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Foot & Ankle International Oct 2023Although hindfoot arthrodeses relieve pain and correct deformity, they have been associated with progressive tibiotalar degeneration. The objective was to quantify...
BACKGROUND
Although hindfoot arthrodeses relieve pain and correct deformity, they have been associated with progressive tibiotalar degeneration. The objective was to quantify changes in tibiotalar kinematics after hindfoot arthrodeses, both isolated subtalar and talonavicular, as well as double arthrodesis, and to determine if the order of joint fixation affects tibiotalar kinematics.
METHODS
Hindfoot arthrodeses were performed in 14 cadaveric mid-tibia specimens. Specimens randomly received isolated fixation of the subtalar or talonavicular joint first, followed by fixation of the remaining joint for the double arthrodesis. A 6-degree-of-freedom robot sequentially simulated the stance phase of level walking for intact, isolated, and double arthrodesis conditions. Tibiotalar kinematic changes were compared for the intact and arthrodesis conditions. A subsequent analysis assessed the effect of the joint fixation order on tibiotalar kinematics.
RESULTS
Isolated and double hindfoot arthrodeses increased tibiotalar plantarflexion, inversion, and internal rotation during late stance. Tibiotalar kinematics changes occurring after isolated arthrodesis remained consistent after the double arthrodesis for both the subtalar- and talonavicular-first conditions. The order of joint fixation influenced tibiotalar kinematics through some portions of stance, where the talonavicular-first double arthrodesis increased tibiotalar plantarflexion, eversion, and internal rotation compared to the subtalar-first double.
CONCLUSION
Tibiotalar kinematics were modestly altered for all conditions, both isolated and double hindfoot arthrodeses. Changes in tibiotalar kinematics were consistent from the isolated to the double arthrodesis conditions and varied depending on which isolated hindfoot arthrodesis was performed first. Further research is needed to assess the clinical implications of the observed changes in tibiotalar kinematics, particularly as it pertains to the development of adjacent joint arthritis.
CLINICAL RELEVANCE
These findings may correlate with clinical research that has cited hindfoot arthrodesis as a risk factor for adjacent tibiotalar arthritis. Once either the subtalar or talonavicular joint is fused, avoiding the arthrodesis of the second joint may not necessarily protect the tibiotalar joint.
Topics: Humans; Ankle Joint; Biomechanical Phenomena; Foot; Arthritis; Arthrodesis; Subtalar Joint
PubMed: 37542424
DOI: 10.1177/10711007231184224 -
Journal of Orthopaedic Surgery and... May 2020Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden.... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis.
METHODS
For the systematic review, a literature search was conducted in 4 English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Three prospective cohort studies and 7 retrospective cohort studies, enrolling a total of 507 patients with ankle arthritis, were included.
RESULTS
For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003).
CONCLUSION
In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, and shorter length of hospitalisation than open surgery.
Topics: Ankle Joint; Arthrodesis; Arthroscopy; Humans; Length of Stay; Osteoarthritis; Prospective Studies; Retrospective Studies
PubMed: 32448398
DOI: 10.1186/s13018-020-01708-4 -
The Journal of Hand Surgery, European... Mar 2022A retrospective study compared outcomes of total wrist arthrodesis as a salvage for total wrist arthroplasty versus primary total wrist arthrodesis. Seventy-one wrists...
A retrospective study compared outcomes of total wrist arthrodesis as a salvage for total wrist arthroplasty versus primary total wrist arthrodesis. Seventy-one wrists were reviewed after a minimum follow-up of 12 months. Thirty-two wrists with failed total wrist arthroplasty were converted to a wrist arthrodesis and 39 wrists received a primary wrist arthrodesis. Seven converted wrist arthrodeses and five primary arthrodeses failed to fuse. Mean patient-rated wrist and hand evaluation scores and work-related questionnaire for upper extremity disorders scores were 43 and 39 for converted total wrist arthrodesis and 38 and 33 for the primary total wrist arthrodesis. Overall, there were 25 complications in 15 patients in the converted wrist arthrodesis group and 21 complications in 16 patients after a primary wrist arthrodesis. The results between the two groups were slightly in favour of patients with a primary wrist arthrodesis. Therefore, we conclude that the timing, primary or conversion, of total wrist arthrodesis could influence patient outcomes. III.
