (OA) cohort. METHODS Participants (n = 159) with symptomatic and radiographic OA in at least one knee underwent technetium-99m methylene diphosphonate bone scan (scored 0-3) of the ankles and forefeet. Knee radiographs were graded for OA features of joint space narrowing (JSN) and osteophyte (OST). Ankle symptoms and history of ankle injury were assessed by self-report. Knee alignment was measured from a long-limb radiograph. Ankle radiographs were obtained on those who returned for follow-up (n = 138) and were graded for ankle tibiotalar JSN and OST. DESIGN Ankle scintigraphic abnormalities were frequent (31% of individuals, one-third bilateral). Ankle symptoms were reported by 23% of individuals and history of ankle injury by 24%. Controlling for gender, age, body mass index (BMI), and contralateral predictor, ankle scintigraphic abnormalities were associated with: ipsilateral ankle symptoms (P = 0.005); contralateral knee JSN (P = 0.001), knee OST (P = 0.006) and knee malalignment (P = 0.08); and history of ankle injury or surgery of either ankle (P < 0.0001). At follow-up, scintigraphic abnormalities of the ankle were strongly associated with presence of tibiotalar radiographic OA (P < 0.0001). CONCLUSIONS Although considered rare, we observed a high prevalence of radiographic features of ankle OA in this knee OA cohort. History of overt ankle injury did not appear to account for the majority of ankle abnormalities. These results are consistent with a probable kinematic association of knee OA pathology and contralateral ankle abnormalities and suggest that interventions targeting mechanical factors may be needed to prevent ankle OA in the setting of knee OA.
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Affiliation(s)
- V B Kraus
- Departments of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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133
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Zaidi R, Cro S, Gurusamy K, Sivanadarajah N, Macgregor A, Henricson A, Goldberg A. The outcome of total ankle replacement. Bone Joint J 2013; 95-B:1500-7. [DOI: 10.1302/0301-620x.95b11.31633] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We performed a systematic review and meta-analysis of modern total ankle replacements (TARs) to determine the survivorship, outcome, complications, radiological findings and range of movement, in patients with end-stage osteoarthritis (OA) of the ankle who undergo this procedure. We used the methodology of the Cochrane Collaboration, which uses risk of bias profiling to assess the quality of papers in favour of a domain-based approach. Continuous outcome scores were pooled across studies using the generic inverse variance method and the random-effects model was used to incorporate clinical and methodological heterogeneity. We included 58 papers (7942 TARs) with an interobserver reliability (Kappa) for selection, performance, attrition, detection and reporting bias of between 0.83 and 0.98. The overall survivorship was 89% at ten years with an annual failure rate of 1.2% (95% confidence interval (CI) 0.7 to 1.6). The mean American Orthopaedic Foot and Ankle Society score changed from 40 (95% CI 36 to 43) pre-operatively to 80 (95% CI 76 to 84) at a mean follow-up of 8.2 years (7 to 10) (p < 0.01). Radiolucencies were identified in up to 23% of TARs after a mean of 4.4 years (2.3 to 9.6). The mean total range of movement improved from 23° (95% CI 19 to 26) to 34° (95% CI 26 to 41) (p = 0.01). Our study demonstrates that TAR has a positive impact on patients’ lives, with benefits lasting ten years, as judged by improvement in pain and function, as well as improved gait and increased range of movement. However, the quality of evidence is weak and fraught with biases and high quality randomised controlled trials are required to compare TAR with other forms of treatment such as fusion. Cite this article: Bone Joint J 2013;95-B:1500–7.
