1
|
Ghasemi SA, Machi AS, Buksbaum J, Rozbruch SR, Fragomen AT. Ankle Distraction Arthroplasty: A Survivorship Review and Meta-Analysis. J Foot Ankle Surg 2023; 62:996-1004. [PMID: 37399902 DOI: 10.1053/j.jfas.2023.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023]
Abstract
Multiple treatments exist for ankle osteoarthritis. Ankle arthrodesis is the gold standard in late-stage osteoarthritis, but sacrifices range of motion and risks nonunion. Total ankle arthroplasty is typically reserved for low-demand patients as the long-term outcomes are poor. Ankle distraction arthroplasty is a joint sparing procedure which utilizes external fixator frame to unload the joint. This promotes chondral repair and improves function. This study aimed to organize clinical data and survivorship in published papers and direct further research efforts. Thirty-one publications were evaluated and 16 were included in the meta-analysis. The Modified Coleman Methodology Score was used to assess quality of the individual publications. Random effects models were used to estimate the failure risk after ankle distraction arthroplasty. Ankle Osteoarthritis Score (AOS), American Orthopedic Foot and Ankle Score (AOFAS), Van Valburg, and Visual Analog Scores (VAS) all improved postoperatively. Random effects model analysis revealed an overall failure ratio of 11% (95% CI: 7%-15%; p value ≤ .001; I2 = 87.01%) after 46.68 ± 7.17 months follow up, 9% (95% CI: 5%-12%; p value≤0.001 I2=81.59%) with less than 5 years follow-up and 28% (95% CI: 16%-41%; p value≤0.001 I2=69.03%) for patients with more than 5 years follow-up. Ankle Distraction Arthroplasty has promising short to intermediate term outcomes which makes this a reasonable treatment option to delay joint sacrificing surgery. The selection of the optimal candidates and consistent technique would improve research and subsequently outcomes. Based on our meta-analysis, negative prognostic factors include female sex, obesity, ROM < 20°, leg muscle weakness, high activity level, low preoperative pain levels, higher preoperative clinical scores, inflammatory arthritis, septic arthritis, and deformity.
Collapse
Affiliation(s)
- S Ali Ghasemi
- Albert Einstein Medical Center - Philadelphia, Philadelphia, PA.
| | - Anthony S Machi
- Albert Einstein Medical Center - Philadelphia, Philadelphia, PA
| | | | | | | |
Collapse
|
2
|
Darden C, Pujari A, Stocchi C, Forsh D. Distal Tibial Metaphyseal Malunion Treated with Clamshell Osteotomy: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00038. [PMID: 37556575 DOI: 10.2106/jbjs.cc.23.00072] [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: 08/11/2023]
Abstract
CASE Here, we describe a case of a 49-year-old female patient with a history of hypertension and polysubstance use disorder presenting with a distal tibial metaphyseal malunion treated with a clamshell osteotomy. Her follow-up was 2.5 years long. CONCLUSION Malunions in the tibial diaphysis and distal metaphysis can cause significantly increased joint reaction forces and altered gait mechanics leading to cosmetic dissatisfaction and decreased quality of life for these patients. Correction of these deformities can improve patient satisfaction and quality of life, along with decrease the risk of early arthritis. The clamshell osteotomy, although initially described to treat diaphyseal long bone malunions, can safely be performed for treatment of complex periarticular metaphyseal malunions.
Collapse
|
3
|
Motta DPD, Faria JLRD, Cruz CM, Aguiar DP, Amaral MVG, Kropf LL, Motta GATAD, Cerqueira FDS, Leonetti BD, Cerqueira FDS. Lateral Gradual Opening Osteotomy of the Tibia With Monolateral External Fixator for Correcting the Valgus Deformity of the Tibia. Arthrosc Tech 2022; 11:e2271-e2277. [PMID: 36632387 PMCID: PMC9827065 DOI: 10.1016/j.eats.2022.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/17/2022] [Indexed: 11/20/2022] Open
Abstract
The valgus deformity in the tibia requires correction because it places increased pressure on the lateral compartment of the knee, intensifying the degenerative process. Correction strategies are diverse and depend on patient profile, age, and soft-tissue conditions as well as the orthopaedic surgeon's experience with different surgical materials. Deformity size and location are the primary factors contributing to material and shape choice, whether gradual or acute. The only gradual correction approach involves the use of a monolateral or circular external fixator. This is the only indication for correction in cases of excellent deformity, soft-tissue involvement, and a history of bone infection. This study aimed to present a gradual correction technique for tibial valgus deformity using a monolateral external fixator as well as its postoperative follow-up. This technique has the advantages of greater patient acceptance, lighter assembly, and briefer distraction owing to the use of a single piece as well as the ability of the operated limb to bear a load the day after the surgical procedure and dynamic outpatient follow-up.
