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Dickinson JD, Collman DR, Russel LH, Choung DJ. Navigating the Challenges of Total Ankle Replacement: Deformity Correction and Infection Considerations. Clin Podiatr Med Surg 2024; 41:119-139. [PMID: 37951670 DOI: 10.1016/j.cpm.2023.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
In recent years, total ankle replacement (TAR) has gained widespread acceptance as a surgical treatment for end-stage ankle arthritis. This shift is due to notable improvements in implant design, surgical instrumentation, technique, and surgeon expertise, resulting in high levels of patient satisfaction comparable to ankle fusion. Additionally, indications for TAR have expanded to include advanced deformities that were previously considered unsuitable for the procedure, making ankle arthrodesis the only option. Despite these advancements, TAR still carries a higher complication rate compared to other ankle surgeries. The complex anatomy of the ankle, coupled with limited soft tissue, presents significant challenges in managing complications associated with TAR.
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Affiliation(s)
- Joseph D Dickinson
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics/Podiatry, Kaiser Permanente Oakland Medical Center, 3600 Broadway, Oakland, CA 94611, USA
| | - David R Collman
- Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Department of Orthopedics, Podiatry, Injury, Sports Medicine, Kaiser Permanente San Francisco Medical Center, 4506th Avenue, French Campus, 5th Floor, San Francisco, CA 94118, USA
| | - Lindsay H Russel
- Department of Orthopedics, Kaiser Permanente South Sacramento Medical Center, 6600 Bruceville Road, Sacramento, CA 95823, USA
| | - Danny J Choung
- Kaiser North Bay Consortium Foot and Ankle Residency Program, Department of Orthopedics/Podiatry, Kaiser Permanente San Rafael, 99 Montecillo Road, San Rafael, CA 94903, USA.
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Yoon YK, Park KH, Shim DW, Han SH, Lee JW, Jung M. Robotic-assisted foot and ankle surgery: a review of the present status and the future. Biomed Eng Lett 2023; 13:571-577. [PMID: 37872981 PMCID: PMC10590355 DOI: 10.1007/s13534-023-00328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
The surgical application of robotics has increased significantly since its first application in 1985 for a brain biopsy acquisition. Robotic-assisted surgery has been one of the viable options in various surgical areas, and also in orthopaedic surgery. Robotic-assisted orthopaedic surgery has gained popularity as a mean of improving accuracy, reducing complications and achieving better patient satisfaction. Numerous clinical research studies have demonstrated advantages of robotic-assisted orthopaedic surgery, however, most of that researches were about the total knee arthroplasty, total hip arthroplasty and spine surgery. The application of robotic technology in foot and ankle surgery is in a very nascent stage. Furthermore, there has been little research on intraoperative use of robotics in foot and ankle surgery in literature. A review of previous preclinical studies in foot and ankle robotics and clinical research studies in various fields of robot-assisted orthopaedic surgery shows that its potential application and benefits over conventional techniques, such as total ankle arthroplasty, minimally invasive surgery for foot and ankle trauma or other corrective procedure, and intraoperative biomechanical testing. More studies on practical application of robotic technology to surgical procedure in the field of foot and ankle surgery are needed to confirm its clinical usefulness and cost effectiveness.
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Affiliation(s)
- Yeo Kwon Yoon
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Kwang Hwan Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Woo Shim
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hwan Han
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Jung
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Ledoux WR. Role of Robotic Gait Simulators in Elucidating Foot and Ankle Pathomechanics. Foot Ankle Clin 2023; 28:45-62. [PMID: 36822688 DOI: 10.1016/j.fcl.2022.11.005] [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: 01/03/2023]
Abstract
Testing with cadaveric foot and ankle specimens began as mechanical techniques to study foot function and then evolved into static simulations of specific instances of gait, before technologies were eventually developed to fully replicate the gait cycle. This article summarizes the clinical applications of dynamic cadaveric gait simulation, including foot bone kinematics and joint function, muscle function, ligament function, orthopaedic foot and ankle pathologies, and total ankle replacements. The literature was reviewed and an in-depth summary was written in each section to highlight one of the more sophisticated simulators. The limitations of dynamic cadaveric simulation were also reviewed.
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Affiliation(s)
- William R Ledoux
- Center for Limb Loss and MoBility (CLiMB), VA Puget Sound Health Care System, ms 151, 1660 South Columbian Way, Seattle, WA 98108, USA; Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; Department of Orthopaedics & Sports Medicine, University of Washington, Seattle, WA, USA.