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Affiliation(s)
- R. Zaidi
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - S. Cro
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - K. Gurusamy
- University College London, Department
of Surgery, Royal Free Campus, Pond
Street, London NW3 2QG, UK
| | - N. Sivanadarajah
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - A. Macgregor
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
| | - A. Henricson
- Falu Central Hospital, Department
of Orthopaedic Surgery, Falun, Sweden
| | - A. Goldberg
- UCL Institute of Orthopaedics & Musculoskeletal Science, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, UK
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134
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Validation of PROMIS ® Physical Function computerized adaptive tests for orthopaedic foot and ankle outcome research. Clin Orthop Relat Res 2013; 471:3466-74. [PMID: 23749433 PMCID: PMC3792246 DOI: 10.1007/s11999-013-3097-1] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In 2012, the American Orthopaedic Foot & Ankle Society(®) established a national network for collecting and sharing data on treatment outcomes and improving patient care. One of the network's initiatives is to explore the use of computerized adaptive tests (CATs) for patient-level outcome reporting. QUESTIONS/PURPOSES We determined whether the CAT from the NIH Patient Reported Outcome Measurement Information System(®) (PROMIS(®)) Physical Function (PF) item bank provides efficient, reliable, valid, precise, and adequately covered point estimates of patients' physical function. METHODS After informed consent, 288 patients with a mean age of 51 years (range, 18-81 years) undergoing surgery for common foot and ankle problems completed a web-based questionnaire. Efficiency was determined by time for test administration. Reliability was assessed with person and item reliability estimates. Validity evaluation included content validity from expert review and construct validity measured against the PROMIS(®) Pain CAT and patient responses based on tradeoff perceptions. Precision was assessed by standard error of measurement (SEM) across patients' physical function levels. Instrument coverage was based on a person-item map. RESULTS Average time of test administration was 47 seconds. Reliability was 0.96 for person and 0.99 for item. Construct validity against the Pain CAT had an r value of -0.657 (p < 0.001). Precision had an SEM of less than 3.3 (equivalent to a Cronbach's alpha of ≥ 0.90) across a broad range of function. Concerning coverage, the ceiling effect was 0.32% and there was no floor effect. CONCLUSIONS The PROMIS(®) PF CAT appears to be an excellent method for measuring outcomes for patients with foot and ankle surgery. Further validation of the PROMIS(®) item banks may ultimately provide a valid and reliable tool for measuring patient-reported outcomes after injuries and treatment.
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135
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Buckwalter JA, Anderson DD, Brown TD, Tochigi Y, Martin JA. The Roles of Mechanical Stresses in the Pathogenesis of Osteoarthritis: Implications for Treatment of Joint Injuries. Cartilage 2013; 4:286-294. [PMID: 25067995 PMCID: PMC4109888 DOI: 10.1177/1947603513495889] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Excessive joint surface loadings, either single (acute impact event) or repetitive (cumulative contact stress), can cause the clinical syndrome of osteoarthritis (OA). Despite advances in treatment of injured joints, the risk of OA following joint injuries has not decreased in the last 50 years. Cumulative excessive articular surface contact stress that leads to OA results from post-traumatic joint incongruity and instability, and joint dysplasia, but also may cause OA in patients without known joint abnormalities. In vitro investigations show that excessive articular cartilage loading triggers release of reactive oxygen species (ROS) from mitochondria, and that these ROS cause chondrocyte death and matrix degradation. Preventing release of ROS or inhibiting their effects preserves chondrocytes and their matrix. Fibronectin fragments released from articular cartilage subjected to excessive loads also stimulate matrix degradation; inhibition of molecular pathways initiated by these fragments prevents this effect. Additionally, injured chondrocytes release alarmins that activate chondroprogentior cells in vitro that propogate and migrate to regions of damaged cartilage. These cells also release chemokines and cytokines that may contribute to inflammation that causes progressive cartilage loss. Distraction and motion of osteoarthritic human ankles can promote joint remodeling, decrease pain and improve joint function in patients with end-stage post-traumatic OA. These advances in understanding of how altering mechanical stresses can lead to remodeling of osteoarthritic joints and how excessive stress causes loss of articular cartilage, including identification of mechanically induced mediators of cartilage loss, provide the basis for new biologic and mechanical approaches to the prevention and treatment of OA.
