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Shah AA, Devana SK, Lee C, SooHoo NF. A predictive algorithm for perioperative complications and readmission after ankle arthrodesis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 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] [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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Traynor C, Coetzee JC. Outcomes of Conversion of Ankle Fusion to Total Ankle Arthroplasty. Foot Ankle Clin 2024; 29:165-170. [PMID: 38309800 DOI: 10.1016/j.fcl.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
With ankle replacements gaining popularity and documented good functional outcomes, there is an increasing number of patients inquiring about the possibility of converting an ankle fusion to a replacement. This could be due to pain, limited function, or increasing adjacent joint arthritis. There is an increasing body of evidence in the literature that a conversion to a replacement is possible and that the outcomes are positive. There are also absolute contradictions for a conversion. An absent fibula, pain of unknown origin, and recent infection fall in this category. Long-term follow-up is needed to see if conversions of ankle fusions to replacements have the same functional results and longevity as primary replacements.
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Affiliation(s)
- Christopher Traynor
- Twin Cities Orthopedics, Minneapolis, MN, USA; Twin Cities Orthopedics, 2700 Vikings Circle, Eagan, MN 55121, USA
| | - J Chris Coetzee
- Twin Cities Orthopedics, Minneapolis, MN, USA; Twin Cities Orthopedics, 2700 Vikings Circle, Eagan, MN 55121, USA.
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Abstract
Ankle fusion is a well-studied, classical procedure for conditions affecting the ankle joint, and has a long history with predictable results. Although there are many different approaches available, a few options are commonly used. The two main focuses of modern literature are on anterior plating versus traditional screw fixation, and on arthroscopic versus open techniques for fusion. This article discusses recent literature and then presents cases and techniques that are commonly used today. This includes arthroscopic ankle arthrodesis, traditional transfibular approach, anterior plating, and the indications and application of external fixation. Standard recovery and complications are discussed.
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Affiliation(s)
- Jason George DeVries
- Orthopedics and Sports Medicin - BayCare Clinic, 1110 Kepler Drive, Green Bay, WI 54311, USA.
| | - Brandon M Scharer
- Orthopedics and Sports Medicin - BayCare Clinic, 1110 Kepler Drive, Green Bay, WI 54311, USA
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Lause GE, Parker EB, Stupay KL, Chiodo CP, Bluman EM, Martin EA, Miller CP, Smith JT. The Fate of Delayed Unions After Isolated Ankle Fusion. Foot Ankle Int 2023; 44:815-824. [PMID: 37312512 DOI: 10.1177/10711007231178541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nonunion remains the most common major complication of ankle arthrodesis. Although previous studies have reported delayed union or nonunion rates, few have elaborated on the clinical course of patients experiencing delayed union. In this retrospective cohort study, we sought to understand the trajectory of patients with delayed union by determining the rate of clinical success and failure and whether the extent of fusion on computed tomography scan (CT) was associated with outcomes. METHODS Delayed union was defined as incomplete (<75%) fusion on CT between 2 and 6 months postoperatively. Thirty-six patients met the inclusion criterion: isolated tibiotalar arthrodesis with delayed union. Patient-reported outcomes were obtained including patient satisfaction with their fusion. Success was defined as patients who were not revised and reported satisfaction. Failure was defined as patients who required revision or reported being not satisfied. Fusion was assessed by measuring the percentage of osseous bridging across the joint on CT. The extent of fusion was categorized as absent (0%-24%), minimal (25%-49%), or moderate (50%-74%). RESULTS We determined the clinical outcome of 28 (78%) patients with mean follow-up of 5.6 years (range, 1.3-10.2). The majority (71%) of patients failed. On average, CT scans were obtained 4 months after attempted ankle fusion. Patients with minimal or moderate fusion were more likely to succeed clinically than those with "absent" fusion (P = .040). Of those with absent fusion, 11 of 12 (92%) failed. In patients with minimal or moderate fusion, 9 of 16 (56%) failed. CONCLUSION We found that 71% of patients with a delayed union at roughly 4 months after ankle fusion required revision or were not satisfied. Patients with less than 25% fusion on CT had an even lower rate of clinical success. These findings may help surgeons in counseling and managing patients experiencing a delayed union after ankle fusion. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Gregory E Lause
- Department of Orthopaedic Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Emily B Parker
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Christopher P Chiodo
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Eric M Bluman
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth A Martin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher P Miller
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeremy T Smith
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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5
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Woods A, Kendal A, Henari S, Rogers M, Brown R, Sharp R, Loizou CL. Association of Preexisting Triple Fusion and Arthroscopic Ankle Arthrodesis nonunion. Foot Ankle Int 2023; 44:579-586. [PMID: 37212175 DOI: 10.1177/10711007231171077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Arthroscopic ankle arthrodesis (AAA) is a successful treatment for end-stage ankle arthritis. A significant early complication of AAA is symptomatic nonunion. Published nonunion rates range from 8% to 13%. Longer term, there is concern that it predisposes to subtalar joint (STJ) fusion. To better understand these risks, we undertook a retrospective investigation of primary AAA. METHODS All adult AAA cases conducted at our institution over a 10-year period were reviewed. A total of 284 eligible AAA cases in 271 patients were analyzed. The primary outcome measure was radiographic union. Secondary outcome measures included reoperative rate, postoperative complications and subsequent STJ fusion. Univariate and multivariate logistic regression analysis was performed to identify nonunion risk factors. RESULTS The overall nonunion rate was 7.7%. Smoking (odds ratio [OR] 4.76 [1.67, 13.6], P = .004) and previous triple fusion (OR 40.29 [9.46, 171.62], P < .001) were independent risk factors on univariate analysis. Only prior triple fusion persisted as a major risk factor associated with nonunion on multivariate analysis (OR 18.3 [3.4, 99.7], P < .001). Seventy percent of patients with a previous triple fusion went on to develop nonunion compared to 5.5% of those without. Increasing age, obesity, surgical grade, diabetes, postoperative weightbearing plan, steroid use, and inflammatory arthropathy were not significant risk factors. The leading cause of reoperation was hardware removal (18%). There were 5 superficial (1.8%) and 4 deep (1.4%) infections. Eleven (4.2%) required subsequent STJ fusion. The "survivorship" of STJ post AAA was 98%, 85%, and 74% at 2, 5, and 9 years, respectively. CONCLUSION As the largest study of AAA in the literature, our findings suggest prior triple fusion is a major independent risk factor for AAA nonunion. These patients should be counseled of this high risk and may benefit from alternative surgical options. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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O'Connor K, Klein S, Ebeling P, Flemister AS, Phisitkul P. Republication of "Total Ankle Arthroplasty: Summary of Current Status". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231195063. [PMID: 37655936 PMCID: PMC10467185 DOI: 10.1177/24730114231195063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
| | - Sandra Klein
- Washington University in St Louis, Chesterfield, MO, USA
| | - Patrick Ebeling
- Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA
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Leslie MD, Schindler C, Rooke GMJ, Dodd A. CT-Verified Union Rate Following Arthrodesis of Ankle, Hindfoot, or Midfoot: A Systematic Review. Foot Ankle Int 2023; 44:665-674. [PMID: 37226736 PMCID: PMC10350704 DOI: 10.1177/10711007231171087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Ankle, hindfoot, and midfoot arthrodesis surgeries are standard procedures performed in orthopaedics to treat pain and functional disabilities. Although fusions can effectively improve pain and quality of life, nonunions remain a significant concern for surgeons. With the increased availability of computed tomography (CT), more surgeons rely on this modality for increased accuracy in determining whether a fusion was successful. The objective of this study was to report the rates of CT-confirmed fusion following ankle, hindfoot, or midfoot arthrodesis. METHODS A systematic review was performed using EMBASE, Medline, and Cochrane central register from January 2000 to March 2020. Inclusion criteria included studies with adults (<18 years) that received 1 or multiple fusions of the ankle, hindfoot, or midfoot. At least 75% of the study cohort must have been evaluated by CT postoperatively. Basic information was collected, including journal, author, year published, and level of evidence. Other specific information was collected, including patient risk factors, fusion site, surgical technique and fixation, adjuncts, union rates, criteria for successful fusion (%), and time of CT. Once data were collected, a descriptive and comparative analysis was performed. RESULTS Included studies (26, n = 1300) had an overall CT-confirmed fusion rate of 78.7% (69.6-87.7). Individual joints had an overall fusion rate of 83.0% (73-92.9). The highest rate of union was in the talonavicular joint (TNJ). CONCLUSION These values are lower than previous studies, which found the same procedures to have greater than 90% fusion rates. With these updated figures, as confirmed by CT, surgeons will have better information for clinical decision making and when having informed consent conversations.
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Affiliation(s)
| | - Christin Schindler
- Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | | | - Andrew Dodd
- Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
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Kyung MG, Lee DO, Easley ME, Cho J, Lee DY, Jeon JY. Preoperative incongruent subtalar joint predicts less favorable clinical outcome in total ankle arthroplasty. Foot Ankle Surg 2023:S1268-7731(23)00105-4. [PMID: 37301676 DOI: 10.1016/j.fas.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/28/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND This study aimed to determine the clinical effect of incongruent subtalar joint space on total ankle arthroplasty (TAA). METHODS Thirty-four consecutive patients who underwent TAA were grouped according to the status of subtalar joint incongruency. A comparison of clinical and radiographic parameters between groups as well as multiple regression analysis was performed to identify contributing factors to the final functional outcome. RESULTS The final American Orthopaedic Foot and Ankle Society (AOFAS) score was significantly higher in the congruent group compared to that of the incongruent group (p = 0.007). There were no significant differences between the two groups in measured radiographic angles. In multiple regression analysis, the female sex (p = 0.006) and incongruency of the subtalar joint (p = 0.013) were found to be significant contributing factors to the final AOFAS score. CONCLUSIONS A thorough preoperative investigation should be taken into the state of the subtalar joint for TAA.
