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Gan TJ, Ma XK, Li YX, Chen Y, Liu X, Li J, Zhang H. Osteoperiosteal Iliac Autograft Transplantation for Unreconstructable Tibial Plafond After Malunions of Pilon Fractures in Young Patients. Foot Ankle Int 2024; 45:33-43. [PMID: 37837388 DOI: 10.1177/10711007231201823] [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: 10/16/2023]
Abstract
BACKGROUND Malunion of tibial pilon fracture, especially with a large cartilage loss of the tibial plafond, is a tough clinical conundrum. This study describes a joint-preserving technique that mainly involves corrective intraarticular osteotomy and osteoperiosteal iliac autograft transplantation for treating these generally considered unreconstructable tibial plafond. METHODS Sixteen patients with an average age of 33.6 years who were treated with this joint-preserving method between 2013 and 2020 were retrospectively analyzed. Ankle distraction was applied in all patients. Additional osteochondral autograft transplantation for talus was performed in 4 patients and supramalleolar osteotomy in 2 patients. The visual analog scale (VAS) score, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the 36-Item Short Form Health Survey (SF-36) score, and the ankle range of motion (ROM) were used for outcome analysis. Radiographic assessment was conducted, and the complications were recorded. RESULTS At a mean follow-up of 41.1 months, the mean VAS, AOFAS, and SF-36 scores improved from 6.3, 47.6, and 38.0 to 1.7, 84.4, and 70.8, respectively (P < .001 for each). The ankle ROM improved from 27.5 to 32.2 degrees (P = .023). The mean area of ilium blocks was 3.5 cm2, and the mean external fixation time was 94.1 days. Radiographs showed that good osteointegration was found in all patients and no significant progression of osteoarthritis in 15 patients. The major complications included poor incision healing in 2 patients and severe ankle stiffness in 2 patients, with one of them developing considerable varus-type osteoarthritis but reporting no pain. No deep infection, nonunion, or malunion occurred, and no secondary arthrodesis was performed during the final follow-up. CONCLUSION Osteoperiosteal iliac autograft transplantation might be an alternative surgical option for reconstructing unreconstructable malunited pilon fractures with a large cartilage loss of the tibial plafond in young patients. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Ting-Jiang Gan
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xi-Kun Ma
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ya-Xing Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yu Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xi Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jia Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hui Zhang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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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.
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Affiliation(s)
- S Ali Ghasemi
- Albert Einstein Medical Center - Philadelphia, Philadelphia, PA.
| | - Anthony S Machi
- Albert Einstein Medical Center - Philadelphia, Philadelphia, PA
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Rodriguez-Merchan EC. In the era of primary prophylaxis in hemophilia, what types of orthopedic surgical interventions have been published in the 2020-2023 period and in which countries? Expert Rev Hematol 2023; 16:1077-1085. [PMID: 37975720 DOI: 10.1080/17474086.2023.2285979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Primary prophylaxis has significantly reduced the number of orthopedic surgical procedures performed on patients with hemophilia (PWH) worldwide. However, studies on orthopedic surgery in PWH are still being published in the medical literature. AREAS COVERED The aim of this article is to determine the types of orthopedic surgical interventions in PWH published between 2020 and 2023 and the countries in which they are published. EXPERT OPINION The following orthopedic surgical procedures are still performed on PWH: total knee, ankle, elbow and hip arthroplasty, ankle fusion, ankle distraction, and the surgical removal of hemophilic pseudotumors. The countries in which articles on orthopedic surgery in hemophilia have been published in the period 2000-2023 include China (14 articles); Republic of Korea and U.S.A. (3 articles each); Germany, Italy, Japan, Poland and Turkey (2 articles each); and 1 article each in the following countries: Austria, Belgium, Chile, France, Ireland, New Zealand, Russia, and The Netherlands. These data suggest that primary prophylaxis should be improved and extended to all patients globally.
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Lineham B, van Duren B, Harwood P, Pandit H. The Feasibility of Hinged Knee Arthrodiastasis for Cartilage Regeneration: A Systematic Review of the Literature. Strategies Trauma Limb Reconstr 2023; 18:37-43. [PMID: 38033931 PMCID: PMC10682560 DOI: 10.5005/jp-journals-10080-1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/20/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Knee joint distraction (KJD) is a potential technique for cartilage regeneration in young patients with osteoarthritis of the knee. Static distraction has been utilised typically; however, a significant proportion of patients complain of knee stiffness post-distractor removal. The use of a hinged distractor may reduce the duration and severity of post-treatment knee stiffness by maintaining the range of motion during distraction. Furthermore, improved cartilage regeneration has been demonstrated in hinged ankle joint distraction as compared to static, and this may also be demonstrated at the knee. An evidence review was undertaken to inform further research and a potential change in practice. Aim A systematic review of all primary research on hinged knee joint distraction for cartilage regeneration. Methods An online systematic search of citation databases was conducted. Quality assessment and data extraction were undertaken by two separate researchers. Results The literature search returned a small number of relevant studies, of which 7 were included. Three of these were animal studies, two cadaveric and two case series. The study quality was low or very low. There was significant methodological heterogeneity with difficulties encountered in the transfer of constructs from animal and cadaveric studies to humans. Issues faced included difficulties with hinge placement and pin site pain in motion. Conclusion The feasibility of hinged knee joint distraction has yet to be proven. Any further research attempting to establish the benefits of hinged-over static knee distraction will have to take construct design considerations into account. How to cite this article Lineham B, van Duren B, Harwood P, et al. The Feasibility of Hinged Knee Arthrodiastasis for Cartilage Regeneration: A Systematic Review of the Literature. Strategies Trauma Limb Reconstr 2023;18(1):37-43.
