1
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Gutteck N, Delank KS, Schilde S. Comparative results of arthroscopic ankle arthrodesis vs. open arthrodesis in patients with diabetes-associated Charcot Neuro-Arthropathy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3577-3584. [PMID: 37245183 PMCID: PMC10225040 DOI: 10.1007/s00590-023-03592-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/14/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Several studies demonstrated a considerable complication rate for open ankle or TTC arthrodesis in patients with diabetes, revision surgery and ulceration. Extensive approaches in combination with multimorbide patients have been suggested as the rationale behind the increased complication rate. METHODS Single-centre, prospective case-control study compared arthroscopic vs. open ankle arthrodesis in patients with Charcot Neuro-Arthropathy of the foot. 18 patients with septic Charcot Neuro-Arthropathy Sanders III-IV received an arthroscopic ankle arthrodesis with TSF (Taylor Spatial Frame®) fixation combined with different additional procedures required for infect treatment and hindfoot realignment. The ankle arthrodesis was required for the realignment of the hindfoot in Sanders IV patients, arthritis or in case of infection. 12 patients were treated with open ankle arthrodesis and TSF fixation combined with various additional procedures. RESULTS A significant improvement has been shown in radiological data in both groups. A significant lower complication rate has been registered in arthroscopic group. A significant correlation was seen between major complications and therapeutic anticoagulation as well as smoking. CONCLUSION In high-risk patients with diabetes and plantar ulceration excellent results could be demonstrated in arthroscopically performed ankle arthrodesis with midfoot osteotomy using TSF as fixation devise.
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Affiliation(s)
- Natalia Gutteck
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany.
| | - Karl-Stefan Delank
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany
| | - Sebastian Schilde
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube str. 40, 06120, Halle, Germany
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2
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Abstract
Despite the increasing popularity of total ankle replacement, ankle arthrodesis remains the gold standard for the treatment of end-stage ankle arthritis. Historically, open techniques have been utilized for ankle arthrodesis. There have been many variations and techniques described, including transfibular, anterior, medial, and miniarthrotomy. Inherent disadvantages to these open techniques include postoperative pain, delayed or nonunion, wound complications, shortening, prolonged healing times, and prolonged hospital stays. Arthroscopic ankle arthrodesis provides the foot and ankle surgeon with an alternative to the traditional open techniques. Arthroscopic ankle arthrodesis has demonstrated faster union rates, decreased complications, reduced postoperative pain, and shorter hospital stays.
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Affiliation(s)
- Michael S Lee
- Capital Orthopaedics & Sports Medicine, 12499 University Avenue, Suite 210, Clive, IA 50325, USA.
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3
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Lorente A, Pelaz L, Palacios P, Bautista IJ, Mariscal G, Barrios C, Lorente R. Arthroscopic vs. Open-Ankle Arthrodesis on Fusion Rate in Ankle Osteoarthritis Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12103574. [PMID: 37240680 DOI: 10.3390/jcm12103574] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
Although open surgery is the conventional option for ankle arthritis, there are some reports in the literature regarding the use of the arthroscopy procedure with outstanding results. The primary purpose of this systematic review and meta-analysis was to analyze the effect of the surgery technique (open-ankle arthrodesis vs. arthroscopy) in patients with ankle osteoarthritis. Three electronic databases (PubMed, Web of Science, and Scopus) were searched until 10 April 2023. The Cochrane Collaboration's risk-of-bias tool was used to assess the risk of bias and grading of the recommendations assessment, development, and evaluation system for each outcome. The between-study variance was estimated using a random-effects model. A total of 13 studies (including n = 994 participants) met the inclusion criteria. The meta-analysis results revealed a nom-significant (p = 0.072) odds ratio (OR) of 0.54 (0.28-1.07) for the fusion rate. Regarding operation time, a non-significant difference (p = 0.573) among both surgical techniques was found (mean differences (MD) = 3.40 min [-11.08 to 17.88]). However, hospital length stay and overall complications revealed significant differences (MD = 2.29 days [0.63 to 3.95], p = 0.017 and OR = 0.47 [0.26 to 0.83], p = 0.016), respectively. Our findings showed a non-statistically significant fusion rate. On the other hand, operation time was similar among both surgical techniques, without significant differences. Nevertheless, lower hospital stay was found in patients that were operated on with arthroscopy. Finally, for the outcome of overall complications, the ankle arthroscopy technique was a protective factor in comparison with open surgery.
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Affiliation(s)
- Alejandro Lorente
- Ankle and Foot Surgery Unit, Department of Traumatology and Orthopaedic Surgery, University Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Leire Pelaz
- Ankle and Foot Surgery Unit, Department of Traumatology and Orthopaedic Surgery, University Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Pablo Palacios
- Department of Traumatology and Orthopaedic Surgery, Sanchinarro University Hospital, 28050 Madrid, Spain
| | - Iker J Bautista
- Institute of Sport, Nursing, and Allied Health, University of Chichester, Chichister PO19 6PE, UK
- Physiotherapy Department, Valencia Catholic University of Valencia, 46900 Valencia, Spain
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
| | - Rafael Lorente
- Department of Orthopedic Surgery and Traumatology, University Hospital of Badajoz, 06080 Badajoz, Spain
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4
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Fahmy FS, Salam MAAE, Mahmoud HF. Improvement in clinical outcome and quality of life after arthroscopic ankle arthrodesis in paralytic foot drop. J Orthop Surg Res 2023; 18:202. [PMID: 36918915 PMCID: PMC10015676 DOI: 10.1186/s13018-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Paralytic foot-drop is a disabling deformity that results from nerve or direct muscle injuries. Palliative surgeries such as tendon transfer and ankle arthrodesis are reserved for permanent deformity, with the arthroscopic technique had not been widely studied before. This study aims to evaluate the clinical outcome and quality of life after arthroscopic ankle fusion of paralytic foot-drop deformity. MATERIALS AND METHODS The patients who were retrospectively enrolled in this study underwent arthroscopic ankle fusion for paralytic foot-drop deformity between March 2017 and December 2021. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Cumberland Ankle Instability Tool (CAIT) were the measures used for clinical assessment. To judge the union, serial plain radiographs of the ankle were obtained. The preoperative and postoperative means were analyzed utilizing a two-tailed paired t-test, with a p value of less than 0.05 indicating statistical significance. RESULTS This study included 21 consecutive patients with a mean follow-up of 35.09 ± 4.5 months and a mean age of 41.5 ± 6.1 years. Highly significant improvements were observed between the preoperative and final follow-up means of the AOFAS score (from 57.6 ± 4.6 to 88.3 ± 2.7) and CAIT (from 12.1 ± 2.2 to 28.9 ± 1.01; p ˂ 0.00001 for both). All patients attained radiographic union and resumed their previous occupations without reporting serious adverse effects. CONCLUSIONS Arthroscopic ankle fusion is an effective, minimally invasive palliative surgery for patients suffering from permanent paralytic foot-drop deformity. This technique was shown to provide good functional and radiologic outcomes without significant complications. LEVEL OF EVIDENCE Retrospective cohort; level of evidence (IV).
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Affiliation(s)
- Fahmy Samir Fahmy
- Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
| | | | - Hossam Fathi Mahmoud
- Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
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5
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Xing G, Xu M, Yin J, Wei Y, Zhang L. Effectiveness of Arthroscopically Assisted Surgery for Ankle Arthrodesis. J Foot Ankle Surg 2023; 62:398-404. [PMID: 36588066 DOI: 10.1053/j.jfas.2022.12.001] [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: 03/02/2019] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
Regarding the treatment of ankle arthritis, the choice of arthroscopic ankle arthrodesis (AAA) or open ankle arthrodesis (OAA) remains controversial. To guide clinical decision-making, we conducted a meta-analysis on the optimal treatment of ankle arthrodesis. We identified eligible studies published from June 1, 1969 to June 1, 2020 using the Cochrane Library, PubMed, OVID, Embase, and Medline searched the references of relevant studies. Randomized and non-randomized studies that compared outcomes of AAA and OAA were included. After the methodologic assessment, available data were extracted and statistically reviewed. The primary outcomes were overall complications rate, tourniquet time, length of the hospital stay, non-union rate, and rate to fusion. The secondary outcomes were delayed union and postoperative infection rate. We included 9 studies comparing arthroscopic and open in patients with ankle arthrodesis, comprising 467 participants. AAA had the advantage of demonstrating a lower overall complication rate (odds ratio [OR], 0.44 [95% confidence interval [CI], 0.26-0.73]; p = .002), shorter intraoperative tourniquet time (mean difference [MD], -16.49 [95% CI, -23.51 to -9.46]; p < .001), shorter length of the hospital stay (MD -1.75, 95% CI -1.94 to -1.2, p < .001),lower non-union rate (OR, -0.07 [95% CI, -0.13 to -0.02]; p <.01) and higher rate to fusion (OR, 4.2 [95% CI, 1.96-8.99]; p < .001) in comparison with OAA. Yet, no significant differences were found in delayed union (OR, 0.46 [95% CI, 0.10-2.04]; p = .30) and postoperative infection rate (OR, 0.45 [95% CI, 0.17-1.15]; p = .09) between the groups. Our results suggest that arthroscopic ankle arthrodesis is superior to open ankle arthrodesis alone in the treatment of ankle arthritis based on the overall complication rate, intraoperative tourniquet time, length of the hospital stay, non-union rate and rate to fusion. However, further high-quality randomized controlled trials with appropriate blinding methods are needed to confirm the findings.