Collapse
Affiliation(s)
- Diego Perez da Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil,Address correspondence to Diego Perez da Motta, Instituto Nacional de Traumatologia e Ortopedia Jamil Haddad - Av. Brasil, 500, São Cristovão. CEP: 20940-070.
| | - José Leonardo Rocha de Faria
- Center for Specialized Care of Knee Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | | | | | - Marcus Vinicius Galvão Amaral
- Center for Specialized Care Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Leandro Lemgruber Kropf
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Guilherme Augusto Tapado Araújo da Motta
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Fernando dos Santos Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Bruno Domenico Leonetti
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | - Flavio dos Santos Cerqueira
- Center for Specialized Care of the Treatment Area of Dysmetry and Deformities of the Locomotor System, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| |
Collapse
|
4
|
Caravelli S, Puccetti G, Vocale E, Di Ponte M, Pungetti C, Baiardi A, Grassi A, Mosca M. Reconstructive Surgery and Joint-Sparing Surgery in Valgus and Varus Ankle Deformities: A Comprehensive Review. J Clin Med 2022; 11:jcm11185288. [PMID: 36142935 PMCID: PMC9504878 DOI: 10.3390/jcm11185288] [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: 06/24/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Osteoarthritis (OA) of the ankle affects about 1% of the world’s adult population, causing an important impact on patient lives and health systems. Most patients with ankle OA can show an asymmetrical wear pattern with a predominant degeneration of the medial or the lateral portion of the joint. To avoid more invasive ankle joint sacrificing procedures, joint realignment surgery has been developed to restore the anatomy of the joints with asymmetric early OA and to improve the joint biomechanics and symptoms of the patients. This narrative, comprehensive, all-embracing review of the literature has the aim to describe the current concepts of joint preserving and reconstructive surgery in the treatment of the valgus and varus ankle early OA, through an original iconography and clear indications and technical notes.
Collapse
Affiliation(s)
- Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence:
| | - Giulia Puccetti
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Emanuele Vocale
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Camilla Pungetti
- Department Orthopaedics and Traumatology, Ospedale Maggiore “Pizzardi”, 40133 Bologna, Italy
| | - Annalisa Baiardi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Grassi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| |
Collapse
|
5
|
Abstract
Ankle distraction arthroplasty (DA) is a joint-preserving option for the treatment of ankle osteoarthritis. The ideal patient is a young, active person who is compliant with follow-up and understands that clinical improvements may not be fully evident until 1 year after surgery. The procedure promotes cartilage healing and regeneration by removing mechanical stress at the joint surface through the application of a joint-spanning external fixator. There is an array of adjuvant procedures commonly performed to optimize healing potential-including microfracture, osteophyte removal, osteotomies, and soft tissue balancing procedures. Short- and intermediate-term studies have been promising, though there is a wide variance in reported failure and complication rates.
Collapse
Affiliation(s)
- Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, 622 West 168th Street, PH 11 - 1102, New York, NY 10032-3720, USA
| | - Ettore Vulcano
- Department of Orthopedic Surgery, Columbia University Orthopedics at Mount Sinai Medical Center, 4302 Alton Road, Suite 220, Miami Beach, FL 33140, USA.
| |
Collapse
|
6
|
Hintermann B, Ruiz R. Joint Preservation Strategies for Managing Varus Ankle Deformities. Foot Ankle Clin 2022; 27:37-56. [PMID: 35219368 DOI: 10.1016/j.fcl.2021.11.002] [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: 02/02/2023]
Abstract
Joint preserving strategies have evolved to a successful treatment option in early and midstage medial ankle OA caused by varus deformity. Though talar tilt can often not be fully corrected, it provides substantial postoperative pain relief, functional improvement, and slowing of the degenerative process. Osseous balancing with osteotomies is the main step for restoration of ankle mechanics and normalization of joint load. Overall, the key for success is to understand the underlying causes that have contributed to the varus OA in each case, and to use all treatment modalities necessary to restore appropriate alignment of the hindfoot complex.
Collapse
Affiliation(s)
- Beat Hintermann
- Center of Excellence for Foot and Ankle Surgery, Clinic of Orthopaedics and Traumatology, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland.
| | - Roxa Ruiz
- Center of Excellence for Foot and Ankle Surgery, Clinic of Orthopaedics and Traumatology, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
| |
Collapse
|
7
|
Fragomen AT. Ankle distraction arthroplasty (ADA): A brief review and technical pearls. J Clin Orthop Trauma 2021; 24:101708. [PMID: 34900579 PMCID: PMC8639464 DOI: 10.1016/j.jcot.2021.101708] [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: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022] Open
Abstract
Ankle distraction arthroplasty (ADA) is a procedure based on the concept that mechanical unloading of an arthritic joint will initiate a healing response in the subchondral bone and articular cartilage. ADA utilizes the patient's own healing response, preserves joint motion, and is a great option for patients with osteoarthritis who are not ready for prosthetic arthroplasty or fusion. The procedure is well described and technically simple and adjunctive biologic therapies are exciting for joint regeneration. Complications are minor, and more serious adverse events are avoidable. Supramalleolar osteotomy pairs well with ankle distraction but requires some analysis and planning.
Collapse
|
8
|
Li J, Li G, Dong M, Chen Y, Zuo S. Comparison of three different correction trajectories for foot and ankle deformity treated by supramalleolar osteotomy using a novel external fixator. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3400. [PMID: 32889768 DOI: 10.1002/cnm.3400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 07/12/2020] [Accepted: 08/25/2020] [Indexed: 06/11/2023]
Abstract
Based on the principle of distraction osteogenesis, external fixators are widely used in deformity correction of the foot and ankle. In this study, a novel ankle external fixator is proposed to correct complex multiplane deformities, especially for supramalleolar osteotomy to correct distal tibia deformities. The relatively simple structure and fewer struts in the proposed fixator reduce the complexity of adjusting the external fixator. Based on two existing adjustment strategies, a new strategy taking into account the orientation and shortest path of the ankle joint center is proposed, which is named joint adjustment for equal bone distraction. By proposing the inverse kinematic solutions of the novel external fixator, mathematical derivations of the bone trajectory and modelling of the bone shape for the three distraction strategies are performed. The results obtained by comparative analysis indicate that a uniformly spaced path of the ankle joint center can be acquired, and a smooth and uniform correction trajectory of the distal tibia end can be obtained using the new adjustment strategy. It can avoid bone end interference and only generates a maximum deviation 0.66% greater than the currently optimal 1 mm/day. The new strategy can perform multiplane corrections simultaneously, which shortens the correction time and reduces the patient's pain.