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Affiliation(s)
- Beth Lineham
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
| | - Bernard van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
| | - Paul Harwood
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
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Lutsenko AM, Karpenko AV, Ananin DA, Prizov AP, Aliev RN, Lazko FL. [Ankle distraction hinged motion arthroplasty in the Ilizarov frame]. Khirurgiia (Mosk) 2023:65-71. [PMID: 37186653 DOI: 10.17116/hirurgia202305165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To study distraction hinged motion arthroplasty of the ankle joint in combined treatment of osteoarthritis in terminal stages. MATERIAL AND METHODS Ankle distraction hinged motion arthroplasty in the Ilizarov frame was performed in 10 patients with terminal post-traumatic osteoarthritis (mean age 54±6.2 years). Surgical technique and design of the Ilizarov frame, as well as additional reconstructive interventions are described. RESULTS Preoperative VAS score of pain syndrome was 7±2.3 cm, after 2 postoperative weeks - 1±0.5 cm, 4 weeks - 0.5±0.5 cm, 9 weeks or before dismantling - 0±0.5 cm. Arthroscopic debridement of anterior part of the ankle joint was carried out in 6 cases, posterior part - 1 case, anchor reconstruction of lateral ligamentous complex (InternalBrace technique) - 1 case, anchor reconstruction of medial ligamentous complex - 2 cases. Restoration of anterior portion of syndesmosis was performed in 1 case. Pin site infections occurred in 2 cases. In one case, there was a breakdown of the wire fixator holding the pin passed through the talus in 5 weeks after surgery. CONCLUSION Preliminary results allow us to characterize the proposed design of the Ilizarov frame layout and surgical technique as relatively simple and promising for postponing radical surgery on the ankle joint.
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Affiliation(s)
- A M Lutsenko
- Peoples' Friendship University of Russia, Moscow, Russia
| | - A V Karpenko
- Moscow City Clinical Hospital No. 13, Moscow, Russia
| | - D A Ananin
- Peoples' Friendship University of Russia, Moscow, Russia
| | - A P Prizov
- Peoples' Friendship University of Russia, Moscow, Russia
| | - R N Aliev
- Peoples' Friendship University of Russia, Moscow, Russia
| | - F L Lazko
- Peoples' Friendship University of Russia, Moscow, Russia
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Ikuta Y, Nakasa T, Sumii J, Nekomoto A, Kawabata S, Adachi N. Distraction Arthroplasty Combined with Autologous Bone Grafting for Diffuse-type Tenosynovial Giant Cell Tumour with Articular Cartilage Defect and Subchondral Bone Cysts: A Case Report. Mod Rheumatol Case Rep 2022:rxac092. [PMID: 36484489 DOI: 10.1093/mrcr/rxac092] [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: 05/12/2022] [Revised: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
Tenosynovial giant cell tumour encompasses a group of lesions that present with synovial differentiation and most commonly occur in the joint synovium, bursae, and tendon sheaths. Diffuse-type tenosynovial giant cell tumour, previously known as pigmented villonodular synovitis, is one of the most common benign soft tissue tumours of the foot and ankle and usually affects young adults. The differential diagnosis of diffuse-type tenosynovial giant cell tumours remains a clinical problem because its clinical symptoms are similar to those of inflammatory arthritis, including rheumatoid arthritis. Moreover, persistent diffuse-type tenosynovial giant cell tumours can lead to articular deterioration, including osseous erosions and subchondral bone cysts. Joint-preserving procedures are considered optimal for treating younger patients with ankle osteoarthritis because the indication of ankle arthrodesis and total ankle arthroplasty is limited. Thus, ankle distraction arthroplasty could be an alternative for treating diffuse-type tenosynovial giant cell tumour with articular deterioration in young patients. Here, we report about a woman in her early 30s who presented with ankle pain owing to a diffuse-type tenosynovial giant cell tumour with an articular cartilage defect and subchondral bone cysts. We performed ankle distraction arthroplasty combined with an autologous bone graft. A follow-up examination at 2 years revealed preservation of physical function and pain alleviation. These findings suggest that distraction arthroplasty is a viable treatment option for remedying the destruction of the articular cartilage and subchondral bone owing to diffuse-type tenosynovial giant cell tumours in young adults.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Sports Medical Center, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Arshad Z, Aslam A, Abu-Zeinah K, Bhatia M. Distraction arthroplasty in the management of osteoarthritis of the ankle: A systematic review. Foot Ankle Surg 2022; 28:1150-1162. [PMID: 35853785 DOI: 10.1016/j.fas.2022.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/20/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the use of distraction arthroplasty for ankle osteoarthritis, with respect to patient reported outcome measures (PROMs), complications, range of motion and radiographic outcomes. METHODS A computer-based search was performed in PubMed, Cinahl, Embase, Scopus and ISI Web of Science. Two reviewers independently performed title/abstract and full-text screening. Quality assessment was performed using The Methodological Index for Non-Randomised Studies (MINORS) and Joanna Briggs Institute criteria. RESULTS Whilst all studies evaluating PROMs reported significant (P < 0.05) improvement, these were either below or only slightly above the minimally clinically important difference. The rate of conversion to arthrodesis or total ankle arthroplasty was high, with failure rates of up to 52% reported. CONCLUSION Due to the inconsistent improvements in PROMs, which are likely overestimated due to substantial bias, and the high failure rate, this review suggests that distraction arthroplasty is not currently an effective treatment option for ankle arthritis. LEVEL OF EVIDENCE Level IV, systematic review of level I to IV studies.
