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Atesok K, Scott DJ, Hurwitz S, Gross CE. Diagnosis and Management of Periprosthetic Joint Infections After Total Ankle Arthroplasty. J Am Acad Orthop Surg 2024; 32:728-737. [PMID: 38759226 DOI: 10.5435/jaaos-d-23-01266] [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: 12/31/2023] [Accepted: 04/14/2024] [Indexed: 05/19/2024] Open
Abstract
Periprosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a dreaded complication that may lead to catastrophic outcomes. Risk factors include a history of surgery on the operated ankle, low preoperative function scores, diabetes, extended surgical time, and postoperative wound-healing problems. Clinical presentation varies and may include increasing ankle pain and swelling, high temperature, local erythema, wound drainage, and dehiscence. The initial diagnostic evaluation should include plain radiographs, erythrocyte sedimentation rate, C-reactive protein levels, and leukocyte count. In suspected cases with elevated erythrocyte sedimentation rate and C-reactive protein, aspiration of the ankle joint for synovial fluid analysis, Gram staining, and culture should be performed. Antibiotic therapy should be based on the pathogen identified, and the surgical strategy should be determined based on the time lines of PJI. Early PJI can be treated with irrigation and débridement with polyethylene exchange. The surgical treatment of choice for late PJI is two-stage revision arthroplasty, which includes removal of the implant, insertion of an antibiotic spacer, and reimplantation of a TAA. In certain chronic PJI cases, permanent articulating antibiotic spacers can be left in place or an ankle arthrodesis can be performed. Below-knee amputation is considered as the final option after limb-sparing procedures have failed.
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Affiliation(s)
- Kivanc Atesok
- From the Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC (Atesok, Scott, and Gross), Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Hurwitz)
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Umbel BD, Haghverdian BA, Schweitzer KM, Adams SB. Diagnosis and Management of Infected Total Ankle Replacements. Orthop Clin North Am 2024; 55:285-297. [PMID: 38403374 DOI: 10.1016/j.ocl.2023.08.001] [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] [Indexed: 02/27/2024]
Abstract
As the number of primary total ankle replacements increases for treatment of end-stage ankle arthritis, failures are also expected to rise. Periprosthetic joint infection is among the causes of failures and has been reported to be as high as 5%. Diagnosis is usually made by a combination of clinical examination findings, imaging, laboratory, and microbiological workup. Management is generally separated into limb salvage or amputation. Limb salvage can be challenging and may involve a single versus staged approach. Options include revision arthroplasty or arthrodesis procedures (ankle versus tibiotalocalcaneal), and a multidisciplinary approach is sought to eradicate infection before definitive management.
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Affiliation(s)
- Benjamin D Umbel
- Department of Orthopedic Surgery, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA.
| | - Brandon A Haghverdian
- Department of Orthopedic Surgery, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA
| | - Karl M Schweitzer
- Duke Orthopaedics of Raleigh, 3480 Wake Forest Road, Suite 204, Raleigh, NC 27609, USA
| | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Medical Center, 200 Trent Drive, Durham, NC 27710, USA
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Anastasio AT, Bagheri K, Johnson L, Hubler Z, Hendren S, Adams SB. Outcomes following total ankle total talus replacement: A systematic review. Foot Ankle Surg 2024; 30:245-251. [PMID: 38228466 DOI: 10.1016/j.fas.2023.12.006] [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: 11/27/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Prosthetic substitution of the talus presents a significant challenge to the foot and ankle surgeon. The shear and compressive forces on the talus and its tenuous blood supply lead to high rates of avascular necrosis and eventual talar collapse. The purpose of this systematic review is to evaluate whether total ankle total talus replacement (TATTR) leads to improved clinical and radiographic outcomes with appropriate safety metrics in patients with a history of avascular necrosis or significant trauma. METHODS We searched the concepts of talus, prosthesis, and arthroplasty in MEDLINE (PubMed), Embase (Elsevier), CINAHL Complete (EBSCOhost), and Scopus (Elsevier) from the database's inception through March 9, 2023. Inclusion Criteria were 1) previous trauma to the talus, 2) post-traumatic arthritis to the tibiotalar joint, 3) avascular necrosis of talus, 4) multiple failed prior interventions, 5) degenerative osteoarthritis to the tibiotalar joint, and 6) inflammatory arthropathy to tibiotalar joint. Patients less than 18 years of age and manuscripts in non-English languages were excluded. RESULTS Of the 7625 references, 16 studies met the inclusion criteria, yielding data from 136 patients (139 ankles). The studies varied in design, with case reports and retrospective case series being predominant. The overall weighted average modified Coleman Methodology Score (mCMS) was 70.4 out of 100, indicating moderate flaws in study design that may be subject to various forms of bias and possible confounders. Demographics showed a diverse range of etiologies, with alumina ceramic being the primary prosthesis material. Functional scores demonstrated improvements in dorsiflexion and plantarflexion, although patient-reported outcome measures (PROs) were inconsistently reported. Complications included fractures, heterotopic ossification, prolonged wound healing, and infections. Revision details were sparsely reported. CONCLUSION TATTR is a promising treatment modality for improving short-term functional outcomes for patients with avascular necrosis or trauma-related issues. However, this systematic review underscores the need for standardized reporting, longer-term follow-ups, and further research to establish the procedure's efficacy and safety, particularly in comparison to other treatment modalities. LEVEL OF EVIDENCE III, Systematic Review of Level IV Studies.
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Affiliation(s)
- Albert T Anastasio
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Kian Bagheri
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA; Campbell University School of Osteopathic Medicine, Lillington, NC, USA.
| | - Lindsey Johnson
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA; Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Zachary Hubler
- Department of Orthopaedic Surgery, Eisenhower Army Medical Center, Forth Eisenhower, GA, USA
| | | | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC, USA
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Edelstein A, McDonald J, Lachance AD, Giro ME, Lee W. The efficacy and safety of tranexamic acid utilization in total ankle arthroplasty: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:641-649. [PMID: 38006436 DOI: 10.1007/s00402-023-05126-z] [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: 08/16/2023] [Accepted: 10/29/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION There is still a lack of information on the role of Tranexamic acid (TXA) in total ankle arthroplasty (TAA). The purpose of this study is to comprehensively review, consolidate, and analyze findings from existing research on the effectiveness and safety of TXA in TAA. MATERIALS AND METHODS The comprehensive literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) using PubMed, Embase, Web of Science, and Cochrane databases, for original, English-language studies investigating the efficacy and safety of TXA in TAA, through February 2023. Evaluated data for the meta-analysis included estimated blood loss (EBL), change in perioperative hemoglobin, need for transfusion, and complications including DVT/PE, and wound complications. RESULTS A total of nine studies were included in this study. In total, 450 TAA were included, with 244 receiving TXA (54.2%) and 206 not receiving TXA (45.8%). TXA in TAA significantly decreased EBL. A significantly lower rate of wound complications in the TXA group with the relative risk (RR) of 0.51. We classified wound complications into wound infection and delayed wound healing/dehiscence. A significant decrease in the rate of wound infection and a tendency showing a decrease in the rate of delayed wound healing/dehiscence in the TXA group were noted: the RR of 0.29, and 0.63, respectively. TXA did not increase the incidence of DVT/PE following TAA. CONCLUSIONS In conclusion, the utilization of TXA during TAA demonstrated a statistically significant reduction in EBL and relative risk for wound complications. However, further RCTs with larger sample sizes will be necessary to establish a more robust conclusion regarding the efficacy and safety of TXA in TAA. LEVEL OF EVIDENCE Level III, systematic review and meta-analysis.
