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Alanazi SA, Vicenzino B, Smith MD. Concerns beyond ankle symptoms predominate healthcare professionals' views of patients with ankle osteoarthritis: A qualitative study. Musculoskelet Sci Pract 2024; 72:102946. [PMID: 38574428 DOI: 10.1016/j.msksp.2024.102946] [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] [Revised: 03/06/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES Explore healthcare professionals' perspectives on the main problems that their patients with ankle osteoarthritis experience and to propose health-related domains. METHODS A qualitative study using semi-structured interviews was conducted with an international multidisciplinary group of healthcare professionals identified as ankle experts. Eligibility criteria were aged ≥18 years, and a certified healthcare professional with ≥ 5-year experience post-qualification in working with ankle osteoarthritis and/or chronic ankle pain. Interviews were recorded, transcribed verbatim and thematically analysed. RESULTS Twenty-one healthcare professionals (20 males; mean (range) age 49 (34-72) years) from four professions (orthopaedic surgeons (n = 9), athletic trainers (n = 5), physiotherapists (n = 4) and podiatrists (n = 3)) were interviewed. Four main themes were identified: 1) people with ankle osteoarthritis have difficulty with weight-bearing activities; 2) symptoms of pain and stiffness predominate, alongside swelling, instability, weakness and poor balance; 3) chronic pain in ankle osteoarthritis has psychosocial consequences; and 4) the loss of activities of daily living and independence compromises quality of life. We proposed 15 health-related domains that emerge from the interview data. CONCLUSION Healthcare professionals recognise that ankle osteoarthritis patients have difficulty in physical, sporting, and occupational weight-bearing activities, and they live with persistent ankle pain, stiffness and other symptoms that have physical and psychosocial consequences. The health-related domains derived from interviews with expert healthcare professionals will contribute to the development of a core domain set for ankle osteoarthritis.
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Affiliation(s)
- Sultan Ayyadah Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi Arabia; The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia.
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia. https://twitter.com/Bill_Vicenzino
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia.
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Alanazi SA, Vicenzino B, van Bergen CJA, Hunter DJ, Wikstrom EA, Menz HB, Golightly YM, Smith MD. Development of a core domain set for ankle osteoarthritis: An international consensus study of patients and health professionals. Osteoarthritis Cartilage 2024:S1063-4584(24)01310-4. [PMID: 39029732 DOI: 10.1016/j.joca.2024.07.004] [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: 12/21/2023] [Revised: 06/21/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVES To develop an internationally agreed-upon core domain set for ankle osteoarthritis (OA). METHODS In a three-part Delphi process, a group of multidisciplinary health professionals with expertise in ankle OA and people with ankle OA responded to online questionnaires. The questionnaires proposed a list of 29 candidate domains derived from a systematic review of ankle OA research, and interviews with people with ankle OA and health professionals. Consensus was defined a priori as ≥70% agreement in people with ankle OA and health professionals whether a domain should or should not be included in a core domain set. An online consensus meeting was held to discuss and resolve undecided candidate domains. RESULTS A total of 100 people (75 health professionals and 25 people with ankle OA) from 18 countries (4 continents) participated in this study. Five domains reached consensus for inclusion in a core domain set for ankle OA - pain severity, health-related quality of life, function, disability and ankle range of motion. Twenty-one candidate domains reached agreement not to be included in the core domain set, and three domains remained undecided (ankle instability, physical capacity, and mental health). CONCLUSION This international consensus study, which included people with ankle OA and health professionals, has established a core domain set for ankle OA with five domains that should be measured and reported in all ankle OA trials - pain severity, health-related quality of life, function, disability and ankle range of motion. This core domain set will guide the reporting of outcomes in clinical trials on ankle OA. Future research should determine which outcome measurement instruments should be used to measure each of the core domains.
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Affiliation(s)
- Sultan Ayyadah Alanazi
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, Australia; Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah 11952, Saudi Arabia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, Australia
| | - Christiaan J A van Bergen
- Department of Orthopedic Surgery, Amphia Hospital, Breda 4818 CK, the Netherlands; Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne M Golightly
- College of Allied Health Professionals, University of Nebraska Medical Center, Omaha, NE, USA; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Michelle D Smith
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, Australia.
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Carpentier SH, Barylak M, Arena S, Queen R. Gait asymmetry persists following unilateral and bilateral total ankle arthroplasty. J Orthop Res 2024. [PMID: 38963180 DOI: 10.1002/jor.25932] [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: 04/02/2024] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024]
Abstract
Total ankle arthroplasty (TAA) improves gait symmetry in patients with unilateral end-stage ankle arthritis but has not been studied in patients undergoing bilateral TAA (B-TAA), and few studies compare TAA patients to control subjects. The purpose of this study was to compare gait symmetry in U-TAA and B-TAA patients and healthy controls. Using prospective databases, 19 unilateral and 19 bilateral ankle arthritis patients undergoing TAA were matched to 19 control subjects by age, sex, and BMI. The Normalized Symmetry Index (NSI) was determined for joint mechanics and ground reaction forces (GRF) during walking trials at a single visit for controls and preoperatively and 1 to 2 years postoperatively for TAA patients. Data was analyzed using linear mixed-effects models to determine differences among time points and cohorts at a significance of α = 0.05. Following surgery, B-TAA and U-TAA experienced improved peak plantarflexion moment symmetry (p = 0.017) but remained less symmetric than controls. B-TAA patients had more symmetry than U-TAA patients during peak weight acceptance GRF (p = 0.002), while U-TAA patients had greater peak dorsiflexion symmetry than B-TAA patients. TAA patients demonstrated more asymmetry compared to control subjects for all outcome measures. There was no significant impact of TAA on gait symmetry for GRF or peak ankle angles, and neither U-TAA nor B-TAA was consistently associated with higher gait symmetry. These results indicate that TAA improves symmetry during peak plantarflexion moment, and that significant gait asymmetry persists for B-TAA and U-TAA patients compared to healthy participants.
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Affiliation(s)
- Stephanie H Carpentier
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Martin Barylak
- Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Sara Arena
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Robin Queen
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
- Department of Orthopedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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Vesely BD, Kipp J, Russell G, LeSavage L, Hoffler H, Medda AW, Scott AT. Predictive Factors of Postoperative Pain in Patients With Tibiotalocalcaneal Arthrodesis With an Intramedullary Nail: A Retrospective Review. J Foot Ankle Surg 2024; 63:482-484. [PMID: 38494111 DOI: 10.1053/j.jfas.2024.03.001] [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: 09/01/2023] [Revised: 02/28/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
Tibiotalocalcaneal arthrodesis has been shown in literature to have good results in regards to low complication rates and deformity correction. While previous studies have investigated functional outcomes and complication rates, no large-scale studies have looked at pain outcomes. The present study performed a retrospective review of 154 extremities to analyze how a patient's comorbidities and characteristics influence pain outcomes following a tibiotalocalcaneal arthrodesis. The present study found an average change of pain from 7.1 to 3.0 in at least a 6 month follow up. We found that a diagnosis of chronic pain and tobacco use had statistically significant less pain improvement compared to patients without chronic pain or current tobacco use. We determined no statistically significant difference in pain outcomes for patients with or without Charcot deformity. Lastly, we found that with older patients there was more pain improvement observed. We physicians can educate current tobacco users of the improved pain outcomes with tobacco cessation prior to surgery. We recommend a multidisciplinary approach for pain in patients with a pre-operative diagnosis of chronic pain and to educate patients on realistic postoperative pain outcomes.
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Affiliation(s)
- Bryanna D Vesely
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC.
| | - Jennifer Kipp
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Gregory Russell
- Senior Biostatistician, Wake Forest University School of Medicine
| | - Lindsay LeSavage
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Hayden Hoffler
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Ashleigh W Medda
- Attending Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Aaron T Scott
- Attending Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
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Qureshi I, Lin CC, Anil U, Butler JJ, Walls RJ. Do Patients With Insulin-Dependent and Non-Insulin-Dependent Diabetes Have Different Risks for Complications After Total Ankle Arthroplasty? Foot Ankle Int 2024; 45:586-592. [PMID: 38501710 DOI: 10.1177/10711007241235897] [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: 03/20/2024]
Abstract
BACKGROUND Patients with diabetes undergoing total ankle arthroplasty tend to be at greater risk for complications than those without diabetes. However, the effect of diabetes severity and how it impacts the risk for perioperative complications is less clear. The purpose of this study was to compare (1) complications, (2) length of hospital stay, and (3) readmissions within 30 days for total ankle arthroplasty (TAA) patients without diabetes, patients with non-insulin-dependent diabetes, and patients with insulin-dependent diabetes. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, a total of 1803 patients undergoing TAA between 2007 and 2019 were collected. The relationship between diabetes status (no diabetes [n = 1,589], insulin-dependent [n = 169], and non-insulin-dependent [n = 45]) and outcomes were compared. Multivariate linear regression models were used to adjust for confounding variables such as age, sex, race, body mass index, smoking, steroid use, hypertension, chronic obstructive pulmonary disease, anesthesia type, dyspnea, and outpatient status. Statistical significance was set at P <.05. RESULTS Insulin-dependent diabetes was an independent risk factor for increased odds of infection within 30 days (odds ratio 6.47, 95% CI 0.79-33.66; P = .043). Hospital length of stay was also increased in patients with non-insulin-dependent diabetes (β = 0.21, 95% CI 0.02-0.40; P = .031) and insulin-dependent diabetes (β = 0.40, 95% CI 0.04-0.76; P = .028). However, neither diabetic state demonstrated a statistically significant increase in readmissions or wound complications within 30 days. CONCLUSION Patients with insulin-dependent diabetes included in this cohort were at increased risk of having an infection within 30 days after TAA. Additionally, patients with diabetes status had an increased hospital length of stay. These results can inform patients on their potential outcomes after total ankle arthroplasty based on their diabetes status.
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Affiliation(s)
- Ibraheem Qureshi
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | | | - Utkarsh Anil
- NYU Langone Orthopedic Hospital, New York, NY, USA
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Park GY, Kyung MG, Yoon YS, Kim DY, Lee DO, Lee DY. Change of Segmental Motion Following Total Ankle Arthroplasty Using a 3-Dimensional Multi-segment Foot Model. Clin Orthop Surg 2024; 16:455-460. [PMID: 38827760 PMCID: PMC11130636 DOI: 10.4055/cios23331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 06/04/2024] Open
Abstract
Background Total ankle arthroplasty (TAA) enhances patients' subjective outcomes with respect to pain and function. The aim of this study was to analyze the biomechanical changes of the affected limb following TAA using gait analysis with a 3-dimensional multi-segment foot model (3D MFM). Methods We reviewed medical records, simple radiographs, and gait analyses using a 3D MFM of patients who underwent TAA for severe varus ankle arthritis. Preoperative and postoperative gait data of 24 patients were compared. Postoperative gait analyses were done at least 1 year after surgery. Results TAA significantly increased stride length (p = 0.024). The total range of motion of all planes in the hindfoot and forefoot showed no significant changes between preoperative and postoperative states. Hindfoot was significantly plantarflexed and pronated after TAA, while forefoot was significantly supinated in all phases. After appropriate calculations, the genuine coronal motion of the hindfoot showed no changes after TAA in all phases. Conclusions TAA did not result in biomechanical improvements of segmental motions in the forefoot and hindfoot, except for changes to the bony structures. Therefore, it is important to point out to patients that TAA will not result in significant improvement of ankle function and range of motion. Clinicians can consider this information during preoperative counseling.
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Affiliation(s)
- Gil Young Park
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Korea
| | - Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young Sik Yoon
- Department of Orthopedic Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Dae-Yoo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Busan, Korea
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, Seoul, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Van den Borre I, Peiffer M, Huysentruyt R, Huyghe M, Vervelghe J, Pizurica A, Audenaert EA, Burssens A. Development and validation of a fully automated tool to quantify 3D foot and ankle alignment using weight-bearing CT. Gait Posture 2024; 113:67-74. [PMID: 38850852 DOI: 10.1016/j.gaitpost.2024.05.029] [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: 12/26/2023] [Revised: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Foot and ankle alignment plays a pivotal role in human gait and posture. Traditional assessment methods, relying on 2D standing radiographs, present limitations in capturing the dynamic 3D nature of foot alignment during weight-bearing and are prone to observer error. This study aims to integrate weight-bearing CT (WBCT) imaging and advanced deep learning (DL) techniques to automate and enhance quantification of the 3D foot and ankle alignment. METHODS Thirty-two patients who underwent a WBCT of the foot and ankle were retrospectively included. After training and validation of a 3D nnU-Net model on 45 cases to automate the segmentation into bony models, 35 clinically relevant 3D measurements were automatically computed using a custom-made tool. Automated measurements were assessed for accuracy against manual measurements, while the latter were analyzed for inter-observer reliability. RESULTS DL-segmentation results showed a mean dice coefficient of 0.95 and mean Hausdorff distance of 1.41 mm. A good to excellent reliability and mean prediction error of under 2 degrees was found for all angles except the talonavicular coverage angle and distal metatarsal articular angle. CONCLUSION In summary, this study introduces a fully automated framework for quantifying foot and ankle alignment, showcasing reliability comparable to current clinical practice measurements. This operator-friendly and time-efficient tool holds promise for implementation in clinical settings, benefiting both radiologists and surgeons. Future studies are encouraged to assess the tool's impact on streamlining image assessment workflows in a clinical environment.
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Affiliation(s)
- Ide Van den Borre
- Department of Telecommunications and Information Processing, Group for Artificial Intelligence and Sparse Modelling (GAIM), Ghent University, St-Pietersnieuwstraat 41, Gent, OVL B-9000, Belgium
| | - Matthias Peiffer
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium; Foot and Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, USA
| | - Roel Huysentruyt
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium
| | - Manu Huyghe
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium
| | - Jean Vervelghe
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium
| | - Aleksandra Pizurica
- Department of Telecommunications and Information Processing, Group for Artificial Intelligence and Sparse Modelling (GAIM), Ghent University, St-Pietersnieuwstraat 41, Gent, OVL B-9000, Belgium
| | - Emmanuel A Audenaert
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium
| | - Arne Burssens
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium.
