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Shah AA, Devana SK, Lee C, SooHoo NF. A predictive algorithm for perioperative complications and readmission after ankle arthrodesis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1373-1379. [PMID: 38175277 DOI: 10.1007/s00590-023-03805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Ankle arthrodesis is a mainstay of surgical management for ankle arthritis. Accurately risk-stratifying patients who undergo ankle arthrodesis would be of great utility. There is a paucity of accurate prediction models that can be used to pre-operatively risk-stratify patients for ankle arthrodesis. We aim to develop a predictive model for major perioperative complication or readmission after ankle arthrodesis. METHODS This is a retrospective cohort study of adult patients who underwent ankle arthrodesis at any non-federal California hospital between 2015 and 2017. The primary outcome is readmission within 30 days or major perioperative complication. We build logistic regression and ML models spanning different classes of modeling approaches, assessing discrimination and calibration. We also rank the contribution of the included variables to model performance for prediction of adverse outcomes. RESULTS A total of 1084 patients met inclusion criteria for this study. There were 131 patients with major complication or readmission (12.1%). The XGBoost algorithm demonstrates the highest discrimination with an area under the receiver operating characteristic curve of 0.707 and is well-calibrated. The features most important for prediction of adverse outcomes for the XGBoost model include: diabetes, peripheral vascular disease, teaching hospital status, morbid obesity, history of musculoskeletal infection, history of hip fracture, renal failure, implant complication, history of major fracture. CONCLUSION We report a well-calibrated algorithm for prediction of major perioperative complications and 30-day readmission after ankle arthrodesis. This tool may help accurately risk-stratify patients and decrease likelihood of major complications.
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Affiliation(s)
- Akash A Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-116 CHS, Los Angeles, CA, 90095, USA.
| | - Sai K Devana
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-116 CHS, Los Angeles, CA, 90095, USA
| | - Changhee Lee
- Department of Artificial Intelligence, Chung-Ang University School of Software and Computer Engineering, Seoul, South Korea
| | - Nelson F SooHoo
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-116 CHS, Los Angeles, CA, 90095, USA
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Glazebrook JM, Glazebrook HM, Glazebrook MA, Morash JG. Ankle arthrodesis or total ankle arthroplasty surgery for end stage ankle arthritis, which is best? A review of the best available evidence. Foot Ankle Surg 2024; 30:1-6. [PMID: 37580181 DOI: 10.1016/j.fas.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND End Stage Ankle Arthritis (ESAA) causes pain and dysfunction. It is treated effectively with Total Ankle Arthroplasty (TAA) or Ankle Arthrodesis (AA). Currently there is no consensus on which surgical procedure is superior. This paper will provide a systematic review of all published high-quality studies directly comparing TAA and AA for the surgical treatment of ESAA to determine superiority. METHODS A comprehensive literature review of the highest quality studies published that directly compare clinical outcomes of TAA and AA for surgical treatment of ESAA was conducted. Each study was assigned a Level of Evidence (LOE) rating (I-III) and then summarized to assign a grade of recommendation (A-C, I). Superiority was determined for the clinical outcomes of pain, activity, Health Related Quality of Life (HRQL), readmission to hospital, revision surgery and general complications. RESULTS There is fair evidence (GOR B) that supports both TAA and AA for the surgical treatment of ESAA. However, TAA trended to be superior for pain relief (GOR B), activity (GOR B), health related quality of life (GOR B) and readmission rate (GOR B) while AA trended to be superior for revision rates (GOR B). Conflicting evidence was presented for general complications (GOR C) CONCLUSION: Due to the lack of level I papers and the findings from the papers reviewed not being consistent, no definitive conclusion on which procedure is better can be made. However, there is enough evidence to provide a basis for which procedure is more effective in each of the outcomes reviewed. This should be considered when deciding on which procedure is best suited for a patient on a case-by-case basis. To allow for a stronger recommendation, further studies-ideally, high-quality level I randomized control trials directly comparing Ankle Arthrodesis and Total Ankle Arthroplasty are needed. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- Jonah M Glazebrook
- Dalhousie University, Queen Elizabeth II Health Sciences Centre Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax Nova, Scotia B3H 3A7, Canada.
| | - Haley M Glazebrook
- Dalhousie University, Queen Elizabeth II Health Sciences Centre Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax Nova, Scotia B3H 3A7, Canada.
| | - Mark A Glazebrook
- Dalhousie University, Queen Elizabeth II Health Sciences Centre Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax Nova, Scotia B3H 3A7, Canada.
| | - Joel G Morash
- Dalhousie University, Queen Elizabeth II Health Sciences Centre Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax Nova, Scotia B3H 3A7, Canada.