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Affiliation(s)
- Joseph A. Buckwalter
- Department of Orthopaedics and Rehabilitation and Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Iowa City Veterans Administration Medical Center, Iowa City, IA, USA
| | - Donald D. Anderson
- Department of Orthopaedics and Rehabilitation and Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Thomas D. Brown
- Department of Orthopaedics and Rehabilitation and Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Yuki Tochigi
- Department of Orthopaedics and Rehabilitation and Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
- Department of Orthopaedics, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - James A. Martin
- Department of Orthopaedics and Rehabilitation and Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
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Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. J Orthop Sports Phys Ther 2013; 43:585-91. [PMID: 23902805 DOI: 10.2519/jospt.2013.0303] [Citation(s) in RCA: 312] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The International Ankle Consortium is an international community of researchers and clinicians whose primary scholastic purpose is to promote scholarship and dissemination of research-informed knowledge related to pathologies of the ankle complex. The constituents of the International Ankle Consortium and other similar organizations have yet to properly define the clinical phenomenon known as chronic ankle instability (CAI) and its related characteristics for consistent patient recruitment and advancement of research in this area. Although research on CAI and awareness of its impact on society and healthcare systems have grown substantially in the last 2 decades, the inconsistency in participant/patient selection criteria across studies presents a potential obstacle to addressing the problem properly. This major gap within the literature limits the ability to generalize this evidence to the target patient population. Therefore, there is a need to provide standards for patient/participant selection criteria in research focused on CAI, with justifications using the best available evidence.
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137
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Baumhauer JF. Ankle arthrodesis versus ankle replacement for ankle arthritis. Clin Orthop Relat Res 2013; 471:2439-42. [PMID: 23728887 PMCID: PMC3705040 DOI: 10.1007/s11999-013-3084-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/21/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Judith F. Baumhauer
- Department of Orthopaedics, University of Rochester School of Medicine, 601 Elmwood Ave., P.O. Box 665, Rochester, NY 14642 USA
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138
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Sota T, Matsuo S, Uchida Y, Hagino H, Kawai Y. Effects of lower body positive pressure on cardiovascular responses during walking in elderly women. Physiol Res 2013; 62:653-62. [PMID: 23869890 DOI: 10.33549/physiolres.932459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study was undertaken to investigate the effects of lower body positive pressure (LBPP) on cardiovascular responses during a 15-min walking trial in young (22.1+/-0.4 years) and elderly women (67.8+/-1.1 years). The application of 20 mm Hg LBPP reduced ground reaction forces by 31.2+/-0.5 kgw in both groups. We hypothesized that cardiovascular responses to LBPP during walking were different between the young and elderly subjects. Applying 20 mm Hg of LBPP increased diastolic and mean blood pressure but not systolic blood pressure in both groups. LBPP-induced reduction in heart rate (HR) occurred more quickly in the young group compared to the elderly group (p<0.05). Applying LBPP also decreased double product (systolic blood pressure x HR) in both groups, suggesting that LBPP reduces myocardial oxygen consumption during exercise. These results suggest that heart rate responses to LBPP during exercise vary with increasing age.
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Affiliation(s)
- T Sota
- Department of Rehabilitation, Tottori University Hospital, Yonago, Japan.
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139
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Alterations in Gait Initiation Are Present in Those With Posttraumatic Ankle Osteoarthritis: A Pilot Study. J Appl Biomech 2013; 29:245-52. [DOI: 10.1123/jab.29.3.245] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this investigation was to determine if stereotypical patterns of gait initiation are altered in those with posttraumatic ankle osteoarthritis. Ten subjects, five with unilateral ankle osteoarthritis and five uninjured controls, participated. Subjects completed the SF-36 and Ankle Osteoarthritis Scale to quantify self-reported disability as well as 10 dual-limb static stance trials and 10 gait initiation trials with each leg. Center of pressure outcomes were calculated for static balance trials while the peak center of pressure excursions were calculated for each phase of gait initiation. The results indicate greater self-reported disability (P< .05) and worse static postural control (P< .05) in the ankle osteoarthritis group. Nonstereotypical patterns were also observed during the first and third phases of gait initiation in those with ankle osteoarthritis. The results of this pilot study suggest that supraspinal motor control mechanisms may have changed in those with posttraumatic ankle osteoarthritis.