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Strage KE, Stacey SC, Mauffrey C, Parry JA. The interobserver reliability of clinical relevance in orthopaedic research. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03346-4. [PMID: 35922640 DOI: 10.1007/s00590-022-03346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE A ratio of observed difference (OD) over the 95% confidence interval (CI) has been shown to be strongly associated with the perceived clinical relevance (CR) of medical research results. The purpose of this study was to evaluate the association between the OD/CI ratio and perceived CR in orthopaedic research. METHODS Sixty-seven orthopaedic surgeons completed a survey with 15 study outcomes (mean difference and CI) and were asked if they perceived the findings as clinically relevant. The interobserver reliability of perceived CR and the association between CR and the OD/CI ratio and p-value were assessed. RESULTS The interobserver reliability of CR between respondents was moderate (kappa = 0.46, CI 0.45 to 0.48). P-values did not differ between results with and without CR (median difference (MD) - 0.12, CI - 0.74 to 0.0009, p = 0.07). The OD/CI ratio, however, was greater for results with CR (MD 1.01, CI 0.3 to 3.9, p = 0.004). The area under the curve (AUC) for the p-value and OD/CI ratio receiver operating characteristic (ROC) curves was 0.80 (p = 0.01) and 0.97 (p = 0.0003). The cutoff p -value and OD/CI ratio that maximized the sensitivity (SN) and specificity (SP) for CR were 0.001 (SN 80%, SP 80%) and 0.84 (SN 100%, SP 90%). The SN and SP of a p-value cutoff of 0.05 was 100% and 50%. CONCLUSION The interobserver reliability of the perceived CR of orthopaedic research findings was moderate. The OD/CI ratio, in contrast to the p-value, was strongly associated with perceived CR making it a potentially useful measure to evaluate research results.
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Affiliation(s)
- Katya E Strage
- Department of Orthopaedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, Colorado, 80204, USA
| | - Stephen C Stacey
- Department of Orthopaedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, Colorado, 80204, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, Colorado, 80204, USA
| | - Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, Denver Health, 777 Bannock St, MC 0188, Denver, Colorado, 80204, USA.
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Zeitlin J, Henry J, Ellis S. Preoperative Guidance With Weight-Bearing Computed Tomography and Patient-Specific Instrumentation in Foot and Ankle Surgery. HSS J 2021; 17:326-332. [PMID: 34539274 PMCID: PMC8436345 DOI: 10.1177/15563316211026325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Abstract
The use of preoperative and intraoperative guidance in foot and ankle surgery has grown substantially in recent years. Weight-bearing computed tomography (WBCT) and patient-specific instrumentation (PSI) are used in total ankle arthroplasty (TAA) to achieve precise bone cutting and implant positioning, and intraoperative 3-dimensional (3D) imaging has been used to reduce complications and improve clinical outcomes in other foot and ankle surgical procedures. This narrative review of the literature focuses on the evidence supporting the use of WBCT and PSI in TAA and looks at other promising technologies used to guide foot and ankle surgery.
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Affiliation(s)
| | | | - Scott Ellis
- Hospital for Special Surgery, New York, NY, USA
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Leardini A, Stebbins J, Hillstrom H, Caravaggi P, Deschamps K, Arndt A. ISB recommendations for skin-marker-based multi-segment foot kinematics. J Biomech 2021; 125:110581. [PMID: 34217032 DOI: 10.1016/j.jbiomech.2021.110581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
The foot is anatomically and functionally complex, and thus an accurate description of intrinsic kinematics for clinical or sports applications requires multiple segments. This has led to the development of many multi-segment foot models for both kinematic and kinetic analyses. These models differ in the number of segments analyzed, bony landmarks identified, required marker set, defined anatomical axes and frames, the convention used to calculate joint rotations and the determination of neutral positions or other offsets from neutral. Many of these models lack validation. The terminology used is inconsistent and frequently confusing. Biomechanical and clinical studies using these models should use established references and describe how results are obtained and reported. The International Society of Biomechanics has previously published proposals for standards regarding kinematic and kinetic measurements in biomechanical research, and in this paper also addresses multi-segment foot kinematics modeling. The scope of this work is not to prescribe a particular set of standard definitions to be used in all applications, but rather to recommend a set of standards for collecting, calculating and reporting relevant data. The present paper includes recommendations for the overall modeling and grouping of the foot bones, for defining landmarks and other anatomical references, for addressing the many experimental issues in motion data collection, for analysing and reporting relevant results and finally for designing clinical and biomechanical studies in large populations by selecting the most suitable protocol for the specific application. These recommendations should also be applied when writing manuscripts and abstracts.
