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Clinics in Podiatric Medicine and... Oct 2015
Topics: Arthrodesis; Arthroplasty, Replacement, Ankle; Forecasting; Humans; Osteotomy; Podiatry; Quality Improvement; Plastic Surgery Procedures; Reoperation
PubMed: 26407746
DOI: 10.1016/j.cpm.2015.07.004 -
Hand (New York, N.Y.) Mar 2023Madelung deformity is a rare wrist anomaly that causes considerable pain while restricting function. In this study, we describe a radioscapholunate (RSL) arthrodesis...
BACKGROUND
Madelung deformity is a rare wrist anomaly that causes considerable pain while restricting function. In this study, we describe a radioscapholunate (RSL) arthrodesis with a neo-distal radioulnar joint (DRUJ) in Madelung deformity patients with an abnormal sigmoid notch and compare results to patients after a reverse wedge osteotomy.
METHODS
Six wrists underwent RSL arthrodesis with a neo-DRUJ in a two-phase approach: (1) modified RSL arthrodesis with triquetrectomy; and (2) distal scaphoidectomy. Seven wrists underwent a reverse wedge osteotomy procedure.
RESULTS
There were no differences found in postoperative pain, grip strength, or range of motion (ROM), apart from extension, which was decreased after RSL arthrodesis with a neo-DRUJ. Quality of life and Michigan Hand Outcomes Questionnaire scores were similar.
CONCLUSIONS
Although clinical outcome parameters are not different among the two groups, the RSL arthrodesis with construction of a neo-DRUJ could prove a valid treatment option for a subset of patients with a severely affected sigmoid notch.
Topics: Humans; Radius; Quality of Life; Wrist Joint; Arthrodesis
PubMed: 34096342
DOI: 10.1177/15589447211017223 -
Clinics in Orthopedic Surgery Dec 2022Tibiotalocalcaneal arthrodesis is an established surgical procedure for treating patients with end-stage ankle joint arthritis and subtalar joint arthritis. Although it...
BACKGROUND
Tibiotalocalcaneal arthrodesis is an established surgical procedure for treating patients with end-stage ankle joint arthritis and subtalar joint arthritis. Although it greatly relives pain, a major drawback is loss of range of motion. Although it is known to restrict an additional subtalar joint compared to tibiotalar arthrodesis, there is a lack of gait analysis studies comparing the two methods. This study aimed to evaluate the differences in kinematics of the foot and ankle joints between tibiotalar and tibiotalocalcaneal arthrodesis. We also compared preoperative and postoperative statuses for each surgical method.
METHODS
The study included 12 and 9 patients who underwent tibiotalar and tibiotalocalcaneal arthrodesis, respectively, and 40 healthy participants were included in the control group. The DuPont foot model was used to analyze intersegmental foot and ankle kinematics during gait.
RESULTS
Compared to controls, both tibiotalar and tibiotalocalcaneal arthrodesis resulted in slow gait speed with reduced stride length, increased step width, and decreased range of sagittal plane motion. Both fusion methods showed similar range of motion in all segments and planes following surgery. Coronal positions showed more supination of the forefoot and pronation of the hindfoot segment after each operation, particularly tibiotalocalcaneal arthrodesis. Gait after tibiotalocalcaneal arthrodesis did not significantly differ from that after tibiotalar arthrodesis, but there was a tendency of more pronation in the hindfoot segment.
CONCLUSIONS
Both fusion methods limited foot and ankle motion in similar ways. Comparing tibiotalar and tibiotalocalcaneal arthrodesis suggests that additionally fusing the subtalar joint does not cause greater movement restriction in patients. Objectively comparing tibiotalar and tibiotalocalcaneal arthrodesis will facilitate further understanding of the effect of tibiotalocalcaneal arthrodesis on movement and the value of subtalar joint motion for improved preoperative counselling.
Topics: Humans; Ankle Joint; Ankle; Arthrodesis; Subtalar Joint; Arthritis
PubMed: 36518930
DOI: 10.4055/cios22034 -
Foot and Ankle Clinics Sep 2014Triple arthrodesis is a powerful corrector of hindfoot deformity related to trauma, rheumatoid arthritis, and long-standing peritalar subluxation with posterior tibial... (Review)
Review
Triple arthrodesis is a powerful corrector of hindfoot deformity related to trauma, rheumatoid arthritis, and long-standing peritalar subluxation with posterior tibial tendon dysfunction. To avoid the common postoperative complications related to triple arthrodesis, one must be meticulous in preoperative evaluation as well as surgical technique. Presented are some tips and tricks to avoid the common complications and provide the patient with a plantigrade, stable foot, as well as some salvage options for triple arthrodesis in a malunited position.
Topics: Arthrodesis; Foot Deformities; Humans
PubMed: 25129357
DOI: 10.1016/j.fcl.2014.06.008 -
Neurosurgery Feb 2023Changes in reimbursement policies have been demonstrated to correlate with clinical practice.
BACKGROUND
Changes in reimbursement policies have been demonstrated to correlate with clinical practice.
