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Anastasio AT, Lau B, Adams S. Ankle Osteoarthritis. J Am Acad Orthop Surg 2024; 32:738-746. [PMID: 38810230 DOI: 10.5435/jaaos-d-23-00743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
Ankle osteoarthritis (OA) is less common than knee and hip OA, and 75% to 80% of all presentations are posttraumatic in nature, resulting from either ligamentous or bony injury to the ankle. While the ankle joint cartilage demonstrates capacity for self-restoration, the ankle joint is sensitive to aberrancies in biomechanics and the inflammatory milieu after an injury is thought to contribute to the onset of posttraumatic ankle OA. Conservative care for ankle OA is currently centered on pain reduction, and derivatives that may delay the progression of ankle OA are the subject of ongoing investigation. Surgical management for end-stage ankle OA currently focuses on ankle arthrodesis and total ankle arthroplasty. Specific indication for one procedure over the other is the topic of much debate. While total ankle arthroplasty has become more frequently used with the advent of newer generation systems, ankle arthrodesis may still be favored in younger patients with high-demand occupations.
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Affiliation(s)
- Albert T Anastasio
- From the Duke University Department of Orthopaedic Surgery, Division of Sports Medicine, Durham, North Carolina
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Wang S, Gao J, Lai L, Zhang X, Gong X, Li H, Wu Y. A finite element model of human hindfoot and its application in supramalleolar osteotomy. Clin Biomech (Bristol, Avon) 2024; 115:106257. [PMID: 38714108 DOI: 10.1016/j.clinbiomech.2024.106257] [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: 12/24/2023] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND The majority of the ankle osteoarthritis cases are posttraumatic and affect younger patients with a longer projected life span. Hence, joint-preserving surgery, such as supramalleolar osteotomy becomes popular among young patients, especially those with asymmetric arthritis due to alignment deformities. However, there is a lack of biomechanical studies on postoperative evaluation of stress at ankle joints. We aimed to construct a verifiable finite element model of the human hindfoot, and to explore the effect of different osteotomy parameters on the treatment of varus ankle arthritis. METHODS The bones of the hindfoot are reconstructed using normal CT tomography data from healthy volunteers, while the cartilages and ligaments are determined from the literature. The finite element calculation results are compared with the weight-bearing CT (WBCT) data to validate the model. By setting different model parameters, such as the osteotomy height (L) and the osteotomy distraction distance (h), the effects of different surgical parameters on the contact stress of the ankle joint surface are compared. FINDINGS The alignment and the deformation of hindfoot bones as determined by the finite element analysis aligns closely with the data obtained from WBCT. The maximum contact stress of the ankle joint surface calculated by this model increases with the increase of the varus angle. The maximum contact stresses as a function of the L and h of the ankle joint surface are determined. INTERPRETATION The relationship between surgical parameters and stress at the ankle joint in our study could further help guiding the planning of the supramalleolar osteotomy according to the varus/valgus alignment of the patients.
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Affiliation(s)
- Shuai Wang
- School of Aeronautic Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing 100191, China.
| | - Junzhe Gao
- School of Aeronautic Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing 100191, China
| | - Liangpeng Lai
- Foot and Ankle Surgery Department, Beijiing Jishuitan Hospital, Capital Medical University, Beijing 100035, China.
| | - Xiaojing Zhang
- School of Aeronautic Science and Engineering, Beijing University of Aeronautics and Astronautics, Beijing 100191, China
| | - Xiaofeng Gong
- Foot and Ankle Surgery Department, Beijiing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Heng Li
- Foot and Ankle Surgery Department, Beijiing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
| | - Yong Wu
- Foot and Ankle Surgery Department, Beijiing Jishuitan Hospital, Capital Medical University, Beijing 100035, China
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Li T, Zhao L, Liu Y, Huang L, Zhu J, Xiong J, Pang J, Qin L, Huang Z, Xu Y, Dai H. Total ankle replacement versus ankle fusion for end-stage ankle arthritis: A meta-analysis. J Orthop Surg (Hong Kong) 2024; 32:10225536241244825. [PMID: 38607239 DOI: 10.1177/10225536241244825] [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: 04/13/2024] Open
Abstract
PURPOSE This study aims to systematically review the efficacy and safety of total ankle replacement (TAR) and ankle fusion (AF) as treatment options for end-stage ankle arthritis. METHODS A comprehensive literature search was conducted on data from multiple databases, including PubMed, The Cochrane Library, Construction and Building Materials, Embase, Web of Science, and Scopus for RCTs and prospective cohort studies comparing TAR and AF in patients with end-stage ankle arthritis from inception up to June, 2023. Our primary outcomes of interest included patients' clinical function scores and complications. We employed Review Manager 5.4 and Stata/MP 14.0 software for the meta-analysis. RESULTS Our analysis incorporated 13 comparative studies, including 11 prospective studies, one pilot RCT, and one RCT. The pooled results revealed no significant difference in postoperative Short Form-36 scores between the TAR and AF groups (MD = -1.19, 95% CI: -3.89 to 1.50, p = .39). However, the postoperative Foot and Ankle Ability Measure scores in the AF group were significantly higher than in the TAR group (MD = 8.30, 95% CI: 1.01-15.60, p = .03). There was no significant difference in postoperative complication rates between the TAR and AF groups (RR = 0.95, 95% CI: 0.59 to 1.54, p = .85). CONCLUSION Currently available evidence suggests no significant disparity in postoperative outcomes between TAR and AF. In the short term, TAR demonstrates better clinical scores than AF and lower complication rates. Conversely, in the long term, AF exhibits superior clinical scores and lower complication rates, although this difference is not statistically significant.
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Affiliation(s)
- Taiyi Li
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Zhao
- Department of Neurology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Liu
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Li Huang
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jin Zhu
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Xiong
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junfeng Pang
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lina Qin
- Department of Neurology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zonggui Huang
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yinglong Xu
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hai Dai
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
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Ghasemi SA, Machi AS, Buksbaum J, Rozbruch SR, Fragomen AT. Ankle Distraction Arthroplasty: A Survivorship Review and Meta-Analysis. J Foot Ankle Surg 2023; 62:996-1004. [PMID: 37399902 DOI: 10.1053/j.jfas.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Abstract
Multiple treatments exist for ankle osteoarthritis. Ankle arthrodesis is the gold standard in late-stage osteoarthritis, but sacrifices range of motion and risks nonunion. Total ankle arthroplasty is typically reserved for low-demand patients as the long-term outcomes are poor. Ankle distraction arthroplasty is a joint sparing procedure which utilizes external fixator frame to unload the joint. This promotes chondral repair and improves function. This study aimed to organize clinical data and survivorship in published papers and direct further research efforts. Thirty-one publications were evaluated and 16 were included in the meta-analysis. The Modified Coleman Methodology Score was used to assess quality of the individual publications. Random effects models were used to estimate the failure risk after ankle distraction arthroplasty. Ankle Osteoarthritis Score (AOS), American Orthopedic Foot and Ankle Score (AOFAS), Van Valburg, and Visual Analog Scores (VAS) all improved postoperatively. Random effects model analysis revealed an overall failure ratio of 11% (95% CI: 7%-15%; p value ≤ .001; I2 = 87.01%) after 46.68 ± 7.17 months follow up, 9% (95% CI: 5%-12%; p value≤0.001 I2=81.59%) with less than 5 years follow-up and 28% (95% CI: 16%-41%; p value≤0.001 I2=69.03%) for patients with more than 5 years follow-up. Ankle Distraction Arthroplasty has promising short to intermediate term outcomes which makes this a reasonable treatment option to delay joint sacrificing surgery. The selection of the optimal candidates and consistent technique would improve research and subsequently outcomes. Based on our meta-analysis, negative prognostic factors include female sex, obesity, ROM < 20°, leg muscle weakness, high activity level, low preoperative pain levels, higher preoperative clinical scores, inflammatory arthritis, septic arthritis, and deformity.
