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Cardoso DV, Veljkovic A. General Considerations About Foot and Ankle Arthrodesis. Any Way to Improve Our Results? Foot Ankle Clin 2022; 27:701-722. [PMID: 36368793 DOI: 10.1016/j.fcl.2022.08.007] [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] [Indexed: 11/09/2022]
Abstract
Nonunion and adjacent joint osteoarthritis (OA) are known complications after a fusion procedure, and foot and ankle surgeons are commonly exposed to such disabling complications. Determining who is at risk of developing nonunion is essential to reducing nonunion rates and improving patient outcomes. Several evidenced-based modifiable risk factors related to adverse outcomes after foot and ankle arthrodesis have been identified. Patient-related risk factors that can be improved before surgery include smoking cessation, good diabetic control (HbAc1 <7%) and vitamin D supplementation. Intraoperatively, using less invasive techniques, avoiding joint preparation with power tools, using bone grafts or orthobiologics in more complex cases, high-risk patients, nonunion revision surgeries, and filling in bone voids at the arthrodesis site should be considered. Postoperatively, pain management with NSAIDs should be limited to a short period (<2 weeks) and avoided in high-risk patients. Furthermore, early postoperative weight-bearing has shown to be beneficial, and it does not seem to increase postoperative complications. The incidence of surrounding joint OA after foot and ankle fusion seems to increase progressively with time. Owing to its progression and high probability of being symptomatic, patients must be informed consequently, as they may require additional joint fusions, resulting in further loss of ankle/foot motion. In patients with symptomatic adjacent joint OA and unsatisfactory results after an ankle arthrodesis, conversion to total ankle arthroplasty (TAA) has become a potential option in managing these complex and challenging situations.
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Affiliation(s)
- Diogo Vieira Cardoso
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.
| | - Andrea Veljkovic
- Division of Orthopaedics and Trauma Surgery, British Columbia University, Vancouver, Canada
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Okumus A. Tissue Coverage and Functional Reconstruction Outcomes With Use of Serratus Osteomusculocutaneous Free Flap in Lateral Malleolar Reconstruction: A Case Report. J Foot Ankle Surg 2022; 61:426-433. [PMID: 34649788 DOI: 10.1053/j.jfas.2021.09.011] [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] [Received: 06/27/2021] [Accepted: 09/10/2021] [Indexed: 02/03/2023]
Abstract
Currently, there is no ideal method defined in the repair of complex lateral malleolar defects, and the existing methods (i.e., bone repair, soft tissue or free flap closure) are far from producing functional results in terms of the ultimate recovery of ankle movements. Herein, an operative technique for soft tissue, ligamentous, and osseous reconstruction of fibular defect, using a free vascularized serratus anterior osteomusculocutaneous flap for reconstruction of a fibular deficit and the sixth costa for soft tissue coverage, was described in relation to tissue coverage and functional reconstruction outcome in a 31-year-old male patient with soft tissue and distal fibula defects in the lateral malleolus region caused by a traffic accident. Ankle movement was regained to almost full extent. No complications requiring further intervention was encountered in the donor site or ankle. In conclusion, the described operative technique enabled the repair of functional ligaments of the ankle joint in addition to repair of the soft tissue, lateral malleolus bone and skin defects in one session without the need for further additional operative intervention. Hence, the use of serratus osteomusculocutaneous free flap as a lateral malleolar reconstruction method seems to enable not only the tissue coverage but also to assist with functional reconstruction.
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Affiliation(s)
- Ayhan Okumus
- Private Aesthetic Plastic and Reconstructive Surgery Office, Bursa, Turkey.
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Greer N, Yoon P, Majeski B, Wilt TJ. Orthobiologics in Foot and Ankle Arthrodesis: A Systematic Review. J Foot Ankle Surg 2021; 60:1029-1037. [PMID: 34039511 DOI: 10.1053/j.jfas.2020.09.022] [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] [Received: 06/30/2020] [Revised: 08/21/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
Orthobiologics are biologically-derived materials intended to promote bone formation and union. We review evidence on effectiveness and harms of orthobiologics compared to no orthobiologics for foot and ankle arthrodesis. We searched multiple databases (1995-2019) and included clinical trials and other studies with concurrent controls, English language, and reporting patient-centered outcomes, union/time to union, costs/resource utilization, or harms. Studies were organized by orthobiologic used. We describe quality and limitations of available evidence but did not formally rate risk of bias or certainty of evidence. Most of the 21 studies included were retrospective chart reviews with orthobiologics used at surgeon's discretion for patients considered at higher risk for nonunion. Ten studies compared autologous bone graft versus no graft and 2 compared remote versus local graft with few studies of other orthobiologics. All studies reported a measure of fusion and about half reported on function/quality of life. Few studies reported harms. Due to limited reporting, we were unable to assess whether effectiveness varies by risk factors for nonunion (eg, age, gender, smoking status, obesity, diabetes) or whether orthobiologics were cost-effective. Available evidence is of poor quality with small sample sizes, inadequate reporting of risk factors for nonunion, variations in orthobiologics, surgical techniques used, and outcome assessment, and potential selection bias. Research is needed to adequately inform surgeons about benefits and harms and guide patient selection for use, or type, of orthobiologics. Careful assessment of individual patient risk for nonunion is critical prior to orthobiologic use.