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Affiliation(s)
- Guangwei Xing
- Department of Orthopedics, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mingjie Xu
- Department of Orthopedics, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinneng Yin
- Department of Internal Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Yan Wei
- Department of Pain, Orthopedics Hospital of JiHua, Zhengzhou, China
| | - Ligui Zhang
- Department of Orthopedics, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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6
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Chawla S, Brage M. Pantalar Arthrodesis. Foot Ankle Clin 2022; 27:883-895. [PMID: 36368803 DOI: 10.1016/j.fcl.2022.08.002] [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] [Indexed: 11/09/2022]
Abstract
A triple arthrodesis is comprised of subtalar, talonavicular, and calcaneocuboid joints arthrodesis. A pantalar arthrodesis is triple arthrodesis combined with tibiotalar arthrodesis. The goal of the procedure is to obtain a correction of deformity and achieve a plantigrade, functional, painless, stable, weightbearing foot that can be used to ambulate. This is done by creating an osseous continuity across the ankle, subtalar, and talonavicular, and calcaneocuboid joints. There are several approaches and fixation strategies that result in successful clinical union and should be chosen to match the clinical situation. Modern techniques result in high rates of union and pain relief.
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Affiliation(s)
- Sagar Chawla
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
| | - Michael Brage
- Department of Orthopaedics and Sports Medicine, University of Washington, Ninth & Jefferson Building, 908 Jefferson Street, Seattle, WA 98104, USA
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7
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Lower Risk of Revision Surgery After Arthroscopic Versus Open Irrigation and Débridement for Shoulder Septic Arthritis. J Am Acad Orthop Surg 2022; 30:e1504-e1514. [PMID: 36084333 DOI: 10.5435/jaaos-d-22-00428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/03/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In the treatment of native shoulder septic arthritis, the optimal irrigation and débridement modality-arthroscopic versus open-is a matter of controversy. We aim to compare revision-free survival (RFS), complications, and resource utilization between these approaches. METHODS The National Readmission Database was queried from 2016 to 2019 to identify patients using International Classification of Diseases, 10th revision, diagnostic and procedure codes. Days to revision irrigation and débridement (I&D) were calculated for patients during index admission or subsequent readmissions. Multivariate regression was used for healthcare utilization analysis. Survival analysis was done using Kaplan-Meier analysis and Cox proportional hazard regression. RESULTS A total of 4,113 patients with native shoulder septic arthritis undergoing I&D were identified, 2,775 arthroscopic (67.5%) and 1,338 open (32.5%). The median follow-up was 170 days (interquartile range 79 to 265). A total of 341 patients (8.3%) underwent revision I&D at a median of 9 days. On multivariate analysis, arthroscopic I&D was associated with a reduction in hospital costs of $4,154 ( P < 0.001) and length of stay of 0.78 days ( P = 0.030). Arthroscopic I&D was associated with reduced blood transfusions (odds ratio 0.69, P = 0.001) and wound complications (odds ratio 0.30, P < 0.001). RFS was 96.4%, 94.9%, 93.3%, and 92.6% for arthroscopic I&D and 94.1%, 92.6%, 90.4%, and 89.0% for open I&D at 10, 30, 90 and 180 days, respectively ( P = 0.00043). On multivariate Cox modeling, arthroscopic I&D was associated with improved survival (hazard ratio 0.67, P = 0.00035). On stratified analysis, arthroscopic I&D was associated with improved RFS in patients aged 65 years or older ( P < 0.001), but RFS was similar in those younger than 65 years ( P = 0.17). CONCLUSION Risk of revision I&D was markedly lower after arthroscopic I&D compared with open, although the protective benefit was limited to patients aged 65 years or older. Arthroscopy was also associated with decreased costs, length of stay, and complications. Although surgeons must consider specific patient factors, our results suggest that arthroscopic I&D is superior to open I&D. LEVEL OF EVIDENCE III.
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8
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Abuhantash M, Veljkovic A, Wing K, Gagne O, Qian H, Wong H, Sadr H, Penner M, Younger A. Arthroscopic Versus Open Ankle Arthrodesis: A 5-Year Follow Up. J Bone Joint Surg Am 2022; 104:1197-1203. [PMID: 35793798 DOI: 10.2106/jbjs.21.01088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND End-stage ankle arthritis has long been managed surgically with open ankle arthrodesis (OAA). Since the first published report in 1983, arthroscopic ankle arthrodesis (AAA) has been thought to be associated with improved patient-reported outcome measures (PROMs) and fewer complications. The purpose of the present study was to compare the long-term PROMs, major complications, and reoperations for these 2 approaches at up to 15 years of follow-up. METHODS This longitudinal cohort study included patients at our institution who underwent primary ankle arthrodesis for the treatment of end-stage arthritis. Demographic data and preoperative COFAS (Canadian Orthopaedic Foot and Ankle Society) ankle arthritis type were collected for all patients. PROMs were completed preoperatively, at 6 months, and annually thereafter to 5 years. PROMs were compared at all time points with use of a mixed-effects regression model that adjusted for preoperative variables and scores. Major complications and reoperations at the site of the ankle arthrodesis were also compared. RESULTS Of 1,294 patients who were screened for inclusion, 351 who had undergone ankle arthrodesis between 2003 and 2019 were eligible for the study. Of those, 223 had undergone AAA and 128 had undergone OAA. The 2 groups were similar preoperatively with respect to demographics, but COFAS Type-4 arthritis was relatively more common in the OAA group and Type-1 arthritis was relatively more common in the AAA group. In addition, the Ankle Osteoarthritis Scale (AOS) score and Ankle Arthritis Score (AAS) were better in the AAA group. In the mixed-effects model analysis, the differences in postoperative outcome scores between the groups were not significant. The risk of revision due to malunion or nonunion was similar in both groups (6% in the AAA group, compared with 4% in the OAA group). Deep infection and wound complications did not occur in the arthroscopic group but occurred in 4% of the patients in the OAA group. CONCLUSIONS After adjustment for baseline patient characteristics, there were no differences in PROMs between the 2 techniques. Ankle arthrodeses done arthroscopically had a similar revision rate but lower infection rate compared with those done with the open technique. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Monther Abuhantash
- Division of Orthopedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrea Veljkovic
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Wing
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Oliver Gagne
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hong Qian
- The Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Hubert Wong
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hooman Sadr
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Murray Penner
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Zhao JZ, Kaiser PB, DeGruccio C, Farina EM, Miller CP. Quality of MIS vs Open Joint Preparations of the Foot and Ankle. Foot Ankle Int 2022; 43:948-956. [PMID: 35382603 DOI: 10.1177/10711007221081865] [Citation(s) in RCA: 2] [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 Minimally invasive surgery (MIS) is growing in the field of foot and ankle, and the MIS burr is an emerging tool. Although commonly used to perform osteotomies, the burr can also be used for arthrodesis joint preparation that traditionally would be performed through open incisions. To date, there is no study comparing the quality of joint preparation between using a fluoroscopy-guided MIS technique compared to traditional open techniques. The goal of this cadaveric study is to compare the percentage of joint surfaces prepared between MIS and open techniques for the most common joints that are fused in foot and ankle surgery. METHODS Open joint preparation was performed under direct visualization with open incisions. MIS joint preparation was performed percutaneously using fluoroscopic guidance alone, without arthroscopy. After joint preparation, cadaveric samples were disarticulated, and joint surfaces were analyzed for percentage of cartilaginous surface removed. The percentage of joint surface prepared was compared between the open and MIS techniques. RESULTS Ten cadaveric samples were used for the MIS technique and 5 samples for the open technique. Percentage of joint surface prepared was similar for all joint surfaces. CONCLUSION The MIS technique in the hands of experienced surgeons was found to provide overall similar percentages of surface area prepared compared to traditional open techniques. CLINICAL RELEVANCE MIS joint preparation may be useful for specific patient populations. This study suggests that MIS joint preparation is a reasonable, and possibly advantageous, alternative to open preparation in arthrodesis surgery when performed by experienced MIS surgeons.
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Affiliation(s)
- John Z Zhao
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Philip B Kaiser
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Christina DeGruccio
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Evan M Farina
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Christopher P Miller
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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10
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Issac RT, Thomson LE, Khan K, Allen P, Best A, Mangwani J. Do degree of coronal plane deformity and patient related factors affect union and outcome of Arthroscopic versus Open Ankle Arthrodesis? Foot Ankle Surg 2022; 28:635-641. [PMID: 34340904 DOI: 10.1016/j.fas.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to analyse if union and outcome of Arthroscopic Ankle Arthrodesis (AAA) versus Open Ankle Arthrodesis (OAA) were influenced by the extent of coronal plane deformity and to report if patient related factors influence union. METHODS A total of 122 ankle arthrodesis procedures were included in the study. These were divided into two groups; Group A (n = 99) with deformity less than 15° and Group B (n = 23) with deformity greater than or equal to 15°. Data was collected on patient demographics, medical comorbidities (smoking, diabetes, obesity) and time to union. Patient reported outcome measures (PROMs) evaluated were Manchester Oxford Foot Questionnaire, EuroQol-5D and EuroQol visual analogue health thermometer (EQ-VAS). RESULTS The mean follow-up in Group A and B was 74.87 and 89.17 months respectively. The average deformity in Group A was 4.9° for AAA and 5.8° for OAA. In Group B it was 18.9° (maximum 28° varus) for AAA and 22.1° (maximum 41° valgus) for OAA. The overall union rate was 95% in Group A (AAA-94%; OAA-100%; [p = 0.20]) and 87% in Group B (AAA-100%; OAA-67%; [p = 0.02]). Mean time to union was 13.2 weeks in Group A (AAA-13.3 weeks; OAA-12.8 weeks; [p = 0.73]) compared to 12.4 weeks for Group B (AAA-12.9 weeks; OAA-11.8 weeks; [p = 0.56]). Irrespective of the extent of deformity and type of surgery, smokers had a 10 times higher likelihood of non-union (p = 0.03). In Group A, none of the PROMs showed significant difference between AAA and OAA. In Group B, EQ-VAS score reached statistical significance (p = 0.03) in favour of AAA whereas other PROMs showed no difference. CONCLUSION AAA is reproducible in achieving union in end stage ankle arthritis and good PROMs can be expected even in ankles with larger deformities. Regardless of the type of surgery and extent of deformity, smoking is a significant risk factor for non-union. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Renjit Thomas Issac
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
| | - Lauren Elizabeth Thomson
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Kinza Khan
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Patricia Allen
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Alistair Best
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
| | - Jitendra Mangwani
- Leicester General Hospital, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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11
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Gaulke R. Die Arthroskopie des oberen Sprunggelenkes –
Möglichkeiten und Grenzen. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1794-5300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDie Arthroskopie des oberen Sprunggelenkes hat, aufgrund der kleinen
Zugänge und der guten Übersichtlichkeit sämtlicher
Gelenkkompartimente in Bezug auf die Synovialektomie, die Entfernung von
Schleimhautfalten, insbesondere unter der Syndesmose, aber auch bei der dorsalen
Synovialektomie, die offenen Verfahren weitgehend abgelöst. Neben der
totalen Synovialektomie über Zugänge von dorsal und ventral ist
es möglich, Osteophyten abzutragen und dadurch die Gelenkbeweglichkeit
zu verbessern. Darüber hinaus können freie Gelenkkörper
entfernt und Knorpelläsionen geglättet werden. Auch die
arthroskopisch assistierte perkutane Schraubenarthrodese entwickelt sich
zunehmend zu einem Standardverfahren in der Therapie des rheumatischen und
degenerativ veränderten oberen Sprunggelenkes. Ist eine
Tenosynovialektomie erforderlich, so wird auch das Gelenk offen therapiert, da
das arthroskopische Vorgehen dann kaum Vorteile bietet.