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Affiliation(s)
- Min Gyu Kyung
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, SNU Seoul Hospital, 237 Gonghang-daero, Gangseo-gu, Seoul, Republic of Korea.
| | - Mark E Easley
- Department of Orthopedic Surgery, Duke University Medical Center, PO Box 2950, Durham, NC 27710, USA.
| | - Jaeho Cho
- Department of Orthopedic Surgery, Hallym University College of Medicine Chuncheon Sacred Heart Hospital, Republic of Korea.
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Ji Young Jeon
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Republic of Korea.
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9
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Marciano GF, Ferlauto HR, Confino J, Kelly M, Surace MF, Vulcano E. Clinical Outcomes Following Percutaneous Ankle Fusion With Bone Graft Substitute. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231178781. [PMID: 37332629 PMCID: PMC10272655 DOI: 10.1177/24730114231178781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Background Percutaneous ankle fusion is an emerging technique with minimal published outcome data. The goal of the present study is to retrospectively review clinical and radiographic outcomes following percutaneous ankle fusion and provide technique tips to perform percutaneous ankle fusion. Methods Patients >18 years of age, treated by a single surgeon, from February 2018 to June 2021, who underwent primary isolated percutaneous ankle fusion supplemented with platelet-derived growth factor B (rhPDGF-BB) and beta-tricalcium phosphate, with at least 1-year follow-up were included. Surgical technique consisted of percutaneous ankle preparation followed by fixation with 3 headless compression screws. Pre- and postoperative visual analog scale (VAS) and Foot Function Index (FFI) were compared using paired t tests. Fusion was assessed radiographically by the surgeon on postoperative radiographs and computed tomography (CT) at 3 months postoperatively. Results Twenty-seven consecutive adult patients were included in the study. Mean follow-up was 21 months. Mean age was 59.8 years. Mean preoperative and postoperative VAS scores were 7.4 and 0.2, respectively (P < .01). Mean preoperative FFI pain domain, disability domain, activity restriction domain, and total score were 20.9, 16.7, 18.5, and 56.4, respectively. Mean postoperative FFI pain domain, disability domain, activity restriction domain, and total score were 4.3, 4.7, 6.7, and 15.8, respectively (P < .01). Fusion was achieved in 26 of 27 patients (96.3%) at 3 months. Four patients (14.8%) had complications. Conclusion We found in this cohort with surgery performed by a surgeon highly experienced in minimally invasive surgery that percutaneous ankle fusion augmented with a bone graft supplement achieved a high rate of fusion (96.3%) and a significant improvement in pain and function postoperatively while associated with minimal complications. Level of Evidence Level IV, case series.
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Affiliation(s)
- Gerard F. Marciano
- Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Harrison R. Ferlauto
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamie Confino
- Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Meghan Kelly
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ettore Vulcano
- Department of Orthopedics, Mount Sinai Medical Center, Miami, FL, USA
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Tay KS, Langit M, Fenton C, Grupping R, Muir R, Moulder E, Sharma H. Complex Ankle Fusion With Circular Frames: Factors Influencing Outcomes, Complications, and Patient Satisfaction. Foot Ankle Int 2023; 44:403-414. [PMID: 36942403 DOI: 10.1177/10711007231157710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Circular frames for ankle fusion are reserved for complex clinical scenarios. The literature is heterogenous and conflicting. We aim to present the indications and outcomes of this procedure. METHODS A retrospective cohort study based on a prospective database of frame surgeries performed in a tertiary institution. Inclusion criteria were patients undergoing complex ankle fusion with circular frames between 2005 and 2020, with a minimum 12-month follow-up. Data were collected on patient demographics, surgical indications, comorbidities, surgical procedures, external fixator time (EFT), length of stay (LOS), radiologic and clinical outcomes, and adverse events. Factors influencing radiologic and clinical outcomes were analyzed. RESULTS 47 patients were included, with a median follow-up of 30 months (interquartile range [IQR] 20-40). The median age at time of surgery was 63.5 years (IQR 58-71). Patients had a median of 2 previous surgeries (IQR 1-3). The median LOS was 8.5 days, and median EFT was 237 days (IQR 166-280). Simultaneous limb lengthening (median 3.3 cm, IQR 1.9-3.5) was performed in 11 patients, increasing the EFT by a mean of 4 months. Primary and final union rates were 91.5% and 95.7%, respectively. At last follow-up, ASAMI bone scores were excellent or good in 87.2%. ASAMI functional scores were good in 79.1%. Patient satisfaction was 83.7%. In addition, 97.7% of patients experienced adverse events, most commonly pin-site related, with major complications in 30.2% and reoperations in 60.5%. There were 3 amputations. Adverse events were associated with increased age, poor soft tissue condition, severe deformities, subtalar fusions, peripheral neuropathy, peripheral vascular disease, and prolonged EFT. CONCLUSION Complex ankle fusion using circular frames can achieve good outcomes, however time in frame may be prolonged with a high rate of adverse events. Identified risk factors for poorer outcomes should be considered in patient counselling and prognostication. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
| | - Mickhael Langit
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Carl Fenton
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Rachael Grupping
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Ross Muir
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Elizabeth Moulder
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Hemant Sharma
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
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Kim SW, Choi SM, Kim MB, Cho BK. The Effects of Tibialis Anterior Tenotomy on Wound Complications and Functional Outcomes After Anterior Fusion Plating for Severe Ankle Arthritis. J Foot Ankle Surg 2023; 62:237-243. [PMID: 35906152 DOI: 10.1053/j.jfas.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 02/03/2023]
Abstract
Nonunion is known to be a relatively common complication following ankle arthrodesis. Various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior (TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis. Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 2 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, 38 patients who underwent arthrodesis without TA tenotomy were analyzed. Functional outcomes were evaluated with Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure. Wound complication rate, time to fusion, fusion rate, time to pain relief were evaluated. Mean Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure scores significantly improved to 32.6 and 69.4 points at final follow-up, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in functional outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed a significantly lower wound complication rate (4.3%) than control group (23.7%) (p < .001). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal. Ankle arthrodesis using anterior fusion plate in conjunction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with excellent fusion rate and less wound complication rate. Although there were no specific functional deficits related to absence of TA tendon, further studies are needed to determine long-term effects of TA tenotomy in patients with a fused ankle.
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Affiliation(s)
- Seok-Won Kim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Chungbuk, Korea
| | - Seung-Myung Choi
- Department of Orthopaedic Surgery, Eulji University School of Medicine, Uijeongbu Hospital, Uijeongbu, Gyeonggi, Korea
| | - Min-Boo Kim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Chungbuk, Korea
| | - Byung-Ki Cho
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Chungbuk, Korea; Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Chungbuk, Korea.
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Patel S, Baker L, Perez J, Vulcano E, Kaplan J, Aiyer A. Risk Factors for Nonunion Following Ankle Arthrodesis: A Systematic Review and Meta-analysis. Foot Ankle Spec 2023; 16:60-77. [PMID: 33660542 DOI: 10.1177/1938640021998493] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Nonunion is a postoperative complication after ankle arthrodesis (AA), which leads to increased morbidity and revision rates. Previous studies have identified risk factors for nonunion following AA, but no meta-analysis has been performed to stratify risk factors based on strength of evidence. METHODS Abstracts and full-text articles were screened by 2 independent reviewers. Relevant data were extracted from the included studies. Random effects meta-analyses were summarized as forest plots of individual study and pooled random effect results. RESULTS Database search yielded 13 studies involving 987 patients were included, and 37 potential risk factors for nonunion. Meta-analysis found 5 significant risk factors for nonunion post-AA. Strong evidence supports male gender (OR: 1.96; 95% CI: 1.13-3.41), smoking (OR: 2.89; 95% CI: 1.23-6.76), and history of operative site infection prior to arthrodesis (OR: 2.40; 95% CI: 1.13-5.09) as predictors for nonunion following AA. There was moderate evidence supporting history of open injury (OR: 5.95; 95% CI: 2.31-15.38) and limited evidence for preoperative avascular necrosis (OR: 13.16; 95% CI: 2.17-79.61) as possible risk factors for nonunion. CONCLUSION The results of our meta-analysis suggest that male gender, smoking, and history of operative site infection have strong evidence and that history of open injury and avascular necrosis also have evidence as risk factors for nonunion. Surgeons should be cognizant of these risks when performing AA and closely follow up with patients with the aforementioned risk factors to ensure postoperative success. LEVELS OF EVIDENCE Level V: Systematic review of cohort and case-control studies.
