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Kostuj T, Hönning A, Mittelmeier W, Malzahn J, H Baums M, Osmanski-Zenk K. Outcome after total ankle replacement or ankle arthrodesis in end-stage ankle osteoarthritis on the basis of german-wide data: a retrospective comparative study over 10 years. BMC Musculoskelet Disord 2024; 25:492. [PMID: 38918769 PMCID: PMC11197266 DOI: 10.1186/s12891-024-07612-w] [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: 09/26/2023] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND In symptomatic end-stage osteoarthritis of the ankle joint, total ankle replacement and ankle arthrodesis are the two primary surgical options for patients for whom conservative treatment fails. Published revision rates are often biased and difficult to compare. In this study, unplanned reoperation rates and revision rates were determined for both surgical interventions based on a large dataset, and risk factors for unplanned reoperations were identified. METHODS German-wide health data of the largest German health-care insurance carrier between 2001 and 2012 were retrospectively analyzed, and unplanned reoperation rates within 10 years were determined for index surgeries conducted in 2001 and 2002. Unplanned reoperation rates within 5 years for index surgeries conducted in 2001/2002 were compared to index surgeries conducted in 2006/2007. Multivariate logistic regression was used to identify risk factors for unplanned reoperations. RESULTS After ankle arthrodesis, 19% (95% confidence interval [CI], 16-22%) of 741 patients needed to undergo an unplanned reoperation within ten years. After total ankle replacement, the unplanned reoperation rate was 38% [95% CI, 29-48%] among 172 patients. For initial surgeries conducted at a later date, unplanned reoperation rates within five years were 21% [95% CI, 19-24%] for 1,168 ankle arthrodesis patients and 23% [95% CI, 19-28%] for 561 total ankle replacement patients. Significant risk factors for unplanned reoperations after ankle arthrodesis in the initial cohort were age < 50 years (odds ratio [OR] = 4.65 [95% CI 1.10;19.56]) and osteoporosis (OR = 3.72 [95% CI, 1.06;13.11]); after total ankle replacement, they were osteoporosis (OR = 2.96 [95% CI, 1.65;5.31]), Patient Clinical Complexity Level (PCCL) grade 3 (OR = 2.19 [95% CI, 1.19;4.03]), PCCL grade 4 (OR = 2.51 [95% CI, 1.22;5.17]) and diabetes mellitus (OR = 2.48 [95% CI, 1.33;4.66]). Kaplan-Meier analyses including 1,525 ankle arthrodesis patients and 644 total ankle replacement patients revealed an average unplanned reoperation-free time of approximately 17 years for both procedures. CONCLUSIONS Similar revision rates and unplanned reoperation rates for both procedures in the later-date cohort can likely be attributed to a learning curve for surgeons as well as advances in implant design. This analysis of billing health insurance data supports an increase in total ankle replacement surgeries.
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Affiliation(s)
- Tanja Kostuj
- Orthopädisch-Traumatologisches Zentrum, St. Marien-Hospital Hamm, Nassauerstraße 13-19, 59065, Hamm, Germany.
| | - Alexander Hönning
- Zentrum für Klinische Forschung, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Wolfram Mittelmeier
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
| | | | - Mike H Baums
- Fachbereich Orthopädie, Katholisches Klinikum Ruhrgebiet Nord (KKRN), Unfallchirurgie und Sporttraumatologie, Dorsten, Germany
| | - Katrin Osmanski-Zenk
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Rostock, Germany
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Fijany AJ, Olsson SE, Givechian BK, Zago I, Bishay AE, Troia T, Page TS, Barnett A, Downey MW, Pekarev M. A Novel Orthoplastic Reconstruction of Relapsed Clubfoot With Total Ankle Arthroplasty. Cureus 2023; 15:e44796. [PMID: 37809200 PMCID: PMC10558358 DOI: 10.7759/cureus.44796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Congenital clubfoot is addressed in infancy and rarely persists into adulthood. Ankle arthroplasty is an increasingly popular surgical intervention for patients with ankle arthritis since it allows a natural ankle range of motion and completely replaces a degenerative hindfoot. Here, we describe the first successful total ankle arthroplasty (TAA) for a patient with previously treated congenital clubfoot that reverted later in life. To address the patient's poor soft-tissue integument and reduce the likelihood of post-surgical complications, a perioperative latissimus muscle-free flap was performed. This two-staged, novel orthoplastic intervention addressed our patient's ankle issues and appears to be a viable option for clubfoot patients.