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Affiliation(s)
- Ralph Gaulke
- Sektion Obere Extremität, Fuß- und Rheumachirurgie,
Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover,
Germany
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12
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Sandiford NA, Wong F, Back DL, Chan O. Ankle arthrodesis in patients with haemophilia-associated ankle arthropathy - does the technique influence the outcome? Acta Orthop Belg 2022; 88:121-125. [PMID: 35512162 DOI: 10.52628/88.1.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Management of symptomatic osteoarthritis (OA) of the ankle in patients with haemophilia can be challenging. Arthroscopic ankle arthrodesis has been shown in non-haemophiliac patients to provide similar or superior rates of fusion to open ankle fusion. However, the literature regarding ankle arthrodesis in patients with haemophilia is limited. Our aim was to compare the rate of successful fusion between open and arthroscopic assisted ankle arthrodesis in patients with haemophilia. A retrospective study was performed. All patients with haemophilia who underwent ankle arthrodesis at our centre were included. Outcomes including peri- and post-operative complications, and lengths of stay were extracted from patients' records. Radiographs were reviewed for signs of successful arthrodesis. Seventeen arthrodesis procedures were performed in 13 patients between 1980 and 2017. Nine procedures were performed arthroscopically and eight were open. Ten patients were diagnosed with haemophilia A and three with haemophilia B. The success rates of arthroscopic and open tibiotalar arthrodesis were 100% and 87.5% respectively. Four complications occurred. In the open technique group, there was one non-union. The same patient also developed subsequent haematoma after revision surgery. One patient developed a superficial wound infection which resolved with antibiotics. In the arthroscopic group, one patient developed a pseudoarthrosis of the distal tibiofibular joint which required a revision procedure. The results of this study suggest that arthroscopic ankle fusion for haemophilia- associated arthropathy is a viable option, with the rate of successful fusion being comparable to open procedures.
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Abstract
End-stage ankle arthritis typically affects an active younger patient population as compared with hip and knee arthritis. The optimal surgical treatment depends on several patient-specific factors. Open ankle arthrodesis has achieved reliable outcomes for this condition over years; however, arthroscopic techniques seem to be advantageous and feasible even in cases with significant intraarticular deformity. This article describes the surgical technique of arthroscopic ankle arthrodesis and discusses the outcome compared with that of open ankle fusion and total ankle replacement.
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Affiliation(s)
- Anna-Kathrin Leucht
- Department of Orthopaedics and Traumatology, Cantonal Hospital of Winterthur, Brauerstrasse 15, Winterthur 8401, Switzerland
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British, Footbridge Center for Integrated Foot and Ankle Care, Footbridge Clinic, Unit 221, 181 Keefer Place, Vancouver, British Columbia V6B6C1, Canada.
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14
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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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15
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Buchhorn T, Polzer H, Szymski D. [Open or arthroscopic arthrodesis of the ankle joint : Which is better?]. Unfallchirurg 2022; 125:196-204. [PMID: 35066594 DOI: 10.1007/s00113-021-01134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 02/07/2023]
Abstract
Due to the change in the age structure in Germany and the steadily increasing number of fractures, arthrosis of the upper ankle joint, mainly caused by posttraumatic conditions, is becoming more and more relevant in routine trauma surgery and orthopedics. Patients suffer from reduced functionality and quality of life as well as immobilizing pain. In addition to an ankle joint prosthesis arthrodesis of the upper ankle joint offers an alternative for the treatment of advanced arthrosis. When performing an arthrodesis there is basically the option of both open and arthroscopic procedures to prepare the joint and remove the cartilage. In both procedures the upper ankle joint is usually fixed with 2-3 cannulated compression screws. Comparative studies to date have shown an advantage of the arthroscopic technique in terms of complication rate, length of hospitalization, proportion of ossification and functional outcome. The indications for arthroscopic fusion should be strictly considered, especially in the case of malalignment, as major axis corrections are difficult to perform. In such cases, open fusion of the upper ankle joint still seems superior to the arthroscopic method.
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Affiliation(s)
- Tomas Buchhorn
- sporthopaedicum Regensburg-Straubing, Bahnhofsplatz 27, 94315, Straubing, Deutschland.
| | - Hans Polzer
- Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU, München, Deutschland
| | - Dominik Szymski
- sporthopaedicum Regensburg-Straubing, Bahnhofsplatz 27, 94315, Straubing, Deutschland
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
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16
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Open versus arthroscopic ankle arthrodesis in high-risk patients: a comparative study. INTERNATIONAL ORTHOPAEDICS 2021; 46:515-521. [PMID: 34611735 DOI: 10.1007/s00264-021-05233-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Arthroscopic ankle arthrodesis is known to offer high fusion rates, improvements in pain and functional outcomes, low risks of complications, and reinterventions. The aim of this study is to compare open vs. arthroscopic ankle arthrodesis in patients at high risk of complications. METHODS A single-centre retrospective comparative analysis of ankle fusions was conducted. Patient records were screened for demographics, type of arthrodesis, follow-up length, pre-operative diagnosis, risk factors for non-union, operative time, radiographic union, time to union, complications, and reinterventions. The American Orthopedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Italian version of the Foot Function Index (FFI), and a visual analog scale (VAS) for pain scores collected pre-operatively and in the last follow-up were used to assess clinical outcomes. RESULTS There were 23 open and 21 arthroscopic ankle fusions. Union rate was higher (90.5% vs. 65.2%, p < 0.05) and complication rate was lower (14.3% vs. 47.8%, p < 0.05) in the arthroscopic group. In addition, patients who underwent arthroscopic arthrodesis reported better pain control, with higher improvements in VAS for pain scores. There was no significant difference in length of operative time, time to fusion, AOFAS, and FFI scores improvements between the two groups. CONCLUSIONS Arthroscopic ankle arthrodesis resulted in higher union rates, fewer complications, and lower reoperation rates in patients at high risk of complications.
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Hanna M, Whicker EA, Traub B, Allam E, Labib SA. Sport activity levels following ankle fusion. INTERNATIONAL ORTHOPAEDICS 2021; 45:2347-2354. [PMID: 34228148 DOI: 10.1007/s00264-021-05100-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/25/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Ankle arthrodesis (AA) is frequently employed in the treatment of end-stage ankle arthritis, which is common following trauma and athletic injuries. While AA remains a popular therapeutic option, little data exists about activity and sporting capacity following AA. The objective of this research was to determine functional outcomes and sporting activity levels in patients following Ankle Arthrodesis. METHODS Validated questionnaires were emailed to 35 patients with a history of AA at an average follow-up of 52 months. Functional outcomes were assessed using the Foot and Ankle Disability Index (FADI), as well as the associated FADI-Sport. Responses were compared to those from a control population of RESULTS: 24 patients scheduled for AA, at an average pre-operative visit of three months. Activity levels were assessed prior to injury as well as pre- and post-operatively using the Tegner activity level scale. Average Tegner scores of the 35 surgical patients decreased from 3.82 ± 0.38 before their injury, to 1.15 ± 0.19 immediately pre-op, with recovery to 2.67 ± 0.26 following fusion. Average post arthrodesis FADI and FADI-sport scores in our patients were 76.5 ± 3.19% and 33.8 ± 23.06%. For the pre-operative control population, corresponding scores were 47.41 ± 2.61% and 22.24 ± 1.03%. Following AA, we found that patients improved upon their pre-op Tegner score, although they did not return to their pre-injury level of sporting participation. Additionally, patients reported that they had no current dysfunction with their lower leg. CONCLUSION Patients undergoing Ankle Arthrodesis should expect improved lower leg function, though will not likely return to their pre-injury level of activity.
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Affiliation(s)
- Maged Hanna
- Department of Orthopedics, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, USA.
| | - Emily A Whicker
- Department of Orthopaedics, Drexel University College of Medicine, 245 N Broad St, Philadelphia, PA, USA
| | - Brian Traub
- Depatment of Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY, 10467, USA
| | - Emad Allam
- Department of Radiology, Emory University, 1364 Clifton Rd, Atlanta, GA, 30322, USA
| | - Sameh A Labib
- Department of Orthopaedics, Emory University, 59 Executive Park South Suite 3000, Atlanta, GA, 30329, USA
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18
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Nakasa T, Ikuta Y, Ota Y, Kanemitsu M, Sumii J, Nekomoto A, Adachi N. The Potential of Bone Debris as a Bioactive Composite for Bone Grafting in Arthroscopic Ankle Arthrodesis. J Foot Ankle Surg 2021; 59:1234-1238. [PMID: 32950370 DOI: 10.1053/j.jfas.2020.08.002] [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: 12/27/2019] [Revised: 01/09/2020] [Accepted: 08/08/2020] [Indexed: 02/03/2023]
Abstract
Arthroscopic ankle arthrodesis (AAA) has advantages of being less invasive and achieving a high bone union rate. However, there are still some nonunion or delayed union cases, especially those of high-grade deformity. During AAA, curettage of the subchondral bone using an abrader burr provides bone debris, and there is the possibility of bone debris being used as autograft to improve bone union. The purpose of this study is to analyze bone debris histologically, and the effect of its implantation on bone union of AAA. Bone debris from 6 patients was collected during AAA. Bone debris/atelocollagen composite was made and cultured for 4 weeks. Histological analyses were performed before and after culture. Twenty-six patients with AAA were divided into 2 groups with or without bone debris implantation, and the time to union after surgery was evaluated. In histological analysis of bone debris/atelocollagen composite, bone debris contained bone, cartilage and synovium fragment at time 0. After 4 weeks of culture, osteocalcin positive cells migrated and proliferated in the gel. Ki67 positive cells significantly increased after culture. In clinical cases, time to union was significantly shorter in the bone debris group (9.3 ± 1.3 weeks) than that in the control (12.4 ± 3.1 weeks). This study showed that bone debris contained the osteochonductive and osteoinductive properties, and there is the potential for its implantation into the ankle joint to improve bone union in ankle arthrodesis.
