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Fadle AA, El-Adly W, Fekry MA, Osman AE, Khalifa AA. Primary arthrodesis for diabetic ankle fractures using a modified retrograde femoral intramedullary locking nail combined with lateral plating, surgical technique, and early results of a pilot study. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03947-1. [PMID: 38693347 DOI: 10.1007/s00590-024-03947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE We aimed to report the early results of performing acute ankle arthrodesis using a modified retrograde femoral intramedullary locking IMN concomitant with plating at the same setting for managing diabetic patients' acute ankle fractures. METHODS We prospectively included patients who presented acutely with ankle fractures, where hemoglobin A1C (HbA1C) on admission was > 7%, and the Adelaide Fracture in the Diabetic Ankle (AFDA) algorithm score was 5 or above. All patients were treated by acute ankle arthrodesis using a modified retrograde femoral IMN combined with lateral plating. Functional assessment was reported according to a modified American Orthopaedic Foot and Ankle Society ankle hindfoot scale (AOFAS), and complications were documented. RESULTS Six patients had an average age of 55.7 years (37-65). The average HbA1C on admission was 7.9 (7.3-9), and the average AFDA score was 7.3 (6-8). The average operative time was 79.2 min (70-90). All patients, except for one, achieved union at the arthrodesis site after an average of 10.3 weeks (8-14). After an average last follow-up of 9 months (6-12), the average modified AOFAS was 73.2 (82 to 62); four patients had an excellent score and one good. Complications developed in two, one deep infection after 2 weeks treated by metal removal and Ilizarov, and the other patient developed a stress fracture at the tibial end of the nail, which was treated by open reduction and internal fixation using a plate and screws. CONCLUSION Using a modified femoral IMN combined with lateral plating is a promising technique to achieve ankle arthrodesis in diabetic patients with acute ankle fractures with acceptable outcomes; however, further studies with larger numbers are needed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Amr A Fadle
- Department of Orthopedic, Assiut University Hospital, Assiut, Egypt
| | - Wael El-Adly
- Department of Orthopedic, Assiut University Hospital, Assiut, Egypt
| | | | - Ahmed E Osman
- Department of Orthopedic, Assiut University Hospital, Assiut, Egypt
| | - Ahmed A Khalifa
- Department of Orthopedic, Qena Faculty of Medicine and University Hospital, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, 83523, Egypt.
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Shah AA, Devana SK, Lee C, SooHoo NF. A predictive algorithm for perioperative complications and readmission after ankle arthrodesis. Eur J Orthop Surg Traumatol 2024; 34:1373-1379. [PMID: 38175277 DOI: 10.1007/s00590-023-03805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Ankle arthrodesis is a mainstay of surgical management for ankle arthritis. Accurately risk-stratifying patients who undergo ankle arthrodesis would be of great utility. There is a paucity of accurate prediction models that can be used to pre-operatively risk-stratify patients for ankle arthrodesis. We aim to develop a predictive model for major perioperative complication or readmission after ankle arthrodesis. METHODS This is a retrospective cohort study of adult patients who underwent ankle arthrodesis at any non-federal California hospital between 2015 and 2017. The primary outcome is readmission within 30 days or major perioperative complication. We build logistic regression and ML models spanning different classes of modeling approaches, assessing discrimination and calibration. We also rank the contribution of the included variables to model performance for prediction of adverse outcomes. RESULTS A total of 1084 patients met inclusion criteria for this study. There were 131 patients with major complication or readmission (12.1%). The XGBoost algorithm demonstrates the highest discrimination with an area under the receiver operating characteristic curve of 0.707 and is well-calibrated. The features most important for prediction of adverse outcomes for the XGBoost model include: diabetes, peripheral vascular disease, teaching hospital status, morbid obesity, history of musculoskeletal infection, history of hip fracture, renal failure, implant complication, history of major fracture. CONCLUSION We report a well-calibrated algorithm for prediction of major perioperative complications and 30-day readmission after ankle arthrodesis. This tool may help accurately risk-stratify patients and decrease likelihood of major complications.
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Affiliation(s)
- Akash A Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-116 CHS, Los Angeles, CA, 90095, USA.
| | - Sai K Devana
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-116 CHS, Los Angeles, CA, 90095, USA
| | - Changhee Lee
- Department of Artificial Intelligence, Chung-Ang University School of Software and Computer Engineering, Seoul, South Korea
| | - Nelson F SooHoo
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 76-116 CHS, Los Angeles, CA, 90095, USA
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Yasutomi M, An VVG, Xu J, Wines A, Sivakumar BS, Symes MJ. Trends in the use of ankle arthrodesis and total ankle replacements in Australia over the past 20 years. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03884-z. [PMID: 38502343 DOI: 10.1007/s00590-024-03884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND End stage ankle osteoarthritis (OA) is debilitating. Surgical management consists of either ankle arthrodesis (AA) or a total ankle replacement (TAR). The purpose of this study is to assess the trends in operative intervention for end stage ankle OA in an Australian population. METHODS This is a retrospective epidemiological study of 15,046 surgeries. Data were collected from publicly available national registries including the Australian Medicare Database and Australian Orthopaedic Association National Joint Replacement Registrar from 2001 to 2020. RESULTS There was a significant increase in all ankle surgeries performed across the period of interest. AA remained the more commonly performed procedure throughout the course of the study (11,946 cases, 79.4%) and was never surpassed by TAR (3100, 20.6%). The overall proportions demonstrated no significant changes from 2001 to 2020. CONCLUSION The incidence of ankle surgeries continues to increase with the ageing and increasingly comorbid population of Australia. Despite demonstrating no significant overall change in the ratio of TAR and AA in our study population and period, there are noticeable trends within the timeframe, with a recent surge favouring TAR in the last 5 years.
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Affiliation(s)
- Motofumi Yasutomi
- Department of Orthopaedics, Royal North Shore Hospital, Pacific Hwy, St Leonards, NSW, 2065, Australia.
| | - Vincent V G An
- Department of Orthopaedics, Royal North Shore Hospital, Pacific Hwy, St Leonards, NSW, 2065, Australia
| | - Joshua Xu
- Department of Orthopaedics, Royal North Shore Hospital, Pacific Hwy, St Leonards, NSW, 2065, Australia
| | - Andrew Wines
- Department of Orthopaedics, Royal North Shore Hospital, Pacific Hwy, St Leonards, NSW, 2065, Australia
| | - Brahman S Sivakumar
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Michael J Symes
- Department of Orthopaedics, Royal North Shore Hospital, Pacific Hwy, St Leonards, NSW, 2065, Australia
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4
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Abstract
With continuing advancements in total ankle arthroplasty (TAA), it is quickly becoming the procedure of choice for older patients with end-stage ankle arthritis. Multiple studies have been conducted on younger patients who have undergone TAA with promising results, but is it the procedure of choice? Considerations of TAA versus ankle arthrodesis, TAA implant longevity, outcomes of revision TAA, and whether patients should be offered an arthrodesis with plans for conversion to arthroplasty may help elucidate whether pursuing ankle arthroplasty in a younger, more active population is the correct approach for surgeons.
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Affiliation(s)
- M Pierce Ebaugh
- Jewett Orthopedic Institute at Orlando Health, 1285 N Orange Avenue, Winter Park, FL 32789, USA.
| | - William C McGarvey
- Orthopedic Foot and Ankle Reconstruction, McGovern College of Medicine - University of Texas Health Science Center at Houston, 6400 Fannin, Suite 1700, Houston, TX 77030, USA
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Xie Q, Sui L, Sun Y, Li X, Liu S, Wang P. Comparisons of ankle arthrodesis with different internal fixation methods in the treatment of post-traumatic osteoarthritis. J Orthop Sci 2024; 29:621-626. [PMID: 36858837 DOI: 10.1016/j.jos.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 01/06/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The aim of this study was to explore the clinical efficacy of ankle arthrodesis with different internal fixation methods in the treatment of post-traumatic osteoarthritis. METHODS We collected 85 patients with post-traumatic osteoarthritis who underwent different ankle arthrodesis between December 2015 and December 2020. The operation performance, complication rate, hindfoot alignment, talus tilt angle, visual analogue scale (VAS), and American Orthopedic Foot and Ankle Society (AOFAS) score were preoperatively and postoperatively evaluated. RESULTS In an anterior approach, the locking plate-fixation exhibited a similarity in operation time, incision length, postoperative drainage, bone fusion, hindfoot alignment, and talus tilt angle with fibula support compression screw-fixation, but it was better in increasing postoperative AOFAS. The locking plate-fixation in the anterior approach had lower operation time, incision length, and postoperative drainage than that in the lateral approach. In addition, the lateral locking plate combined with posterolateral compression screw fixation (LLPPCSF) presented shorter bone fusion time, higher AOFAS score, and lower complication rate than either plate- or screw-fixation alone. CONCLUSION Lateral locking plate fixation was better than fibula support compression screw fixation in relieving postoperative pain. Anterior locking plate fixation was more time-saving and less invasiveness than lateral locking plate fixation, but its application was limited in low degree of ankle deformation. LLPPCSF was the most effective in improving bone fusion and postoperative pain, considering an optimal option for the treatment of post-traumatic osteoarthritis.
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Affiliation(s)
- Qiang Xie
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Lei Sui
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Yupeng Sun
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Xiaodong Li
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Shibo Liu
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China
| | - Pei Wang
- Department of Hand and Foot Surgery, Affiliated Hospital of Chengde Medical University, Chengde City, Hebei Province, 067000, China.
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Rodriguez-Merchan EC, Moracia-Ochagavia I. Results of Total Ankle Arthroplasty Versus Ankle Arthrodesis. Foot Ankle Clin 2024; 29:27-52. [PMID: 38309802 DOI: 10.1016/j.fcl.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
No differences have been found between total ankle arthroplasty (TAA) and ankle arthrodesis (AA) with respect to patient-reported outcome measures (PROMs), although both interventions were shown to improve PROMs with respect to the preoperative situation. That is, both interventions (AA and TAA) were effective in improving preoperative symptoms. On the other hand, 2-year complication rates were higher after AA (27%) than after TAA (16%); however, infection rates were similar (4%). The published revision rate after AA is 16% versus 11% after TAA. In short, TAA and AA appear to offer the same PROMs, but TAA has a lower rate of complications (except for infection) and revisions.
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Affiliation(s)
| | - Inmaculada Moracia-Ochagavia
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, 28046-Madrid, Spain
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Araujo-Monsalvo VM, Toledo-Romo MF, Rodríguez-Castro GA, Vázquez-Escamilla J, Domínguez-Hernández VM, Meneses-Amador A, Cortés-García JR, Martínez-Coria E. Comparative study of two retrograde locked intramedullary nail designs for ankle arthrodesis: A finite element analysis. Proc Inst Mech Eng H 2024; 238:198-206. [PMID: 38193256 DOI: 10.1177/09544119231221191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Ankle arthrodesis is the gold standard for treatment of end-stage arthritis. The goal of ankle arthrodesis is to obtain bony union between the tibia and the talus. Retrograde intramedullary nailing is typically reserved for ankle and subtalar joints arthrodesis. The purpose of this study is to evaluate the effect of two different materials, two locking pin configurations and two nail designs of a retrograde locked intramedullary nail used for ankle arthrodesis. Using the finite element analysis, a numerical study of ankle arthrodesis was developed to evaluate the effect of materials: TI-6Al-4V and stainless steel AISI 316 LVM; two locking pin configurations: five and six pins, on two intramedullary nails: Ø10 × 180 mm and Ø11 × 200 mm. A model of a healthy foot was created from tomographic scans. It was found that the mechanical stimulus required to achieve bone fusion were higher for Ø10 × 180 nails (6.868 ± 0.047) than the Ø11 × 200 nails (5.918 ± 0.047; p < 0.001; mean ± SEM). We also found that six-pin configuration had a higher mechanical stimulus (6.470 ± 0.047) than the five-pin configuration (6.316 ± 0.046; p = 0.020). Similarly, it was higher for titanium (6.802 ± 0.047) than those for stainless steel (5.984 ± 0.046; p < 0.001). Finally, the subtalar zone presented higher values (7.132 ± 0.043) than the tibiotalar zone (5.653 ± 0.050; p < 0.001). The highest mechanical stimulus around the vicinity of tibiotalar and subtalar joint was obtained by Ø10 × 180 nails, made of titanium alloy, with 6P.