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Affiliation(s)
- Sumit Patel
- Department of Orthopaedics at Miller School of Medicine, University of Miami, Miami, Florida
| | - Lauren Baker
- Department of Orthopaedics at Miller School of Medicine, University of Miami, Miami, Florida
| | - Jose Perez
- Department of Orthopaedics at Miller School of Medicine, University of Miami, Miami, Florida
| | - Ettore Vulcano
- Leni & Peter W. May Department of Orthopaedic Surgery, Mount Sinai, New York City, New York
| | | | - Amiethab Aiyer
- Department of Orthopaedics at Miller School of Medicine, University of Miami, Miami, Florida
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Lundeen AL, Raduan FC, Stone McGaver R, Seiffert KJ, Fritz JE, Giveans MR, Coetzee JC. Takedown of Ankle Fusions and Conversion to Total Ankle Replacements. Foot Ankle Int 2022; 43:1402-1409. [PMID: 35942917 DOI: 10.1177/10711007221115170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND With ankle replacements gaining credibility, there is a small subset of patients who might benefit from a conversion of an ankle fusion to a replacement. The objective of this study is to present clinical and radiographic results of patients who had their ankle fusion converted to total ankle arthroplasty (TAA). METHODS Patients presented to the senior author with ongoing ankle pain following fusion or increasing pain after a period of relative comfort after an ankle fusion. Outcomes were evaluated preoperatively and postoperatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS), and visual analog scale (VAS) pain scale. A patient satisfaction survey was also distributed. RESULTS All ankle fusion conversions between April 2010 and December 2019 were included. Fifty-one patients (30 females) with the mean age of 62.6 (range, 37-83) years were followed. Mean follow-up was 4.2±2.3 (range, 2-11.5) years. Two patients were lost to follow-up (1 is deceased). Pre- and postoperative mean patient-reported outcome scores were all significantly different between groups except VR-12 mental subscale scores. VR-12 physical scores improved from 28.7±8.9 preoperatively to 38.9±9.9 (P < .001) postoperatively; VR-12 mental score was stable. AOS pain and disability subscales similarly improved: 55.9±24.4 to 27.9±25.4 (P < .001) and 61.7±21.1 to 31.1±25.7 (P < .001), respectively. VAS pain improved from a mean of 64.5±27.3 to 29.4±27.7 (P < .001). There was no tibiotalar dorsiflexion or plantarflexion with the ankle fusion. Initial postoperative visit revealed that average dorsiflexion was 10.9±5.93 degrees and average plantarflexion was 14.1±5.22 degrees. At the latest follow-up, dorsiflexion improved significantly to 15.5±6.33 degrees (P < .001), with no significant improvement in plantarflexion (P = .980). CONCLUSION In this single-surgeon longitudinal study of 51 patients with a painful, malaligned, or nonhealed ankle fusion treated with an ankle replacement, we found highly satisfactory functional outcomes at an average of 4.2 years. Continued long-term follow-up will reveal whether the longevity of these replacements is comparable to primary replacements.
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Kim JS, Amendola A, Barg A, Baumhauer J, Brodsky JW, Cushman DM, Gonzalez TA, Janisse D, Jurynec MJ, Lawrence Marsh J, Sofka CM, Clanton TO, Anderson DD. Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society's Symposium on Targets for Osteoarthritis Research: Part 2: Treatment Options. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127013. [PMID: 36262470 PMCID: PMC9575443 DOI: 10.1177/24730114221127013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED This second of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey current treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 10, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Topics were chosen by meeting organizers, who then identified and invited the expert speakers. Part 2 overviews the current treatment options, including orthotics, non-joint destructive procedures, as well as arthroscopies and arthroplasties in ankles and feet. Opportunities for future research are also discussed, such as developments in surgical options for ankle and the first metatarsophalangeal joint. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the importance to patients of addressing the foot and ankle with improved basic, translational, and clinical research. LEVEL OF EVIDENCE Level V, review article/expert opinion.
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Affiliation(s)
- Jason S. Kim
- The Arthritis Foundation, Atlanta, GA,
USA,Jason S. Kim, PhD, The Arthritis
Foundation, 1355 Peachtree St NE, Suite 600, Atlanta, GA 30309, USA.
| | | | - Alexej Barg
- Department of Orthopaedics, University
of Utah, Salt Lake City, UT, USA
| | - Judith Baumhauer
- Department of Orthopaedic Surgery,
University of Rochester Medical Center, Rochester, NY, USA
| | | | - Daniel M. Cushman
- Division of Physical Medicine &
Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery,
University of South Carolina, Lexington, SC, USA
| | | | - Michael J. Jurynec
- Department of Orthopaedics and Human
Genetics, University of Utah, Salt Lake City, UT, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | | | - Donald D. Anderson
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
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Liu T, Dong SJ, Li WL, Wang D, Zheng YP, Qu WQ. Ankle Arthrodesis Combined With Mosaic Bone Autograft Transplantation for End-Stage Ankle Osteoarthritis With Large Cysts of Talar Dome. J Foot Ankle Surg 2022; 61:932-937. [PMID: 35649964 DOI: 10.1053/j.jfas.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/08/2020] [Accepted: 11/28/2021] [Indexed: 02/03/2023]
Abstract
End-stage ankle osteoarthritis with large cysts of talar dome can be challenging to treat. Twenty patients diagnosed as end-stage ankle arthritis with large talar cysts between 04/2010 and 02/2016 were randomly divided into experimental group (10 cases) and conventional group (10 cases) by random number method. Patients in the experimental group were treated with ankle arthrodesis combined with a concomitant procedure of mosaic bone autograft transplantation, the conventional group under the ankle arthrodesis. The operation time, intraoperative blood loss, postoperative hospital stay, the time of bone union, and postoperative height of the talus between the 2 groups were compared. The preoperative and postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score were also recorded and compared. There was no significant difference in the operation time, intraoperative blood loss, and postoperative hospital stay between the 2 groups. The postoperative height of the talus body and the time of bone union were better in the experimental group than that in the conventional group (p < .05). The results of follow-up showed that the American Orthopaedic Foot and Ankle Society scores of the conventional group were lower than those in the experimental group (p < .001). And the incidence of complication (10%) in the experimental group was significantly lower than that in the conventional group (40%). The use of tibiotalar arthrodesis combined with mosaic bone autograft transfer may be potentially an effective option for the treatment of end-stage ankle arthritis with large talar cysts.
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Affiliation(s)
- Tong Liu
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Sheng-Jie Dong
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Wen-Liang Li
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Dan Wang
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China
| | - Yan-Ping Zheng
- Department of Orthopaedics, Qilu Hospital (Qingdao) of Shandong University, Jinan, Shandong, China
| | - Wen-Qing Qu
- Department of Orthopaedics, Yantaishan Hospital, Yantai, Shandong, China; Department of Orthopaedics, Qilu Hospital (Qingdao) of Shandong University, Jinan, Shandong, China.
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16
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Does Demineralized Bone Matrix Affect the Nonunion Rate in Arthroscopic Ankle Arthrodesis? J Clin Med 2022; 11:jcm11133893. [PMID: 35807177 PMCID: PMC9267684 DOI: 10.3390/jcm11133893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/13/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022] Open
Abstract
Demineralized bone matrix (DBM) has been shown to have positive effects on union rates in many orthopedic subspecialties; however, minimal evidence exists about bone graft substitutes in foot and ankle surgery. The purpose of this study is to compare nonunion rates in arthroscopic ankle arthrodesis in patients receiving DBM with those without. We hypothesized DBM to be associated with a decreased risk of nonunion. This retrospective review includes 516 consecutive ankle arthrodesis cases from March 2002 to May 2016. Of these, 58 ankles (56 patients) that underwent primary arthroscopic ankle arthrodesis met the inclusion criteria, and 31 of these ankles received DBM, while 27 did not. Nonunion was assessed by clinical examination and routine postoperative radiographs. If nonunion was suspected, a computed tomography (CT) scan was performed. The primary outcome measure was nonunion rate. Secondary outcome measures included wound complications, return to operating room (OR), and rate of postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE). From the study cases, 58 were available for final follow-up. The average age was 55.9 years (±17.4), and mean follow-up was 43.0 months (range 6.3–119.4). There was no difference in nonunion rate in patients who received DBM (4/31, 12.9%) versus those who did not (4/27, 14.8%) (p = 0.83). Similarly, when comparing the two groups, there were no statistically significant differences in superficial wound complications (6.5% vs. 3.7%, p = 1.0) or rate of return to OR (29% or 0.037/person-years vs. 37% or 0.099/person-years; p = 0.20). No major complications including deep wound infections, DVTs, or PEs occurred. This is the largest study to directly compare nonunion rates and complications for patients receiving DBM versus those who did not in primary arthroscopic ankle arthrodesis. No significant association was found between DBM usage and risk of nonunion, wound complications, return to OR, or postoperative DVT or PE development.
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17
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Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis? J Clin Med 2022; 11:jcm11123387. [PMID: 35743458 PMCID: PMC9224582 DOI: 10.3390/jcm11123387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Tibiotalar arthrodesis successfully treats ankle arthritis but carries risk of nonunion. It is unclear whether concurrent distal tibiofibular arthrodesis affects tibiotalar nonunion rate. The purpose of this study is to compare tibiotalar nonunion and complication rates in patients with versus without a distal tibiofibular arthrodesis. This is a retrospective review of 516 consecutive ankle arthrodesis performed between March 2002 and May 2016. A total of 319 ankles (312 patients) underwent primary, open tibiotalar arthrodesis (227 with distal tibiofibular arthrodesis, 92 without). Primary outcome measure was nonunion rate. Secondary outcome measures were time to tibiotalar union, rate of development of post-operative deep vein thrombosis (DVT)/pulmonary embolism (PE), rate of deep wound complications, and rate of return to operating room (OR). No differences in nonunion rates were observed in both cohorts of patients with versus without distal tibiofibular arthrodesis: 17/227 (7.5%) versus 11/92 (12%) (p = 0.2), respectively, odds ratio was 0.74, 95% CI: 0.29~2.08 (p = 0.55). There was no difference in deep wound complications (5.3% versus 10.9%, p = 0.42), time to union (3.7 months versus 4.1 months, p = 0.72), or rate of development of DVT/PE (5.2% versus 2.2%, p = 0.18) between patients with and without distal tibiofibular arthrodesis, respectively. This is the first study directly comparing nonunion and complication rates in primary, open ankle arthrodesis with and without distal tibiofibular arthrodesis. Inclusion of the distal fibular joint with the tibiotalar fusion was not associated with a change in tibiotalar nonunion rate, time to union, wound complications, or postoperative DVT/PE.