Collapse
Affiliation(s)
- Jianfeng Li
- College of Mechanical Engineering and Applied Electronics Technology, Beijing University of Technology, Beijing, China
| | - Guotong Li
- College of Mechanical Engineering and Applied Electronics Technology, Beijing University of Technology, Beijing, China
| | - Mingjie Dong
- College of Mechanical Engineering and Applied Electronics Technology, Beijing University of Technology, Beijing, China
| | - Ying Chen
- College of Mechanical Engineering and Applied Electronics Technology, Beijing University of Technology, Beijing, China
| | - Shiping Zuo
- College of Mechanical Engineering and Applied Electronics Technology, Beijing University of Technology, Beijing, China
| |
Collapse
|
9
|
Supramalleolar osteotomy with a hexapod type external fixator for the treatment of ankle joint three planar deformity: Case report. Jt Dis Relat Surg 2020; 31:372-376. [PMID: 32584739 PMCID: PMC7489153 DOI: 10.5606/ehc.2020.73893] [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: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 12/03/2022] Open
Abstract
The varus ankle deformity can lead to osteoarthritis; therefore, numerous supramalleolar tibia osteotomy techniques are described to correct this deformity. Many of these techniques are more suitable for uniplanar ankle deformity. Particularly, if there are multiplane ankle deformities, the use of the six-axis deformity correction system may be successful in solving the problems which may occur during the correction. In this article, we report two cases of three plane deformities of ankle joint due to trauma sequelae, which were treated with supramalleolar osteotomy using a hexapod fixator which is called the Smart Correction Frame®.
Collapse
|
10
|
Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis. BMC Musculoskelet Disord 2020; 21:31. [PMID: 31937287 PMCID: PMC6961281 DOI: 10.1186/s12891-020-3061-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background In highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief. However, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy is a type of joint preservation surgery that has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator for treating ankle osteoarthritis. Methods A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed, followed by angled osteotomy and correction of the distal tibia; the ankle joint was then stabilized after its condition improved. An external fixator was used in all patients, and joint distraction of approximately 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results The anteroposterior and lateral mortise angle during weight-bearing, talar tilt angle, and anterior translation of the talus on ankle stress radiography were improved significantly (P < 0.05). Signal changes on magnetic resonance imaging also improved in all patients. Visual analog scale and American Orthopedic Foot & Ankle Society scores improved significantly (P < 0.05), and no severe complications were observed. Conclusion DTO with joint distraction may be useful as a joint-preserving surgery for medial ankle osteoarthritis in older patients with high levels of physical activity. Level of evidence Level IV, retrospective case series.
Collapse
|
11
|
Configuration design and correction ability evaluation of a novel external fixator for foot and ankle deformity treated by U osteotomy. Med Biol Eng Comput 2020; 58:541-558. [DOI: 10.1007/s11517-019-02103-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
|
12
|
Abstract
BACKGROUND Supramalleolar deformities require surgical correction to avoid posttraumatic osteoarthrosis of the knee or ankle joint and to prevent definitive treatment options, such as total ankle arthroplasty or arthrodesis of the ankle joint. Various methods for the operative correction of supramalleolar deformities have been described in the literature. OBJECTIVE What results can be achieved with focal dome osteotomy to correct posttraumatic supramalleolar deformities? MATERIAL AND METHODS A total of 10 patients (mean age 37 years) with a supramalleolar posttraumatic deformity were treated by focal dome osteotomy. The mean follow-up was 27 months (min. 6, max. 105 months), 5 patients were female and 5 male. The supramalleolar varus/valgus deformity was on average 20° (at least 12°, maximum 33°). Preoperative and postoperative mechanical axis and joint angles were determined on digital radiographs. The American Orthopedic Foot and Ankle Society (AOFAS) score was used to assess the clinical outcome. RESULTS In seven patients the anatomical leg axis could be restored. In three patients a residual deformity of 2.8° was observed. Bone grafting was not necessary in any of the cases. Of the patients eight had free ankle mobility and two showed an average movement limit of 30° compared to the contralateral side. Posttraumatic ankle arthrosis was not observed in the short-term and medium-term results. The mean AOFAS score of 80 points (minimum 70, maximum 98) documented a functionally good result. CONCLUSION Supramalleolar dome type osteotomy is a technically difficult method for acute correction of supramalleolar deformities. The functional results and complication rates are comparable to those in the literature for alternative osteotomy techniques.
