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Ramamurti P, Schwartz JM, Novicoff WM, Park JS, Cooper MT. Association of Timing of Hindfoot Arthrodesis and Early Reoperation Rates for Total Ankle Arthroplasty. Foot Ankle Int 2024:10711007241241071. [PMID: 38712752 DOI: 10.1177/10711007241241071] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND Prior literature has demonstrated that ipsilateral hindfoot arthrodesis may increase the risk for reoperation after total ankle arthroplasty (TAA) and that simultaneous hindfoot arthrodesis with TAA could result in short-term clinical and radiologic improvements. The purpose of this study is to compare the reoperation rates after TAA with prior hindfoot arthrodesis vs simultaneous arthrodesis and TAA. METHODS Patients who underwent primary TAA were identified in the PearlDiver database. Patients were sorted into 2 study cohorts: hindfoot arthrodesis prior to TAA and simultaneous arthrodesis and TAA. Propensity matched control cohorts were identified for each study group. Multivariate analysis was conducted to account for any confounding variables and covariates when identifying differences in complications between cohorts. RESULTS 297 patients underwent TAA with prior hindfoot arthrodesis and 174 underwent TAA and hindfoot arthrodesis concurrently. The incidence of reoperation (13.8% vs 5.2%, P < .001) and infection (12.6% vs 5.9%, P = .011) for the simultaneous cohort was higher when compared to the matched control cohort. In contrast, there was no statistically significant difference when comparing the prior arthrodesis cohort to the matched control cohort in reoperation rates (5.1% vs 4.7%, P = .787) or infection rates (4.4% vs 4.8%, P = .734). Those undergoing simultaneous procedures had increased incidences of reoperation, wound complications, infection, and emergency department visits (P < .0167) when compared to the TAA with prior arthrodesis cohort. CONCLUSION Patients undergoing TAA and hindfoot arthrodesis concurrently were found to have higher rates of reoperation and infection when compared to the matched control cohort . In contrast, there was no difference in these rates in patients undergoing TAA with prior hindfoot arthrodesis compared with their matched control cohort. Patients undergoing simultaneous procedures had increased rates of reoperations, wound complications, infection, and emergency department visits compared to the TAA with prior arthrodesis cohort. LEVEL OF EVIDENCE Level III, retrospective comparative database study.
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Affiliation(s)
- Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Joshua M Schwartz
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Wendy M Novicoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Joseph S Park
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Minton T Cooper
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
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2
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Sakkab R, MacRae TM, Diaz R, Cullen BD. Patient Reported Outcomes Following Triple Arthrodesis for Adult Acquired Flat Foot Deformity: Minimum Two Year Follow Up. J Foot Ankle Surg 2024; 63:319-323. [PMID: 38097009 DOI: 10.1053/j.jfas.2023.11.019] [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: 02/23/2023] [Revised: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 02/02/2024]
Abstract
The aim of this study is to analyze patient-reported outcomes following this procedure as well as any demographics that may confer prognostic capability. A retrospective analysis was conducted of patients who underwent Triple Arthrodesis at our facility from 2014-2021. Patients were selected if they underwent an isolated triple arthrodesis. All cases included either a gastrocnemius recession versus a percutaneous tendo-achilles lengthening depending on the patient's Silverskiold examination. The electronic medical record was utilized to collect basic patient demographics, previous foot and ankle surgeries, hardware failures, additional procedures, and surgical complications. To evaluate outcomes, we compared patient reported outcomes measurement information system (PROMIS) survey scores with the general population and preoperative versus postoperative visual analog scale (VAS) scores. Foot function index (FFI) scores and scores were utilized as a validation tool for our results. A total of 132 patients met the criteria for our study with a total of 50 participants completing the PROMIS and FFI surveys. The average time point at which the outcomes were collected was 5.50 y postoperatively, ranging from 1.65 to 7.57 y. The average PROMIS physical function was 38.35, pain interference was 61.52, and depression was 49.82 for this population. The mean FFI scores were 58.56 for pain, 60.07 for disability, and 48.07 for activity limitation. There was a significant decrease in preoperative and postoperative VAS scores from 5.4 to 2.55 (p < .001). Three patients experienced wound complications related to decreased sensation. Our results indicated that only PROMIS depression scores were within one standard deviation of the population mean following a triple arthrodesis procedure. PROMIS physical function and pain interference were both outside of one standard deviation for the population.