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Affiliation(s)
- S Ali Ghasemi
- Albert Einstein Medical Center - Philadelphia, Philadelphia, PA.
| | - Anthony S Machi
- Albert Einstein Medical Center - Philadelphia, Philadelphia, PA
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Christidis P, Lampridis V, Kalitsis C, Kantas T, Biniaris G, Gougoulias N. Supramalleolar osteotomies for ankle arthritis: a systematic review. Arch Orthop Trauma Surg 2023; 143:5549-5564. [PMID: 37010603 DOI: 10.1007/s00402-023-04867-1] [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: 11/07/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION We investigated the mid-term outcomes of supramalleolar osteotomies regarding "survivorship" [before ankle arthrodesis (AA) or total ankle replacement (TAR)], complication rate and adjuvant procedures required. MATERIAL AND METHODS PubMed, Cochrane and Trip Medical Database were searched from January 01, 2000. Studies reporting on SMOs for ankle arthritis, in minimum of 20 patients aged 17 or older, followed for a minimum of two years, were included. Quality assessment was performed with the Modified Coleman Methodology Score (MCMS). A subgroup analysis of varus/valgus ankles was performed. RESULTS Sixteen studies met the inclusion criteria, with 866 SMOs in 851 patients. Mean age of patients was 53.6 (range 17-79) years, and mean follow-up was 49.1 (range 8-168) months. Of the arthritic ankles (646 ankles), 11.1% were classified as Takakura stage I, 24.0% as stage II, 59.9% as stage III and 5.0% as stage IV. The overall MCMS was 55.2 ± 9.6 (fair). Eleven studies (657 SMOs) reported on "survivorship" of SMO, before arthrodesis (2.7%), or total ankle replacement (TAR) (5.8%) was required. Patients required AA after an average of 44.6 (range 7-156) months, and TAR after 36.71 (range 7-152) months. Hardware removal was required in 1.9% and revision in 4.4% of 777 SMOs. Mean AOFAS score was 51.8 preoperatively, improving to 79.1 postoperatively. Mean VAS was 6.5 preoperatively and improved to 2.1 postoperatively. Complications were reported in 5.7% (44 out of 777 SMOs). Soft tissue procedures were performed in 41.0% (310 out of 756 SMOs), whereas concomitant osseous procedures were performed in 59.0% (446 out of 756 SMOs). SMOs performed for valgus ankles failed in 11.1% of patients, vs 5.6% in varus ankles (p < 0.05), with disparity between the different studies. CONCLUSIONS SMOs combined with adjuvant, osseous and soft tissue, procedures, were performed mostly for arthritic ankles of stage II and III, according to the Takakura classification and offered functional improvement with low complication rate. Approximately, 10% of SMOs failed and patients required AA or TAR, after an average of just over 4 years (50.5 months) after the index surgery. It is debatable whether varus and valgus ankles treated with SMO reveal different success rates.
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Affiliation(s)
- Panagiotis Christidis
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Vasileios Lampridis
- Department of Trauma and Orthopedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Christos Kalitsis
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Theofanis Kantas
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Georgios Biniaris
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece
| | - Nikolaos Gougoulias
- Department of Orthopedic Surgery, General Hospital of Katerini, 6th km Katerini-Aronas Rd, 60100, Katerini, Greece.
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Calori S, Comisi C, Mascio A, Fulchignoni C, Pataia E, Maccauro G, Greco T, Perisano C. Overview of Ankle Arthropathy in Hereditary Hemochromatosis. Med Sci (Basel) 2023; 11:51. [PMID: 37606430 PMCID: PMC10443289 DOI: 10.3390/medsci11030051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
Hereditary hemochromatosis (HH) is an autosomal recessive bleeding disorder characterized by tissue overload of iron. Clinical systemic manifestations in HH include liver disease, cardiomyopathy, skin pigmentation, diabetes mellitus, erectile dysfunction, hypothyroidism, and arthropathy. Arthropathy with joint pain is frequently reported at diagnosis and mainly involves the metacarpophalangeal and ankle joints, and more rarely, the hip and knee. Symptoms in ankle joints are in most cases non-specific, and they can range from pain and swelling of the ankle to deformities and joint destruction. Furthermore, the main radiological signs do not differ from those of primary osteoarthritis (OA). Limited data are available in the literature regarding treatment; surgery seems to be the gold standard for ankle arthropathy in HH. Pharmacological treatments used to maintain iron homeostasis can also be undertaken to prevent the arthropathy, but conclusive data are not yet available. This review aimed to assess the ankle arthropathy in the context of HH, including all its aspects: epidemiology, physiopathology, clinical and imaging presentation, and all the treatments available to the current state of knowledge.
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Oral Glucosamine in the Treatment of Temporomandibular Joint Osteoarthritis: A Systematic Review. Int J Mol Sci 2023; 24:ijms24054925. [PMID: 36902359 PMCID: PMC10003243 DOI: 10.3390/ijms24054925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/18/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Temporomandibular disorders (TMDs) occur frequently within the general population and are the most common non-dental cause of orofacial pain. Temporomandibular joint osteoarthritis (TMJ OA) is a degenerative joint disease (DJD). There have been several different methods of treatment of TMJ OA listed, including pharmacotherapy among others. Due to its anti-aging, antioxidative, bacteriostatic, anti-inflammatory, immuno-stimulating, pro-anabolic and anti-catabolic properties, oral glucosamine seems to be a potentially very effective agent in the treatment of TMJ OA. The aim of this review was to critically assess the efficacy of oral glucosamine in the treatment of TMJ OA on the basis of the literature. PubMed and Scopus databases were analyzed with the keywords: (temporomandibular joints) AND ((disorders) OR (osteoarthritis)) AND (treatment) AND (glucosamine). After the screening of 50 results, eight studies have been included in this review. Oral glucosamine is one of the symptomatic slow-acting drugs for osteoarthritis. There is not enough scientific evidence to unambiguously confirm the clinical effectiveness of glucosamine supplements in the treatment of TMJ OA on the basis of the literature. The most important aspect affecting the clinical efficacy of oral glucosamine in the treatment of TMJ OA was the total administration time. Administration of oral glucosamine for a longer period of time, i.e., 3 months, led to a significant reduction in TMJ pain and a significant increase in maximum mouth opening. It also resulted in long-term anti-inflammatory effects within the TMJs. Further long-term, randomized, double-blind studies, with a unified methodology, ought to be performed to draw the general recommendations for the use of oral glucosamine in the treatment of TMJ OA.
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Watanabe K, Teramoto A, Kamiya T, Okada Y, Murahashi Y, Yamashita T. A Comparative Study of Foot Range of Motion and Activities of Daily Living Status of Patients Following Ankle Arthrodesis and Tibiotalocalcaneal Arthrodesis. J Foot Ankle Surg 2022; 62:519-523. [PMID: 36635140 DOI: 10.1053/j.jfas.2022.12.007] [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: 11/05/2020] [Revised: 04/03/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
Subtalar arthrodesis in addition to ankle arthrodesis (AA) should have effect on foot motion and functional capabilities pertaining to activities of daily living (ADL); however, it is not well characterized. We compared the foot range of motion and ADL-related functional capabilities between patients who had undergone AA and tibiotalocalcaneal arthrodesis (TTC). Twenty-one AA patients and 10 TTC patients were enrolled. Foot sagittal motion arc was measured by radiographs. Patient satisfaction, ADL, footwear restriction, and rating scale scores were compared between the 2 groups. The mean sagittal motion arc in the AA group (23.5 ± 6.2°) was significantly greater than that in the TTC group (15.3 ± 3.5°). Patient satisfaction and overall ADL status was comparable in the 2 groups. Difficulties in climbing stairs, wearing rubber boots, and sitting in cross-legged position were more frequently reported in the TTC group. Our findings may be valuable for both surgeons and patients in predicting post-treatment ADL status and avoiding over expectations.