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Affiliation(s)
- Arman J Fijany
- Plastic Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Sofia E Olsson
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | | | - Ilana Zago
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | - Anthony E Bishay
- Neurosurgery, Vanderbilt University School of Medicine, Nashville, USA
| | - Thomas Troia
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
| | - Trevor S Page
- Plastic Surgery, Rosalind Franklin University of Medicine and Science, North Chicago, USA
| | | | - Michael W Downey
- Trauma and Reconstructive Surgery, Precision Orthopedics and Sports Medicine, Fort Worth, USA
| | - Maxim Pekarev
- Plastic Surgery, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, USA
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3
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Querci L, Caravelli S, Di Ponte M, Fuiano M, De Blasiis P, Sirico F, Baiardi A, Zannoni F, Mosca M. Enhanced recovery (fast-track surgery) after total ankle replacement: The state of the art. Foot Ankle Surg 2022; 28:1163-1169. [PMID: 35882574 DOI: 10.1016/j.fas.2022.07.001] [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] [Received: 02/15/2022] [Revised: 06/02/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
The post-operative results of a total ankle replacement are not determined solely by an optimal surgical technique, but by an appropriate anesthesiological and rehabilitative post-operative approach. Enhanced functional recovery often depends on a multidisciplinary approach based on a correct framework of the patient and his needs, requests, and characteristics. Extensive bibliographical research has been performed on Pubmed, Google Scholar, Scopus. This comprehensive and inclusive review of the literature aims to examine the state of the art of "fast-track" protocols employed in total ankle replacement (TAR), considering pre-operative preparation, anesthetic management, intraoperative and surgical factors, post-operative rehabilitative care and reduction of hospitalization time.
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Affiliation(s)
- Lorenzo Querci
- Anesthesiology and Critical Care Residency Program, University of Bologna, Via Massarenti, 9, 40138 Bologna
| | - Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo De Blasiis
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania"Luigi Vanvitelli", Naples, Italy
| | - Felice Sirico
- Department of Public Health - Physical Medicine & Rehabilitation Unit, Univeristy of Naples "Federico II", 80131 Naples, Italy
| | - Annalisa Baiardi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Zannoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Smith S, Jupiter DC, Panchbhavi VK, Chen J. Quality and Readability of Information Regarding Total Ankle Arthroplasty Available to Patients on the Internet. Foot Ankle Spec 2022:19386400221109423. [PMID: 35848229 DOI: 10.1177/19386400221109423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study sought to evaluate the reliability, comprehensiveness, and readability of ankle arthroplasty information available on the Internet. We evaluated websites based on category, Journal of the American Medical Association (JAMA) criteria, Health on the Net (HON) code, DISCERN score, an author-created Ankle Replacement Index (ARI), and readability metrics. Based on the ARI, 80 (62.5%) websites provided poor information. The mean reading level was 8.96 ± 2.66, which is above the recommended sixth-grade reading level for patient information. Academic websites had the highest mean DISCERN, ARI, and JAMA scores, and a midrange reading level. The government category had high DISCERN and JAMA scores, a fair ARI score, and the lowest reading level. We found significant correlation between website class and DISCERN score, as well as HON code and DISCERN score. Our results suggest that academic and government websites provide more reliable, complete information than other categories and that websites with an HON code contain more reliable information than those without. We recommend that physicians create handouts to point patients to reliable resources and encourage them to critically evaluate information they read online. We also encourage physicians to take part in evaluating and updating information on their practice websites.Level of Clinical Evidence: N/A.
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Affiliation(s)
- Sydney Smith
- Department of Preventive Medicine and Population Health (DCJ), and Department of Orthopaedic Surgery and Rehabilitation (SS, DCJ, VKP, JC), The University of Texas Medical Branch, Galveston, Texas
| | - Daniel C Jupiter
- Department of Preventive Medicine and Population Health (DCJ), and Department of Orthopaedic Surgery and Rehabilitation (SS, DCJ, VKP, JC), The University of Texas Medical Branch, Galveston, Texas
| | - Vinod K Panchbhavi
- Department of Preventive Medicine and Population Health (DCJ), and Department of Orthopaedic Surgery and Rehabilitation (SS, DCJ, VKP, JC), The University of Texas Medical Branch, Galveston, Texas
| | - Jie Chen
- Department of Preventive Medicine and Population Health (DCJ), and Department of Orthopaedic Surgery and Rehabilitation (SS, DCJ, VKP, JC), The University of Texas Medical Branch, Galveston, Texas
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Herrera-Pérez M, Valderrabano V, Godoy-Santos AL, de César Netto C, González-Martín D, Tejero S. Ankle osteoarthritis: comprehensive review and treatment algorithm proposal. EFORT Open Rev 2022; 7:448-459. [PMID: 35900210 PMCID: PMC9297055 DOI: 10.1530/eor-21-0117] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Ankle osteoarthritis (OA) is much less frequent than knee or hip OA, but it can be equally disabling, greatly affecting the quality of life of the patients. Approximately 80% of ankle OA is post-traumatic, mainly secondary to malleolar fractures, being another of the main causes untreated in chronic instability. The average age of the patient affected by ankle OA is around 50 years, being therefore active patients and in working age who seek to maintain mobility and remain active. The authors conducted a comprehensive review of the conservative, medical, and surgical treatment of ankle OA. Initial conservative treatment is effective and should be attempted in any stage of OA. From a pharmacological point of view, non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular infiltrations can produce temporary relief of symptoms. After the failure of conservative-medical treatment, two large groups of surgical treatment have been described: joint-preserving and joint-sacrificing procedures. In the early stages, only periarticular osteotomies have enough evidence to recommend in ankle OA with malalignment. Both ankle arthrodesis and ankle replacement can produce satisfactory functional results if correctly indicated in the final stages of the disease. Finally, the authors propose a global treatment algorithm that can aid in the decision-making process.
