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Zachariadis CB, Leligou HC, Kourkoulis SK, Magnisalis E, Papagelopoulos PJ, Savvidou OD. Complications Following Intraosseous Injections of Calcium Phosphate Bone Cement in Subchondroplasty. J Long Term Eff Med Implants 2024; 34:15-22. [PMID: 38842229 DOI: 10.1615/jlongtermeffmedimplants.2023049584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
An alternative approach to the major problem of osteoarthritis that has begun to pique the interest of researchers focuses on the pathology of the subchondral bone, its constant cross-talk with the articular cartilage, and its interaction with the joint. The presence of bone marrow lesions, detectable on MRI scans, has proven to be a cause of pain as well as a predictor of the progression of degenerative changes. Subchondroplasty is a relatively new surgical procedure for the treatment of these lesions, in which injectable calcium phosphate bone cement is infused into the affected area percutaneously, under fluoroscopic guidance. In its use as a synthetic scaffold, calcium phosphate bone cement exhibits considerable osteoconductivity, bioabsorbability, and low toxicity, thus showing great potential for restoring subchondral biomechanical properties through structural remodeling. Although published results appear quite promising, there are certain complications that the surgeon should be aware of. We reviewed the published data regarding complications of the procedure, highlighting possible causes according to these data, and suggesting safety measures. Avascular necrosis of the talus is the most reported concern. Postsurgical pain, infection, and continuous wound drainage due to bone substitute material extravasation to the joint or soft tissue are also mentioned, necessitating further standardization of the procedure. There are no reports of permanent postoperative disability or fatal outcomes.
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Affiliation(s)
| | - Helen C Leligou
- University of West Attica, Dept. of Industrial Design and Production Engineering P. Ralli & Thivon 250, 12244 Aigaleo, Athens, Greece
| | - Stauros K Kourkoulis
- National Technical University of Athens, SAMPS, Department of Mechanics Athens, Attiki, Greece
| | - Evaggelos Magnisalis
- First Department of Orthopaedic Surgery, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University General Hospital, 12462, Athens, Greece; National Technical University of Athens, SAMPS, Department of Mechanics Athens, Attiki, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopedics, National and Kapodistrian University of Athens, Atikon University General Hospital, Athens, Greece
| | - Olga D Savvidou
- First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, GREECE
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Koh D, Chandrakumara D, Socklingam R, Kon Kam King C. A Retrospective Study Assessing the Clinical Outcomes After Cheilectomy and Subchondroplasty for Hallux Rigidus. Cureus 2023; 15:e43446. [PMID: 37711927 PMCID: PMC10498132 DOI: 10.7759/cureus.43446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Hallux rigidus (HR) refers to osteoarthritis of the first metatarsal phalangeal joint, resulting in stiffness, pain, and limitation in daily function. Surgery of HR is indicated in those who have failed a trial of non-operative management and is typically divided into joint-preserving (JP) and joint-sacrificing procedures. Cheilectomy is the most commonly practiced JP procedure, often done in conjunction with associated procedures for HR. Our paper aims to report the clinical outcomes after cheilectomy and cheilectomy done with subchondroplasty (SCP) performed for HR. Methods All patients who underwent cheilectomy for HR between 2017 and 2022 were identified and had their outcomes evaluated at the time of this review. The patients had their pre-operative radiographs and clinical and operative notes analyzed for the grading of HR. Functional outcomes were assessed with the use of the visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores, as well as comparing the pre-operative and post-operative degree of dorsiflexion of the affected first metatarsophalangeal joint. This study was approved by the SingHealth Institutional Review Board (IRB) Institution with approval number 2021/2629. Results A total of 19 patients and 20 feet were included in our study at a mean follow-up of 29.8 months. There was an increase in dorsiflexion of the first MTP joint by 27.2 degrees (p-value = <0.0001). Patients who underwent cheilectomy alone (Group 1) had a mean improvement in VAS scores of 5.46 (p-value = <0.0001). Patients who underwent SCP of the first metatarsal head along with cheilectomy (Group 2) had an improvement in VAS scores by 5.78 (p-value = 0.0007). There was a mean improvement in AOFAS scores of 25.6 (p-value = <0.0001) for patients in Group 1. Patients in Group 2 had a mean improvement in AOFAS scores of 31.0 (p-value = 0.0003). Conclusion Both cheilectomy and cheilectomy performed with SCP for HR show good outcomes at short-term follow-up (mean 29.8 months). Cheilectomy is a viable alternative to arthrodesis for the surgical treatment of HR even in patients with higher grades. The use of SCP should be further explored as an adjunct in the surgical treatment of HR.
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Affiliation(s)
- Don Koh
- Orthopaedics, Changi General Hospital, Singapore, SGP
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Tarantino U, Greggi C, Cariati I, Caldora P, Capanna R, Capone A, Civinini R, Colagrande S, De Biase P, Falez F, Iolascon G, Maraghelli D, Masi L, Cerinic MM, Sessa G, Brandi ML. Bone Marrow Edema: Overview of Etiology and Treatment Strategies. J Bone Joint Surg Am 2022; 104:189-200. [PMID: 34780382 DOI: 10.2106/jbjs.21.00300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Bone marrow edema (BME) is a nonspecific but relevant finding, usually indicating the presence of an underlying pathology. ➤ The gold standard technique for detecting BME is magnetic resonance imaging (MRI), as it allows for a correct diagnosis to be made, which is extremely important given the heterogeneity of BME-related diseases. ➤ Depending on the severity of painful symptomatology and the MRI evidence, different treatment strategies can be followed: physical modalities, pharmacological options, and surgical therapy.
