-
The Journal of Foot and Ankle Surgery :... 2022Large osseous defects of the hindfoot and ankle pose a surgical challenge. Tibiotalocalcaneal (TTC) arthrodesis utilizing a structural allograft may be required to fill... (Meta-Analysis)
Meta-Analysis Review
Large osseous defects of the hindfoot and ankle pose a surgical challenge. Tibiotalocalcaneal (TTC) arthrodesis utilizing a structural allograft may be required to fill the osseous void, preserve limb length and achieve fusion. Several authors have reported small case series on this topic, however outcomes have varied and no systematic review of this data has been published to date. The primary aim of this study is to report rates of osseous union, limb salvage and complications in patients undergoing TTC arthrodesis with a structural allograft. A total of 11 publications were identified that met the inclusion criteria. One hundred seventy-five patients were included with a weighted mean age of 60.5 (range 50-72) years and follow-up period of 29.7 (range 3-62) months. Femoral head allograft was the most commonly utilized structural graft and a retrograde intramedullary nail was the most common fixation construct. Results demonstrated an overall union rate of 67.4%, limb salvage rate of 92.5% and complication rate of 26.6%. Allograft-related complications were rare with an allograft fracture rate of 0.1% and allograft collapse rate of 1.2%. There was no significant difference in union rate when using a retrograde intramedullary nail versus a plate construct (p = .9148). TTC arthrodesis with use of a structural allograft is a viable treatment option for limb salvage when faced with complex hindfoot and ankle pathology involving large osseous defects. Despite high rates of radiographic nonunion, this approach can provide patients with a stable and functional limb while avoiding amputation.
Topics: Allografts; Ankle; Ankle Joint; Arthrodesis; Bone Nails; Child; Child, Preschool; Femur Head; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35585002
DOI: 10.1053/j.jfas.2022.01.003 -
Foot and Ankle Surgery : Official... Feb 2022Arthrodesis and metallic hemiarthroplasty are two surgical interventions for the treatment of end-stage osteoarthritis of the first metatarsophalangeal (MTP1) joint.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Arthrodesis and metallic hemiarthroplasty are two surgical interventions for the treatment of end-stage osteoarthritis of the first metatarsophalangeal (MTP1) joint. This systematic review and meta-analysis aims to compare the two operations with regards to patient-reported outcomes, pain reduction, complications and revision rates.
METHODS
A systematic literature search identified all relevant studies. The methodological quality was assessed using two validated tools. Data of interest were derived and presented. For non-comparative studies, data was assessed for trends, while for comparative studies pooling statistics were performed.
RESULTS
A total of 33 studies were included for analysis. The majority of studies (>75%) reported an AOFAS-HMI score greater than 80 points after both metallic hemiarthroplasty and arthrodesis. The lowest VAS pain score was observed after arthrodesis (weighted mean difference -1.58, 95% confidence interval (CI) -2.16 to -1.00 P< 0.00001). Comparable numbers of complications (odds radio 1.48, 95% CI 0.81 to 2.73, P = 0.21, favoring: hemiarthroplasty) and revisions (odds ratio 1.16, 95% CI 0.62 to 2.15 P = 0.64, favoring: hemiarthroplasty) were observed after both interventions. The included non-comparative studies seem to confirm these findings of the comparative studies.
CONCLUSION
Metallic hemiarthroplasty and arthrodesis have excellent clinical outcomes and acceptable complication- and revision rates. Arthrodesis seems to be superior in pain reduction, while metallic hemiarthroplasty is a suitable alternative for patients performing activities that requires motion in the first metatarsophalangeal joint.
Topics: Arthrodesis; Follow-Up Studies; Hallux Rigidus; Hemiarthroplasty; Humans; Metatarsophalangeal Joint; Retrospective Studies; Treatment Outcome
PubMed: 33812802
DOI: 10.1016/j.fas.2021.03.004 -
BMJ Open Nov 2016Systematic review and meta-analysis of published observational cohort studies. To quantify the increased risk smokers have of experiencing a delayed and/or non-union in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Systematic review and meta-analysis of published observational cohort studies. To quantify the increased risk smokers have of experiencing a delayed and/or non-union in fractures, spinal fusion, osteotomy, arthrodesis or established non-unions.
