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The Journal of Foot and Ankle Surgery :... 2021During traditional fusion procedures surgeons initially perform a joint resection and then the structures are realigned for correction of deformity. The procedure... (Review)
Review
During traditional fusion procedures surgeons initially perform a joint resection and then the structures are realigned for correction of deformity. The procedure described herein by the author reverses this traditional surgical approach by first realigning the joint to correct deformity, then after achieving a corrected alignment, joint resection is performed in parallel without wedging. Realigning deformity as an initial step creates the conditions for an in-situ fusion wherein the deformity is corrected simultaneously with parallel bone resection. The purpose of this paper is to review the advantages and technical aspects of a realignment arthrodesis technique in which joint resection begins with the foot in the corrected position. This approach to joint fusion has been shown to simplify bone resection, eliminate post-resection adjustments, create full apposition of fusion surfaces, reliably correct deformity, and result in solid arthrodesis. The technique provides for immediate correction of deformity and is amenable for conditions that require either minimal or significant segmental shortening. There are many areas where the "Realign-resect" approach to joint fusion would be well suited. Full implementation of this technique may be particularly useful to the surgeon who does not have seasoned assistants in the operating room.
Topics: Arthrodesis; Foot; Humans
PubMed: 33685765
DOI: 10.1053/j.jfas.2021.02.002 -
Foot and Ankle Clinics Jun 2022Hallux rigidus can be treated with a variety of surgical procedures, including joint preserving techniques, arthrodesis, and arthroplasty. The most commonly reported... (Review)
Review
Hallux rigidus can be treated with a variety of surgical procedures, including joint preserving techniques, arthrodesis, and arthroplasty. The most commonly reported complications for joint preserving techniques consist of progression of arthritis, continued pain, and transfer metatarsalgia. Although good outcomes have been reported for arthrodesis overall, careful attention must be paid to technique and positioning of the toe to avoid nonunion or malunion. Arthroplasty preserves motion but in the case of failure can present the additional challenge of bone loss. In these scenarios, the authors recommend distraction bone block arthrodesis with structural autograft.
Topics: Arthrodesis; Arthroplasty; Hallux Rigidus; Humans; Metatarsalgia; Metatarsophalangeal Joint
PubMed: 35680287
DOI: 10.1016/j.fcl.2021.11.016 -
Clinics in Podiatric Medicine and... Apr 2022There has been significant enhancement in surgical management of hallux valgus deformity. Recognition of the role of medial column hypermobility has resulted in better... (Review)
Review
There has been significant enhancement in surgical management of hallux valgus deformity. Recognition of the role of medial column hypermobility has resulted in better functional outcomes with decreased risk of recurrence. Modern techniques have evolved to include enhanced fixation in a move toward minimal postoperative downtime. Evolution to include true triplane correction, including frontal plane derotation of the first ray, has resulted in optimal functional outcomes. The addition of anatomic triplane restoration, enhanced internal fixation, and early return to weight-bearing activities are combined resulting in lifelong correction with excellent functional outcomes and a high degree of patient satisfaction.
Topics: Arthrodesis; Bunion; Hallux; Hallux Valgus; Humans; Weight-Bearing
PubMed: 35365323
DOI: 10.1016/j.cpm.2021.11.009 -
The Journal of Hand Surgery Mar 2022Scaphotrapeziotrapezoid (STT) arthrodesis surgery is used for various types of wrist pathologies. The objective of our study was to perform a systematic review of...
PURPOSE
Scaphotrapeziotrapezoid (STT) arthrodesis surgery is used for various types of wrist pathologies. The objective of our study was to perform a systematic review of complications and outcomes after STT arthrodesis.
METHODS
Several major databases were used to perform a systematic literature review in order to obtain articles reporting complications and outcomes following STT arthrodesis. The primary purpose was to identify rates of nonunion and conversion to total wrist arthrodesis. Secondary outcomes included wrist range of motion, grip strength, and Disabilities of the Arm Shoulder and Hand scores. A multivariable analysis was performed to evaluate factors associated with the primary and secondary outcomes of interest.