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Affiliation(s)
- Tomoyuki Nakasa
- Associate Professor, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan; Associate Professor, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
| | - Yasunari Ikuta
- Assistant Professor, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Yuki Ota
- Surgeon, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Munekazu Kanemitsu
- Surgeon, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Junichi Sumii
- Surgeon, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Akinori Nekomoto
- Surgeon, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Nobuo Adachi
- Professor, Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
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19
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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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20
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Bai Z, Yang Y, Chen S, Dong Y, Cao X, Qin W, Sun W. Clinical effectiveness of arthroscopic vs open ankle arthrodesis for advanced ankle arthritis: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24998. [PMID: 33725876 PMCID: PMC7969227 DOI: 10.1097/md.0000000000024998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion. OBJECTIVE To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis. METHODS We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software. RESULTS A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = -2.31, 95% CI:-4.63, -2.21), intraoperative blood loss (MD = -43.37, 95%CI: -48.49, -38.25), hospital stay (MD = -1.80, 95%CI: -2.28, -1.33), and visual analog scale score (MD = -1.75, 95%CI: -2.04, -1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion (P < .00001). CONCLUSION Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application. PROSPERO REGISTRATION NUMBER CRD42020195727.
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21
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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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22
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Yang TC, Tzeng YH, Wang CS, Chang MC, Chiang CC. Arthroscopic Ankle Arthrodesis Provides Similarly Satisfactory Surgical Outcomes in Ankles With Severe Deformity Compared With Mild Deformity in Elderly Patients. Arthroscopy 2020; 36:2738-2747. [PMID: 32497657 DOI: 10.1016/j.arthro.2020.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/12/2020] [Accepted: 05/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the surgical outcome in terms of radiographic measurements, functional outcomes, and complications following arthroscopic ankle arthrodesis (AAA) in patients 60 years of age or older, and to compare the results of patients with mildly deformed ankle with those of patients with severely deformed ankle. METHODS We retrospectively reviewed patients who underwent AAA with 3 cannulated screws between January 2008 and December 2017 and followed postoperatively for at least 24 months. All included patients were 60 years of age or older. Demographic data and radiographic and functional outcomes were compared between patients with coronal deformity of less than 15° (group I) and those with a deformity equal to or greater than 15 degrees (group II). RESULTS A total of 41 patients with a mean age of 70.6 years were included (group I, n = 26; group II, n = 15) and mean follow-up was 51.4 months. Group II had significantly more severe preoperative coronal deformity of tibiotalar angle than group I (20.1 ± 2.9 vs 6.6 ± 4.1°, P < .01). Near-normal tibiotalar alignment was achieved postoperatively in both groups (group I, 3.4 ± 3.3 vs group II, 4.7 ± 3.1°, P = .227). Union was achieved in 39 (95.1%) patients with 2 cases in group I experiencing non-union. Union rate, mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and visual analog scale pain scores were not significantly different between the 2 groups at final follow-up. CONCLUSIONS AAA is a reliable procedure for end-stage ankle arthritis in patients 60 years of age or older resulting in a high union rate, encouraging radiographic and functional outcomes, and a low complication rate, even in cases with severe preoperative deformity. In addition, arthroscopic intra-articular malleolar osteotomy was a useful technique for correcting severe coronal deformity in our series. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Tzu-Cheng Yang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei, Taiwan; Department of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Shun Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Woo BJ, Lai MC, Ng S, Rikhraj IS, Koo K. Clinical outcomes comparing arthroscopic vs open ankle arthrodesis. Foot Ankle Surg 2020; 26:530-534. [PMID: 31257043 DOI: 10.1016/j.fas.2019.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/14/2019] [Accepted: 06/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Over the last twenty years, minimally invasive ankle arthrodesis has evolved into a well-tolerated and safe procedure. It has grown in favor to open ankle arthrodesis due to shorter length of stay and fewer complications recorded. This paper aims to compare the clinical outcomes of arthroscopic vs open ankle arthrodesis at 24-months followup. METHODS From 2004 to 2015, we reviewed a prospectively collected database in a tertiary hospital foot and ankle registry. 28 feet that underwent arthroscopic ankle arthrodesis were matched to 56 feet that underwent open ankle arthrodesis for age, sex and body mass index (BMI). Visual analogue scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-hindfoot Scores and Short Form Health Survey (SF-36) were obtained to assess clinical outcomes. These parameters were collected before surgery, at 6months and 24months after surgery. RESULTS The arthroscopic group demonstrated significant less pain in the perioperative period (arthroscopic: 1.9±1.2, open: 3.8±1.1, p<0.001) and shorter length of hospitalization stay (arthroscopic: 2.1±0.7 open: 3.5±1.7, p<0.001). Patients who underwent arthroscopic ankle arthrodesis also reported a higher SF-36 score on physical functioning at 6months (arthroscopic: 58.4±27.1, open: 47.1±24.0, p<0.05) and higher AOFAS Ankle-hindfoot Scale score at 24-months (arthroscopic: 78.9±18.9, open: 68.9±24.7, p<0.05). There were no postoperative complications in the arthroscopic group but 11 in the open group, including 9 which required followup operations. There was no significant difference in length of operative procedure between both groups. CONCLUSIONS We conclude that the arthroscopic group displayed better clinical outcomes compared to the open group at the 24months followup. The advantages of arthroscopic ankle arthrodesis include significantly less perioperative pain, higher AOFAS Ankle-hindfoot scores at 24months, shorter length of stay, fewer postoperative complications and followup operations. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Bo Jun Woo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mun Chun Lai
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Sean Ng
- Department of Orthopaedic Surgery, Mount Elizabeth Hospital, Singapore, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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24
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Saiga K, Yokoo S, Ohashi H, Horita M, Furumatsu T, Ozaki T. Effect of Lateral Gutter Osteophyte Resection on Correction of Varus Deformity in Arthroscopic Ankle Arthrodesis. Foot Ankle Int 2020; 41:683-688. [PMID: 32131624 DOI: 10.1177/1071100720910388] [Citation(s) in RCA: 4] [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 Recently, arthroscopic ankle arthrodesis has been performed for moderate-to-severe varus-deformed ankle osteoarthritis. However, the effect of osteophyte resection in the lateral gutter in arthroscopic ankle arthrodesis has not been clarified. We hypothesized that a varus-deviated ankle with lateral gutter osteophytes can be corrected by osteophyte resection. METHODS Thirty-nine ankles of 38 patients were included. The mean age of patients was 70.0 (45-83) years. The patients were divided into the following groups: group with an osteophyte in the lateral gutter (osteophyte) and group with no osteophytes (nonosteophyte). Preoperative and postoperative tibiotalar angle, tibial plafond angle, and tibiotalar angle under valgus stress, as well as the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale, were recorded. Twelve ankles underwent lateral gutter osteophyte resection, whereas the other 27 ankles did not require osteophyte resection. RESULTS Preoperative tibiotalar angle was higher in the osteophyte group than in the nonosteophyte group (21.8 vs 11.2 degrees, P = .01). The tibiotalar angle in the preoperative valgus stress imaging was higher in the osteophyte group (12.9 vs 5.7, P < .01). However, the postoperative tibiotalar angle was similar between the 2 groups (7.1 vs 5.4, P = .183). JSSF ankle/hindfoot scale improved in both groups. CONCLUSION Lateral gutter osteophyte resection enabled correction of the varus malalignment in arthroscopic ankle arthrodesis. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Kenta Saiga
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Suguru Yokoo
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Hideki Ohashi
- Department of Orthopaedic Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Masahiro Horita
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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25
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Mok TN, He Q, Panneerselavam S, Wang H, Hou H, Zheng X, Pan J, Li J. Open versus arthroscopic ankle arthrodesis: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:187. [PMID: 32448398 PMCID: PMC7247192 DOI: 10.1186/s13018-020-01708-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods For the systematic review, a literature search was conducted in 4 English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Three prospective cohort studies and 7 retrospective cohort studies, enrolling a total of 507 patients with ankle arthritis, were included. Results For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, and shorter length of hospitalisation than open surgery.