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Affiliation(s)
- Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, Japan.
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yasutaka Murahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Martínez-de-Albornoz P, Monteagudo M. Tibiotalocalcaneal Arthrodesis in Severe Hindfoot Deformities. Foot Ankle Clin 2022; 27:847-866. [PMID: 36368801 DOI: 10.1016/j.fcl.2022.08.008] [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
Tibiotalocalcaneal arthrodesis (TTCA) is the most common and reliable procedure in the treatment of patients with end-stage ankle arthritis combined with severe deformity. Many of these patients present with difficult previous sequelae that include nonunion, malunion, broken implants, vascular deficiencies, skin problems, or a combination of the previous. In that complex scenario, sometimes the only alternative treatment is a below-the-knee amputation. Image studies--weightbearing X-rays, tomography, and magnetic resonance - are fundamental to evaluate alignment and bone stock. When all conservative treatments fail to alleviate pain and dysfunction, the combination of osteotomies and arthrodesis is the procedure of choice. Surgical planning needs to be very detailed and thorough with a special focus on bone loss after debridement of non-healthy tissue and removal of metalwork. TTCA with grafting allows for the preservation of the limb in more than 80% of cases but at the expense of many complications with nonunion rates of approximately 20% of cases. There is controversy about the use of a retrograde nail versus specific TTCA plate and screws but results from biomechanical studies do not show a clear superiority of one specific construct. Amputation rates are close to 5% of cases after repeated failed surgeries. Bulk allografts increase the rate of nonunions but apparently do not have an influence on postoperative infections. Valgus positioning of the ankle/hindfoot is paramount to allow for maximal sagittal plane compensation from the midtarsal joints. Most patients are satisfied with the results of these salvage operations. The studies presented in this article have a considerable wide array of different scenarios that obviously bias some of the results, complications, and outcomes but together they present a persuasive pattern toward considering TTC with grafting and nail or plate fixation as a good salvage procedure that may help the patients to maintain their foot and ankle with a better alignment, function, and pain relief.
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Affiliation(s)
- Pilar Martínez-de-Albornoz
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud, Madrid, Spain; Faculty Medicine UEM, Madrid, Spain.
| | - Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud, Madrid, Spain; Faculty Medicine UEM, Madrid, Spain
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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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11
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Wikstrom EA, Song K, Tennant JN, Pietrosimone B. Gait Biomechanics and Balance Associate with Talar and Subtalar T1ρ Relaxation Times in Those with Chronic Ankle Instability. Med Sci Sports Exerc 2022; 54:1013-1019. [PMID: 35576137 DOI: 10.1249/mss.0000000000002867] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine associations between T1ρ relaxation times of talar and subtalar articular cartilage and commonly altered gait biomechanics and postural control outcomes in those with chronic ankle instability (CAI). METHODS Fifteen individuals with CAI (21.13 ± 1.81 yr) completed a T1ρ magnetic resonance imaging as well as a postural control and an overground gait assessment. Talocrural and subtalar cartilage was segmented manually to calculate T1ρ relaxation times. Greater T1ρ relaxation times were interpreted as decreased proteoglycan content. Pearson product-moment bivariate correlations examined the relationships between T1ρ relaxation times and the gait biomechanics and postural control outcomes. RESULTS Across multiple variables, worse postural control demonstrated moderate to strong associations (range, 0.433-0.642 and -0.713) with greater talar T1ρ relaxation times. At the subtalar joint, greater T1ρ relaxation times were associated with lower peak vertical ground reaction forces, lower average vertical ground reaction force loading rates, and lower peak loading rates (range, -0.438 to -0.622). At the talar dome, greater talar T1ρ relaxation times were associated with increased knee extensor moments (r = 0.457), as well as greater knee flexion (r = 0.482) and knee adduction (r = 0.407) at initial contact. Larger step spatiotemporal gait parameters also associated with greater talar and subtalar T1ρ relaxation times (range, 0.434-0.697). CONCLUSIONS In individuals with CAI, worse postural control and altered kinematic, kinetic, and spatiotemporal outcomes demonstrate moderate to strong associations with greater talar T1ρ and/or subtalar relaxation times (i.e., less proteoglycan content). Associations between modifiable neuromechanical variables and greater T1ρ relaxation times may represent potential therapeutic interventions to mitigate ankle joint degeneration in those with CAI.
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Affiliation(s)
- Erik A Wikstrom
- MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kyeongtak Song
- Sports Medicine Research Institute, Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY
| | - Joshua N Tennant
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Tucker WA, Barnds BL, Morris BL, Tarakemeh A, Mullen S, Schroeppel JP, Vopat BG. Nationwide Analysis of Total Ankle Replacement and Ankle Arthrodesis in Medicare Patients: Trends, Complications, and Cost. Foot Ankle Spec 2022; 15:201-208. [PMID: 32830583 DOI: 10.1177/1938640020950181] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Surgical management of end-stage ankle arthritis consists of either ankle arthrodesis (AA) or total ankle replacement (TAR). The purpose of this study was to evaluate utilization trends in TAR and AA and compare cost and complications. METHODS Medicare patients with the diagnosis of ankle arthritis were reviewed. Patients undergoing surgical intervention were split into AA and TAR groups, which were evaluated for trends as well as postoperative complications, revision rates, and procedure cost. RESULTS A total of 673 789 patients were identified with ankle arthritis. A total of 19 120 patients underwent AA and 9059 underwent TAR. While rates of AA remained relatively constant, even decreasing, with 2080 performed in 2005 and 1823 performed in 2014, TAR rates nearly quadrupled. Average cost associated with TAR was $12559.12 compared with $6962.99 for AA (P < .001). Overall complication rates were 24.9% in the AA group with a 16.5% revision rate compared with 15.1% and 11.0%, respectively, in the TAR group (P < .001). Patients younger than 65 years had both higher complication and revision rates. DISCUSSION TAR has become an increasingly popular option for the management of end-stage ankle arthritis. In our study, TAR demonstrated both lower revision and complication rates than AA. However, TAR represents a more expensive treatment option. LEVELS OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- William A Tucker
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Brandon L Barnds
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Brandon L Morris
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Armin Tarakemeh
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Scott Mullen
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - J Paul Schroeppel
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Bryan G Vopat
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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Abstract
Valgus ankle OA is a complex problem with multiple etiologies that can either be isolated or superimposed on top of other medical or musculoskeletal disorders. Proper medical history, physical, and preoperative radiological examinations are crucial in deciding on surgery and planning the surgical approach. JPS, especially the varisating medial closing-wedge SMOT with solid plate fixation, has been consistently associated with good outcomes for patients with valgus ankle OA. To further improve JPS for valgus ankle OA, further clinical and biomechanical studies are required to address the long-term clinical and functional outcomes and complications.
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Affiliation(s)
- Ahmad Alajlan
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, Basel 4010, Switzerland; Orthopaedic Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Victor Valderrabano
- SWISS ORTHO CENTER, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, Basel 4010, Switzerland.