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Affiliation(s)
- Víctor Manuel Araujo-Monsalvo
- Laboratorio de Biomecánica, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
| | | | | | - Jesús Vázquez-Escamilla
- Deformidades Neuromusculares, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
| | | | - Alfonso Meneses-Amador
- Departamento de Ingeniería Mecánica, SEPI-ESIME, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Juan Ricardo Cortés-García
- Deformidades Neuromusculares, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
| | - Elisa Martínez-Coria
- Tomografía Computada, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra," Mexico City, Mexico
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Feng B, Gao QB, Dai GM, Niu KC, Jiang W, Wang ZY, Zheng HY. Comparison of different internal fixation models in ankle arthrodesis using 3D finite-element analysis. Eur J Med Res 2023; 28:574. [PMID: 38066608 PMCID: PMC10704803 DOI: 10.1186/s40001-023-01554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The purpose of this study is to use three-dimensional finite-element analysis to better understand the biomechanical features of various internal fixators for ankle arthrodesis. METHODS We used finite-element analysis to compare four different types of internal fixations in ankle arthrodesis: Group A had three crossed screws (Ø6.5 mm); Group B had two crossed screws (Ø6.5 mm) and an anterior plate (Ø2.7 mm); Group C only had an anterior anatomical plate (Ø3.5 mm); Group D had one anterior anatomical plate (Ø3.5 mm) and one posterior-lateral screw (Ø6.5 mm). We adopted Ansys 21.0 software to analyze and compare the four types in terms of the displacement of the arthrodesis surface and the stress peak and stress distribution of these models under intorsion, extorsion, dorsiflexion torque, and neutral vertical load. RESULTS ① Displacement of the arthrodesis surface: In Group A, the maximum displacement was larger than Group D under neutral vertical load and dorsiflexion torque but less than it under intorsion and extorsion torque. In Group B, the maximum displacement against dorsiflexion, neutral vertical load, intorsion, and extorsion was less than that in the other three fixation models. In Group C, the maximum displacement against the above four loading patterns were significantly higher than that in another three fixation models. ② Stress peak and stress distribution: based on the stress distribution of the four models, the peak von Mises stress was concentrated in the central sections of the compression screws, plate joints, and bending parts of the plates. CONCLUSIONS The fixation model consisting of two crossed screws and an anterior outperformed the other three fixation models in terms of biomedical advantages; thus, this model can be deemed a safe and reliable internal fixation approach for ankle arthrodesis.
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Affiliation(s)
- Bo Feng
- Department of Orthopaedic Medicine, Third Affiliated Hospital of Inner Mongonia Medical University, No.20 of Shaoxian Road, Kundulun District, Baotou, 014010, China.
| | - Qing-Bo Gao
- Department of Orthopaedic Medicine, Third Affiliated Hospital of Inner Mongonia Medical University, No.20 of Shaoxian Road, Kundulun District, Baotou, 014010, China
| | - Guang-Ming Dai
- Department of Orthopaedic Medicine, Third Affiliated Hospital of Inner Mongonia Medical University, No.20 of Shaoxian Road, Kundulun District, Baotou, 014010, China
| | - Ke-Cheng Niu
- Department of Orthopaedic Medicine, Third Affiliated Hospital of Inner Mongonia Medical University, No.20 of Shaoxian Road, Kundulun District, Baotou, 014010, China
| | - Wei Jiang
- Department of Orthopaedic Medicine, Third Affiliated Hospital of Inner Mongonia Medical University, No.20 of Shaoxian Road, Kundulun District, Baotou, 014010, China
| | - Zhen-Yu Wang
- Department of Orthopaedic Medicine, Third Affiliated Hospital of Inner Mongonia Medical University, No.20 of Shaoxian Road, Kundulun District, Baotou, 014010, China
| | - Hao-Yan Zheng
- Department of Orthopaedic Medicine, Third Affiliated Hospital of Inner Mongonia Medical University, No.20 of Shaoxian Road, Kundulun District, Baotou, 014010, China
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Besor O, Eidelman M, Kotlarsky P. Simultaneous tibio-talar fusion and tibial lengthening for end-stage ankle arthritis. Eur J Orthop Surg Traumatol 2023; 33:3501-3509. [PMID: 37198500 DOI: 10.1007/s00590-023-03579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 05/10/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Arthrodesis of the ankle joint is an accepted treatment option in patients with end-stage ankle arthritis. The goal is to achieve fusion between the tibia and the talus, thereby stabilizing the joint and alleviating pain. There might be associated limb length discrepancy, especially in post-traumatic and post-infectious cases. These patients require limb lengthening and arthrodesis. The purpose of this study is to report our experience with simultaneous ankle arthrodesis and lengthening using external fixation in adolescent and young adult patients. METHODS This retrospective case series included all patients treated in our hospital by concomitant ankle arthrodesis and tibial lengthening procedures on the same limb, using ring external fixation system. All surgeries included distal tibial joint surface resection and the talar dome, thereby correcting any associated deformity at the ankle. The arthrodesis was fixed and compressed using ring external fixator. A concurrent proximal tibial osteotomy was done, and limb lengthening, or bone transport was performed. RESULTS Eight patients operated between the years 2012-2020 were included in this study. Median patient age was 20.4 years (range 4-62 years), 50% women. Median limb lengthening was 20 mm (range 10-55 mm), and median final leg length discrepancy (LLD) was 7.5 mm (range 1-72 mm). The most common complication recorded was pin tract infection, which resolved with empiric antibiotics in all cases. CONCLUSION Based on our experience, combined arthrodesis and proximal tibial lengthening is efficient solution that provides stable ankle and restores length of the tibia even in complex and challenging situations.
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Affiliation(s)
- Omri Besor
- Israel Defense Forces, Medical Corps, Ramat Gan, Israel.
| | - Mark Eidelman
- Pediatric Orthopedics, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Pavel Kotlarsky
- Pediatric Orthopedics, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
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10
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Gutteck N, Delank KS, Schilde S. Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis in patients with diabetes-associated Charcot Neuro-Arthropathy. Eur J Orthop Surg Traumatol 2023; 33:3577-3584. [PMID: 37245183 PMCID: PMC10225040 DOI: 10.1007/s00590-023-03592-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/14/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Several studies demonstrated a considerable complication rate for open ankle or TTC arthrodesis in patients with diabetes, revision surgery and ulceration. Extensive approaches in combination with multimorbide patients have been suggested as the rationale behind the increased complication rate. METHODS Single-centre, prospective case-control study compared arthroscopic vs. open ankle arthrodesis in patients with Charcot Neuro-Arthropathy of the foot. 18 patients with septic Charcot Neuro-Arthropathy Sanders III-IV received an arthroscopic ankle arthrodesis with TSF (Taylor Spatial Frame®) fixation combined with different additional procedures required for infect treatment and hindfoot realignment. The ankle arthrodesis was required for the realignment of the hindfoot in Sanders IV patients, arthritis or in case of infection. 12 patients were treated with open ankle arthrodesis and TSF fixation combined with various additional procedures. RESULTS A significant improvement has been shown in radiological data in both groups. A significant lower complication rate has been registered in arthroscopic group. A significant correlation was seen between major complications and therapeutic anticoagulation as well as smoking. CONCLUSION In high-risk patients with diabetes and plantar ulceration excellent results could be demonstrated in arthroscopically performed ankle arthrodesis with midfoot osteotomy using TSF as fixation devise.
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Affiliation(s)
- Natalia Gutteck
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany.
| | - Karl-Stefan Delank
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany
| | - Sebastian Schilde
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany
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11
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Casais I, Steenwerckx A, Buedts K. Tibiotalocalcaneal and Tibiotalar Arthrodesis for Severe Cavovarus Deformity: Tips and Tricks. Foot Ankle Clin 2023; 28:819-831. [PMID: 37863537 DOI: 10.1016/j.fcl.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Cavovarus foot is a complex 3-dimensional deformity. Clinical history, physical examination, and comorbidity assessment are essential for preoperative evaluation. In severe cases, ankle or tibiotalocalcaneal arthrodesis can provide symptomatic relief and result in a plantigrade foot. This article emphasizes the importance of weight-bearing computed tomography for surgical planning and presents the authors' preferred technique for tibiotalocalcaneal, which includes a novel curved anterolateral incision, partial fibular onlay bridging graft, and patient-specific instrumentation for forefoot deformity correction. The tips and tricks aim to assist surgeons in better treating these challenging patients while optimizing preoperative planning.
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Affiliation(s)
- Inês Casais
- Serviço de Ortopedia, Orthopedics and Traumatology Department, Centro Hospitalar de Vila Nova de Gaia e Espinho, Rua Conceição Fernandes, Vila Nova de Gaia 4434-502, Portugal
| | - Anny Steenwerckx
- Orthopaedics and Traumatology Department, AZ Diest, Statiestraat 65, Diest 3290, Belgium
| | - Kristian Buedts
- Foot and Ankle Unit, Orthopedics and Traumatology Department, ZNA Middelheim, Antwerpen, Belgium; Gewrichtskliniek, Jos Ratinckxstraat 1 bus 53, 2600 Berchem, Belgium.
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12
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Rao NM, Ligas C. The Ankle Joint: Revision Ankle Fusion Options, Nonunion, Malunion, Protocol for Best Outcome. Clin Podiatr Med Surg 2023; 40:703-710. [PMID: 37716746 DOI: 10.1016/j.cpm.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Ankle arthrodesis has been a time-tested procedure for osteoarthritis, avascular necrosis of the talus, deformity correction, and significant trauma of the ankle. Technique guides have created dissection pearls, ease of fixation, and arthroscopic techniques to mitigate complications of the procedure. Major complications, such as nonunion, malunion, or implant infection are the most worrisome and cumbersome complications to handle. The aim of this article is to provide the practicing surgeon evidence to provide innovative management techniques for nonunion, malunion, and infection following primary ankle arthrodesis.
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Affiliation(s)
- Nilin M Rao
- Foot Specialists of Austin, 1600 West 38th Street, #210, Austin, TX, USA.
| | - Chandler Ligas
- Podiatric Surgery, Silicon Valley Reconstructive Foot and Ankle Fellowship- Palo Alto Medical Foundation, 701 E El Camino Real 1st Floor, Mountain View, CA 94040, USA; Sunnyvale, CA, USA
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13
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Iliopoulos E, Makiev K, Georgoulas P, Vordos N, Ververidis A, Tilkeridis K. The use of 3D printing technology in limb reconstruction. Inspirations and challenges. Trauma Case Rep 2023; 46:100848. [PMID: 37228849 PMCID: PMC10203763 DOI: 10.1016/j.tcr.2023.100848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
The management of septic non-unions with associated bone necrosis is challenging, especially when the resulting bone defect after the debridement is extensile. Different techniques have been described in the literature for the treatment of these demanding cases, with the most prominent being free vascularized Fibular graft and bone transport with distraction osteogenesis principles. Recently, 3D printing technology has been increasingly utilized in many complex orthopaedic pathologies. However, the application of those advancements regarding septic non-unions with residual bone defect has not been previously studied. This study presents a novel 3D printing technique for the management of an infected critical bone deficit of the tibia. Queries, challenges and future perspectives concerning the recruiting of 3D printing technology in limb reconstruction are also being discussed. Clinical Evidence Level: IV.