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Affiliation(s)
- Alexander Edelstein
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Square, Sayre, PA, 18840, USA
| | - John McDonald
- Geisinger Commonwealth School of Medicine, 525 Pine St, Scranton, PA, 18510, USA
| | - Andrew D Lachance
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Square, Sayre, PA, 18840, USA
| | | | - Wonyong Lee
- Department of Orthopaedic Surgery, Guthrie Clinic, 1 Guthrie Square, Sayre, PA, 18840, USA.
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Zunarelli R, Fiore M, Lonardo G, Pace A, Persiani V, De Paolis M, Sambri A. Total Ankle Replacement Infections: A Systematic Review of the Literature. J Clin Med 2023; 12:7711. [PMID: 38137779 PMCID: PMC10743530 DOI: 10.3390/jcm12247711] [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: 11/06/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Periprosthetic infection (PJI) after TAR is a serious complication, often requiring further surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. This systematic review aims to summarize the current evidence on the management of TAR PJI and provide a comprehensive overview of this topic, especially from an epidemiologic point of view. Three different databases (PubMed, Scopus, and Web of Science) were searched for relevant articles, and further references were obtained by cross-referencing. Seventy-one studies met the inclusion criteria, reporting on cases of TAR PJI. A total of 298 PJIs were retrieved. The mean incidence of PJI was 3.8% (range 0.2-26.1%). Furthermore, 53 (17.8%) were acute PJIs, whereas most of them (156, 52.3%) were late PJIs. Most of the studies were heterogeneous regarding the treatment protocols used, with a two-stage approach performed in most of the cases (107, 35.9%). While the prevalence of ankle PJI remains low, it is potentially one of the most devastating complications of TAR. This review highlights the lack of strong literature regarding TAR infections, thus highlighting a need for multicentric studies with homogeneous data regarding the treatment of ankle PJI to better understand outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.Z.); (M.F.); (G.L.); (A.P.); (V.P.); (M.D.P.)
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Varga C, Váncsa S, Agócs G, Hegyi P, Gidró BT, Szőke G, Domos G, Rodler E, Kocsis G, Holnapy G. Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis. Foot Ankle Int 2023; 44:1305-1318. [PMID: 37902184 DOI: 10.1177/10711007231201158] [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: 10/31/2023]
Abstract
BACKGROUND The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA. METHODS We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups). RESULTS Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group. CONCLUSION Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis's survival.
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Affiliation(s)
- Csaba Varga
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Gergely Agócs
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | | | - György Szőke
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gyula Domos
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Endre Rodler
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - György Kocsis
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Gergely Holnapy
- Department of Orthopaedics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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April PM, Locke E, Champagne PH, Angers M, Martinez-Gomez AP, Seidel A, Jibri Z, Lalonde KA, Meulenkamp B. Accuracy of a Patient-Specific Total Ankle Arthroplasty Instrumentation. Foot Ankle Int 2023; 44:1150-1157. [PMID: 37727986 DOI: 10.1177/10711007231194049] [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: 09/21/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is a preferred surgical option for end-stage ankle osteoarthritis; however, it is a demanding procedure with a higher historical rate of revision compared with ankle fusion. Patient-specific instrumentation (PSI) has been introduced to optimize prosthesis alignment and theoretically overall improve TAA outcomes. The goal of this study is to report on the experience and surgical outcomes of one implant with specific evaluation of the accuracy and reproducibility of the system with respect to prosthesis alignment and prediction of implant size. METHODS A retrospective, multicentered study involving 4 foot and ankle fellowship-trained orthopaedic surgeon's patients undergoing TAA between January 1, 2015, and December 31, 2018, using the PROPHECY PSI system. RESULTS 80 TAA procedures were performed. On average the postoperative tibial component alignment was 89.9 (range, 86.1-96.5) degrees in the coronal plane, with a mean sagittal alignment of 88.1 (range, 81.3-96.7) degrees. The mean deviation from neutral sagittal alignment improved from 4.9 ± 3.9 degrees preoperatively to 2.7 ± 1.7 degrees postoperatively, whereas the mean coronal alignment improved from 3.3 ± 2.5 degrees to 1.3 ± 1.1 degrees. The PSI software correctly determined the tibial implant size in 70 patients (89%). Prediction of talar implant sizing was less accurate than the tibial component, with 56 patients (71%) using the predicted sized implant. The overall implant survival at a mean follow-up of 45 months (range, 27-76) was 97.5%. CONCLUSION We found that this PSI system accurately and reliably assisted in implant total ankle prosthesis positioning within a clinically acceptable margin and without significant outliers. Prediction of implant size was not as accurate as component orientation. LEVEL OF EVIDENCE Level III, retrospective study.
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Affiliation(s)
| | - Eric Locke
- Department of Orthopaedics, Civic Hospital, Ottawa, Canada
| | | | | | | | - Angela Seidel
- Department of Orthopaedics, Civic Hospital, Ottawa, Canada
| | - Zaid Jibri
- Department of Orthopaedics, Civic Hospital, Ottawa, Canada
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Lee GW, Jung DM, Jung WC, Lee KB. Effect of diabetes mellitus on the outcomes of total ankle arthroplasty: is controlled diabetes mellitus a risk factor? J Orthop Surg Res 2023; 18:636. [PMID: 37644589 PMCID: PMC10463683 DOI: 10.1186/s13018-023-04110-y] [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: 07/16/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND It is still uncertain whether diabetes mellitus (DM) is a risk factor for poor outcomes and increased complications after total ankle arthroplasty (TAA). The objective of this study was to compare clinical outcomes and complication rates of TAA in patients with and without DM. METHODS This study enrolled patients with symptomatic end-stage ankle osteoarthritis with a minimum follow-up period of 24 months after TAA. A total of 252 patients (266 ankles) were classified into two groups according to the presence of DM: (1) DM group (59 patients, 67 ankles) and (2) non-DM group (193 patients, 199 ankles). We defined controlled diabetes as (1) HbA1c level < 7.0%, or (2) fasting glucose level < 130 mg/dL with HbA1c level ≥ 7.0% for hospitalization period. Clinical outcomes data (Ankle Osteoarthritis Scale, American Orthopedic Foot and Ankle Society ankle-hindfoot score, Short Form-36 Physical Component Summary score, and visual analog scale for pain) were compared preoperatively and at the final follow-up between the two groups. Complications following TAA were also compared between the two groups. RESULTS All clinical variables had improved in both groups by the final follow-up (mean follow-up = 77.8 months). There was no significant difference in any clinical variable between the two groups at the final follow-up (P > 0.05). Of the 266 ankles, 73 ankles (19 in the DM group, 54 in the non-DM group) developed periprosthetic osteolysis. Although the DM group showed a higher prevalence of aseptic loosening or subsidence, the difference between the two groups was not statistically significant (P = 0.236). CONCLUSIONS In the intermediate-term follow-up, TAA in patients with controlled DM showed clinical outcomes and complication rates comparable to patients without DM. Our results suggest that TAA can be done safely in diabetic patients if the DM is controlled in the perioperative period. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Gun-Woo Lee
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea
| | - Dong-Min Jung
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea
| | - Woo-Chul Jung
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea
| | - Keun-Bae Lee
- Department of Orthopedic Surgery, Chonnam National University Hospital, 42 Jebongro, Donggu, Gwangju, 61469, Republic of Korea.
- Department of Orthopedic Surgery, Chonnam National University Medical School, Gwangju, Republic of Korea.