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Affiliation(s)
- Zaki Arshad
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
| | - Aiman Aslam
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Khalid Abu-Zeinah
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Maneesh Bhatia
- Department of Trauma and Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Kim JS, Amendola A, Barg A, Baumhauer J, Brodsky JW, Cushman DM, Gonzalez TA, Janisse D, Jurynec MJ, Lawrence Marsh J, Sofka CM, Clanton TO, Anderson DD. Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society's Symposium on Targets for Osteoarthritis Research: Part 2: Treatment Options. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127013. [PMID: 36262470 PMCID: PMC9575443 DOI: 10.1177/24730114221127013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED This second of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey current treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 10, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Topics were chosen by meeting organizers, who then identified and invited the expert speakers. Part 2 overviews the current treatment options, including orthotics, non-joint destructive procedures, as well as arthroscopies and arthroplasties in ankles and feet. Opportunities for future research are also discussed, such as developments in surgical options for ankle and the first metatarsophalangeal joint. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the importance to patients of addressing the foot and ankle with improved basic, translational, and clinical research. LEVEL OF EVIDENCE Level V, review article/expert opinion.
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Affiliation(s)
- Jason S. Kim
- The Arthritis Foundation, Atlanta, GA,
USA,Jason S. Kim, PhD, The Arthritis
Foundation, 1355 Peachtree St NE, Suite 600, Atlanta, GA 30309, USA.
| | | | - Alexej Barg
- Department of Orthopaedics, University
of Utah, Salt Lake City, UT, USA
| | - Judith Baumhauer
- Department of Orthopaedic Surgery,
University of Rochester Medical Center, Rochester, NY, USA
| | | | - Daniel M. Cushman
- Division of Physical Medicine &
Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery,
University of South Carolina, Lexington, SC, USA
| | | | - Michael J. Jurynec
- Department of Orthopaedics and Human
Genetics, University of Utah, Salt Lake City, UT, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | | | - Donald D. Anderson
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
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Yang Z, Cui L, Tao S, Zhao J, Wang L, Zhang F, Shao X. Comparisons between ankle distraction arthroplasty and supramalleolar osteotomy for treatment of post-traumatic varus ankle osteoarthritis. BMC Surg 2022; 22:178. [PMID: 35568850 PMCID: PMC9107238 DOI: 10.1186/s12893-022-01623-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankle distraction arthroplasty and supramalleolar osteotomy were both options for post-traumatic varus ankle arthritis (VAA), but their comparative effectiveness was scarcely reported. This study aimed to compare the outcomes of two operative methods for treatment of Takakura-Tanaka stage 3 post-traumatic VAA. METHODS This was a retrospective study, comprising 73 consecutive patients who presented with Takakura-Tanaka stage 3 post-traumatic VAA treated by either ankle distraction arthroplasty (n = 32) or supramalleolar osteotomy (n = 41) from January 2016 to December 2019. All patients had a minimum 24-month follow-up assessments. The outcome measures were visual analog scale (VAS), the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, patient-rated overall satisfaction and ankle function. RESULTS At an average of 32 months (range, 24-52 months) follow-up, significant improvement was observed for VAS, AOFAS, range of motion (ROM) and most radiographic parameters (except for TAS and TLS for ankle distraction arthroplasty group) compared to preoperative baselines (p < 0.05) for both groups. However, both groups did not differ significantly in terms of VAS or AOFAS, excellent and good rate (78.1% versus 85.4%, p = 0.422), overall rate of postoperative complications (28.1% vs. 17.1%, p = 0.257), or various radiographic parameters (e.g. tibial anterior surface angle, talar tilt angle and tibial lateral surface angle) (all p > 0.05). The ankle distraction arthroplasty group had a better postoperative ankle motion than did the supramalleolar osteotomy group, in terms of plantarflexion (37.8 ± 4.2 vs. 30.4 ± 3.6, p = 0.006), dorsiflexion (36.5 ± 6.4 vs. 28.3 ± 5.5, p = 0.004), varus (32.1 ± 4.5 vs. 27.1 ± 3.1, p = 0.017) and valgus (28.4 ± 3.7 vs. 25.2 ± 2.8, p = 0.046). CONCLUSIONS Both operative treatments are effective for Takakura-Tanaka stage 3 post-traumatic VAA. In practice, individualized treatment option tailored to the ankle condition and patients' specific need should be considered. LEVEL OF EVIDENCE III, retrospective comparative series.