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Affiliation(s)
- Efthymios Iliopoulos
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Makiev
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
| | - Paraskevas Georgoulas
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
| | - Nick Vordos
- Biophysics Laboratory, Physics Department, International Hellenic University, Kavala, Greece
| | - Athanasios Ververidis
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Tilkeridis
- Trauma and Orthopaedics Department, Alexandroupolis University Hospital, University of Thrace, Alexandroupolis, Greece
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Abstract
Despite the increasing popularity of total ankle replacement, ankle arthrodesis remains the gold standard for the treatment of end-stage ankle arthritis. Historically, open techniques have been utilized for ankle arthrodesis. There have been many variations and techniques described, including transfibular, anterior, medial, and miniarthrotomy. Inherent disadvantages to these open techniques include postoperative pain, delayed or nonunion, wound complications, shortening, prolonged healing times, and prolonged hospital stays. Arthroscopic ankle arthrodesis provides the foot and ankle surgeon with an alternative to the traditional open techniques. Arthroscopic ankle arthrodesis has demonstrated faster union rates, decreased complications, reduced postoperative pain, and shorter hospital stays.
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Affiliation(s)
- Michael S Lee
- Capital Orthopaedics & Sports Medicine, 12499 University Avenue, Suite 210, Clive, IA 50325, USA.
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15
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Desnantyo AT, Mahyuddin MH, Saputra PBT, Atsira OP. Fibular strut graft for primary ankle arthrodesis in diabetic charcot neuroarthropathy patients. Int J Surg Case Rep 2023; 108:108430. [PMID: 37399591 PMCID: PMC10382763 DOI: 10.1016/j.ijscr.2023.108430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 07/05/2023] Open
Abstract
INTRODUCTION Arthrodesis is an expensive procedure that is less applicable in developing countries. In this case report we reported a case of diabetic charcot neuroartropathy (CN) with primary ankle arthrodesis technique with a fibular strut graft which is considered cheaper and has a higher union rate. CASE DESCRIPTION A 47 years old female with complaints of pain in her right ankle after falling down the stairs with foot inverted one month before admission. The patient has uncontrolled diabetes mellitus with HbA1C 7.6 % and random blood sugar check >200 mg/dl. The patient's pain score using the visual analog score (VAS) showed a value of 8. While plain film X-ray revealed bony fragmentation in the Ankle joint. Arthrodesis surgery using fibular strut graft was performed. The postoperative X-ray examination revealed two plates attached to the anterior and medial distal tibia. A total of nine wires were attached to the patient. The patient used Ankle Foot Orthosis (AFO) and was able to walk normally 3-weeks post-surgery without pain and ulcer formation. DISCUSSION Fibular strut graft has good cost-effectiveness, that is more suitable for use in developing countries. It also requires a simple implant that is easily applied by all orthopedists. Fibular strut graft has the advantage of having osteogenic, osteoinductive, and osteoconductive properties that can potentially improve union. CONCLUSION The fibular strut graft technique can be an alternative in obtaining durable ankle fusion and functional salvaged limb with low complications.
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Affiliation(s)
- Andre Triadi Desnantyo
- Medical Faculty Universitas Airlangga, Surabaya, East Java 60132, Indonesia; Department of Orthopedics & Traumatology Dr. Soetomo General Hospital/Universitas Airlangga, Surabaya, Indonesia.
| | | | | | - Olga Putri Atsira
- Medical Faculty Universitas Airlangga, Surabaya, East Java 60132, Indonesia
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16
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Amaha K, Yamaguchi S, Teramoto A, Kawasaki Y, Shiko Y, Kitamura N. Clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years: a multicenter, retrospective study. J Orthop Surg Res 2023; 18:244. [PMID: 36966317 PMCID: PMC10039590 DOI: 10.1186/s13018-023-03734-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND This study aimed to clarify the clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥ 75 years and compare these outcomes with those of patients aged < 75 years. METHODS A total of 148 patients, including 65 who underwent total ankle arthroplasty and 83 who underwent ankle arthrodesis, were retrospectively surveyed. Clinical outcomes were assessed preoperatively and at the last follow-up using the Japanese Society for Surgery of the Foot Hindfoot Scale and a self-administered foot evaluation questionnaire (SAFE-Q). Patient characteristics, including age, sex, body mass index, radiographic severity, and follow-up period, were also assessed. The patients were divided into older (≥ 75 years) and younger (< 75 years) age groups. Improvements in outcomes were then compared between age groups using univariate analysis and analysis of covariance adjusted for patient characteristics. Total ankle arthroplasty and ankle arthrodesis were analyzed separately. RESULTS All clinical outcome scores improved postoperatively in the older age groups for both procedures. Scores for the pain and pain-related subscale of the SAFE-Q improved by 37 points (p < 0.001) in post-total ankle arthroplasty patients and by 35 points in post-ankle arthrodesis patients (p < 0.001). Furthermore, multivariate analysis showed that the improvements observed in all scores were not different between the older and younger age groups for both post-total ankle arthroplasty and post-ankle arthrodesis patients, except for the SAFE-Q physical functioning subscale score for post-ankle arthrodesis patients. The clinical outcomes improved significantly in post-total ankle arthroplasty and post-ankle arthrodesis patients aged ≥ 75 years. Moreover, these improvements were similar to those observed in patients aged < 75 years. CONCLUSIONS Surgical treatment of end-stage ankle osteoarthritis can be a viable treatment option, even in elderly patients, and can be expected to improve similarly to younger patients.
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Affiliation(s)
- Kentaro Amaha
- Department of Orthopedic Surgery, St Luke's International Hospital, Akashi-cho, Chuo-ku, Tokyo, Japan.
| | - Satoshi Yamaguchi
- Graduate School of Global and Transdisciplinary Studies, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Inohana, Chuo-ku, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Inohana, Chuo-ku, Chiba, Japan
| | - Nobuto Kitamura
- Department of Orthopedic Surgery, St Luke's International Hospital, Akashi-cho, Chuo-ku, Tokyo, Japan
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Cibura C, Lotzien S, Rosteius T, Ull C, Godolias P, Schildhauer TA, Königshausen M. Rate of progressive healing with a carbon-fiber orthosis in cases of partial union and nonunion after ankle arthrodesis using the Ilizarov external fixator. J Foot Ankle Res 2023; 16:15. [PMID: 36964559 PMCID: PMC10039608 DOI: 10.1186/s13047-023-00613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/12/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The Ilizarov fixator is a popular device for treating arthrodesis of the ankle joint in complex situations. However, the therapy can fail, with nonunion or partial union that might not be load stable. There is the possibility of follow-up surgery or extended wearing of the fixator. Full weight bearing with a carbon orthosis remains another treatment option, which has not yet been investigated.The aim of the study was to determine the rate of progress that can be obtained with a carbon orthosis in cases of partial union or nonunion after fixator removal. METHODS In this retrospective observational study thirty-three patients received a carbon orthosis after fixator removal due to nonunion or partial union. All patients were allowed to walk with the orthosis under full load. The consolidation rate was determined radiologically and compared with the imaging data obtained during the last follow-up. In addition to demographic data, the Foot and Ankle Ability Measure and pain using a numeric rating scale were determined. Nine patients had to be excluded due to insufficient follow-up, and finally n = 24 patients were included in the study. RESULTS The average duration of fixator use was 21 weeks (range 15-40 weeks), and the total average follow-up after removal of the fixator was 16 months (range 4- 56). For 14 (58.33%) patients, there was a further increase in consolidation with the orthosis after the fixator was removed. CONCLUSION The results show that if there is only partial union or nonunion, further consolidations can be achieved after the application of a carbon orthosis. In a difficult patient population, using an orthosis should therefore be attempted to avoid unnecessary revision operations.
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Affiliation(s)
- Charlotte Cibura
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany.
| | - Sebastian Lotzien
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Rosteius
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Christopher Ull
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Periklis Godolias
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
| | - Matthias Königshausen
- Department of Trauma Surgery and General Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-La-Camp-Platz 1, 44789, Bochum, Germany
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18
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Liu S, Wang Y, Zhang M, Wei P, Li Y, Wang T, Meng Q. A comparative study of modern total ankle replacement and ankle arthrodesis for ankle osteoarthritis at different follow-up times: a systematic review and meta-analysis. Int Orthop 2023; 47:1493-1510. [PMID: 36897362 DOI: 10.1007/s00264-023-05753-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE Total ankle replacement (TAR) or ankle arthrodesis (AA) is the main surgical treatment for end-stage ankle osteoarthritis. However, the therapeutic effect of the two surgical procedures at different follow-up times remains controversial. The purpose of this meta-analysis is to compare the short-term, medium-term, and long-term safety and efficiency of the two modern surgical treatments. METHODS We conducted a comprehensive search in PubMed, EMBASE, Cochrane library databases, Web of Science, and Scopus. The main results were the patient's reported outcome measure (PROM) score, satisfaction, complications, reoperation, and surgery success rate. Different follow-up times and implant designs were used to evaluate the source of heterogeneity. We used a fixed effects model for meta-analysis and I2 statistic for evaluating heterogeneity. RESULTS Thirty-seven comparative studies were included. In the short term, TAR significantly improved clinical scores (AOFAS score: WMD = 7.07, 95% Cl: 0.41-13.74, I2 = 0.0%; SF-36 PCS score: WMD = 2.40, 95% Cl: 2.22-2.58, I2 = 0.0%; SF-36 MCS score: WMD = 0.40, 95% Cl: 0.22-0.57, I2 = 0.0%; VAS for pain: WMD = - 0.50, 95% Cl: - 0.56-0.44, I2 = 44.3%) and had the lower incidence of revision (RR = 0.43, 95% CI: 0.23-0.81, I2 = 0.0%) and complications (RR = 0.67, 95% Cl: 0.50-0.90, I2 = 0.0%). In the medium term, there were still higher improvements in both the clinical scores (SF-36 PCS score: WMD = 1.57, 95% Cl: 1.36-1.78, I2 = 20.9%; SF-36 MCS score: WMD = 0.81, 95% Cl: 0.63-0.99, I2 = 48.8%) and the patient satisfaction (RR = 1.24, 95% Cl: 1.08-1.41, I2 = 12.1%) in the TAR group, but its total complications rate (RR = 1.84, 95% Cl: 1.26-2.68, I2 = 14.9%) and revision rate (RR = 1.58, 95% CI: 1.17-2.14, I2 = 84.6%) were significantly higher than that of the AA group. In the long term, there was no significant difference in clinical score and satisfaction, and a higher incidence of revision (RR = 2.32, 95% Cl: 1.70-3.16, I2 = 0.0%) and complications (RR = 3.18, 95% Cl: 1.69-5.99, I2 = 0.0%) was observed in TAR than in AA. The result of the third-generation design subgroup was consistent with that of the above pooled results. CONCLUSION TAR had advantages over AA in the short term due to better performance in terms of PROMs, complications, and reoperation rates, but its complications become a disadvantage in the medium term. In the long term, AA seems to be favored because of lower complications and revision rates, although there is no difference in clinical scores.
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Affiliation(s)
- Shuai Liu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yuxin Wang
- Class 2, Grade 2019, Medical College of Qingdao University, Qingdao, 266003, China
| | - Mengqi Zhang
- Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Pengcheng Wei
- Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Yujing Li
- Department of Pathology, College of Basic Medical Sciences of China Medical University, Shenyang, 110122, China
| | - Tongyu Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Qingyang Meng
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China.
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Tapaninaho K, Ponkilainen VT, Haapasalo H, Mattila VM, Huttunen TT, Repo JP. Incidence of ankle arthrodesis and total ankle replacement between 1997 and 2018: A nationwide registry study in Finland. Foot Ankle Surg 2023; 29:288-292. [PMID: 36878765 DOI: 10.1016/j.fas.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Surgical treatment options for end-stage ankle osteoarthritis (OA) include ankle arthrodesis (AA) and total ankle replacement (TAR). We investigated the national incidence of AA and TAR and assessed trends in the surgical management of ankle OA in Finland between 1997 and 2018. METHODS The Finnish Care Register for Health Care was used to calculate the incidence of AA and TAR based on sex and different age groups. RESULTS The mean age (SD) of patients was similar, 57.8 (14.3) years for AA and 58.1 (14.0) for TAR. TAR showed a 3-fold increase from 0.3 per 100 000 person-years in 1997 to 0.9 per 100 000 person-years in 2018. The incidence of AA operations decreased during the study period from 4.4 per 100 000 person-years in 1997 to 3.8 per 100 000 person-years in 2018. TAR utilization increased notably at the expense of AA between 2001 and 2004. CONCLUSION TAR and AA are both widely used procedures in the treatment of ankle OA, with AA being the favored option for most patients. The incidence of TAR has remained constant for the past 10 years, indicating appropriate treatment indications and utilization.
