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Annals of Internal Medicine Dec 2022End-stage ankle osteoarthritis causes severe pain and disability. There are no randomized trials comparing the 2 main surgical treatments: total ankle replacement (TAR)... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
End-stage ankle osteoarthritis causes severe pain and disability. There are no randomized trials comparing the 2 main surgical treatments: total ankle replacement (TAR) and ankle fusion (AF).
OBJECTIVE
To determine which treatment is superior in terms of clinical scores and adverse events.
DESIGN
A multicenter, parallel-group, open-label randomized trial. (ISRCTN registry number: 60672307).
SETTING
17 National Health Service trusts across the United Kingdom.
PATIENTS
Patients with end-stage ankle osteoarthritis, aged 50 to 85 years, and suitable for either procedure.
INTERVENTION
Patients were randomly assigned to TAR or AF surgical treatment.
MEASUREMENTS
The primary outcome was change in Manchester-Oxford Foot Questionnaire walking/standing (MOXFQ-W/S) domain scores between baseline and 52 weeks after surgery. No blinding was possible.
RESULTS
Between 6 March 2015 and 10 January 2019, a total of 303 patients were randomly assigned; mean age was 68 years, and 71% were men. Twenty-one patients withdrew before surgery, and 281 clinical scores were analyzed. At 52 weeks, the mean MOXFQ-W/S scores improved for both groups. The adjusted difference in the change in MOXFQ-W/S scores from baseline was -5.6 (95% CI, -12.5 to 1.4), showing that TAR improved more than AF, but the difference was not considered clinically or statistically significant. The number of adverse events was similar between groups (109 vs. 104), but there were more wound healing issues in the TAR group and more thromboembolic events and nonunion in the AF group. The symptomatic nonunion rate for AF was 7%. A post hoc analysis suggested superiority of fixed-bearing TAR over AF (-11.1 [CI, -19.3 to -2.9]).
LIMITATION
Only 52-week data; pragmatic design creates heterogeneity of implants and surgical techniques.
CONCLUSION
Both TAR and AF improve MOXFQ-W/S and had similar clinical scores and number of harms. Total ankle replacement had greater wound healing complications and nerve injuries, whereas AF had greater thromboembolism and nonunion, with a symptomatic nonunion rate of 7%.
PRIMARY FUNDING SOURCE
National Institute for Health and Care Research Heath Technology Assessment Programme.
Topics: Male; Humans; Aged; Female; Arthroplasty, Replacement, Ankle; Ankle Joint; Ankle; State Medicine; Treatment Outcome; Osteoarthritis; Arthrodesis
PubMed: 36375147
DOI: 10.7326/M22-2058 -
Foot and Ankle Clinics Dec 2022A triple arthrodesis is comprised of subtalar, talonavicular, and calcaneocuboid joints arthrodesis. A pantalar arthrodesis is triple arthrodesis combined with... (Review)
Review
A triple arthrodesis is comprised of subtalar, talonavicular, and calcaneocuboid joints arthrodesis. A pantalar arthrodesis is triple arthrodesis combined with tibiotalar arthrodesis. The goal of the procedure is to obtain a correction of deformity and achieve a plantigrade, functional, painless, stable, weightbearing foot that can be used to ambulate. This is done by creating an osseous continuity across the ankle, subtalar, and talonavicular, and calcaneocuboid joints. There are several approaches and fixation strategies that result in successful clinical union and should be chosen to match the clinical situation. Modern techniques result in high rates of union and pain relief.