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Affiliation(s)
- Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Julie Stebbins
- Oxford Gait Laboratory, Oxford University Hospitals NHS Foundation Trust, UK
| | - Howard Hillstrom
- Leon Root, MD Motion Analysis Laboratory, Hospital for Special Surgery, NY, USA
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kevin Deschamps
- Faculty of Movement & Rehabilitation Sciences, KULeuven, Bruges, Belgium
| | - Anton Arndt
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden
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Halai MM, Richards M, Daniels TR. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2021; 103:850-859. [PMID: 33784261 DOI: 10.2106/jbjs.21.00146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mansur M Halai
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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Wang S, Yu J, Ma X, Zhao D, Geng X, Huang J, Wang X. Finite element analysis of the initial stability of arthroscopic ankle arthrodesis with three-screw fixation: posteromedial versus posterolateral home-run screw. J Orthop Surg Res 2020; 15:252. [PMID: 32650836 PMCID: PMC7350182 DOI: 10.1186/s13018-020-01767-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/28/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Arthroscopic ankle arthrodesis (AAA) is a standard surgical method for the treatment of advanced traumatic ankle arthritis and has become more popular due to its advantages. To fix the tibiotalar joint, the use of three percutaneous screws is considered to have better mechanical stability than the use of two screws. However, it is sometimes difficult to insert three screws because they might block each other due to the small area of the tibiotalar joint surface and the large diameter of the screws; few articles illustrate how to insert three screws without the screws disturbing each other. The purpose of this study is to explore possible screw configurations of tripod fixation in arthroscopic ankle arthrodesis that avoid the collision of screws and yield better biomechanical performance. Methods We used the finite element method to examine the impact of different screw positions and orientations on the biomechanical characteristics of a three-dimensional (3D) ankle model. Maximum and average micromotion, pressure on the articular surface, and von Mises stress values of the tibia and the talus were used to evaluate the initial stability of the ankle. Results Five kinds of three-screw configurations were identified, and finite element analysis results suggested that configurations with the posteromedial home-run screw presented lower micromotion (maximum, 17.96 ± 7.49 μm versus 22.52 ± 12.8 μm; mean, 4.88 ± 1.89 μm versus 5.19 ± 1.92 μm) (especially configuration 3) and better screw distributions on the articular surface than those with the posterolateral home-run screw. Conclusion Screw configurations with the posteromedial home-run screw avoid collision and are more biomechanically stable than those with the posterolateral home-run screw. Thus, inserting the home-run screw through the posteromedial approach is recommended for clinical practice.
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Affiliation(s)
- Sen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Jian Yu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
| | - Dahang Zhao
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xiang Geng
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
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Radiographic Sagittal Tibio-Talar Offset in Ankle Arthrodesis-Accuracy and Reliability of Measurements. J Clin Med 2020; 9:jcm9030801. [PMID: 32187992 PMCID: PMC7141366 DOI: 10.3390/jcm9030801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/27/2020] [Accepted: 03/14/2020] [Indexed: 11/17/2022] Open
Abstract
Radiographic outcome assessment of ankle arthrodesis (AA) requires accurate measurement techniques. This study aimed to identify the most reliable methods for sagittal tibio-talar alignment measurements with regard to the tibio-talar offset after AA. Lateral weight-bearing radiographs of 38 fused ankles were selected for retrospective review. The sagittal tibio-talar angle (STTA), the modified tibio-talar ratio (mT-T ratio) and the sagittal tibio-talar offset (tibCOR, procLAT) were measured by three independent observers. Intra- and interobserver correlation coefficients (ICC) and mean measurement differences were calculated to assess measurement reliability and accuracy. By defining the talar longitudinal axis as a line from the inferior aspect of the posterior tubercle of the talus to the most inferior aspect of the talar neck, STTA showed excellent (ICC 0.924; CI 95% 0.862–0.959) and mTT-ratio provided high (ICC 0.836; CI 95% 0.721–0.909) interobserver reliability, respectively. For tibio-talar offset measurement the tibCOR method showed superior reliability and better interobserver agreement compared to the procLAT technique. The STTA and a modified T-T ratio are recommended for future scientific radiographic measurements in AA.
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