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Affiliation(s)
- Krista Tapaninaho
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland.
| | | | - Heidi Haapasalo
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and University of Tampere, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and University of Tampere, Finland
| | - Tuomas T Huttunen
- Tampere University Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and University of Tampere, Finland
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20
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Almutairi TA, Ragab KM, Elsayed SM, Elsnhory AB, Elhady MM, Gamal MH, Fathallah AH. 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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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21
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Choi JY, Kim HS, Ngissah R, Suh JS. Operative outcomes of a high-grade talar neck fracture - Lessons from 20 years' clinical experience in a single, tertiary hospital. Foot Ankle Surg 2023; 29:118-127. [PMID: 36526523 DOI: 10.1016/j.fas.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/28/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The operative treatment of high-grade talar neck fractures remains challenging, despite numerous previous reports. Our goal was to determine long-term outcomes and to establish a plan for management of postoperative complications (especially, avascular necrosis [AVN] of talar body) after high-grade talar neck fractures. We hypothesized that not every case with AVN of talar body require secondary surgical interventions. METHODS We retrospectively reviewed the radiographic and clinical findings of 14 patients who underwent operative treatment for high-grade talar neck fractures (modified Hawkins type III and IV) between January 2000 and December 2017. The minimum follow-up duration for inclusion was 3 years. Using radiographs during follow-up, we assessed the development of AVN of the talar body, malunion, nonunion, and posttraumatic osteoarthritis. Information about the secondary operations and their outcomes were also investigated using visual analogue scale (VAS) and American orthopaedic foot and ankle society (AOFAS) ankle-hindfoot scale at the final follow-up. RESULTS In 10 of 14 patients (71.4 %), talar body AVN developed during follow-up. However, secondary operation was required in only 30.0 % (3 of 10 patients). In the remaining 7 patients who did not undergo secondary operation, the symptoms were tolerable with a maximum of 89 months follow-up; although the talar body presented sclerotic changes, but without talar dome collapse. The rates of malunion and post-traumatic subtalar osteoarthritis were 21.4 % and 14.3 %, respectively. No patients presented with fracture site nonunion. After a mean of 55.86 ± 14.45 months (range, 37-89) follow-up, the final mean VAS and AOFAS scores were 3.07 ± 0.73 (range, 2-4) and 80.43 ± 3.11 (range, 75-85), respectively. CONCLUSION We recommend leaving talar body AVN untouched, unless the patient's symptoms become intolerable. In our clinical practice, postoperative AVN could be stably maintained without talar dome collapse for more than 7 years, although the sclerotic change persisted. Despite the small number of patients, our clinical experience may benefit patients with high-grade talar neck fractures and surgeons who treat such rare, serious, and challenging foot injuries. LEVEL OF EVIDENCE Level IV, Case series.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
| | - Hyeong Suh Kim
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
| | - Reuben Ngissah
- Department of Orthopedic Surgery, Greater Accra Regional Hospital, Castle Rd, Accra, Ghana.
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, 170 Juhwa-ro, Ilsanseo-gu, Goyang-si, Gyeonggi-do, South Korea.
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Choi JY, Park SJ, Suh JS. Does ankle arthrodesis induce satisfactory changes in the medial longitudinal arch height of the foot for severe varus ankle arthritis? Int Orthop 2023; 47:107-115. [PMID: 36462088 DOI: 10.1007/s00264-022-05645-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE We designed this study to determine how changes in coronal ankle alignment affect sagittal alignment of the foot. Specifically, we focused on the changes in medial longitudinal arch height, which could be reflected by the medial cuneiform height (MCH), Meary's angle, and calcaneal pitch angle (CPA). METHODS We retrospectively analyzed the radiographic findings of 37 patients who underwent open ankle arthrodesis without inframalleolar correction (such as first metatarsal dorsal closing wedge osteotomy, calcaneal osteotomies, tendon transfers, or tarsal joint arthrodesis) of severe varus ankle arthritis. The inclusion criterion was a pre-operative tibial axis to talar dome angle of 80 degrees or less. The enrolled patients were divided into two groups according to the post-operative decrease in MCH (≥ 2 mm or < 2 mm). RESULTS A post-operative MCH decrease of ≥ 2 mm was observed in 43.2% (16 patients). Although the degree of coronal ankle varus correction was similar, the decrease in the Meary's angle was significantly greater in the group with a post-operative MCH decrease of ≥ 2 mm than in those with < 2 mm (- 4.1 degrees vs. - 1.3 degrees, P = 0.01). The changes in CPA were not significantly different (P = 0.172). CONCLUSION Correction of ankle varus deformity via ankle arthrodesis could lead to a decrease in the medial longitudinal arch height in less than half of the enrolled patients. In these patients, a cavus component of the foot might be an important factor in determining a successful sagittal foot alignment change, while the CPA was maintained post-operatively.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-Si, Gyeonggi-Do, South Korea
| | - Seung Jun Park
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-Si, Gyeonggi-Do, South Korea.
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Cardoso DV, Veljkovic A. General Considerations About Foot and Ankle Arthrodesis. Any Way to Improve Our Results? Foot Ankle Clin 2022; 27:701-722. [PMID: 36368793 DOI: 10.1016/j.fcl.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nonunion and adjacent joint osteoarthritis (OA) are known complications after a fusion procedure, and foot and ankle surgeons are commonly exposed to such disabling complications. Determining who is at risk of developing nonunion is essential to reducing nonunion rates and improving patient outcomes. Several evidenced-based modifiable risk factors related to adverse outcomes after foot and ankle arthrodesis have been identified. Patient-related risk factors that can be improved before surgery include smoking cessation, good diabetic control (HbAc1 <7%) and vitamin D supplementation. Intraoperatively, using less invasive techniques, avoiding joint preparation with power tools, using bone grafts or orthobiologics in more complex cases, high-risk patients, nonunion revision surgeries, and filling in bone voids at the arthrodesis site should be considered. Postoperatively, pain management with NSAIDs should be limited to a short period (<2 weeks) and avoided in high-risk patients. Furthermore, early postoperative weight-bearing has shown to be beneficial, and it does not seem to increase postoperative complications. The incidence of surrounding joint OA after foot and ankle fusion seems to increase progressively with time. Owing to its progression and high probability of being symptomatic, patients must be informed consequently, as they may require additional joint fusions, resulting in further loss of ankle/foot motion. In patients with symptomatic adjacent joint OA and unsatisfactory results after an ankle arthrodesis, conversion to total ankle arthroplasty (TAA) has become a potential option in managing these complex and challenging situations.
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Affiliation(s)
- Diogo Vieira Cardoso
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.
| | - Andrea Veljkovic
- Division of Orthopaedics and Trauma Surgery, British Columbia University, Vancouver, Canada
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Chan JJ, Guzman JZ, Garden E, Chan JC, Poeran J, Zubizarreta N, Mazumdar M, Vulcano E. Economic impact of Comorbidities in Total Ankle Arthroplasty and Ankle Arthrodesis. Orthop Traumatol Surg Res 2022; 108:103133. [PMID: 34706289 DOI: 10.1016/j.otsr.2021.103133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/22/2021] [Accepted: 08/31/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The demand for total ankle arthroplasty (TAA) and ankle arthrodesis surgery is increasing. Findings from other orthopaedic populations suggest an increasing comorbidity burden among those planned for surgery, however, data on TAA and ankle arthrodesis is limited. The goal of this study is to study the comorbidity burden for TAA and ankle arthrodesis. HYPOTHESIS Comorbidity burden is associated with higher resource utilization for both TAA and ankle arthrodesis. PATIENTS AND METHODS This retrospective cohort study utilized data from the nationwide Premier Healthcare Database (2006-2016) which contains inpatient claims on n=10,085 ankle arthrodesis and n=4,977 TAA procedures. Patients were categorized into Deyo-Charlson comorbidity index (DCCI) groups. Outcomes were cost of hospitalization, length of stay (LOS), total opioid utilization, discharge to a skilled nursing facility (SNF), and 30-day readmission. Mixed-effects models estimated associations between DCCI and outcomes. We report odds ratios (OR, or % change for continuous outcomes) and 95% confidence intervals (CI). RESULTS In the TAA group, 67.9% of patients were in DCCI category 0 while 22.4%, 6.6%, and 3.1% were in the 1, 2, and >2 DCCI categories, respectively. This was 61.3%, 18.1%, 9.8% and 10.9% in the ankle arthrodesis group. The most common comorbidities were obesity, diabetes mellitus, and chronic pulmonary disease. Particularly in the ankle arthrodesis group, the proportion of patients with comorbidities has increased over time. After adjustment for relevant covariates, patients in the DCCI group >2 (compared to '0') were associated with stepwise effects of up to 77.1% (CI 70.9%; 83.6%) longer length of stay and up to 48.5% (CI 44.0%; 53.2%) higher cost of hospitalization. DISCUSSIONS Comorbidity burden is increasing among patients undergoing ankle arthrodesis where it is associated with significantly increased resource utilization. Our data demonstrate the potential impact of patient selection, which may be crucial in optimizing preoperative status. LEVEL OF EVIDENCE III.
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Chen J, Wu S, Li Y, Chen Y, Liu X, Qin B, Zhang H. Simultaneous Total Ankle Replacement and Contralateral Ankle Arthrodesis for Bilateral Ankle Osteoarthritis: A Retrospective Study Focused on Clinical Outcomes and Cost-effectiveness. Orthop Surg 2022; 14:1808-1816. [PMID: 35822619 PMCID: PMC9363735 DOI: 10.1111/os.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023] Open
Abstract
Objective Total ankle replacement (TAR) and ankle arthrodesis (AA) are two common surgical treatment options for end‐stage ankle osteoarthritis. However, few reports compare the outcomes of simultaneous TAR and contralateral AA for bilateral ankle osteoarthritis. The aim of this study was to assess changes in pain, joint range of movement (ROM), functional outcomes, patient satisfaction, and cost‐effectiveness following simultaneous TAR and contralateral AA. Methods A retrospective study was conducted on 12 patients with bilateral end‐stage ankle osteoarthritis who underwent simultaneous TAR and contralateral AA in our institution between May 2016 and August 2018, and who had a minimum of two‐year follow‐up data. Clinical and radiological follow‐up data for all patients were collected after 4 months, 1 year and 2 years. The results were assessed clinically on a visual analogue scale (VAS) and included ROM, American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score, and satisfaction questionnaire. The total hospital costs of patients were also recorded. Independent sample t tests were conducted to compare continuous variables between groups. Paired sample t‐tests were conducted to compare changes from the preoperative to postoperative evaluations within each group. Results Both surgical groups presented with pain reduction (P < 0.001) at the one‐year postoperative session, which was generally consistent until the two‐year follow‐up. There was a significant increase (P < 0.001) in the mean AOFAS score postoperatively in both ankles. The functional outcomes at the one‐ and two‐year follow‐up were significantly better in patients in the TAR group than in those in the AA group (P < 0.001). Joint ROM differences were observed between the two groups after surgery (decreased ankle ROM in arthrodesis, P < 0.001; increased ankle ROM in arthroplasty, P < 0.001). The mean satisfaction score was 2 (range, 1–4) for the TAR group and 3 (range, 1–5) for the AA group. A significant difference in the satisfaction score was observed between the two groups (P = 0.036). Simultaneous TAR and contralateral AA was 34.1% less expensive than simultaneous bilateral TAR. No intraoperative complications were noted in either group. Wound healing occurred without problems within 2 weeks after surgery. No symptomatic deep venous thrombosis was found during follow‐up. Conclusion TAR had better patient‐perceived post‐operative function and preserves more anatomic sagittal plane motion compared to ankles undergoing AA. In addition, simultaneous TAR and contralateral AA are more cost‐effective than simultaneous bilateral TAR, with lower costs for the average patient.