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Affiliation(s)
- Ramez Sakkab
- Resident Physician, Scripps Mercy Hospital, San Diego, CA.
| | - Tyler M MacRae
- Resident Physician, Scripps Mercy Hospital, San Diego, CA
| | - Ryan Diaz
- Podiatric Surgeon, Scripps Green Hospital, La Jolla, CA
| | - Benjamin D Cullen
- Section Chief, Department of Podiatry, Scripps Mercy Hospital, San Diego, CA
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3
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Badell JS, Cottom JM. Operative Time, Cost, and Union Rate of Power Rasp Joint Preparation Versus Traditional Preparation in Arthrodesis of the Foot and Rearfoot. J Foot Ankle Surg 2024:S1067-2516(24)00051-6. [PMID: 38494112 DOI: 10.1053/j.jfas.2024.02.004] [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: 08/07/2023] [Revised: 11/09/2023] [Accepted: 02/17/2024] [Indexed: 03/19/2024]
Abstract
Time spent in the operating room is valuable to both surgeons and patients. One of the biggest rate-limiting factors when it comes to arthrodesis procedures of the foot and ankle is cartilage removal and joint preparation. Power instrumentation in joint preparation provides an avenue to decrease joint preparation time, thus decreasing operating room time and costs. Arthrodesis of 47 joints (n) from 27 patients were included. Power rasp joint preparation in 26 joints was compared to traditional osteotome and curette joint preparation in 21 joints in both time (seconds), cost (total operating room time cost per minute), and union rate. The overall mean joint preparation time using power rasp for the subtalar joint was 268.3 seconds, talonavicular joint 212.3 seconds, calcaneocuboid joint 142.6 seconds, 1st TMT 107.2 seconds. Mean joint preparation time using traditional method for subtalar joint 509.8 seconds, talonavicular joint 393.0 seconds, calcaneocuboid joint 400.0 seconds, 1st TMT 319.6 seconds. Mean cost of joint preparation using power rasp for subtalar joint $165.47, talonavicular joint $130.89, calcaneocuboid joint $87.94, 1st TMT $66.11. Mean cost of joint preparation using traditional techniques for subtalar joint $314.34, talonavicular joint $242.35, calcaneocuboid joint $246.67, 1st TMT $197.33. Overall union rate was 98% (1 asymptomatic non-union). Increasing efficiency in the operating room is vital to every surgeon's practice. Power rasp joint preparation is a viable option to increase efficiency and decrease operative time, this study shows no statistically significant differences in union rate, with comparable rates to existing literature.
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Affiliation(s)
- Jay S Badell
- Fellowship Trained Foot and Ankle Surgeon; Fellowship Surgery Faculty, Florida Orthopedic Foot & Ankle Center, Sarasota, FL.
| | - James M Cottom
- Fellowship Trained Foot and Ankle Surgeon; Director, Florida Orthopedic Foot & Ankle Center Fellowship, Sarasota, FL
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Gauthier C, Bakaes Y, Martinez M, Hardin J, Gonzalez T, Jackson JB. Retrospective Review of Complications and Revision Rates Between Isolated Talonavicular vs Talonavicular and Subtalar (Double) Arthrodesis vs Triple Arthrodesis. Foot Ankle Orthop 2024; 9:24730114241231559. [PMID: 38405386 PMCID: PMC10893835 DOI: 10.1177/24730114241231559] [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] [Indexed: 02/27/2024] Open
Abstract
Background Hindfoot fusion procedures are common for the treatment of end-stage arthritis or deformity. Surgical treatments for these conditions include talonavicular joint (single) arthrodesis, talonavicular and subtalar (double) arthrodesis, or talonavicular, subtalar, and calcaneocuboid (triple) arthrodesis. This study evaluated the complication rate, revision surgery rate, and hardware removal rate for those treated with either single, double, or triple arthrodesis. Methods A retrospective review was conducted for patients who underwent single (Current Procedural Terminology [CPT] code 28740), double (CPT 28725 and 28740), or triple (CPT 28715) arthrodesis to treat hindfoot arthritis/deformity (International Classification of Diseases, Ninth Revision [ICD-9] code: 734, International Classification of Diseases, Tenth Revision [ICD-10] codes: M76821, M76822, and M76829) from 2005 to 2022 using the South Carolina Revenue and Fiscal Affairs databank. Data collected included demographics, comorbidities, procedure data, and postoperative outcomes within 1 year of principal surgery. Student t test, chi-squared test, and multivariable logistic regression analysis were utilized during data analysis. Results A total of 433 patients were identified, with 248 undergoing single arthrodesis, 67 undergoing double arthrodesis, and 118 undergoing triple arthrodesis. There was no significant difference between single, double, and triple arthrodesis in the rate of complications, hardware removals, revision surgeries, or 30-day readmission when controlling for confounding variables. However, a decrease in Charlson Comorbidity Index (CCI) was found to be predictive of an increase in the revision surgery rate (OR = 0.46, 95% CI 0.22-0.85, P = .02). Conclusion We found no difference in the rate of complications, hardware removals, or revision surgeries in those undergoing single, double, or triple arthrodesis. Surprisingly we found that a lower Charlson Comorbidity Index, indicating a healthier patient had a significant relationship with a higher rate of revision surgery. Further study including radiographic indications for surgery or the impact of overall health status on revision surgery rates may further elucidate the other components of this relationship. Level of Evidence Level III, cohort study.