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Cifaldi A, McGlone W, McKee T, Bonvillian J, Blacklidge D, Miller JM, Elliott B. Anterior Ankle Incision Healing Complications With and Without Tourniquet Use: A Retrospective Comparative Cohort Study. J Foot Ankle Surg 2023; 62:304-309. [PMID: 36127242 DOI: 10.1053/j.jfas.2022.08.006] [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: 04/20/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 02/03/2023]
Abstract
Anterior ankle incisions and tourniquet use in foot and ankle surgery have both been associated with increased incidence of incisional healing complications. Although a tourniquet is commonly used for procedures such as total ankle replacement and ankle arthrodesis that utilize an anterior ankle incision, it is possible to avoid tourniquet use while preserving adequate visualization with atraumatic layered dissection and closure, appropriate use of electrocautery, and ligation of vessels as needed. The primary aim of this study is to report rates of anterior ankle incisional healing complications both with and without tourniquet use. A retrospective chart review was performed on consecutive patients undergoing total ankle replacement or ankle arthrodesis through a multi-provider foot and ankle surgery practice between 2013 and 2018. A total of 121 patients, 58 (47.9%) in the tourniquet group and 63 (52.1%) in the no-tourniquet group, were included in this study with a median follow-up period of 36 (range 2-96) months. There was a higher rate of incisional healing complications for the tourniquet group (5.2%) compared to the no-tourniquet group (3.2%), however this did not reach statistical significance (p = .670). There was no significant difference in operative time between the tourniquet and no-tourniquet group (p = .405). The overall incisional healing complication rate was 4.1%. Although avoiding tourniquet use alone does not appear to significantly reduce anterior ankle incisional healing complications, the described technique has yielded an overall lower rate of incisional complications compared to those commonly reported in the literature.
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Affiliation(s)
- Andrea Cifaldi
- Foot and Ankle Surgery Fellow, American Health Network, Indianapolis, IN.
| | - William McGlone
- Foot and Ankle Surgery Fellow, American Health Network, Indianapolis, IN
| | - Tyler McKee
- Foot and Ankle Surgeon; Fellowship Attending Staff, American Health Network, Indianapolis, IN
| | - John Bonvillian
- Foot and Ankle Surgeon, Wake Forest Baptist Health, Winston-Salem, NC
| | - Douglas Blacklidge
- Foot and Ankle Surgeon; Fellowship Attending Staff, American Health Network, Indianapolis, IN
| | - J Michael Miller
- Foot and Ankle Surgeon; Fellowship Director, American Health Network, Indianapolis, IN
| | - Brian Elliott
- Foot and Ankle Surgeon; Fellowship Attending Staff, Major Health Partners, Shelbyville, IN
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Othman S, Colen DL, Azoury SC, Piwnica-Worms W, Fischer JP, Levin LS, Kovach SJ. Soft-Tissue Reconstruction of Complicated Total Ankle Arthroplasty. Foot Ankle Spec 2022; 15:464-471. [PMID: 33215522 DOI: 10.1177/1938640020969596] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is a popular modality to treat end-stage arthritis or internal ankle derangement. Unfortunately, failure rates remain undesirably high, with severe complications, including prosthesis failure, ankle fusion, and amputation. The importance of a stable soft-tissue envelope for coverage of implant compromise has been previously described, but the predictive factors for successful salvage of complicated TAA remain poorly understood. METHODS A retrospective review was conducted of patients requiring soft-tissue reconstruction following TAA wound complications. Patient demographics, history, microbiological data, reconstructive approach, and outcomes data were collected. Statistical analysis was used to abstract factors associated with unsuccessful prosthetic salvage. RESULTS In all, 13 patients met inclusion criteria: 8 (61.5%) achieved prosthetic salvage, and 5 (38.5%) failed. The majority (90.9%) of patients presented with infected joints. Reconstructive techniques included skin grafts, dermal substitutes, locoregional flaps, and free tissue transfer. Successful prosthetic salvage was associated with shorter time intervals between wound diagnosis and index reconstructive surgical intervention (median: 20 days for salvage vs 804 days for failure; P = .014). Additionally, salvage was associated with reduced time from the index orthopaedic/podiatric surgical intervention to the index reconstructive surgery procedure (12 vs 727 days; P = .027). CONCLUSION The prognosis of complicated TAA requiring soft-tissue reconstruction remains poor, especially in patients who present with infected joints. Several reconstructive techniques, ranging from simple skin grafts to complex free tissue transfers, can be used successfully. Early intervention to achieve soft-tissue coverage is crucial in maximizing salvage rates in the setting of complicated and infected TAA. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sammy Othman
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David L Colen
- Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Saïd C Azoury
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Piwnica-Worms
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - L Scott Levin
- Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen J Kovach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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D'Errico M, Morelli I, Castellini G, Gianola S, Logoluso N, Romanò D, Scarponi S, Pellegrini A. Is debridement really the best we can do for periprosthetic joint infections following total ankle replacements? A systematic review and meta-analysis. Foot Ankle Surg 2022; 28:697-708. [PMID: 34688527 DOI: 10.1016/j.fas.2021.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/22/2021] [Accepted: 10/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle periprosthetic joint infections are rising in number, but an evidence-based gold standard treatment has not been defined yet. METHODS We made a systematic review about the operative treatment of infections following total ankle arthroplasty. Proportional meta-analysis was used to summarize effects of the surgical techniques included. Primary outcome of this study was infection eradication, followed by complications, re-interventions, amputation rates and functions. RESULTS We included six studies(113 patients) reporting 6 types of surgical interventions, mostly irrigation and debridement (35.4%) and two-stage revisions (24.8%). No differences among all analyzed techniques were found in the infection eradication outcome as well as in the secondary outcomes. Patients receiving a permanent spacer are most likely to end up with amputation. CONCLUSIONS Literature dealing with infections after total ankle replacement is currently composed by few low-quality articles. The overlapping of confidence intervals related to all analyzed interventions showed no superiority of either technique. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mario D'Errico
- IRCCS Istituto Ortopedico Galeazzi (Ortopedia Ricostruttiva Articolare della Clinica Ortopedica - ORACO Unit), via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Ilaria Morelli
- ASST Ovest Milanese, Ospedale di Legnano, UOC Ortopedia e Traumatologia, via Papa Giovanni Paolo II, 20025 Legnano, MI, Italy.
| | - Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi (Unit of Clinical Epidemiology), via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi (Unit of Clinical Epidemiology), via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Nicola Logoluso
- IRCCS Istituto Ortopedico Galeazzi (Centro di Chirurgia Ricostruttiva e delle Infezioni Osteoarticolari - CRIO Unit), via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Delia Romanò
- IRCCS Istituto Ortopedico Galeazzi (Centro di Chirurgia Ricostruttiva e delle Infezioni Osteoarticolari - CRIO Unit), via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Sara Scarponi
- IRCCS Istituto Ortopedico Galeazzi (Centro di Chirurgia Ricostruttiva e delle Infezioni Osteoarticolari - CRIO Unit), via Riccardo Galeazzi 4, 20161 Milano, Italy.
| | - Antonio Pellegrini
- IRCCS Istituto Ortopedico Galeazzi (Centro di Chirurgia Ricostruttiva e delle Infezioni Osteoarticolari - CRIO Unit), via Riccardo Galeazzi 4, 20161 Milano, Italy.
