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Ferrao PNF, Saragas NP, Naude JJ. Outcomes of Total Ankle Arthroplasty After Periprosthetic Cyst Curettage and Bone Grafting. Foot Ankle Clin 2024; 29:123-143. [PMID: 38309797 DOI: 10.1016/j.fcl.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Total ankle arthroplasty (TAA) has become a popular management option for ankle arthritis. Periprosthetic osteolysis is one of the most common causes for reoperation in TAA. A CT scan should be done in all suspected osteolysis cases to confirm location, quantify size and aid in surgical planning. These patients are often asymptomatic with limited evidence regarding appropriate management. Smaller lesions should be monitored for progression in size. Periprosthetic cysts measuring 10-15mm in all three axes should be considered for debridment and curettage with autogenous bone grafting. The authors believe that bone grafting of large asymptomatic periprosthetic cysts could prevent implant failure.
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Affiliation(s)
- Paulo N F Ferrao
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Department of Orthopaedic Surgery, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Nikiforos P Saragas
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Department of Orthopaedic Surgery, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Jaco J Naude
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Life Wilgers Hospital, Denneboom road, Wilgers ext 14, Pretoria, 0040, South Africa
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Henry JK, Rider C, Cody E, Ellis SJ, Demetracopoulos C. Evaluating and Managing the Painful Total Ankle Replacement. Foot Ankle Int 2021; 42:1347-1361. [PMID: 34315246 DOI: 10.1177/10711007211027273] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation.Level of Evidence: Level V, expert opinion or review.
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Mehta N, Serino J, Hur ES, Smith S, Hamid KS, Lee S, Bohl DD. Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty. Foot Ankle Int 2021; 42:230-242. [PMID: 33345610 DOI: 10.1177/1071100720978426] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Periprosthetic osteolysis is a common occurrence after total ankle arthroplasty (TAA) and poses many challenges for the foot and ankle surgeon. Osteolysis may be asymptomatic and remain benign, or it may lead to component instability and require revision or arthrodesis. In this article, we present a current and comprehensive review of osteolysis in TAA with illustrative cases. We examine the basic science principles behind the etiology of osteolysis, discuss the workup of a patient with suspected osteolysis, and present a review of the evidence of various management strategies, including grafting of cysts, revision TAA, and arthrodesis.Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Nabil Mehta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Edward S Hur
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shelby Smith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Rozis M, Benetos I, Afrati SR, Polyzois VD, Pneumaticos SG. Results and Outcomes of Combined Cross Screw and Ilizarov External Fixator Frame in Ankle Fusion. J Foot Ankle Surg 2021; 59:337-342. [PMID: 32131000 DOI: 10.1053/j.jfas.2019.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/01/2019] [Accepted: 05/19/2019] [Indexed: 02/03/2023]
Abstract
Ankle fusion is a treatment option for end-stage ankle arthritis. Fusion site stability and optimal foot positioning are crucial parameters. We present the results of our double fixation technique, combining both cross-screw fixation and Ilizarov external fixator frame via transmalleolar approach. We reviewed the files from 52 patients operated for ankle fusion in our center. In our technique, we use a transmalleolar approach, initial stabilization with 2 cannulated, half-threaded cross screws, and final stabilization with an Ilizarov external fixator frame. Fusion stability, weightbearing time, complication rates, and final functional scores were recorded and evaluated. Mean frame removal time was 11.2 ± 2.1 weeks, and 71.6% of patients were fully weightbearing at that time. Absolute fusion stability was reported in 88.46% of patients at that time, while no pseudarthrosis was noted in final follow-up at 12 months. According to the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot-ankle score evaluation at 12 months, 90.4% of patients reported excellent and 9.6% good results. None of the patients was referred for symptomatic forefoot arthritis, and there were no cases of deep infection or deep vein thrombosis. Material-related complications were reported in 1 patient who was treated with implant removal after 1 year. Ankle fusion is a salvage procedure that offers optimal results in end-stage ankle arthritis. Our technique offers absolute fusion site stability with excellent functional results, minor complications, and the advantages of early protected weightbearing. Careful patient selection in addition to fine foot positioning should be regarded as crucial for the final outcome.
