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Sakkab R, McAlister JE, Ekladios JM, Cottom JM. What is the Total Ankle Arthroplasty Experience of Podiatric Foot and Ankle Surgery Fellows? A National Survey. J Foot Ankle Surg 2025; 64:13-15. [PMID: 39134220 DOI: 10.1053/j.jfas.2024.08.004] [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: 05/14/2024] [Revised: 06/29/2024] [Accepted: 08/04/2024] [Indexed: 09/14/2024]
Abstract
In 2011, the Council of Podiatric Medical Education, the accrediting body of the American Podiatric Medical Association, approved the conversion of all Podiatric Residencies to 3-year surgical programs. In 2012, there were 12 podiatric fellowships recognized by the American College of Foot and Ankle Surgeons. To date, there are 53 programs listed under the college's website. As podiatric fellowships expand, further research is needed to identify advantages and pitfalls of fellowship training. Our primary aim was to obtain current fellow survey data to enhance our understanding of podiatric reconstructive foot and ankle surgery fellowship training programs. In doing so, we decided to use one of the most salient topics in fellowship training- Total Ankle Replacement. Invitation was administered by email and 73.6% of active reconstructive 2023-24 American College of Foot and Ankle Surgeons postgraduate fellows responded. Fellowship total ankle replacement case volume was significantly greater than residency (p = 0.037). Completion of 0-5 total ankle replacement(s) was 30.8%, and greater than 30 in 17.9% of fellows. Fifty nine percent reported feeling "comfortable" or "very comfortable" with total ankle arthroplasty. Patient specific instrumentation was used in a majority of cases (66.7%). Over three fourths (79.8%) of fellows stated they planned on performing TAR as an attending surgeon after their fellowship. Despite its limitations, we hope our survey data can aid graduating and previous fellows and add to the body of knowledge for future TAR educational programs and industry involvement. As podiatric fellowships continue to transform, so too must our research efforts to track progress.
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Affiliation(s)
- Ramez Sakkab
- Fellow, Phoenix Foot & Ankle Institute Fellowship, Scottsdale, AZ.
| | | | - Joshua M Ekladios
- Fellow, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL
| | - James M Cottom
- Program Director, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL
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Boey JJE, Toh RX, Loh YC, Zhang C, Ling RR, Li ZX, Mohamed Buhary KS, Tay KS. Complications of total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis with trial sequential analysis. Foot Ankle Surg 2024:S1268-7731(24)00264-9. [PMID: 39701836 DOI: 10.1016/j.fas.2024.11.008] [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: 10/08/2024] [Accepted: 11/28/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND Ankle osteoarthritis affects 1-3 % of all adults. Contemporary evidence is equivocal when comparing the outcomes and complications of TAA and AA. This review aims to compare the complications between TAA and AA to provide surgeons with an additional perspective when managing ESAO. METHODS We conducted a systematic review and meta-analysis, searching four international databases from inception until 21 Jan 2024 for RCTs and score-matched studies reporting on TAA or AA for ESAO. Score-matched studies were included if matching accounted for four or more covariates related to patient demographics and comorbidities. Random-effects (DerSimonian and Laird) meta-analyses were conducted. The primary outcome was complications stratified into total, major, and minor as guided by previous studies. We rated intra-study risk of bias using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa Scale. We assessed the certainty of evidence using the GRADE approach. RESULTS 5 studies (2 RCTs and 3 score-matched studies) totalling 13,957 patients (6975 TAA, 6982 AA) were included in the meta-analysis. The pooled RR for total complications was 0.95 (95 %-CI: 0.85 to 1.08, p = 0.45, moderate certainty, favourable towards AA). The pooled RR for major complications was 1.18 (95 %-CI: 0.70 to 1.98; p = 0.54, low certainty, favouring TAA) and for minor complications was 0.96 (95 %-CI: 0.75 to 1.22; p = 0.73, moderate certainty, favouring AA). CONCLUSION Previous reviews have recognised TAA and AA as equivocally effective surgical options for patients with ESAO. Our review may suggest that TAA and AA have similar rates of major and minor complications. Surgeons should consider the specific complications for TAA and AA despite the similar rates of complications when counselling patients. PROTOCOL REGISTRATION CRD42023389626.