Collapse
|
13
|
Abstract
Patients with varus ankle deformity and concomitant osteoarthritis experience severe disabling pain that affects their daily activity of living. Most cases rarely respond to nonoperative treatment. One surgical option is corrective ankle arthrodesis. Unfortunately, this corrective surgery is challenging and might not be possible as a purely isolated procedure. Corrective ankle arthrodesis for varus ankle is performed with different surgical approaches and techniques, using different methods of fixations. The goal of surgery is to create a pain-free, stable, and plantigrade ankle, hindfoot, and foot. Both the foot and ankle must be correctly aligned in the optimal position for proper locomotion.
Collapse
Affiliation(s)
- Faisal AlSayel
- Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, 4010 Basel, Switzerland
| | - Victor Valderrabano
- Swiss Ortho Center, University of Basel, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, 4010 Basel, Switzerland.
| |
Collapse
|
14
|
Kim YS, Kim YB, Koh YG. Prognostic Factors Affecting Correction Angle Changes After Supramalleolar Osteotomy Using an Opening Wedge Plate for Varus Ankle Osteoarthritis. J Foot Ankle Surg 2019; 58:417-422. [PMID: 30745268 DOI: 10.1053/j.jfas.2018.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Indexed: 02/03/2023]
Abstract
Supramalleolar osteotomy (SMO) has been suggested as an effective salvage treatment for varus ankle osteoarthritis. To identify the prognostic factors affecting the correction angle changes after SMO, a total of 53 consecutive patients (58 ankles) were evaluated retrospectively. Clinical and radiologic outcomes were evaluated, and statistical analyses were performed to identify the prognostic factors associated with the clinical and radiologic outcomes. The mean visual analogue scale scores and the American Orthopaedic Foot and Ankle Society scores improved significantly at the final follow-up (both p <.001). The mean tibial-ankle surface (TAS), talar tilt (TT), and tibial-lateral surface angles improved significantly after surgery, compared with the preoperative assessments (all, p <.001). However, at the final follow-up, these angles had changed significantly, compared with their immediate postoperative values (all p <.001), and the changes in the TAS and TT angles significantly influenced the clinical outcomes at the final follow-up (both p <.05). Male sex, high body mass index (≥26.4 kg/m2), and the existence of the lateral cortex breakages were significantly associated with the changes in the TAS and TT angle (all p <.05). Therefore, surgeons should consider these prognostic factors before performing SMO.
Collapse
Affiliation(s)
- Yong Sang Kim
- Surgeon, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea.
| | - Yong Beom Kim
- Professor, Department of Orthopaedic Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Yong Gon Koh
- Surgeon, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Korea
| |
Collapse
|
15
|
Antonios T, Barker A, Ibrahim I, Scarsbrook C, Smitham PJ, Goodier WD, Calder PR. A Systematic Review of Patient-reported Outcome Measures Used in Circular Frame Fixation. Strategies Trauma Limb Reconstr 2019; 14:34-44. [PMID: 32559266 PMCID: PMC7001598 DOI: 10.5005/jp-journals-10080-1413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Clinical studies in orthopedics are using patient-reported outcome measures (PROMs) increasingly. PROMs are often being designed for a specific disease or an area of the body with the aim of being patient centered. As yet, none exists specifically for treatment with circular ring external fixation devices. AIM The purpose of this study is to provide a comprehensive systematic review of the published literature related to the use of PROMs in patients that underwent treatment with circular frames (Ilizarov or Hexapod Type Fixators). METHODS An online literature search was conducted for English language articles using the Scopus. RESULTS There were 534 published articles identified. After initial filtering for relevance and duplication, this figure reduced to 17, with no further articles identified through searching the bibliographies. Exclusion criteria removed two articles resulting in 15 articles included in the final review. Out of the 15 studies identified, a total of 10 different scoring measures where used. The majority of studies used a combination of joint/limb-specific and generic health PROMs with an average of 2.5 per study. No paper specifically discussed all eight PROMs criteria when justifying which PROMs they used. CONCLUSION Our findings indicate that none of the PROMs analyzed in this systematic review are truly representative of the health outcomes specific to this patient group and, therefore, propose that a PROM specific to this patient group needs to be developed. HOW TO CITE THIS ARTICLE Antonios T, Barker A, Ibrahim I, et al. A Systematic Review of Patient-reported Outcome Measures Used in Circular Frame Fixation. Strategies Trauma Limb Reconstr 2019;14(1):34-44.
