Stimulation of ankle cartilage: other emerging technologies (cellular, electricomagnetic, etc.)

Healing in the new millennium: bone stimulators: an overview of where we've been and where we may be heading

Electromagnetic fields and their uses in bone healing have been fairly well studied, with most results showing improvement in healing of both bone and cartilage. Most supportive data are found in relation to the spine, femur, and tibia, but there is increasing evidence for its use in the foot and ankle for treatment of nonunions and as an adjunctive device in arthrodeses, particularly in high-risk populations. There are varying data and a significant variety of quality in the current research and publications concerning the use of electrical bone stimulation in the treatment of the foot and ankle. Thus, there is a definite need for further investigation and high-quality study designs to determine the most effective treatment modalities and pathologies best used with bone stimulation. Bone stimulation should be viewed as an adjunctive procedure in which the surgeon optimizes the high-risk patient both medically or surgically whenever possible. But when used appropriately, bone stimulation has the potential to influence outcomes and aid in bone healing when complications arise and in high-risk populations.

The total ankle arthroplasty learning curve with third-generation implants: a single surgeon's experience

BACKGROUND

Renewed interest in total ankle arthroplasty (TAA) has developed globally as a result of recent literature supporting new-generation implants as a viable alternative to arthrodesis. The literature also demonstrates a learning curve among surgeons adopting TAA. The purpose of this study is to better define this learning curve for surgeons using third-generation implants.

METHODS

Charts and radiographs were reviewed for the initial 26 TAA procedures performed by the senior author. Three third-generation implants were used: SBi (Small Bone Innovations) STAR, Salto Talaris, and Wright Medical INBONE. We report perioperative and early postoperative complications.

RESULTS

Two perioperative fractures occurred in the first 9 cases, and the incidence subsequently dropped to 0 (P = .0431). Two cases of component malalignment occurred in the first 3 patients receiving the STAR implant, and the incidence then dropped to 0 (P = .0034). Five wound complications (4 minor and 1 major) occurred, all in the final 14 patients. No cases of nerve injury, tendon laceration, or deep vein thrombosis occurred. Two patients returned to the operating room as a result of complications, and the total perioperative and early postoperative complication rate was 27%.

CONCLUSION

The observed rate of perioperative and early postoperative complications in this case series was low relative to other similar-sized studies, suggesting that third-generation implants can reduce adverse events. Our results demonstrate that some common complications could be avoided altogether (nerve/tendon injuries), some decreased quickly with experience (intraoperative fractures and component malpositioning), and some persisted unchanged throughout this study (wound complications). These findings should influence surgical training, surgeon willingness to adopt this procedure, and patient counseling.

LEVELS OF EVIDENCE

Therapeutic, Level IV, Retrospective Case Series.

Osteochondral talar lesions and defects

Talar dome lesions (TDL) have increasingly been the focus of interest of many foot and ankle surgeons over the past decade. The most important treatment aspect of TDL is diagnosis, so that appropriate treatment protocols can be enacted in a timely and stepwise manner. Minor or mild TDL may be treated conservatively, while severe acute or chronic TDL can be addressed with various surgical interventions. By being aware of all practical treatment options and their indications, success rates, benefits, risks, and alternative options, specialists will be able to make an informed decision on appropriate care selection after perusing this article.