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Ashy CC, Morningstar JL, Gross CE, Scott DJ. The association of ASA score and outcomes following to.tal ankle arthroplasty. Foot Ankle Surg 2024:S1268-7731(24)00072-9. [PMID: 38594104 DOI: 10.1016/j.fas.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/16/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND This study seeks to evaluate the relationship between American Society of Anesthesiologist (ASA) score and postoperative outcomes following TAA. METHODS The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2020 to identify 2210 TAA patients. Patients were stratified into low (n = 1328; healthy/mild systemic disease) or high (n = 881; severe/life-threatening systemic disease) ASA score cohorts. RESULTS There was no statistically significant difference in complications, readmission, or reoperation rate based on ASA score. Increased ASA score was significantly associated with longer length of stay (low = 1.69 days, high = 1.98 days; p < .001) and higher rate of adverse discharge (low = 95.3 %, high = 87.4 %; p < .001). CONCLUSION Higher ASA scores (3 and 4) were statically significantly associated with increased length of stay and non-home discharge disposition. These findings are valuable for physicians and patients to consider prior to TAA given the increased utilization of resources and cost associated with higher ASA scores. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Cody C Ashy
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
| | - Joshua L Morningstar
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
| | - Christopher E Gross
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
| | - Daniel J Scott
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, 96 Jonathan Lucas Street, CSB 708, MSC 622, Charleston, SC 29425, USA.
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Vesely BD, LeSavage L, Kipp J, King MA, Bullock G, Scott AT. Comparison of Loss of Bone Height Following Total Ankle Arthroplasty Versus Tibiotalocalcaneal Arthrodesis. J Foot Ankle Surg 2024; 63:136-139. [PMID: 37777151 DOI: 10.1053/j.jfas.2023.09.010] [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: 02/23/2023] [Revised: 09/06/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023]
Abstract
Ankle arthrodesis and total ankle arthroplasty are both well-accepted surgical treatment options for end-stage ankle arthrosis. However, total ankle arthroplasty has gained popularity as the survivability of implants is improving. It is understood that there is loss of bone height following tibiotalocalcaneal arthrodesis, but to our knowledge, this has not been investigated in the setting of total ankle arthroplasty. A retrospective radiographic review was conducted over a 5-year period. We investigated all patients who underwent a tibiotalocalcaneal arthrodesis or total ankle arthroplasty for treatment of ankle arthritis by a single fellowship-trained orthopedic surgeon. The anterior and posterior height measurements were measured on preoperative and postoperative lateral radiographs. Differences between preoperative and postoperative heights were analyzed through a series of analyses of covariance. One hundred and thirty-three patients and 143 operative extremities were included: 71 operative extremities in the tibiotalocalcaneal arthrodesis group (mean age 55.5 ± 13.3 years, BMI 32.2 ± 7.9) and 72 in the total ankle arthroplasty group (mean age 65.4 ± 9.5 years, BMI 30.7 ± 6.4). Statistical analysis demonstrated a loss of height in the tibiotalocalcaneal arthrodesis group, and an increased anterior and posterior height in the total ankle arthroplasty group. However, when comparing the arthroplasty group and arthrodesis group only the anterior height measurement reached statistical significance when stratified by gender (p < .001). The potential change in height is an important factor to consider during surgical planning as a limb length discrepancy may result.
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Affiliation(s)
- Bryanna D Vesely
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC.
| | - Lindsay LeSavage
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Jennifer Kipp
- Resident Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Matthew A King
- Fellow, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Garret Bullock
- Instructor, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Aaron T Scott
- Attending Physician, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC
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Choi JH, Noh KS, Lee DY, Choi YH, Lee T, Lee KM. Radiographic Evaluation of the Association between Foot Deformities and Ankle Medial Osteoarthritis. Clin Orthop Surg 2024; 16:125-133. [PMID: 38304216 PMCID: PMC10825246 DOI: 10.4055/cios22359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/11/2023] [Accepted: 08/20/2023] [Indexed: 02/03/2024] Open
Abstract
Background Foot deformities can cause abnormal biomechanics of the ankle joint and the development of osteoarthritis. It was hypothesized that foot deformities would be related to medial ankle osteoarthritis, and this study investigated this relationship using radiographic measurements. Methods Seventy-six ankles of 76 patients (32 men and 44 women; mean age, 69.0 years) with medial ankle osteoarthritis were included. Eleven radiographic measurements evaluated ankle joint orientation (tibial plafond inclination [TPI], medial distal tibial angle [MDTA], and anterior distal tibial angle [ADTA]), ankle joint incongruency (tibiotalar tilt [TT]), foot deformities (lateral talo-first metatarsal angle [Lat talo-1MT], anteroposterior talo-first metatarsal angle [AP talo-1MT], and talonavicular coverage), talar body migration (medial talar center migration [MTCM] and anterior talar center migration [ATCM]), internal rotation (IR) of the talus, and mechanical tibiofemoral angle. All were statistically analyzed using Pearson's correlation coefficients and regression analyses. Results Ankle joint orientation to the ground (TPI, p = 0.002), increased foot arch (Lat talo-1MT, p < 0.001), and IR of the talus (p = 0.001) were significantly associated with ankle joint incongruency (TT) in linear regression analysis. Ankle joint incongruency (TT, p = 0.003), medial talar body migration (MTCM, p = 0.042), and increased foot arch (Lat talo-1MT, p = 0.022) were significantly associated with IR of the talus in the binary logistic regression analysis. MTCM was significantly correlated with TPI (r = 0.251, p = 0.029), TT (r = 0.269, p = 0.019), MDTA (r = 0.359, p = 0.001), ATCM (r = -0.522, p < 0.001), and AP talo-1MT (r = 0.296, p = 0.015). ATCM was significantly correlated with TPI (r = -0.253, p = 0.027), ADTA (r = 0.349, p = 0.002), and Lat talo-1MT (r = -0.344, p = 0.002). Conclusions Ankle joint orientation, foot deformities, and talar rotation were associated with ankle joint incongruency in medial ankle osteoarthritis when evaluated radiographically. These findings need to be considered during surgical treatment for medial ankle osteoarthritis. However, the biomechanical significance of these radiographic measurements requires further investigation.
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Affiliation(s)
- Ji Hye Choi
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kwon Seok Noh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Yoon Hyo Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Taeyong Lee
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Seoul, Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Hollander JJ, Paget LDA, Dahmen J, Stornebrink T, Rikken QGH, Sierevelt IN, Kerkhoffs GMMJ, Stufkens SAS. Low annual revision rate in ankle distraction for ankle osteoarthritis: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024; 32:344-351. [PMID: 38294178 DOI: 10.1002/ksa.12049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024]
Abstract
PURPOSE Ankle osteoarthritis severely impacts patients' mental and physical quality of life. Besides total ankle replacement and ankle arthrodesis, ankle distraction has been shown to be a promising alternative. The primary aim of the present study was to determine the annual revision rates (ARRs) after ankle distraction. The secondary aim was to obtain an overview of patient-reported outcome measures and functional outcomes. METHODS A literature search until November 2023 was performed. Methodological quality was assessed using the methodological index for non-randomised studies criteria. Primary outcome was the ARR which was log-transformed and pooled using a random effects model. Secondary outcomes were pooled using a simplified pooling technique and included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS), range of motion (ROM) and post-operative complications. RESULTS The literature search resulted in 287 articles, of which 10 studies, comprising 602 patients, were included. The patients had a pooled mean age of 47 years (range of means: 40-68) and a mean follow-up of 35 months (range of means: 24-48). The overall methodological quality was moderate to fair. The pooled ARR after ankle distraction was 4% (95% confidence interval [CI], 3%-7%). Pooling of AOFAS showed mean 26-point improvement (from 54 to 80). Additionally, ROM dorsiflexion improved at 5°, and the plantarflexion remained at 31°. The overall complication rate was 41% (95% CI, 35%-48%), of which 77% (95% CI, 67%-85%) were pin-tract infections. CONCLUSION Ankle distraction results in an ARR of 4% (95% CI, 3%-7%) with clinically relevant improved AOFAS scores. The overall complication rate is 41% and is mainly attributable to treatable pin-tract infections (77% of recorded complications). LEVEL OF EVIDENCE Level IV, Systematic Review and Meta-Analysis.
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Affiliation(s)
- Julian J Hollander
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Liam D A Paget
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jari Dahmen
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tobias Stornebrink
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Quinten G H Rikken
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Xpert Clinics, Amsterdam, The Netherlands
- Department of Orthopedic Surgery, Spaarne Gasthuis Academy, Hoofddorp, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
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12
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Ha TT, Madeley NJ, Senthil Kumar C. Outcomes of total ankle replacement - Current evidence. J Clin Orthop Trauma 2024; 48:102327. [PMID: 38274642 PMCID: PMC10806254 DOI: 10.1016/j.jcot.2023.102327] [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: 10/23/2023] [Revised: 12/03/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Total ankle replacement surgery is gaining popularity and is beginning to establish itself as a viable alternative to arthrodesis in the treatment of end-stage ankle arthritis. Only a few studies exist directly comparing these 2 techniques. Also lacking are the long-term outcome studies of ankle replacement surgery. A better understanding of clinical and patient-reported outcome measures after ankle fusion and replacement will enable the surgeon to better counsel the patient and help choose the right treatment. This article will summarise the reported clinical outcomes after total ankle replacements and survivorship analysis from the various national arthroplasty registers.
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Affiliation(s)
- Taegyeong Tina Ha
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Nicola Jane Madeley
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Chinnasamy Senthil Kumar
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
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13
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Dickinson JD, Collman DR, Russel LH, Choung DJ. Navigating the Challenges of Total Ankle Replacement: Deformity Correction and Infection Considerations. Clin Podiatr Med Surg 2024; 41:119-139. [PMID: 37951670 DOI: 10.1016/j.cpm.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
In recent years, total ankle replacement (TAR) has gained widespread acceptance as a surgical treatment for end-stage ankle arthritis. This shift is due to notable improvements in implant design, surgical instrumentation, technique, and surgeon expertise, resulting in high levels of patient satisfaction comparable to ankle fusion. Additionally, indications for TAR have expanded to include advanced deformities that were previously considered unsuitable for the procedure, making ankle arthrodesis the only option. Despite these advancements, TAR still carries a higher complication rate compared to other ankle surgeries. The complex anatomy of the ankle, coupled with limited soft tissue, presents significant challenges in managing complications associated with TAR.
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Affiliation(s)
- Joseph D Dickinson
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics/Podiatry, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA
| | - David R Collman
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Podiatry, Injury, Sports Medicine, Kaiser Permanente San Francisco Medical Center, 4506th Avenue, French Campus, 5th Floor, San Francisco, CA 94118, USA
| | - Lindsay H Russel
- Department of Orthopedics, Kaiser Permanente South Sacramento Medical Center, 6600 Bruceville Road, Sacramento, CA 95823, USA
| | - Danny J Choung
- Kaiser North Bay Consortium Foot and Ankle Residency Program, Department of Orthopedics/Podiatry, Kaiser Permanente San Rafael, 99 Montecillo Road, San Rafael, CA 94903, USA.
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14
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Bagheri K, Anastasio AT, Poehlein E, Green CL, Aitchison AH, Cantor N, Hendren S, Adams SB. Outcomes after total ankle arthroplasty with an average follow-up of 10 years: A systematic review and meta-analysis. Foot Ankle Surg 2024; 30:64-73. [PMID: 37775362 DOI: 10.1016/j.fas.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The literature demonstrating positive outcomes after total ankle arthroplasty (TAA) is mounting. However, the long-term outcomes of TAA (≥ 10 years) remain minimally reported. The purpose of this systematic review and meta-analysis was to evaluate outcome metrics over multiple TAA studies with greater than 10 years of average follow-up. METHODS TAA studies were searched in Medline, Embase, and Scopus from the date of inception to September 12, 2022. Inclusion criteria included 1) studies of patients that underwent uncemented TAA, and 2) studies with an average follow-up time of at least ten years. Manuscripts in non-English languages and isolated abstracts were excluded. We collected American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) scores from the included studies for pooled meta-analysis. Due to the varying definition of survivability between studies, this metric was not assessed in our final evaluation. RESULTS Our data included approximately 3651 patients (3782 ankles). Of the 25 studies with an average follow-up of 10 years included in the systematic review, 5 provided pre- and post-operative AOFAS means and 5 provided pre- and post-operative VAS means with associated measures of variability and were included in our meta-analysis. The weighted mean difference between pre-and post-operative AOFAS and VAS scores was -40.36 (95% CI -47.24 to -33.47) and 4.52 (95% CI: 2.26-6.43), respectively. The risk of bias was low to moderate for the included studies. CONCLUSION Outcomes following TAA are favorable and indicate patient-reported outcome improvement over long-term follow-up. However, a significant amount of heterogeneity exists between studies. Future, prospective, randomized research should focus on standardizing outcome measures, survivorship, and complication reporting methodologies to allow for pooled meta-analyses of these important outcome metrics.
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Affiliation(s)
- Kian Bagheri
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA; Campbell University School of Osteopathic Medicine, Lillington, NC, USA.
| | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Nicole Cantor
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | | | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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15
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Moeller RT, Mentzel M, Gabel M, Vergote D, Bauknecht S. Anatomical principles of ankle denervation - An update. Foot Ankle Surg 2023; 29:597-602. [PMID: 37500388 DOI: 10.1016/j.fas.2023.07.005] [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: 02/14/2023] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Denervation is a surgical option in ankle arthrosis when conservative therapy has failed. Sectioning all joint branches is essential for its success. The locations of the articular branches of the saphenous (Sa), tibial (Ti), sural (Su), superficial (Ps) and deep peroneal (Pp) nerves are specified. METHODS In 16 cryopreserved specimens, the courses of the nerves were prepared. Their articular branches were identified, and their respective locations documented by using a new reference system. RESULTS The articular branches to the ankle ranged from 5 to 30 cm measured from the foot sole. The Sa should be transected at 22.5 cm, the Su at 20 cm, and the Pp at 15 cm. The Ti should be skeletonized up to 25 cm. Epifascial dissection of the Ps is to be performed below 15 cm. CONCLUSION The study specifies the joint branches of the ankle in an intraoperatively reproducible reference system and thus minimizes the required skin incisions.