Topics: Arthrodesis; Arthroplasty, Replacement; Humans; Retrospective Studies; Treatment Outcome; Wrist; Wrist Joint
PubMed: 34796775
DOI: 10.1177/17531934211057389 -
Foot and Ankle Surgery : Official... Jul 2024First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly utilised procedure. In this study, the authors aim to explore functional outcomes of patients undergoing...
BACKGROUND
First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly utilised procedure. In this study, the authors aim to explore functional outcomes of patients undergoing nonsynchronous bilateral first MTPJ arthrodesis under the care of a single surgeon using a compression screw/locking plate construct.
METHODS
This is a prospectively collected, retrospectively analysed case series of fifty five patients who underwent bilateral nonsynchronous first MTPJ arthrodesis. Clinical and radiological outcomes were assessed preoperatively and at a minimum of two years postoperatively. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), the Self-Reported Foot and Ankle Score (SEFAS) and the Sports Questionnaire version 1 (SQ). Postoperative radiographs were used to assess evidence of union and compare both hallux valgus and intermetatarsal angles. Removal of hardware, revision surgery and correction of deformities were also recorded.
RESULTS
Fifty five patients were included in the study. There was statistically significant improvements in all five facets of the FAOS (p value < 0.05). The mean postoperative SEFAS was 45.1. In total, patients participated in thirteen different sporting activities. This represented 92 patient specific activities preoperatively and 104 postoperatively. The most common activities were walking, cycling and swimming. Overall, 94.5% (N = 52) of the cohort were satisfied with their return to sport while 98.2% (N = 54) would recommend bilateral first MTPJ arthrodesis. Mean reductions in hallux valgus angles and intermetatarsal angles were noted at 18.87 and 4.69 degrees respectively. There was one non-union in the cohort which required revision surgery. One patient required removal of hardware.
CONCLUSIONS
Bilateral first MTPJ arthrodesis is a safe and effective surgical option for patients with bilateral first MTPJ pathology. It has a high union rate, low complication rate and significantly improves clinical outcomes and allows patients reliably return to physical activities.
Topics: Humans; Arthrodesis; Metatarsophalangeal Joint; Female; Male; Middle Aged; Retrospective Studies; Hallux Valgus; Adult; Aged; Treatment Outcome; Radiography; Bone Screws; Bone Plates
PubMed: 38458912
DOI: 10.1016/j.fas.2024.02.014 -
Medicina (Kaunas, Lithuania) Feb 2023The treatment of end-stage ankle osteoarthritis (OA) and associated hindfoot deformities remains a major challenge for orthopedic surgeons. Numerous techniques and...
BACKGROUND AND OBJECTIVES
The treatment of end-stage ankle osteoarthritis (OA) and associated hindfoot deformities remains a major challenge for orthopedic surgeons. Numerous techniques and surgical approaches have been proposed for tibiotalar (TT) and tibiotalocalcaneal (TTC) arthrodesis, from arthroscopic to open, as well as numerous devices proposed for internal fixation (retrograde intramedullary nails, cannulated screws, and plating systems). The aim of this study was to retrospectively analyze the results, with at least 18 months of follow-up, with Silverback TT/TTC Plating System Paragon28 in a group of 20 patients with severe OA and hindfoot deformities (mainly secondary post-traumatic OA).
MATERIALS AND METHODS
The demographic characteristics and past medical history of the patients were collected and analyzed to identify the cause of the pathology. The degree of OA and deformity were quantified based on foot and ankle weight-bearing radiography and CT examination. Pre- and post-operative clinical and functional scores (ROM, VAS, AOFAS, FFI, and SF-36) and radiographic parameters (anterior distal tibial angle, tibiotalar angle, coronal tibiotalar angle, and hindfoot alignment angle) were evaluated.