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Affiliation(s)
- Jonathan Jia En Boey
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Rui Xiang Toh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Yao Chen Loh
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Chen Zhang
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore; Australia and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Anaesthesia, National University Hospital, National University Health System, Singapore
| | - Zong Xian Li
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | | | - Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Ashy CC, Reid JJ, Morningstar JL, Brennan E, Scott DJ, Gross CE. A systematic review of outcomes of total ankle arthroplasty with INBONE II. Foot Ankle Surg 2024:S1268-7731(24)00234-0. [PMID: 39547917 DOI: 10.1016/j.fas.2024.11.001] [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: 03/12/2024] [Revised: 10/04/2024] [Accepted: 11/03/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND This study systematically reviews the literature and reports on outcomes of total ankle arthroplasty (TAA) with the INBONE II fixed-bearing implant. METHODS PubMed, SCOPUS and CINAHL were searched for clinical studies reporting INBONE II specific outcomes from database inception through July 13th, 2024, according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. RESULTS Seven primary TAA studies and 4 revision TAA studies were included with 406 and 114 patients respectively. Survivorship was 96.5 % (mean follow-up 44.8 months) and 93.9 % (mean follow-up=37.3 months) for primary and revision TAA, respectively. The mean reoperation rate was 11.4 % with a 3.2 % rate of major complications for primary TAA. Meanwhile, the reoperation rate was 9.1 % with a major complication rate of 12.2 % for revision TAA. CONCLUSIONS Primary and revision TAA with this implant results in over 93 % survival at mid-term follow-up with an acceptable complication rate, supporting its continued use. LEVEL OF EVIDENCE Level IV: Systematic Review of Level I-IV Studies.
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Affiliation(s)
- Cody C Ashy
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, USA.
| | - Jared J Reid
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, USA.
| | - Joshua L Morningstar
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, USA.
| | - Emily Brennan
- MUSC Libraries, Medical University of South Carolina, 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, USA.
| | - Christopher E Gross
- Medical University of South Carolina, Department of Orthopaedics and Physical Medicine, USA.
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Puri A. Current concepts in ankle arthrodesis. J Clin Orthop Trauma 2024; 56:102537. [PMID: 39328297 PMCID: PMC11422152 DOI: 10.1016/j.jcot.2024.102537] [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: 02/09/2024] [Revised: 08/15/2024] [Accepted: 09/06/2024] [Indexed: 09/28/2024] Open
Abstract
Ankle osteoarthritis is primarily post traumatic and affects a younger population. It, therefore, not only has a negative effect on the quality of life but also impacts the working life of these patients. A thorough history, clinical examination followed by relevant investigations, radiological and hematological, can provide the necessary information to classify the severity and associated deformity of this condition. This will provide guidance to the necessary and appropriate commencement of treatment. Options include conservative or surgical which can be joint sparing or sacrificing procedures. Ankle arthrodesis, a joint sacrificing procedure, has long been the 'gold standard' and has stood the test of time in providing a pain free plantigrade foot. However, ankle arthroplasty, with newer materials and better understanding, is increasingly being considered for ankle arthritis. In regions with financial constraints and limited accessibility to modern implants ankle arthrodesis should be the preferentially offered surgical procedure. This article will briefly cover the pathophysiology of ankle arthritis, clinical presentation, and its surgical treatment with a focus on ankle arthrodesis.
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Affiliation(s)
- Arvind Puri
- Orthopaedic Surgeon, Cairns Hospital, Australia
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Shaffrey I, Henry J, Demetracopoulos C. An evaluation of the total ankle replacement in the modern era: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2024; 12:71. [PMID: 39118953 PMCID: PMC11304414 DOI: 10.21037/atm-23-1569] [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: 04/25/2023] [Accepted: 06/19/2023] [Indexed: 08/10/2024]
Abstract
Background and Objective Total ankle replacement has become an increasingly popular surgical procedure for treatment of end-stage ankle arthritis. Though ankle arthrodesis has historically been considered the gold standard treatment, advancements in implant design, functional outcomes, and survivorship have made total ankle replacement a compelling alternative. Particularly, in the past 20 years, total ankle replacement has undergone tremendous innovation, and the field of research in this procedure continues to grow. In this review, we aim to summarize the history, evolution, advancements, and future directions of total ankle replacement as described through implant design, indications, surgical procedures, complications, and outcomes. Methods Literature searches were conducted in PubMed to identify relevant articles published prior to March 2023 using the following keywords: "total ankle replacement", "total ankle arthroplasty", and "total ankle". Key Content and Findings Total ankle replacement has demonstrated significant improvements in surgical technique, implant design, survivorship, and clinical and functional outcomes in the modern era. The procedure reports high patient satisfaction, low complication rates, and improved functional abilities that challenge the current gold standard treatment for ankle arthritis. Conclusions Though there are areas of improvement for total ankle replacement, the procedure demonstrates promising outcomes for patients with end-stage ankle arthritis to improve pain and functional abilities. Research studies continue to explore various the facets of total ankle replacement, including outcomes, risk factors, novel techniques and modalities, and complications, to direct future innovation and to optimize patient results.