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Affiliation(s)
- Mario Herrera-Pérez
- Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
- Department of Surgery, Universidad de La Laguna, Tenerife, Spain
| | - Victor Valderrabano
- Foot and Ankle Unit, Orthopaedic Department, Schmerzklinik, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - César de César Netto
- Director of the UIOWA Orthopedic Functional Imaging Research Laboratory (OFIRL), Iowa, USA
- Department of Orthopedic and Rehabilitation, University of Iowa, Iowa, USA
| | - David González-Martín
- Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
- Department of Surgery, Universidad de La Laguna, Tenerife, Spain
| | - Sergio Tejero
- Foot and Ankle Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Department of Surgery, Universidad de Sevilla, Sevilla, Spain
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Stadler C, Luger M, Stevoska S, Gahleitner M, Pisecky L, Gotterbarm T, Klasan A, Klotz MC. High Reoperation Rate in Mobile-Bearing Total Ankle Arthroplasty in Young Patients. Medicina (B Aires) 2022; 58:medicina58020288. [PMID: 35208611 PMCID: PMC8877183 DOI: 10.3390/medicina58020288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Due to inferior survival rates compared to hip and knee arthroplasty, total ankle arthroplasty (TAA) was previously mainly recommended for older and less active patients. However, given the encouraging survival rates and clinical outcomes of modern generations of TAA, some authors have also advocated TAA in young patients. Thus, the aim of this study was to evaluate age related reoperation, revision and survival rates of third-generation mobile-bearing TAAs. Materials andMethods: In this retrospective study, 224 consecutive TAA patients with a minimum follow up (FU) of 2 years were analyzed. Patients were retrospectively assigned to two study groups (Group A: age < 50 years; Group B: age ≥ 50 years). Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. Results: After a mean FU of 7.1 ± 3.2 years, the reoperation rate (Group A: 22.2%; Group B: 5.3%; p = 0.003) and revision rate (Group A: 36.1%; Group B: 13.8%; p = 0.003) were higher within Group A. An age of under 50 years at time of surgery was associated with higher reoperation (odds ratio (OR): 6.54 (95% CI: 1.96–21.8); p = 0.002) and revision rates (OR: 3.13 (95% CI: 1.22–8.04); p = 0.018). Overall, lower patient age was associated with higher reoperation (p = 0.009) and revision rates (p = 0.001). Conclusions: The ideal indication for TAA remains controversial, especially regarding patient age. The findings of this study show high reoperation and revision rates in patients aged under 50 years at time of surgery. Therefore, the outcomes of this study suggest that the indication for TAA in young patients should be considered very carefully and that the association between low patient age and high reoperation rate should be disclosed to all eligible patients.
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Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
- Correspondence:
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Manuel Gahleitner
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Lorenz Pisecky
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Krankenhausstr. 9, 4020 Linz, Austria; (M.L.); (S.S.); (M.G.); (L.P.); (T.G.); (A.K.)
| | - Matthias C. Klotz
- Marienkrankenhaus Soest, Orthopaedics and Trauma Surgery, Widumgasse 5, 59494 Soest, Germany;
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Shah NS, Umeda Y, Suriel Peguero E, Erwin JT, Laughlin R. Outcome Reporting in Total Ankle Arthroplasty: A Systematic Review. J Foot Ankle Surg 2021; 60:770-776. [PMID: 33766479 DOI: 10.1053/j.jfas.2021.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 02/03/2023]
Abstract
Total ankle arthroplasty is an increasingly utilized treatment for ankle arthritis due to decreasing failure rates and improved outcomes. However, the literature on this procedure remains heterogeneous with large variability in outcome reporting methods. PRISMA guidelines were used to systematically review outcome reporting measures used in prospective studies and randomized control trials on total ankle arthroplasty published in 15 high-impact journals between Jan 1, 2009-May 1, 2020. A total of 43 studies were included and outcome measures were grouped into seven categories: pain, subjective function, patient satisfaction, complications, objective function, implant survivorship, and imaging. The most common topic of study was implant design followed by differences in outcomes when comparing total ankle arthroplasty and arthrodesis. The most commonly reported outcome measure was post-surgical complications. No study reported on all seven categories, while 22 (51.2%) studies reported on four or more. Subjective measures had significant variability with fifteen different Patient Reported Outcome Measures used across the studies. While the included studies were quite comprehensive, there was little consistency in reporting outcomes after total ankle arthroplasty. With improving outcomes and techniques in total ankle arthroplasty, and thus an expected increase in utilization and number of published studies, efforts should be made to use commonly employed outcome reporting methods to facilitate comparison of results across studies.
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Affiliation(s)
- Nihar S Shah
- Research Fellow, Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Yuta Umeda
- Medical Student, Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Emil Suriel Peguero
- Medical Student, Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | - Jace T Erwin
- Resident, Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
| | - Richard Laughlin
- Professor, Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH
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Hoang V, Anthony T, Gupta S, Chang R, Chan H, Watson T. Treatment of Severe Ankle and Hindfoot Deformity: Technique Using Femoral Head Allograft for Tibiotalocalcaneal Fusion Using a Cup-and-Cone Reamer. Arthrosc Tech 2021; 10:e1187-e1195. [PMID: 34141530 PMCID: PMC8185523 DOI: 10.1016/j.eats.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/11/2021] [Indexed: 02/03/2023] Open
Abstract
Limb shortening due to structural bone loss in tibiotalocalcaneal arthrodesis is a concern that can negatively impact the patient's gait and weight-bearing. To aid in preventing the risk of limb shortening, the use of a femoral head allograft and intramedullary nail in tibiotalocalcaneal arthrodesis has been shown to successfully preserve limb length in patients with structural bone deficits. We present our technique using a femoral head allograft with a cup-and-cone reamer for the treatment of severe ankle and hindfoot deformity.
