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Cao ZL, Wang CH, Ding XH, Wang ZD, Dong QY. Outcomes of ankle arthrodesis in adult patients with ankle osteoarthritis in Kashin-Beck disease. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06195-4. [PMID: 38679689 DOI: 10.1007/s00264-024-06195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/16/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE We retrospectively evaluated the characteristics of these patients and the effectiveness of ankle arthrodesis in the treatment of ankle arthritis caused by Kashin-Beck disease (KBD). METHODS A retrospective study of KBD patients with ankle osteoarthritis who underwent ankle arthrodesis between December 2012 and January 2022 was performed. A total of 46 patients were included. The general characteristics, clinical manifestations and imaging features of the patients were recorded and summarized. measured using the VAS score, and ankle function was assessed by the AOFAS ankle-hindfoot score. RESULTS Multiple subchondral cystic changes were found in 42(91.3%) patients. The VAS scores for both resting and weight-bearing conditions were 6.28 ± 1.30 vs. 2.09 ± 1.12 (P < .001) and 6.87 ± 1.01 vs. 2.17 ± 0.98 (P < .001), respectively. The AOFAS scores were 59.17 ± 5.50 and 88.39 ± 1.42, respectively (P < .001). CONCLUSIONS The subchondral multiple cystic transformation of the ankle KBD has a certain suggestive role.Arthrodesis is an effective method to reduce ankle pain and improve ankle function in KBD patients with ankle osteoarthritis.
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Affiliation(s)
- Zhen Lu Cao
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Chen Han Wang
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Xiao Heng Ding
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Zheng Dan Wang
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China
| | - Quan Yu Dong
- Department of Hand, Foot and Microsurgery, the Affiliated Hospital of Qingdao University, No. 59, Haier Road, Qingdao City, 266000, Shandong Province, China.
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Faldini C. Osteoarthritis after an ankle fracture: we can't really avoid it. Musculoskelet Surg 2023; 107:375-378. [PMID: 38032524 DOI: 10.1007/s12306-023-00802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Affiliation(s)
- C Faldini
- 1st Orthopaedic and Traumatologic Department, IRCCS - Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy.
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Tucker WA, Barnds BL, Morris BL, Tarakemeh A, Mullen S, Schroeppel JP, Vopat BG. Nationwide Analysis of Total Ankle Replacement and Ankle Arthrodesis in Medicare Patients: Trends, Complications, and Cost. Foot Ankle Spec 2022; 15:201-208. [PMID: 32830583 DOI: 10.1177/1938640020950181] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Surgical management of end-stage ankle arthritis consists of either ankle arthrodesis (AA) or total ankle replacement (TAR). The purpose of this study was to evaluate utilization trends in TAR and AA and compare cost and complications. METHODS Medicare patients with the diagnosis of ankle arthritis were reviewed. Patients undergoing surgical intervention were split into AA and TAR groups, which were evaluated for trends as well as postoperative complications, revision rates, and procedure cost. RESULTS A total of 673 789 patients were identified with ankle arthritis. A total of 19 120 patients underwent AA and 9059 underwent TAR. While rates of AA remained relatively constant, even decreasing, with 2080 performed in 2005 and 1823 performed in 2014, TAR rates nearly quadrupled. Average cost associated with TAR was $12559.12 compared with $6962.99 for AA (P < .001). Overall complication rates were 24.9% in the AA group with a 16.5% revision rate compared with 15.1% and 11.0%, respectively, in the TAR group (P < .001). Patients younger than 65 years had both higher complication and revision rates. DISCUSSION TAR has become an increasingly popular option for the management of end-stage ankle arthritis. In our study, TAR demonstrated both lower revision and complication rates than AA. However, TAR represents a more expensive treatment option. LEVELS OF EVIDENCE Level III: Retrospective comparative study.
