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Semenistyy AA, Kehayov RI. Ankle arthrodesis through minimally-invasive transfibular approach: a new surgical technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2483-2492. [PMID: 38644419 DOI: 10.1007/s00590-024-03950-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE The purpose of our work was to demonstrate the surgical technique of ankle arthrodesis using the minimally-invasive transfibular (MITF) approach, which minimizes soft tissue damage and is advantageous for high-risk patients. METHODS In this prospective study, a total of 12 patients with end-stage varus ankle osteoarthritis, including high-risk individuals, underwent ankle arthrodesis using the MITF approach. The technique involves a unique osteotomy at the joint space level, minimizing soft tissue detachment from the fibula. The primary outcomes assessed included bony union, time to weight-bearing, correction of varus deformity, and functional outcomes measured by the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale. However, the study's limitations encompass a small sample size and the absence of a control group. RESULTS At 6 months post-operation, all patients achieved bony union, with a mean time to union of 13.7 ± 5.2 weeks. The average time to initiate weight-bearing without additional support was 11.2 ± 3.8 weeks. Preoperative varus deformity (17.08 ± 8.36 degrees) and talar tilt (8.75 ± 4.33 degrees) were successfully corrected, with postoperative alignment within 0-5 degrees of valgus. Functional outcomes showed a significant improvement in AOFAS scores from 37.83 ± 7.79 points preoperatively to 77.42 ± 5.63 points one year after surgery (p = 0.002). Minor complications occurred in two patients, both effectively treated with local therapy and antibiotics. CONCLUSIONS The MITF approach for ankle arthrodesis demonstrates promising results in addressing end-stage varus ankle osteoarthritis, even in high-risk patients. However, the study's limitations highlight the need for a prospective comparative clinical trial with a larger sample size to ascertain the technique's effectiveness and safety definitively.
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Affiliation(s)
- Anton A Semenistyy
- Department of Pediatric Orthopedics and Hand Surgery, Specialized Orthopedic University Hospital "Prof. B. Boychev", Nikola Petkov str. 56, Gorna Banya, 1614, Sofia, Bulgaria.
- Department of Orthopedics and Traumatology, Medical University of Sofia, Sofia, Bulgaria.
| | - Raytcho I Kehayov
- Department of Pediatric Orthopedics and Hand Surgery, Specialized Orthopedic University Hospital "Prof. B. Boychev", Nikola Petkov str. 56, Gorna Banya, 1614, Sofia, Bulgaria
- Department of Orthopedics and Traumatology, Medical University of Sofia, Sofia, Bulgaria
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Al-Naseem AO, Hayat J, Addar A, Marwan Y. External Versus Internal Fixation Techniques for Ankle Arthrodesis: A Systematic Review and Meta-analysis. J Foot Ankle Surg 2024:S1067-2516(24)00112-1. [PMID: 38944233 DOI: 10.1053/j.jfas.2024.05.010] [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: 01/26/2024] [Revised: 05/11/2024] [Accepted: 05/25/2024] [Indexed: 07/01/2024]
Abstract
Ankle arthrodesis is an effective surgical intervention for end-stage arthritis or severe ankle joint deformity. Both internal (IF) and external fixation (EF) techniques are valid options, but there is controversy regarding the most effective technique. This study compares the safety and efficacy of EF and IF fixation techniques for ankle arthrodesis. A systematic review and meta-analysis was conducted according to the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) Guidelines. A literature search of electronic databases, including MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), was performed to identify all studies directly comparing the two techniques. Both fixed and random effects models of analysis were used depending on heterogeneity. Odds of union in the EF and IF groups were comparable (OR = 0.60, CI 0.36-1.02, p = .06) however, EF was associated with greater odds of deep hardware infections (OR = 3.67, 1.97-6.83, p < .05) and amputations (OR = 3.17, CI 1.06-9.54, p = .04). Odds of revision surgery and superficial wound complications were similar between groups. EF techniques had significantly longer operation times (MD = 31.23, CI-25.11-37.34, p < .05) and intraoperative blood loss (MD = 44.1, CI 28.77-59.43, p < .05). No significant difference was noted in pain and functionality scores. IF and EF techniques have reasonable union rates with similar postoperative outcomes.
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Affiliation(s)
- Abdulrahman O Al-Naseem
- Division of Surgery and Interventional Science, University College London, London, United Kingdom.