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Affiliation(s)
- Richard-Tobias Moeller
- Department for Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
| | - Martin Mentzel
- Department for Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Michael Gabel
- ATOS Klinik Stuttgart GmbH, Hohenheimer Straße 91, 70184 Stuttgart, Germany
| | - Daniel Vergote
- Department for Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Simon Bauknecht
- Department for Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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16
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Deleu PA, Naaim A, Bevernage BD, Cheze L, Dumas R, Birch I, Besse JL, Leemrijse T. Changes in Relative Work of the Lower Extremity and Distal Foot Joints After Total Ankle Replacement: An Exploratory Study. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4376-4381. [PMID: 37906486 DOI: 10.1109/tnsre.2023.3328936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Ankle osteoarthritis does not only led to lower ankle power generation, but also results in compensatory gait mechanics at the hip and Chopart joints. Much of previous work explored the relative work distribution after total ankle replacement (TAR) either across the lower extremity joints where the foot was modelled as a single rigid unit or across the intrinsic foot joints without considering the more proximal lower limb joints. Therefore, this study aims, for the first time, to combine 3D kinetic lower limb and foot models together to assess changes in the relative joint work distribution across the foot and lower limb joints during level walking before and after patients undergo TAR. We included both patients and healthy control subjects. All patients underwent a three-dimensional gait analysis before and after surgery. Kinetic lower limb and multi-segment foot models were used to quantify all inter-segmental joint works and their relative contributions to the total lower limb work. Patients demonstrated a significant increase in the relative ankle positive joint work contribution and a significant decrease in the relative Chopart positive joint work contribution after TAR. Furthermore, there exists a large effect toward decreases in the relative contribution of the hip negative joint work after TAR. In conclusion, this study seems to corroborate the theoretical rationale that TAR reduces the compensatory strategy in the Chopart and hip joints in patients suffering from end-stage ankle osteoarthritis.
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17
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Morelli KM, Newkirk-Pulliam NE, Angelich CM, Buckner QT, Homan CM, Irwin JP, Butler AJ, Tsai LC. Bilateral lower extremity gait and function after unilateral total ankle arthroplasty: a case report. Physiother Theory Pract 2023; 39:2490-2500. [PMID: 35608622 DOI: 10.1080/09593985.2022.2078752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND End-stage ankle osteoarthritis is one of the leading causes of chronic disability in North America. The main purpose of this case report was to describe the functional recovery of a person following total ankle arthroplasty (TAA) surgery using the INFINITY™ system for end stage osteoarthritis of the left ankle. CASE DESCRIPTION We report a case of a 55-year-old male who had attempted conservative management for end stage ankle osteoarthritis in his left ankle but ultimately elected to undergo TAA using The INFINITY™ Total Ankle System. He not only had significant left ankle pain limiting his daily function, but also had developed severe right knee pain. We performed gait analysis both before and 6 months after his TAA surgery to examine the sagittal and frontal-plane motions of bilateral ankle, knee, and hip joints during gait. OUTCOMES At 6 months post-surgery, the patient demonstrated a 44-point improvement in his Foot and Ankle Outcome questionnaire scores as well as an increase in both left knee and left ankle motion in the sagittal and frontal planes. Kinematic deviations in the left ankle, hip, and knee joints during gait also reduced post-surgery. Despite improvement in his left ankle and overall function, the participant's right knee pain and altered kinematics of the right limb during gait worsened after surgery. DISCUSSION Interventions, either before or after ankle surgery, should consider bilateral lower extremities simultaneously in order to optimize patient care and minimize future secondary complications for individuals with unilateral ankle osteoarthritis.
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Affiliation(s)
- Kimberly M Morelli
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | | | - Claire M Angelich
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Quinton T Buckner
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Conner M Homan
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Jake P Irwin
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Andrew J Butler
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
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18
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Smith MD, Vuvan V, Collins NJ, Hunter DJ, Costa N, Smith MMF, Vicenzino B. Protocol for a randomised feasibility trial comparing a combined program of education and exercise versus general advice for ankle osteoarthritis. J Foot Ankle Res 2023; 16:72. [PMID: 37858226 PMCID: PMC10588035 DOI: 10.1186/s13047-023-00669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Ankle osteoarthritis (OA) is a serious problem with high associated pain and disability. While education and exercise are recommended for the initial management of OA, this has not been investigated in ankle OA. The primary aim of this study is to establish the feasibility of running a full-scale randomised controlled trial (RCT) investigating a combined education and exercise program compared to a general advice program for people with ankle OA. The secondary aims are to collect preliminary data which will inform sample size calculations, and understand the perspectives of people with ankle OA on their participation in the trial. METHODS Thirty individuals aged 35 years or older with symptomatic radiographic ankle OA will be recruited from the community and randomised to receive either a combined education and exercise program or a general advice program, both of which will be delivered by a physiotherapist in a group setting. Primary outcomes of feasibility include responses to study advertisements, number of eligible participants, recruitment rate, adherence with the intervention, fidelity of the intervention, adverse events, drop-out rate, and credibility and expectancy of the intervention. Secondary participant-reported outcomes will include global rating of change, patient acceptable symptom state, severity of ankle pain and stiffness, self-reported function, quality of life, satisfaction with treatment, and use of co-interventions. Follow up will be at 8 weeks and 3 months. Physical measures of 40 m walking speed, timed stairs descent, heel raise endurance and ankle dorsiflexion range of motion will be collected at baseline and 8 weeks. Primary feasibility outcomes will be reported descriptively, and estimates of the variability of secondary participant-reported and physical outcomes will be calculated. Semi-structured interviews will be conducted with participants to understand perspectives about the intervention and participation in the trial, with data analyzed thematically. DISCUSSION Study findings will establish the feasibility of running a full-scale RCT to investigate a combined education and exercise program compared to a general advice program for people with ankle OA. This study is a necessary first step to advance the international research agenda of evaluating the efficacy of exercise in the management of ankle OA. TRIAL REGISTRATION ACTRN12623000017628. Registered 10 January 2023, https://www.anzctr.org.au/ACTRN12623000017628.aspx .
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Affiliation(s)
- Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia.
| | - Viana Vuvan
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
| | - Natalie J Collins
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Rheumatology Department, The University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | - Nathalia Costa
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
- Sydney School of Health Sciences, The University of Sydney, Physiotherapy, Sydney, NSW, Australia
| | - Melinda M Franettovich Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
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19
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Alyousef YS, Johnston V, Smith MD. Work-related outcomes in individuals with and without lower limb osteoarthritis: an online survey. BMC Public Health 2023; 23:1885. [PMID: 37773119 PMCID: PMC10540324 DOI: 10.1186/s12889-023-16723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE While osteoarthritis (OA) affects people who are still participating in the workforce, there is limited data about the impact of OA on work. The aim of this study was to compare work participation in individuals with and without lower limb OA. METHODS This cross-sectional study included workers with (n = 124) and without (n = 106) lower limb OA. Work participation was assessed as work status (full/part time work), work ability (Work Ability Index (WAI)), absenteeism and presenteeism (World Health Organization's Health and Work Performance Questionnaire (WHO-HPQ)), and perceived difficulties meeting work demands (Work Role Functioning Questionnaire (WRFQ)). The data were analyzed using an analysis of covariance with age, body mass index and physical job demands included as covariates. RESULTS Work ability was poorer (p < 0.001) and loss of work performance (p < 0.001) was higher among workers with OA than healthy controls. There was no statistical difference in absenteeism or overall ability to meet work demands between participants with and without lower limb OA. However, workers with lower limb OA had more difficulty with work scheduling demands (p = 0.05) and physical demands (p = 0.003) than healthy workers. CONCLUSION Lower limb OA was associated with poorer work ability, loss of work performance and difficulty in meeting physical and work scheduling demands. Health professionals and employers should consider these challenges when managing individuals with lower limb OA and supporting them to remain in the workforce.
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Affiliation(s)
- Yousef S Alyousef
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia
- College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Venerina Johnston
- College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
| | - Michelle D Smith
- College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia.
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20
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Kloprogge S, Katier N, Mailuhu A, van Vooren J, van Ochten J, Bindels P, Bierma-Zeinstra S, van Middelkoop M. Is radiographic osteoarthritis associated with pain and disability of the ankle? OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100383. [PMID: 37520149 PMCID: PMC10371817 DOI: 10.1016/j.ocarto.2023.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Objective Ankle osteoarthritis (OA) is relatively understudied. It often affects younger people compared to OA in other joints. Evidence on the association between radiographic OA and ankle symptoms remains contradicting. We therefore examined the association of degree of radiographic talocrural, subtalar and talonavicular OA with severity of ankle pain, disability and predominant symptoms. Method A cross-sectional study was conducted in a radiology department serving primary and secondary care. From the total study population (adults referred for ankle radiography), patients with chronic ankle complaints were selected (N = 231). Before radiography, participants completed a questionnaire on severity of ankle pain and disability using the Ankle Osteoarthritis Scale (AOS), and on their predominant symptoms, i.e. pain, functional loss, stiffness and/or instability. To assess the associations of the Kellgren-Lawrence scores (0, 1 or ≥2) with the primary outcomes (AOS), linear regression, and with the secondary outcomes predominant symptoms, logistic regression analyses were applied. Results Radiographic OA was not associated with AOS-pain and -disability. Radiographic talocrural OA was associated with functional loss (OR 3.26, 95% CI: 1.31; 8.11). A positive trend was seen between radiographic talonavicular OA and stiffness (OR 2.63, 95% CI: 0.97; 7.15). Conclusion The presence of radiographic OA is not associated with severity of ankle pain and disability in patients with chronic ankle complaints referred for ankle radiography. However, radiographic talocrural OA is associated with functional loss and radiographic talonavicular OA with stiffness as predominant symptom. These findings may contribute to better recognition of ankle OA in clinical practice.
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Affiliation(s)
- S.E. Kloprogge
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - N. Katier
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - A.K.E. Mailuhu
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - J. van Vooren
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - J.M. van Ochten
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - P.J.E. Bindels
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - S.M.A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - M. van Middelkoop
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
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21
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Paget LDA, Mokkenstorm MJ, Tol JL, Kerkhoffs GMMJ, Reurink G. What Is the Efficacy of Intra-articular Injections in the Treatment of Ankle Osteoarthritis? A Systematic Review. Clin Orthop Relat Res 2023; 481:1813-1824. [PMID: 37039814 PMCID: PMC10427070 DOI: 10.1097/corr.0000000000002624] [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] [Received: 08/19/2022] [Revised: 12/20/2022] [Accepted: 02/14/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Ankle osteoarthritis (OA) is painful and can impact a patient's physical and mental quality of life. Although intra-articular injections are commonly used to alleviate symptoms, there is conflicting evidence concerning their efficacy. Therefore, an updated systematic review would be informative. QUESTION/PURPOSE In this systematic review, we asked: Are there clinically important benefits or harms associated with the use of intra-articular injections in the treatment of ankle OA? METHODS We used PubMed, Embase, and the Cochrane Library to search for randomized controlled trials on intra-articular injections for the treatment of ankle OA in June 2021, and updated the search in January 2022; eligible dates were from the date of inception of each database through January 2022. Reference lists of eligible studies and previous reviews were manually screened. Two reviewers independently assessed studies for eligibility. We included seven studies. Three compared hyaluronic acid (HA) with saline, one compared HA with exercise, one compared four different regimens of HA [ 34 ], one compared platelet-rich plasma (PRP) with saline, and one compared botulinum toxin Type A (BoNT-A) with HA. A total of 340 patients were included: 141 in the HA arms, 48 in the PRP arm, 38 in the BoNT-A arm, and 113 in the saline arms. Across all studies, the mean age was 52 ± 21 years, and 35% were women (119 of 340 patients). Methodologic quality was assessed using the Cochrane Risk of Bias 2.0 tool. Of the included studies, the risk of bias was low in two studies, presented some concerns in one study, and was high in four studies. According to the Grading of Recommendations Assessment, Development, and Evaluation methodology, the level of evidence was very low for HA, moderate for PRP, and very low for BoNT-A. The level of heterogeneity was high, and we opted to perform a systematic review rather than a meta-analysis. A clinically relevant difference was based on whether the between-group difference surpassed the cutoff point determined as the minimum clinically important difference. RESULTS No clinically relevant differences were found among HA, PRP, and BoNT-A and their control groups at 3, 6, or 12 months. No studies reported any serious adverse events in any treatment group. CONCLUSION Given the lack of observed efficacy in this systematic review, these treatments should not be used in practice until or unless future high-quality studies find evidence of efficacy. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Liam D. A. Paget
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, AMC/VUmc International Olympic Committee Research Center, Amsterdam, the Netherlands
| | - Milo J. Mokkenstorm
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, AMC/VUmc International Olympic Committee Research Center, Amsterdam, the Netherlands
| | - Johannes L. Tol
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, AMC/VUmc International Olympic Committee Research Center, Amsterdam, the Netherlands
- Aspetar, Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Gino M. M. J. Kerkhoffs
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, AMC/VUmc International Olympic Committee Research Center, Amsterdam, the Netherlands
| | - Gustaaf Reurink
- Amsterdam UMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands
- Amsterdam Collaboration for Health and Safety in Sports, AMC/VUmc International Olympic Committee Research Center, Amsterdam, the Netherlands
- The Sport Physician Group, Department of Sports Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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22
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Bernstein DN, Friswold A, Waryasz G, DiGiovanni CW, Tobert DG. Evaluating and Comparing the Correlation and Performance of PROMIS and FAAM ADL in a Foot and Ankle Patient Population. Foot Ankle Spec 2023:19386400231192814. [PMID: 37608761 DOI: 10.1177/19386400231192814] [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: 08/24/2023]
Abstract
BACKGROUND There is a paucity of literature assessing 2 of the commonly used static Patient-Reported Outcomes Measurement Information System (PROMIS) forms (PROMIS Global-10 and PROMIS Physical Function Short Form 10a [PF SF 10a]) and the Foot and Ankle Ability Measure Activities of Daily Living (FAAM ADL). METHODS The PROMIS Global-10, PROMIS PF SF 10a, and FAAM ADL were compared among new foot and ankle patients. Spearman rho (ρ) correlations were calculated, and ceiling and floor effects were determined. RESULTS The FAAM ADL demonstrated strong correlations with PROMIS PF SF 10a, P = .88, 95% confidence interval (CI): 0.86-0.90, P < .001, and PROMIS Global-10 Physical Health (P = .75, 95% CI: 0.71-0.78, p < .001). The FAAM ADL and PROMIS Global-10 Mental Health demonstrated a moderate correlation (P = .41, 95% CI: 0.34-0.47, P < .001). No PROM demonstrated an appreciable floor effect. The PROMIS Global-10 Physical Health demonstrated the lowest ceiling effect (n=11 [1.6%]). CONCLUSION Because the PROMIS Global-10 captures physical health adequately, provides mental health insight, and performs as well (if not better), we recommend the PROMIS Global-10 among the PROMs studied.Level of Evidence: Level III.