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14
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Monteagudo M, Martínez-de-Albornoz P. Deciding Between Ankle and Tibiotalocalcaneal Arthrodesis for Isolated Ankle Arthritis. Foot Ankle Clin 2022; 27:217-231. [PMID: 35219367 DOI: 10.1016/j.fcl.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
After isolated ankle (tibiotalar) arthrodesis, the triceps progressively shifts the subtalar joint into varus thus blocking compensatory motion from the midtarsal joints. In a tibiotalocalcaneal arthrodesis, the subtalar may be fixed with the correct valgus. Comparison between ankle and tibiotalocalcaneal arthrodesis does not clearly favor one over another for pain relief, satisfaction, and gait analysis. Compensatory sagittal plane motion through the midtarsal joints when the subtalar is fixed in valgus may be responsible for these results. Tibiotalocalcaneal arthrodesis has become our procedure of choice over isolated tibiotalar for end-stage ankle arthritis regardless of the radiographic state of the subtalar.
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Affiliation(s)
- Manuel Monteagudo
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Calle Diego de Velazquez 1, Pozuelo de Alarcon, 28223 Madrid, Spain.
| | - Pilar Martínez-de-Albornoz
- Orthopaedic Foot and Ankle Unit, Orthopaedic and Trauma Department, Hospital Universitario Quirónsalud Madrid, Faculty Medicine UEM Madrid, Calle Diego de Velazquez 1, Pozuelo de Alarcon, 28223 Madrid, Spain
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15
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Buchhorn T, Polzer H. [Osteoarthritis of the ankle joint]. Unfallchirurg 2022; 125:173-174. [PMID: 35212791 DOI: 10.1007/s00113-021-01132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Affiliation(s)
- T Buchhorn
- Sporthopaedicum Regensburg-Straubing, Bahnhofsplatz 27, 93415, Straubing, Deutschland.
| | - H Polzer
- Sektion Fuß- und Sprunggelenkchirurgie, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, Ziemssenstr. 5, 80336, München, Deutschland.
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16
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Reliability of Manually Segmenting T1ρ Magnetic Resonance Sequences of Talar Articular Cartilage. J Sport Rehabil 2022; 31:111-114. [PMID: 34167081 DOI: 10.1123/jsr.2020-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Quantifying early posttraumatic ankle osteoarthritis pathogenesis using compositional magnetic resonance (MR) imaging sequences is becoming more common. These MR sequences are often manually segmented to isolate the cartilage of interest before cartilage compositional values (eg, T1ρ or T2) are quantified. However, limited information is available regarding the reliability and reproducibility of manual segmentation for the entire talar dome. OBJECTIVE The purpose of this study was to determine the intraobserver and interobserver reliability of manually segmenting T1ρ MR sequences of the entire talar dome and 4 subregions of interest. DESIGN Descriptive observational study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Ten uninjured healthy individuals (4M and 6F: 21.40 [3.03] y, 170.00 [7.93] cm, 71.03 [14.97] kg) participated. INTERVENTION None. MAIN OUTCOME MEASURES Two investigators manually segmented 10 T1ρ ankle MR sequences using ITK-SNAP software to calculate T1ρ mean relaxation times and cartilage volumes. Each observer repeated the segmentation twice, with segmentations separated by 1 month. Intraobserver and interobserver reliability was determined using intraclass correlation coefficients (ICCs) with 95% confidence intervals and root mean square coefficient of variations (RMSCVs). RESULTS For T1ρ relaxation time, intraobserver (ICC = .994-.997, RMSCV = 1.31%-1.51%) and interobserver reliability (ICC = .990, RMSCV = 2.36%) was excellent for the overall talar dome. Excellent intraobserver (ICC = .975-.980, RMSCV = 3.88%-4.59%) and excellent interobserver reliability (ICC = .970, RMSCV = 5.13%) was noted for overall talar cartilage volume. CONCLUSIONS The results demonstrate that manual segmentation of the entire talar dome from a T1ρ MR is reliable and repeatable.
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Tonogai I, Sairyo K. One-stage tibial deformity correction and ankle arthrodesis for ankle osteoarthritis and tibial malalignment after low tibial osteotomy. Int J Surg Case Rep 2021; 89:106624. [PMID: 34844197 PMCID: PMC8636806 DOI: 10.1016/j.ijscr.2021.106624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction There are no reports on one-stage corrective tibial opening wedge osteotomy and arthrodesis for osteoarthritis of the ankle and tibial malalignment after distal tibial osteotomy. Presentation of case The patient was a 70-year-old woman who presented with complaints of ankle pain and lower limb deformity after tibial osteotomy performed for ankle arthritis 17–18 years earlier. Clinical examination revealed marked swelling around the ankle joint and pain and tenderness at the joint line. Imaging showed tibial malalignment and severe osteoarthritic changes in the ankle. The patient had valgus deformity of 21° and recurvatum deformity of 4°. In two months, she admitted to Department of Orthopedics at Tokushima University Hospital in Japan and we performed one-stage corrective tibial opening wedge osteotomy and ankle arthrodesis with an anterolateral plate through a lateral longitudinal incision. After removal of the previous implants, the remaining articular cartilage and osteophytes were removed from the tibial and talar surfaces. After debridement of the talar trochlea and tibial plateau, the center of rotation and angular deformity of the tibia was cut transversely and a 1-cm bone graft obtained from the removed fibula was inserted into the osteotomy site, which decreased the tibial malalignment. An anterolateral locking plate was inserted over the anterior and lateral sides of the tibia, and the ankle was fused using 2 cannulated screws. Discussion The patient wore an above-knee splint for 6 weeks to avoid weight-bearing followed by gradual weightbearing with a brace thereafter. Osseous fusion was achieved after about 3.5 months. Radiographs obtained at the 2-year follow-up visit showed complete union of the tibia and talus. Full correction of valgus and recurvatum deformity was achieved, and the patient was able to perform daily activities with almost no pain. Conclusion We reported a rare case of ankle osteoarthritis and tibial malalignment that was successfully treated with one-stage corrective tibial opening wedge osteotomy and ankle arthrodesis using an anterolateral plate via a transfibular approach. Ankle osteoarthritis and malalignment can be followed by osteotomy. One-stage ankle arthrodesis and deformity correction should be considered. Anterolateral plate was useful for arthrodesis and correction.
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Affiliation(s)
- Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
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18
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Open versus arthroscopic ankle arthrodesis in high-risk patients: a comparative study. INTERNATIONAL ORTHOPAEDICS 2021; 46:515-521. [PMID: 34611735 DOI: 10.1007/s00264-021-05233-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Arthroscopic ankle arthrodesis is known to offer high fusion rates, improvements in pain and functional outcomes, low risks of complications, and reinterventions. The aim of this study is to compare open vs. arthroscopic ankle arthrodesis in patients at high risk of complications. METHODS A single-centre retrospective comparative analysis of ankle fusions was conducted. Patient records were screened for demographics, type of arthrodesis, follow-up length, pre-operative diagnosis, risk factors for non-union, operative time, radiographic union, time to union, complications, and reinterventions. The American Orthopedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Italian version of the Foot Function Index (FFI), and a visual analog scale (VAS) for pain scores collected pre-operatively and in the last follow-up were used to assess clinical outcomes. RESULTS There were 23 open and 21 arthroscopic ankle fusions. Union rate was higher (90.5% vs. 65.2%, p < 0.05) and complication rate was lower (14.3% vs. 47.8%, p < 0.05) in the arthroscopic group. In addition, patients who underwent arthroscopic arthrodesis reported better pain control, with higher improvements in VAS for pain scores. There was no significant difference in length of operative time, time to fusion, AOFAS, and FFI scores improvements between the two groups. CONCLUSIONS Arthroscopic ankle arthrodesis resulted in higher union rates, fewer complications, and lower reoperation rates in patients at high risk of complications.