RESULTS
All of the patients showed clinical and radiographic fusion at an average of 14 weeks (range 12-48), with improvement in pain and functional scores, without major surgical complications and/or infections.
CONCLUSIONS
Despite the limitations of our study, the results with this new plating system showed good results in terms of bone consolidation, post-operative complications, and improvement of pain and quality of life in patients with severe OA and deformities of the ankle and hindfoot.
Topics: Humans; Ankle; Retrospective Studies; Quality of Life; Ankle Joint; Osteoarthritis; Arthrodesis; Treatment Outcome
PubMed: 36837544
DOI: 10.3390/medicina59020344 -
International Orthopaedics Mar 2022Arthroscopic ankle arthrodesis is known to offer high fusion rates, improvements in pain and functional outcomes, low risks of complications, and reinterventions. The... (Comparative Study)
Comparative Study
PURPOSE
Arthroscopic ankle arthrodesis is known to offer high fusion rates, improvements in pain and functional outcomes, low risks of complications, and reinterventions. The aim of this study is to compare open vs. arthroscopic ankle arthrodesis in patients at high risk of complications.
METHODS
A single-centre retrospective comparative analysis of ankle fusions was conducted. Patient records were screened for demographics, type of arthrodesis, follow-up length, pre-operative diagnosis, risk factors for non-union, operative time, radiographic union, time to union, complications, and reinterventions. The American Orthopedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Italian version of the Foot Function Index (FFI), and a visual analog scale (VAS) for pain scores collected pre-operatively and in the last follow-up were used to assess clinical outcomes.
RESULTS
There were 23 open and 21 arthroscopic ankle fusions. Union rate was higher (90.5% vs. 65.2%, p < 0.05) and complication rate was lower (14.3% vs. 47.8%, p < 0.05) in the arthroscopic group. In addition, patients who underwent arthroscopic arthrodesis reported better pain control, with higher improvements in VAS for pain scores. There was no significant difference in length of operative time, time to fusion, AOFAS, and FFI scores improvements between the two groups.
CONCLUSIONS
Arthroscopic ankle arthrodesis resulted in higher union rates, fewer complications, and lower reoperation rates in patients at high risk of complications.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroscopy; Humans; Retrospective Studies; Treatment Outcome
PubMed: 34611735
DOI: 10.1007/s00264-021-05233-9 -
Journal of Anesthesia Dec 2021Ankle arthrodesis and total ankle arthroplasty (TAA) are often associated with significant postoperative pain. While this may be mitigated by the use of peripheral nerve...
PURPOSE
Ankle arthrodesis and total ankle arthroplasty (TAA) are often associated with significant postoperative pain. While this may be mitigated by the use of peripheral nerve blocks (PNB), large-scale data are lacking. Using national data, we aimed to evaluate PNB utilization pattern and its impact on outcomes.
METHODS
This retrospective cohort study utilized data from the nationwide database (2006-2016) on TAA (n = 5,290) and ankle arthrodesis (n = 14,709) procedures. PNB use was defined from billing; outcomes included opioid utilization, length and cost of stay, discharge to a skilled nurse facility, and opioid-related complications. Mixed-effects models estimated the association between PNB use and outcomes, separate by procedure type and inpatient/outpatient setting. We report odds ratios and 95% confidence intervals (CI).
RESULTS
Overall, PNB was utilized in 8.7% of TAA and 9.9% of ankle arthrodesis procedures, with increased utilization from 2006 to 2016 of 2.6% to 11.3% and 5.2% to 12.0%, respectively. After adjustment for relevant covariates, PNB use was significantly associated with decreased total opioid utilization specifically in the inpatient setting in TAA ( - 16.9% CI - 23.9%; - 9.1%) and ankle arthrodesis procedures ( - 18.9% CI - 24.4; - 13.0%), this was particularly driven by a decrease in opioid utilization on the day of surgery. No clinically relevant effects were observed for other outcomes.