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140
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Zaidi R, Pfeil M, Macgregor AJ, Goldberg A. How do patients with end-stage ankle arthritis decide between two surgical treatments? A qualitative study. BMJ Open 2013; 3:bmjopen-2013-002782. [PMID: 23864209 PMCID: PMC3717458 DOI: 10.1136/bmjopen-2013-002782] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To examine how patients decide between ankle fusion and ankle replacement in end-stage ankle arthritis. DESIGN Purposive patient selection, semistructured interviews, thematic analysis. SETTING Royal National Orthopaedic Hospital, Stanmore, UK. PARTICIPANTS 14 patients diagnosed with end-stage ankle osteoarthritis. RESULTS We interviewed 6 men and 8 women with a mean age of 58 years (range 41-83). All had opted for surgery after failure of at least 6 months of conservative management, sequentially trading-off daily activities to limit the evolving pain. To decide between two offered treatments of ankle fusion and total ankle replacement (TAR), three major sources informed the patients' decision-making process: their surgeon, peers and the internet. The treating surgeon was viewed as the most reliable and influential source of information. Information gleaned from other patients was also important, but with questionable reliability, as was information from the internet, both of which invariably required validation by the surgeon and in some cases the general practitioner. CONCLUSIONS Patients seek knowledge from a wealth of sources including the internet, web forums and other patients. While they leverage each of these sources to guide decision-making, the most important and influential factor in governing how patients decide on any particular surgical intervention is their surgeon. A high quality doctor-patient relationship, coupled with clear, balanced and complete information is essential to enable shared decision-making to become a standard model of care.
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Affiliation(s)
- Razi Zaidi
- Institute of Orthopaedics and Musculoskeletal Science (IOMS), Royal National Orthopaedic Hospital (RNOH), University College London, London, UK
| | - Michael Pfeil
- Faculty of Medicine and Health Sciences, School of Nursing Sciences, University of East Anglia, Norwich, UK
| | - Alexander J Macgregor
- Institute of Orthopaedics and Musculoskeletal Science (IOMS), Royal National Orthopaedic Hospital (RNOH), University College London, London, UK
| | - Andy Goldberg
- Institute of Orthopaedics and Musculoskeletal Science (IOMS), Royal National Orthopaedic Hospital (RNOH), University College London, London, UK
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141
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Arnold BL, Wright CJ, Ross SE. Functional ankle instability and health-related quality of life. J Athl Train 2012; 46:634-41. [PMID: 22488189 DOI: 10.4085/1062-6050-46.6.634] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
CONTEXT To our knowledge, no authors have assessed health-related quality of life (HR-QOL) in participants with functional ankle instability (FAI). Furthermore, the relationships between measures of ankle functional limitation and HR-QOL are unknown. OBJECTIVE To use the Short Form-36v2 Health Survey (SF-36) to compare HR-QOL in participants with or without FAI and to determine whether HR-QOL was related to functional limitation. DESIGN Cross-sectional study. SETTING Sports medicine research laboratory. PATIENTS OR OTHER PARTICIPANTS Sixty-eight participants with FAI (defined as at least 1 lateral ankle sprain and 1 episode of giveway per month) or without FAI were recruited (FAI group: n = 34, age = 25 ± 5 years, height = 1.71 ± 0.08 m, mass = 74.39 ± 12.78 kg, Cumberland Ankle Instability Tool score = 19.3 ± 4; uninjured [UI] group: n = 34, age = 23 ± 4 years, height = 1.69 ± 0.08 m, mass = 67.94 ± 11.27 kg, Cumberland Ankle Instability Tool score = 29.4 ± 1). MAIN OUTCOME MEASURE(S) All participants completed the SF-36 as a measure of HR-QOL and the Foot and Ankle Ability Measure (FAAM) and the FAAM Sport version (FAAMS) as assessments of functional limitation. To compare the FAI and UI groups, we calculated multiple analyses of variance followed by univariate tests. Additionally, we correlated the SF-36 summary component scale and domain scales with the FAAM and FAAMS scores. RESULTS Participants with FAI had lower scores on the SF-36 physical component summary (FAI = 54.4 ± 5.1, UI = 57.8 ± 3.7, P = .005), physical function domain scale (FAI = 54.5 ± 3.8, UI = 56.6 ± 1.2, P = .004), and bodily pain domain scale (FAI = 52.0 ± 6.7, UI = 58.5 ± 5.3, P < .005). Similarly, participants with FAI had lower scores on the FAAM (FAI = 93.7 ± 8.4, UI = 99.5 ± 1.4, P < .005) and FAAMS (FAI = 84.5 ± 8.4, UI = 99.8 ± 0.72, P < .005) than did the UI group. The FAAM score was correlated with the physical component summary scale (r = 0.42, P = .001) and the physical function domain scale (r = 0.61, P < .005). The FAAMS score was correlated with the physical function domain scale (r = 0.47, P < .005) and the vitality domain scale (r = 0.36, P = .002). CONCLUSIONS Compared with UI participants, those with FAI had less HR-QOL and more functional limitations. Furthermore, positive correlations were found between HR-QOL and functional limitation measures. This suggests that ankle impairment may reduce overall HR-QOL.