| | - Jafar Hayat
- Department of Surgery, Jaber Al-Ahmad Hospital, Ministry of Health, Al-Zahra, Kuwait
| | - Abdullah Addar
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Yousef Marwan
- Department of Surgery, College of Medicine, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
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Nicot C, David G, Marc C, Hubert L, Rony L. Dedicated locking plate reduces non-union risk in open ankle fusion in obese patients. Orthop Traumatol Surg Res 2024:103901. [PMID: 38703887 DOI: 10.1016/j.otsr.2024.103901] [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: 02/16/2023] [Revised: 02/22/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Obesity is a growing public health concern. In ankle osteoarthritis, non-conservative treatment in advanced stages consists in ankle fusion, or else total ankle replacement, for which obesity is a relative contraindication. One of main complications of ankle fusion is non-union. Devascularization, obesity and fixation material are all factors involved in postoperative non-union, and have to be taken into account in surgical strategy for reliable results. The objective of this study was to compare the rate of ankle non-union in obese patients using quadruple screwing or a dedicated locking plate. The hypothesis was that the locking plate limits the risk of non-union in this population. METHODS All patients were obese (BMI>30kg/m2) and presented ankle osteoarthritis with>10° intra-articular deformity. The approach and joint preparation were performed via an anteromedial approach. Group S was composed of 32 patients, operated on by quadruple screwing; group P comprised 10 patients operated on using a dedicated locking plate. The main endpoint was a significant difference in the rate of non-union between the 2 groups. The secondary endpoint was improvement in pre- and 6-month postoperative AOFAS score. RESULTS Group S presented 31% non-union (10/32) and group P 0% (0/10) (p<0.05). Postoperative AOFAS score was significantly higher in group P: 67.8±10.4 [range, 40-92] vs. 83.1±8.0 [range, 64-92] (p<0.05). CONCLUSION The dedicated anterior locking plate is a technique of choice for ankle fusion in obese patients with intra-articular deformity>10°, to limit the risk of non-union. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Claire Nicot
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Guillaume David
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Clément Marc
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Laurent Hubert
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Louis Rony
- Département de chirurgie osseuse, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
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Lorente A, Pelaz L, Palacios P, Benlloch M, de la Rubia Ortí JE, Barrios C, Mariscal G, Lorente R. Predictive Factors of Functional Outcomes and Quality of Life in Patients with Ankle Fractures: A Systematic Review. J Clin Med 2024; 13:1188. [PMID: 38592026 PMCID: PMC10932135 DOI: 10.3390/jcm13051188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 02/10/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Evaluating the predictors of unfavorable outcomes in patients with ankle fractures is crucial for identifying high-risk patients and implementing personalized treatment strategies. This study aimed to analyze factors that influence quality of life in patients with ankle fractures. Methods: Four databases were consulted. The main outcomes were functionality and quality of life scales combined using the standard mean difference (SMD) (Review Manager 5.4). Results: Eight studies with 2486 patients were included. A significant correlation was found between female sex and worse functionality scores (beta 4.15, 95% CI 1.84-6.46). Additionally, older age was correlated with worse functionality scores (beta -0.24, 95% CI -0.29 to -0.19). Patients with diabetes or metabolic syndrome also had worse outcomes (SMD 0.27, 95% CI 0.18-0.36). High BMI and obesity were also associated with worse quality of life scores (beta 2.62, 95% CI 0.77-4.48). Smokers had greater disability in the analyzed scales (SMD 0.22, 95% CI 0.05-0.39). No significant differences were observed with respect to syndesmotic involvement. Conclusions: Age, sex, diabetes, high BMI, and smoking negatively impact functional outcomes and quality of life in patients with ankle fractures.
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Affiliation(s)
- Alejandro Lorente
- Ankle and Foot Surgery Unit, Department of Traumatology and Orthopaedic Surgery, University Hospital Ramón y Cajal, 28034 Madrid, Spain; (A.L.); (L.P.)
| | - Leire Pelaz
- Ankle and Foot Surgery Unit, Department of Traumatology and Orthopaedic Surgery, University Hospital Ramón y Cajal, 28034 Madrid, Spain; (A.L.); (L.P.)
| | - Pablo Palacios
- Department of Traumatology and Orthopaedic Surgery, Sanchinarro University Hospital, 28050 Madrid, Spain;
| | - María Benlloch
- Department of Basic Medical Sciences, Catholic University of Valencia, 46001 Valencia, Spain; (M.B.); (J.E.d.l.R.O.)
| | - José Enrique de la Rubia Ortí
- Department of Basic Medical Sciences, Catholic University of Valencia, 46001 Valencia, Spain; (M.B.); (J.E.d.l.R.O.)