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18
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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] [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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19
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Patient and Surgical Factors Affecting Fusion Rates After Arthroscopic and Open Ankle Fusion: A Review of a High-Risk Cohort. Indian J Orthop 2022; 56:1217-1226. [PMID: 35813539 PMCID: PMC9232662 DOI: 10.1007/s43465-021-00580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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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20
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van den Heuvel SBM, Penning D, Schepers T. Open Ankle Arthrodesis: A Retrospective Analysis Comparing Different Fixation Methods. J Foot Ankle Surg 2022; 61:233-238. [PMID: 34362652 DOI: 10.1053/j.jfas.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
A wide variation of surgical options, complications, and union rates are reported in the treatment of end-stage ankle arthritis. However, open ankle arthrodesis remains the golden standard for ankle arthritis. The purpose of this study was to evaluate the union rate and complication rate as well as identify potential risk factors for different methods of fixation in patients with end-stage ankle arthritis of different etiology. In total, 42 ankles of 41 patients with ankle osteoarthritis were included for this single-center retrospective study. The mean age was 50 years (range 22-75 years). Twenty patients were treated with screw-fixation, 14 with plate(s) and 8 with intramedullary nail. The results of this study showed an overall union rate of 97.6% (41 of the 42 operated ankles) and an overall complication rate of 21.4% (9 events). The mean follow-up time was 16 months (range 2.5-83.0 months). Complications consisted of 1 nonunion, 4 deep infections, 2 cases of wound dehiscence, 1 delayed union and 1 malalignment of the ankle joint. The plate-fixation group demonstrated significantly higher infections when compared with screw and intramedullary nail fixation (p = .017). There were no other significant variables for incidence of complications between patients in the uncomplicated and complicated group. This study achieved good clinical results for different methods of fixation in open ankle arthrodesis. In specific, the use of intramedullary nail provides excellent results for end-stage ankle arthritis with high union rate and a low complication rate.
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Affiliation(s)
- Stein B M van den Heuvel
- Medical Doctor, Trauma Unit, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Diederick Penning
- Medical Doctor, Trauma Unit, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tim Schepers
- Trauma Surgeon, Trauma Unit, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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21
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22
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Abstract
Ankle distraction arthroplasty (DA) is a joint-preserving option for the treatment of ankle osteoarthritis. The ideal patient is a young, active person who is compliant with follow-up and understands that clinical improvements may not be fully evident until 1 year after surgery. The procedure promotes cartilage healing and regeneration by removing mechanical stress at the joint surface through the application of a joint-spanning external fixator. There is an array of adjuvant procedures commonly performed to optimize healing potential-including microfracture, osteophyte removal, osteotomies, and soft tissue balancing procedures. Short- and intermediate-term studies have been promising, though there is a wide variance in reported failure and complication rates.
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Affiliation(s)
- Alirio J deMeireles
- Department of Orthopedic Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, 622 West 168th Street, PH 11 - 1102, New York, NY 10032-3720, USA
| | - Ettore Vulcano
- Department of Orthopedic Surgery, Columbia University Orthopedics at Mount Sinai Medical Center, 4302 Alton Road, Suite 220, Miami Beach, FL 33140, USA.
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23
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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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24
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Mussawy H, Kehrer M, Strahl A, Rolvien T, Hubert J, Beil FT, Wirtz DC, Oldenburg J, Holstein K, Strauss AC. Clinical and patient reported outcome in total ankle replacement compared to ankle fusion in end-stage haemophilic arthropathy. Haemophilia 2021; 27:e739-e746. [PMID: 34624930 DOI: 10.1111/hae.14429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/14/2021] [Accepted: 09/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ankle arthropathy is a frequent complication of haemophilia, reducing the patients' quality of life. Despite intensive conservative therapy, end-stage arthropathy requires surgical treatment, either by ankle fusion (AF) or total ankle replacement (TAR). METHODS Eleven consecutive AFs were performed in nine patients and 11 TARs were implemented in 10 patients. Outcomes were assessed clinically by AOFAS score and radiologically by the Pettersson and Gilbert scores. RESULTS The mean age of the patients in these groups were 35.7 years and 49.4 years, respectively. Of the 11 ankles that underwent fusion, 10 showed bony consolidation not later than 12 weeks after surgery, whereas one still showed non-union after 6 months. VAS pain scores decreased significantly in both groups. Mean AOFAS scores also improved significantly, from 28.1 before to 80.3 after AF and from 21.5 before to 68.0 after ankle replacement. No perioperative complications were observed in either group. Late deep infection was observed in two patients that underwent TAR, which required removal of the implant. CONCLUSION Our data indicate that both AF and TAR result in significantly reduced pain in patients with haemophilia with end-stage haemophilic arthropathy. While TAR is associated with a higher risk of deep infection and minimal persistent pain, it preserves the pre-operative range of motion. AF on the other hand is associated with the risk of non-union and a longer post-operative recovery period but results in greater pain reduction.
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Affiliation(s)
- Haider Mussawy
- Department of Orthopaedic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Kehrer
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany
| | - André Strahl
- Department of Orthopaedic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Orthopaedic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Hubert
- Department of Orthopaedic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Department of Orthopaedic Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Johannes Oldenburg
- Institute for Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Katharina Holstein
- Department of Oncology and Haematology, Haemophilia Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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25
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Seow D, Yasui Y, Dankert JF, Miyamoto W, Calder JDF, Kennedy JG. Limited Evidence for Biological Adjuvants in Hindfoot Arthrodesis: A Systematic Review and Meta-Analysis of Clinical Comparative Studies. J Bone Joint Surg Am 2021; 103:1734-1743. [PMID: 34191761 DOI: 10.2106/jbjs.20.01475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the present study was to evaluate the efficacy of biological adjuvants in patients managed with hindfoot arthrodesis. METHODS A systematic review of the PubMed and Embase databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with use of specific search terms and eligibility criteria. Assessment of evidence was threefold: level of evidence by criteria as described in The Journal of Bone & Joint Surgery, quality of evidence according to the Newcastle-Ottawa scale, and conflicts of interest. Meta-analysis was performed with fixed-effects models for studies of low heterogeneity (I2 < 25%) and with random-effects models for studies of moderate to high heterogeneity (I2 ≥ 25%). RESULTS A total of 1,579 hindfeet were recruited across all studies, and 1,527 hindfeet were recorded as having completed treatment and follow-up visits. The duration of follow-up ranged from 2.8 to 43 months. Twelve of the 17 included studies comprised patients with comorbidities associated with reduced healing capacity. Based on the random-effects model for nonunion rates for autograft versus allograft, the risk ratio was 0.82 (95% CI, 0.13 to 5.21; I2 = 56%; p = 0.83) in favor of lower nonunion rates for autograft. Based on the random-effects model for rhPDGF/β-TCP versus autograft, the risk ratio was 0.90 (95% CI, 0.74 to 1.10; I2 = 59%; p = 0.30) in favor of lower nonunion rates for rhPDGF/β-TCP. CONCLUSIONS There is a lack of data to support the meaningful use of biological adjuvants as compared with autograft/allograft for hindfoot arthrodesis. The meta-analysis favored the use of autograft when compared with allograft but favored rhPDGF/β-TCP when compared with autograft in the short term. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dexter Seow
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - John F Dankert
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - James D F Calder
- Fortius Clinic, London, United Kingdom.,Imperial College, London, United Kingdom
| | - John G Kennedy
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Shih CL, Chen SJ, Huang PJ. Clinical Outcomes of Total Ankle Arthroplasty Versus Ankle Arthrodesis for the Treatment of End-Stage Ankle Arthritis in the Last Decade: a Systematic Review and Meta-analysis. J Foot Ankle Surg 2021; 59:1032-1039. [PMID: 32709528 DOI: 10.1053/j.jfas.2019.10.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Abstract
Ankle arthrodesis (AA) and total ankle arthroplasty (TAA) are the 2 primary surgical treatments for patients with end-stage ankle arthritis. The comparative outcomes between AA and TAA using modern techniques remain unclear. A systematic search to identify all relevant articles comparing AA with TAA was conducted through 3 online databases. The clinical outcomes were extracted for meta-analysis, including AOFAS (American Orthopaedic Foot & Ankle Society) score, VAS (visual analog scale), AOS (Ankle Osteoarthritis Scale), gait analysis, ROM (range of motion), satisfaction, complication, and reoperation. Our meta-analysis shows no heterogeneity in any subgroup analyses. There were no significant differences in AOFAS total, pain, and alignment scores between the AA and TAA groups. The TAA group had significant improvement in AOFAS function score compared with the AA group. There was no significant difference in VAS and AOS total scores between the 2 groups. No significant differences in gait analysis were observed between the 2 groups. The TAA group had significant improvement in both ROM and change in ROM compared with the AA group. There was no significant difference in satisfaction rate between the 2 groups. The TAA group had significantly higher complication and reoperation rates compared with the AA group. Our meta-analysis provides updated evidence on clinical outcomes comparing AA with TAA using third-generation implants. The TAA group had better improvement in AOFAS function and ROM than the AA group. No significant differences in pain relief, gait analysis, or patient satisfaction were observed between the 2 groups.