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12
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Mazzotti A, Viglione V, Gerardi S, Bonelli S, Zielli S, Geraci G, Faldini C. Post-operative management after total ankle arthroplasty: A systematic review of the literature. Foot Ankle Surg 2022; 28:535-542. [PMID: 34088605 DOI: 10.1016/j.fas.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Currently, there is no consensus on the most appropriate post-operative management for patients undergoing total ankle arthroplasty. The aim of this study is therefore to offer a systematic review of the pertaining literature to identify current post-operative protocols and describe possible differences. METHODS A systematic review to identify recent studies concerning the post-operative management after total ankle arthroplasty was conducted. Five topics were analyzed: length of hospital stay, type and duration of immobilization, weight-bearing management, post-operative pharmacological therapies, adopted rehabilitation scheme. RESULTS Eighty-four studies met the inclusion criteria and were included in the review process. Most of the papers appear to have conflicting opinions with no consensus and homogeneous protocols. CONCLUSION Due to various methodological limitations, it is not possible to provide sufficiently supported evidence-based recommendations, and it is therefore difficult to determine the superiority of one post-operative protocol over the others after total ankle arthroplasty.
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Affiliation(s)
- A Mazzotti
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
| | - V Viglione
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Gerardi
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Bonelli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - S Zielli
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - G Geraci
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123, Bologna, Italy
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13
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Knabel M, Cook JJ, Basile P, McKenna B, Cook EA. Risk Stratification for Revision Surgery Following Total Ankle Replacement. J Foot Ankle Surg 2022; 61:551-556. [PMID: 34785127 DOI: 10.1053/j.jfas.2021.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
As a result of improved implants total ankle replacement (TAR) is becoming a more reliable option for end stage ankle arthritis. As with any surgery there are numerous complications that can occur intraoperatively and postoperatively with TAR. The primary aim of this study is to use recent data on implants currently on the market to develop a well-defined and comprehensive complication classification system which stratifies risk of subsequent surgery for TAR. A systematic review of studies on TARs from 2013 to 2018 was performed. Inclusion criteria were studies published between 2013 and August 2018, studies having at least 20 patients, data with at least 1-year follow-up and use of implants currently on the market. Studies were excluded if they involved revision cases, case reports, basic science articles and studies published in non-peer-reviewed journals. Sixteen studies fit inclusion criteria involving 3,305 implants. Overall survival of all implants was found to be 93% with a pooled complication rate of 75.6% using criteria for classifying complications by Glazebrook et al. Previously published classification systems did not clearly define complication categories leading to inconsistency in complication reporting and inaccurate complication rates. There are also several complications that are unclassifiable with the classifications developed by Gadd et al and Glazebrook et al. Our proposed updated classification system provides more inclusive tier profiles to capture the complications that can occur with implants currently on the market. Furthermore, this system provides a stratification of risk that these complications pose to ultimate procedure success.
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Affiliation(s)
- Matthew Knabel
- Chief Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow in Surgery, Harvard Medical School, Boston, MA.
| | - Jeremy J Cook
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Director of Research and Quality Assurance, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Philip Basile
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Chief, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Bryon McKenna
- Chief Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow in Surgery, Harvard Medical School, Boston, MA
| | - Emily A Cook
- Director of Research and Quality Assurance, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Director of Resident Training, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
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14
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Escudero MI, Le V, Bemenderfer TB, Barahona M, Anderson RB, Davis H, Wing KJ, Penner MJ. Total Ankle Arthroplasty Radiographic Alignment Comparison Between Patient-Specific Instrumentation and Standard Instrumentation. Foot Ankle Int 2021; 42:851-858. [PMID: 33749342 DOI: 10.1177/1071100721996379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several benefits are published supporting patient-specific instrumentation (PSI) in total ankle arthroplasty (TAA). This study seeks to determine if TAA with PSI yields different radiographic outcomes vs standard instrumentation (SI). METHODS Sixty-seven primary TAA patients having surgery using PSI or SI between 2013 and 2015 were retrospectively reviewed using weightbearing radiographs at 6-12 weeks postsurgery. Radiographic parameters analyzed were the medial distal tibia angle (MDTA), talar-tilt angle (TTA), anatomic sagittal distal tibia angle (aSDTA), lateral talar station (LTS), and talar component inclination angle (TCI). A comparison of the 2 groups for each radiologic parameter's distribution was performed using a nonparametric median test and Fisher exact test. Furthermore, TAAs with all radiographic measurements within acceptable limits were classified as "perfectly aligned." The rate of "perfectly aligned" TAAs between groups was compared using a Fisher exact test with a significance of .05. RESULTS Of the 67 TAAs, 51 were done with PSI and 16 with SI. There were no differences between groups in MDTA (P = .174), TTA (P = .145), aSDTA (P = .98), LTS (P = .922), or TCI angle (P = .98). When the rate of "perfectly aligned TAA" between the 2 groups were compared, there was no significant difference (P = .35). CONCLUSION No significant radiographic alignment differences were found between PSI and SI implants. This study showed that both techniques achieve reproducible TAA radiographic coronal and sagittal alignment for the tibial component when performed by experienced surgeons. The talar component's sagittal alignment is similar whether or not PSI was used but is noticeably different from normal anatomic alignment by design. LEVEL OF EVIDENCE Level III, retrospective cohort study using prospectively collected data.
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Affiliation(s)
- Mario I Escudero
- Department of Orthopaedics, University of Chile, Santiago, Chile
| | - Vu Le
- Pacific Orthopaedic Associates, Alhambra, CA, USA
| | | | | | | | - Hodges Davis
- Department of Orthopaedics, OrthoCarolina, Charlotte, NC, USA
| | - Kevin J Wing
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray J Penner
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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15
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McKenna BJ, Cook J, Cook EA, Crafton J, Knabel M, Swenson E, Miner S, Manning E, Basile P. Total Ankle Arthroplasty Survivorship: A Meta-analysis. J Foot Ankle Surg 2021; 59:1040-1048. [PMID: 32600863 DOI: 10.1053/j.jfas.2019.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/02/2019] [Accepted: 10/28/2019] [Indexed: 02/03/2023]
Abstract
The gold standard for management of end-stage ankle arthritis was previously ankle arthrodesis; however, improvements in total ankle replacements are making this a more viable treatment option. The primary aim of this meta-analysis was to evaluate the survivorship of total ankle replacement implants currently in use. An extensive search strategy initially captured 20,842 citations that were evaluated for relevance. Abstract screening produced 97 articles to be read in entirety, of which 10 articles studying 1963 implants met all prospective inclusion criteria for analysis. Overall survivorship of all implants was 93.0% (95% confidence interval, 85.2-96.9) using a random effect model. There was significant heterogeneity between the studies (Q = 131.504). Meta-regression identified an inverse relationship between survivorship and study follow-up duration (p < .0001). Furthermore, age (p = .36) and implant type (fixed-bearing [95.6%, 95% confidence interval, 85.9-98.7] versus mobile-bearing ]89.4%, 95% confidence interval, 79.6%-94.8%]) did not have a statistically significant impact on survivorship, p = .213. However, patients with higher preoperative functional scores had improved survivorship (p = .001). Complications were inconsistently reported with varied definitions. In order of reported frequency, complications were classified into technical error (28.15%), subsidence (16.89%), implant failure (13.28%), aseptic loosening (6.3%), intraoperative fracture (5.67%), wound problems (4.3%), deep infection (1%), and postoperative fracture (0.0001%). Overall study quality was low, with only 10% being prospective and 90% from nonregistry data. The results from this meta-analysis revealed a promising overall survivorship of current implants in use for total ankle replacement; however higher quality studies with standardized outcomes measures are needed.