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Affiliation(s)
- Nancy Greer
- Program Manager, Center for Care Delivery Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN.
| | - Patrick Yoon
- Orthopedic Surgeon, Minneapolis VA Medical Center, Minneapolis, MN
| | - Brittany Majeski
- Research Coordinator, Center for Care Delivery Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN
| | - Timothy J Wilt
- Director Evidence Synthesis Program and Core Investigator, Center for Care Delivery Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN; Staff Physician, Minneapolis VA Medical Center, Minneapolis, MN; Professor of Medicine, University of Minnesota School of Medicine, Minneapolis, MN
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Khademi F, Erfani A, Erfani MA, Vosoughi AR. Bone Graft Harvesting From the Calcaneus Using Lateral Wall Corticotomy Technique by an Osteotome. Foot Ankle Spec 2021; 14:298-301. [PMID: 32326754 DOI: 10.1177/1938640020916269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of this study was to evaluate the complications following calcaneal autologous bone graft harvesting using an osteotome in patients who underwent foot and ankle surgery with follow-up of at least 1 year. Methods: In a cohort study, all consecutive patients underwent forefoot or midfoot surgeries in conjunction with harvesting bone graft from the calcaneus using lateral wall corticotomy technique by an osteotome from 2015 till 2018 were asked to follow. The outcome and morbidity were assessed by visual analogue scale (VAS) pain, numbness in territory of the sural nerve, surgical site numbness or tenderness, infection, hematoma formation, or pathologic fracture. Also any possible restrictions on wearing desired shoes were asked. Results: Totally, 50 patients (11 males, 39 females; 29 right foot, 21 left foot) with the mean age of 48.2 ± 13.8 years (range 8-66 years) were assessed. There were no major complications on donor site such as infection, hematoma formation, or pathologic fracture. The following results were seen; 90% without any pain (VAS 0/10), 96% without numbness at the incision site, 96% without point tenderness on lateral of heel, 98% without paresthesia or numbness in the sural nerve territory, and 84% were able to wear their favorite shoes. Forty-one (82%) cases said if they need another foot surgery, they would permit to harvest bone graft from their heel. Conclusions: Autologous bone graft harvesting from the calcaneus using lateral wall corticotomy technique by an osteotome could be a useful method with very low complications.Levels of Evidence: Therapeutic, level IV: cohort, case series.
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Affiliation(s)
- Farough Khademi
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran (FK, AE).,Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (MAE, ARV)
| | - Amirhossein Erfani
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran (FK, AE).,Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (MAE, ARV)
| | - Mohammad Ali Erfani
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran (FK, AE).,Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (MAE, ARV)
| | - Amir Reza Vosoughi
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran (FK, AE).,Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran (MAE, ARV)
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Abstract
Use of orthobiologics in sports medicine and musculoskeletal surgery has gained significant interest. However, many of the commercially available and advertised products are lacking in clinical evidence. Widespread use of products before fully understanding their true indications may result in unknown adverse outcomes and may also lead to increased health care costs. As more products become available, it is important to remain judicial in use and to practice evidence-based medicine. Likewise, it is important to continue advances in research in hopes to improve surgical outcomes. This article reviews clinical evidence behind common orthobiologics in the treatment of foot and ankle pathology.
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Diaz-Rodriguez P, López-Álvarez M, Serra J, González P, Landín M. Current Stage of Marine Ceramic Grafts for 3D Bone Tissue Regeneration. Mar Drugs 2019; 17:md17080471. [PMID: 31443166 PMCID: PMC6723791 DOI: 10.3390/md17080471] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/10/2019] [Accepted: 08/12/2019] [Indexed: 12/19/2022] Open
Abstract
Bioceramic scaffolds are crucial in tissue engineering for bone regeneration. They usually provide hierarchical porosity, bioactivity, and mechanical support supplying osteoconductive properties and allowing for 3D cell culture. In the case of age-related diseases such as osteoarthritis and osteoporosis, or other bone alterations as alveolar bone resorption or spinal fractures, functional tissue recovery usually requires the use of grafts. These bone grafts or bone void fillers are usually based on porous calcium phosphate grains which, once disposed into the bone defect, act as scaffolds by incorporating, to their own porosity, the intergranular one. Despite their routine use in traumatology and dental applications, specific graft requirements such as osteoinductivity or balanced dissolution rate are still not completely fulfilled. Marine origin bioceramics research opens the possibility to find new sources of bone grafts given the wide diversity of marine materials still largely unexplored. The interest in this field has also been urged by the limitations of synthetic or mammalian-derived grafts already in use and broadly investigated. The present review covers the current stage of major marine origin bioceramic grafts for bone tissue regeneration and their promising properties. Both products already available on the market and those in preclinical phases are included. To understand their clear contribution to the field, the main clinical requirements and the current available biological-derived ceramic grafts with their advantages and limitations have been collected.