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Affiliation(s)
- Tsz Ngai Mok
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.,International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Qiyu He
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.,International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | | | - Huajun Wang
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Huige Hou
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Xiaofei Zheng
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Jinghua Pan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
| | - Jieruo Li
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
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Baumbach SF, Maßen F, Böcker W, Polzer H. [Arthroscopic tibiotalocalcaneal arthrodesis using an intramedullary locking nail]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2020; 32:158-170. [PMID: 31925449 DOI: 10.1007/s00064-019-00646-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/28/2019] [Accepted: 03/06/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Arthroscopic tibiotalocalcaneal arthrodesis (TTCA) aims at reconstructing a pain-free, orthograde, and functional limb with reduced invasiveness and lower complication rates compared to open arthrodesis. INDICATIONS Combined osteoarthritis of the ankle and subtalar joint or hindfoot malalignment. CONTRAINDICATIONS Osteomyelitis/deep soft tissue infections, talus necrosis, severe deformity of hindfoot or distal tibia, pronounced boney defect, indication for combined total ankle replacement and subtalar fusion. SURGICAL TECHNIQUE Patient in supine position; arthroscopic debridement of the cartilage and subchondral zone, perforation of the subchondral bone marrow of the ankle and subtalar joint. Foot and hindfoot positioning. Special attention has to be paid to the calcaneus and talus inclination, hindfoot alignment and rotation. Temporary fixation, insertion of the guide wire, reaming and insertion of the retrograde, curved compression arthrodesis nail. If needed, autologous bone grafting. Proximal locking of the nail, application of compression, distal locking, wound closure. POSTOPERATIVE MANAGEMENT Lymphatic drainage, physical therapy, and restricted bed rest until wound healing. Non-weightbearing, immobilization for 8 weeks, then step-wise increase of weightbearing. Fitting of custom-made shoes. RESULTS Retrospectively included were 15 patients treated by arthroscopic TTCA with an intramedullary nail (average age 56 ± 10 years, 93% male, all had risk factors for postoperative complications). Due to a preoperative plantar ulceration, 4 patients (27%) had 3 ± 1.8 conditioning operations. Sufficient hindfoot correction was achieved in all patients. Major complications occurred in 33% (non-unions). In a subgroup analysis, the presence of a plantar ulceration significantly influenced the development of a major complication. In a case-control study, major complications occurred in 63% and wound complications in 50% of patients for the open technique compared to 33% and 0%, respectively, for the arthroscopic technique. Although the current data do not prove superiority of arthroscopic TTCA compared to open TTCA, there appears to be a strong trend towards considerably lower complication rates following arthroscopic TTCA.
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Affiliation(s)
- Sebastian Felix Baumbach
- Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nußbaumstraße 20, 80336, München, Deutschland
| | - Felix Maßen
- Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nußbaumstraße 20, 80336, München, Deutschland
| | - Wolfgang Böcker
- Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nußbaumstraße 20, 80336, München, Deutschland
| | - Hans Polzer
- Fuß- und Sprunggelenkchirurgie, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München, Nußbaumstraße 20, 80336, München, Deutschland.
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Baumbach SF, Massen FK, Hörterer S, Braunstein M, Waizy H, Böcker W, Polzer H. Comparison of arthroscopic to open tibiotalocalcaneal arthrodesis in high-risk patients. Foot Ankle Surg 2019; 25:804-811. [PMID: 30455093 DOI: 10.1016/j.fas.2018.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/09/2018] [Accepted: 10/16/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Open tibiotalocalcaneal arthrodesis (TTCA) is associated to high complication rates, which led to the development of arthroscopic techniques. Aim was to compare complication rates of open to arthroscopic TTCA in high-risk patients. METHODS Single-center, retrospective case-control study. Patients were selected from the authors' TTCA database. Eligible were high-risk patients receiving arthroscopic-, or open TTCA retrospectively suitable for arthroscopic TTCA. Primary outcome were major complications. RESULTS Eight open and 15 arthroscopic TTCAs were included. Three open and 4 arthroscopic TTCAs presented preoperative plantar ulceration. Fusion rates were similar (75% vs. 67%; p=0.679). Major complications occurred in 63% of open (80% surgical-site-infections (SSI)) and 33% of arthroscopic (100% non-unions) TTCA. Preoperative plantar ulceration did not affect major SSI in open TTCA (67% vs. 60%) but resulted in a significant increase of non-union rates for arthroscopic TTCA (75% vs. 18%; p=0.039). In patients without plantar ulceration the union-rate was 80% for both, open and arthroscopic TTCA. CONCLUSION Arthroscopic TTCA drastically reduced major SSI. Patients without preexisting ulceration had excellent union-rates for open and arthroscopic TTCA.
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Affiliation(s)
- Sebastian Felix Baumbach
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany.
| | - Felix Kurt Massen
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany.
| | - Severin Hörterer
- Department of Trauma and Orthopaedic Surgery, Hospital München-Schwabing, Kölnerplatz 1, 80804 Munich, Germany.
| | - Mareen Braunstein
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany.
| | - Hazibullah Waizy
- Hessing Foundation, Clinic for Foot and Ankle Surgery, Hessingstr. 17, 86159 Augsburg, Germany.
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany.
| | - Hans Polzer
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany.
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Nakasa T, Ikuta Y, Tsuyuguchi Y, Ota Y, Kanemitsu M, Adachi N. Application of a peripheral vein illumination device to reduce saphenous structure injury caused by screw insertion during arthroscopic ankle arthrodesis. J Orthop Sci 2019; 24:697-701. [PMID: 30630767 DOI: 10.1016/j.jos.2018.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/15/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Arthroscopic ankle arthrodesis (AAA) is minimally invasive surgery, whereby percutaneous screw fixation is used through the medial aspect of the distal tibia to fusion the ankle, but it carries the risk of the saphenous vein and nerve injuries. The near-infrared (NIR) vascular imaging system, the VeinViewer® Flex, projects an image of the vein onto the skin, and the visualization of the vein may reduce the vein and nerve injuries. The purpose of this study is to investigate the risk of the saphenous vein injury by the percutaneous screw insertion during AAA, and to evaluate the effectiveness of the NIR vascular imaging system in the reduction of the saphenous vein injury. METHODS Ten patients with the ankle osteoarthritis underwent AAA. Three screw insertion sites (proximal as number 1, anterior distal as number 2, and posterior distal as number 3) were marked and then the vein was depicted on the medial malleolus using the VeinViewer® Flex. The distance between the screw insertion sites and the closest vein was measured. Additionally, the pattern of the vein course on the medial aspect of the distal tibia was investigated in 32 ankles using the VeinViewer® Flex. RESULTS The distance of number 1, 2, and 3 from the vein was 2.4 ± 1.4 mm (range from 0 to 5 mm), 6.3 ± 6.6 mm (range from 0 to 20 mm) and 3.5 ± 3.1 mm (range from 0 to 11 mm) respectively. In anterior screw insertion site, 3 of 10 cases showed just on the vein. The veins were observed at the anterior region from the center axis of the tibia more than 75% of ankles which was suspected as the greater saphenous vein with closely running of the saphenous nerve, but also other regions had the crossing vein. CONCLUSIONS Percutaneous screw fixation during AAA runs the risk of causing the saphenous structure injury. The NIR light imaging system is beneficial in reducing the complications of saphenous structure damage in AAA.
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
| | - Yusuke Tsuyuguchi
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
| | - Munekazu Kanemitsu
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi Minamiku, Hiroshima city, 734-8551, Japan
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Ewalefo SO, Dombrowski M, Hirase T, Rocha JL, Weaver M, Kline A, Carney D, Hogan MV. Management of Posttraumatic Ankle Arthritis: Literature Review. Curr Rev Musculoskelet Med 2018; 11:546-557. [PMID: 30327933 PMCID: PMC6220012 DOI: 10.1007/s12178-018-9525-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Trauma is the principle cause of osteoarthritis in the ankle, which is associated with significant morbidity. This review highlights the current literature for the purpose of bringing the reader up-to-date on the management of posttraumatic ankle arthritis, describing treatment efficacy, indications, contraindications, and complications. RECENT FINDINGS Recent studies on osteoarthritis have demonstrated variability among anatomic locations regarding the mechanisms and rates of development for posttraumatic osteoarthritis, which are attributed to newly discovered biological differences intrinsic to each joint. Regarding surgical management of posttraumatic ankle arthritis, osteochondral allograft transplantation of the talus, and supramalleolar osteotomies have demonstrated promising results. Additionally, the outpatient setting was found to be appropriate for managing pain following total ankle arthroplasty, associated with low complication rates and no readmission. Management for posttraumatic ankle arthritis is generally progressive. Initial treatment entails nonpharmacologic options with surgery reserved for posttraumatic ankle arthritis refractory to conservative treatment. Patient demographics and lifestyles should be carefully considered when formulating a management strategy, as outcomes are dependent upon the satisfaction of each set of respective criteria. Ultimately, the management of posttraumatic ankle arthritis should be individualized to satisfy the needs and desires, which are specific to each patient.
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Affiliation(s)
- Samuel O Ewalefo
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Texas A&M College of Medicine, Bryan, TX, USA.
| | - Malcolm Dombrowski
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Takashi Hirase
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Jorge L Rocha
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mitchell Weaver
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alex Kline
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Dwayne Carney
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Walter RP, Walker RW, Butler M, Parsons S. Arthroscopic subtalar arthrodesis through the sinus tarsi portal approach: A series of 77 cases. Foot Ankle Surg 2018; 24:417-422. [PMID: 29409234 DOI: 10.1016/j.fas.2017.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 01/16/2017] [Accepted: 04/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Subtalar arthrodesis through an open approach carries significant risk of complications. An arthroscopic approach aims to minimise damage to the soft tissue envelope to improve recovery, union and complication rates. A two portal approach through the sinus tarsi was used. METHODS A retrospective review of all patients undergoing isolated arthroscopic arthrodesis was performed. RESULTS Seventy-seven procedures were performed. Successful arthrodesis was achieved in 75 (97.4%). Two patients underwent successful revision arthrodesis for aseptic nonunion. There was one (1.3%) superficial infection and one (1.3%) partial sural nerve injury. CONCLUSIONS Two-portal sinus tarsi arthroscopic subtalar arthrodesis is safe and effective. Advantages over other arthroscopic approaches are the access to all three facets of the joint, avoidance of a posterolateral portal in order to minimise risk to the sural nerve, and the ability to use the same approach to arthrodese the entire triple hindfoot joint complex. Technical tips and pitfalls are discussed.