Topics: Humans; Subtalar Joint; Arthrodesis; Tarsal Joints; Ankle Joint; Weight-Bearing
PubMed: 36368803
DOI: 10.1016/j.fcl.2022.08.002 -
Foot and Ankle Clinics Mar 2022End-stage ankle arthritis typically affects an active younger patient population as compared with hip and knee arthritis. The optimal surgical treatment depends on... (Review)
Review
End-stage ankle arthritis typically affects an active younger patient population as compared with hip and knee arthritis. The optimal surgical treatment depends on several patient-specific factors. Open ankle arthrodesis has achieved reliable outcomes for this condition over years; however, arthroscopic techniques seem to be advantageous and feasible even in cases with significant intraarticular deformity. This article describes the surgical technique of arthroscopic ankle arthrodesis and discusses the outcome compared with that of open ankle fusion and total ankle replacement.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Arthroscopy; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35219365
DOI: 10.1016/j.fcl.2021.11.008 -
The Journal of the American Academy of... Aug 2022Shoulder arthrodesis is an end-stage, salvage procedure for the glenohumeral joint and can provide a pain-free, stable shoulder with varying levels of function. Common...
Shoulder arthrodesis is an end-stage, salvage procedure for the glenohumeral joint and can provide a pain-free, stable shoulder with varying levels of function. Common indications include brachial plexus injury, chronic instability with rotator cuff and deltoid dysfunction, and failed shoulder arthroplasty. Multiple techniques are described, including intra-articular and extra-articular arthrodeses. Fusion can be accomplished with screw fixation, plate fixation, external fixation, and arthroscopic-assisted techniques. The optimal position of the arm is heavily debated in the literature, but the ideal position is thought to be 30° of flexion, 30° of abduction, and 30° of internal rotation. After successful fusion, the patient should be able to bring their hand to their mouth, reach their back pocket, and cross the midline for hygiene. Complications are not uncommon and include nonunion, malunion, fracture, and infection. With the increasing incidence of shoulder arthroplasty, failed arthroplasties are more commonly encountered. In a salvage situation, shoulder arthrodesis may be considered.
Topics: Arthrodesis; Bone Plates; Brachial Plexus; Humans; Range of Motion, Articular; Shoulder; Shoulder Joint; Treatment Outcome
PubMed: 36067462
DOI: 10.5435/JAAOS-D-21-00667 -
The Veterinary Clinics of North... Jan 2020Arthrodesis is an elective surgical procedure that aims at eliminating pain and dysfunction by promoting deliberate osseous fusion of the involved joint(s). Percutaneous... (Review)
Review
Arthrodesis is an elective surgical procedure that aims at eliminating pain and dysfunction by promoting deliberate osseous fusion of the involved joint(s). Percutaneous plating can be used to perform carpal and tarsal arthrodeses in dogs and cats. After cartilage debridement is performed, the plate is introduced through separate plate insertion incisions made remote to the arthrodesis site and advanced along an epiperiosteal tunnel, and screws are inserted through the 3 existing skin incisions. The primary advantage of this technique is a decreased risk of soft-tissue complications, including postoperative swelling, ischemia, and wound dehiscence. Preliminary clinical results have been promising.
Topics: Animals; Arthrodesis; Bone Plates; Fracture Fixation, Internal
PubMed: 31653536
DOI: 10.1016/j.cvsm.2019.08.014 -
Hand Surgery & Rehabilitation Sep 2021Arthrodesis of the trapeziometacarpal (TMC) joint is one of the first surgical procedures used to treat thumb basal joint arthritis. From 1970 to 1990, we performed 254...
Arthrodesis of the trapeziometacarpal (TMC) joint is one of the first surgical procedures used to treat thumb basal joint arthritis. From 1970 to 1990, we performed 254 TMC arthrodeses with crossed K-wires. From 2015 to 2016, we performed 12 TMC arthrodesis procedures with shape-memory staples. The results were evaluated with De La Caffinière's classification and took into account patient satisfaction and any complications. The results were satisfactory overall, without any significant difference between the two fixation methods but with a rather high complication rate. The indication for arthrodesis in surgical treatment of thumb basal joint arthritis is based on the patient's age and occupation. The best indication is a young active patient.
