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The Journal of the American Academy of... Mar 2016Tibiotalocalcaneal fusion is an effective salvage procedure for combined end-stage ankle and subtalar arthrosis and for the management of severe planar deformities of... (Review)
Review
Tibiotalocalcaneal fusion is an effective salvage procedure for combined end-stage ankle and subtalar arthrosis and for the management of severe planar deformities of the ankle and hindfoot. Although the procedure results in a rigid ankle and hindfoot, it is often the only means of providing patients with a stable and painless foot and ankle for ambulation. Some patients who require the procedure have substantial bone loss that can be managed with a variety of autograft and allograft options. Options for tibiotalocalcaneal fixation include both internal and external devices, the selection of which depends on the underlying pathology, amount of bone loss, and type of bone graft selected. Relatively high complication rates associated with tibiotalocalcaneal fusion have been reported, with complications ranging from superficial infection to ultimate amputation; however, proper patient selection and careful graft and fixation planning can minimize the postoperative complications of the procedure.
Topics: Ankle Joint; Arthrodesis; Bone Nails; Bone Plates; Bone Screws; Bone Transplantation; Calcaneus; Humans; Joint Diseases; Osteoarthritis; Patient Selection; Tibia; Transplantation, Autologous; Transplantation, Homologous
PubMed: 26829585
DOI: 10.5435/JAAOS-D-14-00102 -
Foot and Ankle Clinics Sep 2018The subtalar joint plays an important role for the hindfoot when accommodating during gait. Joint degeneration may be caused by posttraumatic, inflammatory, and... (Review)
Review
The subtalar joint plays an important role for the hindfoot when accommodating during gait. Joint degeneration may be caused by posttraumatic, inflammatory, and pathologic biomechanical changes. Once conservative treatment has failed, subtalar fusion should be considered. The indication for surgery is based on thorough clinical and radiographic evaluation. Several techniques for subtalar fusion are published in literature. This article aims to describe a technique for in situ arthrodesis of the subtalar joint, paying special attention to biomechanical aspects as well as preoperative clinical and radiological work-up.
Topics: Arthrodesis; Humans; Joint Diseases; Subtalar Joint
PubMed: 30097085
DOI: 10.1016/j.fcl.2018.04.003 -
Operative Orthopadie Und Traumatologie Oct 2016The goal of Pirogoff's amputation of the hindfoot is a weight-bearing stump with minimal loss of limb length and stable soft tissue coverage with preservation of the...
OBJECTIVE
The goal of Pirogoff's amputation of the hindfoot is a weight-bearing stump with minimal loss of limb length and stable soft tissue coverage with preservation of the sensation of the sole of the heel.
INDICATIONS
Non-reconstructable forefoot and midfoot after complex trauma, deep bony and soft tissue infection, infected Charcot foot, necrosis or gangrene due to vasculopathy, malignant tumors and deformities.
CONTRAINDICATIONS
Possibility for reconstruction of the forefoot and midfoot, minor amputation, loss or irreversible destruction of the sole of the heel.
SURGICAL TECHNIQUE
The incision runs from dorsal, 1-2 cm distal of the Chopart joint, to plantar, 5-6 cm distal of the Chopart joint for creation of an adequate plantar skin flap. Exarticulation of the foot from dorsal to plantar through the Chopart joint with preservation of the posteromedial neurovascular bundle. Enucleation of the talus. Minimal resection of the cuboidal and posterior facets of the calcaneus as well as the malleoli inclusive of the distal tibial joint surface. The calcaneus is brought under the tibia and a tibiocalcaneal arthrodesis is performed with two compression screws.
POSTOPERATIVE MANAGEMENT
No weight bearing until stable scar formation, early mobilization in a walker. Interim prosthesis after 2-4 weeks and definitive prosthesis after 2-3 months.
RESULTS
From January 2010 to December 2014 six patients were treated with a modified Pirogoff's amputation. Primary wound healing was achieved in four patients and in two patients wound healing was impaired. In one patient the wound was conservatively healed and the other patient needed below knee amputation. Early primary prosthetic treatment was possible in four patients. The tibiocalcaneal arthrodesis healed in all five remaining cases. All patients with a healed Pirogoff stump were able to walk for short distances in bare feet without the prosthesis.
Topics: Amputation, Surgical; Arthrodesis; Combined Modality Therapy; Dermatologic Surgical Procedures; Diabetic Foot; Foot; Humans; Surgical Flaps; Treatment Outcome
PubMed: 27339219
DOI: 10.1007/s00064-016-0452-x -
Zeitschrift Fur Rheumatologie Nov 2014
Topics: Arthritis, Rheumatoid; Arthrodesis; Arthroplasty; Foot Diseases; Foot Joints; Humans; Joint Prosthesis
PubMed: 25315122
DOI: 10.1007/s00393-014-1418-8 -
European Journal of Orthopaedic Surgery... Dec 2023Arthrodesis of the ankle joint is an accepted treatment option in patients with end-stage ankle arthritis. The goal is to achieve fusion between the tibia and the talus,...