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Affiliation(s)
- Isabel Shaffrey
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY, USA
| | - Jensen Henry
- Foot and Ankle Department, Hospital for Special Surgery, New York, NY, USA
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Kim J, Kim J, Kim S, Yi Y. Weight-Bearing CT for Diseases around the Ankle Joint. Diagnostics (Basel) 2024; 14:1641. [PMID: 39125518 PMCID: PMC11311840 DOI: 10.3390/diagnostics14151641] [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: 07/11/2024] [Revised: 07/21/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Weight-bearing computed tomography (WBCT) enables acquisition of three-dimensional bony structure images in a physiological weight-bearing position, which is fundamental in understanding the pathologic lesions and deformities of the ankle joint. Over the past decade, researchers have focused on validating and developing WBCT measurements, which has significantly enhanced our knowledge of common foot and ankle diseases. Consequently, understanding the application of WBCT in clinical practice is becoming more important to produce improved outcomes in the treatment of disease around the ankle joint. This review will describe an overview of what is currently being evaluated in foot and ankle surgery using WBCT and where the course of research will be heading in the future.
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Affiliation(s)
- Jahyung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Jaeyoung Kim
- Baylor University Medical Center, Dallas, TX 75246, USA;
| | - Saintpee Kim
- Department of Orthopedic Surgery, Gangbuk Etteum Hospital, Seoul 01170, Republic of Korea;
| | - Young Yi
- Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea
- Department of Orthopaedic Surgery and Rehabilitation, Yale School of Medicine, New Haven, CT 06510, USA
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Valan B, Anastasio AT, Kim B, Krez A, Wu KA, Talaski GM, Nunley J, DeOrio JK, Easley ME, Adams SB. The INVISION Talar Component in Revision Total Ankle Arthroplasty: Analysis of Early Outcomes. Diagnostics (Basel) 2024; 14:1612. [PMID: 39125488 PMCID: PMC11311589 DOI: 10.3390/diagnostics14151612] [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: 06/20/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Launched in 2018 for revision total ankle arthroplasty (rTAA), the INVISION talar component addresses subsidence when poor talar bone stock is present. Due to the recency of the market-availability of the INVISION, studies evaluating its efficacy are lacking. This study presents the first analysis of early-term outcomes of patients undergoing rTAA with the INVISION talar component. METHODS This was a single-center, retrospective review of 28 patients undergoing rTAA with the INVISION talar component and INBONE II tibial component performed between 2018 and 2022. Data on preoperative characteristics, postoperative complications, secondary procedures, and survivorship were collected. The primary outcome measures were rates of major complications, re-operation, and implant failure. Secondary outcomes included post-operative changes in varus and valgus alignment of the tibia and talus. RESULTS The most common secondary procedures performed with rTAA were medial malleolus fixation (n = 22, 78.6%) and gastrocnemius recession (n = 14, 50%). Overall, 10.7% (n = 3) of patients underwent reoperation and 14.3% (n = 4) suffered major complications. Incidence of implant failure was 10.7% (n = 3). All reoperations were caused by infection. Mean varus alignment of the tibia and talus improved from 4.07 degrees and 4.83 degrees to 1.67 degrees and 1.23 degrees, respectively. Mean valgus alignment of the tibia and talus improved from 3.67 degrees and 4.22 degrees to 2.00 degrees and 2.32 degrees, respectively. CONCLUSIONS In a series of 28 patients undergoing rTAA with the INVISION talar component, we discovered comparatively low rates of reoperation, major complication, and implant failure (10.7%, 14.3%, and 10.7%). The INVISION system appears to have a reasonable safety profile, but further studies evaluating long-term outcomes are required to assess the efficacy of the INVISION system.
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Affiliation(s)
- Bruno Valan
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Albert T. Anastasio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Billy Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY 10021, USA;
| | - Alexandra Krez
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Kevin A. Wu
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Grayson M. Talaski
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA
| | - James Nunley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - James K. DeOrio
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Mark E. Easley
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
| | - Samuel B. Adams
- Division of Foot and Ankle, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27710, USA; (B.V.); (A.T.A.); (A.K.); (J.N.); (J.K.D.); (M.E.E.); (S.B.A.)