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Affiliation(s)
- William A Tucker
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Brandon L Barnds
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Brandon L Morris
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Armin Tarakemeh
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Scott Mullen
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - J Paul Schroeppel
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Bryan G Vopat
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
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Buchhorn T, Weber J, Lampert C. Arthrose des oberen Sprunggelenks. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-019-00333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Greenfield S, Matta KM, McCoy TH, Rozbruch SR, Fragomen A. Ankle Distraction Arthroplasty for Ankle Osteoarthritis: A Survival Analysis. Strategies Trauma Limb Reconstr 2019; 14:65-71. [PMID: 32742416 PMCID: PMC7376580 DOI: 10.5005/jp-journals-10080-1429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The treatment algorithm for end-stage ankle arthritis is imperfect. Young or active patients are challenging to treat as fusion and replacement carry predictable consequences. Ankle distraction arthroplasty is a less commonly utilized surgical procedure for the treatment of osteoarthritis of the ankle. The purpose of this study was to report intermediate-term survival of ankle distraction and to identify factors associated with earlier time to failure. Materials and methods A single-centre, multi-surgeon cohort of 258 cases of ankle arthritis, treated with ankle distraction or ankle distraction with supramalleolar osteotomy (SMO), was identified. Patients were contacted by phone to determine the status of the ankle (natural vs fused/replaced). Data were collected through chart review. This included patient demographics, medical comorbidities, surgical procedure, and X-ray characteristics including pattern and severity. A Cox regression model was used to determine factors associated with failure during 10 years of follow-up. Risk factors were analysed as hazard ratios (HRs) and 95% confidence intervals (CIs). Time to failure was illustrated with Kaplan–Meier (KM) curves. Results In total, 144 cases were successfully contacted with median follow-up of 4.57 years. In total, 16.7% of ankles failed (24/144). The 5-year survival was 84% (95% CI: 78–91%). In adjusted Cox regression, female sex (HR = 2.68, p = 0.049) and avascular necrosis (AVN) of the talus (HR = 3.77, p = 0.041) were significantly associated with failure risk. Conclusion Avascular necrosis of the talus and male/female gender differences in survival were found to be significant. Our experience shows that ankle distraction is a valid and effective operation for the treatment of end-stage ankle arthritis. Clinical significance This work is clinically significant in that it demonstrates excellent intermediate-term survival data for hinged ankle distraction for treatment of osteoarthritis of the ankle. Additionally, it evaluated patient and disease characteristics allowing improved patient counselling with regard to survival longevity. Level of evidence IV cohort study. How to cite this article Greenfield S, Matta KM, McCoy TH, et al. Ankle Distraction Arthroplasty for Ankle Osteoarthritis: A Survival Analysis. Strategies Trauma Limb Reconstr 2019;14(2):65–71.
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Affiliation(s)
- Stephen Greenfield
- Department of Orthopaedic Surgery, Foot and Ankle and Limb Deformity and Reconstructive Surgery, OrthoIndy Hospital, Indianapolis, Indiana, USA
| | - Kelsey M Matta
- Department of Orthopaedic Surgery, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Thomas H McCoy
- Department of Orthopaedic Surgery, Harvard Medical School, Center for Quantitative Health, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - S Robert Rozbruch
- Department of Orthopaedic Surgery, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, USA
| | - Austin Fragomen
- Department of Orthopaedic Surgery, The Hospital for Special Surgery, Weill Medical College of Cornell University, New York, USA
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Balaji SM, Selvaraj V, Devadoss S, Devadoss A. Transfibular ankle arthrodesis: A novel method for ankle fusion - A short term retrospective study. Indian J Orthop 2017; 51:75-80. [PMID: 28216754 PMCID: PMC5296852 DOI: 10.4103/0019-5413.197549] [Citation(s) in RCA: 9] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle arthrodesis has long been the traditional operative treatment for posttraumatic arthritis, rheumatoid arthritis, infection, neuromuscular conditions, and salvage of failed ankle arthroplasty. It remains the treatment of choice for patients in whom heavy and prolonged activity is anticipated. We present our short term followup study of functional outcome of patients who underwent transfibular ankle arthrodesis for arthritis of ankle due to various indications. MATERIALS AND METHODS 29 transfibular ankle arthrodesis in 29 patients performed between April 2009 and April 2014 were included in this study. The mean age was 50 years (range 22-75 years). The outcome analysis with a minimum of 1-year postoperative followup were included. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot scale. RESULTS All cases of ankle fusions (100%) progressed to solid union in a mean postoperative duration of 3.8 months (range 3-6 months). All patients had sound arthrodesis. The mean followup period was 32.52 months (standard deviation ± 10.34). The mean AOFAS score was 74 (pain score = 32, functional score = 42). We found that twenty patients (68.96%) out of 29, had excellent results, 7 (24.13%) had good, and 2 (6.89%) showed fair results. CONCLUSION Transfibular ankle arthrodesis is a simple and effective procedure for ankle arthritis. It achieves a high rate of union and good functional outcome on midterm followup.
