Tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a prospective cohort study at a minimum five year follow-up

Effect of electroacupuncture for early ankle osteoarthritis: A randomized controlled trial using three-dimensional gait analysis

BackgroundAnkle osteoarthritis (AOA) is a prevalent condition that affects joint function, often leading to pain, inflammation, and impaired mobility, significantly impacting patients' quality of life.ObjectiveThis study explores the effects of electroacupuncture treatment on clinical outcomes and gait characteristics in patients with ankle osteoarthritis (AOA).MethodsA total of 78 patients with AOA were randomly divided into a experiment group and a control group. The control group was treated with strength training, and the experiment group was additionally treated with electroacupuncture. The Ankle Osteoarthritis Scale (AOS), American Foot and Ankle Society's Ankle and Hindfoot Scale (AOFAS-AHS), and the 3D Motion Analysis System were used before and after the intervention to assess the clinical outcomes and changes in kinematic parameters in the AOA patients before and after therapy.ResultsAfter treatment, the differences in intra-group comparisons and inter-group comparisons of AOS scores, AOFAS-AHS scores, stride length, stride length, single-support phase, and gait variable scores (GVS) of ankle dorsiflexion-plantarflexion of the patients in the experiment group were statistically significant; the differences in inter-group comparisons of GVS scores of hip rotation of the patients in the experiment group were statistically significant; and the differences in the gait profile scores (GPS) and gait deviation indices of the patients in the experiment group were statistically significant. The differences in the intra-group comparisons were statistically significant. The within-group comparisons of AOS score, AOFAS-AHS score, GPS score and GVS score of ankle dorsiflexion-plantarflexion were statistically significant in the control group patients.ConclusionsElectroacupuncture has shown promise as an adjunctive therapy for patients with AOA, offering a more holistic rehabilitation strategy. By improving joint mobility and optimizing gait mechanics, electroacupuncture can effectively reduce pain, facilitate the restoration of normal gait patterns, and enhance patients' overall quality of life.

Difficulty in bone union after arthrodesis to treat Charcot arthropathy of the foot and ankle

Introduction

A major complication of arthrodesis is non-union in patients with Charcot arthropathy. This study examined the bone union in joints affected arthrodesis for Charcot arthropathy of the foot and ankle.

Methods

The current retrospective study enrolled 15 patients (20 feet) who underwent arthrodesis (performed in 47 joints) for Charcot arthropathy from 2014 to 2020. Post-operative radiographs were classified based on the Brodsky anatomical classification system at 6 months, 1 year, and 2 years post-operatively. The association with pre-operative and intra-operative data was determined.

Results

Bone union was achieved in 28 % of patients at 6 months, 57 % at 1 year, and 66 % at 2 years post-operatively. The bone union rates according to the Brodsky anatomic classification at 6 months, 1 year, and 2 years were 50 %, 67 %, and 67 % for type 1; 20 %, 44 %, and 56 % for type 2; and 36 %, 86 %, and 86 % for type 3A, respectively. At 1 year after arthrodesis surgery, the odds ratio for non-union in Brodsky type 2 compared to that in type 3A joints was 8.727 (95 % CI: 1.623-46.935, p = 0.006).

Conclusion

Arthrodesis procedures in joints affected by Charcot arthropathy, especially in Brodsky type 2 joints, should ensure perfect bone-to-bone fitting, good adaptation, sufficient bone grafting, and strong fixation.

Efficacy and safety of carbon fiber retrograde intramedullary nailing in tibio-talar-calcaneal fusion: a single-centre retrospective study

INTRODUCTION

Tibio-talar-calcaneal (TTC) fusion is a salvage procedure designated for treating various severe hindfoot pathologies. While traditional methods have been effective, the advantage of carbon fiber (CF) retrograde intramedullary nailing (RIMN) presents a potentially superior technique. This study evaluates the efficacy and safety of CF RIMN in TTC fusion, focusing on union rates, complication rates, and patient-reported outcomes.

MATERIALS AND METHODS

Conducted as a single-center, retrospective study, this research involved 21 patients who underwent TTC with CF RIMN from 2015 to 2021. Patient selection excluded those with active infections or those needing significant bone allografts. Patient follow-up was conducted at multiple intervals postoperatively, with a minimum follow-up of 24 months, assessing for union complications and using tools like the VAS, SF12, and AOFAS for patient-reported outcomes.