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Affiliation(s)
- Victor Hoang
- Valley Hospital Medical Center, Las Vegas, Nevada, U.S.A.,Address correspondence to Victor Hoang, D.O., Valley Hospital Medical Center, 620 Shadow Lane, Las Vegas, NV 89106.
| | - Taylor Anthony
- Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada, U.S.A
| | - Shivali Gupta
- Valley Hospital Medical Center, Las Vegas, Nevada, U.S.A
| | - Ryan Chang
- University of San Diego, San Diego, California, U.S.A
| | - Holman Chan
- Nevada Orthopedic & Spine Center, Henderson, Nevada, U.S.A
| | - Troy Watson
- Valley Hospital Medical Center, Las Vegas, Nevada, U.S.A.,Desert Orthopaedic Center, Las Vegas, Nevada, U.S.A.,The Foot & Ankle Institute, Henderson, Nevada, U.S.A
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Tai K, Vannabouathong C, Mulla SM, Goldstein CL, Smith C, Sales B, Yeardley D, Bhandari M, Petrisor BA. A Survey for End-Stage Ankle Arthritis Treatment: Ankle Arthrodesis Versus Ankle Arthroplasty. J Foot Ankle Surg 2021; 59:330-336. [PMID: 32130999 DOI: 10.1053/j.jfas.2019.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/13/2019] [Accepted: 09/01/2019] [Indexed: 02/03/2023]
Abstract
With promising technological advances, ankle arthroplasty has become an alternative to arthrodesis, traditionally the gold standard, for treating end-stage ankle arthritis. We collected knowledge and perceptions on both procedures to determine the need for a patient decision aid for these patients by administering a cross-sectional survey to 103 orthopaedic surgeons. Respondents were predominantly male and 41 to 50 years old. Half of those who stated that they do not perform arthroplasty said this was because they do not have adequate training. Additionally, certain variables were associated with the surgeon's choice of intervention: patient gender, age, body mass index, postoperative activity level, employment type, perceived risk of infection, neurovascular injury or wound complication, risk of developing or pre-existing adjacent arthritis, deformity, malalignment, bone loss or abnormal bone quality, number of prior ankle operations, cause of arthritis, and desire for motion preservation. The majority agreed that they always incorporate patient preferences into their decisions and that a decision aid would be beneficial. This survey revealed that several patient characteristics are influential in the surgeon's preference for either arthroplasty or arthrodesis for end-stage ankle arthritis. Because the majority of surgeons incorporate patient preferences in their decisions and report that a decision aid would be beneficial for informed decision-making in this clinical scenario, this survey identified an unmet need supporting the development of such a tool for these patients.
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Affiliation(s)
- Kerry Tai
- Research Assistant, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON
| | | | - Sohail M Mulla
- Assistant Professor, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON
| | - Christina L Goldstein
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | | | | | | | - Mohit Bhandari
- Professor & Orthopaedic Surgeon, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON; Professor & Orthopaedic Surgeon, Department of Surgery, McMaster University, Hamilton, ON
| | - Bradley A Petrisor
- Professor & Orthopaedic Surgeon, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON; Professor & Orthopaedic Surgeon, Department of Surgery, McMaster University, Hamilton, ON
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Imhoff FB, Wirth SH, Camenzind RS, Viehöfer AF, Lampert CP. RETRACTED ARTICLE: Arthrodesen zur Behandlung der Sprunggelenkarthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-019-00326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Messina C, Usuelli FG, Maccario C, Di Silvestri CA, Gitto S, Cortese MC, Albano D, Sconfienza LM. Precision of Bone Mineral Density Measurements Around Total Ankle Replacement Using Dual Energy X-ray Absorptiometry. J Clin Densitom 2020; 23:656-663. [PMID: 30792098 DOI: 10.1016/j.jocd.2019.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Joint prosthesis survival is associated with the quality of surrounding bone. Dual-energy X-ray absorptiometry (DXA) is capable to evaluate areal bone mineral density (BMD) around different prosthetic implants, but no studies evaluated periprosthetic bone around total ankle replacement (TAR). Our aim is to determine the precision of the DXA periprosthetic BMD around TAR. METHODOLOGY Short-term precision was evaluated on 15 consecutive patients. Each ankle was scanned 3 times both in the posteroanterior (PA) and lateral views with a dedicated patient positioning protocol. Up to four squared regions of interest (ROIs) were placed in the periprosthetic bone around tibial and talar implants, with an additional ROI to include the calcaneal body in the lateral scan. Coefficient of variation (CV%) and least significant change were calculated according to the International Society for Clinical Densitometry. RESULTS The lateral projection showed lower mean CV values compared to the PA projection, with an average precision error of 2.21% (lateral scan) compared to 3.34% (PA scans). Overall, the lowest precision error was found at both "global" ROIs (CV = 1.25% on PA and CV = 1.3% on lateral). The highest CV value on PA was found at the medial aspect of talar side (ROI 3; CV = 4.89%), while on the lateral scan the highest CV value was found on the posterior aspect of talar side (ROI 2; CV = 2.99%). CONCLUSIONS We found very good reproducibility BMD values of periprosthetic bone around TAR, that were comparable or even better compared to other studies that evaluated periprosthetic BMD around different prosthetic implants. DXA can be used to precisely monitor bone density around ankle prostheses, despite further long-term longitudinal studies are required to assess the clinical utility of such measurements.