PURPOSE
Arthrodesis of the ankle joint is an accepted treatment option in patients with end-stage ankle arthritis. The goal is to achieve fusion between the tibia and the talus, thereby stabilizing the joint and alleviating pain. There might be associated limb length discrepancy, especially in post-traumatic and post-infectious cases. These patients require limb lengthening and arthrodesis. The purpose of this study is to report our experience with simultaneous ankle arthrodesis and lengthening using external fixation in adolescent and young adult patients.
METHODS
This retrospective case series included all patients treated in our hospital by concomitant ankle arthrodesis and tibial lengthening procedures on the same limb, using ring external fixation system. All surgeries included distal tibial joint surface resection and the talar dome, thereby correcting any associated deformity at the ankle. The arthrodesis was fixed and compressed using ring external fixator. A concurrent proximal tibial osteotomy was done, and limb lengthening, or bone transport was performed.
RESULTS
Eight patients operated between the years 2012-2020 were included in this study. Median patient age was 20.4 years (range 4-62 years), 50% women. Median limb lengthening was 20 mm (range 10-55 mm), and median final leg length discrepancy (LLD) was 7.5 mm (range 1-72 mm). The most common complication recorded was pin tract infection, which resolved with empiric antibiotics in all cases.
CONCLUSION
Based on our experience, combined arthrodesis and proximal tibial lengthening is efficient solution that provides stable ankle and restores length of the tibia even in complex and challenging situations.
Topics: Adolescent; Young Adult; Humans; Female; Child, Preschool; Child; Adult; Middle Aged; Male; Tibia; Ankle; Retrospective Studies; Arthritis; Talus; Ankle Joint; Arthrodesis; Treatment Outcome
PubMed: 37198500
DOI: 10.1007/s00590-023-03579-x -
The Journal of Bone and Joint Surgery.... Mar 2015Ankle arthrodesis traditionally has been regarded as the treatment of choice for many patients with end-stage ankle arthritis. However, a major reported risk of ankle... (Review)
Review
BACKGROUND
Ankle arthrodesis traditionally has been regarded as the treatment of choice for many patients with end-stage ankle arthritis. However, a major reported risk of ankle arthrodesis is adjacent-joint degeneration. There are conflicting views in the literature as to the causative link between ankle arthrodesis and progression to adjacent-joint arthritis. Recent studies have challenged the causative link between arthrodesis and adjacent-joint arthritis, purporting that preexisting adjacent-joint arthritis is present in many patients. The aim of the present study was to systematically review the available literature to determine if there is sufficient evidence to support either hypothesis.
METHODS
A literature search of the EMBASE and PubMed/MEDLINE databases (1974 to present) was performed. A total of twenty-four studies were included for review. The studies were reviewed, and the relevant information was extracted, including research methodology, postoperative outcomes in the adjacent joints of the foot, and whether pre-arthrodesis radiographs and medical records were available for analysis.
RESULTS
The twenty-four manuscripts included eighteen clinical studies, five biomechanical studies, and one gait-analysis study. The majority of biomechanical studies showed altered biomechanics in the fused ankle; however, there was no clear consensus as to whether these findings were causes of adjacent-joint arthritis. In studies assessing clinical outcomes, the reported prevalence of subtalar joint arthritis ranged from 24% to 100% and the prevalence of talonavicular and calcaneocuboid arthritis ranged from 18% to 77%. Correlation between imaging findings of arthritis in adjacent joints and patient symptoms was not established in a number of the clinical studies reviewed.
CONCLUSIONS
There is no true consensus in the literature as to the effects of ankle arthrodesis on biomechanics or whether ankle arthrodesis leads to adjacent-joint arthritis. Similarly, a correlation between postoperative imaging findings and clinical presentation in this cohort of patients has not been conclusively demonstrated.
Topics: Ankle Joint; Arthritis; Arthrodesis; Humans; Tarsal Joints
PubMed: 25788309
DOI: 10.2106/JBJS.N.00426 -
Hand Surgery & Rehabilitation Oct 2023The aim of this study was to analyze clinical and radiological results for 1-stage radiolunate arthrodesis and scaphoidectomy associated to the Sauvé-Kapandji...
OBJECTIVE
The aim of this study was to analyze clinical and radiological results for 1-stage radiolunate arthrodesis and scaphoidectomy associated to the Sauvé-Kapandji procedure, to alleviate pain and conserve wrist motion.
METHODS
Seven patients (8 wrists) with symptomatic osteoarthritis of the radiolunate and distal radioulnar joints were treated from 1999 to 2016. Mean age at surgery was 49 years and M/F sex ratio was 6/1. Etiologies were distal radial intra-articular malunion for 6 patients and bilateral gouty arthritis for 1. The procedure was performed by a dorsal approach in a single step. Pain was assessed on visual analogue scale (VAS). Pre- and post-operative active flexion-extension and pronation-supination were compared. The secondary endpoint was onset of postoperative complications.