Collapse
Affiliation(s)
- Tony Antonios
- Department of Trauma and Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
| | - Amy Barker
- Institute of Orthopaedics and Musculoskeletal Sciences, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Inji Ibrahim
- Institute of Orthopaedics and Musculoskeletal Sciences, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Christine Scarsbrook
- Institute of Orthopaedics and Musculoskeletal Sciences, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Peter J Smitham
- Institute of Orthopaedics and Musculoskeletal Sciences, University College London; Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK; Department of Trauma and Orthopaedics, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia
| | - W David Goodier
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - Peter R Calder
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| |
Collapse
|
16
|
Gruskay JA, Fragomen AT, Rozbruch SR. Idiopathic Rotational Abnormalities of the Lower Extremities in Children and Adults. JBJS Rev 2019; 7:e3. [PMID: 30624306 DOI: 10.2106/jbjs.rvw.18.00016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
17
|
Ewalefo SO, Dombrowski M, Hirase T, Rocha JL, Weaver M, Kline A, Carney D, Hogan MV. Management of Posttraumatic Ankle Arthritis: Literature Review. Curr Rev Musculoskelet Med 2018; 11:546-557. [PMID: 30327933 PMCID: PMC6220012 DOI: 10.1007/s12178-018-9525-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Trauma is the principle cause of osteoarthritis in the ankle, which is associated with significant morbidity. This review highlights the current literature for the purpose of bringing the reader up-to-date on the management of posttraumatic ankle arthritis, describing treatment efficacy, indications, contraindications, and complications. RECENT FINDINGS Recent studies on osteoarthritis have demonstrated variability among anatomic locations regarding the mechanisms and rates of development for posttraumatic osteoarthritis, which are attributed to newly discovered biological differences intrinsic to each joint. Regarding surgical management of posttraumatic ankle arthritis, osteochondral allograft transplantation of the talus, and supramalleolar osteotomies have demonstrated promising results. Additionally, the outpatient setting was found to be appropriate for managing pain following total ankle arthroplasty, associated with low complication rates and no readmission. Management for posttraumatic ankle arthritis is generally progressive. Initial treatment entails nonpharmacologic options with surgery reserved for posttraumatic ankle arthritis refractory to conservative treatment. Patient demographics and lifestyles should be carefully considered when formulating a management strategy, as outcomes are dependent upon the satisfaction of each set of respective criteria. Ultimately, the management of posttraumatic ankle arthritis should be individualized to satisfy the needs and desires, which are specific to each patient.
Collapse
Affiliation(s)
- Samuel O Ewalefo
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
| | - Malcolm Dombrowski
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Takashi Hirase
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Jorge L Rocha
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mitchell Weaver
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex Kline
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dwayne Carney
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
18
|
Abstract
Ankle distraction is an alternative to ankle arthrodesis or total ankle arthroplasty in younger patients with arthritis. Ankle distraction involves the use of external fixation to mechanically unload the ankle joint, which allows for stable, congruent range of motion in the setting of decreased mechanical loading, potentially promoting cartilage repair. Adjunct surgical procedures are frequently done to address lower-extremity malalignment, ankle equinus contractures, and impinging tibiotalar osteophytes. Patients can bear full weight during the treatment course. The distraction frame frequently uses a hinge, and patients are encouraged to do daily range-of-motion exercises. Although the initial goal of the procedure is to delay arthrodesis, many patients achieve lasting clinical benefits, obviating the need for total ankle arthroplasty or fusion. Complications associated with external fixation are common, and patients should be counseled that clinical improvements occur slowly and often are not achieved until at least 1 year after frame removal.
Collapse
|
19
|
Choi GW, Lee SH, Nha KW, Lee SJ, Kim WH, Uhm CS. Effect of Combined Fibular Osteotomy on the Pressure of the Tibiotalar and Talofibular Joints in Supramalleolar Osteotomy of the Ankle: A Cadaveric Study. J Foot Ankle Surg 2017; 56:59-64. [PMID: 27989347 DOI: 10.1053/j.jfas.2016.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Indexed: 02/03/2023]
Abstract
We investigated the effect of combined fibular osteotomy on the pressure of the tibiotalar and talofibular joints in medial opening-wedge supramalleolar osteotomy. Three different tibial osteotomy gaps (6, 8, and 10 mm) were created in 10 cadaveric models, and the pressure in the tibiotalar and talofibular joints was measured under axial load before and after fibular osteotomy. The heel alignment angle and talar translation ratio were evaluated radiographically. An increase in osteotomy gap led to increases in hindfoot valgus (p = .001) and the contact and peak pressures in the talofibular joint (p = .03 and p = .004). In contrast, the contact and peak pressures in the tibiotalar joint were unchanged with an increasing osteotomy gap (p = .52 and p = .76). Fibular osteotomy reduced the contact and peak pressures in the talofibular joint (p < .001 and p = .001, respectively), and it did not influence the contact and peak pressures in the tibiotalar joint (p = .46 and p = .14, respectively). Therefore, fibular osteotomy might be necessary in supramalleolar osteotomy for medial ankle arthritis to minimize the increase in pressure in the talofibular joint, especially when the osteotomy gap is large.
Collapse
Affiliation(s)
- Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, South Korea
| | - Soon Hyuck Lee
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, South Korea.
| | - Kyung Wook Nha
- Department of Orthopedic Surgery, Inje University Ilsanpaik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sung Jae Lee
- Department of Biomedical Engineering, Inje University, Gimhae-si, Gyeongsangnam-do, South Korea
| | - Won Hyeon Kim
- Department of Biomedical Engineering, Inje University, Gimhae-si, Gyeongsangnam-do, South Korea
| | - Chang-Sub Uhm
- Department of Anatomy, College of Medicine, Korea University, Seoul, South Korea
| |
Collapse
|
20
|
Küçükdurmaz F, Sağlam N, Kurtulmuş T, Akpınar F. A novel intramedullary nail for use in the treatment of supramalleolar malunion and nonunion: A preliminary report of three cases. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2016; 50:578-583. [PMID: 27842936 PMCID: PMC6197296 DOI: 10.1016/j.aott.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/14/2014] [Accepted: 11/15/2014] [Indexed: 11/17/2022]
Abstract
Introduction The fractures around the supramalleolar region are difficult to manage and deformities may occur following insufficient or inadequate treatment attempts. The treatment of those deformities is even more challenging. The available options for surgical fixation have inherent problems considering the soft tissue problems, infection and compliance of the patients. In this study, we report the preliminary outcome of new IMN system in use of supramalleolar deformities. Patients and Methods Three patients with supramalleolar deformities were recruited for this study. Two patients had periarticular distal tibia malunions and one patient had nonunion in same region. All patients were operated with using newly designed intramedullary nail system with a unique distal interlocking bolt screw. The outcome for each patient was followed-up and evaluated with using AOFAS score. Results The patients were followed up for 3 years, 3 months, and 6 months, respectively. The AOFAS scores were 36, 33, and 21 preoperatively; and 75, 68, and 75 postoperatively in Patients 1, 2 and 3, respectively. Conclusion In our patient series, adequate fixation following correction of the deformity was seen. Although the number of the cases are limited this study provides encouraging results regarding the outcome of new IMN system in use of supramalleolar deformities.