OBJECTIVE
To investigate trends in physician reimbursement for anterior, posterior, and combined anterior/posterior (AP) lumbar arthrodesis and relative utilization of AP.
METHODS
We queried the American College of Surgeons National Surgical Quality Improvement Project registry for anterior, posterior, and AP lumbar arthrodeses during 2010 and 2020. Work relative value units per operative hour (wRVUs/h) were calculated for each procedure. Trends in reimbursement and utilization of the AP approach were assessed with linear regression. Subgroup analyses of age and underlying pathology of AP arthrodesis were also performed.
RESULTS
During 2010 and 2020, AP arthrodesis was associated with significantly higher average wRVUs/h compared with anterior and posterior arthrodesis (AP = 17.4, anterior = 12.4, posterior = 14.5). The AP approach had a significant yearly increase in wRVUs/h (coefficient = 0.48, P = .042), contrary to anterior (coefficient = -0.01, P = .308) and posterior (coefficient = -0.13, P = .006) approaches. Utilization of AP approaches over all arthrodeses increased from 7.5% in 2010 to 15.3% in 2020 (yearly average increase 0.79%, P < .001). AP fusions increased significantly among both degenerative and deformity cases (coefficients 0.88 and 1.43, respectively). The mean age of patients undergoing AP arthrodesis increased by almost 10 years from 2010 to 2020. Rates of major 30-day complications were 2.7%, 3.1%, and 3.5% for AP, anterior, and posterior arthrodesis, respectively.
CONCLUSION
AP lumbar arthrodesis was associated with higher and increasing reimbursement (wRVUs/h) during the period 2010 to 2020. Reimbursement for anterior arthrodesis was relatively stable, while reimbursement for posterior arthrodesis decreased. The utilization of the combined AP approach relative to the other approaches increased significantly during the period of interest.
Topics: Humans; Child; Spinal Fusion; Treatment Outcome; Arthrodesis; Lumbosacral Region; Lumbar Vertebrae; Retrospective Studies
PubMed: 36637267
DOI: 10.1227/neu.0000000000002194 -
Acta Chirurgiae Orthopaedicae Et... 2017About 90 % of all cases of painful posttraumatic ankle arthritis can be very successfully treated with a minor invasive ankle arthrodesis technique by using a small...
About 90 % of all cases of painful posttraumatic ankle arthritis can be very successfully treated with a minor invasive ankle arthrodesis technique by using a small anterior approach and a fixation with four 6. 5 mm screws of which the posteromedial and transfibular one are inserted percutaneously. The results with this standardized procedure have been reported previously as excellent and good in a mid-term run of 6 years (34). This technique leads to a high union rate of 99% (92 of 93) with rapid bone healing within 8 ± 2 weeks, it causes a low minor complication rate of 8 % and enables a significant increase of the AOFAS ankle/hindfoot score (17) from 36 preoperatively to 85 postoperatively as well as a midtarsal movement of 24° ± 16°. In some cases of ankle arthritis due to chronic syndesmotic instability a 5th screw is additionally used to compress the reamed espace claire for regaining a stable ankle fork. A 5th screw is used also in case of necessary shortening of the fibula or in cases of idiopathic ankle arthritis with gross varus deformity when a transfibular approach becomes necessary instead of the anterior approach. About 10% of ankle arthrodesis need different procedures like in cases of malunited ankle or pilon fractures with low grade infection, larger bony defects due to resection of necrotic bone, due to primary bone loss in open fractures or due to secondary bone loss in failed ankle replacement cases. They need usually a two stage procedure with primary debridement and temporary joint transfixation and secondary anterior double plate fixation with autogenous bone grafting. In case of critical anterior soft tissues a posterolateral approach with a bladeplate-fixation is performed. In the very rare cases of severe ankle infection a three stage procedure is recommended with a radical necrectomy of infected soft tissues or dead bone and/or combined with taking biopsies, filling the defects with Gentamycin-PMMA- beads and stabilizing the reamed joint with a threaded compression Charnley fixator in the first stage. A re-debridement in the second stage might need additionally a permanent lavage with sensitive antibiotics according to the probes and in the third stage a third debridement with finally autogeneous bonegrafting is done. Key words: ankle arthrodesis, anterior, posterolateral, transfibular ankle approach, 4- to 5-screw fixation technique, double plate fixation, autogeneous bonegrafting, Charnley compression fixator.