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Hermus JPS, van Kuijk SM, Witlox MA, Poeze M, van Rhijn LW, Arts JJ. Alignment of CCI total ankle replacements in relation to midterm functional outcome and complication incidence. J Foot Ankle Res 2023; 16:34. [PMID: 37291623 DOI: 10.1186/s13047-023-00630-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Total ankle arthroplasty is increasingly used as a treatment for end stage ankle arthropathy. The aim of this study was to report the mid-term clinical function and survival results of Ceramic Coated Implant (CCI) ankle replacements and assess the association between the alignment of the CCI total ankle replacements and early functional outcome and complication incidence. METHODS Data of 61 patients, who received 65 CCI implants between 2010 and 2016, were obtained from a prospectively documented database. Mean follow-up time was 85.2 months (range 27-99 months). Clinical function was assessed with AOFAS questionnaire and passive range of motion (ROM). Survival analysis and elaborate radiographic analysis was performed. Furthermore, complications and reoperations were recorded for all patients. RESULTS Progression in ROM was most seen in the first 10 months from 21.8 degrees of passive range of motion preoperative to 27.6 degrees postoperative (p < 0.001), while the mean AOFAS gradually increased during follow-up postoperative from a mean of 40.9 points preoperative to an average of 82.5 but shows a small decline towards the end of follow-up (p < 0.001). During follow-up we recorded 8 failures (12.3%) resulting in a Kaplan-Meier survival analysis of 87.7% with a median follow-up of 85.2 months. CONCLUSION We observed excellent clinical results and survival after TAA with the CCI implant with only a low mid-term complication rate. LEVEL OF EVIDENCE Level III, prospective cohort study.
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Affiliation(s)
- Joris P S Hermus
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
| | - Sander M van Kuijk
- Department of Trauma Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marianne A Witlox
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Martijn Poeze
- Department of Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University, Maastricht, the Netherlands
| | - Lodewijk W van Rhijn
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Jacobus J Arts
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
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Safety and efficacy of total ankle arthroplasty versus ankle arthrodesis for ankle osteoarthritis: A systematic review and meta-analysis. Foot (Edinb) 2023; 55:101980. [PMID: 36863247 DOI: 10.1016/j.foot.2023.101980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/04/2023]
Abstract
Osteoarthritis is the most common joint disease-causing pain and disability, and its management keeps creating a debate. So, we aimed to compare the safety and efficacy of total ankle arthroplasty and ankle arthrodesis for ankle osteoarthritis. We searched PubMed, Cochrane, Scopus, and Web of Science till August 2021. The outcomes were pooled as Mean difference (MD) or Risk Ratio (RR), and 95% confidence interval. We included 36 studies. The results showed a significantly lower risk of infections in total ankle arthroplasty (TAA) than ankle arthrodesis (AA) (RR= 0.63, 95% CI [0.57, 0.70], p < 0.00001), amputations (RR= 0.40, 95% CI [0.22, 0.72], p = 0.002), postoperative non-union (RR= 0.11, 95% CI [0.03, 0.34], p = 0.0002), and a significant increase of overall range of motion in TAA than AA. Our results preferred total ankle arthroplasty over ankle arthrodesis in terms of lowering the rates of infections, amputations, and postoperative non-union, with better change in the overall range of motion.