SETTING
Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Allied and Complementary Medicine Database (AMED) and Web of Science Core Collection from 1966 to 2015.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS
Observational cohort studies that reported adult smokers and non-smokers with delayed and/or non-union or time to union of the fracture, spinal fusion, osteotomy, arthrodesis or established non-union were eligible.
DATA EXTRACTION AND OUTCOME MEASURES
2 authors screen titles, abstracts and full papers. Data were extracted by 1 author and checked independently by a second. The relative risk ratios of smoking versus non-smoking and the mean difference in time to union patients developing a delayed and/or non-union were calculated.
RESULTS
The search identified 3013 articles; of which, 40 studies were included. The meta-analysis of 7516 procedures revealed that smoking is linked to an increased risk of delayed and/or non-union. When considered collectively, smokers have 2.2 (1.9 to 2.6) times the risk of experiencing delayed and/or non-union. In all the subgroups, the increased risk was always ≥1.6 times that of non-smokers. In the patients where union did occur, it was a longer process in the smokers. The data from 923 procedures were included and revealed an increase in time to union of 27.7 days (14.2 to 41.3).
CONCLUSIONS
Smokers have twice the risk of experiencing a non-union after fracture, spinal fusion, osteotomy, arthrodesis or treatment of non-union. Time to union following fracture, osteotomy, arthrodesis or treatment of an established non-union is longer in smokers. Smokers should be encouraged to abstain from smoking to improve the outcome of these orthopaedic treatments.
Topics: Arthrodesis; Fracture Healing; Fractures, Bone; Fractures, Malunited; Fractures, Ununited; Humans; Osteotomy; Postoperative Complications; Risk Factors; Smoking; Surgical Wound Infection
PubMed: 28186922
DOI: 10.1136/bmjopen-2015-010303 -
Journal of Foot and Ankle Research Apr 2022First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end-stage hallux rigidus. It has been postulated to produce good results in the... (Review)
Review
BACKGROUND
First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end-stage hallux rigidus. It has been postulated to produce good results in the literature. Various fixation techniques offer differences in union rates, complications and functional outcomes, stirring debates about which produces the best outcomes for patients. Therefore, this review aims to synthesise and compare the outcomes of modern fixation techniques used for first metatarsophalangeal joint (FMPJ) arthrodesis.
METHODS
The electronic database searched were PubMed, CINAHL, Cochrane Library, and Google Scholar. The critical appraisal skills programme tool for cohort study was used. The interventions consisted of screw(s), plate(s), and staple(s). Studies comprising outdated fixation techniques such as suture, metallic wire, external fixation, Rush rods or Steinmann pins were excluded. Participants were adults over 18 years, undergoing FMPJ arthrodesis in the UK. Studies with the population consisting primarily of revision cases, patients with rheumatoid arthritis or diabetes were excluded.
RESULTS
Seven UK studies included 277 feet and a 95.7% overall union rate at a mean union time of 83.5 days. Staples had the highest union rate of 98.2% at mean union time of 84 days, followed by plates (95.2%, 92 days), and finally screws (94.9%, 71 days). The overall complication incidence is 5.8%. All of the fixation techniques produced good functional outcomes postoperatively.
CONCLUSIONS
Whilst staple techniques showed the highest union rate, plating techniques are preferable over screws or staples for better results across several outcome measures, including reduced complication incidence, stability, early ambulation, and good functional outcome. The Manchester-Oxford Foot Questionnaire and EuroQol-5Dimensional are recommended as measurement tools to assess functional outcomes following FMPJ arthrodesis.