Collapse
|
21
|
Abstract
Supramalleolar osteotomy is a joint-preserving surgical treatment for patients with asymmetric valgus or varus ankle arthritis. The primary goal of the procedure is to realign the spatial relationship between the talus and tibia and thereby normalize joint loading within the ankle. Procedures to balance the soft tissues, as well as hindfoot osteotomy and arthrodesis, may also be necessary. Clinical studies of supramalleolar osteotomy demonstrate that correction of the altered biomechanics associated with asymmetric arthritis improves functional outcomes.
Collapse
|
22
|
Kobayashi H, Kageyama Y, Shido Y. Treatment of Varus Ankle Osteoarthritis and Instability With a Novel Mortise-Plasty Osteotomy Procedure. J Foot Ankle Surg 2015; 55:60-7. [PMID: 26190784 DOI: 10.1053/j.jfas.2015.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 02/03/2023]
Abstract
Although joint-preserving surgery for intermediate ankle osteoarthritis has been reported to be effective, failures of supramalleolar osteotomy and plafond-plasty can occur because of persistent malalignment of the distal tibia and incongruent ankle mortise. We introduce a novel opening wedge distal tibial osteotomy procedure (mortise-plasty) with rigid plate fixation combined with synthetic bone wedges. We performed 27 mortise-plasties in 25 patients with varus ankle osteoarthritis and instability. Six males (24%) and 19 females (76%), with a mean age of 63 (range 28 to 79) years, were followed up for a mean of 27.3 (range 14 to 45) months. The mean preoperative visual analog scale score, American Orthopaedic Foot and Ankle Society score, and Takakura ankle scale score were 7.4 (range 5.4 to 10), 58.7 (range 18 to 84), and 55.9 (range 29 to 88), respectively. These scores improved significantly to 2.1 (range 0 to 6.5), 89.3 (range 67 to 100), and 84.7 (range 55 to 100) postoperatively (p < .001). The mean preoperative tibial-anterior surface angle and talar tilt angle were 84.9° (range 78° to 90°) and 8.3° (range 3° to 21°), respectively. At the most recent follow-up visit, the corresponding values were 95.0° (range 82° to 99°) and 1.8° (range 0° to 8°), respectively (p < .001). Computed tomography scans indicated that the ankle mortise narrowed by approximately 1.8 mm and the tibial plafond was lowered after osteotomy. No patients underwent lateral ligament reconstruction, ankle joint replacement, or arthrodesis. Mortise-plasty osteotomy corrects the intra-articular and extra-articular deformities simultaneously and provides good clinical and radiographic outcomes for patients with varus ankle osteoarthritis and instability.
Collapse
Affiliation(s)
- Hayato Kobayashi
- Department of Orthopaedic Surgery, Fujieda Heisei Memorial Hospital, Shizuoka, Japan.
| | - Yasunori Kageyama
- Department of Orthopaedic Surgery, Hamamatsu Minami Hospital, Shizuoka, Japan
| | - Yoji Shido
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| |
Collapse
|
23
|
Mulhern JL, Protzman NM, Brigido SA, Deol PPS. Supramalleolar Osteotomy: Indications and Surgical Techniques. Clin Podiatr Med Surg 2015; 32:445-61. [PMID: 26117578 DOI: 10.1016/j.cpm.2015.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Supramalleolar osteotomies are a surgical treatment option for asymmetric varus or valgus ankle arthritis where at least 50% of the joint surface is spared. Procedure selection requires significant preoperative planning for appropriate execution. Thus, the surgeon must be familiar with the principles of deformity correction. With appropriate patient selection and proper preoperative planning, the procedure has been shown to yield excellent results, redistributing forces more evenly across the ankle joint by restoring the mechanical axis of the lower leg with minimal complications.
Collapse
Affiliation(s)
- Jennifer L Mulhern
- Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA
| | - Nicole M Protzman
- Clinical Education and Research Department, Coordinated Health, 3435 Winchester Road, Allentown, PA 18104, USA
| | - Stephen A Brigido
- Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA.
| | - Premjit Pete S Deol
- Orthopaedics Department, Panorama Orthopedics & Spine Center, 660 Golden Ridge Road, Suite 250, Golden, CO 80401, USA
| |
Collapse
|
24
|
Galli MM, Scott RT. Supramalleolar Osteotomies: An Algorithm for the Deformed Ankle. Clin Podiatr Med Surg 2015; 32:435-44. [PMID: 26117577 DOI: 10.1016/j.cpm.2015.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supramalleolar osteotomies are powerful osteotomies that realign the tibiotalar and optimize hindfoot position in the presence of varus, valgus, procurvatum, recurvatum, as well as internal and external rotation of the tibia. Although used in the pediatric and hemophilic population earlier, supramalleolar osteotomy is a relatively new reconstructive surgical technique that was introduced in 1995. Conducted primarily in cancellous bone, supramalleolar osteotomies offer rapid, reliable bony consolidation compared with dome osteotomies and complex arthrodesis.