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Affiliation(s)
| | - Jeremy Cook
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Director of Research and Quality Assurance, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Emily A Cook
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Director of Resident Training, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
| | - Jordan Crafton
- Chief Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow in Surgery, Harvard Medical School, Boston, MA
| | - Matthew Knabel
- Chief Resident, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA; Clinical Fellow in Surgery, Harvard Medical School, Boston, MA
| | - Eric Swenson
- Clinical Fellow in Surgery, Harvard Medical School, Boston, MA
| | - Samantha Miner
- Clinical Fellow in Surgery, Harvard Medical School, Boston, MA
| | - Elena Manning
- Attending Surgeon, Orthopedic Care Physician Network, Raynham, MA
| | - Philip Basile
- Assistant Professor in Surgery, Department of Surgery, Harvard Medical School, Boston, MA; Chief, Division of Podiatric Surgery, Department of Surgery, Mount Auburn Hospital, Cambridge, MA
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16
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Reb CW, Watson BC, Fidler CM, Van Dyke B, Hyer CF, Berlet GC, Prissel MA. Anterior Ankle Incision Wound Complications Between Total Ankle Replacement and Ankle Arthrodesis: A Matched Cohort Study. J Foot Ankle Surg 2021; 60:47-50. [PMID: 33168440 DOI: 10.1053/j.jfas.2020.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 02/03/2023]
Abstract
The anterior incision is commonly used for total ankle replacement (TAR) and ankle arthrodesis. Historically, the anterior incision has demonstrated a high incidence of complications. The purpose of this study was to evaluate anterior incisional healing and soft tissue complications between TAR and ankle arthrodesis with anterior plate fixation.This was an IRB-approved retrospective review of wound healing and other complications among 304 patients who underwent primary TAR (191 patients) or ankle arthrodesis (113 patients) via the anterior approach over a 4-year period. The operative approach, intraoperative soft tissue handling, and postoperative protocol for the first 30 days were the same between groups. The mean follow-up was 11.8 months. To diminish the effect of selection bias, a subgroup analysis was performed comparing 91 TAR patients matched to an equal number of demographically similar ankle arthrodesis patients. Overall, 19.7% of patients experienced delayed wound healing greater than 30 days. Although the TAR and arthrodesis subgroups had dissimilar demographics, there was no difference in outcomes. Between matched pairs, no statistically significant differences were observed; however, trends were identified with matched cohort groups when compared to the overall patient series. These trends toward statistically significant differences in delayed wound healing and incidence of wound care in the matched cohort groups warrants further investigation in larger series or multicenter study. Further work is needed to identify the modifiable risk factors associated with the anterior ankle incision.
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Affiliation(s)
- Christopher W Reb
- Surgeon, Division of Foot and Ankle Surgery, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | | | - Corey M Fidler
- Surgeon, Carilion Clinic, Orthopedics & Neurosciences Institute, Roanoke, VA
| | | | | | | | - Mark A Prissel
- Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH.
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Hirao M, Ebina K, Etani Y, Kaneshiro S, Tsuboi H, Noguchi T, Okamura G, Kunugiza Y, Nakaya H, Nishikawa M, Tsuji S, Takahi K, Owaki H, Hashimoto J. Modified Anterolateral Approach for Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211013342. [PMID: 35097449 PMCID: PMC8725997 DOI: 10.1177/24730114211013342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Level of Evidence: Level V.
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Affiliation(s)
- Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Etani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shoichi Kaneshiro
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Hideki Tsuboi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan
| | - Gensuke Okamura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Yasuo Kunugiza
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Hoshigaoka Medical Center, Osaka, Japan
| | - Hiroyuki Nakaya
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Masataka Nishikawa
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Shigeyoshi Tsuji
- Department of Orthopaedic Surgery/Rheumatology, National Hospital Organization, Osaka Minami Medical Center, Osaka, Japan
| | - Koichiro Takahi
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka-Toneyama Medical Center, Osaka, Japan
| | - Hajime Owaki
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Osaka Hospital, Osaka, Japan
| | - Jun Hashimoto
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO), Hoshigaoka Medical Center, Osaka, Japan
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18
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Nielsen NM, Saito GH, Sanders AE, Ellis SJ, Sofka CM, Demetracopoulos CA. Sagittal Tibiotalar Alignment May Not Affect Functional Outcomes in Fixed-Bearing Total Ankle Replacement: A Retrospective Cohort Study. HSS J 2020; 16:300-304. [PMID: 33380960 PMCID: PMC7749918 DOI: 10.1007/s11420-019-09728-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND In total ankle replacement (TAR), correct positioning of the implant is crucial. Malposition of the components may increase contact pressures and diminish prosthesis survival. The effect of sagittal tibiotalar alignment on functional outcomes after fixed-bearing TAR remains unclear, however, and no studies have compared fixed-bearing implants with respect to the anteroposterior (AP) position of the talar component. QUESTIONS/PURPOSE The purposes of this study were (1) to evaluate the effect of sagittal tibiotalar alignment on functional outcomes in fixed-bearing TAR and (2) to compare post-operative sagittal tibiotalar alignment in two types of fixed-bearing implants. METHODS In a retrospective analysis of 71 primary TARs performed at a single center, we studied the INBONE™ II Total Ankle System and the Salto Talaris® Ankle. Radiographic measurements of the tibial axis-talus (T-T) ratio and the AP offset ratio were performed before and after surgery, respectively, and we evaluated Foot and Ankle Outcome Scores (FAOSs) and the 12-item Short Form Health Survey (SF-12) mental component summary (MCS) and physical component summary (PCS) scales pre-operatively and at 2 years after surgery. The Pearson correlation and independent-samples t test were used to evaluate differences in FAOSs, SF-12 MCS scores, and SF-12 PCS scores regarding post-operative sagittal alignment. RESULTS Post-operative sagittal tibiotalar alignment was neutral in 39 ankles and anterior in 32 ankles. We observed no significant between-group differences in clinical outcome scores. Patients with a Salto Talaris Ankle prosthesis had a greater AP offset ratio (0.12) than patients with an INBONE II implant (0.05). However, the greater translation did not correlate with outcome scores. CONCLUSION At the 2-year follow-up, no correlation between the post-operative AP offset ratio and functional outcome scores was observed between the two fixed-bearing-implant groups. Further studies with longer follow-up are needed to determine whether the difference in sagittal alignment has an effect on functional outcomes in the long term.
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Affiliation(s)
- Natalie M. Nielsen
- Foot and Ankle Service, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, 10021 USA
| | - Guilherme H. Saito
- Foot and Ankle Service, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, 10021 USA
| | - Austin E. Sanders
- Foot and Ankle Service, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, 10021 USA
| | - Scott J. Ellis
- Foot and Ankle Service, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, 10021 USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY USA
| | - Constantine A. Demetracopoulos
- Foot and Ankle Service, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, 10021 USA
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19
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Etani Y, Ebina K, Hirao M, Miyama A, Hashimoto J, Noguchi T, Okamura G, Takami K, Yoshikawa H. A report of three cases which required tibialis anterior tendon resection to recover delayed wound healing after total ankle arthroplasty in patients with rheumatoid arthritis. Mod Rheumatol Case Rep 2020; 4:6-10. [PMID: 33086968 DOI: 10.1080/24725625.2019.1641297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Delayed wound healing is one of the severe complications after total ankle arthroplasty (TAA). In particular, once tibialis anterior (TA) tendon is exposed from tendon sheath of extensor retinaculum, wound healing will be critically intractable. We report three cases (mean age: 75.3 years old) of delayed wound healing after TAA cured by resection of TA tendon in patients with rheumatoid arthritis (RA). All three cases underwent TAA through an anterior approach, with careful suture of extensor retinaculum in wound closure. Ankle joint was fixed with splint and avoid weight bearing for three weeks after surgery. Delayed wound healing with TA tendon exposure was observed, and initially treated by debridement, basic fibroblast growth factor spray, and negative pressure wound therapy, which all failed to obtain wound healing. Finally, complete resection of TA tendon led to rapid wound healing. In all cases, ankle dorsal flexion was compensated by other extensors, with maintained range of motion and muscle strength (manual muscle testing 3 to 4) compared to pre-operation at 1 year after TAA operation. Resection of TA tendon may be considered as one of the salvage treatment options of severe delayed wound healing in TAA with anterior approach, especially in elderly patients.