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Affiliation(s)
- S Muthukumar Balaji
- Department of Orthopaedics, Institute of Orthopaedic Research and Accident Surgery, Devadoss Multispeciality Hospital, Madurai, Tamil Nadu, India,Address for correspondence: Dr. S Muthukumar Balaji, No. 1145, Mardhini Autocare Products, 13th Cross, Chandra Layout 1st Stage, Bengaluru - 560 072, Karnataka, India. E-mail:
| | - V Selvaraj
- Department of Orthopaedics, Institute of Orthopaedic Research and Accident Surgery, Devadoss Multispeciality Hospital, Madurai, Tamil Nadu, India
| | - Sathish Devadoss
- Department of Orthopaedics, Institute of Orthopaedic Research and Accident Surgery, Devadoss Multispeciality Hospital, Madurai, Tamil Nadu, India
| | - Annamalai Devadoss
- Department of Orthopaedics, Institute of Orthopaedic Research and Accident Surgery, Devadoss Multispeciality Hospital, Madurai, Tamil Nadu, India
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Guo C, Zhu Y, Hu M, Deng L, Xu X. Reliability of measurements on lateral ankle radiographs. BMC Musculoskelet Disord 2016; 17:297. [PMID: 27431806 PMCID: PMC4949875 DOI: 10.1186/s12891-016-1150-4] [Citation(s) in RCA: 10] [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: 03/31/2016] [Accepted: 07/02/2016] [Indexed: 12/02/2022] Open
Abstract
Background The aims of our study were to evaluate the validation of measurement of weight-bearing lateral radiographs. Two hypotheses were tested: the measurements on the lateral radiographs are reliable, and a theoretical limit could be identified when a surgeon can “eyeball” an incongruous ankle joint on lateral radiographs. Methods To test the first hypothesis, 3 experienced ankle surgeons evaluated 50 normal weight-bearing lateral radiographs of patients. The measurements assessed were the tibial lateral surface angle (TLS), the distance from the center of the talar joint circle to the longitudinal axis of the tibia (x) and the displacement from the center of the talar articular joint circle to the center of the distal tibia articular joint circle (d). To test the second hypothesis, we used CAD software to create schematic diagrams on which lateral radiographs of the ankle joint were not parallel (d = 1, 2, 3, 4 mm). Five experienced ankle surgeons were asked to judge whether the ankle articular surfaces were parallel. Intraobserver reliability was determined using the intraclass correlation coefficients (ICCs) and interobserver agreement by the Kendall coefficient of concordance. Results First, the intraobserver reliability was high (Cronbach’s alpha >0.80) with regard to radiographic measurements according to the ICC. Significant interobserver disagreement was found (Kendall tauB, p < 0.01) using the Kendall concordance coefficient. Second, when the d-value was 4 mm, all the observers identified the incongruous ankle joint at two separate times. Conclusions Consultation with experienced foot and ankle surgeons and precise definitions for lateral measurement assessments do not guarantee a high level of agreement. Surgeons can observe an incongruous ankle joint on lateral radiographs when the d-value is 4 mm.
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Affiliation(s)
- Changjun Guo
- Department of Orthopaedics, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Zhu
- Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mu Hu
- Department of Orthopaedics, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfu Deng
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiangyang Xu
- Department of Orthopaedics, Rui Jin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Department of Orthopaedics, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Arthroscopic debridement of the ankle for mild to moderate osteoarthritis: a midterm follow-up study in former professional soccer players. J Orthop Surg Res 2016; 11:37. [PMID: 27029804 PMCID: PMC4815268 DOI: 10.1186/s13018-016-0368-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 03/15/2016] [Indexed: 12/26/2022] Open
Abstract
Background The aim of this study is to report the clinical and functional outcomes following arthroscopic management of anterior impingement, grade III–IV cartilage lesions, and mild to moderate osteoarthritis of the ankle in former soccer players. Methods The study included 15 former male professional soccer players with mild to moderate degenerative changes of the ankle who had undergone arthroscopic debridement and management of secondary injuries of the ankle. Preoperatively and at the last follow-up, at an average of 7.4 years, the American Orthopaedic Foot and Ankle Society (AOFAS) and the Kaikkonen scales and visual analogue scale (VAS) assessment were administered to all patients. Ankle osteoarthritis was assessed from weightbearing anteroposterior and lateral radiographs of both ankles. Results and discussion At the last follow-up, the average AOFAS score had increased significantly from 48 (range, 29–69) to 86 (range, 63–94) (P < 0.0001), with good to excellent scores in 11 patients (74 %). The average Kaikkonen preoperative score of 43 (range, 28–70) had significantly improved to 85 (range, 61–95) (P < 0.0001), with good excellent scores in 11 patients (74 %). VAS values were also improved at the last follow-up. At the last appointment, only one (7 %) patient had abandoned altogether any sport, as he did not feel safe with his ankle and he felt too old to continue. Conclusions Anterior ankle arthroscopy for management of mild to moderate ankle arthritis is safe, effective, and low cost and allows former athletes to safely return to ordinary daily activities and recreational sport activities.