Topics: Adult; Arthrodesis; Cohort Studies; Hallux Valgus; Humans; Metatarsophalangeal Joint; Retrospective Studies; Treatment Outcome
PubMed: 35468802
DOI: 10.1186/s13047-022-00540-9 -
Spine Jul 2008Systematic review of published incidence of radiographic adjacent segment degeneration (ASDeg) and symptomatic adjacent segment disease (ASDis) after arthrodesis or... (Review)
Review
STUDY DESIGN
Systematic review of published incidence of radiographic adjacent segment degeneration (ASDeg) and symptomatic adjacent segment disease (ASDis) after arthrodesis or total disc replacement.
OBJECTIVE
Assess impact of surgery method and other factors on the incidence of ASDeg and ASDis.
SUMMARY OF BACKGROUND DATA
Twenty-seven articles, none of which were class I or II, met the inclusion criteria. Twenty involved arthrodesis (1732 patients) and 7 involved arthroplasty (758 patients). Nineteen detailed ASDeg and 16 detailed ASDis.
METHODS
Data were established for number of patients, gender, average patient age, incidence of ASDeg and ASDis, average time to follow-up, and level and type of surgery. Multivariate logistic regression was used to identify which parameters had a significant effect on the incidence of ASDeg and ASDis.
RESULTS
Three hundred fourteen of 926 patients in the arthrodesis group (34%) and 31 out of 313 patients in the total disc replacement group (9%) developed ASDeg. (P < 0.0001) Multivariate logistic regression indicated that higher odds of ASDeg were associated with: older patients (P < 0.001); arthodesis (P = 0.0008); and longer follow-up (P = 0.0025). For ASDis, 173/1216 (14%) arthrodesis patients developed ASDis compared to 7/595 (1%) of arthroplasty patients (P < 0.0001). Using multivariate logistic regression, higher odds of ASDis were seen in studies with fusion (P < 0.0001), higher percentages of male patients (P = 0.0019), and shorter follow-up (P < 0.05).
CONCLUSION
Analysis of the literature suggests a correlation between fusion and the development of ASDeg compared to arthroplasty, but this association is dampened by the influence of patient age. There is a stronger correlation between fusion and ASDis compared to arthroplasty. The data supports only a class C recommendation (lowest tier) for the use of arthroplasty to reduce ASDis and disc degeneration compared to arthrodesis.
Topics: Arthroplasty, Replacement; Chi-Square Distribution; Diskectomy; Humans; Incidence; Intervertebral Disc; Logistic Models; Lumbar Vertebrae; Postoperative Complications; Prosthesis Implantation; Spinal Fusion
PubMed: 18594464
DOI: 10.1097/BRS.0b013e31817bb956 -
The Journal of Hand Surgery May 2022The purpose of this study was to compare the union rates and clinical outcomes of 4-corner arthrodesis with different methods of osteosynthesis.
PURPOSE
The purpose of this study was to compare the union rates and clinical outcomes of 4-corner arthrodesis with different methods of osteosynthesis.
METHODS
A systematic review of studies published in Ovid, Medline, Embase, and PubMed was conducted. Primary studies that reported clinical and radiographic results following 4-corner arthrodesis for scapholunate advanced collapse (SLAC), scaphoid nonunion advanced collapse (SNAC), or other types of wrist arthritis in human subjects were eligible. Biomechanical or cadaveric studies, case reports, studies that did not define and report a radiographic union rate, reviews and technical articles, studies that did not report the method of osteosynthesis, and studies that used multiple methods of osteosynthesis, but did not separate results for individual methods of osteosynthesis were excluded. Radiographic union rate, range of motion, and grip strength were analyzed.
RESULTS
We identified and reviewed 291 full texts, selecting 57 studies for coding. The radiographic union rate did not significantly differ between studies using K-wire, screw, staple, nonlocking plate, metal locking plate, and radiolucent locking plate osteosynthesis. Fixation method significantly affected flexion, but pairwise comparison did not reveal any significant differences between individual groups. Grip strength as a percentage of the contralateral limb was significantly lower in studies with metal locking plate fixation compared to K-wire fixation (63.2% vs 82.6%). There were no other statistically significant differences between groups with respect to flexion, extension, radial deviation, ulnar deviation, and grip strength.