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Affiliation(s)
- Yuki Etani
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Miyama
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jun Hashimoto
- Department of Rheumatology, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan
| | - Takaaki Noguchi
- Department of Orthopaedic Surgery, National Hospital Organization Osaka Minami Medical Center, Kawachinagano, Japan
| | - Gensuke Okamura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kenji Takami
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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20
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Halai MM, Pinsker E, Daniels TR. Effect of Novel Anteromedial Approach on Wound Complications Following Ankle Arthroplasty. Foot Ankle Int 2020; 41:1198-1205. [PMID: 32683898 DOI: 10.1177/1071100720937247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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 evaluate all wound complications following total ankle arthroplasty (TAA) before and after the implementation of a novel extensile anteromedial surgical approach. We further investigated patients and operative factors associated with wound complications. METHODS A series of 660 TAAs were collected. The median follow-up was 84 months (range, 12-204 months). Minor wound complications included discoloration, swelling, or clinical concern that merited bringing the patient back sooner for review. Major wound complications included plastic surgical consultation, debridement by the nurse specialist, negative pressure therapy, or reoperation. All major complications initially had a course of empirical oral antibiotics. Since 2011, higher-risk patients have had their TAA performed through an extensile anteromedial approach. RESULTS Fifty-six patients (8.5%) had wound healing issues (17 major [2.6%], 39 minor [5.9%]). All issues became evident <21 days postoperatively. Inflammatory arthritis, smoking, and coronary disease were patient factors associated with major wound complications. Four patients were treated with negative pressure therapy, 4 with debridement in the operating room, and 2 eventually converted to fusions. Fourteen patients (82%) who had major complications had an ancillary procedure to balance the TAA through a separate incision. All major wound complications had an anterior surgical approach for their TAA. Before 2011, there were 13 major wound complications. Since 2012, there have been 4 major wound complications overall, with no wound complications in the anteromedial approach cohort. CONCLUSION We recommend an extensile anteromedial approach for smokers and patients with heart disease or inflammatory arthritis undergoing TAA. If a wound complication developed, a multidisciplinary team to evaluate wounds was useful. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Mansur M Halai
- Division of Orthopedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Ellie Pinsker
- Division of Orthopedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Timothy R Daniels
- Division of Orthopedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
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21
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Steinmetz RG, Luick L, Tkach S, Falcon S, Stoner J, Hollabaugh K, Ringus V, Haleem AM. Effect of Tranexamic Acid on Wound Complications and Blood Loss in Total Ankle Arthroplasty. Foot Ankle Int 2020; 41:1117-1121. [PMID: 32659136 DOI: 10.1177/1071100720934889] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is a medication that has been shown to decrease blood loss and risk of blood transfusion in total knee and total hip arthroplasty. The purpose of this study was to evaluate the use of TXA in patients undergoing total ankle arthroplasty (TAA). We hypothesized there would be less blood loss and wound complications in patients receiving TXA. METHODS A retrospective review of 2 patient cohorts operated on by 2 surgeons was performed from 2010 to 2018. We compared a group of TAA patients that did not receive TXA vs a subsequent group that received TXA. Patients received 1g intravenous TXA before the tourniquet was inflated followed by another 1 g after release of the tourniquet. Intraoperative blood loss was recorded and preoperative hemoglobin and hematocrit levels were compared to postoperative levels. Intraoperative and postoperative complications were compared between the 2 groups. A total of 119 patients were included in the study, of whom 55 received TXA. No significant difference existed between the 2 groups in gender, age, body mass index, or Charlson comorbidity index. RESULTS There was no difference in estimated blood loss, postoperative hemoglobin/hematocrit values or preoperative to postoperative change in hemoglobin/hematocrit values. Additionally, there was no difference in wound complications or overall complication rate between the groups. CONCLUSION TXA has been shown to be effective in total knee and total hip arthroplasty in decreasing blood loss and transfusion risk. We did not find it to be effective in reducing intraoperative blood loss, perioperative blood loss, or wound complications in TAA. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
| | - Laura Luick
- Department of Orthopedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shaun Tkach
- Department of Orthopedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Spencer Falcon
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Julie Stoner
- Department of Orthopedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kimberly Hollabaugh
- Department of Orthopedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Vytautas Ringus
- Orthopaedic and Sports Medicine Center of Norman, Norman, OK, USA
| | - Amgad M Haleem
- Department of Orthopedic Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Department of Orthopedic Surgery, Kasr Al-Ainy Hospitals, Cairo University College of Medicine, Cairo, Egypt
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22
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Sung KS. Total ankle arthroplasty. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.8.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
For end-stage ankle arthritis, either arthrodesis or total ankle arthroplasty is a available surgical option. With the failure of earlier generation of arthroplasty, arthrodesis has been the gold standard. However, there are some considerable weaknesses of the arthrodesis. Current total ankle arthroplasty is presently an effective surgical treatment for endstage ankle arthritis with much improvement. The goals of surgery are to decrease pain, preserve range of motion, and eventually improve the patient’s quality of life. Recent literatures on total ankle arthroplasty havs shown successful long-term clinical results due to the innovation of second-generation implants, including more anatomic concepts and designs. For successful outcomes, a thorough evaluation of the entire lower limb alignment, deformities of the foot and ankle, and proper selection of patients are very important. Nevertheless, complications, such as wound problems, osteolysis, gutter pain or impingement, infection, loosening, and others, may occur. In this review, we provide a summary of the current research on total ankle arthroplasty.
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Jensen J, Hicks RW, Labovitz J. Understanding and Optimizing Tourniquet Use During Extremity Surgery. AORN J 2020; 109:171-182. [PMID: 30694553 DOI: 10.1002/aorn.12579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tourniquet use during extremity surgery is commonplace and a relatively safe practice. The surgical team's knowledge of the patient history, proper assessment, and indications and contraindications for and risks of tourniquet use can prevent unwanted outcomes. Exploration of these critical areas reinforces perioperative nurses' awareness and understanding of safe tourniquet use. Additionally, a review of the physiological effect of tourniquets on the skin, the body's response to local compression, the risk of vascular compromise, and the effect of the tourniquet on postoperative pain and swelling provides insight into AORN recommended practice guidelines. This article summarizes the indications and assessments for and risks of tourniquet use for patients during extremity surgery. An understanding of these topics can improve surgical outcomes and promote safe perioperative care.