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Affiliation(s)
- R P Walter
- Royal Cornwall Hospitals NHS Trust, Treliske, Cornwall, UK.
| | - R W Walker
- Royal Cornwall Hospitals NHS Trust, Treliske, Cornwall, UK
| | - M Butler
- Royal Cornwall Hospitals NHS Trust, Treliske, Cornwall, UK
| | - S Parsons
- Royal Cornwall Hospitals NHS Trust, Treliske, Cornwall, UK
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Application of 3D-Printed Personalized Guide in Arthroscopic Ankle Arthrodesis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3531293. [PMID: 30276205 PMCID: PMC6157116 DOI: 10.1155/2018/3531293] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022]
Abstract
Objective To accurately drill the Kirschner wire with the help of the 3D-printed personalized guide and to evaluate the feasibility of the 3D technology as well as the outcome of the surgery. Methods Patients' DICM data of ankle via CT examinations were introduced into the MIMICS software to design the personalized guides. Two 2mm Kirschner wires were drilled with the help of the guides; the C-arm fluoroscopy was used to confirm the position of the wires before applying the cannulated screws. The patients who underwent ankle arthrodesis were divided into two groups. The experimental group adopted the 3D-printed personalized guides, while the control group received traditional method, i.e., drilling the Kirschner wires according to the surgeon's previous experience. The times of completing drilling the Kirschner wires to correct position were compared between the two groups. Regular follow-ups were conducted to statistically analyze the differences in the ankle fusion time and AOFAS scores between the two groups. Results 3D-printed personalized guides were successfully prepared. A total of 29 patients were enrolled, 15 in the experimental group and 14 in the control group. It took 2.2 ± 0.8 minutes to drill the Kirschner wires to correct position in the experimental group and 4.5 ± 1.6 minutes in the control group (p=0.001). No obvious complications occurred in the two groups during and after surgery. Postoperative radiographs confirmed bony fusion in all cases. There were no significant differences in the fusion time (p=0.82) and AOFAS scores at 1 year postoperatively between the two groups (p=0.55). Conclusions The application of 3D-printed personalized guide in assisting the accurate drilling of Kirschner wire in ankle arthrodesis can shorten the operation time and reduce the intraoperative radiation. This technique does not affect the surgical outcome. Trial Registration Number This study is registered on www.clinicaltrials.gov with NCT03626935.
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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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Choi GW. Author Reply to "Arthroscopic Versus Open Ankle Arthrodesis". Arthroscopy 2018; 34:2010-2011. [PMID: 29976420 DOI: 10.1016/j.arthro.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
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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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Jones CR, Wong E, Applegate GR, Ferkel RD. Arthroscopic Ankle Arthrodesis: A 2-15 Year Follow-up Study. Arthroscopy 2018; 34:1641-1649. [PMID: 29395553 DOI: 10.1016/j.arthro.2017.11.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of our study was to determine the results of arthroscopic ankle arthrodesis (AAA) and how the procedure affects adjoining joints and functional scores. METHODS Between 1993 and 2013, 116 patients (120 ankles) underwent AAA. Nineteen ankles were lost to follow-up due to death, insufficient radiographic studies, or inability to contact, resulting in 97 patients (101 ankles). Mean age at surgery was 61.1 years (range, 35.8-79.6 years); mean follow-up was 86 months (range, 24-247 months). Patients were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot scale, Ankle Osteoarthritis Scale (AOS), and Foot and Ankle Outcome Score (FAOS) and underwent comprehensive clinical and radiographic examinations. RESULTS A total of 94.6% of patients achieved ankle fusion on radiographs. Mean AOFAS score was 83.3 (standard deviation [SD], 13.2). Mean modified FAOS score was 87.4 (SD, 10.4). The AOS scoring system showed 75% good/excellent results. According to the Kellgren-Lawrence score and van Dijk osteoarthritis grading scale, 85% and 69% of patients had no change in talonavicular or subtalar grade of osteoarthritis, respectively. There were no cases of deep infection or other serious adverse events. All but 4 patients were able to return to work following AAA. CONCLUSIONS AAA is an effective operation for treating degenerative ankle disease, even in cases of moderate tibiotalar coronal deformity. At a mean of 86 months postop, nearly three quarters of our patients had good/excellent functional outcomes. Arthritis found in the adjacent hindfoot joints at the time of tibiotalar fusion appears to be a function of preexisting arthritic change and not directly caused by the tibiotalar fusion. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
| | | | | | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, U.S.A..
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Bernasconi A, Mehdi N, Laborde J, de Cesar Netto C, Dagneaux L, Lintz F. Joystick of the Talus for Correcting Malalignment During Arthroscopic Ankle Arthrodesis: A Surgical Tip. Arthrosc Tech 2018; 7:e517-e522. [PMID: 29868428 PMCID: PMC5984356 DOI: 10.1016/j.eats.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/15/2018] [Indexed: 02/03/2023] Open
Abstract
Ankle arthrodesis has been widely reported as an effective solution in treating tibiotalar joint osteoarthritis. The arthroscopic tibiotalar approach for arthrodesis has also been proven to give excellent results in terms of bone fusion rates and reduction of wound-related pain and complications. Historically, ankle malalignment has represented one of the main contraindications for the arthroscopic procedure, but interestingly some investigators have shown that the coronal joint deformity may be addressed arthroscopically as well. Other investigators have also demonstrated that part of the valgus/varus is due to malrotation of the talus within the mortise; therefore, controlling the talar position becomes crucial for correcting more severe deformities. We present here a technique for correcting tibiotalar malalignment during arthroscopic arthrodesis in varus or valgus ankles, performed through a K-wire used as a joystick to manage the talar position on both the coronal and axial planes.
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Affiliation(s)
- Alessio Bernasconi
- Orthopaedic and Traumatology Unit, Department of Public Health, “Federico II” Naples University, Napoli, Italy,Department of Trauma and Orthopaedics, St. George's Hospital, London, United Kingdom,Address correspondence to Alessio Bernasconi, M.D., Orthopaedics and Traumatology Unit, Department of Public Health, University Federico II of Naples, via Pansini n 5, 90131 Naples, Italy.
| | - Nazim Mehdi
- Clinique de l'Union, Ankle and Foot Surgery Center, Saint-Jean, France
| | - Julien Laborde
- Clinique de l'Union, Ankle and Foot Surgery Center, Saint-Jean, France
| | | | - Louis Dagneaux
- Hip, Knee and Foot Surgery Unit, Montpellier University Hospital, Montpellier, France
| | - François Lintz
- Clinique de l'Union, Ankle and Foot Surgery Center, Saint-Jean, France
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Arthroscopic Versus Open Ankle Arthrodesis: A Systematic Review. Arthroscopy 2018; 34:988-997. [PMID: 29122435 DOI: 10.1016/j.arthro.2017.08.284] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/18/2017] [Accepted: 08/18/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review comparing the clinical scores, union rate, complications, reoperations, hospital stay, and operation time between open ankle arthrodesis (OAA) and arthroscopic ankle arthrodesis (AAA). METHODS We conducted a comprehensive search in the MEDLINE, Embase, and Cochrane Library databases. Only comparative studies were included in this meta-analysis. The literature search, data extraction, and quality assessment were conducted by 2 independent reviewers. The outcomes analyzed included clinical scores, union rate, complications, reoperations, hospital stay, operation time, and intraoperative blood loss. RESULTS A total of 7 retrospective comparative studies were included in this systematic review. Clinical scores were noted in 3 studies. The American Orthopaedic Foot & Ankle Society ankle-hindfoot score and the Ankle Osteoarthritis Scale score were better in the AAA group than in the OAA group. The union rate was similar between the OAA (70%-100%) and AAA (76.2%-100%) groups. The complication rate was higher in the OAA group (6.7%-47.1%) than in the AAA group (0%-23.8%) in 6 studies. The reoperation rate was similar between the OAA (0%-26.5%) and AAA (0%-27.6%) groups. The hospital stay was shorter in the AAA group in 6 studies. Among the 5 studies that reported operation time, 4 reported no significant difference. Two studies showed that intraoperative blood loss was significantly less in the AAA group. CONCLUSIONS AAA was shown to offer the advantages of better clinical scores, fewer complications, a shorter hospital stay, and less blood loss compared with OAA. However, the union rate, reoperation rate, and operation time were similar overall between the 2 groups. LEVEL OF EVIDENCE Level III, systematic review of Level III studies.
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Ferkel RD. Editorial Commentary: Does It Matter Which Way I Fuse Your Ankle: Arthroscopically or Open? I Hope So! Arthroscopy 2018; 34:998-999. [PMID: 29502710 DOI: 10.1016/j.arthro.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 02/02/2023]
Abstract
Arthroscopic ankle arthrodesis is the treatment method of choice to achieve good clinical scores, faster time to union, fewer complications, and shorter hospital stay. However, the union rate, reoperation rate, and operative time are similar to open arthrodesis. The choice of which method to use for arthrodesis is influenced by surgeon preference and experience, clinical presentation, and equipment availability. Overall, we must choose the method of ankle arthrodesis that gives the best result with the least morbidity to the patient.
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Honnenahalli Chandrappa M, Hajibandeh S, Hajibandeh S. Ankle arthrodesis-Open versus arthroscopic: A systematic review and meta-analysis. J Clin Orthop Trauma 2017; 8:S71-S77. [PMID: 29339846 PMCID: PMC5761700 DOI: 10.1016/j.jcot.2017.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/30/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Our objective was to perform a systematic review of the literature and conduct a meta-analysis to investigate the outcomes of open versus arthroscopic methods of ankle fusion. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomised and non-randomised studies comparing outcomes of arthroscopic and open ankle arthrodesis. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect or random-effects models were applied to calculate pooled outcome data. RESULTS We identified one prospective cohort study and 5 retrospective cohort studies, enrolling a total of 286 patients with ankle arthritis. Our analysis showed that open ankle fusion was associated with a lower fusion rate (OR 0.26, 95% CI 0.13-0.52, P = 0.0002), longer tourniquet time (MD 16.49, 95% CI 9.46-23.41, P < 0.00001), and longer length of stay (MD 1.60,95% CI 1.10-2.10, P < 0.00001) compared to arthroscopic ankle fusion; however, there was no significant difference between two groups in terms of infection rate (OR 2.41, 95% CI 0.76-7.64, P = 0.14), overall complication rate (OR: 1.54, 95% CI 0.80-2.96, P = 0.20), and operation time (MD 4.09, 95% CI -2.49-10.66, P = 0.22). The between-study heterogeneity was high for tourniquet time but low or moderate for other outcomes. The direction of the effect sizes remains unchanged throughout sensitivity analyses. CONCLUSIONS The best available evidence demonstrates that arthroscopic ankle fusion may be associated with a higher fusion rate, shorter tourniquet time, and shorter length of stay compared to open ankle fusion. We found no significant difference between two groups in terms of infection rate, overall complication rate, and operation time. The best available evidence is not adequately robust to make definitive conclusions. Long-term results of the comparative efficacy of arthroscopic ankle fusion over open ankle fusion are not currently available. Further high quality randomised controlled trials that are adequately powered are required.