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Ross BJ, Savage-Elliott I, Wu VJ, Rodriguez RF. Complications Following Total Ankle Arthroplasty Versus Ankle Arthrodesis for Primary Ankle Osteoarthritis. Foot Ankle Spec 2023; 16:20-27. [PMID: 33472419 DOI: 10.1177/1938640020987741] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There are minimal data comparing complications between ankle arthrodesis (AA) versus total ankle arthroplasty (TAR) for operative management of primary osteoarthritis (OA). This study aimed to compare outcomes following AA versus TAR for primary ankle OA using a large patient database. METHODS Patients who received AA or TAR for primary ankle OA from 2010 to 2019 were queried from PearlDiver. Rates of common joint complications were compared at 90 days, 1 year, and 2 years postoperatively using multivariable logistic regression. RESULTS A total of 1136 (67%) patients received AA and 584 (33%) patients underwent TAR. Patients that received AA exhibited significantly higher rates of at least one common joint complication at 90 days (19.3% vs 12.6%; odds ratio [OR] 1.69), 1 year (25.6% vs 15.0%; OR 2.00), and 2 years (26.9% vs 16.2%; OR 1.91) postoperatively. This included higher rates of adjacent fusion or osteotomy procedures, periprosthetic fractures, and hardware removal at each postoperative follow-up (all P < .05). Rates of prosthetic joint infection were comparable at 2 years postoperatively (4.3% vs 4.2%; OR 0.91). CONCLUSION The AA cohort exhibited higher rates of postoperative joint complications in the short and medium-term, namely, subsequent fusions or osteotomies, periprosthetic fractures, and hardware removal. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Bailey J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ian Savage-Elliott
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Victor J Wu
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ramon F Rodriguez
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Ross BJ, Savage-Elliott I, Wu VJ, Flick TR, Sherman WF, Rodriguez RF. Reoperation Rates Following Total Ankle Arthroplasty Versus Ankle Arthrodesis for Posttraumatic Indications. Foot Ankle Spec 2023; 16:50-56. [PMID: 33618546 DOI: 10.1177/1938640021993630] [Citation(s) in RCA: 1] [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
AIMS This studied aimed to compare rates of reoperation for patients who received primary ankle arthrodesis (AA) versus total ankle replacement (TAR) for posttraumatic indications between 2010 and 2016 Q2 using a nationwide claims database. METHODS A retrospective cohort study analyzing patients who received primary AA or TAR for posttraumatic indications was performed using PearlDiver. Reoperations assessed included prosthetic joint infection (PJI), hardware removal, adjacent joint fusion, and local open reduction internal fixation (ORIF). Multivariable logistic regression was used to compare rates of reoperations at 1 and 2 years postdischarge. RESULTS A total of 862 (74%) patients received AA and 318 (26%) patients underwent TAR for a posttraumatic indication. At 1 year, 305 (35.4%) AA patients had at least 1 reoperation compared with 55 (17.3%) TAR patients (OR 2.32; 95% CI, 1.68-3.26). At 2 years, 364 (42.2%) AA patients and 66 (20.8%) TAR patients had at least 1 reoperation (OR 2.51; 95% CI, 1.84-3.45). ORIF, hardware removal, and adjacent joint fusions were more likely for AA patients at both time intervals (all Ps < .05). CONCLUSION Patients who received primary AA for posttraumatic indications exhibited higher rates of major reoperations in the short to medium term compared with patients who underwent TAR. LEVELS OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- Bailey J Ross
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ian Savage-Elliott
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Victor J Wu
- Department of Orthopaedic Surgery, University of Texas, McGovern School of Medicine at UTHealth, Houston, Texas
| | - Travis R Flick
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ramon F Rodriguez