RESULTS

The study observed a 90% union rate among patients. Complication rates included a 14% incidence of iatrogenic fractures to the anterior tibial cortex and 19% postoperative complications. Significant improvement was noted in VAS scores but not in SF12 and AOFAS scores. The use of 200 mm RIMN was identified as requiring careful consideration due to associated complications.

CONCLUSION

CF RIMN in TTC fusion demonstrates a high union rate with notable complications. The significant improvement in VAS scores indicates patient satisfaction, but the lack of statistical significance in SF12 and AOFAS scores warrants attention. The findings advocate for the cautious use of 200 mm RIMN and highlight the need for further research, suggesting prospective, multicenter studies to validate these findings and explore long-term outcomes.

LEVEL OF EVIDENCE

III.

Midterm Results after Tibiotalar or Tibiotalocalcaneal Fusion Using an Ilizarov External Fixator

Background

Ankle fusion is considered a treatment of choice for end-stage ankle arthritis when a total ankle replacement procedure is not indicated. However, the potential risk of secondary arthritis in the adjacent joint after ankle fusion raises arguments on whether preserving the adjacent joint during an isolated tibiotalar (TT) fusion brings about any future benefits with regard to pain and gait discomfort. In this study, we intended to present midterm results following TT or tibiotalocalcaneal (TTC) fusion using an Ilizarov external fixator and to investigate whether spontaneous fusion occurred in the subtalar or midtarsal joint.

Methods

This is a retrospective observational study. Medical records of patients who underwent TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint between 1994 and 2018 were manually searched. Forty-one patients were included and the status of the joints adjacent to the fusion site was evaluated in radiographic examinations.

Results

Of the 34 patients who underwent TT fusion, 30 patients (88.3%) had a spontaneous fusion in the adjacent joints. Specifically, 11 patients (29.4%) had subtalar joint fusion and 19 patients (55.9%) had both midtarsal joint and subtalar joint fusion. In TTC fusion, the midtarsal joint was spontaneously fused in all 7 patients.

Conclusions

In this study, we observed spontaneous adjacent joint fusion following TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint. Although a careful approach should be made since patients treated in this study may not represent typical candidates that need primary joint-sacrificing procedures, we believe that this study may draw attention from surgeons concerned about the fate of the adjacent joint status after TT or TTC fusion.

Predictive Factors of Postoperative Pain in Patients With Tibiotalocalcaneal Arthrodesis With an Intramedullary Nail: A Retrospective Review

Tibiotalocalcaneal arthrodesis has been shown in literature to have good results in regards to low complication rates and deformity correction. While previous studies have investigated functional outcomes and complication rates, no large-scale studies have looked at pain outcomes. The present study performed a retrospective review of 154 extremities to analyze how a patient's comorbidities and characteristics influence pain outcomes following a tibiotalocalcaneal arthrodesis. The present study found an average change of pain from 7.1 to 3.0 in at least a 6 month follow up. We found that a diagnosis of chronic pain and tobacco use had statistically significant less pain improvement compared to patients without chronic pain or current tobacco use. We determined no statistically significant difference in pain outcomes for patients with or without Charcot deformity. Lastly, we found that with older patients there was more pain improvement observed. We physicians can educate current tobacco users of the improved pain outcomes with tobacco cessation prior to surgery. We recommend a multidisciplinary approach for pain in patients with a pre-operative diagnosis of chronic pain and to educate patients on realistic postoperative pain outcomes.

Comparison of different fibula procedures in tibiotalocalcaneal arthrodesis with a retrograde intramedullary nail: a mid-term retrospective study

BACKGROUND

Tibiotalocalcaneal (TTC) arthrodesis with a retrograde intramedullary nail for severe tibiotalar and talocalcaneal arthritis has a high fusion rate; however, no studies have focused on how to handle the fibula intraoperatively to achieve better results. This study aimed to compare the efficacies of various fibular procedures.