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Affiliation(s)
- Meletis Rozis
- Orthopaedic Resident, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece.
| | - Ioannis Benetos
- Orthopaedic Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
| | - Spyridoula-Roberta Afrati
- Anesthesiologist Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
| | - Vasilios D Polyzois
- Orthopaedic Consultant, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
| | - Spyros G Pneumaticos
- Orthopaedic Professor, 3rd Orthopaedic Clinic, University of Athens, KAT Hospital, Athens, Greece
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[Aseptic loosening of total ankle replacement and conversion to ankle arthrodesis]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2017; 29:207-219. [PMID: 28444407 DOI: 10.1007/s00064-017-0492-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/25/2017] [Accepted: 02/12/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To remove loosened prosthesis components, to perform augmentation, to address osseous defects, to perform neutrally aligned ankle arthrodesis, and to achieve postoperative pain relief. INDICATIONS Symptomatic, aseptic loosening of total ankle replacement (TAR) with/without substantial bone defect of the tibial and/or talar bone stock. CONTRAINDICATIONS General surgical or anesthesiological risks, periprosthetic infection, local or systemic infection, nonmanageable soft tissue problems. SURGICAL TECHNIQUE Removal of both prosthesis components using the previous incision (mostly using anterior ankle approach). Careful debridement of bone stock at the tibial and talar side. Osseous augmentation of defects using autologous or homologous cancellous bone, if needed, using structural allografts. POSTOPERATIVE MANAGEMENT A soft wound dressing is used. Thromboprophylaxis is recommended. Patient mobilization starts on postoperative day 1 with 15 kg partial weight bearing using a stabilizing walking boot or cast for 6-8 weeks. Following clinical and radiographic follow-up at 6 weeks, full weight bearing is initiated gradually after progressive osseous healing has been confirmed. RESULTS Between January 2007 and December 2012, ankle arthrodesis was performed in 9 patients with failed TAR (6 men and 3 women, mean age 56.4 ± 7.0 years, range 47.8-66.0 years). The mean time between the initial TAR and revision surgery was 4.5 ± 2.4 years (range 1.2-7.9 years). In one patient irrigation and debridement was performed due to superficial wound infection. Another patient had a delayed osseous healing 11 months after the revision surgery.
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Kolodziej L, Sadlik B, Sokolowski S, Bohatyrewicz A. Results of Arthroscopic Ankle Arthrodesis with Fixation Using Two Parallel Headless Compression Screws in a Heterogenic Group of Patients. Open Orthop J 2017; 11:37-44. [PMID: 28400871 PMCID: PMC5366382 DOI: 10.2174/1874325001711010037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 01/08/2017] [Accepted: 01/20/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As orthopedic surgeons become skilled in ankle arthroscopy technique and evidence -based data is supporting its use, arthroscopic ankle arthrodesis (AAA) will likely continue to increase, but stabilization methods have not been described clearly. We present a technique for two parallel 7.3-mm headless compression screws fixation (HCSs) for AAA in cases of ankle arthritis with different etiology, both traumatic and non-traumatic, including neuromuscular and inflammatory patients. MATERIALS AND METHODS We retrospectively verified 24 consecutive patients (25 ankles) who underwent AAA between 2011 and 2015. The average follow-up was 26 months (range 18 to 52 months). Arthrodesis was performed in 16 patients due to posttraumatic arthritis (in 5 as a sequela of pilon, 6 ankles, 3 tibia fractures, and 2 had arthritis due to chronic instability after lateral ligament injury), in 4 patients due to neuromuscular ankle joint deformities, and in 4 patients due to rheumatoid arthritis. RESULTS Fusion occurred in 23 joints (92%) over an average of 12 weeks (range 6 to 18 weeks). Ankle arthrodesis was not achieved in 2 joints (8%), both in post-pilon fracture patients. The correct foot alignment was not achieved in 4 feet (16%). None of the treated patients required hardware removal. CONCLUSION The presented technique was effective in achieving a high fusion rate in a variety of diseases, decreasing intra- and post-operative hardware complications while maintaining adequate bone stability.