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Affiliation(s)
- Brent L Arnold
- Virginia Commonwealth University, Richmond, VA 23284, USA.
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142
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Abstract
Taking into account numerous individual criteria, the correct indication substantially influences the outcome of patients with end-stage ankle arthritis treated by ankle arthrodesis or total ankle replacement. The purpose of this report is to assist the foot and ankle surgeon or orthopedic surgeon involved in choosing ankle arthrodesis or total ankle replacement in decision-making. Balancing the criteria that are discussed in consideration of the recent relevant literature and evidence available, the surgeon is directed to the correct individual decision.
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143
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McIlwraith CW, Frisbie DD, Kawcak CE. The horse as a model of naturally occurring osteoarthritis. Bone Joint Res 2012; 1:297-309. [PMID: 23610661 PMCID: PMC3626203 DOI: 10.1302/2046-3758.111.2000132] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 09/24/2012] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis (OA) is an important cause of
pain, disability and economic loss in humans, and is similarly important in
the horse. Recent knowledge on post-traumatic OA has suggested opportunities
for early intervention, but it is difficult to identify the appropriate
time of these interventions. The horse provides two useful mechanisms
to answer these questions: 1) extensive experience with clinical
OA in horses; and 2) use of a consistently predictable model of
OA that can help study early pathobiological events, define targets
for therapeutic intervention and then test these putative therapies.
This paper summarises the syndromes of clinical OA in horses including
pathogenesis, diagnosis and treatment, and details controlled studies
of various treatment options using an equine model of clinical OA.
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Affiliation(s)
- C W McIlwraith
- Orthopaedic Research Center, Colorado State University, 300 West Drake Road, Fort Collins, Colorado 80523, USA
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144
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Cronkey J, LaPorta G. Rating systems for evaluation of functional ankle instability: prospective evaluation in a cohort of patients treated with monopolar capacitive-coupled radiofrequency. Foot Ankle Spec 2012; 5:293-9. [PMID: 23008239 DOI: 10.1177/1938640012457941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Evaluation of patient outcomes should include the use of validated scoring systems to determine disease-specific outcomes. Many scoring systems are being used for disorders of the ankle joint. However, not all instruments are capable of detecting changes associated with functional ankle instability (FAI), since their focus is toward pathological entities with greater impact on individual's physical and mental well-being. METHODS In this prospective study, 6 instruments were used to evaluate outcomes associated with an intervention aimed at improving FAI. Twenty ankles that had been unsuccessfully treated for FAI were treated with a single session of noninvasive monopolar capacitive-coupled radiofrequency (mcRF) and followed prospectively. RESULTS Five out of 6 instruments failed to show changes that could be correlated with patients' outcomes. Only one instrument, the Cumberland Ankle Instability Tool (CAIT) demonstrated enough sensitivity and correlated well with meaningful clinical differences. Based on study's success criteria (proper function, no pain, no adverse events, and patient satisfaction), 78% of the ankles treated had successful outcomes whereas 87.5% evidenced significant improvement based on CAIT (P < .001). No adverse events were present during the study. CONCLUSIONS The study of FAI is hampered by the lack of disease-specific questionnaires, which oftentimes introduce ceiling or flooring effects. The CAIT was capable of detecting changes in patients' condition and response to the noninvasive mcRF procedure without evidencing ceiling or flooring effects. In this study, the CAIT was found to be reliable, valid, sensitive to changes of clinical importance, in addition to being short and practical to use.