METHODS

We retrospectively reviewed the cases of severe tibiotalar and talocalcaneal arthritis in adults treated with TTC arthrodesis using a retrograde intramedullary nail between January 2012 and July 2017. The patients were divided into three groups according to different fibular procedures: Fibular osteotomy (FO), fibular strut (FS), and fibular preservation (FP). Functional outcomes and pain were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scales (VAS), respectively. The operation time, fusion time, radiographic evaluation, and complications were also recorded.

RESULTS

Fifty-eight patients with an average age of 53.2 (range, 32-69) years were enrolled in the final analysis. The numbers of patients enrolled in the three groups were 21, 19, and 18 in the FO, FS, and FP groups, respectively. The mean postoperative follow-up time was 66.0 (range, 60-78) months. All groups showed a high fusion rate (90.5% for FO, 94.7% for FS, and 94.4% for FP) and significant improvement in AOFAS ankle and hindfoot scores and VAS scores at the latest follow-up. There were no significant differences in these parameters among the three groups. The mean operation time of FS (131.3 ± 17.1 min) was longer than that of FO (119.3 ± 11.7 min) and FS (112.2 ± 12.6 min), but the fusion time was shorter (15.1 ± 2.8 weeks for FS, 17.2 ± 1.9 weeks for FO, and 16.8 ± 1.9 weeks for FP). Statistically significant differences were observed in these parameters.

CONCLUSIONS

TTC arthrodesis using a retrograde intramedullary nail is an effective procedure with a high rate of fusion to treat severe tibiotalar and talocalcaneal arthritis in adults; however, FSs can shorten fusion time when compared with FO and FP.

LEVEL OF CLINICAL EVIDENCE

Level 3.

Tibiotalocalcaneal Arthrodesis in Severe Hindfoot Deformities

Tibiotalocalcaneal arthrodesis (TTCA) is the most common and reliable procedure in the treatment of patients with end-stage ankle arthritis combined with severe deformity. Many of these patients present with difficult previous sequelae that include nonunion, malunion, broken implants, vascular deficiencies, skin problems, or a combination of the previous. In that complex scenario, sometimes the only alternative treatment is a below-the-knee amputation. Image studies--weightbearing X-rays, tomography, and magnetic resonance - are fundamental to evaluate alignment and bone stock. When all conservative treatments fail to alleviate pain and dysfunction, the combination of osteotomies and arthrodesis is the procedure of choice. Surgical planning needs to be very detailed and thorough with a special focus on bone loss after debridement of non-healthy tissue and removal of metalwork. TTCA with grafting allows for the preservation of the limb in more than 80% of cases but at the expense of many complications with nonunion rates of approximately 20% of cases. There is controversy about the use of a retrograde nail versus specific TTCA plate and screws but results from biomechanical studies do not show a clear superiority of one specific construct. Amputation rates are close to 5% of cases after repeated failed surgeries. Bulk allografts increase the rate of nonunions but apparently do not have an influence on postoperative infections. Valgus positioning of the ankle/hindfoot is paramount to allow for maximal sagittal plane compensation from the midtarsal joints. Most patients are satisfied with the results of these salvage operations. The studies presented in this article have a considerable wide array of different scenarios that obviously bias some of the results, complications, and outcomes but together they present a persuasive pattern toward considering TTC with grafting and nail or plate fixation as a good salvage procedure that may help the patients to maintain their foot and ankle with a better alignment, function, and pain relief.

Deciding Between Ankle and Tibiotalocalcaneal Arthrodesis for Isolated Ankle Arthritis

After isolated ankle (tibiotalar) arthrodesis, the triceps progressively shifts the subtalar joint into varus thus blocking compensatory motion from the midtarsal joints. In a tibiotalocalcaneal arthrodesis, the subtalar may be fixed with the correct valgus. Comparison between ankle and tibiotalocalcaneal arthrodesis does not clearly favor one over another for pain relief, satisfaction, and gait analysis. Compensatory sagittal plane motion through the midtarsal joints when the subtalar is fixed in valgus may be responsible for these results. Tibiotalocalcaneal arthrodesis has become our procedure of choice over isolated tibiotalar for end-stage ankle arthritis regardless of the radiographic state of the subtalar.