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Affiliation(s)
- Chia-Lung Shih
- Assistant Research Fellow, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Jung Chen
- Attending Physician, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Peng-Ju Huang
- Attending Physician, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Associate Professor, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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27
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Shibuya N, McAlister JE, Prissel MA, Piraino JA, Joseph RM, Theodoulou MH, Jupiter DC. Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis. J Foot Ankle Surg 2021; 59:1019-1031. [PMID: 32778440 DOI: 10.1053/j.jfas.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Naohiro Shibuya
- Professor, College of Medicine, Texas A&M University, Temple, TX.
| | | | - Mark A Prissel
- Faculty, Advanced Foot and Ankle Reconstruction Fellowship Program, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Jason A Piraino
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Florida Health, Gainesville, FL
| | - Robert M Joseph
- Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
| | - Michael H Theodoulou
- Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Instructor of Surgery, Harvard Medical School, Cambridge, MA
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
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28
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Schuberth JM, King CM, Jiang SF, Ross JS, Christensen JC, Steck JK. Takedown of Painful Ankle Arthrodesis to Total Ankle Arthroplasty: A Case Series of 77 Patients. J Foot Ankle Surg 2021; 59:535-540. [PMID: 32063484 DOI: 10.1053/j.jfas.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 11/22/2019] [Accepted: 01/11/2020] [Indexed: 02/03/2023]
Abstract
Treatment of painful or malaligned ankle arthrodesis can present as a challenging issue. Several published studies have demonstrated that takedown of a painful ankle arthrodesis to total ankle arthroplasty can assist in restoring some sagittal plane motion and improving functional scores. The goal of this study was to contribute to the limited body of literature with the largest cohort and longest follow-up to date. A retrospective analysis was performed on patient and surgical characteristics of those who underwent a conversion of a painful ankle arthrodesis to a total ankle arthroplasty by 1 of 3 experienced total ankle arthroplasty surgeons from February 2003 to December 2016 with ≥2 years of follow up. Seventy-seven subjects were included for evaluation, with an implant retention rate of 88% (68 of 77) and mean follow-up of 8.3 years (range 2.6 to 15.8). Of the 11 (14%) failures (defined as retrieval or exchange of metallic components), 8 (10%) were revised to a total ankle replacement, 2 (2%) underwent revision arthrodesis, and 1 (1%) elected for below-the-knee amputation. The mean time since the primary arthrodesis was 8.6 years (range 1 to 44), and the longer time interval between primary arthrodesis to takedown total ankle arthroplasty did not correlate with poorer outcome scores or increased risk of failure. The mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, Buechel-Pappas, and visual analog pain scale scores improved from preoperative values, with less satisfaction noted in those who needed revision surgery. The conversion of a painful ankle arthrodesis to a total ankle implant is a viable option to obtain range of motion and improved patient satisfaction scores similar to primary total ankle replacement.
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Affiliation(s)
- John M Schuberth
- Attending Staff, Department of Orthopedic Surgery, Kaiser Permanente, San Francisco, San Francisco, CA.
| | - Christy M King
- Attending Staff, Department of Podiatric Surgery, Kaiser Permanente, Oakland, Oakland, CA
| | - Shen-Fang Jiang
- Research Analyst, Division of Research, Kaiser Permanente, Oakland, Oakland, CA
| | - Justin S Ross
- Attending Staff, Kaiser Permanente, Sacramento, Sacramento, CA
| | - Jeffrey C Christensen
- Attending Staff, Department of Orthopedics, Division of Podiatric Surgery, Swedish Medical Center, Seattle, WA
| | - Jerome K Steck
- Private Practice, Southern Arizona Orthopedics, Tucson, AZ
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Hu M, Xu XY. Osteotomy combined with lateral ligament reconstruction in treating osteochondral lesion in patients with talar injury and varus ankle. Medicine (Baltimore) 2021; 100:e24330. [PMID: 33761633 PMCID: PMC9282085 DOI: 10.1097/md.0000000000024330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 12/19/2020] [Indexed: 01/05/2023] Open
Abstract
This study aimed to investigate the therapeutic effects of osteotomy combined with lateral ligament reconstruction on the osteochondral lesion of patients with talar injuries and varus ankles.Seventy five patients with talar injuries and varus ankles who received osteotomy combined with lateral ligament reconstruction for the osteochondral lesions from June 2008 to December 2014 were retrospectively reviewed. Patients were followed up for 32.4 ± 15.3 months after surgeries, and the AOFAS-AH score, VAS score and SF36 score were determined preoperatively and postoperatively. The iconographic data were compared preoperatively and postoperatively, including tibial anterior surface angle (TAS), TTS, TT, and tibial lateral surface angle (TLS) angles.After surgeries, the AOFAS-AF score increased from 43.2 ± 8.1 to 82.1 ± 5.6, the VAS score decreased from 6.9 ± 2.3 to 1.8 ± 1.5, and the SF36 score increased from 48.7 ± 9.4 to 83.5 ± 6.2. TAS increased from 83.3 ± 5.1 to 90.3 ± 6.1, TTS increased from 70.3 ± 6.1 to 82.5 ± 5.4, TT decreased from 12.9 ± 6.1 to 6.9 ± 5.7, and TLS increased from 76.5 ± 4.1 to 81.2 ± 3.3 (P < .05).Osteotomy combined with lateral ligament reconstruction is effective for the treatment of talar osteochondral lesion with varus ankle, which could relieve the arthritic symptoms induced by cartilage lesions. By correcting the force line on lower limbs and metapedes with osteotomy completely, the treatments on talar osteochondral lesion and lateral ligament reconstruction are the critical factors with better results.
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Affiliation(s)
- Mu Hu
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiang-Yang Xu
- Department of Orthopedics, Shanghai Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Hess MC, Abyar E, McKissack HM, Strom S, Johnson MD. Applications of the transfibular approach to the hindfoot: A systematic review and description of a preferred technique. Foot Ankle Surg 2021; 27:1-9. [PMID: 32061502 DOI: 10.1016/j.fas.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/01/2020] [Accepted: 01/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The indications and technique for the transfibular approach to the tibiotalar joint have evolved since its initial popularization in 1942. The purpose of this systematic review is to assess the indications, techniques, and postoperative outcomes among procedures performed with the transfibular approach. METHODS A comprehensive search of PubMed, Medline, and Embase databases from 1942 to 2018 was performed in accordance with PRISMA guidelines. After an initial broad search of transfibular approach indications, articles were stratified into 4 major surgical categories for assessment: (1) tibiotalar arthrodesis (2) tibiotalocalcaneal arthrodesis (3) total ankle replacement and (4) distal tibial tumor excision. Data was analyzed according to these 4 categories. RESULTS A total of 32 studies (874 ankles) were included. Fibular non-union rates were 0.7 % (5 of 672) across all studies, 0.6% (2 of 329) for tibiotalar arthrodesis, 0.0% (0 of 12) for tibiotalocalcaneal arthrodesis, 1.0 % (3 of 296) for total ankle arthroplasty and 0.0% (0 of 15) for other procedures. Rates of deep infection were 2.5% (23 of 903) across all studies, 3.2% (15 of 466) for tibiotalar arthrodesis, 3.7% (4 of 106) for tibiotalocalcaneal arthrodesis, 1.3% (4 of 296) for total ankle arthroplasty, and 0.0% (0 of 15) for other procedures. CONCLUSIONS The transfibular approach is useful for cases requiring extensile exposure of the tibiotalar joint. This study provides evidence that the transfibular approach yields satisfactory results, with low complication and infection rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthew C Hess
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
| | - Eildar Abyar
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
| | - Haley M McKissack
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
| | - Shane Strom
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
| | - Michael D Johnson
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
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Rogero RG, Fuchs DJ, Corr D, Shakked RJ, Raikin SM. Ankle Arthrodesis Through a Fibular-Sparing Anterior Approach. Foot Ankle Int 2020; 41:1480-1486. [PMID: 32762358 DOI: 10.1177/1071100720946740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The open anterior approach to ankle arthrodesis offers a technique that provides several advantages for surgeons, such as easier visualization of the joint for deformity correction and preservation of the malleoli for potential future conversion to total ankle arthroplasty. The purpose of this study was to evaluate clinical, radiographic, and functional outcomes in a large series of patients undergoing open ankle arthrodesis via a fibular-sparing anterior approach. METHODS A retrospective review was performed of patients undergoing primary ankle arthrodesis with a single fellowship-trained foot and ankle orthopedic surgeon between 2009 and 2017. Patients were excluded if an approach other than anterior was performed. Patient-reported outcome measures (Foot and Ankle Ability Measure-Activities of Daily Living [FAAM-ADL], Short-Form 12 [SF-12], and visual analog scale [VAS] pain) were subsequently collected at a minimum of 24 months (2 years) following index surgery, along with outcome satisfaction and likelihood to repeat surgery. Fusion of the tibiotalar joint at the time of last radiographic follow-up was also assessed. Paired t tests were performed to assess change in pre- to postoperative outcomes, while linear regression analysis was performed to identify any patient factors associated with outcomes. Eighty-one patients, including 31 women and 50 men, with a mean age of 51.5 years and a mean follow-up of 58.9 (range, 24-104) months, were included. RESULTS Sixty-two patients reported significant improvement in mean FAAM-ADL (P < .0001), SF-12 Physical Composite Scale (P < .0001), and VAS pain (P < .0001), while the SF-12 Mental Composite Scale also improved, though not significantly (P = .2854). Twelve patients (14.8%) experienced complications following their arthrodesis procedure. Seventy-nine patients (97.5%) achieved fusion at their last radiographic follow-up. Multiple linear regression analysis revealed age (B = 0.071 [0.004, 0.128]; P = .0373) to have a positive association with postoperative VAS pain. CONCLUSION Ankle arthrodesis utilizing a fibular-sparing anterior approach combined with the transarticular screw fixation technique offers surgeons several advantages, along with a low postoperative complication rate, high rate of radiographic evidence of joint fusion, and substantially large improvement in pain and functional levels. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ryan G Rogero
- Rothman Orthopaedic Institute, Philadelphia, PA, USA.,Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | | | - Daniel Corr
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Lawton CD, Prescott A, Butler BA, Awender JF, Selley RS, Dekker Ii RG, Balderama ES, Kadakia AR. Modern total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis. Orthop Rev (Pavia) 2020; 12:8279. [PMID: 33312482 PMCID: PMC7726823 DOI: 10.4081/or.2020.8279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 01/15/2023] Open
Abstract
The controversy in surgical management of end-stage tibiotalar arthritis with Total Ankle Arthroplasty (TAA) versus Ankle Arthrodesis (AA) has grown in parallel with the evolution of both procedures. No randomized controlled trials exist due to the vast differences in surgical goals, patient expectations, and complication profiles between the two procedures. This makes high quality systematic reviews necessary to compare outcomes between these two treatment options. The aim of this study was to provide a systematic review with meta-analysis of publications reporting outcomes, complications, and revision data following third-generation TAA and/or modern AA published in the past decade. Thirtyfive articles met eligibility criteria, which included 4312 TAA and 1091 AA procedures. This review reports data from a mean follow-up of 4.9 years in the TAA cohort and 4.0 years in the AA cohort. There was no significant difference in overall complication rate following TAA compared to AA (23.6% and 25.7% respectively, P-value 0.31). Similarly, there was no significant difference in revision rate following TAA compared to AA (7.2% and 6.3% respectively, P-value 0.65). Successful treatment of end-stage tibiotalar arthritis requires an understanding of a patients’ goals and expectations, coupled with appropriate patient selection for the chosen procedure. The decision to proceed with TAA or AA should be made on a case-by-case basis following an informed discussion with the patient regarding the different goals and complication profiles for each procedure.