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Affiliation(s)
- Chase Gauthier
- Department of Orthopedic Surgery, Prisma Health, Columbia, SC, USA
| | - Yianni Bakaes
- Department of Orthopedic Surgery, Prisma Health, Columbia, SC, USA
| | - Matthew Martinez
- Department of Orthopedic Surgery, Prisma Health, Columbia, SC, USA
| | - James Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, SC, USA
| | - Tyler Gonzalez
- Department of Orthopedic Surgery, Prisma Health, Columbia, SC, USA
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Pasquinelly A, Blood D, Elattar O, Hanna M. Optimal Sequence of Corrective Surgeries for Concomitant Valgus Knee and Rigid Pes Planus Deformities: The Knee-First Approach. Arthroplast Today 2023; 24:101265. [PMID: 38023651 PMCID: PMC10652122 DOI: 10.1016/j.artd.2023.101265] [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: 08/31/2023] [Revised: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
In patients requiring surgical correction of ipsilateral valgus knee and rigid pes planovalgus deformities, the optimal operative sequence is controversial. Growing evidence suggests these 2 deformities are related in etiology and interrelated in disease course. We present the case of a 72-year-old female with concomitant valgus knee and rigid pes planovalgus deformities successfully treated with total knee arthroplasty followed by triple arthrodesis and Achilles lengthening. Surgical correction of these deformities must be carefully planned between the operating surgeons to avoid over- or under-correction of alignment that could further impact gait. In contrast with the limited available literature, the authors recommend correction at the knee first and the foot and ankle second. Further prospective studies are needed to elucidate the best operative sequence in these patients.
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Affiliation(s)
- Adam Pasquinelly
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Dalton Blood
- Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Osama Elattar
- Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Maged Hanna
- Department of Orthopedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH
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Casciato DJ, Bischoff A, Mendicino RW. Anatomic Description of the Calcaneocuboid Joint: Implications for Staple Fixation. J Foot Ankle Surg 2023; 62:568-570. [PMID: 36868929 DOI: 10.1053/j.jfas.2023.01.004] [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: 11/19/2021] [Revised: 01/04/2023] [Accepted: 01/17/2023] [Indexed: 01/30/2023]
Abstract
Understanding the anatomy of the calcaneocuboid (CCJ) remains essential when selecting staple fixation to optimize osseous purchase during rearfoot procedures. This anatomic study quantitatively describes the CCJ in relation to staple fixation sites. The calcaneus and cuboid from 10 cadavers were dissected. Widths at 5 mm and 10 mm increments away from the joint were measured in dorsal, midline, and plantar thirds of each bone. The widths between each position's 5 mm and 10 mm increments were compared using the Student's t test. The widths among the positions at both distances were compared using an ANOVA then post hoc testing. Statistical significance was set at p ≤ 0.05. The middle (23 ± 3 mm) and plantar third (18 ± 3 mm) of the calcaneus at the 10 mm interval was greater than the 5 mm interval (p = .04). At 5 mm distal to the CCJ, the dorsal third of the cuboid maintained a statistically significant greater width than the plantar third (p = .02). The 5 mm (p = .001) and 10 mm (p = .005) dorsal calcaneus widths as well as the 5 mm (p = .003) and 10 mm (p = .007) middle calcaneus widths were significantly greater than the plantar widths. This investigation supports the use of 20 mm staple 10 mm away from the CCJ in dorsal and midline orientations. Care should be taken when placing a plantar staple within 10 mm proximal to the CCJ as the legs may extend beyond the medial cortex compared to dorsal and midline placements.