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Mulhern JL, Protzman NM, Brigido SA, Deol PPS. Supramalleolar Osteotomy: Indications and Surgical Techniques. Clin Podiatr Med Surg 2015; 32:445-61. [PMID: 26117578 DOI: 10.1016/j.cpm.2015.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Supramalleolar osteotomies are a surgical treatment option for asymmetric varus or valgus ankle arthritis where at least 50% of the joint surface is spared. Procedure selection requires significant preoperative planning for appropriate execution. Thus, the surgeon must be familiar with the principles of deformity correction. With appropriate patient selection and proper preoperative planning, the procedure has been shown to yield excellent results, redistributing forces more evenly across the ankle joint by restoring the mechanical axis of the lower leg with minimal complications.
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Affiliation(s)
- Jennifer L Mulhern
- Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA
| | - Nicole M Protzman
- Clinical Education and Research Department, Coordinated Health, 3435 Winchester Road, Allentown, PA 18104, USA
| | - Stephen A Brigido
- Foot and Ankle Department, Coordinated Health, 2775 Schoenersville Road, Bethlehem, PA 18017, USA.
| | - Premjit Pete S Deol
- Orthopaedics Department, Panorama Orthopedics & Spine Center, 660 Golden Ridge Road, Suite 250, Golden, CO 80401, USA
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Bigsby E, Cowie S, Middleton RG, Kemp M, Hepple S. Complications after revision surgery of malreduced ankle fractures. J Foot Ankle Surg 2014; 53:426-8. [PMID: 24795206 DOI: 10.1053/j.jfas.2014.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Indexed: 02/03/2023]
Abstract
Ankle fractures are common orthopedic injuries requiring reduction and cast immobilization or fixation. Fractures fixed in a malreduced (misaligned) position can require revision surgery. However, because this has been a relatively rare occurrence, little is known about the complications that can occur after such surgery. We reviewed all adult closed ankle fractures that underwent revision surgery for technical failure in a regional trauma hospital from January 2007 to January 2010. Those with open fractures and those who required external fixation at any point in their treatment were excluded. Nine patients underwent revision surgery during the study period. Of these 9 patients, 3 (33%) developed a deep infection, all with positive microbiology cultures for methicillin-sensitive Staphylococcus aureus. Each of these patients underwent removal of the metalwork and wound debridement, followed by plastic surgery free flap coverage. In addition to the 3 infection cases, those with noninfected complications included 1 patient (11%) with chronic regional pain syndrome, 1 (11%) with failure of plate fixation, and 1 (11%) with persistent pain requiring arthroscopy and debridement. The overall incidence of complications was 66.67% in this group of 9 patients who had undergone revision surgery for the treatment of a malreduced malleolar ankle fracture. Although our observational study involved a small subset of patients who had undergone surgical repair for ankle fracture, we suggest that if revision surgery will be undertaken, the high incidence of infection and the potential need for plastic surgery should be highlighted during the consent process before the original, open reduction internal fixation procedure.
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Affiliation(s)
- Ewan Bigsby
- SpR, Frenchay Hospital, Frenchay, Bristol, United Kingdom.