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Affiliation(s)
- Zongyu Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China.,Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Liang Cui
- Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Shiwu Tao
- Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Jianyong Zhao
- Department of Sports Medicine-Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM, Hebei, 061001, Cangzhou, People's Republic of China
| | - Li Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Fengqi Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Xinzhong Shao
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Hebei, 050051, Shijiazhuang, People's Republic of China. .,Department of Hand Surgery, The 3rd Hospital, Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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10
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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.
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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.
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Femino JE, Shamrock A. The Role of Anterior Ankle Arthroscopy in the Management of Ankle Arthritis: Literature Review, Patient Evaluation, Goals of Treatment and Technique. Foot Ankle Clin 2022; 27:159-174. [PMID: 35219364 DOI: 10.1016/j.fcl.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The current body of literature regarding anterior ankle arthroscopic debridement for anterior ankle impingement (AAI) cases with ankle osteoarthritis (OA) has significant limitations. The reported poor outcomes lack the necessary rigor in patient selection, preoperative evaluations and in most reports, the use of a systematic operative approach. Furthermore, the lack of postoperative evaluation by authors using physical examination and radiologic studies to determine the etiology of ongoing pain leaves open the possibility that treatment of impingement was incomplete. For these reasons, it would be inappropriate to conclude that anterior arthroscopic debridement has no role in the treatment of ankle OA. Critical analysis of some studies provides encouragement that this can be a useful intermediate treatment of appropriately selected patients with AAI and ankle OA. The level of required detail in the physical examination and radiologic evaluation is much greater than for more straight-forward cases of soft tissue impingement or simple osteophyte impingement in otherwise healthy joints. The success of the treatment requires a systematic approach to the evaluation and performance of the procedure, which is perhaps why results in the literature have been suboptimal in most series. Future studies should apply this rigorous approach to patient selection, procedure performance, and postoperative analysis to best clarify which patients can be best served with this procedure as part of the various intermediate treatment options for ankle OA.
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Affiliation(s)
- John E Femino
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA, USA.
| | - Alan Shamrock
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA, USA
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12
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Godoy-Santos AL, Fonseca LF, de Cesar Netto C, Giordano V, Valderrabano V, Rammelt S. Ankle Osteoarthritis. Rev Bras Ortop 2021; 56:689-696. [PMID: 34900095 PMCID: PMC8651441 DOI: 10.1055/s-0040-1709733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
Abstract
Osteoarthritis (OA) is characterized by a chronic, progressive and irreversible degradation of the joint surface associated with joint inflammation. The main etiology of ankle OA is post-traumatic and its prevalence is higher among young and obese people. Despite advances in the treatment of fractures around the ankle, the overall risk of developing post-traumatic ankle OA after 20 years is almost 40%, especially in Weber type B and C bimalleolar fractures and in fractures involving the posterior tibial border. In talus fractures, this prevalence approaches 100%, depending on the severity of the lesion and the time of follow-up. In this context, the current understanding of the molecular signaling pathways involved in senescence and chondrocyte apoptosis is fundamental. The treatment of ankle OA is staged and guided by the classification systems and local and patient conditions. The main problems are the limited ability to regenerate articular cartilage, low blood supply, and a shortage of progenitor stem cells. The present update summarizes recent scientific evidence of post-traumatic ankle OA with a major focus on changes of the synovia, cartilage and synovial fluid; as well as the epidemiology, pathophysiology, clinical implications, treatment options and potential targets for therapeutic agents.