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Wu SX, Liu SZ, Ling M, Che YH, Tian X, Duan XL, Yi Z. A Novel Method for Preoperative Positioning of Total Ankle Replacement Using 3D Digital Model. Orthop Surg 2022; 14:1378-1384. [PMID: 35656705 PMCID: PMC9251280 DOI: 10.1111/os.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To establish a digital model of the ankle joint through 3D imaging technology and explore the preoperative placement of ankle replacement prostheses. METHODS Computed tomography images of intact ankle joints from 54 cases in the outpatient and inpatient departments of our hospital were collected; according to the INBONE® total ankle system surgery process, the surgery model and surgical osteotomy were finished using MIMICS based on computer simulation method. The shortest distance was measured between the center point and the anterior, posterior, medial, and lateral, respectively, to ensure the precise position of the ankle replacement prosthesis by digital simulation surgery. The relationship between the two variables was analyzed by bivariate correlation analysis. RESULTS The dataset of this study included 48 cases of the sub-data set (26 males and 22 females) and included 27 cases of left ankle and 21 cases of right ankle. The average medial malleolar angle was 18.67°± 2.87°, the average amount of bone resection was 12.13 ± 1.86 cm3 , the mid-anterior distance was 1.72 ± 0.19 cm, the mid-posterior distance was 2.00 ± 0.19 cm, the ratio of mid-anterior to mid-posterior was 0.87, the mid-medial distance was 1.26 ± 0.17 cm, the mid-lateral distance was 1.19 ± 0.16 cm, and the ratio of mid-medial to mid-lateral was 1.06. After osteotomy, the anteroposterior diameter was 3.73 ± 0.32 cm, the transverse diameter was 2.46 ± 0.27 cm, and the ratio of anteroposterior diameter to transverse diameter was 1.53. In the bottom view, the shape after osteotomy is rectangular. The mid-anterior distance was strongly negatively correlated with age, the mid-anterior distance and the amount of bone resection, the mid-medial distance and the amount of bone resection, the mid-lateral distance and the amount of bone resection, the mid-lateral distance and the anteroposterior diameter, the anteroposterior diameter and the transverse diameter were all strongly positively correlated. CONCLUSION The projection point of the lower tibia centerline on the tibial horizontal osteotomy surface is located at a position slightly anterior to the midpoint of the transverse diameter after ankle arthroplasty. The rational positioning of the total ankle replacement is located at both a position slightly anterior to the midpoint of the transverse diameter and midpoint of the anteroposterior diameter, which can be used as a reference method before total ankle arthroplasty surgery.
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Affiliation(s)
- Shi-Xun Wu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China.,The College of Life Sciences and Medicine, Northwest University, xi'an, China
| | - Shi-Zhang Liu
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ming Ling
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yan-Hui Che
- First Middle School of Xi'an City, Xi'an, China
| | - Xin Tian
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xiang-Long Duan
- The College of Life Sciences and Medicine, Northwest University, xi'an, China.,Second Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhi Yi
- Department of Orthopedics Surgery, Shaanxi Provincial People's Hospital, Xi'an Jiaotong University, Xi'an, China
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Monteagudo M, Martínez-de-Albornoz P. Deciding Between Ankle and Tibiotalocalcaneal Arthrodesis for Isolated Ankle Arthritis. Foot Ankle Clin 2022; 27:217-231. [PMID: 35219367 DOI: 10.1016/j.fcl.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
After isolated ankle (tibiotalar) arthrodesis, the triceps progressively shifts the subtalar joint into varus thus blocking compensatory motion from the midtarsal joints. In a tibiotalocalcaneal arthrodesis, the subtalar may be fixed with the correct valgus. Comparison between ankle and tibiotalocalcaneal arthrodesis does not clearly favor one over another for pain relief, satisfaction, and gait analysis. Compensatory sagittal plane motion through the midtarsal joints when the subtalar is fixed in valgus may be responsible for these results. Tibiotalocalcaneal arthrodesis has become our procedure of choice over isolated tibiotalar for end-stage ankle arthritis regardless of the radiographic state of the subtalar.
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Affiliation(s)
- Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Calle Diego de Velazquez 1, Pozuelo de Alarcon, 28223 Madrid, Spain.