CONCLUSIONS
All methods of osteosynthesis result in similar union rates, with no significant differences between methods. While there are some significant differences in range of motion and grip strength, these differences are unlikely to be clinically relevant.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic IV.
Topics: Arthrodesis; Bone Plates; Hand Strength; Humans; Range of Motion, Articular; Retrospective Studies; Scaphoid Bone; Wrist Joint
PubMed: 34253392
DOI: 10.1016/j.jhsa.2021.06.002 -
Journal of Shoulder and Elbow Surgery Jun 2024The purpose of this study was to systematically review the evidence in the literature to determine the clinical outcomes following glenohumeral arthrodesis.
BACKGROUND
The purpose of this study was to systematically review the evidence in the literature to determine the clinical outcomes following glenohumeral arthrodesis.
METHODS
Two independent reviewers performed a literature search in the PubMed database based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were included if they reported on outcomes following shoulder arthrodesis from the years of 2000-2022. Functional outcomes that were collected included the Subjective Shoulder Value, American Shoulder and Elbow Surgeons shoulder index score, visual analog scale pain score, and Oxford Shoulder Score. Range-of-motion data were also collected.
RESULTS
This review included 17 studies, with a total of 316 patients, that met the inclusion criteria. The majority of the patients were male (67.4%), and the average age was 38.4 years (range, 7-82 years). The overall fusion rate was 88.7%, and the time to fusion was on average, 3.9 months (range, 2-8 months). Shoulder arthrodesis resulted in improvement in each of the functional outcomes assessed: Subjective Shoulder Value (preoperatively, 18.8; postoperatively, 43.9; and percent change, 132.8%), American Shoulder and Elbow Surgeons shoulder index score (postoperatively, 62.1), visual analog scale pain score (preoperatively, 8.5; postoperatively, 3.03; and percent change, 62.4%), and Oxford Shoulder Score (preoperatively, 9.4; postoperatively, 30.9; and percent change, 328.7%). The abduction, forward flexion, external rotation, and internal rotation range-of-motion measurements postoperatively were 57°, 64°, 3°, and 48°, respectively. Complications were reported in 33.6% of patients, with fractures (20.9%) and infections (18.6%) being the most common sources of complication.
CONCLUSION
Shoulder arthrodesis provides improvement in functional outcomes for end-stage glenohumeral injuries; however, it is also associated with high rates of complications.
Topics: Aged; Humans; Male; Arthrodesis; Postoperative Complications; Range of Motion, Articular; Shoulder Joint; Treatment Outcome
PubMed: 38104717
DOI: 10.1016/j.jse.2023.10.025 -
Foot (Edinburgh, Scotland) May 2023Osteoarthritis is the most common joint disease-causing pain and disability, and its management keeps creating a debate. So, we aimed to compare the safety and efficacy... (Meta-Analysis)
Meta-Analysis Review
Osteoarthritis is the most common joint disease-causing pain and disability, and its management keeps creating a debate. So, we aimed to compare the safety and efficacy of total ankle arthroplasty and ankle arthrodesis for ankle osteoarthritis. We searched PubMed, Cochrane, Scopus, and Web of Science till August 2021. The outcomes were pooled as Mean difference (MD) or Risk Ratio (RR), and 95% confidence interval. We included 36 studies. The results showed a significantly lower risk of infections in total ankle arthroplasty (TAA) than ankle arthrodesis (AA) (RR= 0.63, 95% CI [0.57, 0.70], p < 0.00001), amputations (RR= 0.40, 95% CI [0.22, 0.72], p = 0.002), postoperative non-union (RR= 0.11, 95% CI [0.03, 0.34], p = 0.0002), and a significant increase of overall range of motion in TAA than AA. Our results preferred total ankle arthroplasty over ankle arthrodesis in terms of lowering the rates of infections, amputations, and postoperative non-union, with better change in the overall range of motion.