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19
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Sadoun M, Hardy A, Cladière V, Guichard L, Bauer T, Stiglitz Y. Outpatient total ankle replacement. INTERNATIONAL ORTHOPAEDICS 2021; 45:2429-2433. [PMID: 34274986 DOI: 10.1007/s00264-021-05140-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Since the development of the last generation of implants total ankle replacements (TAR) is becoming more and more popular in patients and in specialized surgeon teams, the trend for outpatient surgery is growing, and protocols now are well established for hip or knee replacement. We adapted a protocol for outpatient TAR and hypothesized that it could be performed safely as standard procedure. PATIENTS AND METHODS Twenty-five consecutive patients among 141 TAR were treated with our outpatient protocol relying on three fundamentals: bleed control, pain control, and autonomy. They received 1 g of tranexamic acid before surgery, and after discard from post-operative care unit, they were operated under long-lasting nerve block precociously relayed by oral NSAIDs and had an immediate full weight-bearing authorization at discharge. RESULTS No patients we readmitted for an acute care following TAR, especially for haematoma or uncontrolled pain. Mean VAS was < 1 before discharge from post-operative care unit and < 2 until day 90. One patient had a delayed wound healing treated surgically at day 30 without implant revision. CONCLUSION Outpatient TAR is possible and safe if a risk management process is used, and the three basic principles for outpatient procedures are respected: bleed control, pain control, and patient autonomy. We consider now this modality as a routine.
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Affiliation(s)
- Maxime Sadoun
- Department of Orthopedics, Ambroise Paré University Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, Paris, France
| | - Alexandre Hardy
- Clinique du Sport, Paris 5, 36 boulevard Saint-Marcel, 75005, Paris, France
| | - Victoire Cladière
- Department of Orthopedics, Cochin University Hospital, APHP, 27 Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Leah Guichard
- Department of Anesthesiology, Raymond Poincaré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 104 Boulevard Raymond Poincaré, 92380, Garches, Paris, France
| | - Thomas Bauer
- Department of Orthopedics, Ambroise Paré University Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, Paris, France
| | - Yves Stiglitz
- Clinique Victor Hugo, 5 rue du Dôme, 75116, Paris, France.
- Department of Orthopaedics, Raymond Poincaré Hospital, AP-HP, Versailles Saint-Quentin-en-Yvelines University, 104 Boulevard Raymond Poincaré, 92380, Garches, Paris, France.
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20
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Conlin C, Khan RM, Wilson I, Daniels TR, Halai M, Pinsker EB. Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients' Perspective. Foot Ankle Int 2021; 42:1153-1161. [PMID: 33890511 DOI: 10.1177/10711007211004447] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total ankle replacement (TAR) and ankle fusion are effective treatments for end-stage ankle arthritis. Comparative studies elucidate differences in treatment outcomes; however, the literature lacks evidence demonstrating what outcomes are important to patients. The purpose of this study was to investigate patients' experiences of living with both a TAR and ankle fusion. METHODS This research study used qualitative description. Individuals were selected from a cohort of patients with TAR and/or ankle fusion (n = 1254). Eligible patients were English speaking with a TAR and contralateral ankle fusion, and a minimum of 1 year since their most recent ankle reconstruction. Surgeries were performed by a single experienced surgeon, and semistructured interviews were conducted by a single researcher in a private hospital setting or by telephone. Ankle Osteoarthritis Scale (AOS) scores, radiographs, and ancillary surgical procedures were collected to characterize patients. Themes were derived through qualitative data analysis. RESULTS Ten adults (8 men, 2 women), ages 59 to 90 years, were included. Average AOS pain and disability scores were similar for both surgeries for most patients. Participants discussed perceptions of each reconstructed ankle. Ankle fusions were considered stable and strong, but also stiff and compromising balance. TARs were considered flexible and more like a "normal ankle," though patients expressed concerns about their TAR "turning" on uneven ground. Individuals applied this knowledge to facilitate movement, particularly during a first step and transitioning between positions. They described the need for careful foot placement and attention to the environment to avoid potential challenges. CONCLUSION This study provides insight into the experiences of individuals living with a TAR and ankle fusion. In this unusual but limited group of patients, we found that each ankle reconstruction was generally perceived to have different characteristics, advantages, and disadvantages. Most participants articulated a preference for their TAR. These findings can help clinicians better counsel patients on expectations after TAR and ankle fusion, and improve patient-reported outcome measures by better capturing meaningful outcomes for patients. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Ryan M Khan
- Unity Health Toronto-St. Michael Hospital, Toronto, ON, Canada
| | - Ian Wilson
- North Island Hospital Comox Valley, Courtenay, BC, Canada
| | - Timothy R Daniels
- University of Toronto, Toronto, ON, Canada.,Unity Health Toronto-St. Michael Hospital, Toronto, ON, Canada
| | - Mansur Halai
- University of Toronto, Toronto, ON, Canada.,Unity Health Toronto-St. Michael Hospital, Toronto, ON, Canada
| | - Ellie B Pinsker
- Unity Health Toronto-St. Michael Hospital, Toronto, ON, Canada
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21
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Abstract
BACKGROUND Information regarding the effect of total ankle arthroplasty (TAA) on midfoot function is extremely limited. The purpose of this study was to characterize midfoot region motion and power during walking in people before and after TAA. METHODS This was a prospective cohort study of 19 patients with end-stage ankle arthritis who received a TAA and 19 healthy control group participants. A motion capture and force plate system was used to record sagittal and transverse plane first metatarsal and lateral forefoot with respect to hindfoot motion, as well as sagittal plane midfoot region positive and negative peak power during walking. Parametric or nonparametric tests to examine differences and equivalence across time were conducted. Comparisons to examine differences between postoperative TAA group and control group foot function were also performed. RESULTS Involved-limb midfoot function was not different between the preoperative and 6-month postoperative time point in the TAA group (all P ≥ .17). Equivalence testing revealed similarity in all midfoot function variables across time (all P < .05). Decreased first metatarsal and lateral forefoot motion, as well as positive peak power generation, were noted in the TAA group postoperative involved limb in comparison to the control group (all P ≤ .01). CONCLUSION The similarity of midfoot function across time, along with differences in midfoot function in comparison to controls, suggests that TAA does not change midfoot deficits by 6 months postoperation. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Frank E DiLiberto
- Physical Therapy Movement Analysis Laboratory, Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | | | - Steven A Miller
- Department of Psychology. College of Health Professions, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Anand M Vora
- Illinois Bone & Joint Institute, LLC, Libertyville, IL, USA
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22
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Jantzen C, Ebskov LB, Andersen KH, Benyahia M, Rasmussen PB, Johansen JK. The Effect of a Single Hyaluronic Acid Injection in Ankle Arthritis: A Prospective Cohort Study. J Foot Ankle Surg 2021; 59:961-963. [PMID: 32475656 DOI: 10.1053/j.jfas.2020.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023]
Abstract
Nonoperative measures are often used as first line treatment in ankle osteoarthritis. One of these measures consists of hyaluronic acid injections in the affected ankle joint, but efficiency of this treatment is uncertain. The purpose of the study was to evaluate the effect on Self-reported Foot and Ankle Score, visual analog scale score at rest, and visual analog scale score at activity 6 months after a single dose of hyaluronic acid in patients with ankle osteoarthritis. Patients were included from December 2017 to March 2019. A single intra-articular injection of Cingal or MonoVisc was administered. Age, gender, osteoarthritis-grade, Self-reported Foot and Ankle Score, visual analog score at activity, and at rest before injection and after 6 months was registered. A total of 33 patients were included, with 14 lost to follow-up. Four were treated with MonoVisc and were excluded to reduce confounding. The remaining 15 patients were included for analysis. Median Self-reported Foot and Ankle Score remained unchanged (p = .06), whereas visual analog score at activity went from 7 to 6 (.02) and visual analog score at rest was reduced from 4 to 3 (.02). Subgroup analysis on arthrosis grade (grade I-II and III-IV) showed no statistically significant changes for all variables even though patients with grade III-IV arthrosis seemed to benefit more from the treatment. The results indicate that a single injection of hyaluronic acid is insufficient to produce at clinically relevant response after 6 months even though there is a high risk of underpowering because of a small patient population.