| | - Pilar Martínez-de-Albornoz
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Calle Diego de Velazquez 1, Pozuelo de Alarcon, 28223 Madrid, Spain
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Kwon NF, Danilkowicz RM, Kim J, Grimm NL, Adams SB. Short-Term Complications Following Total Ankle Arthroplasty and Associated Risk Factors: A NSQIP Database Analysis. Foot Ankle Spec 2022:19386400211072379. [PMID: 35100911 DOI: 10.1177/19386400211072379] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Total ankle arthroplasty (TAA) has become increasingly utilized over the past 20 years to treat osteoarthritis of the ankle. The efficacy and safety of this procedure has been previously reported, but relatively few studies have documented the risk of postoperative complications associated with TAA over the past 10 years. Thus, the aim of this study is to provide a current report on the safety of TAA, particularly in association with a number of preoperative risk factors. METHODS A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent TAA between 2012 and 2018 was performed. A total of 1333 patients were included in this analysis. Penalized logistic regression to consider small numbers of the postoperative complications was used to identify factors associated with incidence of the complications. RESULTS The rate of readmission and superficial wound infection were found to be 1.4% and 0.6%, respectively. Risk factors associated with a prolonged hospital stay were black race, Hispanic race, and smoking. Diabetes was associated with a significantly increased risk of readmission. Age, sex, body mass index, and steroid use were not associated with increased risk of postoperative complications. CONCLUSION In this study, the rate of surgical site infection and readmission in TAA was found to be relatively low, compared to published data on total knee arthroplasty and total hip arthroplasty. Both race and smoking increase the risk of prolonged hospital stay, while diabetes increases the risk of readmission. LEVELS OF EVIDENCE Level III, retrospective comparative trial.
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Affiliation(s)
- Nicholas F Kwon
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | | | - Jaewhan Kim
- Department of Physical Therapy, The University of Utah, Salt Lake City, Utah
| | | | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Giardini P, Di Benedetto P, Mercurio D, Gisonni R, Molinari M, Causero A, Cortese F. Infinity ankle arthroplasty with traditional instrumentation and PSI prophecy system: preliminary results. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020021. [PMID: 33559635 PMCID: PMC7944708 DOI: 10.23750/abm.v91i14-s.10989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 02/01/2023]
Abstract
Ankle arthrodesis has been considered the surgical Gold Standard for advanced ankle arthritis; prosthetic replacement of the tibio-talar joint played a secondary role.The introduction of last generation ankle prostheses lead to better outcome and a lower rate of complication. PSI represents the most recent innovations introduced on the market of ankle arthroplasty:PSI is proposed as a surgical technique capable of making ankle arthroplasty more accurate and more reproducible compared to standard referencing guides Aim of the study is to report early clinical and radiographic outcomes obtained from a single surgeon experience by implanting the same ankle prosthesis using a standard (STD) or a PSI instrumentation Unlike no difference in the average increment of normalized sub score related to function in each group (PSI vs STD), the analysis of normalized pain sub score pointed out a greater average improvement in the PSI group(+75%)compared to the STD group(+62%);this result has been adovacated to the absence of post operative gutter impingement syndrome in the PSI group compared to the STD referencing group. The analysis of radiographic angles revealed a more accurate and reproducible positioning of the components in the PSI group; ankle arthroplasty performed with PSI reported a reduction of both surgical times and the need of intraop.fluoroscopy. PSI ankle arthroplasty achived more accurate and reproducible clinical and radiographic results compared to STD instrumentation;long-term follow-up are needed to demonstrate whether a better positioning of the implant is associated with an increased survival of the prosthesis and therefore justifies the additional costs of PSI.
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Affiliation(s)
| | - Paolo Di Benedetto
- Department of Orthopaedic Surgery, University Hospital of Udine, Udine, Italy.
| | - Domenico Mercurio
- Department of Orthopaedic Surgery, S. Maria della Misericordia Hospital, Rovereto, Italy.
| | - Renato Gisonni
- Department of Orthopaedic Surgery, University Hospital of Udine, Udine, Italy.
| | - Marco Molinari
- Department of Orthopaedic Surgery, Fiemme Hospital, Cavalese, Italy.
| | - Araldo Causero
- Department of Orthopaedic Surgery, University Hospital of Udine, Udine, Italy.
| | - Fabrizio Cortese
- Department of Orthopaedic Surgery, S. Maria della Misericordia Hospital, Rovereto, Italy.
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Daniels TR, Wilson IR, Fu JM. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2020; 102:856-865. [PMID: 32187125 DOI: 10.2106/jbjs.20.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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