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Affiliation(s)
- Alexandre Leme Godoy-Santos
- Laboratório Prof Manlio Mario Marco Napoli, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
- Programa Aparelho Locomotor, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, United States
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, SP, Brasil
| | | | - Stefan Rammelt
- Universitäts Centrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Alemanha
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Jansen MP, Boymans TA, Custers RJ, Van Geenen RC, Van Heerwaarden RJ, Huizinga MR, Nellensteijn JM, Sollie R, Spruijt S, Mastbergen SC. Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available. Cartilage 2021; 13:1113S-1123S. [PMID: 32698704 PMCID: PMC8808886 DOI: 10.1177/1947603520942945] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD. DESIGN MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies. RESULTS Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response. CONCLUSIONS Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.
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Affiliation(s)
- Mylène P. Jansen
- Department of Rheumatology &
Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands,Mylène P. Jansen, Department of Rheumatology
& Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100
(G02.228), Utrecht, 3584CX, The Netherlands.
| | - Tim A.E.J. Boymans
- Department of Orthopaedic Surgery,
Maastricht UMC, Maastricht, Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedic Surgery,
University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | - Jorm M. Nellensteijn
- Department of Orthopaedic Surgery,
Medisch Spectrum Twente, Enschede, Netherlands
| | - Rob Sollie
- Department of Orthopaedic Surgery,
Annatommie mc, Amstelveen/Utrecht, Netherlands
| | - Sander Spruijt
- Department of Orthopaedic Surgery,
HagaZiekenhuis, The Hague, Netherlands
| | - Simon C. Mastbergen
- Department of Rheumatology &
Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
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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.
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Hikichi T, Matsubara H, Ugaji S, Hamada T, Tsuchiya H. Large Osteochondral Defects of the Distal Tibia Plafond After Septic Arthritis of the Ankle Joint Treated by Arthrodiastasis and Iliac Bone Graft: A Case Report. J Foot Ankle Surg 2021; 59:857-862. [PMID: 32312656 DOI: 10.1053/j.jfas.2020.03.001] [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: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 02/03/2023]
Abstract
Bone defects after septic arthritis of the ankle joint result in arthrodesis and severe loss of ankle motion. This must be prevented in young athletes. We report the case of a 17-year-old male patient with large osteochondral defects in the distal tibia plafond after septic arthritis, in whom iliac bone graft and arthrodiastasis were performed to preserve ankle motion. He was diagnosed with septic arthritis of the ankle joint postoperatively at the age of 16 years. After irrigation and hardware removal, C-reactive protein level was normal. However, he experienced continuous pain and could not walk; he was referred to our hospital. Computed tomography showed large osteochondral defects in the medial tibia plafond occupying ∼30% of the plafond articular surface. Simultaneous iliac bone block graft and arthrodiastasis with an external fixator were performed. We placed iliac bone graft into the defect in the medial tibia plafond using the anterior approach, and we placed an external fixator with hinge and tractioned and fixed the ankle joint. One week postoperatively, range of motion training of the ankle was started. We removed the foot ring at 3 months and the external fixator at 4 months postoperatively. The patient started jogging at 8 months and performing long jump at 1 year postoperatively. The Japanese Society for Surgery of the Foot ankle/hindfoot scale improved from 56 to 97 points at 2-year follow-up. Despite large osteochondral defects with septic arthritis, arthrodiastasis and iliac bone graft were beneficial for preserving the ankle joint and its function.
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Affiliation(s)
- Toshifumi Hikichi
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Kanazawa University Hospital, Ishikawa, Japan
| | - Hidenori Matsubara
- Assistant Professor, Department of Orthopaedic Surgery, Kanazawa University Hospital, Ishikawa, Japan.