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Glazebrook JM, Glazebrook HM, Glazebrook MA, Morash JG. Ankle arthrodesis or total ankle arthroplasty surgery for end stage ankle arthritis, which is best? A review of the best available evidence. Foot Ankle Surg 2024; 30:1-6. [PMID: 37580181 DOI: 10.1016/j.fas.2023.08.001] [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: 07/07/2022] [Revised: 07/19/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND End Stage Ankle Arthritis (ESAA) causes pain and dysfunction. It is treated effectively with Total Ankle Arthroplasty (TAA) or Ankle Arthrodesis (AA). Currently there is no consensus on which surgical procedure is superior. This paper will provide a systematic review of all published high-quality studies directly comparing TAA and AA for the surgical treatment of ESAA to determine superiority. METHODS A comprehensive literature review of the highest quality studies published that directly compare clinical outcomes of TAA and AA for surgical treatment of ESAA was conducted. Each study was assigned a Level of Evidence (LOE) rating (I-III) and then summarized to assign a grade of recommendation (A-C, I). Superiority was determined for the clinical outcomes of pain, activity, Health Related Quality of Life (HRQL), readmission to hospital, revision surgery and general complications. RESULTS There is fair evidence (GOR B) that supports both TAA and AA for the surgical treatment of ESAA. However, TAA trended to be superior for pain relief (GOR B), activity (GOR B), health related quality of life (GOR B) and readmission rate (GOR B) while AA trended to be superior for revision rates (GOR B). Conflicting evidence was presented for general complications (GOR C) CONCLUSION: Due to the lack of level I papers and the findings from the papers reviewed not being consistent, no definitive conclusion on which procedure is better can be made. However, there is enough evidence to provide a basis for which procedure is more effective in each of the outcomes reviewed. This should be considered when deciding on which procedure is best suited for a patient on a case-by-case basis. To allow for a stronger recommendation, further studies-ideally, high-quality level I randomized control trials directly comparing Ankle Arthrodesis and Total Ankle Arthroplasty are needed. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- Jonah M Glazebrook
- Dalhousie University, Queen Elizabeth II Health Sciences Centre Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax Nova, Scotia B3H 3A7, Canada.
| | - Haley M Glazebrook
- Dalhousie University, Queen Elizabeth II Health Sciences Centre Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax Nova, Scotia B3H 3A7, Canada.
| | - Mark A Glazebrook
- Dalhousie University, Queen Elizabeth II Health Sciences Centre Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax Nova, Scotia B3H 3A7, Canada.
| | - Joel G Morash
- Dalhousie University, Queen Elizabeth II Health Sciences Centre Halifax Infirmary, Room 4867, 1796 Summer Street, Halifax Nova, Scotia B3H 3A7, Canada.
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Li T, Zhao L, Liu Y, Huang L, Zhu J, Xiong J, Pang J, Qin L, Huang Z, Xu Y, Dai H. Total ankle replacement versus ankle fusion for end-stage ankle arthritis: A meta-analysis. J Orthop Surg (Hong Kong) 2024; 32:10225536241244825. [PMID: 38607239 DOI: 10.1177/10225536241244825] [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: 04/13/2024] Open
Abstract
PURPOSE This study aims to systematically review the efficacy and safety of total ankle replacement (TAR) and ankle fusion (AF) as treatment options for end-stage ankle arthritis. METHODS A comprehensive literature search was conducted on data from multiple databases, including PubMed, The Cochrane Library, Construction and Building Materials, Embase, Web of Science, and Scopus for RCTs and prospective cohort studies comparing TAR and AF in patients with end-stage ankle arthritis from inception up to June, 2023. Our primary outcomes of interest included patients' clinical function scores and complications. We employed Review Manager 5.4 and Stata/MP 14.0 software for the meta-analysis. RESULTS Our analysis incorporated 13 comparative studies, including 11 prospective studies, one pilot RCT, and one RCT. The pooled results revealed no significant difference in postoperative Short Form-36 scores between the TAR and AF groups (MD = -1.19, 95% CI: -3.89 to 1.50, p = .39). However, the postoperative Foot and Ankle Ability Measure scores in the AF group were significantly higher than in the TAR group (MD = 8.30, 95% CI: 1.01-15.60, p = .03). There was no significant difference in postoperative complication rates between the TAR and AF groups (RR = 0.95, 95% CI: 0.59 to 1.54, p = .85). CONCLUSION Currently available evidence suggests no significant disparity in postoperative outcomes between TAR and AF. In the short term, TAR demonstrates better clinical scores than AF and lower complication rates. Conversely, in the long term, AF exhibits superior clinical scores and lower complication rates, although this difference is not statistically significant.