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Affiliation(s)
| | - Alex Bischoff
- Resident Physician, OhioHealth Grant Medical Center, Columbus, OH
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Rai AK, Rathod TN, Mohanty SS. Management Dilemma of a Neuropathic Knee in a Known Case of Larsen Syndrome: A Case Report. J Orthop Case Rep 2022; 12:22-26. [PMID: 36659883 PMCID: PMC9826694 DOI: 10.13107/jocr.2022.v12.i07.2900] [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] [Received: 02/09/2022] [Revised: 05/08/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Larsen syndrome (LS) is a rare genetic disorder affecting mainly the connective tissues. It is characterized by characteristic facial anomalies, cervical kyphosis, cardiorespiratory disorders, and multiple joint dislocations. We present a case of a 15-year-old male with unstable neuropathic knee joint instability in a known case of LS. The paucity of literature on the management of this rare condition puts an orthopedician in dilemma regarding the optimal treatment. Case Report A 15-year-old male, known case of LS, presented to our outpatient department with pain and instability in the right knee for 2 years. Clinically, the patient was having syndromic facies. The diagnosis of LS was confirmed on gene mapping. The right knee was swollen with medial joint line tenderness and restricted flexion. The patient had coronal plane valgus instability. The hypertrophied synovium eroded the articular surface. The radiograph of knee was suggestive of neuropathic arthropathy in fragmentation stage. Conclusion Orthopedician should be aware of such rare entity with its bony and soft-tissue manifestations. Neuropathic knee is not an absolute contraindication to total knee replacement, especially with advanced prosthesis. Primary arthrodesis to be considered in young adults with instability.
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Affiliation(s)
- Abhishek Kumar Rai
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India,Address of Correspondence: Dr. Abhishek Kumar Rai, Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Tushar Narayan Rathod
- Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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8
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Nakasa T, Ikuta Y, Kanemitsu M, Adachi N. Arthroscopic triple arthrodesis for the patient with rheumatoid arthritis; a case report. Mod Rheumatol Case Rep 2021; 5:29-35. [PMID: 33191869 DOI: 10.1080/24725625.2020.1847430] [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] [Received: 07/22/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
We treated a 60 - year - old man with pes planovalgus due to rheumatoid arthritis. He had been suffering from left foot pain with swelling. Despite drug therapy, his foot pain and deformity had got worsen. Taking into consideration his skin and bone quality, arthroscopic triple arthrodesis was performed. To access the subtalar joint, 2 portals were applied at the sinus tarsi, and decortication was performed. For calcaneocuboid joint, 1.5 cm portal was applied along with joint line at calcaneocuboid joint. Calcaneocuboid joint was fully decorticated, then, 1.5 cm portal was applied at the joint line of talonavicular joint in parallel. Synovectomy and decortication under arthroscopy were performed. Once each joint was sufficiently prepared, it was fixed using screws via a percutaneous stab incision with an autologous bone graft from the iliac crest to the calcaneocuboid and talonavicular joint. At 12 weeks postoperatively, bone union was confirmed. The Japan Society for Surgery of the Foot (JSSF) RA foot and ankle scale had improved from the postoperative value of 38 points to a postoperative score of 86 points at one year. Plain radiographs showed that good alignment of the patient's hindfoot was maintained. We found that arthroscopic approach was able to achieve satisfactory outcome and minimise soft tissue trauma in a compromised patient.
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Munekazu Kanemitsu
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Baumhauer JF, Glazebrook M, Younger A, Quiton JD, Fitch DA, Daniels TR, DiGiovanni CW. Long-term Autograft Harvest Site Pain After Ankle and Hindfoot Arthrodesis. Foot Ankle Int 2020; 41:911-915. [PMID: 32432488 DOI: 10.1177/1071100720920846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/01/2023]
Abstract
BACKGROUND Pain following autograft harvest has been studied; however, published literature has typically focused on the iliac crest with follow-up limited to only a few years. It remains unknown if pain continues or improves over time. The purpose of this study was to evaluate long-term pain associated with autograft harvest to supplement hindfoot or ankle arthrodesis. METHODS Subjects in the control arm of a previously conducted trial comparing autograft with a synthetic bone graft for hindfoot or ankle arthrodesis were invited back for a single visit at a minimum of 5 years following their initial surgery. Harvest site, fusion site, and weight-bearing pain were evaluated using a 100-point visual analog scale (VAS). Of the 130 invited subjects, 60 (46.1%) returned for assessment, 58 of whom completed pain assessments. RESULTS At a mean follow-up of 9.0 years (range, 7.8-10.5), more than a third (36.6%) of subjects had some level of harvest site pain. Using VAS greater than 20 mm as a threshold of clinical significance, pain remained clinically significant in 5.2% of subjects. There was a significant correlation between harvest site pain and both weight-bearing and fusion site pain. There was not a significant correlation between harvest site pain and volume of graft harvested. CONCLUSION Autograft harvest can result in chronic, clinically significant pain that can last up to 10 years. In the era of shared decision making, this information will help surgeons and patients quantify the risks of chronic pain after arthrodesis procedures that include a secondary operative incision for graft harvest. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
| | | | - Alastair Younger
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Timothy R Daniels
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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10
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Abstract
Background. Hindfoot fusion procedures are increasingly being performed in the outpatient setting. However, the cost savings of these procedures compared with the risks and benefits has not been clearly investigated. The objective of this study was to compare patient characteristics, costs, and short-term complications between inpatient and outpatient procedures. Methods. This was a retrospective review of all patients who underwent inpatient and outpatient hindfoot fusion procedures by a single surgeon, at 1 academic institution, from 2013 to 2017. Data collected included demographics, operative variables, comorbidities, complications, costs, and subsequent reencounters. Results. Of 124 procedures, 34 were inpatient and 90 were outpatient. Between procedural settings, with the numbers available, there was no significant increase in complication rate or frequency of reencounters within 90 days. There were no significant differences in the number of patients with reencounters related to the index procedure within 90 days (P = .43). There were 30 reencounters within 90 days after outpatient surgery versus 4 after inpatient surgery (P = .05). The total number of emergency room visits in the outpatient group within 90 days was significantly higher compared with the inpatient group (P = .04). The average cost for outpatient procedures was US$4159 less than inpatient procedures (P < .0001). Conclusion. Outpatient hindfoot fusion may be a safe alternative to inpatient surgery, with significant overall cost savings and similar rate of short-term complications. On the basis of these findings, we believe that outpatient management is preferable for the majority of patients, but further investigation is warranted. Levels of Evidence: Level III.