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Affiliation(s)
- Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Carlo Pascal, 36, 20133, Milan, Italy.
| | | | - Camilla Maccario
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | | | - Salvatore Gitto
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Maria Cristina Cortese
- Radiologia Diagnostica e Interventistica Generale, Area Diagnostica per Immagini, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, IRCCS Fondazione Policlinico Universitario A. Gemelli, Roma, Italia; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, via Carlo Pascal, 36, 20133, Milan, Italy
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Samaila EM, Bissoli A, Argentini E, Negri S, Colò G, Magnan B. Total ankle replacement in young patients. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:31-35. [PMID: 32555074 PMCID: PMC7944830 DOI: 10.23750/abm.v91i4-s.9725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
Abstract
High physical demand and younger age are currently considered contraindications for total ankle replacement. The number of Total Ankle Replacements (TAR) is widespread increasing and indications are expanding thanks to a steady improvement in prosthetic designs and better outcome.
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Affiliation(s)
| | - Andrea Bissoli
- Department of Orthopedics and Trauma Surgery, University of Verona.
| | | | - Stefano Negri
- Department of Orthopedics and Trauma Surgery, University of Verona.
| | - Gabriele Colò
- Department of Orthopedics and Traumatology, Regional Center for Joint Arthroplasty, Alessandria.
| | - Bruno Magnan
- Department of Orthopedics and Trauma Surgery, University of Verona.
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13
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Viehöfer AF, Camenzind RS, Imhoff FB, Wirth SH. Arthrodesen am oberen Sprunggelenk. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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14
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Nery C, Lemos AVKC, Ferreira Martins CEC, Baumfeld D. Brazilian Total Ankle Replacement Experience. Orthop Clin North Am 2020; 51:293-302. [PMID: 32138866 DOI: 10.1016/j.ocl.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early total ankle replacement generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience with Brazilian surgeons unable to participate in the development of the technique and implant designs during these years. This article discusses the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed.
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Affiliation(s)
- Caio Nery
- Foot and Ankle Clinic, UNIFESP - Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Daniel Baumfeld
- Department of the Locomotor Apparatus, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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15
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16
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Gaul F, Barr CR, McCauley JC, Copp SN, Bugbee WD. Outcomes of Salvage Arthrodesis and Arthroplasty for Failed Osteochondral Allograft Transplantation of the Ankle. Foot Ankle Int 2019; 40:537-544. [PMID: 30698469 DOI: 10.1177/1071100718824082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteochondral allograft (OCA) transplantation is a useful treatment for posttraumatic ankle arthritis in young patients, but failure rates are high and reoperations are not uncommon. The aim of this study was to evaluate the outcomes of failed ankle OCA transplantation converted to ankle arthrodesis (AA) or total ankle arthroplasty (TAA). METHODS We evaluated 24 patients who underwent salvage procedures (13 AA and 11 TAA) after primary failed ankle OCA transplantation. Reoperations were assessed. Failure of the salvage procedure was defined as an additional surgery that required a revision AA/TAA or amputation. Evaluation among nonfailing ankles included the American Academy of Orthopaedic Surgeons Foot and Ankle Module (AAOS-FAM), pain, and satisfaction. RESULTS In the salvage AA cohort, 3 patients were classified as failures (2 revision AA and 1 amputation). The 10 nonfailing patients had a mean follow-up of 7.4 years. Eighty-eight percent were satisfied with the procedure, but 63% reported continued problems with their ankle (eg, pain, swelling, stiffness). Mean pain level was 1.9 and AAOS-FAM core score was 83±13. In the salvage TAA cohort, 2 patients were classified as failures (both revision TAA). The 9 nonfailing patients had a mean follow-up of 3.8 years. Fifty percent were satisfied with the procedure, but 40% reported continued problems with their ankle. The mean pain level was 1.3, and the median AAOS-FAM core score was 82±26. CONCLUSION Revision and reoperation rates for salvage procedures following failed OCA transplantation of the ankle are higher compared to published data for primary AA and TAA procedures. However, we believe OCA transplantation can serve as an interim procedure for younger patients with advanced ankle joint disease who may not be ideal candidates for primary AA or TAA at the time of initial presentation. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Florian Gaul
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
- 2 Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, USA
- 4 Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Germany
| | - Cameron R Barr
- 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Julie C McCauley
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Steven N Copp
- 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - William D Bugbee
- 1 Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
- 3 Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
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17
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Cottom JM, Plemmons BS, Douthett SM. A Critical Radiographic Analysis of Coronal Plane Deformity Correction Using a 3-Piece Mobile Bearing Ankle Joint Replacement: A Retrospective Study of 25 Patients. J Foot Ankle Surg 2019; 57:1161-1166. [PMID: 30368427 DOI: 10.1053/j.jfas.2018.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Indexed: 02/03/2023]
Abstract