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Affiliation(s)
- Jun Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Shizhou Wu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yaxing Li
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yu Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xi Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Boquan Qin
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Hui Zhang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Chalak A, Singh S, Ghodke A, Kale S, Hussain J, Mishra R. Ilizarov Ankle Arthrodesis: A Simple Salvage Solution for Failed and Neglected Ankle Fractures. Indian J Orthop 2022; 56:1587-1593. [PMID: 36052393 PMCID: PMC9385916 DOI: 10.1007/s43465-022-00669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Infection around the ankle joint after fracture fixation, or septic arthritis with active discharging sinuses is often challenging to manage with conventional procedures of arthrodesis. The Ilizarov method of arthrodesis gives a better alternative for salvage in such cases. METHODS This was a retrospective study including 20 patients who were subjected to tibiotalar arthrodesis with Ilizarov method. The major pathologies included internal fixation of ankle fractures complicated by infection, posttraumatic infected ankle arthritis, and osteomyelitis. The patients were evaluated on the basis of Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. The aim of the surgery was to achieve plantigrade, stable, and painless foot with no signs of infection. RESULTS A total of 20 patients were operated and reviewed at our institute. The study comprised of 15 male and 5 female patients with a mean age of 43.9 years (range 33-55 years). Out of 20 patients, 4 patients had complications of pin-tract infection and one had wire breakage of the forefoot ring. According to the ASAMI criteria, 17 patients had excellent bone scores and 18 patients had good functional scores. Union was achieved in all patients with resolution of infection and the mean limb length discrepancy was 1.92 cm (range 1-2.5 cm). CONCLUSIONS The Ilizarov fixator for ankle arthrodesis provides an excellent way for strong bone fusion, infection eradication, early weight-bearing, and the added benefits of compression at the arthrodesis site post-operatively.
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Affiliation(s)
- Ajit Chalak
- Department of Orthopaedics, Dr. D Y Patil Medical College and Hospital, Sector 7, Nerul, Navi Mumbai, Maharashtra 400706 India
| | - Sushmit Singh
- Department of Orthopaedics, Dr. D Y Patil Medical College and Hospital, Sector 7, Nerul, Navi Mumbai, Maharashtra 400706 India
| | - Ashok Ghodke
- Department of Orthopaedics, MGM Medical College Hospital, Kamothe, Navi Mumbai, India
| | - Sachin Kale
- Department of Orthopaedics, Dr. D Y Patil Medical College and Hospital, Sector 7, Nerul, Navi Mumbai, Maharashtra 400706 India
| | - Javed Hussain
- Department of Orthopaedics, Dr. D Y Patil Medical College and Hospital, Sector 7, Nerul, Navi Mumbai, Maharashtra 400706 India
| | - Ronak Mishra
- Department of Orthopaedics, Dr. D Y Patil Medical College and Hospital, Sector 7, Nerul, Navi Mumbai, Maharashtra 400706 India
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Watts DT, Moosa A, Elahi Z, Palmer AJR, Rodriguez-Merchan EC. Comparing the Results of Total Ankle Arthroplasty Vs Tibiotalar Fusion ( Ankle Arthrodesis) in Patients with Ankle Osteoarthritis since 2006 to 2020- A Systematic Review. Arch Bone Jt Surg 2022; 10:470-479. [PMID: 35928907 PMCID: PMC9295584 DOI: 10.22038/abjs.2021.55790.2778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/15/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study compares the outcomes of patients undergoing total ankle arthroplasty (TAA) and tibiotalar fusion (ankle arthrodesis) in patients with end-stage osteoarthritis. The primary outcome assessed was Patient Reported Outcome Measures (PROMS); secondary outcomes included the incidence of revision, re-operation, and complications. METHODS A systematic review of studies examining the outcomes of patients undergoing TAA and/or tibiotalar fusion from 2006 to 2020 was conducted. Individual cohort studies and randomized control trials were included. Outcomes were assessed at two and five years. RESULTS 21 studies were included: 16 arthroplasty (2,016 patients) and 5 arthrodesis (256 patients) studies. No significant difference in PROMS was evident two years post-surgery - American Orthopaedic Foot and Ankle Society (AOFAS) scores were 78.8 (95% CI-confidence interval: 76.6-80.8; n=1548) and 80.8 (95% CI: 80.1-81.5; n=206 patients) for the arthroplasty and arthrodesis groups respectively. Two years post-surgery the revision rates for the arthroplasty and arthrodesis groups were similar - 3.5% (n=9) and 3.7% (n=61) respectively (OR-odds ratio: 1.05; 95% CI: 0.51-2.13); however, the re-operation rate was 2.5 times higher for the arthroplasty group (12.2%) in comparison to the arthrodesis group (5.1%) (OR: 2.57; 95% CI: 1.43-4.62). Documented complications in the arthroplasty group were half those documented in the arthrodesis group two years post-surgery (OR: 0.53; 95% CI: 0.37-0.77). No arthrodesis studies were found which contained mean 5-year follow-up data within the study period. CONCLUSION Despite recent developments in TAA design, we found no clear evidence as to their superiority over ankle arthrodesis when considering patient outcomes two years postoperatively. However, this conclusion could be debatable in some types of patients such as diabetic patients, posttraumatic patients and patients with stiff hindfoot and midfoot.
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Affiliation(s)
- Daniel T. Watts
- University of Oxford NHS Foundation Trust. Nuffield Orthopaedic Centre, Windmill Rd, Oxford, OX3 7LD, UK
| | - Aliabbas Moosa
- University of Oxford NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Zain Elahi
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Ave, Redhill RH1 5RH, UK
| | - Antony J. R. Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom, OX3 7LD, UK
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Brage ME, Mathews CS. Ankle and Tibiotalocalcaneal Fusion. Foot Ankle Clin 2022; 27:343-353. [PMID: 35680292 DOI: 10.1016/j.fcl.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arthrodesis of the ankle and/or tibiotalocalcaneal joints is a reliable treatment of arthritic conditions of the ankle and hindfoot. It may be complicated by infection, nonunion, malunion, fracture, wound complications, nerve injury, and adjacent joint degeneration. These complications may be addressed with a variety of techniques but should be done so carefully so as not to lead to more complex problems. A thorough work-up and discussion should take place prior to any surgical intervention and treatment. Several cases are presented to illustrate revision arthrodesis techniques and the management of these complications.
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Affiliation(s)
- Michael E Brage
- University of Washington, 325 9th Avenue, Seattle, WA 98104, USA
| | - Chelsea S Mathews
- University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot #531, Little Rock, AR 72205, USA.
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Shah AB, Davis W, Littlefield ZL, Young S, Alexander B, Andrews NA, Khurana A, Cage B, Sinha T, McGwin G, Shah A. Patient and Surgical Factors Affecting Fusion Rates After Arthroscopic and Open Ankle Fusion: A Review of a High-Risk Cohort. Indian J Orthop 2022; 56:1217-26. [PMID: 35813539 DOI: 10.1007/s43465-021-00580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/21/2021] [Indexed: 02/04/2023]
Abstract
ABSTRACT We present a case series with the objective of identifying risk factors for nonunion after open and arthroscopic primary ankle arthrodesis. Eighty-seven patients who underwent primary ankle arthrodesis and met inclusion criteria were divided into open (N = 46) and arthroscopic (N = 41) groups. Patient and operative characteristics were retrospectively analyzed as possible risk factors for nonunion within each technique. The nonunion rate was 11% in the open and 12% in the arthroscopic group. Obesity, smoking, and ASA class 3 were highly prevalent in both groups. In the arthroscopic group, a remote history of infection and the use of headed screws had notably higher risk of nonunion, though not statistically significant. In the open group, use of bone graft trended toward lower risk of nonunion, though also not statistically significant. The results of this study demonstrated, nonunion rates are comparable between open and arthroscopic ankle arthrodesis in high-risk patients. For patients with a remote history of infection, open ankle arthrodesis may be preferable, and bone graft importance may vary with open versus arthroscopic technique. LEVEL OF EVIDENCE III.
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Li B, Wang S, Li Q, Zhang Z, Li J, Yang H, Liu L. Effectiveness of Ilizarov Ankle Arthrodesis in the Treatment of End-Stage Varus Ankle Osteoarthritis: A Retrospective Study. Orthop Surg 2022; 14:937-945. [PMID: 35441475 PMCID: PMC9087455 DOI: 10.1111/os.13286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023] Open
Abstract
Objective To evaluate the outcomes of Ilizarov ankle arthrodesis in the treatment of end‐stage varus ankle osteoarthritis (OA). Methods This was a retrospective study of 63 patients with varus ankle OA who underwent Ilizarov ankle arthrodesis between June 2013 and December 2018. There were 24 males and 39 females with an average age of 56.57 ± 4.45 years (range, 47–64 years). Thirty‐six cases were affected on the left side, and 27 were affected on the right side. The patients' mean body mass index (BMI) was 25.18 ± 2.93 kg/m2. According to the modified Takakura staging criteria, there were 18 cases of stage 3b (28.57%) and 45 cases of stage 4 (71.43%). Nine patients were primary (14.29%), 48 were traumatic (76.19%), and six were caused by rheumatoid OA (9.52%). Functional assessments were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle‐hindfoot score, Ankle Osteoarthritis Scale (AOS), and visual analogue scale (VAS). The tibial anterior surface angle (TAS), coronal plane tibial‐talar angle (CPT), talar tilt angle (TT), deformity angle (DA), and tibial lateral surface angle (TLS) were assessed on X‐ray films. Results The average operation time was 147.84 ± 13.67 min (range, 135–168 min). The average follow‐up time was 34.24 ± 8.72 months (range, 24–61 months). Bony fusion was achieved in all ankles, and the fusion time was 12.43 ± 1.99 weeks on average. The average AOFAS score at the final follow‐up increased from 42.14 ± 8.66 to 80.90 ± 6.80. The average VAS score and AOS pain and disability scores at the final follow‐up decreased from 7.29 ± 1.27 to 2.24 ± 0.94, from 67.94 ± 7.68 to 27.92 ± 5.82, and from 71.64 ± 9.37 to 41.32 ± 8.99, respectively. The average TAS, CPT, and TLS at the final follow‐up increased from 77.76° ± 4.44° to 89.81° ± 1.25°, from 69.04° ± 3.73° to 90.43° ± 1.80°, and from 82.14° ± 3.77° to 88.67° ± 2.50°, respectively. The average TT and DA at the final follow‐up decreased from 8.76° ± 4.30° to 2.05° ± 1.28° and from 20.95° ± 3.73° to 1.57° ± 0.93°, respectively. Three patients developed superficial pin tract infections, all settled with local dressing and antibiotic treatment. Two patients were found to have subtalar arthritis and underwent conservative treatment. Conclusion Ankle arthrodesis using the Ilizarov technique is efficient in treating end‐stage varus ankle OA.
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Affiliation(s)
- Bohua Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Shanxi Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengdong Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.,National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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Feroz J, Nilesh M, Lyndon M, Paul H, Alison R. Accuracy and quality of the British Orthopaedic Foot and Ankle Society (BOFAS) Registry - Ankle Arthrodesis Pathway. Foot Ankle Surg 2022; 28:362-370. [PMID: 34006451 DOI: 10.1016/j.fas.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study investigated the completeness, accuracy, quality and clinical outcomes of the British Orthopaedic Foot and Ankle Society (BOFAS) registry - Ankle Arthrodesis pathway. METHODS An observational study using retrospective data derived from the BOFAS registry. Adults aged ≥18 years with a record of undergoing ankle arthrodesis in the UK from 2014 to 31/10/2019 were included. Accuracy of data capture and completeness were explored using means, SD, medians and IQR for continuous variables and frequencies for categorical variables. The pre and post treatment pathway was evaluated by analysing Patient Reported Outcome Measures (PROMs) including MOXF-FQ scores for pain/walking/standing/social interaction; NRS pain; EQ-5D-5L; and EQ-5D-5L-Health VAS at baseline, 6 months, and 12 months. RESULTS Mean age of the study population (n = 186) was 62.3 (±12.9) years and 65% of the study cohort were male. Completeness of data collection was disappointing but variables such as BMI (62.4%) smoking status (82.3%) were reasonably well recorded. PROMs scores were well recorded at baseline but rapidly declined at 6 and 12-months intervals. Reductions in MOXFQ and NRS pain scores by 12 months following surgery were statistically significant (p = 0.001 and p = 0.008), illustrating that most patients demonstrated reductions in pain intensity, improved walking/standing ability, and social interaction. CONCLUSION These findings illustrate the potential effectiveness of surgery on all outcomes following ankle arthrodesis that merits evaluation in a clinical trial; but also demonstrated the difficulties in obtaining representative data sets. The analyses strongly suggest that with the improvements in data quality greater resources would bring, the BOFAS registry would become a valuable tool.