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Affiliation(s)
- Andrew S Moon
- University of Alabama School of Medicine, Birmingham, Alabama (AS Moon, AS McGee, HAP, RC, SN, AS).,Tufts University School of Medicine, Boston, Massachusetts (AS Moon); and Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama (GM)
| | - Andrew S McGee
- University of Alabama School of Medicine, Birmingham, Alabama (AS Moon, AS McGee, HAP, RC, SN, AS).,Tufts University School of Medicine, Boston, Massachusetts (AS Moon); and Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama (GM)
| | - Harshadkumar A Patel
- University of Alabama School of Medicine, Birmingham, Alabama (AS Moon, AS McGee, HAP, RC, SN, AS).,Tufts University School of Medicine, Boston, Massachusetts (AS Moon); and Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama (GM)
| | - Ryan Cone
- University of Alabama School of Medicine, Birmingham, Alabama (AS Moon, AS McGee, HAP, RC, SN, AS).,Tufts University School of Medicine, Boston, Massachusetts (AS Moon); and Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama (GM)
| | - Gerald McGwin
- University of Alabama School of Medicine, Birmingham, Alabama (AS Moon, AS McGee, HAP, RC, SN, AS).,Tufts University School of Medicine, Boston, Massachusetts (AS Moon); and Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama (GM)
| | - Sameer Naranje
- University of Alabama School of Medicine, Birmingham, Alabama (AS Moon, AS McGee, HAP, RC, SN, AS).,Tufts University School of Medicine, Boston, Massachusetts (AS Moon); and Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama (GM)
| | - Ashish Shah
- University of Alabama School of Medicine, Birmingham, Alabama (AS Moon, AS McGee, HAP, RC, SN, AS).,Tufts University School of Medicine, Boston, Massachusetts (AS Moon); and Department of Epidemiology, University of Alabama School of Public Health, Birmingham, Alabama (GM)
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Abstract
The contemporary literature is unclear regarding the joint that is most "at risk" to yield a nonunion in the performance of triple arthrodesis of the foot. There is also a debate regarding the best methods of joint preparation. A retrospective radiographic review was conducted of all primary triple arthrodeses performed within in a Northern California health maintenance organization between January 2007 and June 2013. Data documenting joint preparation techniques were collected, and postoperative imaging was reviewed to measure time to osseous union. Patient demographics were also collected. One hundred fifty-two patients (157 procedures) met the inclusion criteria. The overall nonunion rate for triple arthrodesis in this series was 29.9% (47/157). The nonunion rate of the talonavicular joint was 20.4% (32/157); the nonunion rate of the calcaneocuboid joint was 17.2% (27/157); and the nonunion rate of the subtalar joint was 8.9% (14/157). In conclusion, we found the most likely joint to obtain nonunion during triple arthrodesis was the talonavicular joint. Furthermore, the most efficacious joint preparation technique was a combination joint resection or curettage with fish scaling.