| | - Shuhei Ugaji
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Kanazawa University Hospital, Ishikawa, Japan
| | - Tomo Hamada
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Kanazawa University Hospital, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Professor, Department of Orthopaedic Surgery, Kanazawa University Hospital, Ishikawa, Japan
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16
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Ghasemi SA, Zhang D, Fragomen A, Rozbruch SR. Subtalar distraction arthroplasty with bone marrow aspirate concentrate (BMAC), preliminary results of a new joint preservation technique. Foot Ankle Surg 2021; 27:87-92. [PMID: 32165094 DOI: 10.1016/j.fas.2020.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/25/2020] [Accepted: 02/20/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Isolated subtalar osteoarthritis (OA) is a debilitating condition usually occurring after trauma and particularly in the setting of an intraarticular calcaneal fracture. Currently, subtalar (talo-calcaneal joint) fusion surgery is the treatment of choice in managing subtalar OA after failure of conservative treatment. Unfortunately, subtalar fusion eliminates joint motion and increases the load over the adjacent midfoot and ankle joints, which affects the outcome of the surgery over time. Popular in the ankle, distraction arthroplasty offers another joint-preserving option, particularly important for active patients. In contrast to fusion as a salvage procedure, subtalar distraction arthroplasty allows the possibility of maintaining the function of the arthritic subtalar joint while reducing pain and improving the overall function of the foot and ankle. METHODS We performed subtalar distraction arthroplasty using a circular external fixator combined with BMAC on seven patients with symptomatic and refractory subtalar OA. All these patients were interested in an alternative to fusion. We obtained clinical and radiographic data before and after surgery. Ankle Osteoarthritis Score (AOS) and the Marijnissen Distraction Clinical Score (MDCS) were obtained before surgery, after one year, and at latest follow-up. RESULTS The average age was 56 years (range 45-69). The mean duration of post-operative follow-up was 35.4 months (range 15.2-53.5). The inversion of the ankle joint changed from 16.9° (10°-25°) pre-operatively to 14.3° (10°-20°) post-operatively (P = 0.28), and the eversion from 5.6° (0°-10°) to 10.0° (0°-20°) (P = 0.17). We found an increase in subtalar joint space from 1.4 mm (0-3) to 2.6 mm (2-4) before and after surgery (P = 0.01), respectively. Finally, Pixel Density Ratio (PDR) increased from 0.87 (0.66-1.30) to 1.01 (0.89-1.18) (P = 0.19). Compared to pre-operative conditions, we observed a decrease in subchondral sclerosis on X-ray in all cases post-operatively. The AOS score for ankle pain improved from 58.8 (47-74) to 15.1 (0-31) (p < 0.01). The AOS score for ankle disability improved from 68.2 (57-81) to 16.1 (0-43.5) (p < 0.001). We found improvement in the MDCS over time for all measured parameters. The clinical condition improved from 1.4 (0-2) to 0.8 (0-2) after one year and to 0.3 (0-2) at the latest follow-up (p < 0.001). Mobility was measured as ROM in the treated ankle relative to each patient's contralateral ankle. This increased from 35% (0-100) to 66% (15-120) to 76% (15-100) (p = 0.059). Function improved from 2.3 (0-3) to 1.3 (0-3) to 0.6 (0-3) (p < 0.001). Pain decreased from 7.4 (2-10) to 4.4 (2-8) to 2.1 (0-7) (p < 0.01). Complications include one patient with sensory neuralgia. CONCLUSIONS Preliminarily, results of subtalar distraction arthroplasty as a new joint preservation technique are encouraging. Our research suggests the possibility of subtalar distraction arthroplasty as an effective treatment for symptomatic subtalar OA. Furthermore, this new operation does not eliminate the possibility of a future surgery like fusion. Subtalar distraction arthroplasty can be helpful in the management of subtalar OA in active patients who desire preservation of foot and ankle motion.
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Liu XN, Chang F, Zhang HY, Zhong Z, Xue P, Huang BZ. Ankle distraction arthroplasty for the treatment of severe ankle arthritis: Case report, technical note, and literature review. Medicine (Baltimore) 2020; 99:e22330. [PMID: 32991444 PMCID: PMC7523852 DOI: 10.1097/md.0000000000022330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Widely applied in the treatment of severe ankle arthritis (AA), ankle distraction arthroplasty (ADA) can avoid not only the ankle range of motion loss but also ankle fusion. However, the clinical outcomes of ADA for severe AA are poorly understood. This study aims to present our clinical outcomes of severe AA treated by ADA. PATIENT CONCERNS A 53-year-old man suffered right ankle sprain 10 years ago, endured right ankle pain and limited movement for 6 years. DIAGNOSIS The patient was diagnosed as severe AA. INTERVENTIONS He received ankle distraction arthroplasty. No adjuvant procedures were performed. The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the short-form (SF)-36 physical component summary (PCS) score and ankle activity score (AAS) were recorded to access the clinical outcomes pre- and postoperatively. Moreover, ankle joint space distance was evaluated on weight-bearing radiographs. OUTCOMES The patient derived effective pain relief and restored a satisfactory range of movement. There was a 13-month follow-up period after frame removal. The AOFAS score improved from 56 preoperatively to 71 postoperatively. The VAS score decreased from 6 prior to surgery to 1 after surgery. The SF-36 PCS was 47.2 and 71.8 pre- and postoperative, respectively. The AAS scores were improved from 3.4 preoperatively to 7.3 postoperatively. LESSONS ADA is reliable to achieve pain relief, functional recovery, and serve AA resolution. Besides, it is an alternative to ankle arthrodesis or total ankle arthroplasty in selected patients with severe AA.