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Affiliation(s)
- Taiyi Li
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Zhao
- Department of Neurology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yan Liu
- Department of Anesthesiology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Li Huang
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jin Zhu
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jie Xiong
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junfeng Pang
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lina Qin
- Department of Neurology, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zonggui Huang
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yinglong Xu
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hai Dai
- Department of Trauma Orthopaedics and Hand Surgery, The Fifth Affiliated Hospital of Guangxi Medical University, Nanning, China
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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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Safety and efficacy of total ankle arthroplasty versus ankle arthrodesis for ankle osteoarthritis: A systematic review and meta-analysis. Foot (Edinb) 2023; 55:101980. [PMID: 36863247 DOI: 10.1016/j.foot.2023.101980] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/04/2023]
Abstract
Osteoarthritis is the most common joint disease-causing pain and disability, and its management keeps creating a debate. So, we aimed to compare the safety and efficacy of total ankle arthroplasty and ankle arthrodesis for ankle osteoarthritis. We searched PubMed, Cochrane, Scopus, and Web of Science till August 2021. The outcomes were pooled as Mean difference (MD) or Risk Ratio (RR), and 95% confidence interval. We included 36 studies. The results showed a significantly lower risk of infections in total ankle arthroplasty (TAA) than ankle arthrodesis (AA) (RR= 0.63, 95% CI [0.57, 0.70], p < 0.00001), amputations (RR= 0.40, 95% CI [0.22, 0.72], p = 0.002), postoperative non-union (RR= 0.11, 95% CI [0.03, 0.34], p = 0.0002), and a significant increase of overall range of motion in TAA than AA. Our results preferred total ankle arthroplasty over ankle arthrodesis in terms of lowering the rates of infections, amputations, and postoperative non-union, with better change in the overall range of motion.
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Anderson AM, Chapman LS, Siddle HJ, Watson S, Klugerman J, Antcliff D, Keenan AM, Brockett CL. "I could have a proper ankle" - a qualitative study of patients' perceptions of total ankle replacement and ankle fusion surgery. J Foot Ankle Res 2022; 15:88. [PMID: 36503504 PMCID: PMC9743489 DOI: 10.1186/s13047-022-00595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND End-stage ankle osteoarthritis typically causes severe pain and impaired function. Surgical treatment involves total ankle replacement (TAR) or ankle fusion. Definitive evidence about which procedure is optimal is lacking. No previous studies have thoroughly explored patients' experiences across the entire TAR/ankle fusion pathway. This study aimed to address this gap by exploring perceptions of surgery, education, rehabilitation and outcomes among patients who had undergone TAR or ankle fusion. METHODS Seven participants were purposively selected from an orthopaedic centre in northern England (3 females, 4 males). Participants had undergone primary TAR without revision (n = 2), TAR requiring revision (n = 3) or ankle fusion (n = 2). Each participant completed a single semi-structured interview. Interviews were digitally recorded, transcribed verbatim and analysed thematically. RESULTS Three themes, each with two subthemes, were identified: decision-making (seeking help; surgical options), perceptions of support (information/education; clinical support) and impact on the individual (personal circumstances and beliefs; post-operative outcomes). Pain affecting participants' valued activities was key to their decision to seek help. Participants' decision between TAR and ankle fusion was influenced by multiple factors. Concerns regarding the lack of joint flexibility following fusion were highlighted, with some participants perceiving TAR as a "proper ankle" that would enable them to avoid limping. Participants obtained information from various sources, with most feeling that the education from their care team was inadequate. Participants' individual circumstances and beliefs influenced their decision-making and perceptions of their post-operative outcomes. Finally, whilst most participants were pleased with their outcomes, some experienced substantial ongoing problems such as difficulty walking and chronic pain. CONCLUSIONS This study demonstrates the importance of providing adequate education about TAR and ankle fusion to enable patients to make informed decisions. Most participants felt that the education and clinical support they received did not fully meet their needs. Participants' personal circumstances and beliefs had a strong influence on their decision-making and perceptions of their post-operative outcomes, highlighting the need to personally tailor education and clinical support. Future work with a larger sample of patients and other key stakeholders is required to develop consensus-based guidelines on pre- and post-operative support for patients undergoing TAR/ankle fusion.