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Affiliation(s)
- Lindsey J Klassen
- Attending Physician, Kaiser Permanente South San Francisco, South San Francisco, CA
| | - Eric Shi
- Resident, Kaiser Permanente San Leandro, San Leandro, CA.
| | - Glenn M Weinraub
- Attending Physician, Kaiser Permanente San Leandro, San Leandro, CA
| | - Jennifer Liu
- Biostatistician, Division of Research, Kaiser Permanente Northern California, Oakland, CA
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12
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Merrill RK, Ferrandino RM, Hoffman R, Ndu A, Shaffer GW. Identifying Risk Factors for 30-Day Readmissions After Triple Arthrodesis Surgery. J Foot Ankle Surg 2019; 58:109-113. [PMID: 30448379 DOI: 10.1053/j.jfas.2018.08.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/05/2017] [Indexed: 02/03/2023]
Abstract
Rigid flatfoot deformity is a debilitating condition that can be managed by triple arthrodesis surgery. Triple arthrodesis has the potential to restore health-related quality of life, but it is also associated with several complications. Few studies have examined the 30-day readmission rates after triple arthrodesis. The objective of this study was to investigate risk factors for 30-day all-cause readmissions after triple arthrodesis. The nationwide readmission database was queried from 2013. By using International Classification of Disease, Ninth Revision, procedure codes, all triple arthrodesis procedures were identified. Demographic factors, comorbidities, insurance status, and hospital characteristics were statistically compared between patients who experienced a 30-day readmission and those who did not. Multivariable logistic regression was used to identify independent risk factors for 30-day readmission. Overall, 1916 triple arthrodesis cases were identified. The overall 30-day readmission rate after triple arthrodesis was 4.6%. Univariate analysis revealed a statistically higher proportion of patients with electrolyte abnormalities (13.8% vs 4.6%; p < .01) in the patients who were readmitted within 30 days compared with those who were not. Multivariable analysis demonstrated Medicaid insurance, relative to private insurance, as the only statistically significant predictor of 30-day readmission with an odds ratio of 4.43 (p < .05). These results suggest that patients of lower socioeconomic status may be at a greater risk for development of a short-term readmission after triple arthrodesis surgery. These findings are important for surgeon and patient communication, counseling, and postoperative care when choosing to pursue triple arthrodesis surgery.
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Affiliation(s)
- Robert K Merrill
- Resident, Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, PA.
| | - Rocco M Ferrandino
- Resident, Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryan Hoffman
- Resident, Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, PA
| | - Anthony Ndu
- Surgeon, Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, PA
| | - Gene W Shaffer
- Surgeon, Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, PA
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VanWye WR, Hoover DL. Management of a patient's gait abnormality using smartphone technology in-clinic for improved qualitative analysis: A case report. Physiother Theory Pract 2018; 34:403-410. [PMID: 29308956 DOI: 10.1080/09593985.2017.1419326] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Qualitative analysis has its limitations as the speed of human movement often occurs more quickly than can be comprehended. Digital video allows for frame-by-frame analysis, and therefore likely more effective interventions for gait dysfunction. Although the use of digital video outside laboratory settings, just a decade ago, was challenging due to cost and time constraints, rapid use of smartphones and software applications has made this technology much more practical for clinical usage. CASE DESCRIPTION A 35-year-old man presented for evaluation with the chief complaint of knee pain 24 months status-post triple arthrodesis following a work-related crush injury. In-clinic qualitative gait analysis revealed gait dysfunction, which was augmented by using a standard IPhone® 3GS camera. After video capture, an IPhone® application (Speed Up TV®, https://itunes.apple.com/us/app/speeduptv/id386986953?mt=8 ) allowed for frame-by-frame analysis. Corrective techniques were employed using in-clinic equipment to develop and apply a temporary heel-to-toe rocker sole (HTRS) to the patient's shoe. OUTCOMES Post-intervention video revealed significantly improved gait efficiency with a decrease in pain. The patient was promptly fitted with a permanent HTRS orthosis. This intervention enabled the patient to successfully complete a work conditioning program and progress to job retraining. DISCUSSION Video allows for multiple views, which can be further enhanced by using applications for frame-by-frame analysis and zoom capabilities. This is especially useful for less experienced observers of human motion, as well as for establishing comparative signs prior to implementation of training and/or permanent devices.
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Affiliation(s)
- William R VanWye
- a Department of Physical Therapy , Western Kentucky University , Bowling Green , USA
| | - Donald L Hoover
- b Department of Physical Therapy , Western Michigan University , Kalamazoo , MI
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Abstract
UNLABELLED Neurogenic contracture often results in spastic, nonreducible equinovarus deformity. Rigid contracture leads to pain, instability, and bracing difficulties. This case report details the utilization of the modified Lambrinudi triple arthrodesis intended to create a plantigrade, functional limb that is amenable to an extremity brace in a case of an acquired neurologic clubfoot. LEVELS OF EVIDENCE Therapeutic, Level IV: Case Report.