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Affiliation(s)
- David N Bernstein
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alec Friswold
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Waryasz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher W DiGiovanni
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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23
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Deleu PA, Naaim A, Chèze L, Dumas R, Devos Bevernage B, Birch I, Leemrijse T, Besse JL. Concomitant Triceps Surae Lengthening in Total Ankle Arthroplasty Affects the Mechanical Work at the Ankle Joint. Foot Ankle Int 2023; 44:754-762. [PMID: 37309118 DOI: 10.1177/10711007231176819] [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: 06/14/2023]
Abstract
BACKGROUND Previous studies have examined the effect of concomitant triceps surae lengthening on ankle dorsiflexion motion at the time of total ankle arthroplasty (TAA). As plantarflexor muscle-tendon structures are important for producing positive ankle work during the propulsive phase of gait, caution should be exercised when lengthening triceps surae, as it may decrease plantarflexion strength. In order to develop an understanding of the work of the anatomical structures crossing the ankle during propulsion, joint work must be measured. The aim of this explorative study was to assess the effect of concomitant triceps surae lengthening with TAA on the resultant ankle joint work. METHODS Thirty-three patients were recruited to the study and divided into 3 groups of 11. The first group underwent both triceps surae lengthening (Strayer and TendoAchilles) and TAA (Achilles group), the second group underwent only TAA (Non-Achilles group), and the third group underwent only TAA, but had a greater radiographic prosthesis range of motion (Control group) compared to the first 2 groups. The 3 groups were matched in terms of demographic variables and walking speed. All patients underwent a 3D gait analysis 1 year after surgery to measure intersegmental joint work using a 4-segmented kinetic foot model. An analysis of variance (ANOVA) or Kruskal-Wallis test was used to compare the 3 groups. RESULTS The ANOVA showed significant differences between the 3 groups. Post hoc analyses suggested that (1) the Achilles group had less positive work at the ankle joint than the Non-Achilles and Control groups; (2) the Achilles group produced less positive work performed by all foot and ankle joints than the Control group; and (3) the Achilles and Non-Achilles groups absorbed less energy across all foot and ankle joints during the stance phase than the Control group. CONCLUSION Concomitant triceps surae lengthening in TAA may reduce the positive work at the ankle joint. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Paul-André Deleu
- Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC UMR_T9406, Lyon, France
- Foot & Ankle Institute, Brussels, Belgium
| | - Alexandre Naaim
- Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC UMR_T9406, Lyon, France
| | - Laurence Chèze
- Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC UMR_T9406, Lyon, France
| | - Raphaël Dumas
- Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC UMR_T9406, Lyon, France
| | | | - Ivan Birch
- Sheffield Teaching Hospitals NHS Foundation Trust, Woodhouse Clinic, Sheffield, United Kingdom
| | - Thibaut Leemrijse
- Foot & Ankle Institute, Brussels, Belgium
- CHIREC Delta Hospital, Brussels, Belgium
| | - Jean-Luc Besse
- Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, LBMC UMR_T9406, Lyon, France
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, Pierre-Bénite Cédex, France
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24
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Paget LD, Reurink G, de Vos RJ, Weir A, Moen MH, Bierma-Zeinstra SM, Stufkens SA, Goedegebuure S, Krips R, Maas M, Meuffels DE, Nolte PA, Runhaar J, Kerkhoffs GM, Tol JL. Platelet-Rich Plasma Injections for the Treatment of Ankle Osteoarthritis. Am J Sports Med 2023; 51:2625-2634. [PMID: 37417359 PMCID: PMC10394962 DOI: 10.1177/03635465231182438] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/07/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Ankle osteoarthritis is debilitating and usually affects relatively young people, often as a result of previous ankle traumas, frequently occurring in sports. Platelet-rich plasma (PRP) injections for ankle osteoarthritis have shown no evidence of benefit over the course of 26 weeks. Previous studies on PRP for knee osteoarthritis showed that clinically significant improvements with PRP occurred between 6 to 12 months in the absence of initial benefit. No studies have evaluated the effect of PRP from 6 to 12 months in ankle osteoarthritis. PURPOSE To assess the efficacy of PRP injections in ankle osteoarthritis over the course of 52 weeks. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS In this 52-week follow-up trial, 100 patients with ankle osteoarthritis were randomized to a PRP group or placebo (saline) group. Patients received 2 intra-articular talocrural injections: at inclusion and after 6 weeks. Patient-reported outcome measures were used to assess pain, function, quality of life, and indirect costs over 52 weeks. RESULTS Two patients (2%) were lost to follow-up. The adjusted between-group difference for the patient-reported American Orthopaedic Foot & Ankle Society score over 52 weeks was -2 points (95% CI, -5 to 2; P = .31) in favor of the placebo group. No significant between-group differences were observed for any of the secondary outcome measures. CONCLUSION For patients with ankle osteoarthritis, PRP injections did not improve ankle symptoms and function over 52 weeks compared with placebo injections. REGISTRATION NTR7261 (Netherlands Trial Register).
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Affiliation(s)
- Liam D.A. Paget
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Academic Center for Evidence-based Sports Medicine [ACES], Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports [ACHSS], AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Gustaaf Reurink
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands; The Sport Physician Group, Department of Sports Medicine, OLVG, Amsterdam, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Adam Weir
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Aspetar Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Hospital, Doha, Qatar; Sport Medicine and Exercise Clinic Haarlem [SBK], Haarlem, the Netherlands
| | - Maarten H. Moen
- The Sport Physician Group, Department of Sports Medicine, OLVG, Amsterdam, the Netherlands; Department of Sports Medicine, Bergman Clinics, Naarden, the Netherlands
| | - Sita M.A. Bierma-Zeinstra
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sjoerd A.S. Stufkens
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Simon Goedegebuure
- The Sport Physician Group, Department of Sports Medicine, OLVG, Amsterdam, the Netherlands
| | - Rover Krips
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, the Netherlands
| | - Mario Maas
- ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Duncan E. Meuffels
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Peter A. Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands; Department of Oral Cell Biology, Academic Center for Dentistry Amsterdam [ACTA], UvA and VU, Amsterdam, the Netherlands
| | - J. Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gino M.M.J. Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands; ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Johannes L. Tol
- ACES, Amsterdam, the Netherlands; ACHSS, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands; Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Investigation performed at Amsterdam UMC, Amsterdam, the Netherlands
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25
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Alanazi SA, Vicenzino B, Maclachlan LR, Smith MD. "It's like a nail being driven in the ankle": A qualitative study of individuals' lived experiences to inform a core domain set for ankle osteoarthritis. Musculoskelet Sci Pract 2023; 66:102813. [PMID: 37421757 DOI: 10.1016/j.msksp.2023.102813] [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: 04/13/2023] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES Explore individuals' lived experience with ankle osteoarthritis and to identify health-related domains for ankle osteoarthritis based on the perspectives of people living with the condition, as an initial step to address the International Foot and Ankle Osteoarthritis Consortium's recommendation to develop a core domain set for ankle osteoarthritis. METHODS A qualitative study using semi-structured interviews was conducted. Interviews were undertaken with individuals with symptomatic ankle osteoarthritis who were aged ≥35 years. Interviews were recorded, transcribed verbatim and thematically analysed. RESULTS Twenty-three individuals (16 females; mean (range) age 62 (42-80) years) were interviewed. Five themes were identified: pain, often severe, is a central feature of living with ankle osteoarthritis; stiffness and swelling are key symptoms; ankle osteoarthritis induced mobility impairments compromise enjoyment in life; ankle osteoarthritis instability and balance impairments lead to concerns about falling; there are financial implications of living with ankle osteoarthritis. We propose 17 domains based on individuals' experiences. CONCLUSION Study findings indicate that individuals with ankle osteoarthritis live with chronic ankle pain, stiffness and swelling which affect their ability to participate in physical, and social activities, maintain an active lifestyle, and work in physical occupations. From the data, we propose 17 domains that are important to people with ankle osteoarthritis. These domains require further evaluation to ascertain their inclusion in a core domain set for ankle osteoarthritis.
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Affiliation(s)
- Sultan Ayyadah Alanazi
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia; Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Kingdom of Saudi Arabia. https://twitter.com/PTsultan_
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia. https://twitter.com/Bill_Vicenzino
| | - Liam R Maclachlan
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia. https://twitter.com/LiamRobMac
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia.
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26
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Taylor MA, Lachman JR, Adams SB, Nunley JA, DeOrio JK. Republication of "Keeping It in the Fairway: Golf Handicap Following Total Ankle Arthroplasty". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231195060. [PMID: 37578850 PMCID: PMC10422897 DOI: 10.1177/24730114231195060] [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: 08/16/2023] Open
Abstract
Background Total ankle arthroplasty (TAA) provides a surgical alternative to tibiotalar arthrodesis when treating end-stage ankle arthritis. TAA preserves range of motion at the tibiotalar joint leading to improved postoperative function. Many patients who undergo TAA wish to maintain a high level of activity, including participation in low-impact sports such as golf. There are several studies in the total hip and total knee arthroplasty literature that have looked at the effect of total joint arthroplasty on golf handicap. We hypothesized that similar to hip and knee arthroplasty research, TAA is likely to result in a postoperative increase in golf handicap. Methods After obtaining institutional review board approval, we retrospectively identified 60 patients (from 140 consecutive TAAs performed between August 2016 and February 2017) who had undergone TAA, played golf pre- and postoperatively, and had at least 1 year of postoperative follow-up. The average postoperative follow-up for the cohort was 28.1 months. Variables including preoperative and postoperative golf handicaps, swing laterality, age, gender, surgical laterality, implant used, and operating surgeon were recorded. Results The average preoperative and postoperative handicaps were 19.7 and 17.9, respectively, which did not represent a statistically significant difference (P = .07). Patients who played 3 or more rounds per week had better preoperative and postoperative handicaps compared to patients who played 2 rounds or less; however, the change in their handicap following TAA and the number of rounds played per week was not affected. There was no association between the change in handicap and the follow-up period, handedness of golf shot, surgical laterality, implant used, or the operating surgeon. Conclusion Our findings showed that golf handicap was not negatively affected following TAA in this series. Level of Evidence Level IV, case series.
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Affiliation(s)
- Michel A Taylor
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - James R Lachman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - James K DeOrio
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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27
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Phisitkul P, Glass N, Ebeling PB, Klein SE, Johnson JE. Republication of "Perspectives in Treatments of End-Stage Ankle Arthritis Among Orthopaedic Surgeons: Analysis of an American Orthopaedic Foot & Ankle Society (AOFAS) Member Survey". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231192977. [PMID: 37566691 PMCID: PMC10408348 DOI: 10.1177/24730114231192977] [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: 08/13/2023] Open
Abstract
Background This study aimed to assess the preferred operative treatment for patients over the age of 60 with end-stage ankle arthritis and perspectives on total ankle replacement (TAR) among American Orthopaedic Foot & Ankle Society (AOFAS) members. Associated factors were analyzed for potential contraindications among members with different levels of experience. Method A questionnaire containing 6 questions was designed and sent to 2056 members of the AOFAS. Responses were received from 467 orthopaedic surgeons practicing in the United States (76%), Canada (5%), and 26 other countries (20%). Participants were grouped for response comparisons according to country as well as experience level. Differences in contraindications were compared using χ2 tests or exact tests. Results Respondents practicing in the United States and surgeons who perform 11 or more TARs per year tended to recommend operative treatments favoring TAR and displayed recognition of its increasing role (P < .05). Overall, respondents felt that 41% of typical patients over 60 years old with end-stage arthritis would be best treated with TAR. Talus avascular necrosis, morbid obesity (body mass index >40 kg/m2), and poorly controlled diabetes with neuropathy were most recognized as the absolute contraindications to TAR. Surgeon's experience affected the consideration of these clinical factors as contraindications. Conclusions Total ankle replacement has a substantial and increasing role in the treatment of end-stage ankle arthritis in patients over the age of 60. Absolute and potential contraindications of the procedures were indicated from a cross-sectional survey of AOFAS members. Surgeons more experienced with total ankle replacement felt more comfortable employing it in a wider range of clinical settings. Level of Evidence Level III, therapeutic.
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Affiliation(s)
| | - Natalie Glass
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Sandra E Klein
- Department of Orthopedic Surgery, Washington University in St. Louis, Chesterfield, MO, USA
| | - Jeffrey E Johnson
- Department of Orthopedic Surgery, Washington University in St. Louis, Chesterfield, MO, USA
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28
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Hong CC, Calder J. The Burden of the "Simple Ankle Sprains": A Review of the Epidemiology and Long-Term Impact. Foot Ankle Clin 2023; 28:187-200. [PMID: 37137618 DOI: 10.1016/j.fcl.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lateral ankle sprain (LAS) is not as simple as it was believed to be as it has substantial negative impacts on the active sporting population. The negative impact on physical function, quality of life (QoL) and economic burden is significant with increased risk of reinjury, development of chronic lateral ankle instability and posttraumatic ankle osteoarthritis resulting in functional deficits, decreased QoL and chronic disabilities. Economic burden from a societal perspective demonstrated notably higher indirect costs from productivity loss. Preventative interventions with early surgery for a selective cohort of active sporting population may be considered to mitigate morbidities associated with LAS.
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Affiliation(s)
- Choon Chiet Hong
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Orthopaedic Surgery, National University Hospital of Singapore, 1E, Kent Ridge Road, Singapore 119228, Singapore.