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145
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Ketz J, Myerson M, Sanders R. The salvage of complex hindfoot problems with use of a custom talar total ankle prosthesis. J Bone Joint Surg Am 2012; 94:1194-200. [PMID: 22760387 DOI: 10.2106/jbjs.k.00421] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been recent interest in the use of a custom long-stemmed talar component for salvage of failed total ankle replacement or for management of combined ankle and hindfoot pathology. The purpose of this study was to retrospectively review prospective data on patients who underwent total ankle arthroplasty with a custom long-stemmed talar prosthesis. METHODS From November 2004 to February 2006, thirty-three custom total ankle arthroplasties were performed in thirty-two patients. The indication for this prosthesis was stage-IV adult-acquired flatfoot deformity in six patients (19%), failure of a prior total ankle replacement because of severe subsidence and loosening of the talar component in thirteen (41%), and combined arthritis of the ankle and hindfoot joints in thirteen patients (41%; fourteen ankles). Patients were assessed for range of motion, radiographic results, and functional outcomes with use of the Short Form-36 (SF-36) subscale scores, American Orthopaedic Foot & Ankle (AOFAS) hindfoot score, and the Maryland Foot Score (MFS) at a minimum of four years. RESULTS All patients were followed for an average of 58.6 months (minimum, fifty-two months) There was an overall increase in the total arc of motion following surgery from an average (and standard deviation) of 21.3° ± 14° preoperatively to 32.2° ± 11° postoperatively (p < 0.05). Subsidence (<3 mm) was noted in three patients. One patient had asymptomatic osteolysis around the talar stem. The mean Physical Component Summary score on the SF-36 was 28.2 ± 5.6 preoperatively and increased to 39.7 ± 6.5 postoperatively (p < 0.05). The mean SF-36 Mental Component Summary value increased from 42.2 ± 13.8 preoperatively to 50.8 ± 12.6 postoperatively (p < 0.05). The mean MFS was 47 ± 13 preoperatively and increased to 75 ± 10 postoperatively (p < 0.05). The average AOFAS hindfoot score increased from 41 ± 16 preoperatively to 68 ± 12 postoperatively (p < 0.05). There were three failures at greater than thirty-six months after surgery. CONCLUSIONS Our data indicate that the use of a custom long-stemmed talar component, either placed primarily in patients with ankle and hindfoot arthritis or used as a revision prosthesis in patients with a failed total ankle replacement, is promising.
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Affiliation(s)
- John Ketz
- Florida Orthopaedic Institute, Tampa, Florida, USA.
