Outcomes of Tibiotalocalcaneal Arthrodesis vs Talar Body Prosthesis as Treatment of Collapsed Avascular Necrosis of the Talus: A 10- to 13-Year-Follow-up Retrospective Comparative Study

BACKGROUND

Joint salvage surgeries such as tibiotalocalcaneal arthrodesis and talar prosthesis are commonly used in the surgical treatment of collapsed avascular necrosis of the talus (AVNT). However, differences in outcomes of these 2 surgical treatments are still inconclusive. This study compared the 10- to 13-year outcomes and 10-year survivorship rates of tibiotalocalcaneal arthrodesis and talar body prosthesis in the surgical treatment of collapsed AVNT.

METHODS

A retrospective comparative study was conducted of patients who underwent either tibiotalocalcaneal arthrodesis or talar body prosthesis implantation between 2005 and 2012. The demographic matching process resulted in 24 patients per treatment group. Clinical outcomes were evaluated using a numeric rating scale (NRS) of 2 hours of activities of daily living (ADL) and Foot and Ankle Ability Measure (FAAM) for ADL. Radiographic assessments included the incidence of nonunion, adjacent joint arthritis, and prosthesis loosening. The 10-year survivorship of both surgical treatments was calculated. A P value of less than .05 was considered statistically significant.

RESULTS

The median NRS of 2 hours of ADL and FAAM score for ADL were statistically significantly better in the talar body prosthesis group, with P values of .001 and <.001, respectively. The statistically significant differences in FAAM score for ADL exceeded the minimum clinically important difference. In the tibiotalocalcaneal arthrodesis group, nonunion was observed in 7 of 24 patients (29.2%). No prosthesis loosening was reported in the talar body prosthesis group. The 10-year survivorship was statistically significantly higher in talar body prosthesis than tibiotalocalcaneal arthrodesis (95.8% vs 70.8%), P = .023.

CONCLUSION

Talar body prosthesis implantation in selected eligible patients demonstrated statistically significantly better 10- to 13-year clinical outcomes and higher 10-year survivorship compared with tibiotalocalcaneal arthrodesis in the surgical treatment of collapsed AVNT.

LEVEL OF EVIDENCE

Level III, retrospective cohort comparative study.

Sport and Exercise Activity After Isolated Ankle Arthrodesis for Advanced-Stage Ankle Osteoarthritis: A Single-Center Retrospective Analysis

Background

Ankle arthrodesis, a recognized operative treatment for advanced-stage ankle osteoarthritis (OA), is recommended when conservative treatment proves unsuccessful. This single-center retrospective analysis examined the change in functional outcomes and the type of sport/exercise activity performed by advanced-stage ankle OA patients after ankle arthrodesis treatment.

Methods

A total of 61 advanced-stage ankle OA patients (age, 63.1 ± 12.6 years) who had undergone ankle arthrodesis were included in this single-center retrospective study. The patients had functional outcomes evaluated via American Orthopaedic Foot & Ankle Society Score (AOFAS), Foot Function Index (FFI), Tegner Activity Level Scale (TAS), and High-Activity Arthroplasty Score (HAAS) questionnaires. Clinical status was compared across prearthritic, arthritic, and postarthrodesis periods, and satisfaction with return to sport/exercise activity was recorded.

Results

Patients' tarsal sagittal ROM (mean [95% CI]: 22.7 degrees [21.4-24.0]); time to union (15.7 weeks [11.8-19.6]); time to walk without gait aid (14.4 weeks [11.0-17.7]); time to return to work (17.9 weeks [15.1-20.8]); and time to exercise activity (20.6 weeks [17.9-23.4]) were recorded postarthrodesis. Hindfoot alignment angle toward a neutral position (difference: 11.4 degrees [9.2-13.6], P < .001) and functional outcomes (P < .001) significantly improved after arthrodesis surgery; however, only the TAS questionnaire indicated patients returned to their prearthritic activity level (P > .99). Patients generally reported "good" satisfaction with their recovery from ankle arthrodesis surgery, with 64% of patients returning to high-impact-type activity.

Conclusion

Advanced-stage ankle OA patients had improved functional outcomes at ~1 year postarthrodesis surgery, enabling the majority of patients to return to high-impact-type activity.

Level of Evidence

Level III, retrospective cohort study.

The Efficacy of Posterior Fasciotomy Versus Inserted Vacuum Drainage in Reducing Postoperative Surgical Site Infection in Open Achilles Tendon Repair: A Prospective Cohort Study With Inverse Probability Treatment Weight Propensity Score Analysis

Posterior crural fasciotomy (PF) may reduce postoperative surgical site infection (SSI) rate compared to inserted vacuum suction drainage (VD) in open Achilles tendon repair surgery. Thus, we aimed to compare the postoperative SSI rate between PF and VD in open Achilles's tendon repair surgery. A prospective, single-centered, nonrandomized controlled study of consecutive adult patients undergoing primary open Achilles tendon repair was performed at tertiary referral hospital between January 2017 and January 2020. Patients received either PF or VD from 2 experienced surgeons. Data were collected on demographic, clinical, and intraoperative characteristics along with postoperative SSI and other outcomes. The primary outcome was SSI rate. Secondary outcomes were Achilles tendon total rupture score, functional foot index, and visual analogue scale. A total of 60 patients were eligible and included in the final analysis (PF group n = 30 and VD group n = 30). Two (6.7%) patients in the PF group and 5 (16.7%) patients in the VD group experience postoperative SSI (crude risk ratio 0.40; 95% confidence interval 0.08, 1.90; p = .228). In inverse-probability-treatment-weighted propensity score analysis, the PF group had a significantly lower SSI rate than the VD group (adjusted risk ratio 0.30; 95% confidence interval 0.01, 0.91; p = .033). Inverse-probability-treatment-weighted propensity score analysis of Achilles tendon total rupture score along with crude analysis of total functional foot index and visual analogue scale were also significantly better in the PF group than the VD group (all p < .05). PF during open Achilles repair was associated with a significant reduction in postoperative SSI infection rate compared to VD.