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Affiliation(s)
- Jadhakhan Feroz
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Makwana Nilesh
- Orthopaedic Surgery, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
| | - Mason Lyndon
- Trauma and Orthopaedic Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Halliwell Paul
- Dept of Trauma and Orthopaedic Surgery, Royal Surrey County Hospital NHS Trust, Guildford, UK
| | - Rushton Alison
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; School of Physical Therapy, Faculty of Health Sciences, Western University, London, Canada.
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Abstract
End-stage ankle arthritis typically affects an active younger patient population as compared with hip and knee arthritis. The optimal surgical treatment depends on several patient-specific factors. Open ankle arthrodesis has achieved reliable outcomes for this condition over years; however, arthroscopic techniques seem to be advantageous and feasible even in cases with significant intraarticular deformity. This article describes the surgical technique of arthroscopic ankle arthrodesis and discusses the outcome compared with that of open ankle fusion and total ankle replacement.
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Affiliation(s)
- Anna-Kathrin Leucht
- Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Brauerstrasse 15, Winterthur 8401, Switzerland
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British, Footbridge Center for Integrated Foot and Ankle Care, Footbridge Clinic, Unit 221, 181 Keefer Place, Vancouver, British Columbia V6B6C1, Canada.
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Abstract
Open ankle arthrodesis remains a reliable solution for ankle arthritis, especially in the setting of deformity. Careful preoperative evaluation needs to be performed, both clinically and radiographically. The specific deformity present helps determine the approach used and the fixation choices. Deformity is most commonly seen intraarticularly, though deformity can also be present anywhere along the lower extremity, including compensatory deformity in the foot. Multiple different techniques can be used to address both the deformity and achieve a successful ankle arthrodesis. Patient outcomes reported in the literature are generally good, with high union rates and improved functional outcomes.
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Subawa W, Nugraha HK, Afandi R, Rusdianto IA. Different approach to charcot neuroarthropathy: A case report. Ann Med Surg (Lond) 2022; 73:103078. [PMID: 34976376 DOI: 10.1016/j.amsu.2021.103078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction and importance Charcot neuroarthropathy (CN) is a degenerative, progressive disease affecting the ankle and foot and it is usually a disabling factor in diabetic patients. Surgical management of CN aims to obtain a painless stable plantigrade foot which can be achieved through fusion. Achieving joint arthrodesis in CN usually carries a high failure rate. Cases presentation We presented two patients with late-stage CN foot deformity. The first case is a 52-year-old female with CN on her left ankle and presented without any infection or prior correction. The second case reported a 47-year-old man with complaints of deformity on his right ankle, he had undergone surgical treatment with an external fixator before, and now presented with infection in the surgical site. Clinical discussion Ankle arthrodesis has been considered by many as the treatment of choice for severe and late-stage CN foot. This treatment aims to give a rigid enough fixation which will maintain the stability of the ankle joint and prevents further destruction of surrounding tissue. Multiple modalities of treatment are available and must be chosen accordingly to each clinical case. Minimal implants and the use of multiple bone grafts could be considered as a plan of treatment. Both patients have promising and positive results from the two procedures. Conclusion Treatment of CN Foot with internal plate fixation combined with fibular strut graft seemed to give promising results, both radiographically and functionally. Furthermore, a slight modification of treatment with a minimal implant or iliac graft may be considered. We present case reports consist of 2 patients with CN and diabetes mellitus condition. The management for this varied condition has not described in many published literatures. We performed minimal implant and multiple bone grafts technique surgery in different kind of patient's condition, both in non-infected and infected patient. The follow up of clinical and radiograph imaging shows satisfiying outcome, and both patients now progresses to a partially weight bearing and continue to give promising results.
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Tonogai I, Sairyo K. One-stage tibial deformity correction and ankle arthrodesis for ankle osteoarthritis and tibial malalignment after low tibial osteotomy. Int J Surg Case Rep 2021; 89:106624. [PMID: 34844197 PMCID: PMC8636806 DOI: 10.1016/j.ijscr.2021.106624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction There are no reports on one-stage corrective tibial opening wedge osteotomy and arthrodesis for osteoarthritis of the ankle and tibial malalignment after distal tibial osteotomy. Presentation of case The patient was a 70-year-old woman who presented with complaints of ankle pain and lower limb deformity after tibial osteotomy performed for ankle arthritis 17–18 years earlier. Clinical examination revealed marked swelling around the ankle joint and pain and tenderness at the joint line. Imaging showed tibial malalignment and severe osteoarthritic changes in the ankle. The patient had valgus deformity of 21° and recurvatum deformity of 4°. In two months, she admitted to Department of Orthopedics at Tokushima University Hospital in Japan and we performed one-stage corrective tibial opening wedge osteotomy and ankle arthrodesis with an anterolateral plate through a lateral longitudinal incision. After removal of the previous implants, the remaining articular cartilage and osteophytes were removed from the tibial and talar surfaces. After debridement of the talar trochlea and tibial plateau, the center of rotation and angular deformity of the tibia was cut transversely and a 1-cm bone graft obtained from the removed fibula was inserted into the osteotomy site, which decreased the tibial malalignment. An anterolateral locking plate was inserted over the anterior and lateral sides of the tibia, and the ankle was fused using 2 cannulated screws. Discussion The patient wore an above-knee splint for 6 weeks to avoid weight-bearing followed by gradual weightbearing with a brace thereafter. Osseous fusion was achieved after about 3.5 months. Radiographs obtained at the 2-year follow-up visit showed complete union of the tibia and talus. Full correction of valgus and recurvatum deformity was achieved, and the patient was able to perform daily activities with almost no pain. Conclusion We reported a rare case of ankle osteoarthritis and tibial malalignment that was successfully treated with one-stage corrective tibial opening wedge osteotomy and ankle arthrodesis using an anterolateral plate via a transfibular approach. Ankle osteoarthritis and malalignment can be followed by osteotomy. One-stage ankle arthrodesis and deformity correction should be considered. Anterolateral plate was useful for arthrodesis and correction.
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Affiliation(s)
- Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
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Martinelli N, Bianchi A, Raggi G, Parrini MM, Cerbone V, Sansone V. Open versus arthroscopic ankle arthrodesis in high-risk patients: a comparative study. Int Orthop 2021. [PMID: 34611735 DOI: 10.1007/s00264-021-05233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Arthroscopic ankle arthrodesis is known to offer high fusion rates, improvements in pain and functional outcomes, low risks of complications, and reinterventions. The aim of this study is to compare open vs. arthroscopic ankle arthrodesis in patients at high risk of complications. METHODS A single-centre retrospective comparative analysis of ankle fusions was conducted. Patient records were screened for demographics, type of arthrodesis, follow-up length, pre-operative diagnosis, risk factors for non-union, operative time, radiographic union, time to union, complications, and reinterventions. The American Orthopedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Italian version of the Foot Function Index (FFI), and a visual analog scale (VAS) for pain scores collected pre-operatively and in the last follow-up were used to assess clinical outcomes. RESULTS There were 23 open and 21 arthroscopic ankle fusions. Union rate was higher (90.5% vs. 65.2%, p < 0.05) and complication rate was lower (14.3% vs. 47.8%, p < 0.05) in the arthroscopic group. In addition, patients who underwent arthroscopic arthrodesis reported better pain control, with higher improvements in VAS for pain scores. There was no significant difference in length of operative time, time to fusion, AOFAS, and FFI scores improvements between the two groups. CONCLUSIONS Arthroscopic ankle arthrodesis resulted in higher union rates, fewer complications, and lower reoperation rates in patients at high risk of complications.
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Realpe AX, Blackstone J, Griffin DR, Bing AJF, Karski M, Milner SA, Siddique M, Goldberg A. Barriers to recruitment to an orthopaedic randomized controlled trial comparing two surgical procedures for ankle arthritis : a qualitative study. Bone Jt Open 2021; 2:631-637. [PMID: 34378406 PMCID: PMC8384444 DOI: 10.1302/2633-1462.28.bjo-2021-0074.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aims A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two surgical procedures was set up to obtain high-quality evidence of effectiveness. However, the trial faced recruitment challenges and struggled to maintain recruitment rates over 30%, although this is not unusual for surgical trials. We conducted a qualitative study with the aim of gathering information about recruitment practices to identify barriers to patient consent and participation to an orthopaedic trial. Methods We collected 11 audio recordings of recruitment appointments and interviews of research team members (principal investigators and research nurses) from five hospitals involved in recruitment to an orthopaedic trial. We analyzed the qualitative data sets thematically with the aim of identifying aspects of informed consent and information provision that was either unclear, disrupted, or hindered trial recruitment. Results Recruiters faced four common obstacles when recruiting to a surgical orthopaedic trial: patient preferences for an intervention; a complex recruitment pathway; various logistical issues; and conflicting views on equipoise. Clinicians expressed concerns that the trial may not show significant differences in the treatments, validating their equipoise. However, they experienced role conflicts due to their own preference and perceived patient preference for an intervention arm. Conclusion This study provided initial information about barriers to recruitment to an orthopaedic randomized controlled trial. We shared these findings in an all-site investigators’ meeting and encouraged researchers to find solutions to identified barriers; this led to the successful completion of recruitment. Complex trials may benefit for using of a mixed-methods approach to mitigate against recruitment failure, and to improve patient participation and informed consent. Cite this article: Bone Jt Open 2021;2(8):631–637.
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Affiliation(s)
- Alba X Realpe
- Bristol Medical School, University of Bristol, Bristol, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | | | - Andrew J F Bing
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire, UK
| | - Michael Karski
- Foot and Ankle Surgery, Wrightington Hospital, Wigan, UK
| | - Stephen A Milner
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Malik Siddique
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
| | - Andrew Goldberg
- The Wellington Hospital, London, UK.,Imperial College London, London, UK.,UCL Institute of Orthopaedics and Musculoskeletal Science, Stanmore, UK
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Hanna M, Whicker EA, Traub B, Allam E, Labib SA. Sport activity levels following ankle fusion. Int Orthop 2021; 45:2347-2354. [PMID: 34228148 DOI: 10.1007/s00264-021-05100-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/25/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Ankle arthrodesis (AA) is frequently employed in the treatment of end-stage ankle arthritis, which is common following trauma and athletic injuries. While AA remains a popular therapeutic option, little data exists about activity and sporting capacity following AA. The objective of this research was to determine functional outcomes and sporting activity levels in patients following Ankle Arthrodesis. METHODS Validated questionnaires were emailed to 35 patients with a history of AA at an average follow-up of 52 months. Functional outcomes were assessed using the Foot and Ankle Disability Index (FADI), as well as the associated FADI-Sport. Responses were compared to those from a control population of RESULTS: 24 patients scheduled for AA, at an average pre-operative visit of three months. Activity levels were assessed prior to injury as well as pre- and post-operatively using the Tegner activity level scale. Average Tegner scores of the 35 surgical patients decreased from 3.82 ± 0.38 before their injury, to 1.15 ± 0.19 immediately pre-op, with recovery to 2.67 ± 0.26 following fusion. Average post arthrodesis FADI and FADI-sport scores in our patients were 76.5 ± 3.19% and 33.8 ± 23.06%. For the pre-operative control population, corresponding scores were 47.41 ± 2.61% and 22.24 ± 1.03%. Following AA, we found that patients improved upon their pre-op Tegner score, although they did not return to their pre-injury level of sporting participation. Additionally, patients reported that they had no current dysfunction with their lower leg. CONCLUSION Patients undergoing Ankle Arthrodesis should expect improved lower leg function, though will not likely return to their pre-injury level of activity.