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146
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Schuh R, Hofstaetter J, Krismer M, Bevoni R, Windhager R, Trnka HJ. Total ankle arthroplasty versus ankle arthrodesis. Comparison of sports, recreational activities and functional outcome. INTERNATIONAL ORTHOPAEDICS 2011; 36:1207-14. [PMID: 22173565 DOI: 10.1007/s00264-011-1455-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 11/29/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE Ankle arthrodesis (AAD) and total ankle replacement (TAR) are the major surgical treatment options for severe ankle arthritis. There is an ongoing discussion in the orthopaedic community whether ankle arthrodesis or ankle fusion should be the treatment of choice for end stage osteoarthritis. The purpose of this study was to compare the participation in sports and recreational activities in patients who underwent either AAD or TAR for end-stage osteoarthritis of the ankle. METHODS A total of 41 patients (21 ankle arthrodesis /20 TAR) were examined at 34.5 (SD18.0) months after surgery. At follow-up, pre- and postoperative participation in sports and recreational activities has been assessed. Activity levels were determined using the ankle activity score according to Halasi et al. and the University of California at Los Angeles (UCLA) activity scale. Clinical and functional outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. The percentage of patients participating in sports and recreational activities, UCLA score and AOFAS score were compared between both treatment groups. RESULTS In the AAD group 86% were active in sports preoperatively and in the TAR group this number was 76%. Postoperatively in both groups 76% were active in sports (AAD, p = 0.08). The UCLA score was 7.0 (± 1.9) in the AAD group and 6.8 (± 1.8) in the TAR group (p = 0.78). The AOFAS score reached 75.6 (± 14) in the AAD group and 75.6 (± 16) in the TAR group (p = 0.97). The ankle activity score decrease was statistically significant for both groups (p = 0.047). CONCLUSIONS Our study revealed no significant difference between the groups concerning activity levels, participation in sports activities, UCLA and AOFAS score. After AAD the number of patients participating in sports decreased. However, this change was not statistically significant.
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Affiliation(s)
- Reinhard Schuh
- Department of Orthopaedics, Medical University of Vienna, Vienna, Austria.
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147
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Queen RM, Carter JE, Adams SB, Easley ME, DeOrio JK, Nunley JA. Coronal plane ankle alignment, gait, and end-stage ankle osteoarthritis. Osteoarthritis Cartilage 2011; 19:1338-42. [PMID: 21875677 DOI: 10.1016/j.joca.2011.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 06/22/2011] [Accepted: 07/29/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Unilateral ankle osteoarthritis (OA) is a debilitating condition which may lead to limb deformity, severe pain, and functional disability due to tibiotalar malalignment and gait dysfunction. The purpose of this study was to determine if coronal plane alignment (varus, valgus, or neutral) of the ankle resulted in different spatial-temporal gait mechanics, clinically-assessed function, and self-reported function in patients with end-stage ankle OA. METHODS Following informed consent, 96 patients with end-stage unilateral ankle OA were radiographically categorized as having varus, valgus, or neutral tibiotalar alignment. Each subject completed the foot and ankle disability index (FADI) questionnaire to assess self-reported function. The spatial-temporal parameters of interest (stance time, step length, stride length, stride width, single-support time, double support time, and walking speed) were assessed while the subject walked at a self-selected speed. RESULTS The varus group performed the timed up and go test significantly faster than the other groups (P=0.05). All other variables were similar between the three alignment groups. CONCLUSION There was little difference in gait mechanics and function between patients with end-stage OA based on coronal plane ankle alignment suggesting that factors other than coronal plane alignment contribute to diminished function.
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Affiliation(s)
- R M Queen
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
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148
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Chu CR, Beynnon BD, Buckwalter JA, Garrett WE, Katz JN, Rodeo SA, Spindler KP, Stanton RA. Closing the gap between bench and bedside research for early arthritis therapies (EARTH): report from the AOSSM/NIH U-13 Post-Joint Injury Osteoarthritis Conference II. Am J Sports Med 2011; 39:1569-78. [PMID: 21730208 PMCID: PMC3182453 DOI: 10.1177/0363546511411654] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This report summarizes the 2010 AOSSM/NIH (American Orthopaedic Society for Sports Medicine/National Institutes of Health) U13 Post-Joint Injury Osteoarthritis II Conference to include the discussion concerning potential study cohorts, assessment considerations, and research priorities. There was strong consensus and enthusiasm for approaching the development of disease-modifying treatments for osteoarthritis through study of "pre-osteoarthritic" cohorts, particularly human subjects under 30 years of age following acute anterior cruciate ligament injuries. Clinical study of acute treatment strategies initiated within a few days after injury will need development of recruitment pathways and short-term proof-of-concept outcome measures that are specific to the intervention being studied. For example, measures of joint inflammation can be used in short-term prospective randomized controlled trials to determine whether an anti-inflammatory intervention was effective in decreasing early inflammation. These short-term clinical trials will need to be followed by longer-term evaluation of the clinical cohorts for joint and cartilage degeneration to determine if the acute intervention affected later development of osteoarthritis. Research priorities were identified in several disciplines, particularly regarding development and validation of quantitative imaging, biomechanics, and biomarker measures of joint structure, composition, and function that predict the accelerated development of osteoarthritis. Systematic study of posttraumatic osteoarthritis is anticipated to advance understanding and treatment of all forms of osteoarthritis.