Total ankle replacement can be a viable option for patients with end-stage ankle arthritis associated with coronal plane deformity. With proper ankle balancing, a well-aligned ankle implant can be maintained over time and provide successful patient outcomes. The purpose of this study was to evaluate radiographic and subjective outcomes in patients with ankle arthritis along with coronal plane deformity who underwent total ankle arthroplasty with a 3-piece mobile-bearing implant. Our primary inclusion criterion was patients who demonstrated more than 5° of tibiotalar coronal deformity in either varus or valgus direction. Sixty-three consecutive patients who underwent total ankle replacement were reviewed. Of these, 25 (39.7%) met the inclusion criteria. Sixteen (64%) patients had a varus deformity (Group 1) and 9 (36%) had valgus deformity (Group 2) preoperatively. Alignment was evaluated radiographically at 5 different intervals: preoperative, immediate postoperative, and 6, 12, and 36 months postoperative. In patients with varus deformity, the mean tibiotalar angle was 12.6°, 0.8°, 1.0°,1.0°, and 0.8° for preoperative, immediate postoperative, and 6, 12, and 36 months, respectively. The same measurements and intervals for patients with valgus deformity were found to be 10.3°, 1.4°, 1.6°, 1.4°, and 1.4°. A statistically significant difference was observed in preoperative and postoperative coronal plane deformity. This correction was maintained at final follow-up visit. American Orthopaedic Foot and Ankle Society scores and visual analogue scale scores were recorded as well, and statistically significant improvements in preoperative and postoperative scores were found (p < .001). In conclusion, coronal plane deformity correction of the ankle can be accomplished and maintained in total ankle replacement procedures with proper soft tissue balancing and osseous procedures as indicated.
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Affiliation(s)
- James M Cottom
- Fellowship Director, Florida Orthopedic Foot & Ankle Center, Sarasota, FL.
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18
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Malik AT, Noordin S. The Top 50 most-cited articles on Total Ankle Arthroplasty: A bibliometric analysis. Orthop Rev (Pavia) 2018; 10:7498. [PMID: 29770176 PMCID: PMC5937363 DOI: 10.4081/or.2018.7498] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/11/2018] [Accepted: 01/21/2018] [Indexed: 12/21/2022] Open
Abstract
Total Ankle Arthroplasty (TAA) is a relatively new and evolving field in Foot and Ankle surgery. We conducted a citation analysis to identify the characteristics of the top 50 most cited articles on total ankle arthroplasty. Using the Web of Science database and the search strategy total ankle arthroplasty OR total ankle replacement, we identified 2445 articles. After filtering for relevant articles, the top 50 cited articles on total ankle arthroplasty were retrieved for descriptive and statistical analysis. The publication years ranged from 1979 to 2013. USA was the most productive country in terms of research output, followed by the UK. Though citation analysis has its flaws, this is a comprehensive list of the top 50 articles significantly impacting literature on total ankle arthroplasty. Based on our study, we conclude that there is marked deficiency of high level articles with respect to the number of citations and future researches need to cater to this question to produce high quality studies.
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Affiliation(s)
- Azeem Tariq Malik
- Department of Orthopedics, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Shahryar Noordin
- Section of Orthopedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
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19
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Use of CT Scan-derived Patient-specific Instrumentation in Total Ankle Arthroplasty. TECHNIQUES IN FOOT & ANKLE SURGERY 2017. [DOI: 10.1097/btf.0000000000000175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Odum SM, Van Doren BA, Anderson RB, Davis WH. In-Hospital Complications Following Ankle Arthrodesis Versus Ankle Arthroplasty: A Matched Cohort Study. J Bone Joint Surg Am 2017; 99:1469-1475. [PMID: 28872529 DOI: 10.2106/jbjs.16.00944] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ankle arthrodesis has been the traditional surgical treatment for end-stage hindfoot arthritis. However, utilization of total ankle arthroplasty (TAA) is increasing as surgical techniques and implants have substantially improved. The purpose of this study was to compare the U.S. national rates of perioperative (in-hospital) complications between a statistically matched cohort of patients who underwent either an ankle arthrodesis or a TAA. METHODS Data from the 2002 to 2013 Nationwide Inpatient Sample releases were analyzed. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify 4,192 patients treated with TAA (ICD 81.56) and 16,278 treated with ankle arthrodesis (ICD 81.11). ICD-9-CM diagnosis codes were utilized to identify major and minor in-hospital complications, and mortality was determined using the Uniform Bill patient disposition. The arthrodesis and TAA groups were matched with regard to age, sex, race, surgery year, hospital type, comorbidities, adjunctive procedures, and surgical indication. Unadjusted and adjusted in-hospital complication risks were compared between groups using the Fisher exact test and multiple logistic regression analysis. RESULTS We were able to statistically match 1,574 patients who underwent a TAA (37.5%) with a patient who underwent arthrodesis. A major in-hospital complication occurred in 8.5% (134) of the 1,574 patients in the ankle arthrodesis group compared with 5.3% (84) of the 1,574 in the TAA group (p < 0.001) whereas a minor complication was found in 4.7% (74) in the ankle arthrodesis group compared with 5.9% (93) in the TAA group (p = 0.14). There were no deaths in either group. After adjusting for case mix, we found that ankle arthrodesis was 1.8 times more likely to be followed by a major complication (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 1.32 to 2.39) whereas the minor complication rate was 29% lower in that group (OR = 0.71, 95% CI = 0.45 to 1.13). CONCLUSIONS In a matched cohort of 3,148 patients treated with either TAA or ankle arthrodesis, ankle arthrodesis was associated with a 1.8 times higher risk of a major complication but a 29% lower risk of a minor complication. Our findings are consistent with other studies that have shown TAA to be a safe procedure in the inpatient environment. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Susan M Odum
- 1OrthoCarolina Research Institute, Charlotte, North Carolina 2Health Services Research Program, College of Health & Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina 3OrthoCarolina Foot and Ankle Institute, Charlotte, North Carolina
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21
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Abstract
Total ankle arthroplasty is a treatment option for end-stage osteoarthritis of the ankle, as is ankle arthrodesis. Many variables, including patient characteristics, are thought to influence clinical outcome and survival. As with any surgery, but especially with total ankle replacement (TAR), patient selection is considered critical for good (long-term) outcome. In this review, we summarize the available scientific evidence regarding patient characteristics and its influence on the results of TAR.