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Saito GH, Sanders AE, O'Malley MJ, Deland JT, Ellis SJ, Demetracopoulos CA. Accuracy of patient-specific instrumentation in total ankle arthroplasty: A comparative study. Foot Ankle Surg 2019; 25:383-389. [PMID: 30321969 DOI: 10.1016/j.fas.2018.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/22/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patient-specific instrumentation (PSI) for TAA is a novel technology with several potential benefits. The primary goal of this study was to compare the use of PSI with the standard referencing guide (SRG) in regards to accuracy of tibial implant positioning. Operative time, fluoroscopy time and accuracy of PSI preoperative reports were also evaluated. METHODS A retrospective analysis of 99 patients who underwent a primary TAA with the INFINITY prosthesis (Wright Medical, Memphis, TN) was performed. Patients were divided in two groups based on the type of instrumentation used during the TAA (75 in the PSI group vs 24 in the SRG group). There was no significant difference between groups in regards to age at the time of surgery (P=0.122), sex (P=0.138), number of concomitant procedures performed during surgery (P=0.567) and etiology (P=0.841). However, preoperative deformity was significantly smaller in the PSI group (P=0.002). RESULTS Tibial implant positioning was similar between groups. In the coronal plane, the absolute deviation of the tibial implant from the intended alignment was 1.7±1.4° for the SRG and 1.6±1.2° for PSI (P=0.710). In the sagittal plane, the absolute alignment deviation of the tibial implant was 1.8±1.4° for the SRG and 1.9±1.5° for PSI (P=0.675). Operative time (167 vs 190min, P=0.040) and fluoroscopy time (85 vs 158s, P<0.001) were significantly decreased in the PSI group. The PSI preoperative plan report correctly predicted the implant size in 73% of cases for the tibial component and in 51% of cases for the talar component. CONCLUSIONS PSI provided similar tibial component alignment as standard instrumentation. Additionally, PSI preoperative plan reports were poor predictors of implant sizing. Therefore, the final decision should always be based on surgeon's experience in order to prevent errors in implant sizing and positioning. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Guilherme H Saito
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States.
| | - Austin E Sanders
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Martin J O'Malley
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Jonathan T Deland
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Scott J Ellis
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
| | - Constantine A Demetracopoulos
- Foot and Ankle Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
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Conti MS, Savenkov O, Ellis SJ. Association of Peripheral Vascular Disease With Complications After Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419843379. [PMID: 35097324 PMCID: PMC8696873 DOI: 10.1177/2473011419843379] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite limited evidence, peripheral vascular disease is often cited as a contraindication for total ankle arthroplasty. The purpose of our study was to identify whether peripheral vascular disease in patients undergoing total ankle arthroplasty increased the rate of infection, postoperative irrigation and debridement, or failure of the implant. METHODS The PearlDiver Database was used to identify Medicare patients who underwent a total ankle arthroplasty from 2005 to 2014. These data were then analyzed for postoperative infections within 90 days, subsequent irrigation and debridements, and failure of total ankle arthroplasties. A diagnosis of preoperative peripheral vascular disease only included those patients who had peripheral vascular disease as an ICD-9 diagnosis code and underwent a preoperative lower extremity angiogram prior to total ankle arthroplasty. Medical comorbidities were identified using ICD-9 diagnosis codes. Three multivariable logistic regression models were then developed in order to identify risk factors associated with postoperative infections and failure after total ankle arthroplasty. RESULTS A total of 10 698 Medicare patients who underwent a primary total ankle arthroplasty were identified. There were 334 patients who had a postoperative infection within 90 days of their total ankle arthroplasty, and 95 of those patients required an irrigation and debridement. Regression analysis demonstrated that patients with peripheral vascular disease had the greatest risk of developing a postoperative infection within 90 days (OR 2.85, P < .01), requiring an irrigation and debridement postoperatively (OR 4.87, P < .001), and having a total ankle arthroplasty failure at any time point postoperatively (OR 2.51, P < .001). CONCLUSIONS Our study suggests that preoperative peripheral vascular disease is a significant risk factor for an acute postoperative infection, postoperative irrigation and debridement, and failure of the implant in Medicare patients undergoing a total ankle arthroplasty. LEVEL OF EVIDENCE Level III, therapeutic.
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Ciufo DJ, Thirukumaran CP, Marchese R, Oh I. Risk factors for reoperation, readmission, and early complications after below knee amputation. Injury 2019; 50:462-466. [PMID: 30396770 DOI: 10.1016/j.injury.2018.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/16/2018] [Accepted: 10/27/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many patients undergoing below knee amputations (BKA) return for subsequent unplanned operations, hospital readmission, or postoperative complications. This unplanned medical management negatively impacts both patient outcomes and our healthcare system. This study primarily investigates the risk factors for unplanned reoperation following BKA. METHODS Below knee amputations from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from the years 2012-2014 were identified by CPT code 27880 for amputation through the tibia and fibula. Our query identified 4631 BKA cases, including 30 day complications. Multivariate logistic regression modeling was performed on several patient demographic and disease factors to assess for independent predictors of unplanned reoperation. Secondary outcomes of unplanned and related readmissions (related to the procedure), major complications, minor complications, and mortality were also included in the analysis. RESULTS Of 4631 BKAs identified, 9.63% (446/4631) underwent unplanned reoperations and 8.75% (405/4631) had unplanned and related readmissions. Major complications were experienced by 12.8% (593/4631) and minor complications by 8.7% (401/4631). Thirty day mortality rate was 5.14% (238/4631). The most common procedures for unplanned operations were thigh amputations (128/446, 28.7%), debridement/secondary closure (114/446, 25.6%), and revision leg amputations (46/446, 10.32%). Factors associated with an increased risk of unplanned reoperation included patients transferred from another facility (Adjusted Odds Ratio [AOR] = 1.28; p = .04), recent smokers (AOR = 1.34; p = .02), bleeding disorder (AOR = 1.30; p = .02), and preoperative ventilator use (AOR = 2.38; p = .01). CONCLUSION Patients that were ongoing/recent smokers, had diagnosed bleeding disorders, required preoperative ventilator use, or were transferred in from another facility were associated with the highest risks of reoperation following BKA. This patient population experiences high rates of reoperation, readmission, complication, and mortality.
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Affiliation(s)
- David J Ciufo
- University of Rochester, Department of Orthopaedics and Rehabilitation, United States.
| | | | | | - Irvin Oh
- University of Rochester, Department of Orthopaedics and Rehabilitation, United States
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Tedder C, DeBell H, Dix D, Smith WR, McGwin G, Shah A, Naranje S. Comparative Analysis of Short-Term Postoperative Complications in Outpatient Versus Inpatient Total Ankle Arthroplasty: A Database Study. J Foot Ankle Surg 2019; 58:23-26. [PMID: 30316642 DOI: 10.1053/j.jfas.2018.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Indexed: 02/06/2023]
Abstract
Ankle arthritis is a potentially debilitating disease, with approximately 50,000 cases diagnosed annually. One treatment option for these patients is total ankle arthroplasty (TAA). This procedure has historically been performed in the inpatient setting with a 1-2-night postoperative hospital stay. Outpatient surgeries are gaining popularity due to their cost effectiveness, decreased length of hospital stay, and convenience. Therefore it is important to evaluate the safety of specific procedures in the outpatient setting compared with the inpatient setting. This study evaluated the complication rates in inpatient versus outpatient TAA. It analyzed data from the National Surgical Quality Improvement Program for 591 patients who received TAA. Postoperative complication rates were compared between 66 outpatients and 535 inpatients. Frequencies of the following complications were analyzed: wound complications, pneumonia, hematologic complications (pulmonary embolism and deep vein thrombosis), renal failure, stroke, and return to the operating room within 30 days. Unadjusted direct comparisons of the cohorts revealed higher complication rates in the inpatient cohort. Inpatients had higher rates of superficial surgical site infections, deep surgical site infections, number of organ/space surgical site infections, pneumonia occurrences, and return to the operating room, but these differences were not significant. These results showed no significant increase in complication rates in outpatients compared to inpatients. Our results suggest that inpatient and outpatient TAA show similar complication rates. This suggests that outpatient TAA is safe and may be a superior option for certain populations. Further investigation is warranted to verify these conclusions.