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Affiliation(s)
- Lukas Kolodziej
- Orthopaedic, Traumatology and Orthopedic Oncology Clinic, Pomeranian Medical University, Szczecin, Poland
| | - Boguslaw Sadlik
- Biological Joint Reconstruction Department, St. Luke's Hospital, Bielsko-Biala, Poland
| | - Sebastian Sokolowski
- Orthopaedic, Traumatology and Orthopedic Oncology Clinic, Pomeranian Medical University, Szczecin, Poland
| | - Andrzej Bohatyrewicz
- Orthopaedic, Traumatology and Orthopedic Oncology Clinic, Pomeranian Medical University, Szczecin, Poland
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Mulhern JL, Protzman NM, White AM, Brigido SA. Salvage of Failed Total Ankle Replacement Using a Custom Titanium Truss. J Foot Ankle Surg 2016; 55:868-73. [PMID: 26884264 DOI: 10.1053/j.jfas.2015.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Indexed: 02/03/2023]
Abstract
Subsidence of the talar component results in significant morbidity after total ankle replacement. When recognized, prompt revision could be needed to preserve the function of the implant; however, this is not always the case. In situations in which the implant cannot be revised, tibiotalocalcaneal arthrodesis might be necessary to salvage the extremity. The purpose of the present report is to describe the use of a custom titanium alloy truss to fill a bony void created by explantation of the implant components. Total ankle replacement was performed as the initial surgery to address end-stage osteoarthritis. Two years after the index procedure, the patient underwent revision of the polyethylene and talar components with subtalar arthrodesis secondary to progressive subtalar osteoarthritis and talar subsidence. The implant subsequently became infected and was removed. The patient underwent re-implantation after the infection had resolved, but significant talar subsidence required conversion to a tibiotalocalcaneal arthrodesis with a custom titanium alloy truss and retrograde intramedullary nail. At the most recent follow-up appointment, the patient was weightbearing on a stable extremity and pain free. Radiographic examination confirmed appropriate implant alignment and evidence of bone formation throughout the titanium truss. Although our results are restricted to a single case with initial, limited follow-up data, combining sound structural mechanics with an open architecture and unique texture, the custom titanium truss appears to maintain the limb length and promote healing across a large void.
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Affiliation(s)
- Jennifer L Mulhern
- Fellow, Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA
| | - Nicole M Protzman
- Research Associate, Department of Clinical Education and Research, Coordinated Health, Allentown, PA
| | - Amari M White
- Resident, Podiatric Residency Program, New York Methodist Hospital, Brooklyn, NY
| | - Stephen A Brigido
- Fellowship Director, Foot and Ankle Reconstruction, and Department Chair, Foot and Ankle Department, Coordinated Health, Bethlehem, PA; and Clinical Professor of Surgery, Clinical Sciences Department, The Commonwealth Medical College, Scranton, PA.
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Napiontek M, Jaszczak T. Ankle arthrodesis from lateral transfibular approach: analysis of treatment results of 23 feet treated by the modified Mann’s technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1195-9. [DOI: 10.1007/s00590-015-1663-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/21/2015] [Indexed: 12/25/2022]
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9
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Evaluation and management of the painful total ankle arthroplasty. J Am Acad Orthop Surg 2015; 23:272-82. [PMID: 25829450 DOI: 10.5435/jaaos-d-14-00017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 08/25/2014] [Indexed: 02/01/2023] Open
Abstract
Total ankle arthroplasty (TAA) is an increasingly popular treatment option for patients with end-stage ankle arthritis. Although improved short- and long-term clinical and radiographic outcomes have been achieved with TAA, revision surgery may be necessary in the setting of aseptic loosening, subsidence, impingement, arthrofibrosis, or infection. Factors such as patient selection, implant design, and surgical technique can all contribute to TAA failure. Treatment of patients with a painful TAA is complex and requires careful consideration of symptom history, workup, and nonsurgical and surgical treatment options. Surgical management of failed TAA includes arthrodesis, revision surgery, or below-knee amputation.