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18
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Gianakos AL, Haring RS, Shimozono Y, Fragomen A, Kennedy JG. Effect of Microfracture on Functional Outcomes and Subchondral Sclerosis Following Distraction Arthroplasty of the Ankle Joint. Foot Ankle Int 2020; 41:631-638. [PMID: 32354229 DOI: 10.1177/1071100720917144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment for post-traumatic osteoarthritis (PTOA) of the ankle remains challenging. Distraction arthroplasty (DA) is an alternative for patients who are averse to or poor candidates for arthrodesis or joint replacement. The purpose of this study was to examine the role of microfracture (MFX) and concentrated bone marrow aspirate (CBMA) on the outcome of patients undergoing DA for end-stage PTOA of the ankle joint. METHODS Ninety-five patients who underwent DA for the treatment of end stage PTOA from 2009 to 2014 were selected from the hospital ankle registry. Demographic data, functional activity levels, complications, and radiographs taken at 6, 12, 24, and 36 months postoperatively were reviewed. Foot and Ankle Outcome Scores (FAOS) were obtained at the same time intervals. A total of 78 patients were included in this study. Interventions were divided into 4 groups for comparison: DA+MFX (n = 8), DA+MFX+CBMA (n = 35), DA+CBMA (n = 22), and DA alone (n = 13). RESULTS Patients undergoing DA+MFX or DA+MFX+CBMA had significantly worse motion (P = .003) when compared with DA alone. Patients undergoing MFX had significantly reduced postoperative joint space and a greater length of time to return to activity when compared to subgroups not using MFX (P = .01). The use of MFX was associated with significantly lower FAOS scores. CONCLUSION The current study showed no benefit from MFX when combined with DA in the treatment of PTOA. CBMA may have helped mitigate the adverse effect of MFX but conferred no benefit when used with DA alone. DA remains a useful alternative to ankle arthrodesis and arthroplasty in patients with PTOA. However, MFX and biologic augmentation using CBMA appeared to have no additional benefit. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Arianna L Gianakos
- Department of Orthopedic Surgery, Robert Wood Johnson Barnabas Health-Jersey City Medical Center, Jersey City, NJ, USA
| | - R Sterling Haring
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yoshiharu Shimozono
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.,Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Austin Fragomen
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John G Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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19
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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.
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21
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Debridement and hinged motion distraction is superior to debridement alone in patients with ankle osteoarthritis: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2019; 27:2802-2812. [PMID: 30264242 DOI: 10.1007/s00167-018-5156-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 09/19/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate and compare complication rates and postoperative outcomes in patients with ankle debridement alone vs. debridement and hinged ankle distraction arthroplasty. METHODS A total of 50 patients with posttraumatic ankle osteoarthritis (OA) with a mean age of 40.0 ± 8.5 years were included into this prospective randomized study: 25 patients in ankle debridement alone group and 25 patients in debridement and hinged ankle distraction group. The mean follow-up was 46 ± 12 months (range 36-78 months). The clinical and radiographic outcomes were evaluated at the 6-month and 3-year follow-up using the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, SF-36 quality of life score, and van Dijk OA classification. A Kaplan-Meier survival analysis was performed to calculate the 3-year and 5-year survival rates. RESULTS Both patient groups experienced significant pain relief, functional improvement, and improvement in quality of life postoperatively. In total, 26 major secondary procedures were performed. The overall survival rates in the debridement and ankle distraction group were 19 of 25 (74%) and 15 of 25 (59%) at 3 years and 5 years, respectively. The overall survival rates in the ankle debridement alone group were 12 of 25 (49%) and 9 of 25 (34%) at 3 years and 5 years, respectively. CONCLUSIONS The study demonstrated comparable postoperative functional outcome and quality of life. However, rate of postoperative revision surgery was substantially higher in ankle debridement alone group. LEVEL OF EVIDENCE Randomized controlled study, Level I.
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Abstract
Ankle arthritis is a major source of morbidity impacting a younger working age population than hip and knee arthritis. Unlike the hip and knee, more than 70% of ankle arthritis cases are post-traumatic, with the remainder being inflammatory or primary arthritis. Nonoperative treatment begins with lifestyle and shoe-wear modifications and progresses to bracing, physical therapy, anti-inflammatory medications, and intra-articular injections. Ankle arthrodesis and total ankle arthroplasty are the 2 main surgical options for end-stage ankle arthritis, with debridement, realignment osteotomy, and distraction arthroplasty being appropriate for limited indications.