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Affiliation(s)
- Chandler Tedder
- Medical Student, University of South Alabama College of Medicine, Mobile, AL
| | - Henry DeBell
- Medical Student, University of Alabama School of Medicine, Birmingham, AL
| | - Daniel Dix
- Medical Student, University of Alabama School of Medicine, Birmingham, AL
| | - Walter R Smith
- Medical Student, University of Alabama School of Medicine, Birmingham, AL
| | - Gerald McGwin
- Professor and Vice Chairman, Department of Epidemiology, School of Public Health, University of Alabama School of Medicine, Birmingham, AL
| | - Ashish Shah
- Assistant Professor, Department of Orthopaedic Surgery, University of Alabama School of Medicine, Birmingham, AL.
| | - Sameer Naranje
- Assistant Professor, Department of Orthopaedic Surgery, University of Alabama School of Medicine, Birmingham, AL
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Ewalefo SO, Dombrowski M, Hirase T, Rocha JL, Weaver M, Kline A, Carney D, Hogan MV. Management of Posttraumatic Ankle Arthritis: Literature Review. Curr Rev Musculoskelet Med 2018; 11:546-557. [PMID: 30327933 PMCID: PMC6220012 DOI: 10.1007/s12178-018-9525-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Trauma is the principle cause of osteoarthritis in the ankle, which is associated with significant morbidity. This review highlights the current literature for the purpose of bringing the reader up-to-date on the management of posttraumatic ankle arthritis, describing treatment efficacy, indications, contraindications, and complications. RECENT FINDINGS Recent studies on osteoarthritis have demonstrated variability among anatomic locations regarding the mechanisms and rates of development for posttraumatic osteoarthritis, which are attributed to newly discovered biological differences intrinsic to each joint. Regarding surgical management of posttraumatic ankle arthritis, osteochondral allograft transplantation of the talus, and supramalleolar osteotomies have demonstrated promising results. Additionally, the outpatient setting was found to be appropriate for managing pain following total ankle arthroplasty, associated with low complication rates and no readmission. Management for posttraumatic ankle arthritis is generally progressive. Initial treatment entails nonpharmacologic options with surgery reserved for posttraumatic ankle arthritis refractory to conservative treatment. Patient demographics and lifestyles should be carefully considered when formulating a management strategy, as outcomes are dependent upon the satisfaction of each set of respective criteria. Ultimately, the management of posttraumatic ankle arthritis should be individualized to satisfy the needs and desires, which are specific to each patient.
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Affiliation(s)
- Samuel O Ewalefo
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
| | - Malcolm Dombrowski
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Takashi Hirase
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Jorge L Rocha
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mitchell Weaver
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex Kline
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dwayne Carney
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abstract
Ankle injuries are a common traumatic injury. Rupture to the syndesmosis may occur as a result of these injuries. Strategies for the treatment of both acute and chronic syndesmotic repair are reviewed in detail. Significance of Chaput, Wagstaffe, and posterior malleolus fractures on syndesmotic stability are reviewed. Treatment considerations for total ankle arthroplasty are discussed, and correction of coronal plane deformity as a result of late syndesmotic injury at the time of ankle arthroplasty is outlined.
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Affiliation(s)
- Michael Swords
- Orthopedic Surgery, Sparrow Hospital, Michigan Orthopedic Center, 2815 South Pennsylvania Avenue, Suite 204, Lansing, MI 48910, USA.
| | - Jean Brilhault
- Service de Chirurgie Orthopédique, C.H.R.U. Tours, 1, Tours F-37000, France; Service de Chirurgie Orthopédique, C.H.R.U. Tours, Université François-Rabelais de Tours, 37044 Tours Cedex 9, France
| | - Andrew Sands
- Foot and Ankle Surgery, Weill Cornell Medical College, Downtown Orthopedic Associates, AO Foot and Ankle Expert Group, 170 William Street, New York, NY 10038, USA
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Cheng C, Nayernama A, Christopher Jones S, Casey D, Waldron PE. Wound healing complications with lenvatinib identified in a pharmacovigilance database. J Oncol Pharm Pract 2018; 25:1817-1822. [DOI: 10.1177/1078155218817109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The U.S. Food and Drug Administration (FDA) has approved several vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors, including lenvatinib, for thyroid and renal malignancies. Inhibition of the VEGFR signaling pathway impairs angiogenesis and can disrupt wound healing. The objective of this work was to evaluate wound healing complications as a potential safety risk for patients treated with lenvatinib. We searched the FDA Adverse Event Reporting System (FAERS) database for postmarketing reports of wound healing complications with lenvatinib between 13 February 2015 (FDA approval date) and 15 February 2017. The search identified nine FAERS cases of lenvatinib-associated wound healing complications that were not previously reported in the medical literature. Seven cases involved postoperative wound healing complications, such as impaired healing or wound dehiscence. In our case series, the reported time to identification of delayed wound healing from tissue injury or surgery varied over a wide range (4–58 days). The time of initial lenvatinib exposure relative to the tissue injury was also highly varied in our series, which may have influenced the development and detection of impaired healing. FAERS case-level evidence suggests that lenvatinib may have contributed to wound healing complications based on temporality and biologic plausibility. Healthcare professionals should be aware of this safety risk to facilitate prompt recognition and risk mitigation.
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Affiliation(s)
- Connie Cheng
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Afrouz Nayernama
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - S Christopher Jones
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Denise Casey
- Division of Oncology Products, Office of Hematology and Oncology Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Peter E Waldron
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
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Borenstein TR, Anand K, Li Q, Charlton TP, Thordarson DB. A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty. Foot Ankle Int 2018; 39:143-148. [PMID: 29160727 DOI: 10.1177/1071100717738748] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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 arthroplasty (TAA) is commonly pursued for patients with painful arthritis. Outpatient TAA are increasingly common and have been shown to decrease costs compared to inpatient surgery. However, there are very few studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive patients who received outpatient TAA to identify complication rates. METHODS The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum 6-month follow-up were reviewed. All patients received popliteal and saphenous blocks prior to surgery and were managed with oral pain medication postoperatively. All received a STAR total ankle. Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and perioperative complications including wound breakdown, infection, revision, and nonrevision surgeries were observed. Mean follow-up was 16.6 ± 9.1 months (range, 6-42 months). RESULTS There were no readmissions for pain control and 1 patient had a wound infection. The overall complication rate was 15.4%. One ankle (1.5%) had a wound breakdown requiring debridement and flap coverage. This patient thrombosed a popliteal artery stent 1 month postop. The 1 ankle (1.5%) with a wound infection occurred in a patient with diabetes, obesity, hypertension, and rheumatoid arthritis. CONCLUSION This study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory experience with no readmissions for pain control and 1 wound infection. The 1 wound breakdown complication (1.5%) was attributed to arterial occlusion and not outpatient management. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Todd R Borenstein
- 1 Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kapil Anand
- 2 Department of Anesthesiology, Regional Anesthesia/Acute Pain Fellowship Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Quanlin Li
- 3 Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Timothy P Charlton
- 1 Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David B Thordarson
- 1 Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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