| | - Simon Cowie
- SpR, Frenchay Hospital, Frenchay, Bristol, United Kingdom
| | - Rory G Middleton
- SpR, Royal Cornwall Hospital, Treliske, Truro, Cornwall, United Kingdom
| | - Mark Kemp
- SpR, Frenchay Hospital, Frenchay, Bristol, United Kingdom
| | - Steve Hepple
- Consultant, Frenchay Hospital, Frenchay, Bristol, United Kingdom
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Herrera-Pérez M, Pais-Brito JL, de Bergua-Domingo J, Aciego de Mendoza M, Guerra-Ferraz A, Cortés-García P, Déniz-Rodríguez B. [Results of arthrodiastasis in postraumatic ankle osteoarthritis in a young population: prospective comparative study]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 57:409-16. [PMID: 24126145 DOI: 10.1016/j.recot.2013.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The most common cause of osteoarthritis of the ankle is post-traumatic, and although tibiotalar arthrodesis remains the surgical gold standard, a number of techniques have been described to preserve joint mobility, such as joint distraction arthroplasty or arthrodiastasis. OBJECTIVE To evaluate the functional outcome and changes in Visual Analogue Scale (VAS) for pain after the application of the distraction arthroplasty for post-traumatic ankle osteoarthritis. PATIENTS AND METHODS A prospective comparative study of a group of 10 young patients with post-traumatic ankle osteoarthritis treated by synovectomy and arthrodiastasis, compared to a control group of 10 patients treated by isolated synovectomy. Results were calculated using the AOFAS scale and the VAS for pain before and after treatment. RESULTS As regards the pain measured by VAS, no difference was observed between the two groups before surgery (P=.99), but there was a difference at 3 months (P<.001), 6 months (P=.005), and 12 months (P=.006). No differences were observed in the AOFAS scale between the two groups before surgery (P=.99), or at 3 months (P<.99), but there was a difference at 6 months (P<.001). CONCLUSIONS Ankle arthrodiastasis is effective in reducing pain in post-traumatic ankle arthropathy, and is superior to isolated synovectomy.
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Affiliation(s)
- M Herrera-Pérez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Canarias, La Laguna, Tenerife, España; Facultad de Medicina, Universidad de La Laguna, La Laguna, Tenerife, España; Unidad de Tobillo y Pie, Hospital Universitario de Canarias, La Laguna, Tenerife, España.
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Barg A, Pagenstert GI, Hügle T, Gloyer M, Wiewiorski M, Henninger HB, Valderrabano V. Ankle osteoarthritis: etiology, diagnostics, and classification. Foot Ankle Clin 2013; 18:411-26. [PMID: 24008208 DOI: 10.1016/j.fcl.2013.06.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is defined as the syndrome of joint pain and dysfunction caused by substantial joint degeneration. In general, OA is the most common joint disease and is one of the most frequent and symptomatic health problems for middle-aged and older people: OA disables more than 10% of people who are older than 60 years. This article reviews the etiology of ankle OA, and describes the onset and development of posttraumatic ankle OA, the most common form of OA in the tibiotalar joint. Various methods of clinical and radiographic assessment are described in detail.
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Affiliation(s)
- Alexej Barg
- Orthopaedic Department, Osteoarthritis Research Center Basel, University Hospital of Basel, University of Basel, Spitalstrasse 21, Basel CH-4031, Switzerland.
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Berti L, Vannini F, Lullini G, Caravaggi P, Leardini A, Giannini S. Functional evaluation of patients treated with osteochondral allograft transplantation for post-traumatic ankle arthritis: one year follow-up. Gait Posture 2013; 38:945-50. [PMID: 23711988 DOI: 10.1016/j.gaitpost.2013.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/15/2013] [Accepted: 04/27/2013] [Indexed: 02/02/2023]
Abstract
Severe post-traumatic ankle arthritis poses a reconstructive challenge in active patients. Whereas traditional surgical treatments, i.e. arthrodesis and arthroplasty, provide good pain relief, arthrodesis is associated to functional and psychological limitations, and arthroplasty is prone to failure in the active patient. More recently the use of bipolar fresh osteochondral allografts transplantation has been proposed as a promising alternative to the traditional treatments. Preliminary short- and long-term clinical outcomes for this procedure have been reported, but no functional evaluations have been performed to date. The clinical and functional outcomes of a series of 10 patients who underwent allograft transplantation at a mean follow-up of 14 months are reported. Clinical evaluation was performed with the AOFAS score, functional assessment by state-of-the-art gait analysis. The clinical score significantly improved from a median of 54 (range 12-65) pre-op to 76.5 (range 61-86) post-op (p=0.002). No significant changes were observed for the spatial-temporal parameters, but motion at the hip and knee joints during early stance, and the range of motion of the ankle joint in the frontal plane (control: 13.8°±2.9°; pre-op: 10.4°±3.1°, post-op: 12.9°±4.2°; p=0.02) showed significant improvements. EMG signals revealed a good recovery in activation of the biceps femoris. This study showed that osteochondral allograft transplantation improves gait patterns. Although re-evaluation at longer follow-ups is required, this technique may represent the right choice for patients who want to delay the need for more invasive joint reconstruction procedures.