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Affiliation(s)
| | - Shahin Hajibandeh
- General Surgery department, Royal Blackburn Hospital, Haslingden Rd, Blackburn BB2 3HH, United Kingdom
| | - Shahab Hajibandeh
- General Surgery department, Royal Blackburn Hospital, Haslingden Rd, Blackburn BB2 3HH, United Kingdom
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Kerkhoff YRA, Keijsers NLW, Louwerens JWK. Sports Participation, Functional Outcome, and Complications After Ankle Arthrodesis: Midterm Follow-up. Foot Ankle Int 2017; 38:1085-1091. [PMID: 28708946 DOI: 10.1177/1071100717717221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ankle arthrodesis provides satisfactory functional outcome based on basic daily activities, but information regarding more demanding tasks is limited. Also, studies reporting longer term survival and complication rates are sparse and concern small study populations. This study reports functional outcome with more focus on demanding tasks and sports and reports the mid- to long-term union and complication rates in a large study population. METHODS Between 2005 and 2010, an ankle arthrodesis was performed on 185 ankles. Clinical results were retrospectively assessed with the Foot Function Index (FFI), visual analog scale (VAS) for pain, and the Foot and Ankle Ability Measure (FAAM). Information regarding sports pre- and postoperatively was obtained through a questionnaire. In addition, postoperative complications, reoperations, and failures (defined as nonunion of the ankle arthrodesis) were determined. Mean follow-up time was 8 years. RESULTS FFI scores significantly improved, the FAAM ADL score was 70%, and the mean VAS for pain at the ankle/hindfoot at follow-up was 20. Sports participation slightly diminished from 79.5% prior to the onset of disabling complaints to 68.9% postoperatively. Of the patients, 73.1% were able to hike with a median hiking time of 40 minutes (range, 2-600 minutes). Kneeling could be performed on average 10 minutes (range, 2-60 minutes) in 39.8% and jumping down from steps by 23.5% of the patients. A small selection of patients was able to sprint (14%), and 16.8% of the patients were able to run a median distance of 60 meters (range, 3-1000 meters). Failure occurred in 9.2% and other postoperative complications were present in 21.6%, requiring reoperation in 8.6% of the cases. CONCLUSION Ankle arthrodesis led to satisfactory functional outcome and pain reduction. Most patients remained active in sports, but a transition to less demanding sporting activities was seen. The complication and failure rates were similar with previous literature, and the incidence of nonrevision secondary surgery was relatively low. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Yvonne R A Kerkhoff
- 1 Department of Orthopaedics, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël L W Keijsers
- 2 Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands
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Abstract
Arthroscopic ankle arthrodesis provides an alternative to open techniques. Advancements in arthroscopic techniques and instrumentation have made the procedure easier to perform. Arthroscopic ankle arthrodesis has demonstrated faster rates of union, fewer complications, reduced postoperative pain, and shorter hospital stays. Sound surgical techniques, particularly with regard to joint preparation, are critical for success. Comorbidities such as increased body mass index, history of smoking, malalignment, and posttraumatic arthritis should be considered when contemplating arthroscopic ankle arthrodesis. Although total ankle replacement continues to grow in popularity, arthroscopic ankle arthrodesis remains a viable alternative for management of the end-stage arthritic ankle.
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Affiliation(s)
- Jason A Piraino
- Foot and Ankle Surgery, Podiatric Medicine and Surgery Residency, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA
| | - Michael S Lee
- Foot and Ankle Surgery, Capital Orthopaedics and Sports Medicine, PC, 12499 University Avenue, Suite 210, Clive, IA 50325, USA.
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Lawton CD, Butler BA, Dekker RG, Prescott A, Kadakia AR. Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade. J Orthop Surg Res 2017; 12:76. [PMID: 28521779 PMCID: PMC5437567 DOI: 10.1186/s13018-017-0576-1] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/04/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The surgical treatment of end-stage tibiotalar arthritis continues to be a controversial topic. Advances in surgical technique and implant design have lead to improved outcomes after both ankle arthrodesis (AA) and total ankle arthroplasty (TAA), yet a clear consensus regarding the most ideal form of treatment is lacking. In this study, the outcomes and complications following AA and TAA are compared in order to improve our understanding and decision-making for care and treatment of symptomatic tibiotalar arthritis. METHODS Studies reporting on outcomes and complications following TAA or AA were obtained for review from the PubMed database between January 2006 and July 2016. Results from studies reporting on a minimum of 200 total ankle arthroplasties or a minimum of 80 ankle arthrodesis procedures were reviewed and pooled for analysis. All studies directly comparing outcomes and complications between TAA and AA were also included for review. Only studies including modern third-generation TAA implants approved for use in the USA (HINTEGRA, STAR, Salto, INBONE) were included. RESULTS A total of six studies reporting on outcomes following TAA and five reporting on outcomes following AA met inclusion criteria and were included for pooled data analysis. The adjusted overall complication rate was higher for AA (26.9%) compared to TAA (19.7%), with similar findings in the non-revision reoperation rate (12.9% for AA compared to 9.5% for TAA). The adjusted revision reoperation rate for TAA (7.9%) was higher than AA (5.4%). Analysis of results from ten studies directly comparing TAA to AA suggests a more symmetric gait and less impairment on uneven surfaces after TAA. CONCLUSIONS Pooled data analysis demonstrated a higher overall complication rate after AA, but a higher reoperation rate for revision after TAA. Based on the existing literature, the decision to proceed with TAA or AA for end-stage ankle arthritis should be made on an individual patient basis.
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Affiliation(s)
- Cort D Lawton
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Bennet A Butler
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Robert G Dekker
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Adam Prescott
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA
| | - Anish R Kadakia
- Department of Orthopedic Surgery, Northwestern University, Chicago, IL, 60661, USA. .,Department of Orthopedic Surgery, Feinberg School of Medicine, Foot and Ankle Orthopedic Fellowship, Northwestern University - Northwestern Memorial Hospital, Chicago, IL, USA. .,, 676 North Saint Clair, Suite 1350, Chicago, IL, 60611, USA. .,, 259 East Erie, 13th Floor, Chicago, IL, 60611, USA.
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Malekpour L, Rahali S, Potage D, Duparc F, Dujardin F, Roussignol X. Posterior Arthroscopic Tibiotalar Arthrodesis: Anatomic Feasibility Study. J Foot Ankle Surg 2017; 56:704-707. [PMID: 28410782 DOI: 10.1053/j.jfas.2017.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Indexed: 02/03/2023]
Abstract
Anterior arthroscopic tibiotalar arthrodesis has been well codified. A posterior approach with the patient in prone position is indicated when the anterior approach is precluded by soft tissue issues or for a 1-step procedure associated with posterior subtalar fusion. In an anatomic study, we assessed the feasibility of posterior arthroscopic tibiotalar fusion and sought to determine the arthroscopy entry points, mortise cartilage freshening quality, and risk of osseous, tendinous, vascular, and neural complications. We mapped 22 zones of the fibular tibiotalar mortise from 10 specimens. Medial and lateral para-Achilles arthroscopic approaches were used, with a 4-mm arthroscope at 30°. For chondral resection, we used a motorized burr, curette, and osteotome. The entire plafond of the tibial mortise could be freshened in all cases, but the talar dome could be freshened in its entirety in only 20% of cases. In 80%, only the posterior two thirds could be treated, because the anterior portion descending to the neck of the talus was poorly accessible. More than 50% of the area of the malleolar grooves was freshened. One medial malleolar fracture and one posterior fibular artery lesion developed. Thus, the technique was shown to be feasible, if no frontal hindfoot deformity or tibiotalar equinus is present, which would prevent satisfactory resection of the posterior and anterior talar cartilage. The procedure allows for single-step associated subtalar fusion, requiring 2 complementary arthroscopic approaches, 1 cm distally.
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Affiliation(s)
- Louis Malekpour
- Surgeon, Department of Orthopaedics Surgery and Traumatology, Rouen University Hospital, Rouen, France
| | - Said Rahali
- Surgeon, Department of Orthopaedics Surgery and Traumatology, Rouen University Hospital, Rouen, France
| | - Damien Potage
- Surgeon, Department of Orthopaedics Surgery and Traumatology, Rouen University Hospital, Rouen, France
| | - Fabrice Duparc
- Professor, Anatomy Laboratory, Faculty of Medicine, Rouen University, Rouen, France
| | - Franck Dujardin
- Professor, Department of Orthopaedics Surgery and Traumatology, Rouen University Hospital, Rouen, France
| | - Xavier Roussignol
- Assistant Professor, Department of Orthopaedics Surgery and Traumatology, Rouen University Hospital, Rouen, France.