Collapse
Affiliation(s)
- Melissa M Galli
- Department of Orthopedics, The CORE Institute, 18444 North 25th Avenue, Suite 210, Phoenix, AZ 85023-1264, USA
| | - Ryan T Scott
- Department of Orthopedics, The CORE Institute, 18444 North 25th Avenue, Suite 320, Phoenix, AZ 85023, USA.
| |
Collapse
|
25
|
Abstract
A variety of surgical procedures are utilized for management of ankle osteoarthritis. The most common etiology in patients with ankle osteoarthritis is post-traumatic often resulting in asymmetric ankle osteoarthritis with concomitant valgus or varus deformity. A substantial part of tibiotalar joint is often preserved, therefore, in appropriate patients, joint-preserving surgery holds the potential to be a superior treatment option than joint-sacrificing procedures including total ankle replacement or ankle arthrodesis. This review is designed to describe indications and contraindications for single-stage supramalleolar realignment surgery. Complications associated with this type of surgery and postoperative outcome are highlighted using recent literature.
Collapse
Affiliation(s)
- Alexej Barg
- Head Foot and Ankle Surgery, Department of Orthopedic Surgery, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland,
| | | |
Collapse
|
26
|
Faschingbauer M, Heuer HJD, Seide K, Wendlandt R, Münch M, Jürgens C, Kirchner R. Accuracy of a hexapod parallel robot kinematics based external fixator. Int J Med Robot 2014; 11:424-35. [DOI: 10.1002/rcs.1620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 08/19/2014] [Accepted: 08/27/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Maximilian Faschingbauer
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Department for Trauma Surgery, Orthopaedics and Sportstraumatology; Hamburg Germany
| | - Hinrich J. D. Heuer
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Department for Trauma Surgery, Orthopaedics and Sportstraumatology; Hamburg Germany
| | - Klaus Seide
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Department for Trauma Surgery, Orthopaedics and Sportstraumatology; Hamburg Germany
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Laboratory for Biomechanics; Hamburg Germany
| | - Robert Wendlandt
- University Medical Center Schleswig-Holstein, Campus Luebeck; Biomechanics Laboratory; Luebeck Germany
| | - Matthias Münch
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Laboratory for Biomechanics; Hamburg Germany
| | - Christian Jürgens
- Berufsgenossenschaftliches Unfallkrankenhaus (Trauma Hospital) Hamburg; Department for Trauma Surgery, Orthopaedics and Sportstraumatology; Hamburg Germany
- University Medical Center Schleswig-Holstein, Campus Luebeck; Clinic for Musculoskeletal Surgery; Luebeck Germany
| | - Rainer Kirchner
- University Medical Center Schleswig-Holstein, Campus Luebeck; Clinic for Musculoskeletal Surgery; Luebeck Germany
| |
Collapse
|
27
|
Barg A, Pagenstert GI, Horisberger M, Paul J, Gloyer M, Henninger HB, Valderrabano V. Supramalleolar osteotomies for degenerative joint disease of the ankle joint: indication, technique and results. INTERNATIONAL ORTHOPAEDICS 2014; 37:1683-95. [PMID: 23959222 DOI: 10.1007/s00264-013-2030-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 01/24/2023]
Abstract
Patients with varus or valgus hindfoot deformities usually present with asymmetric ankle osteoarthritis. In-vitro biomechanical studies have shown that varus or valgus hindfoot deformity may lead to altered load distribution in the tibiotalar joint which may result in medial (varus) or lateral (valgus) tibiotalar joint degeneration in the short or medium term. The treatment of asymmetric ankle osteoarthritis remains challenging, because more than half of the tibiotalar joint surface is usually preserved. Therefore, joint-sacrificing procedures like total ankle replacement or ankle arthrodesis may not be the most appropriate treatment options. The shortand midterm results following realignment surgery, are very promising with substantial pain relief and functional improvement observed post-operatively. In this review article we describe the indications, surgical techniques, and results from of realignment surgery of the ankle joint in the current literature.
Collapse
Affiliation(s)
- Alexej Barg
- Orthopaedic Department, University Hospital of Basel, University of Basel, Switzerland
| | | | | | | | | | | | | |
Collapse
|
28
|
Valderrabano V, Paul J, Monika H, Pagenstert GI, Henninger HB, Barg A. Joint-preserving surgery of valgus ankle osteoarthritis. Foot Ankle Clin 2013; 18:481-502. [PMID: 24008214 DOI: 10.1016/j.fcl.2013.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with posttraumatic ankle osteoarthritis (OA) typically present with asymmetric involvement of the tibiotalar joint, resulting in valgus or varus deformity of the ankle and hindfoot. Without appropriate treatment, patients with asymmetric ankle OA typically develop full end-stage ankle OA. Ankles with valgus deformities suffer from a lateral joint overload with subsequent lateral tibiotalar joint degeneration, which causes further lateral load shift. In these cases patients may benefit from joint-preserving realignment surgery to unload the degenerated lateral area and normalize joint biomechanics. This article describes the authors' algorithm for the treatment of patients with asymmetric valgus ankle OA.
