Clinical and Radiological Mid-to-Long-term Outcomes Following Ankle Arthrolysis

Clinical and Radiological Mid- to Long-term Results Following Triple Arthrodesis

BACKGROUND/AIM

Triple arthrodesis (TA) is a common procedure for stabilization of painful and unstable hind foot deformities. The aim of the study was to analyze postoperative changes in function and pain following isolated TA based on clinical outcomes, radiological findings, and pain scores. The study also considered economic aspects, such as the inability to work, before and after surgery.

PATIENTS AND METHODS

This was a single-center retrospective study, with a mean follow-up of 7.8 (range=2.9-12.6) years, of isolated triple fusions was performed. Short-Form 36 (SF-36), Foot Function Index (FFI), American Orthopedic Foot and Ankle Society Score (AOFAS) were analyzed. Clinical examination and standardized radiographs pre- and post-surgery were evaluated.

RESULTS

All 16 patients were very satisfied with the outcome after TA. In patients with secondary arthrosis of the ankle joint, AOFAS scores were significantly lower (p=0.012), whereas arthrosis in tarsal and tarsometatarsal joints did not affect the score. Body mass index (BMI) was associated with lower AOFAS, FFI-pain, FFI-function and increased hindfoot valgus. The non-union rate was approximately 11%.

CONCLUSION

TA leads to good clinical and radiological outcomes. None of the study participants reported a deterioration in their quality of life after TA. Two thirds of the patients reported significant limitations when walking on uneven ground. More than half of the feet developed secondary arthrosis of the tarsal joints and 44% of the ankle joint.

Mobile-Bearing Total Ankle Replacement In Vivo Kinematic Assessment: A Prospective Study Protocol

Total ankle prosthesis as a surgical solution in the case of end-stage osteoarthritis has seen a considerable increase in the last two decades. This study protocol arises from the need to understand the in vivo kinematics of mobile-bearing, flat tibial component total ankle replacement, evaluating the real range of motion and the reciprocal relationships between the components during normal motor tasks through the use of model-based radio-stereometric analysis (MB-RSA). In addition, pre- and post-operative evaluation of walking kinematics with inertial motion sensors, proprioception through a dedicated workstation, and clinical outcomes are discussed. We expect that based on our study protocol researchers will be able to improve future prosthetic designs and validate the setup of MB-RSA, as well as to understand "how an ankle prosthesis moves" once implanted in the patient.

[Surgical treatment of arthrofibrosis of the knee joint]

Die Arthrofibrose des Kniegelenks ist eine schwerwiegende Komplikation nach Trauma und Operation, da die Funktion des Gelenks häufig dauerhaft beeinträchtigt wird. Es werden nach wie vor frühzeitige Mobilisierungstechniken und die Anästhesie eingesetzt, ohne dass die zugrunde liegenden Prozesse ausreichend aufgeklärt wurden. Während die Frühphase der Arthrofibrose gut auf konservative Maßnahmen zur Schmerzreduktion und zur Wundheilungsregulation anspricht, ist in der Spätphase häufig straffes kollagenes Narbengewebe vorhanden, das die Beweglichkeit dauerhaft einschränkt. In dieser Phase ist eine Verbesserung der Beweglichkeit ohne chirurgische Maßnahmen in der Mehrzahl der Fälle aussichtslos. Bei einer chirurgischen Therapie sollte zwischen der lokalisierten (zumeist sekundären) Arthrofibrose (z. B. Kreuzbandoperation) und einer generalisierten Arthrofibrose (primär, in der Mehrzahl der Fälle nach einer Knietotalendoprothese [Knie-TEP]) unterschieden und die Behandlung entsprechend geplant werden. Begleitende pathologische Veränderungen (Transplantatposition, Instabilität der TEP, Implantatverschleiß, „Low-grade“-Infektion, patellofemorale Instabilität oder „maltracking“, Patella baja) müssen bei der Behandlung berücksichtigt werden. Eine multimodale Begleitbehandlung (Physiotherapie, Schmerztherapie, Psychosomatik) ist zur Sicherung des Behandlungserfolgs notwendig.