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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29
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Megerian MF, Harlow ER, LaTulip SM, Zhao C, Ina JG, Sattar A, Feighan JE. Total Ankle Arthroplasty for Posttraumatic Fracture Versus Primary Osteoarthritis: An Analysis of Complications, Revisions, and Prosthesis Survival. J Am Acad Orthop Surg 2023:00124635-990000000-00674. [PMID: 37079718 DOI: 10.5435/jaaos-d-22-01192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/16/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Most outcome studies of total ankle arthroplasty (TAA) do not discriminate by arthritis etiology. The primary purpose of this study was to compare the complications of TAA between posttraumatic fracture osteoarthritis (fracture PTOA) and primary osteoarthritis (POA). METHODS Ninety-nine patients who underwent TAA were retrospectively evaluated with a mean follow-up of 3.2 years (range 2 to 7.6 years). 44 patients (44%) had a diagnosis of POA while 55 patients (56%) had a diagnosis of fracture PTOA (40 malleolar fractures [73%], 14 pilon fractures[26%], and 1 talar fracture [1%]). Patient demographics, preoperative coronal plane alignment, postoperative complications, and revision surgery data were collected. Categorical variables were compared with chi square and Fisher exact tests and means with the Student t-test. Survival was assessed with Kaplan-Meier and log-rank analyses. RESULTS A higher overall complication rate was associated with fracture PTOA (53%) compared with POA (30%) (P = 0.04). No difference was observed in rates of any specific complication by etiology. Survival, defined as revision surgery with TAA prosthesis retention, was comparable between POA (91%) and fracture PTOA (87%) (P = 0.54). When defined as failure requiring prosthesis explant, POA demonstrated significantly greater survival (100%) as compared with fracture PTOA (89%) (P = 0.03). A higher rate of talar implant subsidence and loosening was noted in TAA with prior pilon (29%) as compared to malleolar fractures (8%) that was not statistically significant (P = 0.07). Fracture PTOA was associated with preoperative valgus deformity (P = 0.04). Compared with varus and normal alignment, preoperative valgus deformity was associated with the need for any revision surgery (P = 0.01) and prosthesis explant (P = 0.02). CONCLUSIONS Compared with POA, fracture PTOA was associated with a markedly higher complication rate after TAA and was at higher risk of failure requiring prosthesis explant. Fracture PTOA was markedly associated with preoperative valgus malalignment, an identified risk factor in this series for revision surgery and prosthesis explant. Pilon fractures may represent a group at risk of complications related to talar implant subsidence and loosening compared with malleolar fractures and thus warrants additional investigation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mark F Megerian
- From the Case Western Reserve University School of Medicine, Cleveland, OH (Megerian), the Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH (Megerian, Harlow, Ina, and Feighan), the Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT (LaTulip), and the Case Western Reserve University, Cleveland, OH (Zhao and Sattar)
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30
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Mikami Y, Yamaguchi S, Teramoto A, Amaha K, Yasui T, Kurashige T, Nagashima R, Endo J, Takakura Y, Noguchi K, Sadamasu A, Kimura S. Impact of pain in other body regions on the foot-specific quality of life in patients with hallux valgus. Mod Rheumatol 2023; 33:428-433. [PMID: 35106594 DOI: 10.1093/mr/roac003] [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: 09/15/2021] [Revised: 12/12/2021] [Accepted: 01/04/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The purpose of this study was to clarify the prevalence of pain outside the foot, and to determine the associations of pain outside the foot with foot-specific quality of life (QOL) in patients with hallux valgus. METHODS Patients scheduled to undergo hallux valgus surgery were recruited. Patients answered whether they experienced disabling pain in 13 body regions other than the foot. Foot-specific QOLwas assessed using the Self-Administered Foot Evaluation questionnaire (SAFE-Q). Foot pain was quantified using the visual analogue scale (VAS). Patient characteristics, including age, sex, comorbidity, anxiety, and depression, were also surveyed. The association between pain elsewhere and the SAFE-Q and pain VAS scores were assessed using univariate and multivariate analyses. RESULTS Of 102 patients, 55 (54%) experienced pain other than the foot. All SAFE-Q subscale scores were lower, and pain VAS was higher in patients with pain elsewhere than in patients without. In the multivariate analysis, an increase in the number of pain regions was independently associated with a decrease in SAFE-Q scores and an increase in pain VAS. CONCLUSION More than half of the patients with hallux valgus experienced pain elsewhere. The presence of pain elsewhere was associated with poorer foot-specific QOL and severer foot pain.
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Affiliation(s)
- Yukio Mikami
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan.,Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University, Hokkaido, Japan
| | - Kentaro Amaha
- Department of Orthopaedic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Tetsuro Yasui
- Department of Orthopaedic Surgery, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Toshinori Kurashige
- Department of Orthopaedic Surgery, Chiba Aiyukai Memorial Hospital, Chiba, Japan
| | | | - Jun Endo
- Department of Orthopaedic Surgery, Yoh memorial Hospital, Chiba, Japan
| | | | - Koji Noguchi
- Department of Orthopaedic Surgery, Kurume General Hospital, Fukuoka, Japan
| | - Aya Sadamasu
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Seiji Kimura
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Chiba, Japan
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31
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Goldberg AJ, Chowdhury K, Bordea E, Blackstone J, Brooking D, Deane EL, Hauptmannova I, Cooke P, Cumbers M, Skene SS, Doré CJ. Total ankle replacement versus ankle arthrodesis for patients aged 50-85 years with end-stage ankle osteoarthritis: the TARVA RCT. Health Technol Assess 2023; 27:1-80. [PMID: 37022932 PMCID: PMC10150410 DOI: 10.3310/ptyj1146] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Background We aimed to compare the clinical effectiveness, cost-effectiveness and complication rates of total ankle replacement with those of arthrodesis (i.e. ankle fusion) in the treatment of end-stage ankle osteoarthritis. Methods This was a pragmatic, multicentre, parallel-group, non-blinded randomised controlled trial. Patients with end-stage ankle osteoarthritis who were aged 50-85 years and were suitable for both procedures were recruited from 17 UK hospitals and randomised using minimisation. The primary outcome was the change in the Manchester-Oxford Foot Questionnaire walking/standing domain scores between the preoperative baseline and 52 weeks post surgery. Results Between March 2015 and January 2019, 303 participants were randomised using a minimisation algorithm: 152 to total ankle replacement and 151 to ankle fusion. At 52 weeks, the mean (standard deviation) Manchester-Oxford Foot Questionnaire walking/standing domain score was 31.4 (30.4) in the total ankle replacement arm (n = 136) and 36.8 (30.6) in the ankle fusion arm (n = 140); the adjusted difference in the change was -5.6 (95% confidence interval -12.5 to 1.4; p = 0.12) in the intention-to-treat analysis. By week 52, one patient in the total ankle replacement arm required revision. Rates of wound-healing issues (13.4% vs. 5.7%) and nerve injuries (4.2% vs. < 1%) were higher and the rate of thromboembolic events was lower (2.9% vs. 4.9%) in the total ankle replacement arm than in the ankle fusion arm. The bone non-union rate (based on plain radiographs) in the ankle fusion arm was 12.1%, but only 7.1% of patients had symptoms. A post hoc analysis of fixed-bearing total ankle replacement showed a statistically significant improvement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score (-11.1, 95% confidence interval -19.3 to -2.9; p = 0.008). We estimate a 69% likelihood that total ankle replacement is cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over the patient's lifetime. Limitations This initial report contains only 52-week data, which must therefore be interpreted with caution. In addition, the pragmatic nature of the study means that there was heterogeneity between surgical implants and techniques. The trial was run across 17 NHS centres to ensure that decision-making streams reflected the standard of care in the NHS as closely as possible. Conclusions Both total ankle replacement and ankle fusion improved patients' quality of life at 1 year, and both appear to be safe. When total ankle replacement was compared with ankle fusion overall, we were unable to show a statistically significant difference between the two arms in terms of our primary outcome measure. The total ankle replacement versus ankle arthrodesis (TARVA) trial is inconclusive in terms of superiority of total ankle replacement, as the 95% confidence interval for the adjusted treatment effect includes both a difference of zero and the minimal important difference of 12, but it can rule out the superiority of ankle fusion. A post hoc analysis comparing fixed-bearing total ankle replacement with ankle fusion showed a statistically significant improvement of total ankle replacement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score. Total ankle replacement appears to be cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over a patient's lifetime based on long-term economic modelling. Future work We recommend long-term follow-up of this important cohort, in particular radiological and clinical progress. We also recommend studies to explore the sensitivity of clinical scores to detect clinically important differences between arms when both have already achieved a significant improvement from baseline. Trial registration This trial is registered as ISRCTN60672307 and ClinicalTrials.gov NCT02128555. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Andrew J Goldberg
- Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery, University College London, London, UK
| | - Kashfia Chowdhury
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ekaterina Bordea
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Deirdre Brooking
- Department of Research & Innovation, Royal National Orthopaedic Hospital, London, UK
| | - Elizabeth L Deane
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Iva Hauptmannova
- Department of Research & Innovation, Royal National Orthopaedic Hospital, London, UK
| | - Paul Cooke
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Marion Cumbers
- Department of Research & Innovation, Royal National Orthopaedic Hospital, London, UK
| | - Simon S Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
| | - Caroline J Doré
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
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32
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Hinh CM, Chong ACM, Bierman BR, Uglem TP. Computed Tomography Derived Patient-specific Instrumentation Total Ankle Arthroplasty Survivorship Outcomes. J Foot Ankle Surg 2023; 62:338-346. [PMID: 36180364 DOI: 10.1053/j.jfas.2022.08.012] [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: 05/09/2022] [Revised: 08/19/2022] [Accepted: 08/27/2022] [Indexed: 02/03/2023]
Abstract
Computed tomography (CT) derived patient-specific total ankle arthroplasty (TAA) systems have been utilized for improved accuracy and reproducible implant alignment. The purpose of the present study was to report the overall implant survivorship as well as radiographic analysis of patients who underwent primary TAA utilizing CT-derived patient-specific instrumentation. A retrospective review of medical charts and radiographs were performed on patients who had undergone primary TAA at a single institution in the Midwest region from March 2013 to October 2020. Radiographic analysis included preoperative, initial postoperative, and final follow-up coronal and sagittal tibiotalar alignment as well as periprosthetic radiolucency. A total of 96 patients with a mean follow-up of 3 years (range, 0.3-7.3 years) were included. Implant survivorship was found to be 92% at median follow-up of 3 years. A total of 8 cases (8.3%) required revision/reoperation, with 6 (6.3%) of these reoperations directly related for failure of one of the metallic implant components. There was significant improvement in both coronal and sagittal tibiotalar alignment from preoperative to initial postoperative follow-up (p < .001). At latest postoperative follow-up, there were 88% of TAAs that remained in a neutral alignment following surgery. A total of 10 cases were found to have radiolucency at latest follow-up. In conclusion, the use of CT derived patient-specific TAA showed high implant survivorship with significant improvement of sagittal and coronal tibiotalar alignment. With better implant alignment and position, it potentially reduces the risk of early implant failure or implant loosening in long-term follow-up.
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Affiliation(s)
- Christopher M Hinh
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND
| | - Alexander C M Chong
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND; Department of Graduate Medical Education - Sanford Health, Fargo, ND.
| | - Bennen R Bierman
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND
| | - Timothy P Uglem
- Sanford Health Podiatric Medicine and Surgery Residency, Sanford Orthopedics and Sports Medicine, Fargo, ND
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Outcome measures in clinical studies of ankle osteoarthritis: a systematic review. Physiotherapy 2023; 118:54-63. [PMID: 36243563 DOI: 10.1016/j.physio.2022.08.008] [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: 09/07/2021] [Revised: 06/08/2022] [Accepted: 08/26/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To explore and describe the outcome measures reported in primary research of ankle osteoarthritis (OA) and to propose aligned health-related domains. METHODS Six databases were searched, and studies were screened by two independent reviewers. Studies of participants with ankle OA who were> 18 years of age and reported outcome measure data were included. Non-English, animal, cadaveric, reviews, and studies with< 5 participants were excluded. Outcome measures were examined for content and mapped to health-related domains. RESULTS 1386 studies were identified, of which 547 met selection criteria - reporting 250 outcome measures. Most commonly reported measures were the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (n = 257 studies), plain radiographs to measure ankle alignment (n = 211), numerical rating scale for pain severity (n = 177) and goniometry to measure ankle range of motion (n = 148). Outcome measures were organised into 19 domains. The most common domains were pain severity (315 (58%) studies), ankle alignment (254 (46%)), ankle motion (181 (33%)), disability (169 (31%)) and health-related quality of life (128 (23%)). These domains fell into the Outcome Measures in Rheumatology (OMERACT) core areas of life impact and pathophysiological manifestations. CONCLUSION Many outcome measures are used in ankle OA research, most of which assess joint alignment, pain, and motion. Based on the outcome measures identified, we proposed 19 possible health-related domains, predominantly in the OMERACT core areas of life impact and pathophysiological manifestations of ankle OA. Clinicians and researchers can use this review in guiding selection of outcome measures.
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Perisano C, Cannella A, Polichetti C, Mascio A, Comisi C, De Santis V, Caravelli S, Mosca M, Spedicato GA, Maccauro G, Greco T. Tibiotalar and Tibiotalocalcaneal Arthrodesis with Paragon28 Silverback TM Plating System in Patients with Severe Ankle and Hindfoot Deformity. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020344. [PMID: 36837544 PMCID: PMC9965899 DOI: 10.3390/medicina59020344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/31/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND OBJECTIVES The treatment of end-stage ankle osteoarthritis (OA) and associated hindfoot deformities remains a major challenge for orthopedic surgeons. Numerous techniques and surgical approaches have been proposed for tibiotalar (TT) and tibiotalocalcaneal (TTC) arthrodesis, from arthroscopic to open, as well as numerous devices proposed for internal fixation (retrograde intramedullary nails, cannulated screws, and plating systems). The aim of this study was to retrospectively analyze the results, with at least 18 months of follow-up, with SilverbackTM TT/TTC Plating System Paragon28 in a group of 20 patients with severe OA and hindfoot deformities (mainly secondary post-traumatic OA). MATERIALS AND METHODS The demographic characteristics and past medical history of the patients were collected and analyzed to identify the cause of the pathology. The degree of OA and deformity were quantified based on foot and ankle weight-bearing radiography and CT examination. Pre- and post-operative clinical and functional scores (ROM, VAS, AOFAS, FFI, and SF-36) and radiographic parameters (anterior distal tibial angle, tibiotalar angle, coronal tibiotalar angle, and hindfoot alignment angle) were evaluated. RESULTS All of the patients showed clinical and radiographic fusion at an average of 14 weeks (range 12-48), with improvement in pain and functional scores, without major surgical complications and/or infections. CONCLUSIONS Despite the limitations of our study, the results with this new plating system showed good results in terms of bone consolidation, post-operative complications, and improvement of pain and quality of life in patients with severe OA and deformities of the ankle and hindfoot.