RESULTS
At a mean 71 months' follow-up (range, 30-168 months), there was significant reduction in pain (VAS, 0.5/10; p < 0.0001). Motion results were satisfactory, with 32° flexion, 39° extension, for a non-significant decrease of 11° and 5° respectively; pronation and supination were significantly increased, by a mean 23° and 30° respectively. Three wrists (37.5%) required a second surgery. There were no cases of surgical site infection or non-union.
CONCLUSION
Radiolunate arthrodesis and scaphoidectomy combined to Sauvé-Kapandji procedure was an effective solution for the treatment of symptomatic radiolunate and distal radioulnar osteoarthritis.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Wrist; Osteoarthritis; Arthrodesis; Radiography; Pain
PubMed: 37490952
DOI: 10.1016/j.hansur.2023.07.011 -
Knee Surgery, Sports Traumatology,... Aug 2014Primary stability in arthrodesis of the knee can be achieved by external fixation, intramedullary nailing or plate fixation. Each method has different features and... (Review)
Review
PURPOSE
Primary stability in arthrodesis of the knee can be achieved by external fixation, intramedullary nailing or plate fixation. Each method has different features and results. We present a practical algorithm for arthrodesis of the knee following a failed (infected) arthroplasty, based on our own results and a literature review.
METHODS
Between 2004 and 2010, patients were included with an indication for arthrodesis after failed (revision) arthroplasty of the knee. Patients were analyzed with respect to indication, fusion method and bone contact. End-point was solid fusion.
RESULTS
Twenty-six arthrodeses were performed. Eighteen patients were treated because of an infected arthroplasty. In total, ten external fixators, ten intramedullary nails and six plate fixations were applied; solid fusion was achieved in 3/10, 8/10 and 3/6, respectively.
CONCLUSIONS
There is no definite answer as to which method is superior in performing an arthrodesis of the knee. Intramedullary nailing achieved the best fusion rates, but was used most in cases without--or cured--infection. Our data and the contemporary literature suggest that external fixation can be abandoned as standard fusion method, but can be of use following persisting infection. The Ilizarov circular external fixator, however, seems to render high fusion rates. Good patient selection and appropriate individual treatment are the key to a successful arthrodesis. Based upon these findings, a practical algorithm was developed.
Topics: Aged; Arthrodesis; Arthroplasty, Replacement, Knee; Female; Humans; Knee Joint; Male; Prosthesis-Related Infections; Reoperation; Retrospective Studies; Treatment Failure
PubMed: 23708381
DOI: 10.1007/s00167-013-2539-3 -
Der Unfallchirurg Dec 2016Restoration of stability of the thumb represents an enormous gain of function for the patient and can be achieved by arthrodesis or ligament reconstruction. Ligament... (Review)
Review
Restoration of stability of the thumb represents an enormous gain of function for the patient and can be achieved by arthrodesis or ligament reconstruction. Ligament reconstruction should only be performed if good stability and mobility and a pain-free grip can also be achieved. In every case surgery must protect the delicate soft tissues and should be based on a profound knowledge of the anatomical and biomechanical circumstances. Instability of the trapeziometacarpal joint is rare but metacarpophalangeal joint instability (ulnar, palmar and radial) is relatively frequent. For both conditions arthrodesis is the most frequently used and easier surgical procedure. Ligament reconstruction is more difficult to perform but can maintain the mobility of these joints.
Topics: Arthrodesis; Evidence-Based Medicine; Humans; Joint Instability; Ligaments; Metacarpophalangeal Joint; Plastic Surgery Procedures; Thumb; Trapezium Bone; Treatment Outcome
PubMed: 27787575
DOI: 10.1007/s00113-016-0263-4 -
Clinics in Podiatric Medicine and... Jul 2014Triple arthrodesis has traditionally been the procedure of choice for end-stage adult-acquired flatfoot. The results have been universally good, and it has proven to be... (Review)
Review
Triple arthrodesis has traditionally been the procedure of choice for end-stage adult-acquired flatfoot. The results have been universally good, and it has proven to be dependable and predictable. Nonetheless, complications have been reported following triple arthrodesis in certain patients. Selective arthrodesis of the talonavicular joint and subtalar joint through a single medial approach has been developed as an alternative. The authors especially prefer this procedure with severe transverse plane deformity and often choose this approach as an alternative to triple arthrodesis in high-risk patients, including those patients with diabetes mellitus, rheumatoid arthritis, long-term steroid use, and the elderly.
Topics: Adult; Arthrodesis; Bone Transplantation; Flatfoot; Foot Bones; Foot Joints; Humans; Osteotomy; Radiography; Tendon Transfer
PubMed: 24980932
DOI: 10.1016/j.cpm.2014.04.001