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Affiliation(s)
- Christopher Jantzen
- Senior Resident, Department of Orthopedic Surgery, Foot and Ankle Department, Hvidovre University Hospital, Copenhagen, Denmark; Senior Resident, Hvidovre University Hospital, Copenhagen, Denmark.
| | - Lars Bo Ebskov
- Senior Resident, Department of Orthopedic Surgery, Foot and Ankle Department, Hvidovre University Hospital, Copenhagen, Denmark; Foot and Ankle Surgeon, Hvidovre University Hospital, Copenhagen, Denmark
| | - Kim Hegnet Andersen
- Senior Resident, Department of Orthopedic Surgery, Foot and Ankle Department, Hvidovre University Hospital, Copenhagen, Denmark; Foot and Ankle Surgeon, Hvidovre University Hospital, Copenhagen, Denmark
| | - Mostafa Benyahia
- Senior Resident, Department of Orthopedic Surgery, Foot and Ankle Department, Hvidovre University Hospital, Copenhagen, Denmark; Foot and Ankle Surgeon, Hvidovre University Hospital, Copenhagen, Denmark
| | - Peter Bro Rasmussen
- Senior Resident, Department of Orthopedic Surgery, Foot and Ankle Department, Hvidovre University Hospital, Copenhagen, Denmark; Foot and Ankle Surgeon, Hvidovre University Hospital, Copenhagen, Denmark
| | - Jens Kurt Johansen
- Senior Resident, Department of Orthopedic Surgery, Foot and Ankle Department, Hvidovre University Hospital, Copenhagen, Denmark; Foot and Ankle Surgeon, Hvidovre University Hospital, Copenhagen, Denmark
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23
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Coetzee JC, Raduan F, McGaver RS. Converting Ankle Arthrodesis to a Total Ankle Arthroplasty. Orthop Clin North Am 2021; 52:181-190. [PMID: 33752840 DOI: 10.1016/j.ocl.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Several articles in the literature discuss the positive results of converting a painful ankle fusion to an ankle replacement. Our results confirm that in well-selected cases a conversion to a total ankle replacement is not only possible, but also significantly improves quality of life and reduces pain. The outcome of a total ankle replacement after an ankle fusion depends to a degree on the method of fusion. Less destructive fusion that is arthroscopic has better results than conventional transfibular open fusions. Absence of a fibula should be an absolute contraindication for a conversion.
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Affiliation(s)
- J Chris Coetzee
- Twin Cities Orthopedics, 2700 Vikings Circle, Eagan, MN 55121, USA.
| | - Fernando Raduan
- Twin Cities Orthopedics, 2700 Vikings Circle, Eagan, MN 55121, USA
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Choi W, Chung CY, Park MS, Lee S, Lee KM. Radiographic differences in the concomitant deformities in two types of medial ankle osteoarthritis. PLoS One 2021; 16:e0247816. [PMID: 33657183 PMCID: PMC7928528 DOI: 10.1371/journal.pone.0247816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/07/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives Motion preserving surgeries could be unsuccessful because of underestimation of deformities of the foot and knee in ankle osteoarthritis. This study aimed to investigate the concomitant deformities in medial ankle osteoarthritis and the difference between the two types, varus angulation and medial translation. Methods A retrospective study was conducted using medical records and radiographic data. Patients with medial ankle osteoarthritis that underwent weight-bearing X ray imaging and radiographic measurements including tibial plafond inclination (TPI), tibiotalar tilt angle (TT), lateral talo-first metatarsal angle, naviculo-cuboid overlap, and mechanical tibiofemoral angle (mTFA) were studied. The patients were categorized into two groups, the varus angulation group (TT ≥4°) and medial translation group (TT <4°). The radiographic measurements were compared between the two groups. Results A total of 102 patients (male = 44; female = 58) were included; the mean age was 64.9 years (SD 8.3 years). The varus rotation group (N = 66) showed a significantly smaller lateral talo-first metatarsal angle (p<0.001), naviculo-cuboid overlap (p<0.001), and mTFA (p = 0.019) compared to the medial displacement group (N = 36). The TT showed a significant correlation with lateral talo-first metatarsal angle (r = -0.520, p<0.001), naviculo-cuboid overlap (r = -0.501, p<0.001), and mTFA (r = -0.243, p = 0.014). Lateral talo-first metatarsal angle was found to be the significant factor (p = 0.018) discriminating varus angulation and medial translation types in the binary logistic analysis. Conclusions Varus angulation of the ankle was correlated with knee alignment and foot deformity. Radiographic indices were different between the varus angulation and medial translation groups. The role of concomitant deformities needs to be further investigated in terms of a causal relationship. Surgeons need to pay attention to concomitant deformities in the treatment of medial ankle osteoarthritis.
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Affiliation(s)
- Wooyoung Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chin Youb Chung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sanghoon Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- * E-mail:
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25
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Tonogai I, Sairyo K. A case of osteophyte excision and arthroscopic arthrodesis for tarsal tunnel syndrome with traumatic osteoarthritis of the ankle. Int J Surg Case Rep 2020; 76:510-516. [PMID: 33207421 PMCID: PMC7596014 DOI: 10.1016/j.ijscr.2020.10.053] [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: 09/14/2020] [Accepted: 10/15/2020] [Indexed: 12/04/2022] Open
Abstract
We successfully treated tarsal tunnel syndrome (TTS) accompanied with traumatic osteoarthritis of the ankle. Osteophyte excision for the TTS and arthroscopic for the osteoarthritis was effective for even TTS with traumatic osteoarthritis of the ankle. There were many advantages in arthroscopic ankle arthrodesis, compared with open ankle arthrodesis.
Introduction There are some reports of tarsal tunnel syndrome (TTS) entrapment/impingement from bony factors, including exostosis and fragment, but there are no reports on TTS with traumatic osteoarthritis of the ankle that were treated with osteophyte excision for TTS and arthroscopic arthrodesis for osteoarthritis of the ankle. Presentation of case A 61-year-old woman with left trimalleolar fracture had undergone surgery 3 years earlier and was referred to our hospital for further investigation of persistent left ankle pain and numbness around the left medial malleolus and plantar aspect of the foot. Clinical examination demonstrated plantar hypesthesia and a positive Tinel’s sign at the tarsal tunnel. Imaging showed severe osteoarthritic change in the ankle and an osteophyte of the posteromedial distal tibia that appeared to be impinging on the tibial nerve. We performed arthroscopic ankle arthrodesis, which is less invasive than the open procedure, with removal of the osteophyte as the cause of TTS. Tarsal tunnel exploration revealed a large osteophyte pushing on the tibial nerve, and the osteophyte was removed. Discussion About 8 weeks after surgery, bony union was achieved. At the 2-year follow-up visit, the patient could perform daily activities with almost no pain or numbness. This case offers further insight into the management of TTS with traumatic osteoarthritis of the ankle. Conclusion We report here successful treatment of a rare case of tarsal tunnel syndrome (TTS) accompanied with traumatic osteoarthritis of the ankle, treated with osteophyte excision for the TTS and arthroscopic for the osteoarthritis.
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Affiliation(s)
- Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima, 770-8503, Japan.
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima, 770-8503, Japan.