CONCLUSION
PNB utilization is associated with substantial reductions in opioid utilization, particularly in the inpatient setting. Our study is in support of a wider use of this analgesic technique, which may translate into more benefits in terms of clinical outcomes and resource utilization.
LEVEL OF EVIDENCE
III.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Peripheral Nerves; Retrospective Studies
PubMed: 34480661
DOI: 10.1007/s00540-021-02994-w -
Archives of Orthopaedic and Trauma... Oct 2023Sixty-eight patients with seventy-one total wrist fusions were retrospectively reviewed with a mean follow-up of 11.7 years. The main purpose of this study was to...
Sixty-eight patients with seventy-one total wrist fusions were retrospectively reviewed with a mean follow-up of 11.7 years. The main purpose of this study was to determine long-term functional results and define possible reasons for remaining pain. Except one asymptomatic non-union, all wrist fusions united. The long-term functional result averaged 30 points using the DASH score and appears to be more favorable compared to midterm results in another publication from this department. Only 15 patients were completely free of pain. Most patients complained about remaining pain during strong activities with a mean VAS of 4/10 that could not further been defined on clinical or radiological examinations. Patients with more than two previous operations had a significant worse outcome concerning the modified Mayo wrist score [≤ 1 operation mean 61 points vs. ≥ 2 operations mean 56 points (Mann-Whitney U test: p = 0.009)] and PRWE-G [≤ 1 operation mean 27 points vs. ≥ 2 operations mean 37 points (t test: p = 0.047)] and furthermore a downward trend for worse DASH [≤ 1 operation mean 265 points vs. ≥ 2 operations mean 35 points (t test: p = 0.086)] results. Despite the loss of wrist motion and remaining pain, patients were highly satisfied with the long-term result and 93% would undergo the operation again.
Topics: Humans; Wrist; Treatment Outcome; Retrospective Studies; Arthrodesis; Wrist Joint; Pain; Range of Motion, Articular; Follow-Up Studies
PubMed: 37344687
DOI: 10.1007/s00402-023-04938-3 -
Foot and Ankle Clinics Dec 2023The cavovarus foot is a complex deformity that can be treated using multiple surgical procedures, ranging from soft tissue surgery to triple arthrodesis. Among these... (Review)
Review
The cavovarus foot is a complex deformity that can be treated using multiple surgical procedures, ranging from soft tissue surgery to triple arthrodesis. Among these options, anterior midfoot tarsectomy is a three-dimensional closed-wedge osteotomy, traditionally performed slowly and progressively in a blind fashion, and remaining a challenge for unexperimented surgeons with variable outcomes. As such, we investigated and discussed the use of patient-specific cutting guides (PSCGs) in computer-assisted anterior midfoot tarsectomy in terms of accuracy, reproducibility, and safety.
Topics: Humans; Reproducibility of Results; Foot; Arthrodesis; Osteotomy
PubMed: 37863535
DOI: 10.1016/j.fcl.2023.05.003 -
Foot and Ankle Clinics Dec 2023The aim of hindfoot fusions in the cavovarus foot is to establish a painless, plantigrade, balanced and stable foot. A comprehensive clinical and radiographic assessment... (Review)
Review
The aim of hindfoot fusions in the cavovarus foot is to establish a painless, plantigrade, balanced and stable foot. A comprehensive clinical and radiographic assessment enables the surgeon to fully understand the patient's deformity and plan a reliable surgical strategy for deformity correction. Pre-operative planning and intraoperative techniques are discussed.
Topics: Humans; Talipes Cavus; Foot; Foot Deformities; Osteotomy; Arthrodesis
PubMed: 37863536
DOI: 10.1016/j.fcl.2023.05.004