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Affiliation(s)
- Constance R. Chu
- University of Pittsburgh, Department of Orthopaedic Surgery, Cartilage Restoration Center, Pittsburgh, Pennsylvania.,Address correspondence to Constance R. Chu, MD, University of Pittsburgh, Department of Orthopaedic Surgery, Cartilage Restoration Center, 3471 Fifth Ave, Suite 911, Pittsburgh, PA 15213
| | - Bruce D. Beynnon
- University of Vermont College of Medicine, Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, Burlington, Vermont
| | | | | | - Jeffrey N. Katz
- Brigham and Women’s Hospital, Division of Rheumatology, Immunology and Allergy, Boston, Massachusetts
| | - Scott A. Rodeo
- Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York
| | - Kurt P. Spindler
- Vanderbilt University, Department of Orthopaedic Surgery, Nashville, Tennessee
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149
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Schuh R, Hofstaetter JG, Hofstaetter SG, Adams SB, Kristen KH, Trnka HJ. Plantar pressure distribution after tibiotalar arthrodesis. Clin Biomech (Bristol, Avon) 2011; 26:620-5. [PMID: 21392869 DOI: 10.1016/j.clinbiomech.2011.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 02/02/2011] [Accepted: 02/02/2011] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Arthrodesis is a well-established treatment option for end-stage osteoarthritis of the ankle. Osteoarthritis of the ankle can alter plantar pressure distribution. However, surprisingly little is known about the effect of ankle arthrodesis to alter plantar pressure distribution. The purpose of this study was to determine plantar pressure distribution in a selected group of patients with unilateral arthrodesis of the ankle joint. METHODS 20 patients with an average age of 60 years who underwent isolated unilateral ankle arthrodesis using a 3-crossed screw technique by a single surgeon were included. After a mean of 25 months (range 12-75 months) post surgery plantar pressure distribution was determined in five regions of the foot. The outcome was evaluated clinically, using the American Orthopaedic Foot and Ankle Society hindfoot score, as well as radiographically. The contralateral normal foot was used as a control. FINDINGS Comparing the foot that underwent tibiotalar arthrodesis to the contralateral normal foot, differences were found in the peak pressure and maximum force in the toe region and the lateral midfoot region. In addition, a decrease in the contact time in the forefoot region and a decrease of the contact area in the toe region of the operated foot were identified. The other regions did not show a significant difference. The mean American Orthopaedic Foot and Ankle Society score of the operated leg was 79 (range 46-92) at the last follow up, and the mean fixation angle of the arthrodesis on lateral weight bearing radiographs was 90° (range 86°-100°). INTERPRETATION Our results indicate that arthrodesis of the ankle joint can provide high levels of function with minimal changes in the plantar pressure distribution.
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Affiliation(s)
- Reinhard Schuh
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria.
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150
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Barton T, Lintz F, Winson I. Biomechanical changes associated with the osteoarthritic, arthrodesed, and prosthetic ankle joint. Foot Ankle Surg 2011; 17:52-7. [PMID: 21549972 DOI: 10.1016/j.fas.2011.01.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 12/23/2010] [Accepted: 01/13/2011] [Indexed: 02/04/2023]
Affiliation(s)
- Tristan Barton
- Department of Trauma and Orthopaedics, Avon Orthopaedic Centre, Southmead Hospital, Bristol, United Kingdom.
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