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Affiliation(s)
- L Berti
- Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Bologna, Italy
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14
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Pimenta R, Carvalho P, Amado P. Fresh bipolar osteochondral allograft of the ankle. Review of the literature and case report of a young patient with bilateral post-traumatic osteoarthritis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Pimenta R, Carvalho P, Amado P. [Fresh bipolar osteochondral allograft of the ankle. Review of the literature and case report of a young patient with bilateral post-traumatic osteoarthritis]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012; 56:120-6. [PMID: 23594753 DOI: 10.1016/j.recot.2011.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 11/07/2011] [Accepted: 11/08/2011] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The treatment of severe post-traumatic ankle arthritis remains a challenge nowadays. Since patients suffering from this pathology are mainly young and active people, a correct reconstruction, if possible, of the articular cartilage defects of the tibiotalar joint is very important to achieve a good result. Fresh bipolar osteochondral allograft (FBOA) is a promising operative technique, as an alternative to arthrodesis and total ankle replacement, in pain relief, restoration of function and indefinite delay of arthritic disease progression. METHODS The authors made a review of the literature and present a case report of a young 30 years-old man, with bilateral post-traumatic osteoarthritis of the ankle, treated with (FBOA). The patient was evaluated clinically and radiographically monthly. RESULTS Pain relief and postoperative function was significantly improved reaching 94 points in the left ankle (preoperative of 40 points), and 92 points in the right ankle (preoperative 42 points) AOFAS score. CONCLUSIONS Fresh tibiotalar allografting seems to be a good alternative to arthrodesis and prosthetic replacement, in the treatment of ankle arthropathy and big articular cartilage defects mainly in young and active patients. This procedure achieves a good pain relief, maintaining functional joint motion and decreasing the risk of adjacent joint arthritis.
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Affiliation(s)
- R Pimenta
- Unidad de Tobillo-Pie, Instituto CUF, Porto, Portugal.
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16
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Frigg A, Nigg B, Davis E, Pederson B, Valderrabano V. Does alignment in the hindfoot radiograph influence dynamic foot-floor pressures in ankle and tibiotalocalcaneal fusion? Clin Orthop Relat Res 2010; 468:3362-70. [PMID: 20585909 PMCID: PMC2974889 DOI: 10.1007/s11999-010-1449-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 06/14/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Saltzman-el-Khoury hindfoot alignment view (HAV) is considered the gold standard for assessing the axis from hindfoot to tibia. However, it is unclear whether radiographic alignment influences dynamic load distribution during gait. QUESTIONS/PURPOSES We evaluated varus-valgus alignment by the HAV and its influence on dynamic load distribution in ankle and tibiotalocalcaneal (TTC) arthrodesis. PATIENTS AND METHODS We clinically assessed 98 patients (ankle, 56; TTC, 42) with SF-36 and American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual hindfoot alignment, HAV angle, and dynamic pedobarography using a five-step method. For comparison, 70 normal feet were evaluated. Minimum followup was 2 years (average, 4.11 years; range, 2-6 years). RESULTS The mean HAV angle was -0.8° ± 7.8° for ankle and -1.2° ± 6.9° for TTC arthrodesis. The HAV angle correlated with pedobarographic load distribution (r = 0.35-0.53). Radiographic alignment did not influence SF-36 or AOFAS scores; however, load distribution correlated to qualities of these scores. Visual alignment only predicted the corresponding HAV angle in 48%. To reproduce the dynamic load of healthy subjects, HAV angles of 5° to 10° valgus were needed. CONCLUSIONS Visual positioning is inadequate to determine intraoperative positioning and resulted in a varus position with a relatively large SD. The HAV should be used to assess the hindfoot alignment correctly. HAV angles of 5° to 10° valgus are needed to reproduce a physiologic gait pattern.