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain;
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain;
| | - Rafael Lorente
- Department of Orthopedic Surgery and Traumatology, University Hospital of Badajoz, 06006 Badajoz, Spain;
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Newton W, Hoch C, Chen C, Scott DJ, Gross CE. Preoperative Opioid Use Predicts Poorer Outcomes of Total Ankle Arthroplasty and Hindfoot Fusions. Foot Ankle Spec 2023; 16:497-505. [PMID: 37119178 DOI: 10.1177/19386400231164677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative opioid use on outcomes of patients undergoing ankle or hindfoot arthrodesis, or total ankle arthroplasty (TAA). METHODS We conducted a retrospective review of 190 patients undergoing an ankle or hindfoot arthrodesis (n=122) or TAA (n=68) between December 2015 and September 2020 with a single fellowship-trained orthopaedic foot and ankle surgeon at an academic medical center. Data collected included demographics, medical comorbidities, treatment history, complications and reoperation rates, patient-reported outcome measures (PROMs) (eg, Foot and Ankle Outcome Score [FAOS]), and opioid use. RESULTS Patients with preoperative opioid use were more likely to continue usage at 90 (r = 0.931, P < .001) and 180 (r = 0.940, P < .001) days postoperatively. For the entire cohort, complication and reoperation rates were 48.9% and 13.2%, respectively. While preoperative opioid use groups did not differ in the overall complication rate, users had significantly more infections (user = 12.5%, nonuser = 3.3%; P = .036) and reoperations (user = 22.5%, nonuser = 10.7%; P = .049). When analyzing postoperative opioid prescriptions, there were many significant correlations with preoperative PROMs, mainly FAOS, such that increased postoperative opioid use was associated with worse subjective outcomes. CONCLUSION Preoperative opioid users are more likely to continue postoperative opioid use, experience infections, and undergo reoperations. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
- William Newton
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Caroline Hoch
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Caroline Chen
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel J Scott
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Christopher E Gross
- Department of Orthopaedics & Physical Medicine, Medical University of South Carolina, Charleston, South Carolina
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Arshad Z, Haq II, Bhatia M. Patient-related risk factors associated with poorer outcomes following total ankle arthroplasty. Bone Joint J 2023; 105-B:985-992. [PMID: 37654132 DOI: 10.1302/0301-620x.105b9.bjj-2023-0052.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Aims This scoping review aims to identify patient-related factors associated with a poorer outcome following total ankle arthroplasty (TAA). Methods A scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer-based literature search was performed in PubMed, Embase, Cochrane trials, and Web of Science. Two reviewers independently performed title/abstract and full-text screening according to predetermined selection criteria. English-language original research studies reporting patient-related factors associated with a poorer outcome following TAA were included. Outcomes were defined as patient-reported outcome measures (PROMs), perioperative complications, and failure. Results A total of 94 studies reporting 101,552 cases of TAA in 101,177 patients were included. The most common patient-related risk factor associated with poorer outcomes were younger age (21 studies), rheumatoid arthritis (17 studies), and diabetes (16 studies). Of the studies using multivariable regression specifically, the most frequently described risk factors were younger age (12 studies), rheumatoid arthritis (eight studies), diabetes (eight studies), and high BMI (eight studies). Conclusion When controlling for confounding factors, the most commonly reported risk factors for poor outcome are younger age, rheumatoid arthritis, and comorbidities such as diabetes and increased BMI. These patient-related risk factors reported may be used to facilitate the refinement of patient selection criteria for TAA and inform patient expectations.
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Affiliation(s)
- Zaki Arshad
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ibrahim I Haq
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Maneesh Bhatia
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Woods A, Kendal A, Henari S, Rogers M, Brown R, Sharp R, Loizou CL. Association of Preexisting Triple Fusion and Arthroscopic Ankle Arthrodesis nonunion. Foot Ankle Int 2023; 44:579-586. [PMID: 37212175 DOI: 10.1177/10711007231171077] [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: 05/23/2023]
Abstract
BACKGROUND Arthroscopic ankle arthrodesis (AAA) is a successful treatment for end-stage ankle arthritis. A significant early complication of AAA is symptomatic nonunion. Published nonunion rates range from 8% to 13%. Longer term, there is concern that it predisposes to subtalar joint (STJ) fusion. To better understand these risks, we undertook a retrospective investigation of primary AAA. METHODS All adult AAA cases conducted at our institution over a 10-year period were reviewed. A total of 284 eligible AAA cases in 271 patients were analyzed. The primary outcome measure was radiographic union. Secondary outcome measures included reoperative rate, postoperative complications and subsequent STJ fusion. Univariate and multivariate logistic regression analysis was performed to identify nonunion risk factors. RESULTS The overall nonunion rate was 7.7%. Smoking (odds ratio [OR] 4.76 [1.67, 13.6], P = .004) and previous triple fusion (OR 40.29 [9.46, 171.62], P < .001) were independent risk factors on univariate analysis. Only prior triple fusion persisted as a major risk factor associated with nonunion on multivariate analysis (OR 18.3 [3.4, 99.7], P < .001). Seventy percent of patients with a previous triple fusion went on to develop nonunion compared to 5.5% of those without. Increasing age, obesity, surgical grade, diabetes, postoperative weightbearing plan, steroid use, and inflammatory arthropathy were not significant risk factors. The leading cause of reoperation was hardware removal (18%). There were 5 superficial (1.8%) and 4 deep (1.4%) infections. Eleven (4.2%) required subsequent STJ fusion. The "survivorship" of STJ post AAA was 98%, 85%, and 74% at 2, 5, and 9 years, respectively. CONCLUSION As the largest study of AAA in the literature, our findings suggest prior triple fusion is a major independent risk factor for AAA nonunion. These patients should be counseled of this high risk and may benefit from alternative surgical options. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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