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Affiliation(s)
- Carlo Perisano
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Adriano Cannella
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Polichetti
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Mascio
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Chiara Comisi
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Vincenzo De Santis
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Orthopedics and Trauma Surgery, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Silvio Caravelli
- U.O.C. II Clinic of Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Massimiliano Mosca
- U.O.C. II Clinic of Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | - Giulio Maccauro
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Tommaso Greco
- Department of Ageing, Neurosciences, Head-Neck and Orthopedics Sciences, Orthopedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-3807582118
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35
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Kloprogge SES, Katier NN, Mailuhu AKEA, van Vooren JJ, van Ochten JMJ, Bindels PJEP, Bierma-Zeinstra SMAS, van Middelkoop MM. Prevalence of radiographic ankle osteoarthritis in different subgroups of patients referred for ankle radiography. Semin Arthritis Rheum 2023; 58:152138. [PMID: 36455405 DOI: 10.1016/j.semarthrit.2022.152138] [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: 08/22/2022] [Revised: 10/05/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ankle osteoarthritis(OA) has detrimental effects on physical health and has a relatively early disease onset compared to OA in other joints. However, the prevalence of radiographic ankle OA in different subgroups of patients referred for ankle radiography remains unknown. Therefore, we aimed to determine the prevalence of radiographic talocrural, subtalar and talonavicular OA(Kellgren-Lawrence scale ≥2) in a population referred for ankle radiography. Moreover, we aimed to identify differences in prevalence between specific subgroups of patients i.e. Body Mass Index (BMI), sex, age and reason for referral. METHODS A cross-sectional study was conducted at a radiology department serving primary and secondary care. Patients completed a questionnaire before radiography. Features of radiographic ankle OA were assessed for subgroups of patients, including; BMI, sex, age and reason for referral (chronic vs (sub)acute complaints). To examine the difference in (features of) radiographic OA for subgroups, multinomial and logistic regression were used to calculate Odds Ratios (ORs), with adjustment for age, sex and BMI. RESULTS Data from 893 patients that visited the radiology department across 16 months in 2017 or 2018 were included for analysis. Prevalence of radiographic ankle OA was 9.2%, 0.4% and 7.0%, for the talocrural, subtalar and talonavicular joint, respectively. Obesity was associated with radiographic talonavicular OA (adjusted OR 2.16, 95%CI:1.09; 5.26). Radiographic talocrural and talonavicular OA were both positively associated with male sex [(adjusted OR 4.64, 95%CI:276; 7.81) and (adjusted OR 1.95, 95%CI:1.13; 3.35), respectively]. CONCLUSION Radiographic ankle OA was more common in men and obese patients that were referred to radiology.
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Affiliation(s)
- S E Sabine Kloprogge
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, the Netherlands.
| | - N Nienke Katier
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, the Netherlands
| | - A K E Adinda Mailuhu
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, the Netherlands
| | | | - J M John van Ochten
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, the Netherlands
| | - P J E Patrick Bindels
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, the Netherlands
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Goldberg AJ, Chowdhury K, Bordea E, Hauptmannova I, Blackstone J, Brooking D, Deane EL, Bendall S, Bing A, Blundell C, Dhar S, Molloy A, Milner S, Karski M, Hepple S, Siddique M, Loveday DT, Mishra V, Cooke P, Halliwell P, Townshend D, Skene SS, Doré CJ, Brown R, Butler M, Chadwick C, Clough T, Cullen N, Davies M, Davies H, Harries B, Khoo M, Makwana N, Murty A, Najefi A, O'Donnell P, Raglan M, Thomas R, Torres P, Welck M, Winson I, Zaidi R. Total Ankle Replacement Versus Arthrodesis for End-Stage Ankle Osteoarthritis: A Randomized Controlled Trial. Ann Intern Med 2022; 175:1648-1657. [PMID: 36375147 DOI: 10.7326/m22-2058] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND End-stage ankle osteoarthritis causes severe pain and disability. There are no randomized trials comparing the 2 main surgical treatments: total ankle replacement (TAR) and ankle fusion (AF). OBJECTIVE To determine which treatment is superior in terms of clinical scores and adverse events. DESIGN A multicenter, parallel-group, open-label randomized trial. (ISRCTN registry number: 60672307). SETTING 17 National Health Service trusts across the United Kingdom. PATIENTS Patients with end-stage ankle osteoarthritis, aged 50 to 85 years, and suitable for either procedure. INTERVENTION Patients were randomly assigned to TAR or AF surgical treatment. MEASUREMENTS The primary outcome was change in Manchester-Oxford Foot Questionnaire walking/standing (MOXFQ-W/S) domain scores between baseline and 52 weeks after surgery. No blinding was possible. RESULTS Between 6 March 2015 and 10 January 2019, a total of 303 patients were randomly assigned; mean age was 68 years, and 71% were men. Twenty-one patients withdrew before surgery, and 281 clinical scores were analyzed. At 52 weeks, the mean MOXFQ-W/S scores improved for both groups. The adjusted difference in the change in MOXFQ-W/S scores from baseline was -5.6 (95% CI, -12.5 to 1.4), showing that TAR improved more than AF, but the difference was not considered clinically or statistically significant. The number of adverse events was similar between groups (109 vs. 104), but there were more wound healing issues in the TAR group and more thromboembolic events and nonunion in the AF group. The symptomatic nonunion rate for AF was 7%. A post hoc analysis suggested superiority of fixed-bearing TAR over AF (-11.1 [CI, -19.3 to -2.9]). LIMITATION Only 52-week data; pragmatic design creates heterogeneity of implants and surgical techniques. CONCLUSION Both TAR and AF improve MOXFQ-W/S and had similar clinical scores and number of harms. Total ankle replacement had greater wound healing complications and nerve injuries, whereas AF had greater thromboembolism and nonunion, with a symptomatic nonunion rate of 7%. PRIMARY FUNDING SOURCE National Institute for Health and Care Research Heath Technology Assessment Programme.
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Affiliation(s)
- Andrew J Goldberg
- UCL Institute of Orthopaedics & Musculoskeletal Science, Division of Surgery, Royal Free Hospital, MSK Lab, Imperial College London, Sir Michael Uren Hub Imperial College London White City Campus, London, and Department of Research & Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, United Kingdom (A.J.G.)
| | - Kashfia Chowdhury
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom (K.C., E.B., J.B., E.L.D., C.J.D.)
| | - Ekaterina Bordea
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom (K.C., E.B., J.B., E.L.D., C.J.D.)
| | - Iva Hauptmannova
- Department of Research & Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, United Kingdom (I.H., D.B.)
| | - James Blackstone
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom (K.C., E.B., J.B., E.L.D., C.J.D.)
| | - Deirdre Brooking
- Department of Research & Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, United Kingdom (I.H., D.B.)
| | - Elizabeth L Deane
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom (K.C., E.B., J.B., E.L.D., C.J.D.)
| | - Stephen Bendall
- University Hospitals Sussex NHS Foundation Trust, Haywards Heath, United Kingdom (S.B.)
| | - Andrew Bing
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, United Kingdom (A.B.)
| | - Chris Blundell
- Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Sheffield, United Kingdom (C.B.)
| | - Sunil Dhar
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (S.D.)
| | - Andrew Molloy
- Liverpool University Hospitals NHS Foundation Trust, Fazakerley, Liverpool, United Kingdom (A.M.)
| | - Steve Milner
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, United Kingdom (S.M.)
| | - Mike Karski
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, Lancashire, United Kingdom (M.K.)
| | - Steve Hepple
- North Bristol NHS Trust, Bristol, United Kingdom (S.H.)
| | - Malik Siddique
- Newcastle Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, United Kingdom (M.S.)
| | - David T Loveday
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk and Norwich University Hospital, Norwich, United Kingdom (D.T.L.)
| | - Viren Mishra
- Hull University Teaching Hospitals NHS Trust, Hull Royal Infirmary, Hull, United Kingdom (V.M.)
| | - Paul Cooke
- Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Oxford, United Kingdom (P.C.)
| | - Paul Halliwell
- Royal Surrey NHS Foundation Trust, Guildford, Surrey, United Kingdom (P.H.)
| | - David Townshend
- Northumbria Healthcare NHS Foundation Trust, Tyne and Wear, North Shields, United Kingdom (D.T.)
| | - Simon S Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, Surrey, United Kingdom (S.S.S.)
| | - Caroline J Doré
- UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom (K.C., E.B., J.B., E.L.D., C.J.D.)
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Van Haecke A, Semay B, Fessy MH, Romain-Scelle N, Besse JL. 97 HINTEGRA ankle prostheses: Results and survival at more than 5 years' follow-up. Foot Ankle Surg 2022; 28:1241-1247. [PMID: 35637107 DOI: 10.1016/j.fas.2022.05.001] [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: 06/24/2021] [Revised: 04/27/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND In Europe, fixed-bearing implants predominate again in total ankle replacement (TAR). The present single-center single-surgeon study assesses the Hintegra® mobile-bearing implant (NEWDEAL). METHODS Between November 2008 and November 2015, 97 Hintegra® were implanted in 94 patients: mean age, 62.4±10.9 years (26-83); 59% (57/97) male; normal mean body-mass index (BMI), 27.5 ± 4.3 kg/m2. Indications mainly comprised posttraumatic (40.2%), instability (29.9%) and primary osteoarthritis (16.5%). 17.5% of patients had prior surgery during the previous 6 months (9 fusions, 8 ligament reconstructions, and 4 osteotomies); in 59.8%, other procedures were associated to TAR. Functional, clinical and radiological follow-up was conducted at 1 year, 2 years and last follow-up (>5 years). RESULTS Ninety-four TARs were analyzed at a mean 81 ± 21.6 months (19-124). Revision-free survival was 76% (95% confidence interval (95%CI): 0.66-0.8), and explantation-free survival 92% (95%CI: 0.85-1) with 10 cases of curettage and 5 explantations. Mean AOFAS score improved from 41.8 ± 12.5 (21-69) to 77.5 ± 16.5 (24-100) up (p < 0.001); 75% of patients had no or only mild pain (p < 0.001). Clinical ranges of motion were 8.0 ± 7.1° dorsiflexion (p < 0.001) and 35.1 ± 9.4° plantar flexion (preoperatively, 34.1 ± 7.9°) (p = 0.71). Radiologically, tibial components were well-positioned; 87% of talar components were well-centered. Global ankle range of motion was 23.5 ± 10.2° (5-48) (p = 0.17). 54.6% of TARs showed posterior tibial calcification at follow-up. Risk of severe cyst (>1 cm) on CT was 36% (95%CI: 23-47) at a mean 77 ± 21.9 months (18-123). CONCLUSION Hintegra® TAR incurred a low risk of revision, and is a reliable option for ankle osteoarthritis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Adrien Van Haecke
- Centre Hospitalier Universitaire de Lyon, Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Lyon-Sud, FR69495 Pierre-Bénite, Rhône-Alpes, France.
| | - Bertrand Semay
- Clinique Mutualiste Chirurgicale, 42000 Saint-Etienne, Rhône-Alpes, France
| | - Michel-Henri Fessy
- Centre Hospitalier Universitaire de Lyon, Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Lyon-Sud, FR69495 Pierre-Bénite, Rhône-Alpes, France; Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, Laboratoire de Biomécanique et Mécanique des chocs, 69975 Bron, Rhône-Alpes, France
| | - Nicolas Romain-Scelle
- Université Lyon 1, F-69100 Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, F-69003 Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, F-69100 Villeurbanne, France; Université de Lyon, F-69000 Lyon, France
| | - Jean-Luc Besse
- Centre Hospitalier Universitaire de Lyon, Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Lyon-Sud, FR69495 Pierre-Bénite, Rhône-Alpes, France; Université Lyon 1, IFSTTAR, LBMC UMR-T 9406, Laboratoire de Biomécanique et Mécanique des chocs, 69975 Bron, Rhône-Alpes, France
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Stadler C, Stöbich M, Ruhs B, Kaufmann C, Pisecky L, Stevoska S, Gotterbarm T, Klotz MC. Intermediate to long-term clinical outcomes and survival analysis of the Salto Mobile Bearing total ankle prothesis. Arch Orthop Trauma Surg 2022; 142:3697-3704. [PMID: 34086075 PMCID: PMC9596531 DOI: 10.1007/s00402-021-03946-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Osteoarthritis of the ankle is a major burden to affected patients. While tibio-talar arthrodesis has been the gold-standard regarding the treatment of osteoarthritis of the ankle joint for many years, at present total ankle arthroplasty (TAA) provides appealing clinical outcomes and is continually gaining popularity. The aim of this study was to evaluate the intermediate- to long-term clinical outcome including the survival rate of Salto Mobile Bearing TAA (Tonier SA, Saint Ismier, France). MATERIAL AND METHODS In this retrospective study intermediate- to long-term outcomes measures [Ankle Range of Motion (ROM), American Orthopaedic Foot and Ankle Score (AOFAS score) and survival rate] of 171 consecutive TAA were analysed and compared before and after surgery. Revision was defined as secondary surgery with prothesis component removal, while reoperation was defined as a non-revisional secondary surgery involving the ankle. RESULTS At a mean follow-up (FU) period of 7.2 ± 2.7 years (range 2.0 to 14.1 years) there was a significant improvement in ankle ROM (total ROM improved from 25.0° ± 15.0° to 28.7° ± 11.3°, p = 0.015; plantarflexion improved from 18.4° ± 11.7° to 20.6° ± 8.2°, p = 0.044; dorsiflexion improved from 6.6° ± 5.7° to 8.1° ± 4.9°, p = 0.011). AOFAS score increased significantly by 41 ± 15 points after surgery (43.3 ± 11.1 before and 84.3 ± 12.0 after surgery, p < 0.001). Overall survival rate within the FU was 81.3% (95% CI 75.3% to 87.3%) with any secondary surgery, 89.9% (95% CI 84.1% to 93.6%) with revision and 93.6% (95% CI 89.8% to 97.3%) with reoperation as endpoint. CONCLUSION This study endorses the previously reported appealing intermediate- to long-term outcomes of the Salto Mobile Bearing TAA. There was a significant increase in ROM and AOFAS score as well as decent implant survival at final FU.