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Affiliation(s)
- Arno Frigg
- Department of Orthopaedics, University of Calgary, Calgary, Canada ,Human Performance Laboratory, University of Calgary,
Calgary, Canada ,Department of Orthopaedic Surgery, University of Basel Hospital, Spitalstrasse 21, CH-4031 Basel, Switzerland
| | - Benno Nigg
- Human Performance Laboratory, University of Calgary,
Calgary, Canada
| | - Elysia Davis
- Human Performance Laboratory, University of Calgary,
Calgary, Canada
| | - Beth Pederson
- Department of Orthopaedics, University of Calgary, Calgary, Canada
| | - V. Valderrabano
- Human Performance Laboratory, University of Calgary,
Calgary, Canada ,Department of Orthopaedic Surgery, University of Basel Hospital, Spitalstrasse 21, CH-4031 Basel, Switzerland
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17
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Giannini S, Faldini C, Acri F, Leonetti D, Luciani D, Nanni M. Surgical treatment of post-traumatic malalignment of the ankle. Injury 2010; 41:1208-11. [PMID: 20934697 DOI: 10.1016/j.injury.2010.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Post-traumatic malalignment is evident in cases of malunion of ankle fractures. This condition predisposes to the development of chronic pain, functional impairment, and finally post-traumatic arthritis. The aim of this paper is to present a joint-saving surgical treatment of post-traumatic ankle malalignment. It is based on the review of a series of patients who developed fracture malunion and were treated with articular reconstruction. Twenty-two ankle fractures, which malunited and resulted into valgus deformity and fibular shortening are presented. Pre-reconstruction and mid-term follow-up evaluation included the AOFAS score and standard weight-bearing radiographs. Surgical treatment consisted in articular reconstruction with malleolar osteotomies. Post-operatively, the non-weight-bearing period extended to 6 weeks post-surgery, while full weight-bearing was allowed at 12 weeks on average. All osteotomies healed, while no intra-operative or early post-operative complications were reported. The average pre-operative AOFAS score was 45, while post-operatively climbed to 87. At the last follow-up, on average at 5-years post-surgery, 10 patients reported "excellent" function, 7 "good", 3 "fair" and 2 "poor" function. The correction of the malalignment was maintained in 20 cases. The two patients with poor function and loss of reduction underwent ankle fusion. Articular reconstruction with malleolar osteotomies is indicated for the treatment of ankle post-traumatic malalignment, offering reduction of pain, improvement of the ankle function, delaying the development of post-traumatic arthritis, and minimising the need of radical surgery such as ankle fusion or prosthetic replacement. Moreover, once a correct alignment of the joint is achieved, secondary surgery, if necessary, can be performed more easily, and with better results.
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Affiliation(s)
- Sandro Giannini
- Department of Orthopaedic Surgery, University of Bologna, Instituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, Italy.
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18
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Abstract
Anatomic reduction and fixation of unstable ankle fractures is necessary to prevent posttraumatic arthritis. Malunion of the distal fibula in unstable ankle fractures may lead to progressive talar instability. Ankle fracture malunions often present with concomitant syndesmotic widening, which can cause surgeons to overlook changes in fibula length and rotation. The decision to proceed with surgery should be made only after a careful diagnostic workup and detailed preoperative discussion with the patient. Considerations for surgical management include location and orientation of a corrective osteotomy, use of structural graft, widening of the syndesmosis, assessment of reduction, and the need for medial exposure. Good and excellent clinical results after fibular reconstruction have been reported in 67% to 92% of ankles. Proper patient selection is critical, because ankle malunions can be complicated, with coexisting fibular, syndesmotic, medial, and posterior malleolar malalignment, along with degenerative joint disease. Understanding the indications and surgical technique for revising fibular malunions may obviate a future salvage procedure.
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19
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Bloom T, Renard R, Yalamanchili P, Wapner K, Chao W, Lin SS. Stimulation of ankle cartilage: other emerging technologies (cellular, electricomagnetic, etc.). Foot Ankle Clin 2008; 13:363-79, viii. [PMID: 18692005 DOI: 10.1016/j.fcl.2008.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Advances in understanding age-related changes in articular cartilage, joint homeostasis, the natural healing process after cartilage injury, and improved standards for evaluation of a joint surface made the ultimate goal of cartilage repair a possibility. New strategies for enhancement of articular cartilages' limited healing potential and biologic regeneration include advances in tissue engineering and the use of electromagnetic fields. This article reviews developments in basic science and clinical research made with these emerging technologies concerning treatment of articular cartilage defects and treatment of osteoarthritis of the ankle.
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Affiliation(s)
- Tamir Bloom
- Division of Pediatric Othopaedics, Department of Orthopaedic Surgery, New Jersey Medical School-University of Medicine and Dentistry of New Jersey, 90 Bergen Street, Newark, NJ 07103, USA.
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