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Affiliation(s)
- Vu Le
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Peter Salat
- Department of Radiology, University of Calgary, Alberta, Canada
| | - Kevin Wing
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Murray Penner
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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Greenfield S, Matta KM, McCoy TH, Rozbruch SR, Fragomen A. Ankle Distraction Arthroplasty for Ankle Osteoarthritis: A Survival Analysis. Strategies Trauma Limb Reconstr 2019; 14:65-71. [PMID: 32742416 PMCID: PMC7376580 DOI: 10.5005/jp-journals-10080-1429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The treatment algorithm for end-stage ankle arthritis is imperfect. Young or active patients are challenging to treat as fusion and replacement carry predictable consequences. Ankle distraction arthroplasty is a less commonly utilized surgical procedure for the treatment of osteoarthritis of the ankle. The purpose of this study was to report intermediate-term survival of ankle distraction and to identify factors associated with earlier time to failure. Materials and methods A single-centre, multi-surgeon cohort of 258 cases of ankle arthritis, treated with ankle distraction or ankle distraction with supramalleolar osteotomy (SMO), was identified. Patients were contacted by phone to determine the status of the ankle (natural vs fused/replaced). Data were collected through chart review. This included patient demographics, medical comorbidities, surgical procedure, and X-ray characteristics including pattern and severity. A Cox regression model was used to determine factors associated with failure during 10 years of follow-up. Risk factors were analysed as hazard ratios (HRs) and 95% confidence intervals (CIs). Time to failure was illustrated with Kaplan–Meier (KM) curves. Results In total, 144 cases were successfully contacted with median follow-up of 4.57 years. In total, 16.7% of ankles failed (24/144). The 5-year survival was 84% (95% CI: 78–91%). In adjusted Cox regression, female sex (HR = 2.68, p = 0.049) and avascular necrosis (AVN) of the talus (HR = 3.77, p = 0.041) were significantly associated with failure risk. Conclusion Avascular necrosis of the talus and male/female gender differences in survival were found to be significant. Our experience shows that ankle distraction is a valid and effective operation for the treatment of end-stage ankle arthritis. Clinical significance This work is clinically significant in that it demonstrates excellent intermediate-term survival data for hinged ankle distraction for treatment of osteoarthritis of the ankle. Additionally, it evaluated patient and disease characteristics allowing improved patient counselling with regard to survival longevity. Level of evidence IV cohort study. How to cite this article Greenfield S, Matta KM, McCoy TH, et al. Ankle Distraction Arthroplasty for Ankle Osteoarthritis: A Survival Analysis. Strategies Trauma Limb Reconstr 2019;14(2):65–71.
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Affiliation(s)
- Stephen Greenfield
- Department of Orthopaedic Surgery, Foot and Ankle and Limb Deformity and Reconstructive Surgery, OrthoIndy Hospital, Indianapolis, Indiana, USA
| | - Kelsey M Matta
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Thomas H McCoy
- Department of Orthopaedic Surgery, Harvard Medical School, Center for Quantitative Health, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - S Robert Rozbruch
- Department of Orthopaedic Surgery, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, USA
| | - Austin Fragomen
- Department of Orthopaedic Surgery, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, USA
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Hamdy RC, Bernstein M, Fragomen AT, Rozbruch SR. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2018; 100:1436-1442. [PMID: 30106829 DOI: 10.2106/jbjs.18.00584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Reggie C Hamdy
- Shriners Hospital for Children, Montreal, Quebec, Canada
| | - Mitchell Bernstein
- Shriners Hospital for Children, Montreal, Quebec, Canada.,McGill University Health Center, Montreal, Quebec, Canada
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Xu Y, Zhu Y, Xu XY. Ankle joint distraction arthroplasty for severe ankle arthritis. BMC Musculoskelet Disord 2017; 18:96. [PMID: 28245830 PMCID: PMC5331661 DOI: 10.1186/s12891-017-1457-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/21/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Ankle distraction arthroplasty is one option for the treatment of severe ankle arthritis in young patients. The outcomes and factors predicting success in distraction arthroplasty are poorly understood. METHODS From January 2011 to May 2015, 16 patients who had undergone ankle distraction arthroplasty for ankle arthritis were operated, including six males and ten females. All patients were available for analysis. The main outcome measurements included joint space on weight bearing radiographs, AOFAS-AH scores (American Orthopaedic Foot & Ankle Society ankle-hindfoot score), VAS scores and SF-36 scores. RESULTS All 16 patients were followed for a mean follow-up of 40.9 ± 14.7 months (range, 17-67 months). Fourteen of the 16 patients still had their native ankle joints. One patient had undergone ankle arthrodesis 1 year after the operation and one patient had converted to spontaneous ankle fusion at the 3 years follow-up postoperative. The VAS score improved from 5.9 ± 0.8 to 3.7 ± 2.2 (p = 0.0028). The mean AOFAS-AH score improved from 41.9 ± 7.2 preoperatively to 68.1 ± 20.0 postoperatively (p = 0.001). The mean SF-36 score improved from 43.1 ± 7.6 preoperatively to 62.7 ± 18.8 postoperatively (p = 0.002). A weight-bearing ankle space larger than 3 mm at 1 year following distraction is a positive predictive factor. CONCLUSIONS In this study, the treatment of ankle motion distraction for end stage ankle arthritis showed benefit in 9/16 (56.25%) patients at 41 months. It is a promising method for young patients with severe ankle arthritis.
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Affiliation(s)
- Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.,Shanghai Institute of Traumatology and Orthopedics, Shanghai, China
| | - Yuan Zhu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Xiang-Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
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