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Affiliation(s)
- Maged Hanna
- Department of Orthopedics, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, USA.
| | - Emily A Whicker
- Department of Orthopaedics, Drexel University College of Medicine, 245 N Broad St, Philadelphia, PA, USA
| | - Brian Traub
- Depatment of Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY, 10467, USA
| | - Emad Allam
- Department of Radiology, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
| | - Sameh A Labib
- Department of Orthopaedics, Emory University, 59 Executive Park South Suite 3000, Atlanta, GA, 30329, USA
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Chinnakkannu K, McKissack HM, He JK, Alexander B, Wilson J, Viner GC, Shah A. Mini-open vs. Transfibular Approach for Ankle Arthrodesis, Which Approach is Superior in Joint Preparation: A Cadaver Study. Indian J Orthop 2021; 55:135-141. [PMID: 34122766 PMCID: PMC8149565 DOI: 10.1007/s43465-020-00244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthrodesis is considered the gold standard for end-stage ankle arthritis in patients who fail conservative management. Achieving union is paramount while minimizing complications. An essential item for successful union is preparation of the articular surface. Our study aims to evaluate the difference in joint preparation between direct lateral and dual mini-open approaches. MATERIALS AND METHODS Ten below knee fresh-frozen specimens were used for this study. Five were prepared through lateral approach, and five using dual mini-incisions. After preparation, all ankles were dissected and images of tibial plafond and talar articular surfaces were taken. Surface areas of articulating facets and unprepared cartilage of talus, distal tibia, and distal fibula were measured and analyzed. RESULTS A greater amount of total surface area was prepared with the mini-open approach in comparison to the transfibular approach. Percentage of prepared surface area of total articulating surface (including talus and tibia/fibula), talus, tibia, and fibula with the transfibular approach were 76.9%, 77.7%, and 75%, respectively. Percentages were 90.9%, 92.9%, and 88.6% with the mini-open approach. When excluding medial gutter, there was no significant difference between techniques (83.94% vs. 90.85%, p = 0.1412). CONCLUSION Joint preparation with the mini-open approach is equally efficacious as the transfibular approach for the tibiotalar joint. The mini-open approach does provide superior preparation of the medial gutter and inferior tibial surface which may help to increase union rates and decreased complications. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Karthikeyan Chinnakkannu
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205 USA
| | - Haley M. McKissack
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205 USA
| | - Jun Kit He
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205 USA
| | - Bradley Alexander
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205 USA
| | - John Wilson
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205 USA
| | - Gean C. Viner
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205 USA
| | - Ashish Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL 35205 USA
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Giannoudis VP, Ewins E, Taylor DM, Foster P, Harwood P. Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study. Strategies Trauma Limb Reconstr 2021; 16:86-95. [PMID: 34804224 PMCID: PMC8578245 DOI: 10.5005/jp-journals-10080-1516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS AND OBJECTIVES To examine clinical and functional outcomes in patients with intra- and extra-articular distal tibial fractures treated definitively by Ilizarov fixation. MATERIALS AND METHODS Patients with tibial fractures extending within 1 Müller square of the ankle joint were identified from our Ilizarov database over a 5-year period. Data on treatment and outcome were assembled from this database and supplemented by a review of patient records. General measures of health-related quality of life and limb-specific functional outcome scores were recorded. Adverse events were documented according to Paley's classification. RESULTS One hundred and sixty-eight patients with 169 fractures were identified, 28% were open and 63% intra-articular. One hundred and sixty-five (98%) of the fractures united, two following bone grafting in their original frames, at a median of 166.5 days (range 104-537). Three patients with nonunions united with further treatment. One patient (an end-stage diabetic) elected to undergo amputation following multiple early complications during treatment. Closed fractures united more rapidly than open (median 157 vs 183 days; p = 0.005) and true Pilon (43C3) fractures took longer to unite than other fractures (median 157 vs 177 days; p = 0.01).Sixty-seven percent of patients completed functional outcome scores. Sixty-two percent reported good or excellent ankle scores at more than 6 months post frame removal, 38% fair and 10% poor. Patients with intra-articular fractures reported significantly worse ankle scores than those with extra-articular injuries. General measures of health-related quality of life (EuroQol-5D) revealed significant ongoing effects despite good clinical outcomes. CONCLUSION This study demonstrates a high union and low serious complication rate, suggesting that external ring fixation is a safe and effective treatment for these injuries. HOW TO CITE THIS ARTICLE Giannoudis VP, Ewins E, Taylor DM, et al. Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study. Strategies Trauma Limb Reconstr 2021;16(2):86-95.
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Affiliation(s)
| | - Emma Ewins
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - D Martin Taylor
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Patrick Foster
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Paul Harwood
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, Leeds, United Kingdom
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Glazebrook M, Burgesson BN, Younger AS, Daniels TR. Clinical outcome results of total ankle replacement and ankle arthrodesis: a pilot randomised controlled trial. Foot Ankle Surg 2021; 27:326-331. [PMID: 33148476 DOI: 10.1016/j.fas.2020.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/18/2020] [Accepted: 10/09/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle arthrodesis (AA) and replacement (TAA) are widely accepted options in managing end-stage ankle arthritis (ESAA). We hypothesize that clinical outcomes would be similar for both interventions. METHODS We conducted a multicenter randomized controlled trial that collected data on patient demographics, complication rates, Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) scores. We evaluated pre and postoperative scores within and between cohorts. RESULTS The thirty-nine ankles enrolled had a mean follow-up of 5.1 ± 2.8 years. Total AOS scores improved significantly in both groups; 59.4 ± 15.9 to 38 ± 20 (p-value = 0.002) for TAA and 64.6 ± 19.7 to 31.8 ± 16.5 (p-value < 0.001) for AA at last follow-up. Complication rate was higher in the AA cohort with four major complications (20%). CONCLUSION We observed a statistically significant benefit with TAA and AA. As a pilot trial, this study is meant to inform on design and feasibility of future RCTs. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mark Glazebrook
- Department of Orthopedic Surgery, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Halifax, Nova Scotia, B3H 3A7, Canada
| | - Bernard N Burgesson
- Dalhousie University, Division of Orthopedic Surgery, Queen Elizabeth II Health Sciences Center, 1796 Summer Street, Halifax, Nova Scotia, B3H 3A7, Canada.
| | - Alastair S Younger
- University of British Columbia Faculty of Medicine, Orthopaedics 1144 Burrard Street 560, Vancouver, BC, V6Z 2C7, Canada
| | - Timothy R Daniels
- University of Toronto, Surgery, 55 Queen Street East 800, Toronto, ON, M5N 1R6, Canada
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Pradana AS, Phatama KY, Mustamsir E, Cahyono GD, Oktafandi IGNAA, Hidayat M. Double posterior lateral plating arthrodesis for charcot ankle: A case series. Ann Med Surg (Lond) 2021; 65:102250. [PMID: 33996041 PMCID: PMC8091877 DOI: 10.1016/j.amsu.2021.102250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Ankle arthrodesis is one of the managements for a significantly unstable Charcot ankle. Some of the methods of internal fixation for ankle arthrodesis include the use of intramedullary nails, screws, and plates. Ankle arthrodesis using intramedullary nails has become more popular. However, studies evaluating the use of plate fixation, particularly double posterior lateral plating, are limited. We report the clinical and radiological outcomes of double posterior lateral plating ankle arthrodesis in three diabetic Charcot ankle patients. Presentation of case Three patients, aged 73, 67, and 65 years old, complained of ankle pain and with a history of type 2 diabetes mellitus. The physical examination revealed swelling and erythema without a sign of active infection. The radiological examination showed ankle deformity, and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores were 5, 10, and 0, respectively. All patients were diagnosed with a diabetic Charcot ankle and underwent ankle arthrodesis using double posterior lateral plating. Four months and six months follow up revealed talus union, improved ankle deformity, and improved AOFAS Ankle-Hindfoot scores to 70, 76, and 73, respectively. Discussion Various methods of ankle arthrodesis are retrograde intramedullary nails, screws, and plates. In this report, we opt for plate fixation because it allows for stable internal fixation, adequate compression, high angular stability, and a lower irreversible deformation in osteoporotic bone. Conclusion Double posterior lateral plating ankle arthrodesis provided satisfactory clinical and radiological outcomes. This method can be an alternative for patients with Charcot ankle requiring ankle arthrodesis. Double posterior lateral plating ankle arthrodesis is satisfactory. This method can be an alternative for patients with Charcot ankle. Plate fixation allows stable internal fixation and adequate compression.
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Affiliation(s)
- Ananto Satya Pradana
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Krisna Yuarno Phatama
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Edi Mustamsir
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | - Ganang Dwi Cahyono
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
| | | | - Mohamad Hidayat
- Orthopaedic and Traumatology Department, Faculty of Medicine, Brawijaya University-Saiful Anwar General Hospital, Malang, East Java, Indonesia
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Novoa-Parra CD, Gil-Monzó E, Díaz-Fernández R, Lizaur-Utrilla A. Trend in Spain in the use of total ankle arthroplasty versus arthrodesis in the period 1997-2017. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:S1888-4415(21)00016-3. [PMID: 33722516 DOI: 10.1016/j.recot.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/13/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The main objective of this study is to compare proportionally the incidence of total ankle arthroplasty (TAA) versus ankle arthrodesis and to determine the variables that may have influenced its indication. The secondary objective is to analyse the trend in the use of TAA using a population-based analysis and to compare our results with those reported by national registries in other countries. MATERIAL AND METHOD A retrospective review of the Minimum Basic Data Set from 1997-2017 was performed. Subjects were categorised according to surgical procedure. Their temporal evolution was analysed and hospital variables associated with the indication (age, sex, hospital complexity) were identified. In order to compare the trend in Spain with respect to other countries, the information was standardised as number of procedures per 100,000 inhabitants/year and a projection was made for the five-year period 2020-2025. RESULTS In the period 1997-2017, 11,669 ankle arthrodesis and 1,049 TAAs were performed. The trend was increasing and significant for both procedures, however, in the last 10 years analysed the proportional trend of TAA decreased significantly. Being female (OR 1.32), being 65 years or older (OR 1.50) and being operated in a complex hospital (OR 1.31) were associated with the indication for a TAA. Compared to other countries, Spain has much lower rates of TAA utilisation, with minimal growth estimated for the year 2025. CONCLUSION Although the use of TAA has increased, its growth has been lower than that of ankle arthrodesis and its current trend is proportionally decreasing, with female sex, age≥65 years and the patient being operated in a medium/high complexity hospital being associated with the indication for TAA. Compared with other countries, Spain has much lower rates of use and its projection over the next five years, although increasing, is expected to be minimal.