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Affiliation(s)
- Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy.,Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - Chiara Greggi
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy.,Medical-Surgical Biotechnologies and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | - Ida Cariati
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy.,Medical-Surgical Biotechnologies and Translational Medicine, "Tor Vergata" University of Rome, Rome, Italy
| | | | - Rodolfo Capanna
- Department of Orthopaedics and Traumatology, Universal Hospital of Pisa, Pisa, Italy
| | - Antonio Capone
- Department of Surgical Sciences, University of Cagliari, Monserrato, Italy
| | - Roberto Civinini
- Department of Surgical Science, University of Florence, Florence, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Pietro De Biase
- General Orthopaedics and Traumatology, AOU Careggi, Florence, Italy
| | - Francesco Falez
- Orthopaedic and Traumatology Department, S. Spirito Hospital, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli," Caserta, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Laura Masi
- Metabolic Bone Diseases Unit, University Hospital of Florence, AOU Careggi, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Sessa
- Section of Orthopaedics and Traumatology, Department of General Surgery and Medical Surgical Specialties, University Hospital Policlinico Rodolico-San Marco, University of Catania, Catania, Italy
| | - Maria L Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Hanselman AE, Cody EA, Easley ME, Adams SB, Parekh SG. Avascular Necrosis of the Talus After Subchondroplasty. Foot Ankle Int 2021; 42:1138-1143. [PMID: 34024148 DOI: 10.1177/10711007211005435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subchondroplasty (SCP) is a relatively new procedure, developed in 2007 for the treatment of bone marrow lesions (BMLs), that has shown promising results in the knee through several different case series. The foot and ankle literature, however, is sparse, with only a few documented case reports or case series. At our institution, we have identified several patients with complications after this specific procedure. As a result, we report our case series of patients who developed talar avascular necrosis (AVN) after undergoing SCP. METHODS A retrospective review was performed of patients who underwent SCP for a talar BML at our facility or who were referred to our facility after undergoing SCP at an outside institution. Patients were included if they developed radiographic evidence of talar AVN after the procedure. Patient demographics, comorbidities, concomitant intraoperative procedures, complications, and subsequent interventions were reviewed. RESULTS Seven patients were identified as having radiographic evidence of talar AVN after SCP. Average time interval was 23 months postoperative from index procedure to radiographic confirmation of AVN. Two of the index procedures were performed at our institution, whereas 5 of the index procedures were performed at outside institutions and referred for further management. Three patients had documented risk factors for AVN before the SCP procedure. All 7 patients were symptomatic from the AVN. CONCLUSION We identified 7 patients who went on to develop talar AVN after having undergone SCP. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Andrew E Hanselman
- Department of Orthopaedic Surgery, Duke University, Wake Forest, NC, USA
| | - Elizabeth A Cody
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Stamford, CT, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Alhadhoud MA, Alsiri NF, Daniels TR, Glazebrook MA. Surgical interventions of Freiberg's disease: A systematic review. Foot Ankle Surg 2021; 27:606-614. [PMID: 32917526 DOI: 10.1016/j.fas.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/21/2020] [Accepted: 08/11/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Freiberg's disease is an osteonecrosis of the metatarsal head bone. Numerous surgical interventions can be provided; however, the literature is limited in systematic reviews discussing the various options. The study aimed to systematically review the quantity and quality of literatures exploring the surgical interventions. METHODS Fifty articles were found to be relevant for assessing the efficacy of common surgical interventions. The articles were assigned a level of evidence (I-V) to assess their quality. Next, the studies were reviewed to provide a grade of recommendation (A-C, I). RESULTS Two studies were found at level III that explored osteotomy and autologous transplantation; the other studies were level IV-V. There is poor evidence (grade C) in supporting of joint sparing and joint sacrificing for Freiberg's disease. CONCLUSION Poor evidence exists to support the surgical interventions for Freiberg's disease, higher quality trials are needed to support the increasing application of these surgical techniques. LEVEL OF EVIDENCE Level IV, Systematic review.
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Affiliation(s)
- Meshal A Alhadhoud
- Al-Adan Hospital, Kuwait; Al-Razi Orthopedics and Rehabilitation Hospital, Kuwait; Dalhousie University, Orthopedic, 1796 Summer Street, Halifax, Canada.
| | - Najla F Alsiri
- Al-Razi Orthopedics and Rehabilitation Hospital, Kuwait.
| | - Timothy R Daniels
- University of Toronto, Surgery, 55 Queen Street, East Toronto, Canada.
| | - Mark A Glazebrook
- Dalhousie University, Orthopedic, 1796 Summer Street, Halifax, Canada.
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Foran IM, Bohl DD, Vora AM, Mehraban N, Hamid KS, Lee S. Talar Osteonecrosis After Subchondroplasty for Acute Lateral Ligament Injuries: Case Series. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420907072. [PMID: 35097366 PMCID: PMC8697153 DOI: 10.1177/2473011420907072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Talar osteonecrosis is a well-described phenomenon following talar neck fracture, but is a rarely described complication after procedures about the foot and ankle. Here we describe the clinical course of 5 cases of talar osteonecrosis following injection of calcium phosphate into the talus (subchondroplasty) with or without acute lateral ligament repair after acute lateral ankle ligament injuries performed at an outside institution. Practitioners should be aware of this potentially devastating complication. Future research is indicated to determine the safety and efficacy of subchondroplasty for the talus.
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Affiliation(s)
- Ian M. Foran
- Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, IL, USA
| | - Daniel D. Bohl
- Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, IL, USA
| | - Anand M. Vora
- Illinois Bone and Joint Institute, Lake Forest Illinois, Chicago, IL, USA
| | - Nasima Mehraban
- Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, IL, USA
| | - Kamran S. Hamid
- Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, IL, USA
| | - Simon Lee
- Rush University Medical Center, Midwest Orthopedics at Rush, Chicago, IL, USA
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