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Abstract
PURPOSE The arthroscopic assisted ankle arthrodesis (AAAA) is a minimally invasive procedure for end-stage ankle arthritis with numerous benefits like faster time of union, insignificant blood loss, less morbidity, less infection rate, and less soft tissue complications. A shorter hospital stay decreases the cost and results in early mobilization compared to open methods. We present a retrospective series of 32 patients, who underwent AAAA during a period of 8 years. METHODS Thirty-two patients were reviewed retrospectively from 2008 to 2015. We calculated the Karlsson and Peterson ankle function scoring system pre-operatively and at 3 and 12 months after the surgery, in all the patients. All the patients were operated using arthroscopic denuding of degenerated cartilage followed by percutaneous criss-cross screw fixation through the tibia crossing the ankle joint into the talus. RESULTS The mean age at operation time was 43.7 years. Four patients were excluded from the study. 18 were male, and 10 were female patients. All the 28 cases were followed up for a minimum of 1 year (mean 1.7 years). The average time to union was 14 weeks. The complications included four cases requiring removal of a screw for prominence, and one superficial infection. There were 20 (71.4%) patients with excellent, 4 (14.2%) with good, 3 (10.7%) with fair and 1 (3.5%) with poor clinical outcome. The average tourniquet time for the surgery was 70 min. The mean hospital stay was 2 days. The average Karlsson and Peterson's scoring was 32.71 pre-operatively and 74.10 and 89.00 postoperatively measured at 3 months and 1-year follow-up. CONCLUSION With the high incidence of soft-tissue problems and the young age of onset of post-traumatic arthritis, AAAA remains the treatment of choice in most cases with numerous advantages over open technique.
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Duan X, Yang L, Yin L. Arthroscopic arthrodesis for ankle arthritis without bone graft. J Orthop Surg Res 2016; 11:154. [PMID: 27903299 PMCID: PMC5131494 DOI: 10.1186/s13018-016-0490-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 10/02/2016] [Indexed: 01/25/2023] Open
Abstract
Background Ankle arthrodesis is considered by many to be the standard operative treatment for end-stage ankle arthritis. The purpose of this study was to perform a new technique for ankle joint surface and determine the outcome for the union rates of ankle arthroscopic arthrodesis. Methods A total of 68 patients with posttraumatic arthritis, primary osteoarthritis, and rheumatoid arthritis were treated by ankle arthroscopic arthrodesis between May 2007 and December 2012. Our surgical indication was deformity less than 15° measured by weight-bearing radiographs. Firstly, the remaining articular cartilage was removed with different curettes and shavers. Then, the new technique (microfracture) was done at tibiotalar surfaces. Finally, the ankle was fixed with two cannulated percutaneous screws. The wound healing, complications, postoperative radiographs, and American Orthopaedic Foot and Ankle Society (AOFAS) score were evaluated. Results The average follow-up time was 32 months (range 25–58 months). There was no bone grafting, and a fusion rate of 100% was achieved. The average fusion time was 12.1 weeks. One patient developed superficial infection at 2 weeks postoperatively and was cured by nonsurgical treatment. No deep infections, deep venous thrombosis, or revision surgery were observed. Screws had been removed in four patients because of prominence. One patient had fusion in the subtalar joint because of arthritis at 5 years postoperatively. At the last follow-up, radiographic signs of developed or progressing arthritis were observed in nine patients at subtalar joint and in four patients at talonavicular joint. At 1-year follow-up, the mean AOFAS ankle/hindfoot score had increased to 84 from a mean preoperative value of 38 (P < 0.01). Conclusions Arthroscopic arthrodesis provides surgeons with an alternative to traditional open techniques for the management of severe ankle arthritis. Our data show that preparation of the joint surface with microfracture is an effective technique to increase the union rate of arthroscopic ankle arthrodesis, while bone graft and other promoting substances are not necessary to be routinely used. Electronic supplementary material The online version of this article (doi:10.1186/s13018-016-0490-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaojun Duan
- Center for Joint Surgery, Southwest Hospital, The Third Military Medical University, 30 Gaotanyan St., Shapingba, Chongqing, 400038, China.
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, The Third Military Medical University, 30 Gaotanyan St., Shapingba, Chongqing, 400038, China
| | - Li Yin
- Center for Joint Surgery, Southwest Hospital, The Third Military Medical University, 30 Gaotanyan St., Shapingba, Chongqing, 400038, China
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Yasui Y, Hannon CP, Seow D, Kennedy JG. Ankle arthrodesis: A systematic approach and review of the literature. World J Orthop 2016; 7:700-708. [PMID: 27900266 PMCID: PMC5112338 DOI: 10.5312/wjo.v7.i11.700] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 07/15/2016] [Accepted: 09/18/2016] [Indexed: 02/06/2023] Open
Abstract
Ankle arthrodesis is a common treatment used for patients with end-stage ankle arthritis (ESAA). The surgical goal of ankle arthrodesis is to obtain bony union between the tibia and talus with adequate alignment [slight valgus (0°-5°)], neutral dorsiflexion, and slight external rotation positions) in order to provide a pain-free plantigrade foot for weightbearing activities. There are many variations in operative technique including deferring approaches (open or arthroscopic) and differing fixation methods (internal or external fixation). Each technique has its advantage and disadvantages. Success of ankle arthrodesis can be dependent on several factors, including patient selection, surgeons’ skills, patient comorbidities, operative care, etc. However, from our experience, the majority of ESAA patients obtain successful clinical outcomes. This review aims to outline the indications and goals of arthrodesis for treatment of ESAA and discuss both open and arthroscopic ankle arthrodesis. A systematic step by step operative technique guide is presented for both the arthroscopic and open approaches including a postoperative protocol. We review the current evidence supporting each approach. The review finishes with a report of the most recent evidence of outcomes after both approaches and concerns regarding the development of hindfoot arthritis.
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Abstract
Arthroscopic ankle arthrodesis is a cost-effective option for many patients with posttraumatic arthritis of the ankle joint. Rehabilitation is generally quicker than conventional open techniques, and rates of fusion are comparable or better than traditional open techniques. Unless the arthroscopic surgeon has considerable experience, the best results are seen in patients with very little deformity in the ankle joint.
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Affiliation(s)
- Byron Hutchinson
- Highline Clinic, 16233 Sylvester Road Southwest G-10, Seattle, WA 98166, USA.
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Abstract
Arthroscopic approaches to subtalar, double, and triple arthrodesis allow relative preservation of the soft tissue envelope compared with traditional open approaches. The surgical technique involving the use of a 4.5-mm 30° arthroscope via sinus tarsi portals is described. All 3 joints of the triple joint can be prepared for fusion with motorized burrs. Rigid fixation is achieved with cannulated screws. High union rates and low complication rates have been reported.
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Affiliation(s)
- Richard Walter
- Department of Trauma and Orthopaedics, Sports and Orthopaedic Clinic, Bristol Spire Hospital, Redland Road, Bristol BS6 6UT, UK
| | - Stephen Parsons
- Department of Trauma and Orthopaedics, Sports and Orthopaedic Clinic, Bristol Spire Hospital, Redland Road, Bristol BS6 6UT, UK
| | - Ian Winson
- Department of Trauma and Orthopaedics, Sports and Orthopaedic Clinic, Bristol Spire Hospital, Redland Road, Bristol BS6 6UT, UK.
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Goetzmann T, Molé D, Jullion S, Roche O, Sirveaux F, Jacquot A. Influence of fixation with two vs. three screws on union of arthroscopic tibio-talar arthrodesis: Comparative radiographic study of 111 cases. Orthop Traumatol Surg Res 2016; 102:651-6. [PMID: 27185332 DOI: 10.1016/j.otsr.2016.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/12/2016] [Accepted: 03/29/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ankle arthrodesis is a treatment of choice for advanced tibio-talar disease unresponsive to conservative treatment. Using arthroscopy to perform this procedure minimises soft-tissue trauma while providing similar outcomes to those of open surgery. Union rates have ranged across studies from 85% to 100%. The objective of this study was to assess the potential influence on union of the number of screws used for arthrodesis fixation. HYPOTHESIS The working hypothesis was that using three screws for arthrodesis produced a higher union rate than did using only two screws. MATERIAL AND METHODS This single-centre retrospective comparative study included 111 cases of arthroscopic ankle arthrodesis (in 108 patients) carried out between February 1994 and October 2012. The number of screws was two in 75 cases and three in 36 cases. Union was assessed on radiographs taken 2, 6, and 12months postoperatively. RESULTS Mean age at surgery was 55.8years. After 12months, union was achieved in 87.4% cases overall. The non-union rate was 16% with two screws and 5.6% with three screws. Three-screw fixation was associated with a significantly higher rate of union of the medial gutter after 6months and of the lateral gutter after 12months. DISCUSSION Our findings support the use of three screws for fixation of arthroscopic tibio-talar arthrodesis. Adding a third screw seems associated with a lower risk of non-union and a shorter time to union. These effects can be ascribed to greater stability of the construct. LEVEL OF EVIDENCE Level IV, retrospective study.
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Affiliation(s)
- T Goetzmann
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - D Molé
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France
| | - S Jullion
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France
| | - O Roche
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France
| | - F Sirveaux
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France
| | - A Jacquot
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France
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Jain SK, Tiernan D, Kearns SR. Analysis of risk factors for failure of arthroscopic ankle fusion in a series of 52 ankles. Foot Ankle Surg 2016; 22:91-6. [PMID: 27301727 DOI: 10.1016/j.fas.2015.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/05/2015] [Accepted: 05/11/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this retrospective study is to analyze the effect of different variables on union rate and functional outcome in patients who underwent arthroscopic ankle fusion for end-stage arthritis of ankle. METHODS Clinical records and radiographs were reviewed to evaluate the variables that could predispose patients to non-union and poor functional outcome. Union and functional outcomes were correlated with different variables. RESULTS Fifty patients had arthroscopic ankle fusion on 52 ankles. The mean age at the time of surgery was 59.4 (27-80) years and mean length of follow up was 32.1 (8-78) months. Forty-eight out of 52 ankles (92.3%) achieved radiographic and clinical union. The average time to fusion was 12.2 (8-28) weeks. The time taken for union was significantly higher in smokers as compared to non-smokers (p<0.001). All the patients in this series who had non-union shared one common factor - neuromuscular imbalance. Age, gender, smoking, diabetes, steroid, bisphosphonates, neuropathy, frontal and sagittal plane alignment and tibial-axis-to-talus (T:T) ratio did not significantly affect the union rate and functional outcome. CONCLUSION Smokers should refrain from smoking before surgery and patients with neuromuscular problems may require more rigid fixation and a longer period of immobilization to achieve more consistent union rates.
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