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Affiliation(s)
- C D Novoa-Parra
- Servicio de Cirugía Ortopédica y Traumatología, Hospital de Denia, Alicante, España.
| | - E Gil-Monzó
- Unidad de pie y tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr. Peset, Valencia, España
| | - R Díaz-Fernández
- Unidad de pie y tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital de Manises, Valencia, España; Unidad de pie y tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Quironsalud, Valencia, España; Facultad de Medicina, Universidad Católica de Valencia, San Vicente Mártir, Valencia, España
| | - A Lizaur-Utrilla
- Facultad de Medicina, Universidad Miguel Hernández, Elche, España
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El-Tantawy A, Atef A, Samy A. Trans-calcaneal retrograde nailing for secondary-displaced traumatic ankle fractures in diabetics with insensate feet: a less-invasive salvage-arthrodesis technique. Eur J Orthop Surg Traumatol 2021; 32:37-46. [PMID: 33687556 DOI: 10.1007/s00590-021-02898-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Secondary displacement of traumatic ankle fractures with subsequent soft-tissue breakdown is a troublesome issue after inappropriate conservative treatment among non-compliant diabetic patients with severe peripheral neuropathy. This study was conducted to evaluate the results of a less-invasive arthrodesis procedure as an alternative to osteosynthesis in these complex scenarios. METHODS A total of 46 diabetics, who underwent fluoroscopy-assisted trans-calcaneal retrograde nailing-based ankle arthrodesis between 2012 and 2018 for salvaging secondary-displaced diabetic ankle fractures in their insensate feet, were evaluated in this retrospective study. All fractures were associated with uninfected mechanical ulcers overlying malleoli, without Charcot changes, after failed conservative cast immobilization. The patients (mean age: 52.52 ± 3.70 years; 18 males; 46 feet) were evaluated radiologically for union and clinically for limb salvage, modified American Orthopedic Ankle and Foot Scale (AOAFS), and the overall subjective patients' satisfaction. RESULTS The mean follow-up was 29.5 ± 3.1 months. All ulcers have healed with local care only with 100% limb salvage. Four patients experienced minor wound healing problems at posterior heel, and another one developed acute Charcot changes that was successfully managed by offloading and repeat surgery. Forty patients (86.96%) had fully consolidated fusions with a mean time to fusion 15.78 ± 2.58 weeks, while the other six cases had stable fibrous-union. At the final follow-up, the mean modified-AOFAS was 76.85 ± 6.0 from 86 total points. All, but four patients (91.30%) were completely satisfied while the other four patients were partially satisfied. CONCLUSIONS The presented less-invasive arthrodesis technique is reproducible and effective alternative for salvaging unstable diabetic ankle fractures in the insensate feet when standard surgical procedures would be more risky. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Ahmad El-Tantawy
- Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Ashraf Atef
- Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Samy
- Orthopedic and Traumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Probasco WV, Lee D, Lee R, Bell J, Labaran L, Stein BE. Differences in 30-day complications associated with total ankle arthroplasty and ankle arthrodesis: A matched cohort study. Foot (Edinb) 2021; 46:101750. [PMID: 33278810 DOI: 10.1016/j.foot.2020.101750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 10/13/2020] [Accepted: 11/11/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The objective of this study was to identify whether total ankle arthroplasty (TAA) was associated with greater risk for 30-day complications and/or greater financial burden in comparison to ankle arthrodesis (AA). METHODS The PearlDiver Patient Records Database was queried to identify all patients who underwent an arthroscopic/open AA or TAA from 2006 to 2013. The two cohorts were then matched in a 1:1 manner to control for comorbidities and demographics. Postoperative complications were compared between the two cohorts, in addition to the associated costs with respect to each procedure. RESULTS No significant differences in risk for postoperative complications were noted between the two procedures with the numbers available. Significant differences were demonstrated in total length of hospital stay (LOS), with a mean of 2.13 days for the TAA cohort and 2.42 days for the AA cohort (p < 0.001). Higher mean total hospital costs were noted for TAA (x¯ = $62,416.62) compared to AA (x¯ = $37,737.43, p < 0.001); however, TAA was associated with a higher mean total reimbursement (x¯ = $12,254.43) than AA (x¯ = $7915.72, p < 0.001). CONCLUSION With no notable differences in 30-day complication rates, TAA remains a viable alternative to AA in the appropriately selected patient and provides the ability to preserve tibiotalar motion resulting in superior functional scores. Additionally, TAA demonstrated higher total costs to implant, but also greater reimbursement, in line with the recent literature suggesting TAA to be a cost-effective alternative to AA. LEVEL OF EVIDENCE III Retrospective study.
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Affiliation(s)
- William V Probasco
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, United States.
| | - Danny Lee
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, United States.
| | - Ryan Lee
- Department of Orthopaedic Surgery, The George Washington University, Washington, DC, United States
| | - Joshua Bell
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States
| | - Lawal Labaran
- Department of Orthopaedic Surgery, University of Illinois School of Medicine, Chicago, IL, United States
| | - Benjamin E Stein
- Department of Orthopaedic Surgery, Johns Hopkins Sibley Memorial Hospital, Washington, DC, United States
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Sundet M, Johnsen E, Eikvar KH, Eriksen ML. Retrograde nailing, trabecular metal implant and use of bone marrow aspirate concentrate after failed ankle joint replacement. Foot Ankle Surg 2021; 27:123-128. [PMID: 32273230 DOI: 10.1016/j.fas.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle fusion after removal of alloplasty is known to be a procedure with a high potential for non-unions and poor function, especially tibio-talo-calcaneal fusion. We wanted to review our results after using a novel method for the procedure, combining retrograde nailing with a trabecular metal implant and bone marrow aspirate concentration applied in an ostoconductive pad in addition to autologous bone grafting. MATERIALS AND METHODS Retrospective review of a patient series, with some prospectively registered data. 31 ankles in 30 patients were operated from January 2016 to February 2019. RESULTS There were two non-unions (6.5%), and one delayed union, none of these were reoperated. The mean postoperative Manchester-Oxford Foot and Ankle Questionnaire score (MOxFQ) was 33.6 points. 9 patients scored an average MOxFQ at 72.9 immediately before surgery, while at follow-up this had decreased to 36.2, an improvement of 36.7 points (95% CI 18.3-54.9). There were 1 minor infection and 5 possible nerve injuries. One patient had the leg amputated 1 year after the surgery due to a non-related necrotizing fasciitis. CONCLUSION We present reasonably good short to medium term patient satisfaction and fusion rates with this novel combination of techniques.
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Affiliation(s)
- Mads Sundet
- Consultant Foot and Ankle Surgeon, Diakonhjemmet Hospital, Oslo, Norway.
| | - Elena Johnsen
- Consultant Radiologist, Diakonhjemmet Hospital, Oslo, Norway.
| | - Kari Helene Eikvar
- Department of Professional Affairs,The Norwegian Medical Association, Oslo, Norway.
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Politikou O, Wirth S, Giesen T, Guggenberger R, Giovanoli P, Calcagni M. Corticoperiosteal medial femoral condyle flap for recalcitrant nonunion in ankle and foot: Outcomes and radiological evaluation of donor site morbidity. Foot Ankle Surg 2020; 26:918-923. [PMID: 32067885 DOI: 10.1016/j.fas.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/11/2019] [Accepted: 12/29/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the effectiveness and safety of free corticoperiosteal medial femoral condyle (MFC) flap for ankle, hindfoot and midfoot reconstruction in patients with recalcitrant nonunion. METHODS Patients who underwent ankle and foot reconstruction using the MFC flap at our clinic were recruited for assessment of the union rate, time to union and functional outcome. Furthermore, a clinical and radiological examination of the donor knee was performed using both computed tomography and magnetic resonance imaging. RESULTS Thirteen patients with a mean follow-up time of 2.5 years were included; 10 of them had a previously failed ankle and foot arthrodesis. Union was achieved in 11 patients in an average time of 10 months after MFC flap surgery. Donor site morbidity was minor with no radiological evidence for soft tissue or bone complication. CONCLUSION MFC flaps are a useful and safe reconstructive tool and may be considered after failed ankle and foot arthrodesis.
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Affiliation(s)
- Olga Politikou
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Stephan Wirth
- Division Foot and Ankle Surgery, Orthopaedics Department, University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Thomas Giesen
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Roman Guggenberger
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Pietro Giovanoli
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
| | - Maurizio Calcagni
- Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
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Abstract
A malaligned ankle arthrodesis is a painful and complicated pathology. Deformities may be present in the frontal, sagittal, or transverse plane or a combination of planes. Thorough preoperative evaluation of the deformity and the patient as a whole is crucial to successful revision. Surgical site for revision should be based on center of rotation of angulation, when possible. Revision commonly is performed through opening wedge osteotomy. Closing wedge and focal dome osteotomies, however, are excellent options. Revision also may be performed through external fixation or total ankle replacement. Although the literature is not rich with data, the options discussed provide favorable results.
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Affiliation(s)
- Christopher L Reeves
- Advent Health East Orlando Podiatric Surgery Residency, Orlando Foot and Ankle Clinic- Upperline Health, 2111 Glenwood Drive Suite 104, Winter Park, FL 32792, USA.
| | - Amber M Shane
- Department of Podiatric Surgery Advent Health System, Advent Health East Orlando Podiatric Surgery Residency, Orlando Foot and Ankle Clinic- Upperline Health, 250 North Alafaya Trail Suite 115, Orlando, FL 32828, USA
| | - Hannah Sahli
- Department of Podiatric Surgery AdventHealth System, Orlando, FL, USA
| | - Cody Togher
- Department of Podiatric Surgery AdventHealth System, Orlando, FL, USA
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Woo BJ, Lai MC, Ng S, Rikhraj IS, Koo K. Clinical outcomes comparing arthroscopic vs open ankle arthrodesis. Foot Ankle Surg 2020; 26:530-534. [PMID: 31257043 DOI: 10.1016/j.fas.2019.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/14/2019] [Accepted: 06/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Over the last twenty years, minimally invasive ankle arthrodesis has evolved into a well-tolerated and safe procedure. It has grown in favor to open ankle arthrodesis due to shorter length of stay and fewer complications recorded. This paper aims to compare the clinical outcomes of arthroscopic vs open ankle arthrodesis at 24-months followup. METHODS From 2004 to 2015, we reviewed a prospectively collected database in a tertiary hospital foot and ankle registry. 28 feet that underwent arthroscopic ankle arthrodesis were matched to 56 feet that underwent open ankle arthrodesis for age, sex and body mass index (BMI). Visual analogue scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-hindfoot Scores and Short Form Health Survey (SF-36) were obtained to assess clinical outcomes. These parameters were collected before surgery, at 6months and 24months after surgery. RESULTS The arthroscopic group demonstrated significant less pain in the perioperative period (arthroscopic: 1.9±1.2, open: 3.8±1.1, p<0.001) and shorter length of hospitalization stay (arthroscopic: 2.1±0.7 open: 3.5±1.7, p<0.001). Patients who underwent arthroscopic ankle arthrodesis also reported a higher SF-36 score on physical functioning at 6months (arthroscopic: 58.4±27.1, open: 47.1±24.0, p<0.05) and higher AOFAS Ankle-hindfoot Scale score at 24-months (arthroscopic: 78.9±18.9, open: 68.9±24.7, p<0.05). There were no postoperative complications in the arthroscopic group but 11 in the open group, including 9 which required followup operations. There was no significant difference in length of operative procedure between both groups. CONCLUSIONS We conclude that the arthroscopic group displayed better clinical outcomes compared to the open group at the 24months followup. The advantages of arthroscopic ankle arthrodesis include significantly less perioperative pain, higher AOFAS Ankle-hindfoot scores at 24months, shorter length of stay, fewer postoperative complications and followup operations. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Bo Jun Woo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mun Chun Lai
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Sean Ng
- Department of Orthopaedic Surgery, Mount Elizabeth Hospital, Singapore, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Rüschenschmidt M, Glombitza M, Dahmen J, Hax PM, Lefering R, Steinhausen E. External versus internal fixation for arthrodesis of chronic ankle joint infections - A comparative retrospective study. Foot Ankle Surg 2020; 26:398-404. [PMID: 31129101 DOI: 10.1016/j.fas.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/13/2019] [Accepted: 05/02/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Arthrodesis of the ankle is a salvage procedure in case of chronic ankle joint infection. External fixation still is the gold standard. We compared the outcome of external fixator versus intramedullary nailing for arthrodesis of the infected ankle joint. METHODS All patients with ankle joint infection who received arthrodesis with either external fixator or intramedullary nail between 08/2009 and 09/2017 were retrospectively analyzed. Endpoints were the successful control of infection, osseous fusion, and mobilization with full weightbearing. RESULTS Seventy-one patients were included. Nineteen patients (27%) suffered reinfection. Patients with intramedullary nailing showed significantly fewer reinfections (p=0.019), achieved full weightbearing significantly more often (p=0.042) and faster and developed significantly fewer complications (p<0.001). Forty-three patients showed bone fusion without significant differences between the groups. CONCLUSIONS Ankle arthrodesis with intramedullary nailing appears to be a successful alternative to the established procedure of external fixation in cases of chronic ankle joint infection.
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