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Affiliation(s)
- C Stadler
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria.
| | - M Stöbich
- Orthopaedics and Traumatology, Klinik Diakonissen, Weißenwolffstrasse 13, 4020, Linz, Austria
| | - B Ruhs
- Orthopaedics, Klinik Diakonissen, Weißenwolffstrasse 13, 4020, Linz, Austria
| | - C Kaufmann
- Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
| | - L Pisecky
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
| | - S Stevoska
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
| | - T Gotterbarm
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
| | - M C Klotz
- Department for Orthopaedics and Traumatology, Med Campus III, Kepler University Hospital GmbH, Johannes Kepler University Linz, Altenberger Strasse 96, 4040 Linz and Krankenhausstraße 9, 4020, Linz, Austria
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Casciato DJ, Thompson J, Rushing CJ, McKenna B, Hyer C. Consumer Interest in Total Ankle Replacements Over the Last 10 Years: A Google Trends™ Analysis From 2009 to 2019. J Foot Ankle Surg 2022; 62:492-497. [PMID: 36564307 DOI: 10.1053/j.jfas.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 05/11/2021] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
With an aging population, the incidence of osteoarthritis (OA) continues to grow. After exhausting conservative therapy for many forms of OA, patients regularly opt for surgical intervention in the form of total joint replacement surgery. One form, total ankle replacement, has continued to gain favorability in the medical community. Improved implant design and surgical technique have enabled success rates of total ankle replacements to approach those of the hip and knee. As a new and improving therapy to address end-stage ankle OA, knowledge of patient-interest has yet to be determined. We used search inquiry data for the keywords "ankle arthritis" "ankle replacement" and "ankle fusion" available from Google Trends™ to identify trends in patient and geographic interest from 2009 to 2019. Search inquiries significantly increased for all keywords over time (p < .001). Trend analysis over this 10-year period revealed a strong correlation for ankle arthritis (0.88) and ankle replacement (0.76). Moreover, the correlation between "ankle arthritis" and "ankle replacement" was strong (0.83) during this period. The geographic distribution of these search terms showed the greatest increase in interest for the keywords "ankle arthritis" "ankle replacement" and "ankle fusion" in Arizona, New York, and Virginia respectively. Results of this study illustrate a similar increasing patient interest in ankle arthritis and ankle replacements. This data can be used effectively identify, educate, and treat populations interested in ankle replacements. To the best of our knowledge, this is the first study to utilize Google Trends™ to analyze patient interest in foot and ankle surgery.
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Affiliation(s)
| | - John Thompson
- Resident, OhioHealth Grant Medical Center, Columbus, OH
| | | | - Bryon McKenna
- Fellow, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Christopher Hyer
- Fellowship Co-Director, Orthopedic Foot and Ankle Center, Worthington, OH
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40
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Deleu PA, Piron M, Leemrijse G, Besse JL, Chèze L, Devos Bevernage B, Lalevée M, Leemrijse T. Patients' point of view on the long-term results of total ankle arthroplasty, tibiotalar and tibiotalocalcaneal arthrodeses. Orthop Traumatol Surg Res 2022; 108:103369. [PMID: 35850423 DOI: 10.1016/j.otsr.2022.103369] [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] [Received: 11/26/2020] [Revised: 04/16/2021] [Accepted: 11/02/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Total ankle arthroplasty (TAA), tibiotalar (TT) arthrodesis and tibiotalocalcaneal (TTC) arthrodesis are common surgical procedures that are sometimes concurrent. The functional results of TTC are deemed to be inferior because of the double joint sacrifice. Patient-Reported Outcome Measures (PROMs), as well as satisfaction scores, are commonly used to assess the outcome of these surgeries, but lack at capturing patients' ability to cope with potential functional limitations. The objective of our study was to compare the results of TAA, TT and TTC arthrodeses according to patients' point of view. We proposed two hypotheses: 1) TAA confer better results than TT arthrodeses, 2) and TT arthrodeses confer better results than TTC arthrodeses, on this specific criterion. MATERIAL AND METHODS We carried out a retrospective study integrating all TAA, TT and TTC arthrodeses performed in our center from 2010 to 2017. These surgeries were compared using PROMs (Foot Function Index (FFI), Foot and Ankle Outcome Scale (FAOS) and 12-Item Short Form Survey (SF-12)), a satisfaction rating and self-reported perceived recovery state. RESULTS Fifty-one patients were included in the TAA group, 50 in the TT group and 51 in the TTC group. The mean duration of follow-up was 46±20.8 months. The TAA group had better results than the TT group regarding the FFI score and satisfaction, thus confirming our primary hypothesis. On the other hand, no significant difference was found between the TT group and the TTC group, which invalidated our secondary hypothesis. No significant difference between the groups was found regarding the distribution of patients' perceived recovery state. CONCLUSION Our hypothesis was not confirmed. In fact, TAAs, TT and TTC arthrodeses presented substantially similar results. Although it is difficult to compare surgeries with different indications, it is surprising to find that the patients' perceived recovery state, deviating from the usual clinical and radiological results, are relatively similar. LEVEL OF EVIDENCE IV; Retrospective study.
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Affiliation(s)
- Paul-André Deleu
- Univ Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T9406, 69622, Lyon, France; Foot & Ankle Institute, Bruxelles, Belgium.
| | - Maud Piron
- Centre Hospitalier Régional La Citadelle, Liège, Belgium
| | | | - Jean-Luc Besse
- Univ Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T9406, 69622, Lyon, France; Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, 69495 Pierre-Bénite, France
| | - Laurence Chèze
- Univ Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T9406, 69622, Lyon, France
| | | | - Matthieu Lalevée
- Centre Hospitalo-Universitaire de Rouen, Service de chirurgie Orthopédique et Traumatologique, 76000 Rouen, France
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Kim JS, Amendola A, Barg A, Baumhauer J, Brodsky JW, Cushman DM, Gonzalez TA, Janisse D, Jurynec MJ, Lawrence Marsh J, Sofka CM, Clanton TO, Anderson DD. Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society's Symposium on Targets for Osteoarthritis Research: Part 1: Epidemiology, Pathophysiology, and Current Imaging Approaches. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127011. [PMID: 36262469 PMCID: PMC9575439 DOI: 10.1177/24730114221127011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This first of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey the state of scientific knowledge related to incidence, diagnosis, pathologic mechanisms, and injection treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 3, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Part 1 overviews areas of epidemiology and pathophysiology, current approaches in imaging, diagnostic and therapeutic injections, and genetics. Opportunities for future research are discussed. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the needs of patients that suffer from arthritis of foot and ankle. The foot and ankle contain a myriad of interrelated joints and tissues that together provide a critical functionality. When this functionality is compromised by OA, significant disability results, yet the foot and ankle are generally understudied by the research community. Level of Evidence: Level V - Review Article/Expert Opinion.
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Affiliation(s)
- Jason S. Kim
- The Arthritis Foundation, Atlanta, GA,
USA,Jason S. Kim, PhD, The Arthritis
Foundation, 1355 Peachtree St NE, Suite 600, Atlanta, GA 30309, USA.
| | | | - Alexej Barg
- Department of Orthopaedics, University
of Utah, Salt Lake City, UT, USA
| | - Judith Baumhauer
- Department of Orthopaedic Surgery,
University of Rochester Medical Center, Rochester, NY, USA
| | | | - Daniel M. Cushman
- Division of Physical Medicine &
Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery,
University of South Carolina, Lexington, SC, USA
| | | | - Michael J. Jurynec
- Department of Orthopaedics and Human
Genetics, University of Utah, Salt Lake City, UT, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | | | - Donald D. Anderson
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
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42
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Kim JS, Amendola A, Barg A, Baumhauer J, Brodsky JW, Cushman DM, Gonzalez TA, Janisse D, Jurynec MJ, Lawrence Marsh J, Sofka CM, Clanton TO, Anderson DD. Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society's Symposium on Targets for Osteoarthritis Research: Part 2: Treatment Options. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127013. [PMID: 36262470 PMCID: PMC9575443 DOI: 10.1177/24730114221127013] [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: 11/23/2022] Open
Abstract
UNLABELLED This second of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey current treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 10, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Topics were chosen by meeting organizers, who then identified and invited the expert speakers. Part 2 overviews the current treatment options, including orthotics, non-joint destructive procedures, as well as arthroscopies and arthroplasties in ankles and feet. Opportunities for future research are also discussed, such as developments in surgical options for ankle and the first metatarsophalangeal joint. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the importance to patients of addressing the foot and ankle with improved basic, translational, and clinical research. LEVEL OF EVIDENCE Level V, review article/expert opinion.
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Affiliation(s)
- Jason S. Kim
- The Arthritis Foundation, Atlanta, GA,
USA,Jason S. Kim, PhD, The Arthritis
Foundation, 1355 Peachtree St NE, Suite 600, Atlanta, GA 30309, USA.
| | | | - Alexej Barg
- Department of Orthopaedics, University
of Utah, Salt Lake City, UT, USA
| | - Judith Baumhauer
- Department of Orthopaedic Surgery,
University of Rochester Medical Center, Rochester, NY, USA
| | | | - Daniel M. Cushman
- Division of Physical Medicine &
Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery,
University of South Carolina, Lexington, SC, USA
| | | | - Michael J. Jurynec
- Department of Orthopaedics and Human
Genetics, University of Utah, Salt Lake City, UT, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | | | - Donald D. Anderson
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
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Manz WJ, Nash AE, Novak J, Fink J, Kadakia R, Coleman MM, Bariteau JT. Non-emergent Conditions of the Ankle, Hindfoot, and Midfoot in Elderly Patients Are as Mobility Limiting as Congestive Heart Failure. Foot Ankle Spec 2022:19386400221127836. [PMID: 36210764 DOI: 10.1177/19386400221127836] [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: 11/16/2022]
Abstract
BACKGROUND Mobility limitations are well linked to increased morbidity and mortality. Older patients with chronic pathologies of the foot and ankle can suffer from significant mobility limitations; however, the magnitude of limitation experienced by this cohort is not well characterized. Conversely, the effects of congestive heart failure (CHF) on patient mobility are routinely assessed via the New York Heart Association (NYHA) classification. New York Heart Association classification is determined by a patient's physical activity limitation and is strongly correlated to functional status. We hypothesized that non-emergent conditions of the foot and ankle would be as mobility limiting as CHF. METHODS Life-Space Mobility Assessments (LSAs) were prospectively collected from orthopaedic patients at their preoperative visits and from CHF patients at a cardiology clinic. Patients over the age of 50 years were included in this study. Congestive heart failure patients NYHA class II or greater were included. The non-emergent foot and ankle cohort included Achilles tendonitis, ankle joint cartilage defects, ankle arthritis, subtalar arthritis, and midfoot arthritis. Patient demographics and LSA scores were analyzed using Mann-Whitney U and chi-squared tests. RESULTS A total of 96 elderly, non-emergent foot and ankle operative patients and 45 CHF patients met inclusion criteria. All medical comorbidities, except smoking status, were significantly more prevalent in the CHF cohort. No statistical difference was observed between CHF and preoperative foot and ankle LSA scores (56.1 vs 62.4, P = .320). Life-Space Mobility Assessment scores in the foot and ankle cohort were significantly improved relative to CHF patients, at 6-month and 1-year postoperative visits (P = .028, P < .0001, respectively). CONCLUSION Non-emergent ankle, hindfoot, and midfoot pathology is associated with similar mobility limitation to that of NYHA class II and III CHF. Older patients undergoing elective foot and ankle procedures exceeded the mobility of CHF patients at 6 months post-operation, and the mobility gains persisted at 1-year post-operation. LEVELS OF EVIDENCE Level II: Prospective cohort study.
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Affiliation(s)
- Wesley J Manz
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Amalie E Nash
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Jack Novak
- Emory University School of Medicine, Atlanta, Georgia
| | - Juliet Fink
- Emory University School of Medicine, Atlanta, Georgia
| | - Rishin Kadakia
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Michelle M Coleman
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
| | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
- Emory University School of Medicine, Atlanta, Georgia
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Deleu PA, Naaim A, Chèze L, Dumas R, Devos Bevernage B, Birch I, Besse JL, Leemrijse T. Decreased Mechanical Work Demand in the Chopart Joint After Total Ankle Replacement. Foot Ankle Int 2022; 43:1354-1363. [PMID: 35904211 DOI: 10.1177/10711007221112094] [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: 02/01/2023]
Abstract
BACKGROUND The success of total ankle replacement (TAR) must be based on restoring reasonable mechanical balance with anatomical structures that can produce mechanical joint work through elastic (eg, tendons, fascia) or viscoelastic (eg, heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution across the affected joint and the neighboring foot joints after TAR is lacking. Therefore, the objective of this study was to investigate if there is a change in the joint work distribution across the Ankle, Chopart, Lisfranc and Metatarsophalangeal joints during level walking before and after patients undergo TAR. METHODS Fifteen patients with end-stage ankle osteoarthritis scheduled for primary TAR for pain relief were recruited and peer-matched with a sample of 15 control subjects. All patients underwent a 3D gait analysis before and after surgery, during which a kinetic multisegment foot model was used to quantify intersegmental joint work. RESULTS The contribution of the Ankle joint (P = .007) to the total foot and ankle positive work increased significantly after TAR. In contrast, a significant decrease in the contribution to the total foot and ankle joint positive work (P < .001) were found at the Chopart joint after TAR. The foot joints combined produced a significant increase in a net mechanical work from +0.01 J/kg before surgery to +0.05 J/kg after TAR (P = .006). CONCLUSION The findings of this study corroborate the theoretical rationale that TAR reduces significantly the compensatory strategy in the Chopart joint in patients with end-stage ankle osteoarthritis after TAR. However, the findings also showed that the contribution of the ankle joint of patients after TAR to the total foot and ankle joint positive work remained impaired compared to the control group.