Topics: Ankle Injuries; Arthritis; Arthrodesis; Bone Screws; Debridement; Female; Fracture Fixation, Internal; Humans; Male; Treatment Outcome
PubMed: 28253941
DOI: No ID Found -
Orthopadie (Heidelberg, Germany) Feb 2023Shoulder arthrodesis and resection arthroplasty can be used as salvage procedures to treat severe complications after shoulder prosthesis failure. for both procedures,... (Review)
Review
Shoulder arthrodesis and resection arthroplasty can be used as salvage procedures to treat severe complications after shoulder prosthesis failure. for both procedures, the indication and patient selection must be very strict. Shoulder arthrodesis after prosthesis failure can be indicated in young patients in case of chronic neuromuscular dysfunction. Filling the bony defect with either autologous or allogenic material and osteosynthetic primary stability are decisive for a good functional outcome. Aftercare comprises immobilization for 12 weeks and physical load is increased thereafter, depending on the sufficiency of bony consolidation. Resection arthroplasty after shoulder prosthesis failure is mostly reserved for multimorbid patients in case of a chronic infection. Thorough debridement and adequate systemic antibiotic treatment are crucial to achieve bacterial eradication.
Topics: Humans; Arthrodesis; Arthroplasty; Arthroplasty, Replacement, Shoulder; Prosthesis Failure; Shoulder Joint
PubMed: 36656335
DOI: 10.1007/s00132-022-04340-8 -
Foot & Ankle Specialist Apr 2022The purpose of this study is to determine if arthrodesis, compared with open reduction and internal fixation (ORIF), produces favorable American Orthopaedic Foot and... (Meta-Analysis)
Meta-Analysis
The purpose of this study is to determine if arthrodesis, compared with open reduction and internal fixation (ORIF), produces favorable American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores, and to determine if differences in complication, revision surgery, and secondary arthrodesis rates exist for patients with Lisfranc fracture/dislocation injuries. Searches were performed in PubMed using the keywords "Lisfranc fracture," "metatarsal fracture," "ORIF," "open reduction internal fixation," "arthrodesis," and "fusion." These criteria left 183 articles for review. Exclusions left 21 articles and 2 translations of Chinese abstracts. Data analysis was performed using Student's 2-sample test for samples of equal variance, and chi-square test for goodness of fit. The test revealed a significant difference ( = .03) between the average AOFAS score for patients who underwent primary arthrodesis (84.7 ± 6.14) compared with those who were treated with ORIF (78.9 ± 5.09). There was no significant difference for the average VAS scores ( = .33) of the arthrodesis and ORIF groups. The complication rate of arthrodesis patients was significantly lower than ORIF patients ( = .04), and the rates of revision surgery ( = .22) and secondary arthrodesis ( = .53) were not significant between the groups. The results of this study indicate that arthrodesis may be a better surgical option than ORIF, due to the higher functional scores and the lower complication rate.Levels of Evidence: Level III: A meta-analysis.
Topics: Arthrodesis; Fracture Fixation, Internal; Fractures, Bone; Humans; Open Fracture Reduction; Retrospective Studies; Treatment Outcome
PubMed: 33269645
DOI: 10.1177/1938640020971419 -
The Journal of Bone and Joint Surgery.... Jul 2022End-stage ankle arthritis has long been managed surgically with open ankle arthrodesis (OAA). Since the first published report in 1983, arthroscopic ankle arthrodesis...
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.
Topics: Ankle; Arthrodesis; Canada; Follow-Up Studies; Humans; Longitudinal Studies; Osteoarthritis; Retrospective Studies; Treatment Outcome
PubMed: 35793798
DOI: 10.2106/JBJS.21.01088 -
Hand (New York, N.Y.) Sep 2022Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion...
BACKGROUND
Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion rate and risk factors for reoperation after STT arthrodesis in the Veterans Affairs Department patient population. The purpose of our study was to assess the long-term nonunion rate following STT arthrodesis and to identify factors associated with reoperation.
METHODS
The national Veterans Health Administration Corporate Data Warehouse and Current Procedural Terminology codes identified STT arthrodesis procedures from 1995 to 2016. Frequencies of total wrist arthrodesis (TWA) and secondary operations were determined. Univariate analyses provided odds ratios for risk factors associated with complications.
RESULTS
Fifty-eight STT arthrodeses were performed in 54 patients with a mean follow-up of 120 months. Kirschner wires (K-wires) were the most common fixation method (69%). Six wrists (10%) required secondary procedures: 5 TWAs and 1 revision STT arthrodesis. Four patients underwent additional procedures for nonunion (7%). Twenty-four patients required K-wire removal, 8 (14%) of these in the operating room, which were not included in regression analysis. Every increase in 1 year of age resulted in a 15% decrease in likelihood of reoperation (95% confidence interval: 0.77-0.93; < .0001). Opioid use within 90 days before surgery ( = 1.00), positive smoking history ( = 1.00), race ( = .30), comorbidity count ( = .25), and body mass index ( = .19) were not associated with increased risk of reoperation.
CONCLUSIONS
At a mean follow-up of 10 years, patients undergoing STT arthrodesis have a 10% risk of reoperation, and this risk decreases with older patient age. There was a symptomatic nonunion rate of 7%, similar to prior published rates. Patient demographics, comorbidity, smoking history, and opioid use did not appear to increase risk of reoperation.
Topics: Analgesics, Opioid; Arthrodesis; Follow-Up Studies; Humans; Retrospective Studies; Wrist
PubMed: 33106027
DOI: 10.1177/1558944720964972