RESULTS
Out of the 854 records identified in the primary literature search, 30 studies were included in the analysis. A total of 1,429 procedures were performed for 1,404 patients. The pooled nonunion rate was 6.3% (95% CI, 3.5-9.9) and the rate of conversion to total wrist arthrodesis following the index STT was 4.2% (95% CI, 2.2-6.7). The mean pooled wrist flexion was 40.7° (95% CI, 30.8-50.5) and extension was 49.7° (95% CI, 43.5-55.8). At final follow-up, the mean pooled grip strength was 75.9% (95% CI, 69.3-82.5) of the nonsurgical contralateral hand. Compared with all other known indications, Kienbock disease had a statistically significant lower nonunion rate (14.1% vs 3.3%, respectively). Mixed-effects linear regression using patient-level data revealed that increasing age was significantly associated with complications, independent of occupation and diagnosis.
CONCLUSIONS
Our study demonstrated a low failure rate and conversion to total wrist arthrodesis after STT arthrodesis and acceptable postoperative wrist range of motion and strength when compared to the contralateral hand.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Arthrodesis; Hand Strength; Humans; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Wrist Joint
PubMed: 35033404
DOI: 10.1016/j.jhsa.2021.09.029 -
Foot and Ankle Clinics Dec 2022Chronic injuries at the tarsometatarsal joint represent a wide array of painful malunions ranging from isolated instability to complex three-dimensional deformities with... (Review)
Review
Chronic injuries at the tarsometatarsal joint represent a wide array of painful malunions ranging from isolated instability to complex three-dimensional deformities with rapid development of posttraumatic arthritis. Deformity correction and arthrodesis of the symptomatic joints leads to significant pain reduction and functional improvement provided that realignment of the anatomic axes is achieved. Arthrodesis should be limited to the first to third tarsometatarsal joints, whereas interposition arthroplasty is preferred for symptomatic arthritis of the fourth to fifth tarsometatarsal joints. For complex deformities and instability, the intercuneiform and naviculocuneiform joints may need to be included into corrective fusion.
Topics: Humans; Arthrodesis; Foot Joints; Joint Dislocations; Fractures, Bone; Arthritis
PubMed: 36368795
DOI: 10.1016/j.fcl.2022.07.002 -
Seminars in Musculoskeletal Radiology Jun 2022Postoperative ankle imaging requires knowledge of the underlying surgical techniques, the usefulness of various imaging modalities, as well as an appreciation for the...
Postoperative ankle imaging requires knowledge of the underlying surgical techniques, the usefulness of various imaging modalities, as well as an appreciation for the desired clinical outcomes. Surgical procedures discussed in this article are tibiotalar fracture fixation, tibiotalar, subtalar, and tibiotalocalcaneal arthrodesis, total ankle arthroplasty, talar osteochondral lesion repair and grafting, lateral ligamentous repair and reconstruction, and peroneal and Achilles tendon repair and reconstruction. Imaging can play a vital role in determining if the expected outcome has been achieved and identifying complications, with particular emphasis placed on the use of radiographs, computed tomography (including weight-bearing), magnetic resonance imaging, and ultrasonography.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Radiography
PubMed: 35654090
DOI: 10.1055/s-0042-1750841 -
Foot and Ankle Clinics Dec 2022Tibiotalocalcaneal arthrodesis (TTCA) is the most common and reliable procedure in the treatment of patients with end-stage ankle arthritis combined with severe... (Review)
Review
Tibiotalocalcaneal arthrodesis (TTCA) is the most common and reliable procedure in the treatment of patients with end-stage ankle arthritis combined with severe deformity. Many of these patients present with difficult previous sequelae that include nonunion, malunion, broken implants, vascular deficiencies, skin problems, or a combination of the previous. In that complex scenario, sometimes the only alternative treatment is a below-the-knee amputation. Image studies--weightbearing X-rays, tomography, and magnetic resonance - are fundamental to evaluate alignment and bone stock. When all conservative treatments fail to alleviate pain and dysfunction, the combination of osteotomies and arthrodesis is the procedure of choice. Surgical planning needs to be very detailed and thorough with a special focus on bone loss after debridement of non-healthy tissue and removal of metalwork. TTCA with grafting allows for the preservation of the limb in more than 80% of cases but at the expense of many complications with nonunion rates of approximately 20% of cases. There is controversy about the use of a retrograde nail versus specific TTCA plate and screws but results from biomechanical studies do not show a clear superiority of one specific construct. Amputation rates are close to 5% of cases after repeated failed surgeries. Bulk allografts increase the rate of nonunions but apparently do not have an influence on postoperative infections. Valgus positioning of the ankle/hindfoot is paramount to allow for maximal sagittal plane compensation from the midtarsal joints. Most patients are satisfied with the results of these salvage operations. The studies presented in this article have a considerable wide array of different scenarios that obviously bias some of the results, complications, and outcomes but together they present a persuasive pattern toward considering TTC with grafting and nail or plate fixation as a good salvage procedure that may help the patients to maintain their foot and ankle with a better alignment, function, and pain relief.