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Affiliation(s)
- Paul-André Deleu
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France.,Foot & Ankle Institute, Brussels, Belgium
| | - Alexandre Naaim
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France
| | - Laurence Chèze
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France
| | - Raphaël Dumas
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France
| | | | - Ivan Birch
- Sheffield Teaching Hospitals NHS Foundation Trust, Woodhouse Clinic, Sheffield, United Kingdom
| | - Jean-Luc Besse
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, LBMC UMR_T9406, Lyon, France.,Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service de Chirurgie Orthopédique et Traumatologique, France
| | - Thibaut Leemrijse
- Foot & Ankle Institute, Brussels, Belgium.,CHIREC Delta Hospital, Brussels, Belgium
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Alanazi SA, Vicenzino B, van Bergen CJA, Hunter DJ, Wikstrom EA, Menz HB, Golightly YM, Smith MD. Protocol for the development of a core domain set for individuals with ankle osteoarthritis. Trials 2022; 23:748. [PMID: 36064628 PMCID: PMC9446870 DOI: 10.1186/s13063-022-06692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ankle osteoarthritis (OA) is a debilitating health condition that is increasing in prevalence. Currently, there are no evidence-based guidelines for managing ankle OA. One of the current challenges to establishing guidelines is the lack of a widely agreed-upon set of outcome measures that are consistently used in ankle OA research. Without a set of agreed-upon outcome measures, it is difficult to synthesise clinical trial outcomes through meta-analysis—an essential element of evidence-informed practice. In order to develop an appropriate set of outcome measures for ankle OA, it is important first to develop a core domain set. In this protocol, we describe the methodological approach that we will use to develop such a core domain set for ankle OA. Methods We established an international steering committee to guide the development of a core domain set for ankle OA. The core domain set development will follow a multi-staged approach consisting of three phases, involving participation by patients and clinicians/healthcare professionals. In phase 1, a list of candidate domains will be gleaned from (a) a scoping review of outcome measures used in ankle OA research, (b) qualitative interviews with individuals with ankle OA, and (c) qualitative interviews with healthcare professionals with expertise in ankle OA. In phase 2, the steering committee will review and generate a list of candidate domains from those gleaned in phase 1. In phase 3, this list of candidate domains will be considered in a Delphi process to reach a consensus on a core domain set. We anticipated this will involve 3 rounds of surveys. Conclusion This protocol describes the methods that will be used to develop a core domain set of health-related aspects for ankle OA. Importantly, it will include both healthcare professional and patient involvement. This is a prerequisite step to developing a core outcome set for ankle OA that should be reported in all clinical trials for ankle OA. The findings will be widely disseminated across peer-refereed publication(s) and national and international conferences, as well as via relevant professional societies, patient support group organisations, and social media platforms. Project registration This project is registered with the Core Outcome Measures in Effectiveness Trials (COMET) database on 17 March 2021. https://www.comet-initiative.org/Studies/Details/1837. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06692-0.
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Affiliation(s)
- Sultan Ayyadah Alanazi
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia.,Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, 11952, Saudi Arabia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia
| | - Christiaan J A van Bergen
- Department of Orthopedic Surgery, Amphia, Breda, the Netherlands.,Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, Australia.,Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne M Golightly
- College of Allied Health Professionals, University of Nebraska Medical Center, Omaha, NE, USA.,Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences: Physiotherapy, Brisbane, Australia.
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Paracha N, Idrizi A, Gordon AM, Lam AW, Abdelgawad AA, Razi AE. Utilization Trends of Total Ankle Arthroplasty and Ankle Fusion for Tibiotalar Osteoarthritis: A Nationwide Analysis of the United States Population. Foot Ankle Spec 2022:19386400221110133. [PMID: 35848212 DOI: 10.1177/19386400221110133] [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: 11/17/2022]
Abstract
Introduction: Studies evaluating utilization and trends of total ankle arthroplasty (TAA) and ankle fusion (AF) are sparse. The purpose of this study was to use a nationwide administrative claims database to compare baseline demographics between TAA and ankle arthrodesis and to determine whether patients who had a TAA have increased rates of: (1) utilization, (2) in-hospital length of stay (LOS), and (3) costs of care. Methods: PearlDiver, a nationwide claims database was queried from 2005 to December 2013 for all patients who underwent primary TAA or AF for the treatment of osteoarthritis of the ankle and foot. Baseline demographics of age, sex, geographic distribution, and the prevalence of comorbidities comprising the Elixhauser comorbidity index (ECI) were compared between patients who had TAA and AF. Linear regression was used to compare differences in utilization and in-hospital LOS between the 2 cohorts during the study interval. Annual charges and reimbursement rates for TAA were assessed during the study period. A P value less than .05 was considered to be statistically significant. Results: A total of 21 433 patients undergoing primary TAA (n = 7126) and AF (n = 14 307) were included. Patients undergoing TAA had significantly greater ECI driven by arrythmias, congestive heart failure, diabetes mellitus, electrolyte/fluid disorders, iron deficiency anemia than patients undergoing AF (P < .001). From 2005 to 2013, TAA utilization increased from 21.5% to 49.4% of procedures (P < .0001). There was reduced in-hospital LOS over the time interval for patients with TAA compared with AF (2.15 days vs. 3.11 days, P < .0001). Total ankle arthroplasty reimbursements remained stable while charges per patient increased significantly from $40 203.48 in 2005 to doubling by the end of 2013 to $86 208.59 (P < .0001). Conclusion: This study demonstrated increased use of TAA compared to AF showing decreased in-hospital LOS and increased cost of care with stagnant reimbursement rates.Level of Evidence: Level III.
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Affiliation(s)
- Noorulain Paracha
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Adem Idrizi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Aaron W Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Amr A Abdelgawad
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York (NP, AI, AMG, AL, AAA, AER).,College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, New York (NP, AI)
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47
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Does Demineralized Bone Matrix Affect the Nonunion Rate in Arthroscopic Ankle Arthrodesis? J Clin Med 2022; 11:jcm11133893. [PMID: 35807177 PMCID: PMC9267684 DOI: 10.3390/jcm11133893] [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] [Received: 05/08/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Demineralized bone matrix (DBM) has been shown to have positive effects on union rates in many orthopedic subspecialties; however, minimal evidence exists about bone graft substitutes in foot and ankle surgery. The purpose of this study is to compare nonunion rates in arthroscopic ankle arthrodesis in patients receiving DBM with those without. We hypothesized DBM to be associated with a decreased risk of nonunion. This retrospective review includes 516 consecutive ankle arthrodesis cases from March 2002 to May 2016. Of these, 58 ankles (56 patients) that underwent primary arthroscopic ankle arthrodesis met the inclusion criteria, and 31 of these ankles received DBM, while 27 did not. Nonunion was assessed by clinical examination and routine postoperative radiographs. If nonunion was suspected, a computed tomography (CT) scan was performed. The primary outcome measure was nonunion rate. Secondary outcome measures included wound complications, return to operating room (OR), and rate of postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE). From the study cases, 58 were available for final follow-up. The average age was 55.9 years (±17.4), and mean follow-up was 43.0 months (range 6.3–119.4). There was no difference in nonunion rate in patients who received DBM (4/31, 12.9%) versus those who did not (4/27, 14.8%) (p = 0.83). Similarly, when comparing the two groups, there were no statistically significant differences in superficial wound complications (6.5% vs. 3.7%, p = 1.0) or rate of return to OR (29% or 0.037/person-years vs. 37% or 0.099/person-years; p = 0.20). No major complications including deep wound infections, DVTs, or PEs occurred. This is the largest study to directly compare nonunion rates and complications for patients receiving DBM versus those who did not in primary arthroscopic ankle arthrodesis. No significant association was found between DBM usage and risk of nonunion, wound complications, return to OR, or postoperative DVT or PE development.
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48
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Arnold JB, Bowen CJ, Chapman LS, Gates LS, Golightly YM, Halstead J, Hannan MT, Menz HB, Munteanu SE, Paterson KL, Roddy E, Siddle HJ, Thomas MJ. International Foot and Ankle Osteoarthritis Consortium review and research agenda for diagnosis, epidemiology, burden, outcome assessment and treatment. Osteoarthritis Cartilage 2022; 30:945-955. [PMID: 35176480 PMCID: PMC10464637 DOI: 10.1016/j.joca.2022.02.603] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarise the available evidence relating to the diagnosis, epidemiology, burden, outcome assessment and treatment of foot and ankle osteoarthritis (OA) and to develop an agenda to guide future research. METHOD Members of the International Foot and Ankle Osteoarthritis Consortium compiled a narrative summary of the literature which formed the basis of an interactive discussion at the Osteoarthritis Research Society International World Congress in 2021, during which a list of 24 research agenda items were generated. Following the meeting, delegates were asked to rank the research agenda items on a 0 to 100 visual analogue rating scale (0 = not at all important to 100 = extremely important). Items scoring a mean of 70 or above were selected for inclusion. RESULTS Of the 45 delegates who attended the meeting, 31 contributed to the agenda item scoring. Nineteen research agenda items met the required threshold: three related to diagnosis, four to epidemiology, four to burden, three to outcome assessment and five to treatment. CONCLUSIONS Key knowledge gaps related to foot and ankle OA were identified, and a comprehensive agenda to guide future research planning was developed. Implementation of this agenda will assist in improving the understanding and clinical management of this common and disabling, yet relatively overlooked condition.
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Affiliation(s)
- J B Arnold
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - C J Bowen
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, SO17 1BJ, UK
| | - L S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - L S Gates
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, SO17 1BJ, UK
| | - Y M Golightly
- Department of Epidemiology, Gillings School of Global Public Health, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA
| | - J Halstead
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK; Podiatry Services, Leeds Community Healthcare NHS Trust, Leeds, LS6 1PF, UK
| | - M T Hannan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, And Harvard Medical School, Boston, MA, 02108, USA
| | - H B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - S E Munteanu
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - K L Paterson
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - E Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK
| | - H J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - M J Thomas
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK
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49
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Tarricone A, Gee A, Chen S, De La Mata K, Muser J, Axman W, Krishnan P, Perake V. A Systematic Review and Meta-analysis of Total Ankle Arthroplasty or Ankle Arthrodesis for Treatment of Osteoarthritis in Patients With Diabetes. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221112955. [PMID: 35924005 PMCID: PMC9340373 DOI: 10.1177/24730114221112955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: End-stage ankle osteoarthritis often requires one of 2 major surgical procedures: total ankle arthroplasty or ankle arthrodesis. Although the gold standard has been arthrodesis, patients with diabetes represent a unique cohort that requires additional considerations because of their decreased mobility and risk factors for cardiovascular complications. The purpose of this study is to review odds of major and minor adverse events for patients with diabetes and patients without diabetes in both total ankle arthroplasty and ankle arthrodesis. Methods: A total of 14 articles published between 2010 and 2020 were included in this review. Databases included PubMed, Scopus, MEDLINE/Embase, and Cochrane Library. Key words included ankle arthroplasty, total ankle arthroplasty, ankle arthrodesis, and diabetes. Results: The total number of procedures was 26 287, comprising 13 830 arthroplasty and 12 457 arthrodesis procedures. There was a significant association between patients with diabetes treated with arthrodesis and major adverse events (odds ratio [OR] 1.880, 95% CI 1.279, 2.762), whereas no significant association was observed between patients with diabetes treated with arthroplasty and major adverse events (OR 1.106, 95% CI 0.871, 1.404). Conclusion: This meta-analysis suggests patients with diabetes to be at significantly higher risk for major and minor adverse events after undergoing ankle arthrodesis. However, it suggests no significant differences in major adverse events between patients with diabetes and patients without diabetes having undergone total ankle arthroplasty. Level of Evidence: Level III, systematic review and meta-analysis.
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Affiliation(s)
- Arthur Tarricone
- SUNY Downstate Medical Center University Hospital of Brooklyn, Brooklyn, NY, USA
| | - Allen Gee
- Nova Southeastern University, Dr Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Simon Chen
- Faculty Of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karla De La Mata
- Lenox Hill Hospital at Northwell Health New York, New York, NY, USA
| | - Justin Muser
- Our Lady of Lourdes Memorial Hospital, Binghamton, NY, USA
| | - Wayne Axman
- NYC Health, Hospitals/Queens Hospital Center, Jamaica, NY, USA
| | | | - Vinayak Perake
- NYC Health, Hospitals/Queens Hospital Center, Jamaica, NY, USA
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50
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Brodeur PG, Walsh DF, Modest JM, Salameh M, Licht AH, Hartnett DA, Gil J, Cruz AI, Hsu RY. Trends and Reported Complications in Ankle Arthroplasty and Ankle Arthrodesis in the State of New York, 2009-2018. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221117150. [PMID: 36046550 PMCID: PMC9421042 DOI: 10.1177/24730114221117150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Ankle arthroplasty has emerged as a viable alternative to ankle arthrodesis due in large part to recent advancements in both surgical technique and implant design. This study seeks to document trends of arthroplasty and arthrodesis for ankle osteoarthritis in New York State from 2009-2018 in order to determine if patient demographics play a role in procedure selection and to ascertain the utilization of each procedure and rates of complications. Methods: Patients 40 years and older from 2009-2018 were identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10), Clinical Modification (CM) diagnosis and procedure codes for ankle osteoarthritis, ankle arthrodesis, and ankle arthroplasty in the New York statewide planning and research cooperative system database. A trend analysis for both inpatient and outpatient procedures was performed to evaluate the changing trends in utilization of ankle arthrodesis and ankle arthroplasty over time. A multivariable logistic regression was used to assess the odds of receiving ankle arthrodesis relative to ankle arthroplasty. Complications were compared between inpatient ankle arthrodesis and arthroplasty using multivariable Cox proportional hazards regression. Results: A total of 3735 cases were included. Ankle arthrodesis increased by 25%, whereas arthroplasty increased by 757%. African American race, federal insurance, workers compensation, presence of comorbidities, and higher social deprivation were associated with increased odds of having an ankle arthrodesis vs an ankle arthroplasty. Compared with ankle arthroplasty, ankle arthrodesis was associated with increased rates of readmission, surgical site infection, acute renal failure, cellulitis, urinary tract infection, and deep vein thrombosis. Conclusion: Ankle arthroplasty volume has grown substantially without a decrease in ankle arthrodesis volume, suggesting that ankle arthroplasty may be selectively used for a different population of patients than ankle arthrodesis patients. Despite the increased growth of ankle arthroplasty, certain patient demographics including patients from minority populations, federal insurance, and from areas of high social deprivation have higher odds of receiving arthrodesis. Level of Evidence: Level III, retrospective cohort.
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Affiliation(s)
| | - Devin F. Walsh
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacob M. Modest
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Motasem Salameh
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Aron H. Licht
- Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Joseph Gil
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Aristides I. Cruz
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Raymond Y. Hsu
- Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI, USA
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