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Gross C, Erickson BJ, Adams SB, Parekh SG. Ankle arthrodesis after failed total ankle replacement: a systematic review of the literature. Foot Ankle Spec 2015; 8:143-51. [PMID: 25561701 DOI: 10.1177/1938640014565046] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE As the number of total ankle replacements (TARs) performed has risen, so has the need for revision. The purpose of this investigation was to perform a systematic review of clinical outcomes following a salvage ankle arthrodesis from a failed TAR to identify patient- and technique-specific prognostic factors and to determine the clinical outcomes and complications following an ankle arthrodesis for a failed TAR. METHODS We searched PubMed, Medline, EMBASE, and the Cochrane Central Register of Controlled Trials for studies that analyzed ankle fusion after failed TAR with a minimum follow-up of 1 year. RESULTS We included 16 studies (193 patients). The majority of patients (41%) underwent the index TAR for rheumatoid arthritis. The majority of these revision surgeries were secondary to component loosening, frequently of the talar component (38%). In the cases that were revised to an ankle arthrodesis, 81% fused after their first arthrodesis procedure. The intercalary bone graft group and the blade plate group had the highest rate of fusion after the first attempt at fusion at 100%, whereas the tibiotalocalcaneal fusion with cage group had the lowest fusion rate at 50%. The overall complication rate was 18.2%, whereas the overall nonunion rate was 10.6%. CONCLUSION A salvage ankle arthrodesis for a failed TAR results in favorable clinical end points and overall satisfaction at short-term follow-up if the patients achieve fusion. The bone graft fusion and blade plate group resulted in the highest first-attempt fusion rate, with a low complication rate. Future studies should include prospective, comparative control or surgical groups and use standardized outcome measurements that will make direct comparisons easier. LEVELS Level IV: Systematic Review of Level IV Studies.
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Affiliation(s)
- Christopher Gross
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP)
| | - Selene G Parekh
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (CG, SBA, SGP)Rush University Medical Center; Chicago, Illinois (BJE)Duke Fuqua School of Business, Durham, North Carolina (SGP)
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Deleu PA, Devos Bevernage B, Maldague P, Gombault V, Leemrijse T. Arthrodesis After Failed Total Ankle Replacement. Foot Ankle Int 2014; 35:549-557. [PMID: 24829375 DOI: 10.1177/1071100714536368] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The literature on salvage procedures for failed total ankle replacement (TAR) is sparse. We report a series of 17 patients who had a failed TAR converted to a tibiotalar or a tibiotalocalcaneal arthrodesis. METHODS Between 2003 and 2012, a total of 17 patients with a failed TAR underwent an arthrodesis. All patients were followed on a regular basis through chart review, clinical examination and radiological evaluation. The following variables were analyzed: pre- and postoperative Meary angle, cause of failure, method of fixation, type of graft, time to union, complications, and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score. The average follow-up was 30.1 months. The average period from the original arthroplasty to the arthrodesis was 49.8 months. RESULTS Thirteen of the 17 ankles were considered radiographically healed after the first attempt in an average time of 3.7 months and 3 after repeat arthrodesis. Bone grafts were used in 16 patients. The median postoperative AOFAS score was 74.5. The mean Meary angle of the hindfoot was 5 degrees of valgus. CONCLUSION Tibiotalar and tibiotalocalcaneal arthrodeses were effective salvage procedures for failed TAR. Massive cancellous allografts were a good alternative to compensate for the large bone defect after removal of the prosthesis and to preserve the leg length. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Paul-André Deleu
- 1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium.,2 Institut D'Enseignement Supérieur Parnasse Deux-Alice, Division of Podiatry, Bruxelles, Belgium
| | | | - Pierre Maldague
- 1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium
| | - Vincent Gombault
- 1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium
| | - Thibaut Leemrijse
- 1 Foot & Ankle Institute, Clinique du Parc Léopold, Bruxelles, Belgium
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