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Affiliation(s)
- Cort D Lawton
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | - Adam Prescott
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | - Bennet A Butler
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | - Jakob F Awender
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | - Ryan S Selley
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
| | | | - Earvin S Balderama
- Department of Mathematics and Statistics, Loyola University Chicago, IL, USA
| | - Anish R Kadakia
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL
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Salvage arthrodesis for infected ankle fractures with segmental bone-loss using Ilizarov concepts: a prospective study. INTERNATIONAL ORTHOPAEDICS 2020; 45:233-240. [PMID: 33196902 DOI: 10.1007/s00264-020-04874-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Complex ankle fractures accompanied with infection and segmental bone loss are a worrying issue. This prospective study was conducted to explore the effectiveness of using Ilizarov concepts in achieving salvage arthrodesis and reconstructing post-debridement defects in such complicated scenarios. METHODS A total of 44 consecutive patients (mean age 35.61 ± 8.57 years, 30 males, 44 feet) of post-traumatic infected ankle fractures, who met our selection criteria, were enrolled and subjected to radical debridement and salvage arthrodesis using the bifocal bone transport concepts of Ilizarov. All patients were treated between 2012 and 2017 either by acute shortening compression of the arthrodesis site with re-lengthening (ASRL) through the created proximal metaphyseal osteotomy (group I, n = 20) or by gradual bone transport (BT) through the proximal osteotomy with gradual closure of the distal ankle defect (group II, n = 24). Plain-radiographs were used for radiological assessment. Clinically, the outcomes were objectively graded according to the Hawkins criteria, while subjectively the patients reported their satisfaction on a 1-5 points acceptance scale. RESULTS The mean follow-up was 37.16 ± 5.31 (30-48 months). Successful fusion was achieved in 43/44 patients, with a significantly (P < 0.05) lesser needs for bone-grafting in favour of group II. The results were good in 32 cases, fair in 11, and poor in a single case with no significant difference between the two groups. The acceptance scores were significantly (P < 0.05) superior in group II (3.08 ± 1.1 points) than that group I (2.25 ± 1.4 points). CONCLUSIONS Bifocal bone transport is effective in salvaging troublesome infected ankle fractures with bone loss. BT is more comprehensive and acceptable than ASRL with lesser needs for bone grafting.
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Sackstein P, Cooper P, Kessler C. The role of total ankle replacement in patients with haemophilia and end-stage ankle arthropathy: A review. Haemophilia 2020; 27:184-191. [PMID: 33164268 DOI: 10.1111/hae.14196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
Haemophilia is the most common X-linked bleeding disorder, affecting over 1 million individuals throughout the world. Patients are subclassified into mild, moderate and severe disease based on per cent factor activity level. Nearly, all patients with haemophilia develop haemophilic arthropathy (HA) by age 30 and HA is known to have a negative impact on physical health subscores in Haem-A-QOL, a validated quality of life scoring system for patients with haemophilia. Unfortunately, many patients progress to end-stage HA of the ankle, which is characterized by pain, contractures, decreased range of motion and muscle atrophy. Ankle arthrodesis (AAD) has been the standard of care in the definitive surgical management of end-stage HA of the ankle. While AAD is a safe surgical procedure known to improve HA-related pain, it decreases functional mobility and has been associated with secondary hindfoot arthritis as well as subtalar degeneration. In recent years, total ankle replacement (TAR) has emerged as an alternative surgical procedure that strives to improve functional mobility, pain and quality of life in end-stage HA of the ankle. However, the safety, durability, and efficacy of this procedure in these patients are unknown. In this review, we analyse the clinical studies investigating TAR in patients with end-stage HA of the ankle. We also discuss important considerations in the perioperative management of patients with haemophilia and compare the risks and benefits of AAD and TAR for patients with end-stage HA of the ankle.
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Affiliation(s)
| | - Paul Cooper
- Georgetown University Hospital, Washington, DC, USA
| | - Craig Kessler
- Georgetown University Hospital, Washington, DC, USA.,Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Lee HS, Park JH, Suh DH, Kim HJ, Koo BM, Kim HK, Yang SH, Choi GW. Effects of teriparatide on fusion rates in patients undergoing complex foot and ankle arthrodesis. Foot Ankle Surg 2020; 26:766-770. [PMID: 31690528 DOI: 10.1016/j.fas.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/06/2019] [Accepted: 10/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Here, we determined whether teriparatide treatment would increase fusion rates after foot and ankle arthrodesis by comparing treatment results between patients with high-risk factors for nonunion who received teriparatide against those who did not. METHODS We retrospectively reviewed 66 consecutive patients who underwent foot and ankle arthrodesis. The inclusion criterion was the presence of at least one of the following risk factors for nonunion after previous foot and ankle arthrodesis: deformity, bone defects, avascular necrosis, and nonunion. Sixteen patients were finally enrolled and divided into 2 groups: 8 patients received teriparatide treatment after fusion surgery (PTH group), and 8 patients did not (control group). RESULTS The fusion rate was significantly greater in the PTH group than in the control group (100% vs 50%). Four patients in the control group developed nonunion, 3 of whom underwent revision fusion; however, all patients received the teriparatide treatment after revision surgery and subsequently achieved union. No significant differences in demographics, fusion sites, and complication rates were found. CONCLUSION Though the sample size was small, the current study suggests that teriparatide administration may improve fusion rates in patients with high-risk factors for nonunion after foot and ankle arthrodesis.
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Affiliation(s)
- Hee Seop Lee
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Jung Ho Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Dong Hun Suh
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Bong Mo Koo
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Hak Kyu Kim
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Se Hyun Yang
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, South Korea
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea.
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Reeves CL, Shane AM, Sahli H, Togher C. Revision of the Malaligned Ankle Arthrodesis. Clin Podiatr Med Surg 2020; 37:475-487. [PMID: 32471613 DOI: 10.1016/j.cpm.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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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Gagne OJ, Veljkovic AN, Glazebrook M, Penner M, Wing K, Younger ASE. Agonizing and Expensive: A Review of Institutional Costs of Ankle Fusion Nonunions. Orthopedics 2020; 43:e219-e224. [PMID: 32271927 DOI: 10.3928/01477447-20200404-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/03/2019] [Indexed: 02/03/2023]
Abstract
Nonunion after ankle arthrodesis requiring revision is a challenging operative complication, and bone graft substitutes are costly. This study sought to summarize all institutional expenditures related to the revision of an ankle fusion nonunion, presuming that cost and skin-to-skin time would exceed those of the index surgery. The electronic records from 2 foot and ankle centers were reviewed, leading to a list of patients with 2 or more entries for tibiotalar fusions being generated. A total of 24 cases were found to match the criteria. Demographic factors and skin-to-skin time of the remaining patients were compiled. This cohort included 24 patients (6 female and 18 male) with a mean age of 64 years and body mass index of 30.4 kg/m2. Supplemental clinic visits and investigations were included either after computed tomography to assess union or 365 days after index surgery. Total cost of the revision was calculated from billing codes, length of operation, and period of hospitalization. Postrevision outpatient fees were included as well. The revisions were performed open in all cases, and 21 patients received autograft and/or bone substitute. Mean postoperative hospitalization was 3 days. The additional costs (in US dollars) associated with nonunion were $1061 for imaging, $627 for prerevision visits, $3026 for the revision, $3432 for the hospital stay, and $1754 for postrevision follow-up. The total mean amount was $9683, equivalent to 9 nights of acute inpatient stay. Mean index skin-to-skin time was 114 minutes, being 126 minutes for revisions (P=.26). Additional care related to ankle fusion nonunion represents a financial burden equivalent to 9 nights of acute inpatient stay. The use of an orthobiologic would need to be less than $436 to be cost saving. Revision surgery is not significantly longer intraoperatively than index surgery. [Orthopedics. 2020;43(4):e219-e224.].