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Affiliation(s)
- Patricia Diaz-Rodriguez
- R + D Pharma Group (GI-1645), Department of Pharmacology, Pharmacy and Pharmaceutical Technology, School of Pharmacy, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain.
- Department of Chemical Engineering and Pharmaceutical Technology, School of Sciences, Universidad de La Laguna (ULL), Campus de Anchieta, 38200 La Laguna (Tenerife), Spain.
| | - Miriam López-Álvarez
- New Materials Group, Department of Applied Physics, University of Vigo, IISGS, MTI-Campus Lagoas-Marcosende, Vigo 36310, Spain
| | - Julia Serra
- New Materials Group, Department of Applied Physics, University of Vigo, IISGS, MTI-Campus Lagoas-Marcosende, Vigo 36310, Spain
| | - Pío González
- New Materials Group, Department of Applied Physics, University of Vigo, IISGS, MTI-Campus Lagoas-Marcosende, Vigo 36310, Spain
| | - Mariana Landín
- R + D Pharma Group (GI-1645), Department of Pharmacology, Pharmacy and Pharmaceutical Technology, School of Pharmacy, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Abstract
Orthobiologics are a group of biological materials and substrates that promote bone, ligament, muscle, and tendon healing. These substances include bone autograft, bone allograft, demineralized bone matrix, bone graft substitutes, bone marrow aspirate concentrate, platelet-rich plasma, bone morphogenetic proteins, platelet-derived growth factor, parathyroid hormone, and vitamin D and calcium. Properties of orthobiologics in bone healing include osteoconduction, osteoinduction, and osteogenesis. This article discusses the important properties of orthobiologics in bone healing, many of the orthobiologics currently available for bone healing, the related literature, their current clinical uses in sports medicine, and systemic factors that inhibit bone healing.
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Affiliation(s)
- Jacob G Calcei
- Department of Sports Medicine and Shoulder, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.
| | - Scott A Rodeo
- Department of Sports Medicine and Shoulder, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
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Hirao M, Ebina K, Etani Y, Tsuboi H, Noguchi T, Tsuji S, Hashimoto J, Yoshikawa H. Use of autologous bone grafting from the calcaneus and interconnected porous hydroxyapatite ceramic for bone transplantation in rheumatoid foot surgery. SAGE Open Med Case Rep 2018; 6:2050313X18784413. [PMID: 30013786 PMCID: PMC6041860 DOI: 10.1177/2050313x18784413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 05/31/2018] [Indexed: 11/27/2022] Open
Abstract
Cancellous bone grafts from the calcaneus have been used for the foot and ankle
as well as iliac bone graft; however, there is a sparse report for calcaneal
bone transplantation in the field of rheumatoid foot surgery. In this study,
safety and usefulness of calcaneal bone grafts, and combination with
interconnected porous hydroxyapatite ceramic, was evaluated in rheumatoid
arthritis foot surgeries. Of six rheumatoid arthritis cases, three
(talo-navicular joint fusion) used a calcaneal bone graft alone, and the
remaining three cases (subtalar joint and talo-navicular joint fusion) used a
combination of calcaneal bone graft and interconnected porous hydroxyapatite
ceramic augmented with dense calcium hydroxyapatite for subtalar bony defect
(1.5–2.0 cm) after the correction. Pre- and postoperative Japanese Society for
Surgery of the Foot rheumatoid arthritis foot ankle scale scores were obtained
for the clinical assessment. As radiographic assessment, tibio-calcaneal angle,
calcaneal pitch, talo-1st metatarsal angle, and pronated foot index were also
evaluated. After starting weight-bearing or walking, there was no pain and skin
trouble at the fusion and harvesting sites. All cases achieved bony fusion
within 6–10 weeks. Japanese Society for Surgery of the Foot rheumatoid arthritis
foot ankle score was improved in all six cases. Furthermore, tibio-calcaneal
angle, talo-1st metatarsal angle, and pronated foot index were also improved at
latest follow-up in all cases. In conclusion, autologous bone grafting from the
calcaneus was safe and convenient even in rheumatoid foot surgeries. For larger
bony defects (1.5–2.0 cm), combination use with interconnected porous
hydroxyapatite ceramic augmented with dense calcium hydroxyapatite was also
useful.
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Affiliation(s)
- Makoto Hirao
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kosuke Ebina
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuki Etani
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hideki Tsuboi
- Department of Orthopaedics, Osaka Rosai Hospital, Sakai, Japan
| | - Takaaki Noguchi
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Shigeyoshi Tsuji
- Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Japan
| | - Jun Hashimoto
- Department of Orthopaedics/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Kawachinagano, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedics, Graduate School of Medicine, Osaka University, Suita, Japan
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