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Affiliation(s)
- Anna M. Anderson
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK ,grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,grid.9909.90000 0004 1936 8403Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Lara S. Chapman
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Heidi J. Siddle
- grid.9909.90000 0004 1936 8403Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sue Watson
- Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK
| | - Jane Klugerman
- Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK
| | - Deborah Antcliff
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,grid.451052.70000 0004 0581 2008Bury Integrated Pain Service, Bury Care Organisation, Northern Care Alliance NHS Foundation Trust, Bury, England, UK ,grid.9757.c0000 0004 0415 6205School of Medicine, Keele University, Keele, UK
| | - Anne-Maree Keenan
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,Leeds National Institute for Health and Care Research Biomedical Research Centre, Leeds, UK
| | - Claire L. Brockett
- grid.9909.90000 0004 1936 8403Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Querci L, Caravelli S, Di Ponte M, Fuiano M, De Blasiis P, Sirico F, Baiardi A, Zannoni F, Mosca M. Enhanced recovery (fast-track surgery) after total ankle replacement: The state of the art. Foot Ankle Surg 2022; 28:1163-1169. [PMID: 35882574 DOI: 10.1016/j.fas.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/02/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
The post-operative results of a total ankle replacement are not determined solely by an optimal surgical technique, but by an appropriate anesthesiological and rehabilitative post-operative approach. Enhanced functional recovery often depends on a multidisciplinary approach based on a correct framework of the patient and his needs, requests, and characteristics. Extensive bibliographical research has been performed on Pubmed, Google Scholar, Scopus. This comprehensive and inclusive review of the literature aims to examine the state of the art of "fast-track" protocols employed in total ankle replacement (TAR), considering pre-operative preparation, anesthetic management, intraoperative and surgical factors, post-operative rehabilitative care and reduction of hospitalization time.
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Affiliation(s)
- Lorenzo Querci
- Anesthesiology and Critical Care Residency Program, University of Bologna, Via Massarenti, 9, 40138 Bologna
| | - Silvio Caravelli
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Marco Di Ponte
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo De Blasiis
- Department of Mental and Physical Health and Preventive Medicine, Section of Human Anatomy, University of Campania"Luigi Vanvitelli", Naples, Italy
| | - Felice Sirico
- Department of Public Health - Physical Medicine & Rehabilitation Unit, Univeristy of Naples "Federico II", 80131 Naples, Italy
| | - Annalisa Baiardi
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesca Zannoni
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Massimiliano Mosca
- II Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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A modified passive-dynamic ankle-foot orthosis: can it prevent amputation and arthrodesis in patients with ankle-foot trauma? Arch Orthop Trauma Surg 2022; 142:2719-2726. [PMID: 34319472 DOI: 10.1007/s00402-021-04083-9] [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: 04/29/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION High-energy lower extremity trauma (HELET) may cause severe damage within the foot-ankle complex. Occasionally, arthrodesis or amputation are the only remaining options to increase activity levels. The modified passive dynamic ankle-foot orthosis (PDAFO) may prove to be a nonsurgical alternative. This study evaluated the effect of a modified PDAFO with a 6-week training program on pain and performance in patients after HELET. MATERIALS AND METHODS A retrospective cohort study was conducted on seventeen patients who considered an arthrodesis or an amputation after HELET. In an attempt to avoid surgery, the modified PDAFO with a 6-week training program was provided. Pain scores was measured with the Numeric Rating Scale and administered at the start of testing, immediately after the two performance tests and at the end of the day of testing. Performance was evaluated with the 6-min walk test (6MWT) and the Comprehensive high-level activity mobility predictor (CHAMP). RESULTS A significant pain reduction was achieved after the treatment procedure. At the start of the test days (p = 0.002), after the 6MWT (p = 0.001), after the CHAMP (p < 0.001) and at the end of the day (p < 0.001). In addition, a significant improvement on performance was observed in the 6MWT (p < 0.001) and the CHAMP (p = 0.01). None of the patients considered a surgical intervention anymore. CONCLUSIONS Patients after HELET show a decrease in pain and an improvement in performance after a 6-week training program with modified PD-AFO. The results suggest that the modified PDAFO is an effective alternative for a surgical approach.
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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: 0.3] [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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