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Pitts C, Alexander B, Washington J, Barranco H, Patel R, McGwin G, Shah AB. Factors affecting the outcomes of tibiotalocalcaneal fusion. Bone Joint J 2020; 102-B:345-351. [DOI: 10.1302/0301-620x.102b3.bjj-2019-1325.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Tibiotalocalcaneal (TTC) fusion is used to treat a variety of conditions affecting the ankle and subtalar joint, including osteoarthritis (OA), Charcot arthropathy, avascular necrosis (AVN) of the talus, failed total ankle arthroplasty, and severe deformity. The prevalence of postoperative complications remains high due to the complexity of hindfoot disease seen in these patients. The aim of this study was to analyze the relationship between preoperative conditions and postoperative complications in order to predict the outcome following primary TTC fusion. Methods We retrospectively reviewed the medical records of 101 patients who underwent TTC fusion at the same institution between 2011 and 2019. Risk ratios (RRs) associated with age, sex, diabetes, cardiovascular disease, smoking, preoperative ankle deformity, and the use of bone graft during surgery were related to the postoperative complications. We determined from these data which pre- and perioperative factors significantly affected the outcome. Results Out of the 101 patients included in the study, 29 (28.7%) had nonunion, five (4.9%) required below-knee amputation (BKA), 40 (39.6%) returned to the operating theatre, 16 (15.8%) had hardware failure, and 22 (21.8%) had a postoperative infection. Patients with a preoperative diagnosis of Charcot arthropathy and non-traumatic OA had significantly higher nonunion rates of 44.4% (12 patients) and 39.1% (18 patients) (p = 0.016) and infection rates of 29.6% (eight patients) and 37% (17 patients) compared to patients with traumatic arthritis, respectively (p = 0.002). There was a significantly increased rate of nonunion in diabetic patients (RR 2.22; p = 0.010). Patients with chronic kidney disease were 2.37-times more likely to have a nonunion (p = 0.006). Patients aged over 60 years had more than a three-fold increase in the rate of postoperative infection (RR 3.60; p = 0.006). The use of bone graft appeared to be significantly protective against postoperative infection (p = 0.019). Conclusion We were able to confirm, in the largest series of TTC ankle fusions currently in the literature, that there remains a high rate of complications following this procedure. We found that patients with a Charcot or non-traumatic arthropathy had an increased risk of nonunion and postoperative infection compared to individuals with traumatic arthritis. Those with diabetes, chronic kidney disease, or aged over 60 years had an increased risk of nonunion. These findings help to confirm those of previous studies. Additionally, our study adds to the literature by showing that autologous bone graft may help in decreasing infection rates. These data can be useful to surgeons and patients when considering, discussing and planning TTC fusion. It helps surgeons further understand which patients are at a higher risk for postoperative complications when undergoing TTC fusion. Cite this article: Bone Joint J. 2020;102-B(3):345–351.
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Affiliation(s)
- Charles Pitts
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bradley Alexander
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joshua Washington
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hannah Barranco
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Romil Patel
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ashish B. Shah
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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40
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So E, Brandão RA, Bull PE. A Comparison of Talar Surface Area Occupied by 2- Versus 3-Screw Fixation for Ankle Arthrodesis. Foot Ankle Spec 2020; 13:50-53. [PMID: 30862189 DOI: 10.1177/1938640019832359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background. Ankle arthrodesis is a procedure utilized in the treatment of end-stage ankle arthritis. Internal fixation with screws is traditionally relied on to achieve union. Although the use of screw fixation alone has produced satisfactory outcomes, nonunion rates can range from 9% to as high as 35%. Adding an additional screw to the traditional 2-screw fixation construct may improve the likelihood of union by adding strength and stiffness; however, this addition may counteract the theoretical fusion enhancement benefit by reducing the joint surface area (SA) available for fusion. Methods. A cadaver study was performed to compare the amount of SA lost from a standard 2-screw (group 1) versus the 3-screw ankle fusion construct (group 2). A total of 10 fresh cadaveric below-knee specimens were used. Cannulated 7.0-mm partially threaded screws were placed across the ankle joint. Each talus was examined to precisely determine joint SA loss following each procedure. Results. The mean total talus SA in group 1 was 1833.71 mm2 compared with 2125.76 mm2 in group 2. The mean SA lost by the 2-screw construct was 5.91%, versus 9.51% in the 3-screw construct group. The talus SA loss percentage difference between groups reached statistical significance (P = .0220). Conclusion. The addition of a third 7.0-mm screw to a 2-screw ankle fusion construct raised the percentage of joint surface lost from 5.91% to 9.5%. Clinical Relevance. Surgeons may consider using extra-articular plates with 1 or 2 intra-articular screws instead of the traditional 3-screw construct if there is an elevated concern for nonunion. Levels of Evidence: Level IV: Cadaveric case series.
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Affiliation(s)
- Eric So
- The CORE Institute, Phoenix, Arizona (ES).,Orthopedic Foot and Ankle Center, Westerville, Ohio (RAB, PEB)
| | - Roberto A Brandão
- The CORE Institute, Phoenix, Arizona (ES).,Orthopedic Foot and Ankle Center, Westerville, Ohio (RAB, PEB)
| | - Patrick E Bull
- The CORE Institute, Phoenix, Arizona (ES).,Orthopedic Foot and Ankle Center, Westerville, Ohio (RAB, PEB)
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Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis. BMC Musculoskelet Disord 2020; 21:31. [PMID: 31937287 PMCID: PMC6961281 DOI: 10.1186/s12891-020-3061-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background In highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief. However, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy is a type of joint preservation surgery that has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator for treating ankle osteoarthritis. Methods A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed, followed by angled osteotomy and correction of the distal tibia; the ankle joint was then stabilized after its condition improved. An external fixator was used in all patients, and joint distraction of approximately 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery. Results The anteroposterior and lateral mortise angle during weight-bearing, talar tilt angle, and anterior translation of the talus on ankle stress radiography were improved significantly (P < 0.05). Signal changes on magnetic resonance imaging also improved in all patients. Visual analog scale and American Orthopedic Foot & Ankle Society scores improved significantly (P < 0.05), and no severe complications were observed. Conclusion DTO with joint distraction may be useful as a joint-preserving surgery for medial ankle osteoarthritis in older patients with high levels of physical activity. Level of evidence Level IV, retrospective case series.
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Adukia V, Mangwani J, Issac R, Hussain S, Parker L. Current concepts in the management of ankle arthritis. J Clin Orthop Trauma 2020; 11:388-398. [PMID: 32405197 PMCID: PMC7211821 DOI: 10.1016/j.jcot.2020.03.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 01/15/2023] Open
Abstract
Ankle arthritis is a common condition. It causes a significant socioeconomic burden, and is associated with significant morbidity. Patients with ankle arthritis are either elderly with significant co-morbidities, or young adults who have previously suffered with ankle injuries, resulting in post-traumatic arthritis. There is a wide variation in the management of these patients with ankle arthritis. We therefore present an overview of the current evidence based management of patients with symptomatic ankle arthritis.
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Affiliation(s)
- V. Adukia
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom,Corresponding author.
| | - J. Mangwani
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
| | - R. Issac
- Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, United Kingdom
| | - S. Hussain
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
| | - L. Parker
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel, London, E1 1BB, United Kingdom
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Total ankle arthroplasty and ankle arthrodesis affect the biomechanics of the inner foot differently. Sci Rep 2019; 9:13334. [PMID: 31527781 PMCID: PMC6746773 DOI: 10.1038/s41598-019-50091-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/05/2019] [Indexed: 02/08/2023] Open
Abstract
Ankle arthrodesis and total ankle arthroplasty are the two primary surgeries for treatment of end-stage degenerative ankle arthritis. The biomechanical effects of them on the inner foot are insufficient to identify which is superior. This study compared biomechanical parameters among a foot treated by ankle arthrodesis, a foot treated by total ankle arthroplasty, and an intact foot using computational analysis. Validated finite element models of the three feet were developed and used to simulate the stance phase of gait. The results showed total ankle arthroplasty provides a more stable plantar pressure distribution than ankle arthrodesis. The highest contact pressure, 3.17 MPa, occurred in the medial cuneonavicular joint in the total ankle arthroplasty foot. Neither of the surgeries resulted in contact pressure increase in the subtalar joint. The peak stress in the metatarsal bones was increased in both surgical models, especially the second and third metatarsals. This study enables us to get visual to the biomechanics inside of an intact foot, and feet treated by total ankle arthroplasty and ankle arthrodesis during walking.
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Abstract
Patients with varus ankle deformity and concomitant osteoarthritis experience severe disabling pain that affects their daily activity of living. Most cases rarely respond to nonoperative treatment. One surgical option is corrective ankle arthrodesis. Unfortunately, this corrective surgery is challenging and might not be possible as a purely isolated procedure. Corrective ankle arthrodesis for varus ankle is performed with different surgical approaches and techniques, using different methods of fixations. The goal of surgery is to create a pain-free, stable, and plantigrade ankle, hindfoot, and foot. Both the foot and ankle must be correctly aligned in the optimal position for proper locomotion.
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Affiliation(s)
- Faisal AlSayel
- Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, 4010 Basel, Switzerland
| | - Victor Valderrabano
- Swiss Ortho Center, University of Basel, Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, 4010 Basel, Switzerland.