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Egglestone A, Kakwani R, Aradhyula M, Kingman A, Townshend D. Outcomes of revision surgery for failed total ankle replacement: revision arthroplasty versus arthrodesis. INTERNATIONAL ORTHOPAEDICS 2020; 44:2727-2734. [DOI: 10.1007/s00264-020-04784-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
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Buchhorn T, Weber J, Lampert C. Arthrose des oberen Sprunggelenks. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-019-00333-6] [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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De la Fuente C, Martinez-Valdes E, Cruz-Montecinos C, Guzman-Venegas R, Arriagada D, Peña Y Lillo R, Henríquez H, Carpes FP. Changes in the ankle muscles co-activation pattern after 5 years following total ankle joint replacement. Clin Biomech (Bristol, Avon) 2018; 59:130-135. [PMID: 30227278 DOI: 10.1016/j.clinbiomech.2018.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/23/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Hintegra® arthroplasty provides inversion-eversion stability, permits axial rotation, ankle flexion-extension, and improvements of the gait patterns are expected up to 12 months of rehabilitation. However, sensorimotor impairments are observed in ankle flexors/extensors muscles after rehabilitation, with potential negative effects on locomotion. Here we determined the timing and amplitude of co-activation of the tibialis anterior and medial gastrocnemius muscles during gait by assessing non-operated and operated legs of patients with total ankle replacement, 5 years after surgery. METHODS Twenty-nine patients (age: 58 [5.5] years, height: 156.4 [6.5] cm, body mass: 72.9 [6.5] kg, 10 men, and 19 women) that underwent Hintegra® ankle arthroplasty were included. Inclusion criteria included 5 years prosthesis survivorship. The onset and offset of muscle activation (timing), as well as the amplitude of activation, were determined during barefoot walking at self-selected speed by surface electromyography. The timing, percentage, and index of co-activation between the tibialis anterior and medial gastrocnemius were quantified and compared between non-operated and operated legs. FINDINGS The operated leg showed higher co-activation index and temporal overlapping between tibialis anterior and medial gastrocnemius during gait (p < 0.001). INTERPRETATION The neuromuscular changes developed during the process of degeneration do not appear to be restored 5 years following arthroplasty. The insertion of an ankle implant may restore anatomy and alignment but neuromuscular adaptations to degeneration are not corrected by 5 years following joint replacement.
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Affiliation(s)
- Carlos De la Fuente
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica, #7820436 Santiago, Chile; Laboratorio LIBFE, Escuela de Kinesiología, Universidad de los Andes, #7620086 Santiago, Chile; Centro de Salud Deportivo, Clinica Santa Maria, #8340518 Santiago, Chile
| | - Eduardo Martinez-Valdes
- School of Sport, Exercise and Rehabilitation Sciences, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), College of Life and Environmental Sciences, University of Birmingham, # Edgbaston, B15 2TT Birmingham, United Kingdom; Centro de Investigacion en Fisiologia del Ejercicio (CIFE), Universidad Mayor, Santiago, Chile
| | - Carlos Cruz-Montecinos
- Laboratory of Biomechanics and Kinesiology, Hospital San José, #8380419 Santiago, Chile; Laboratory of Clinical Biomechanics, Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, #8380453 Santiago, Chile
| | - Rodrigo Guzman-Venegas
- Laboratorio LIBFE, Escuela de Kinesiología, Universidad de los Andes, #7620086 Santiago, Chile
| | - David Arriagada
- Kinesiología, Universidad de Santiago de Chile, #9170124 Santiago, Chile
| | - Roberto Peña Y Lillo
- Kinesiología, Universidad de Santiago de Chile, #9170124 Santiago, Chile; Servicio de Tobillo y Pie, Instituto Traumatológico, #8340220 Santiago, Chile
| | - Hugo Henríquez
- Servicio de Tobillo y Pie, Instituto Traumatológico, #8340220 Santiago, Chile; Facultad de Medicina, Universidad de Chile, #8380419 Santiago, Chile
| | - Felipe P Carpes
- Laboratory of Neuromechanics, Universidade Federal do Pampa, Campus Uruguaiana, #97508000 Uruguaiana, Brazil.
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Nelson AE, Golightly YM, Lateef S, Renner JB, Jordan JM, Aspden RM, Hillstrom H, Gregory JS. Cross-sectional associations between variations in ankle shape by statistical shape modeling, injury history, and race: the Johnston County Osteoarthritis Project. J Foot Ankle Res 2017; 10:34. [PMID: 28770007 PMCID: PMC5530536 DOI: 10.1186/s13047-017-0216-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Injury is an important risk factor for osteoarthritis (OA), a highly prevalent and disabling joint disease. Joint shape is linked to OA, but the interplay of injury and joint shape and their combined role in OA, particularly at the ankle, is not well known. Therefore, we explored cross-sectional associations between ankle shape and injury in a large community-based cohort. Methods Ankles without radiographic OA were selected from the current data collection of the Johnston County OA Project. Ankles with self-reported prior injury were included as injury cases (n = 108) along with 1:1 randomly selected non-injured ankles. To define ankle shape, a 68 point model on weight-bearing lateral ankle radiographs was entered into a statistical shape model, producing a mean shape and a set of continuous variables (modes) representing variation in that shape. Nineteen modes, explaining 80% of shape variance, were simultaneously included in a logistic regression model with injury status as the dependent variable, adjusted for intra-person correlation, sex, race, body mass index (BMI), baseline OA radiographic grade, and baseline symptoms. Results A total of 194 participants (213 ankles) were included; mean age 71 years, BMI 30 kg/m2, 67% white and 71% women. Injured ankles were more often symptomatic and from whites. In a model adjusted only for intra-person correlation, associations were seen between injury status and modes 1, 6, 13, and 19. In a fully adjusted model, race strongly affected the estimate for mode 1 (which was no longer statistically significant). Conclusions This study showed variations in ankle shape and history of injury as well as with race. These novel findings may indicate a change in ankle morphology following injury, or that ankle morphology predisposes to injury, and suggest that ankle shape is a potentially important factor in the development of ankle OA.
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Affiliation(s)
- Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.,Injury Prevention Research Center University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Shahmeer Lateef
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Richard M Aspden
- Arthritis and Musculoskeletal Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Howard Hillstrom
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York City, NY USA
| | - Jennifer S Gregory
- Arthritis and Musculoskeletal Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Dai CH, Sun J, Gu XF, Zheng YX. USING ARTHROSCOPY TO OBSERVE THE EFFECT OF LIVER-SOFTENING MEDICINE ON KNEE OSTEOARTHRITIS. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES 2017; 14:12-21. [PMID: 28480412 PMCID: PMC5412216 DOI: 10.21010/ajtcam.v14i3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Arthroscopy was used to observe the clinical effect of liver-softening medicine for treating knee osteoarthritis (OA). Materials and Methods: Forty knee OA patients with cartilage classifications of Outerbridge grade II, III, or II plus III determined via arthroscopy were randomly assigned to a treatment of liver-softening medicine plus glucosamine or a control treatment of glucosamine alone. Clinical observation and determination of the comprehensive effect score were performed at 60, 120, and 180 days. A second arthroscopy was performed at 180 days. Results: Signs and symptoms significantly improved at different time points in the treatment group. The effects in the treatment group were better than those in the control group. When analyzing the cartilage during the second arthroscopy, no further degeneration was observed. Conclusions: After arthroscopic debridement, the treatment of knee OA with liver-softening medicine in conjunction with glucosamine is a feasible and effective solution.