Topics: Arthritis; Arthrodesis; Humans; Patient Satisfaction; Sutures
PubMed: 33401006
DOI: 10.1016/j.hansur.2020.09.010 -
Clinics in Podiatric Medicine and... Jul 2023Despite the increasing popularity of total ankle replacement, ankle arthrodesis remains the gold standard for the treatment of end-stage ankle arthritis. Historically,... (Review)
Review
Despite the increasing popularity of total ankle replacement, ankle arthrodesis remains the gold standard for the treatment of end-stage ankle arthritis. Historically, open techniques have been utilized for ankle arthrodesis. There have been many variations and techniques described, including transfibular, anterior, medial, and miniarthrotomy. Inherent disadvantages to these open techniques include postoperative pain, delayed or nonunion, wound complications, shortening, prolonged healing times, and prolonged hospital stays. Arthroscopic ankle arthrodesis provides the foot and ankle surgeon with an alternative to the traditional open techniques. Arthroscopic ankle arthrodesis has demonstrated faster union rates, decreased complications, reduced postoperative pain, and shorter hospital stays.
Topics: Humans; Ankle; Arthroscopy; Arthritis; Ankle Joint; Arthrodesis; Pain, Postoperative; Retrospective Studies; Treatment Outcome
PubMed: 37236683
DOI: 10.1016/j.cpm.2023.02.001 -
Foot and Ankle Clinics Jun 2022Arthrodesis of the ankle and/or tibiotalocalcaneal joints is a reliable treatment of arthritic conditions of the ankle and hindfoot. It may be complicated by infection,... (Review)
Review
Arthrodesis of the ankle and/or tibiotalocalcaneal joints is a reliable treatment of arthritic conditions of the ankle and hindfoot. It may be complicated by infection, nonunion, malunion, fracture, wound complications, nerve injury, and adjacent joint degeneration. These complications may be addressed with a variety of techniques but should be done so carefully so as not to lead to more complex problems. A thorough work-up and discussion should take place prior to any surgical intervention and treatment. Several cases are presented to illustrate revision arthrodesis techniques and the management of these complications.
Topics: Ankle; Ankle Joint; Arthrodesis; Humans; Osteoarthritis; Retrospective Studies; Subtalar Joint
PubMed: 35680292
DOI: 10.1016/j.fcl.2021.11.020 -
Hand Clinics May 2022Trapeziometacarpal arthrodesis is a beneficial surgery for young and higher-demand patients who have trapeziometacarpal arthritis. Surgical techniques can vary, but... (Review)
Review
Trapeziometacarpal arthrodesis is a beneficial surgery for young and higher-demand patients who have trapeziometacarpal arthritis. Surgical techniques can vary, but certain aspects of the surgery are critical, including bony preparation and positioning of the thumb in space. Reported outcomes are generally favorable, although the quality of evidence is poor. There are no comparison studies assessing different arthrodesis techniques, and only a few comparing arthrodesis to the trapeziometacarpal arthroplasty procedures. Most published results are case series with retrospectively collected data.
Topics: Arthrodesis; Carpometacarpal Joints; Humans; Osteoarthritis; Retrospective Studies; Thumb; Trapezium Bone
PubMed: 35465940
DOI: 10.1016/j.hcl.2021.11.003 -
Clinics in Podiatric Medicine and... Apr 2022The correction of the deformed arthritic foot and ankle is a complicated and somewhat controversial topic. After conservative methods fail, there is a wide range of... (Review)
Review
The correction of the deformed arthritic foot and ankle is a complicated and somewhat controversial topic. After conservative methods fail, there is a wide range of possible bony procedures and arthrodesis that maybe performed. The appropriate work up and understanding of the pathomechanics is vital to the correct choice of procedures to correct these deformities. Once the work up and procedure selection is done, the operation must also be technically performed well and with efficiency, as most often the condition is corrected with a variety of procedures. This article discusses some of the most common procedures necessary to fully correct deformity of the midfoot, hindfoot, and ankle. This article will also discuss the authors' technique and pearls.
Topics: Ankle; Ankle Joint; Arthrodesis; Foot; Humans; Lower Extremity
PubMed: 35365325
DOI: 10.1016/j.cpm.2021.11.011