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Guichard L, Vanhaesebrouck A, Fletcher D, Stiglitz Y, Rouquette A, Martinez V. Pain Trajectory After Ankle Surgeries for Osteoarthritis. Foot Ankle Int 2019; 40:367-373. [PMID: 30628475 DOI: 10.1177/1071100718817514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: The pain trajectory after ankle surgeries for osteoarthritis is relevant to describe. The purpose of this prospective study was to describe pain after ankle surgery and explore the link between perioperative factors and the development of postoperative pain. METHODS: Duration, severity, type of preoperative pain, psychological distress, opioid consumption, and type of surgery were evaluated in 49 patients who were followed for 18 months. Acute postoperative pain in the first 10 days after surgery was modeled by a pain trajectory. Univariate analysis was conducted to identify predictors of acute pain trajectory and chronic pain. RESULTS: Eighty-seven percent of patients had preoperative chronic pain, 34% had a high postoperative pain trajectory, 44% of whom reported chronic pain at 18 months. The patients who developed a high acute pain trajectory had higher preoperative opioid consumption (50% vs 19.4%, P = .04), a higher incidence of preoperative neuropathic pain (68.8% vs 32.3%, P = .02), a higher brief pain inventory score (51.5 vs 34, P = .01), and a higher psychological distress score (8 vs 3, P = .002). The patients who developed chronic pain had a higher brief pain inventory score (42 vs 33, P = .04), a higher psychological distress score (6 vs 4, P = .04), and a higher preoperative pain intensity (8 vs 6, P = .008). No association was found between the type of ankle surgery and pain. CONCLUSION: Patients with psychological distress and more severe preoperative pain were more at risk to develop acute pain and chronic pain after ankle surgery regardless of the surgery performed. LEVEL OF EVIDENCE: Level II, prospective comparative study.
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Affiliation(s)
- Leah Guichard
- 1 Service d'anesthésie, Hôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris, France
| | - Alexis Vanhaesebrouck
- 2 Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel Dieu, Biostatistics and Epidemiology Department, Paris, France
| | - Dominique Fletcher
- 1 Service d'anesthésie, Hôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris, France.,3 INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, France.,4 Université Versailles Saint-Quentin, France
| | - Yves Stiglitz
- 5 Service d'orthopédie, Hôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris, France
| | - Alexandra Rouquette
- 6 CESP, INSERM, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,7 Assistance Publique-Hôpitaux de Paris, Hôpital du Kremlin Bicêtre, Le Kremelin Bicêtre
| | - Valeria Martinez
- 1 Service d'anesthésie, Hôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris, France.,3 INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, France.,4 Université Versailles Saint-Quentin, France
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Henricson A, Jehpsson L, Carlsson Å, Rosengren BE. Re-arthrodesis after primary ankle fusion: 134/1,716 cases from the Swedish Ankle Registry. Acta Orthop 2018; 89:560-564. [PMID: 29947274 PMCID: PMC6202729 DOI: 10.1080/17453674.2018.1488208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Arthrodesis is the most common treatment of severe ankle arthritis. Large studies on the occurrence of re-arthrodesis are few, especially with information in terms of risk. We used the National Swedish Ankle Registry to assess incidence and risk factors for re-arthrodesis. Patients and methods - In the Registry, we examined the occurrence of re-arthrodesis in 1,716 patients with a primary ankle arthrodesis. We also analyzed associations between the re-arthrodesis risk and sex, diagnosis, and surgical method. Results - The risk of first re-arthrodesis at 2.5 years was 7.4% and the rate at 9 years 7.8%. The risk following arthroscopic surgery with fixation by screws was 15%, which is statistically significantly higher than the 8% following the gold standard technique with open screw fixation, the 5% following fixation by intramedullary nailing, and the 3% following fixation by plate and screws. Patients with either idiopathic osteoarthritis or posttraumatic arthritis had a higher risk of re-arthrodesis than patients with rheumatoid arthritis. We could not find that the risk of re-arthrodesis was associated with sex. Interpretation - In Sweden, the re-arthrodesis risk varied by primary technique and was especially high after arthroscopic surgery. Reasons are unknown but poor surgical technique and/or surgeon inexperience may contribute, as may patient selection.
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Affiliation(s)
- Anders Henricson
- Department of Orthopedic Surgery, Falun Central Hospital, Falun; ,Correspondence:
| | - Lars Jehpsson
- Department of Clinical Sciences and Orthopedic Surgery, Skåne University Hospital, Malmö, Sweden
| | - Åke Carlsson
- Department of Clinical Sciences and Orthopedic Surgery, Skåne University Hospital, Malmö, Sweden
| | - Björn E Rosengren
- Department of Clinical Sciences and Orthopedic Surgery, Skåne University Hospital, Malmö, Sweden
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O’Connor K, Klein S, Ebeling P, Flemister AS, Phisitkul P. Total Ankle Arthroplasty. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418790003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Sandra Klein
- Washington University in St Louis, Chesterfield, MO, USA
| | - Patrick Ebeling
- Department of Orthopaedic Surgery, University of Rochester School of Medicine, Rochester, NY, USA
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Kim JG, Ha DJ, Gwak HC, Kim CW, Kim JH, Lee SJ, Kim YJ, Lee CR, Park JH. Ankle Arthrodesis: A Comparison of Anterior Approach and Transfibular Approach. Clin Orthop Surg 2018; 10:368-373. [PMID: 30174814 PMCID: PMC6107825 DOI: 10.4055/cios.2018.10.3.368] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 01/02/2018] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of this study was to compare clinical and radiological results of arthrodesis performed by the anterior approach and by the transfibular approach in ankle osteoarthritis. Methods Sixty patients underwent open arthrodesis (38 by the anterior approach and 22 by the transfibular approach). The visual analogue scale score and the American Orthopedic Foot and Ankle Society (AOFAS) score were examined clinically, and radiological examination was performed on the alignment of the lower extremity and bone union. Results Both groups showed significant improvement in AOFAS score (from 39.8 to 58.3 in the anterior approach group and from 44.5 to 60.7 in the transfibular approach group). There was no significant difference in AOFAS score at the last follow-up in both groups. The time to fusion was 13.5 weeks in the anterior approach group and 11.8 weeks in the transfibular approach group. Nonunion occurred in four cases in the anterior approach group and in one case in the transfibular approach group. Conclusions Ankle arthrodesis by the anterior approach and the transfibular approach showed comparably good clinical results.
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Affiliation(s)
- Jeon-Gyo Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong-Jun Ha
- Department of Orthopaedic Surgery, Busan City Medical Center, Busan, Korea
| | - Heui-Chul Gwak
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jung-Han Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seon-Joo Lee
- Department of Radiology, Inje University Busan Paik Hospital, Busan, Korea
| | - Young-Jun Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang-Rak Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji-Hwan Park
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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49
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Walcher MG, Seefried L, Konrads C, Plumhoff P, Hoberg M, Rudert M, Fraissler L. Arthroskopisch gestützte Arthrodese des oberen Sprunggelenks. ARTHROSKOPIE 2018. [DOI: 10.1007/s00142-018-0201-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Mulligan RP, McCarthy KJ, Grear BJ, Richardson DR, Ishikawa SN, Murphy GA. Preoperative Risk Factors for Complications in Elective Ankle and Hindfoot Reconstruction. Foot Ankle Spec 2018; 11:54-60. [PMID: 28423940 DOI: 10.1177/1938640017706155] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to examine medical, social, and psychological factors associated with complications and reoperation after foot and ankle reconstruction. METHODS A retrospective chart review was conducted of 132 patients (135 feet; 139 operative cases) who had elective foot and ankle reconstruction. Medical, social, and psychological variables were documented. Primary outcomes included complications and reoperations. RESULTS The overall complication rate was 28% (39/139), and the reoperation rate was 17% (24/139). Alcohol use (P = .03) and preoperative narcotic use (P = .02) were risk factors for complications, with delayed wound healing more frequent in alcohol users (P = .03) and deep infection (P = .045) and nonunion (P = .046) more frequent preoperative narcotic use. Deep infection also was more frequent in tobacco users (P < .01). Older patients were less likely to undergo reoperation (risk of reoperation increased with age). Other variables were not associated with increased complications. CONCLUSION Patients who consumed alcohol or had been prescribed any amount of narcotic within 3 months preoperatively were at increased risk for complications. Patients who smoked were more likely to have a wound infection. Surgeons should be aware of these factors and counsel patients before surgery. LEVELS OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- Ryan P Mulligan
- Campbell Clinic, Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, Memphis, Tennessee (RPM, BJG, DRR, SNI, GAM).,HSHS Orthopaedic Surgery and Sports Medicine, Belleville, Illinois (KM)
| | - Kevin J McCarthy
- Campbell Clinic, Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, Memphis, Tennessee (RPM, BJG, DRR, SNI, GAM).,HSHS Orthopaedic Surgery and Sports Medicine, Belleville, Illinois (KM)
| | - Benjamin J Grear
- Campbell Clinic, Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, Memphis, Tennessee (RPM, BJG, DRR, SNI, GAM).,HSHS Orthopaedic Surgery and Sports Medicine, Belleville, Illinois (KM)
| | - David R Richardson
- Campbell Clinic, Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, Memphis, Tennessee (RPM, BJG, DRR, SNI, GAM).,HSHS Orthopaedic Surgery and Sports Medicine, Belleville, Illinois (KM)
| | - Susan N Ishikawa
- Campbell Clinic, Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, Memphis, Tennessee (RPM, BJG, DRR, SNI, GAM).,HSHS Orthopaedic Surgery and Sports Medicine, Belleville, Illinois (KM)
| | - G Andrew Murphy
- Campbell Clinic, Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, Memphis, Tennessee (RPM, BJG, DRR, SNI, GAM).,HSHS Orthopaedic Surgery and Sports Medicine, Belleville, Illinois (KM)
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