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Affiliation(s)
- Chong-Hua Dai
- Luliang County People's Hospital, Qujing City, Yunnan Province 655600, China
| | - Jun Sun
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China
| | - Xin-Feng Gu
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China
| | - Yu-Xin Zheng
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200021, China
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Lateef S, Golightly YM, Renner JB, Jordan JM, Nelson AE. A Cross-sectional Analysis of Radiographic Ankle Osteoarthritis Frequency and Associated Factors: The Johnston County Osteoarthritis Project. J Rheumatol 2017; 44:499-504. [PMID: 28202744 PMCID: PMC5468490 DOI: 10.3899/jrheum.161076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Because there are no epidemiologic data regarding the frequency of ankle osteoarthritis (OA) in a general population, we sought to analyze this disabling condition in a large, well-characterized, community-based cohort of older individuals. METHODS Cross-sectional data, including ankle radiographs, were from the most recent data collection (2013-2015) of the Johnston County OA Project. Radiographic ankle OA (rAOA) was defined as a Kellgren-Lawrence arthritis grading scale of ≥ 2 on weight-bearing lateral and mortise radiographs. The presence of pain, aching, or stiffness in the ankles as well as history of ankle injury (limiting ability to walk for at least 2 days) were assessed. Chi-square statistics (categorical variables) and Student t tests (continuous variables) were used to compare all participant characteristics by rAOA status. Joint-based logistic regression models with generalized estimating equations were used to examine associations of rAOA and covariates of interest [age, body mass index (BMI), sex, race, ankle symptoms, and injury history]. RESULTS Of 864 participants with available data, 68% were women, 34% were African American, with a mean age of 72 years and BMI of 31 kg/m2. Nearly 7% of this sample had rAOA. Increasing age, high BMI, history of ankle injury, and presence of ankle symptoms were all independently associated with greater odds of having rAOA; no significant differences were seen by sex or race. CONCLUSION The frequency of rAOA was higher than estimates generally quoted in the literature. While injury was an important contributor, other factors such as age, BMI, and symptoms were also significantly associated with rAOA.
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Affiliation(s)
- Shahmeer Lateef
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Yvonne M Golightly
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Jordan B Renner
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Joanne M Jordan
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Amanda E Nelson
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA.
- S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine.
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Hofmann KJ, Shabin ZM, Ferkel E, Jockel J, Slovenkai MP. Salto Talaris Total Ankle Arthroplasty: Clinical Results at a Mean of 5.2 Years in 78 Patients Treated by a Single Surgeon. J Bone Joint Surg Am 2016; 98:2036-2046. [PMID: 28002366 DOI: 10.2106/jbjs.16.00090] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In recent years, the number of total ankle arthroplasty procedures performed has increased dramatically. We sought to report the clinical results of the largest cohort of patients treated with a modern fixed-bearing total ankle arthroplasty by a single surgeon. METHODS We retrospectively reviewed the charts of 78 consecutive patients (81 ankles) who underwent total ankle arthroplasty with a minimum clinical follow-up of 2 years. Sixty-three patients completed standardized questionnaires including the Foot and Ankle Disability Index (FADI), the Short Musculoskeletal Function Assessment (SMFA), the Short Form (SF)-36v2, and a visual analog scale (VAS) for pain. In addition, each patient underwent serial range-of-motion examination and radiographic implant evaluation at each follow-up appointment. RESULTS Implant survival was 97.5% at a mean follow-up time of 5.2 years. There was 1 revision of a tibial component and 1 revision of a talar component. Thirty-six patients underwent a concurrent procedure at the time of the index surgery, with the most common being removal of previous hardware. Seventeen patients underwent additional procedures following the index surgery, with the most common being gutter debridement. Total range of motion averaged 35.5° preoperatively and 39.9° postoperatively (p = 0.02). Fifty-seven ankles (70%) had >2 years of radiographic follow-up, and 25 ankles (31%) displayed evidence of lucency around a metallic component at the final radiographic follow-up. Outcome scores at a mean of 5.2 years revealed promising results for the cohort, with a mean VAS pain score of 17.7 and a mean FADI score of 79.1. CONCLUSIONS Modern fixed-bearing total ankle arthroplasty had excellent implant survival, improved plantar flexion and total range of motion, and had good-to-excellent functional outcome at a mean follow-up of 5.2 years. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kurt J Hofmann
- 1Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts 2Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts 3Southern California Orthopaedic Institute, Van Nuys, California 4Orthopaedics Department, Colorado Permanente Medical Group, Denver, Colorado
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Castagnini F, Pellegrini C, Perazzo L, Vannini F, Buda R. Joint sparing treatments in early ankle osteoarthritis: current procedures and future perspectives. J Exp Orthop 2016; 3:3. [PMID: 26915003 PMCID: PMC4713405 DOI: 10.1186/s40634-016-0038-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 01/08/2016] [Indexed: 02/07/2023] Open
Abstract
Ankle osteoarthritis (AOA) is a severe pathology, mostly affecting a post-traumatic young population. Arthroscopic debridement, arthrodiastasis, osteotomy are the current joint sparing procedures, but, in the available studies, controversial results were achieved, with better outcomes in case of limited degeneration. Only osteotomy in case of malalignment is universally accepted as a joint sparing procedure in case of partial AOA. Recently, the biological mechanism of osteoarthritis has been intensively studied: it is a whole joint pathology, affecting cartilage, bone and synovial membrane. In particular, the first stage is characterized by a reversible catabolic activity with a state of chondropenia. Thus, biological procedures for early AOA were proposed in order to delay or to avoid end stage procedures. Mesenchymal stem cells (MSCs) may be a good solution to prevent or reverse degeneration, due to their immunomodulatory features (able to control the catabolic joint environment) and their regenerative osteochondral capabilities (able to treat the chondral defects). In fact, MSCs may regulate the cytokine cascade and the metalloproteinases release, restoring the osteochondral tissue as well. After interesting reports of mesenchymal stem cells seeded on scaffold and applied to cartilage defects in non-degenerated joints, bone marrow derived cells transplantation appears to be a promising technique in order to control the degenerative pathway and restore the osteochondral defects.
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Affiliation(s)
- Francesco Castagnini
- I Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - Camilla Pellegrini
- I Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Perazzo
- I Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Francesca Vannini
- I Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Roberto Buda
- Orthopaedics and Traumatology, I Clinic, Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
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Kim CY, Wiznia DH, Roth AS, Walls RJ, Pelker RR. Survey of Patient Insurance Status on Access to Specialty Foot and Ankle Care Under the Affordable Care Act. Foot Ankle Int 2016; 37:776-81. [PMID: 27026727 DOI: 10.1177/1071100716642015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the effect of insurance type (Medicaid, Medicare, and private insurance) on access to foot and ankle surgeons for total ankle arthroplasty. METHODS We called 240 foot and ankle surgeons who performed total ankle arthroplasty in 8 representative states (California, Massachusetts, Ohio, New York, Florida, Georgia, Texas, and North Carolina). The caller requested an appointment for a fictitious patient to be evaluated for a total ankle arthroplasty. Each office was called 3 times to assess the responses for Medicaid, Medicare, and BlueCross. From each call, we recorded appointment success or failure and any barriers to an appointment, such as need for a referral. RESULTS Patients with Medicaid were less likely to receive an appointment compared to patients with Medicare (19.8% vs 92.0%, P < .0001) or BlueCross (19.8% vs 90.4%, P < .0001) and experienced more requests for referrals compared to patients with Medicare (41.9% vs 1.6%, P < .0001) or BlueCross (41.9% vs 4%, P < .0001). Waiting periods were longer for patients with Medicaid compared to those with Medicare (22.6 days vs 11.7 days, P = .004) or BlueCross (22.6 days vs 10.7 days, P = .001). Reimbursement rates did not correlate with appointment success rate or waiting period. CONCLUSION Despite the passage of the PPACA, patients with Medicaid continue to have difficulty finding a surgeon who will provide care, increased need for a primary care referral, and longer waiting periods for appointments. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Chang-Yeon Kim
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Daniel H Wiznia
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Alexander S Roth
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Raymond J Walls
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Richard R Pelker
- Department of Orthopedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06510, USA
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