Topics: Humans; Ankle Joint; Ankle; Treatment Outcome; Arthroplasty, Replacement, Ankle; Osteoarthritis; Arthrodesis; Retrospective Studies
PubMed: 36863247
DOI: 10.1016/j.foot.2023.101980 -
Journal of Neurosurgery. Spine Sep 2015The object of this study was to determine the fusion rate and safety profile of an axial interbody arthrodesis of the L5-S1 motion segment. (Review)
Review
OBJECT
The object of this study was to determine the fusion rate and safety profile of an axial interbody arthrodesis of the L5-S1 motion segment.
METHODS
A systematic search of MEDLINE was conducted for literature published between January 1, 2000, and August 17, 2014. All peer-reviewed articles related to the fusion rate of L5-S1 and the safety profile of an axial interbody arthrodesis were evaluated.
RESULTS
Seventy-four articles were identified, but only 15 (13 case series and 2 retrospective cohort studies) met the study inclusion criteria. The overall pseudarthrosis rate at L5-S1 was 6.9%, and the rate of all other complications was 12.9%. A total of 14.4% of patients required additional surgery, and the infection rate was 5.4%. Deformity studies reported a significantly increased rate of complications (46.3%), and prospectively collected data demonstrated significantly higher complication (36.8%) and revision (22.6%) rates. Lastly, studies with a conflict of interest reported lower complication rates (12.4%).
CONCLUSIONS
A systematic review of the literature indicates that an axial interbody fusion performed at the lumbosacral junction is associated with a high fusion rate (93.15%) and an acceptable complication rate (12.90%). However, these results are based mainly on retrospective case series by authors with a conflict of interest. The limited prospective data available indicate that the actual fusion rate may be lower and the complication rate may be higher than currently reported.
Topics: Humans; Lumbar Vertebrae; Reoperation; Sacrum; Spinal Fusion; Treatment Outcome
PubMed: 26068275
DOI: 10.3171/2015.1.SPINE14900 -
Foot & Ankle International Aug 2020There is no consensus regarding participation in sports and recreational activities following total ankle replacement (TAR) and ankle arthrodesis (AA). This systematic...
BACKGROUND
There is no consensus regarding participation in sports and recreational activities following total ankle replacement (TAR) and ankle arthrodesis (AA). This systematic review summarizes the evidence on return to sports and activity after operative management with either TAR or AA for ankle osteoarthritis (OA).
METHODS
A literature search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed. Risk of bias of included studies was assessed using Methodological Index for Non-Randomized Studies (MINORS) criteria. Included studies reported sport and activity outcomes in patients undergoing TAR and AA, with primary outcomes being the percentage of sports participation and level of sports participation.
RESULTS
Twelve studies met inclusion criteria for analysis. There were 1270 ankle procedures, of which 923 TAR and 347 AA were performed. The mean reported patient age was 59.2 years and the mean BMI was 28 kg/m. The mean follow-up was 43 months. Fifty-four percent of patients were active in sports preoperatively compared with 63.7% postoperatively. The mean preoperative activity participation rate was 41% in the TAR cohort, but it improved to 59% after TAR, whereas the preoperative activity participation rate of 73% was similar to the postoperative rate of 70% in the AA cohort. The most common sports in the TAR and AA groups were swimming, hiking, cycling, and skiing.
CONCLUSION
Participation in sports activity was nearly 10% improved after operative management of ankle OA with TAR and remains high after AA. The existing literature demonstrated a large improvement in pre- to postoperative activity levels after TAR, with minimal change in activity after AA; however, AA patients were more active at baseline. The most frequent postoperative sports activities after operative management of ankle OA were swimming, hiking, cycling, and skiing. Participation in high-impact sports such as tennis, soccer, and running was consistently limited after surgery. This review of the literature will allow patients and foot and ankle surgeons to set evidence-based goals and establish realistic expectations for postoperative physical activity after TAR and AA.
LEVEL OF EVIDENCE
Level III, systematic review.
Topics: Adult; Aged; Aged, 80 and over; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Athletic Injuries; Female; Humans; Male; Middle Aged; Return to Sport; Walking
PubMed: 32501110
DOI: 10.1177/1071100720927706