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Affiliation(s)
| | - Daniël Haverkamp
- Slotervaart Center of Research and Education (SCORE), MC Slotervaart Hospital, Amsterdam, the Netherlands,
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22
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Strauß V, Scheer AC, Andermahr J. Pathogenese von Knochenzysten nach Sprunggelenksendoprothesen. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.fuspru.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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Usuelli FG, Maccario C, Indino C, Manzi L, Gross CE. Tibial slope in total ankle arthroplasty: Anterior or lateral approach. Foot Ankle Surg 2017; 23:84-88. [PMID: 28578799 DOI: 10.1016/j.fas.2016.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/25/2016] [Accepted: 10/16/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND A new total ankle arthroplasty (TAA) system performed through a lateral approach provides direct visualization of the centre of rotation, allowing for accurate reconstruction of the joint alignment and less bone resection. Radiographic references are needed to describe deformities and plan the surgical procedures. The tibial slope is an important factor when treating malalignment. The aim of this study is to show if there is any difference regarding the post-operative tibial slope (β angle) measurement comparing a fixed-bearing TAA through a lateral approach and a mobile-bearing TAA through an anterior approach. METHODS The study included 217 ankles. Between May 2011 and April 2015, 77 patients underwent a TAA with a mobile-bearing implant through an anterior approach and 45 with a fixed-bearing implant through a lateral approach: in these patients the β angle was measured 2 and 12 months postoperatively. 95 subjects with unilateral post-traumatic ankle arthritis composed the control group: in these patients we measured the anterior distal tibial angle (ADTA) of the controlateral, non arthritic tibiotalar joint. RESULTS In the mobile-bearing group, the mean β angle at 2 and 12 months postoperatively was 86.4±3.1 and 86.8±3.1 (p-value=0.12). In the fixed-bearing group, the mean β angle at 2 and 12 months postoperatively was 83.1±5.4 and 83.9±6.5 (p-value=0.26). A statistically significant difference was found between the β angle of the two groups. In the control group the mean ADTA was 84.9±2.5. A non-statistically significant difference was observed only between β angle of the fixed-bearing group and the ADTA of the control group. CONCLUSIONS Regarding the tibial slope, fixed-bearing TAA through a lateral approach showed a more anatomic placement. In contrast, β angle in mobile-bearing group appeared more reproducible than fixed-bearing group.
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Affiliation(s)
| | - Camilla Maccario
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Universita' degli Studi di Milano, Milan, Italy
| | | | - Luigi Manzi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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25
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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: 144] [Impact Index Per Article: 20.6] [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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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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27
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Usuelli FG, Indino C, Maccario C, Manzi L, Salini V. Total ankle replacement through a lateral approach: surgical tips. SICOT J 2016; 2:38. [PMID: 27855774 PMCID: PMC5115059 DOI: 10.1051/sicotj/2016029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 10/04/2016] [Indexed: 12/27/2022] Open
Abstract
Purpose: Recently, the Zimmer Trabecular Metal Total Ankle Replacement (Zimmer TM TAR) was developed to be used through a lateral transfibular approach. The purpose of this paper is to describe the surgical technique and early outcomes of the TAR via the lateral approach using the Zimmer TM TARs. Methods: Sixty-seven patients underwent primary TAR using the Zimmer TM TAR between May 2013 and May 2015. Patients were clinically evaluated preoperatively and postoperatively at six and twelve months and annually using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores, visual analogue scale (VAS) pain score, and the Short Form Health Survey (SF-12) questionnaire. The minimum follow-up was 12 months. Results: The mean AOFAS hindfoot score increased from 32.8 preoperatively to 85.0 at the latest follow-up (p-value < 0.001). The mean VAS pain score decreased from 8.0 to 2.0 at the latest follow-up (p-value < 0.001). The Physical and Mental Health Composite Scale scores (PCS and MCS) of the SF-12 passed from a mean value of 30.2 preoperatively to 43.1 (p-value < 0.001) and from a mean value of 44.6 to 53.5 at the latest follow-up (p-value < 0.001), respectively. Conclusions: We present our surgical tips and the early results of this prosthetic design which are encouraging. They could be useful as an adjunct to the manufacturer’s surgical technique guidance for surgeons who utilize these implants.