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Affiliation(s)
- Eric So
- Grant Medical Center, Columbus, Ohio (ES, LMH).,Step Lively Foot and Ankle Center, Columbus, Ohio (LMH)
| | - Lee M Hlad
- Grant Medical Center, Columbus, Ohio (ES, LMH).,Step Lively Foot and Ankle Center, Columbus, Ohio (LMH)
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Abstract
The single medial incision subtalar joint and talonavicular joint arthrodesis has been shown to be a useful alternative for the correction of hindfoot valgus deformity. We describe an arthroscopic method of joint preparation using this approach. The present case report included 6 consecutive patients aged 35 to 72 (mean ± standard deviation 55.8 ± 15.54) years (4 males [66.7%] and 2 females [33.3%]), who had undergone the medial approach for modified double arthrodesis of the foot. Of the 6 patients, 3 (50.0%) had undergone arthroscopic joint preparation and 3 (50.0%) traditional (manual) joint preparation. Osteobiologic agents were used in all patients. We found a shorter tourniquet time for the patients who had undergone an arthroscopic approach, with a mean of 110 ± 7.21 minutes, compared with a traditional joint preparation, with a mean of 121.3 ± 8.08 minutes. We also found a shorter time to radiographic union in the patients who had undergone an arthroscopic approach, all of whom showed signs of union at 6 weeks. Only 2 of the 3 patients in the traditional joint preparation group had achieved union at a mean of 10 ± 2.83 weeks, with 1 case resulting in nonunion. This technique could be a viable alternative to traditional methods of joint preparation by decreasing the operative time and improving the union rates.
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Affiliation(s)
- Eric Shi
- Resident Physician, Kaiser Permanente South Bay Consortium, Santa Clara, CA.
| | - Glenn M Weinraub
- Attending Physician, Department of Orthopaedic Surgery, The Permanente Medical Group, San Leandro, CA
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Röhm J, Zwicky L, Horn Lang T, Salentiny Y, Hintermann B, Knupp M. Mid- to long-term outcome of 96 corrective hindfoot fusions in 84 patients with rigid flatfoot deformity. Bone Joint J 2015; 97-B:668-74. [PMID: 25922462 DOI: 10.1302/0301-620x.97b5.35063] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 12/24/2022]
Abstract
Talonavicular and subtalar joint fusion through a medial incision (modified triple arthrodesis) has become an increasingly popular technique for treating symptomatic flatfoot deformity caused by posterior tibial tendon dysfunction. The purpose of this study was to look at its clinical and radiological mid- to long-term outcomes, including the rates of recurrent flatfoot deformity, nonunion and avascular necrosis of the dome of the talus. A total of 84 patients (96 feet) with a symptomatic rigid flatfoot deformity caused by posterior tibial tendon dysfunction were treated using a modified triple arthrodesis. The mean age of the patients was 66 years (35 to 85) and the mean follow-up was 4.7 years (1 to 8.3). Both clinical and radiological outcomes were analysed retrospectively. In 86 of the 95 feet (90.5%) for which radiographs were available, there was no loss of correction at final follow-up. In all, 14 feet (14.7%) needed secondary surgery, six for nonunion, two for avascular necrosis, five for progression of the flatfoot deformity and tibiotalar arthritis and one because of symptomatic overcorrection. The mean American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score) at final follow-up was 67 (between 16 and 100) and the mean visual analogue score for pain 2.4 points (between 0 and 10). In conclusion, modified triple arthrodesis provides reliable correction of deformity and a good clinical outcome at mid- to long-term follow-up, with nonunion as the most frequent complication. Avascular necrosis of the talus is a rare but serious complication of this technique.
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Affiliation(s)
- J Röhm
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - L Zwicky
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - T Horn Lang
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - Y Salentiny
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - B Hintermann
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - M Knupp
- Kantonsspital Baselland, Rheinstrasse 26, CH-4410 Liestal, Switzerland
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Milshteyn MA, Dwyer M, Andrecovich C, Bir C, Needleman RL. Comparison of two fixation methods for arthrodesis of the calcaneocuboid joint: a biomechanical study. Foot Ankle Int 2015; 36:98-102. [PMID: 25384391 DOI: 10.1177/1071100714552479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 02/01/2023]
Abstract
BACKGROUND The traditional fixation for a calcaneocuboid (CC) arthrodesis in triple arthrodesis is with a 6.5-mm cancellous screw. This procedure can be technically challenging. Fixation with a locking compression plate (LCP) may be easier to perform while achieving compression perpendicular to the fusion site. The purpose of this study was to compare the load to failure and the stiffness for each fixation method. METHODS Five matched-pair cadaver feet had an arthrodesis of the CC joint. For each matched pair, one was fixed with a screw and the other with an LCP. Surface bead markers were applied. Each specimen was then secured to a material testing machine through the calcaneus. The plantar surface of the cuboid faced the hydraulic ram to simulate weightbearing. A force was applied while the specimen was recorded with a high-resolution camera. The endpoint was maximal force at 2-mm separation between the calcaneus and cuboid measured along a horizontal axis. RESULTS The average force to failure and the average stiffness in the screw group were significantly less than the LCP group (P < .05). The screw construct failed in pullout from the cuboid; the LCP construct failed by plastic deformation of the plate. CONCLUSION Calcaneocuboid joint fixation with the LCP withstood a higher load until failure and demonstrated greater stiffness than with a 6.5-mm cancellous lag screw. CLINICAL RELEVANCE The use of LCP fixation can be considered as an alternative to oblique lag screw fixation for CC arthrodesis in a triple arthrodesis. It remains to be determined if LCP fixation leads to better clinical outcomes.