Topics: Humans; Retrospective Studies; Arthrodesis; Ankle Joint; Foot; Treatment Outcome
PubMed: 36368801
DOI: 10.1016/j.fcl.2022.08.008 -
Foot and Ankle Clinics Mar 2022Open ankle arthrodesis remains a reliable solution for ankle arthritis, especially in the setting of deformity. Careful preoperative evaluation needs to be performed,... (Review)
Review
Open ankle arthrodesis remains a reliable solution for ankle arthritis, especially in the setting of deformity. Careful preoperative evaluation needs to be performed, both clinically and radiographically. The specific deformity present helps determine the approach used and the fixation choices. Deformity is most commonly seen intraarticularly, though deformity can also be present anywhere along the lower extremity, including compensatory deformity in the foot. Multiple different techniques can be used to address both the deformity and achieve a successful ankle arthrodesis. Patient outcomes reported in the literature are generally good, with high union rates and improved functional outcomes.
Topics: Ankle; Ankle Joint; Arthritis; Arthrodesis; Humans; Retrospective Studies
PubMed: 35219366
DOI: 10.1016/j.fcl.2021.11.009 -
Foot and Ankle Clinics Dec 2022Charcot neuroarthropathy (CN) is a systemic disease that causes fractures, dislocations, and deformities involving the foot and ankle, resulting in substantial risk of... (Review)
Review
Charcot neuroarthropathy (CN) is a systemic disease that causes fractures, dislocations, and deformities involving the foot and ankle, resulting in substantial risk of ulceration, infection, and function loss. Early recognition and prevention of collapsing foot and ankle are still the best options for the management of patients with diabetic CN. For a successful arthrodesis procedure, the principles of adequate joint preparation, deformity correction, and soft tissue protection and care are essentials, associated with robust fixation (internal and/or external), use of different biological graft options in segmental losses, and prolonged off-loading.
Topics: Humans; Arthropathy, Neurogenic; Diabetic Foot; Arthrodesis; Ankle Joint; Ankle
PubMed: 36368800
DOI: 10.1016/j.fcl.2022.08.005 -
Foot and Ankle Clinics Mar 2024The debate between ankle arthrodesis and total ankle replacement for patients with end-stage arthritis of the ankle joint is an ongoing topic in orthopedic surgery.... (Review)
Review
The debate between ankle arthrodesis and total ankle replacement for patients with end-stage arthritis of the ankle joint is an ongoing topic in orthopedic surgery. Ankle arthrodesis, or fusion, has been the traditional treatment for ankle arthritis. It involves fusing the bones of the ankle joint together, eliminating the joint and creating a solid bony union. Arthrodesis is effective in reducing pain in the ankle, but it results in a loss of ankle motion. This can increase the load on adjacent joints, such as the subtalar joint, which may lead to accelerated degeneration and arthritis in those joints over time.
Topics: Humans; Arthroplasty, Replacement, Ankle; Treatment Outcome; Ankle Joint; Ankle; Arthritis; Subtalar Joint; Arthrodesis; Retrospective Studies
PubMed: 38309799
DOI: 10.1016/j.fcl.2023.08.007