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Affiliation(s)
| | - Cristian Indino
- CASCO, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Camilla Maccario
- CASCO, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy - Scuola di Specializzazione in Ortopedia e Traumatologia, Universita' degli Studi di Milano, Via della Commenda 10, 20122 Milan, Italy
| | - Luigi Manzi
- CASCO, IRCCS Istituto Ortopedico Galeazzi, via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Vincenzo Salini
- Orthopaedics and Traumatology, University G. dAnnunzio, Chieti Pescara, Via dei Vestini, 66100 Chieti, Italy
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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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30
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Natsakis T, Burg J, Dereymaeker G, Jonkers I, Sloten JV. Insertion of a pressure sensing arrayminimally affects hindfoot bone kinematics. J Foot Ankle Res 2015; 8:24. [PMID: 26146518 PMCID: PMC4490695 DOI: 10.1186/s13047-015-0081-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the development of ankle osteoarthritis (OA) is of high importance and interest; however its causality is poorly understood and several links to joint loading conditions have been made. One way of quantifying joint loading conditions is by measuring the intra-articular pressure distribution during gait simulations performed by in-vitro experimental set-ups. However the effect of inserting a pressure sensing array in the ankle joint could potentially disturb the proper kinematics and therefore the loading conditions. METHODS In this study, we performed in-vitro gait simulations in 7 cadaveric feet, before and after inserting a pressure sensing array and quantified the effect on the joints range of motion (ROM). The gait was simulated with a stance phase duration of one second using a custom build cadaveric gait simulator (CGS). RESULTS The results show a limited effect in the ROM for all the joints of the hind foot, not exceeding the variability observed in specimens without a sensor. However, no consistent direction (increase/decrease) can be observed. CONCLUSION The results suggest that even though the effect of inserting a pressure sensing array is minimal, it needs to be evaluated against the demands/requirements of the application.
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Affiliation(s)
- Tassos Natsakis
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300c, Box 2419, Heverlee, 3001 Belgium
| | - Josefien Burg
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300c, Box 2419, Heverlee, 3001 Belgium ; Faculty of Kinesiology and Rehabilitation Science, KU Leuven, Tervuursevest 101, Box 1500, Heverlee, 3001 Belgium
| | - Greta Dereymaeker
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300c, Box 2419, Heverlee, 3001 Belgium
| | - Ilse Jonkers
- Faculty of Kinesiology and Rehabilitation Science, KU Leuven, Tervuursevest 101, Box 1500, Heverlee, 3001 Belgium
| | - Jos Vander Sloten
- Department of Mechanical Engineering, KU Leuven, Celestijnenlaan 300c, Box 2419, Heverlee, 3001 Belgium
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31
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The impact of ankle osteoarthritis. The difference of opinion between patient and orthopedic surgeon. Foot Ankle Surg 2014; 20:241-7. [PMID: 25457659 DOI: 10.1016/j.fas.2014.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/24/2014] [Accepted: 05/21/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Outcome measures for ankle osteoarthritis (OA) are created by physicians with little input of the target patient group. The aim of this study was to determine the difference in opinion between patients and orthopedic surgeons concerning the importance of specific symptoms of ankle OA and its impact on daily life and function. METHODS A modified Delphi method was applied, consisting of structured interviews with patient focus groups and experts, followed by a poll using 32 statements. The difference in opinion between patients and orthopedic surgeons was evaluated. RESULTS Forty patients and forty orthopedic surgeons responded to the 32 statements. Statistically significant differences in opinion on symptoms, function and the impact of ankle OA on daily life were found. CONCLUSIONS This study demonstrates a significant difference in opinion between patients and orthopedic surgeons concerning specific symptoms of ankle OA. These results advocate incorporating the needs and demands of the individual patient for new outcome measures.
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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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[Arthrodesis and endoprostheses of the ankle joint: indications, techniques and pitfalls]. Unfallchirurg 2013; 116:797-805. [PMID: 23979169 DOI: 10.1007/s00113-013-2386-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
If adequate conservative measures for the treatment of end-stage ankle osteoarthritis have failed, surgery may be taken into consideration. After exorbitant failure rates in the beginning of total ankle replacement, nowadays this kind of treatment has regained lot of interest and has become a viable alternative to ankle fusion. The correct indication and a precise explanation of the surgical procedure, outcomes and potential complications provide a solid base for future success.Currently, there is no doubt that total ankle replacement has become an important player in the treatment of symptomatic and debilitating end-stage ankle arthritis. With increasing number of patients who undergo total ankle replacement the experience with this kind of procedure increases too. As a consequence several surgeons have started to stretch indications favoring total ankle replacement. However, it must be mentioned here, despite progress in terms of improved anatomical and biomechanical understanding of the hindfoot and improved surgical techniques and instruments, total ankle replacement and ankle fusion remain challenging and difficult procedures. We provide a review article including an overview of the relevant techniques. This article should serve as rough guide for surgeons and help in decision-making regarding total ankle replacement and ankle fusion.
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