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Affiliation(s)
- Michael A Milshteyn
- Wayne State University, Department of Orthopaedic Surgery, Taylor, Michigan, USA
| | - Mark Dwyer
- Wayne State University, Department of Orthopaedic Surgery, Taylor, Michigan, USA
| | | | - Cynthia Bir
- University of Southern California, Los Angeles, California, USA
| | - Richard L Needleman
- Wayne State University, Department of Orthopaedic Surgery, Taylor, Michigan, USA
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Abstract
BACKGROUND Triple arthrodesis is a powerful hindfoot corrective procedure involving fusion of the talonavicular (TN), calcaneocuboid (CC), and subtalar (ST) joints. A 2-incision approach, a single-incision medial triple arthrodesis, and a single-incision medial double arthrodesis are well described. We present a single-incision lateral approach to triple arthrodesis. METHODS We retrospectively reviewed 70 patients who underwent triple arthrodesis at our institution from 2007 to 2011. Patients had either double-incision (n = 33) or single-incision lateral (n = 37) triple arthrodesis. A single surgeon performed all procedures. The most common diagnosis was stage III planovalgus deformity. Deformity correction, union rate, time of surgery, complications, wound healing, reoperations, and pre- and postoperative visual analog scale (VAS) pain scores were analyzed for both groups. RESULTS There were no statistical differences in deformity correction, wound healing, complications, reoperations, or improvement in VAS pain scores. Operation time was significantly shorter in the single-incision lateral group (86 minutes vs 95 minutes, P = .0395). There was no difference in union rates with regard to the TN, ST, or CC joints. Five patients had radiographic nonunions of the CC joint between both groups. CONCLUSIONS This is the first study that presents outcomes of a single lateral approach for triple arthrodesis. The single-incision approach was faster. The low rate of symptomatic nonunions suggests that fusion of the CC joint may not be important in symptomatic relief or deformity correction. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Abstract
Damaging effects of joint function can occur after fractures of the lower extremity that have healed with an angular malunion. Surgical techniques have been described to restore the normal mechanics and establish a plantigrade foot, including osteotomy and fusion. In the present report, we describe a unique case of a 17-year-old male who had initially experienced a severe injury to his left lower extremity and foot when he had been run over by a jeep. Originally, a Lisfranc injury with navicular and cuboid fractures were surgically corrected. He had also sustained an extra-articular distal tibial and fibular fracture, which had been conservatively managed. Seven months after the initial incident, he underwent 3-staged reconstructive surgery because of a malaligned valgus ankle with fibular malunion and a painful collapsing pes planovalgus deformity. A supramalleolar tibial osteotomy with fibular lengthening was first performed, followed by triple arthrodesis with removal of hardware and then syndesmosis repair. The present report discusses our clinical evaluation and surgical technique for this multiplanar post-traumatic deformity.
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Affiliation(s)
- Thomas A Brosky
- Attending Surgeon, Dekalb Medical Residency Program; Faculty, Podiatry Institute, Decatur, GA; and Foot and Ankle Clinic of Oakwood, Oakwood, GA
| | - Joshua J Mann
- Attending Surgeon, Dekalb Medical Residency Program; Faculty, Podiatry Institute, Decatur, GA; and Foot and Ankle Clinic of Oakwood, Oakwood, GA; Faculty, Podiatry Institute, Decatur, GA; and Ankle and Foot Centers of Georgia, Jonesboro, GA.
| | - Sean Patrick Dunn
- Attending Surgeon, Dekalb Medical Residency Program; Faculty, Podiatry Institute, Decatur, GA; and Foot and Ankle Clinic of Oakwood, Oakwood, GA
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