Collapse
Affiliation(s)
- Victor Valderrabano
- Orthopaedic Department, Osteoarthritis Research Center Basel, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel 4031, Switzerland.
| | | | | | | | | | | |
Collapse
|
29
|
Sabharwal S, Fragomen A, Iobst C. What's new in limb lengthening and deformity correction. J Bone Joint Surg Am 2013; 95:1527-34. [PMID: 23965706 DOI: 10.2106/jbjs.m.00599] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA.
| | | | | |
Collapse
|
30
|
The concept of ankle joint preserving surgery: why does supramalleolar osteotomy work and how to decide when to do an osteotomy or joint replacement. Foot Ankle Clin 2012; 17:545-53. [PMID: 23158369 DOI: 10.1016/j.fcl.2012.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The structure of the ankle is stabilized by bone, and external force is distributed to the adjacent intertarsal joints, reducing the vulnerability of the joint to osteoarthritis. Joint-preserving surgical techniques include arthroscopic debridement, ligament reconstruction, distraction arthroplasty, and osteotomy. Supramalleolar osteotomy to treat varus-type osteoarthritis of the ankle is also known as "low tibial osteotomy," as opposed to "high tibial osteotomy" to treat varus-type osteoarthritis of the knee.
Collapse
|
31
|
Abstract
Within the past several years, the arthritic varus ankle has been addressed extensively in Foot and Ankle Clinics, with numerous excellent reviews by particularly knowledgeable authors. To support these outstanding contributions, this article provides a practical approach to this challenging constellation of foot and ankle abnormalities. Varus ankle arthritis exists on a continuum that prompts the treating surgeon to be familiar with a spectrum of surgical solutions, including joint-sparing realignment, arthroplasty, and arthrodesis. Each of these treatment options is addressed with several expanded case examples and supports the management approaches with the available pertinent literature.
Collapse
Affiliation(s)
- Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Box 2950, Durham, NC 27703, USA.
| |
Collapse
|
32
|
Siddiqui NA, Herzenberg JE, Lamm BM. Supramalleolar osteotomy for realignment of the ankle joint. Clin Podiatr Med Surg 2012; 29:465-82. [PMID: 23044057 DOI: 10.1016/j.cpm.2012.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ankle replacement systems have not been as reliable as hip replacements in providing long-term relief of pain, increased motion, and return to full activity. Supramalleolar Osteotomy is an extraarticular procedure that realigns the mechanical axis, thereby restoring ankle function. The literature discussing knee arthritis has shown that realignment osteotomies of the tibia improve function and prolong total knee replacement surgery. The success of the procedure is predicated on understanding the patient's clinical and radiographic presentation and proper preoperative assessment and planning.
Collapse
Affiliation(s)
- Noman A Siddiqui
- International Center for Limb Lenghtening/Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, 2401 W. Belvedere Avenue, Baltimore MD 21215, USA.
| | | | | |
Collapse
|
33
|
Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion. Clin Orthop Relat Res 2012; 470:2864-73. [PMID: 22777590 PMCID: PMC3441986 DOI: 10.1007/s11999-012-2470-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 06/22/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ankle arthrodesis may be achieved using the Ilizarov method. Comorbidities, such as diabetes, Charcot neuroarthropathy, osteomyelitis, leg length discrepancy, and smoking, can make an ankle fusion complex and may be associated with lower rates of healing. QUESTIONS/PURPOSES We asked if (1) smoking and other comorbidities led to lower fusion rates, (2) time wearing the frame affected outcome, and (3) simultaneous tibial lengthening improved fusion rates. METHODS We retrospectively studied 101 patients who underwent complex ankle fusion using the Ilizarov technique. The median time wearing the frame was 25 weeks (range, 10-65 weeks). Twenty-four patients had simultaneous tibial lengthening. The minimum followup for 91 of the 101 patients was 27 months (median, 65 months; range, 27-134 months). RESULTS Fusion was achieved in 76 of 91 patients. Smoking was associated with a 54% rate of nonunion. Fifteen of 19 patients with Charcot neuroarthropathy achieved union but had a high rate of subsequent subtalar joint failure. Time wearing the frame did not affect union rates. Tibial lengthening did not improve ankle fusion rates. CONCLUSION Smokers should be warned of the high risk of nonunion and we recommend they quit smoking. We also recommend surgeons recognize the higher nonunion rate in patients with Charcot neuroarthropathy. We believe tibial lengthening should not be performed to enhance healing at the fusion site. LEVEL OF EVIDENCE Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
|
34
|
Abstract
Considerable recent orthopedic literature is dedicated to either the surgical management of OLTs and correction of varus ankle alignment, but little is published on the combination of these 2 problems. We anticipate that future clinical and biomechanical research will address their simultaneous treatment; until then, we will continue to extrapolate from their independent management.
Collapse
Affiliation(s)
- Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, 4709 Creekstone Drive, Box 2950, Durham, NC 27703, USA
| | | |
Collapse
|
35
|
Rammelt S, Marti RK, Raaymakers EL, Grass R, Zwipp H. Gelenkerhaltende Rekonstruktion fehlverheilter Pilon-tibiale-Frakturen. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.fuspru.2011.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|