-
Foot & Ankle International Jun 2007Arthroscopic arthrodesis has been used mainly for in situ fusion of arthritic ankles without deformity. This paper presents the application of arthroscopic arthrodesis...
BACKGROUND
Arthroscopic arthrodesis has been used mainly for in situ fusion of arthritic ankles without deformity. This paper presents the application of arthroscopic arthrodesis of ankles with marked deformity.
METHODS
The results of 78 consecutive cases of arthroscopic ankle arthrodeses, performed in 74 patients, were retrospectively evaluated. Forty-eight ankles had minor deformity (group A), whereas 30 ankles had a varus or valgus deformity of more than 15 degrees (maximum 45 degrees) (group B). The average hospital stay was 3.8 and 3.4 days in groups A and B, respectively (p = 0.74). Postoperative treatment included ankle immobilization for 3 months. Progressive weightbearing was initiated at 2 weeks. Mean followup was 21.1 months.
RESULTS
Fusion occurred in 47 of 48 (97.9%) ankles in group A at an average time of 13.1 +/- 5.8 weeks and in 29 of 30 (96.7%) ankles at 11.6 +/- 2.4 weeks in group B (p = 0.19). Unplanned operative procedures were required in 11 ankles (14.1%). One superficial wound infection occurred. Symptomatic arthritis from the adjacent joints developed in six ankles (7.7%). Postoperative ankle alignment in the frontal plane averaged 0.7 and 0.4 degrees of valgus (p = 0.41), whereas the sagittal plane angle averaged 106 +/- 4 degrees and 104.5 +/- 7 degrees in groups A and B, respectively (p = 0.22). The outcome was graded as very good in 79.2% (38 feet) in group A and 80% (24 feet) in group B, fair in 18.8% (9 feet) in group A and 16.7% (5 feet) in group B and poor in one ankle in each group (p = 0.68).
CONCLUSIONS
The arthroscopic technique offered high fusion rates and low morbidity. Deformity correction was achieved with good results.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ankle Joint; Arthritis; Arthrodesis; Arthroscopy; Female; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 17592700
DOI: 10.3113/FAI.2007.0695 -
Hand Surgery & Rehabilitation Oct 2021The aim of this retrospective study was to report medium- to long-term outcome of scaphotrapeziotrapezoid (STT) arthrodesis with staple fixation to treat painful...
The aim of this retrospective study was to report medium- to long-term outcome of scaphotrapeziotrapezoid (STT) arthrodesis with staple fixation to treat painful isolated osteoarthritis (OA). Twenty-one consecutive patients (22 wrists) who had undergone STT arthrodesis were retrospectively reviewed by an independent examiner. Clinical and radiological evaluation was performed. At a mean follow-up of 8 years (range 2-20 years), pain levels were significantly decreased, and functional scores were significantly improved. Grip and pinch strength were 86% and 82% of those of the contralateral side. Wrist range of motion in flexion-extension and radial-ulnar deviation was significantly less than on the contralateral side at last follow-up (104° vs. 131° and 38° vs. 55°, respectively). Non-union was found on X-ray in 4 wrists (18%), but in 2 cases showed as partial non-union on CT, with complete scaphotrapezial consolidation; 1 of the 4 wrists required surgical revision. Another patient was re-operated on for symptomatic external staple displacement without non-union. There were 8 cases (36%) of radiographic narrowing of the styloscaphoid joint space; contact between the staple and styloid was found in all 8 cases. Four patients (18%) had narrowing of the scaphocapital joint space; protrusion of the proximal part of the staple into the joint space was noted in all 4 wrists. No differences were found for the radioscaphoid, capitolunate and scapholunate angles before and after surgery. STT arthrodesis with staple fixation to treat isolated STT OA led to a significant reduction in pain, with improved strength and functional scores. To avoid styloid impingement, we recommend systematic styloidectomy. Complete non-union seems to be overestimated on radiographs. Partial non-union with scaphotrapezial union should not be considered as a complication. LEVEL OF EVIDENCE: IV.
Topics: Arthrodesis; Follow-Up Studies; Humans; Osteoarthritis; Retrospective Studies; Wrist Joint
PubMed: 33992817
DOI: 10.1016/j.hansur.2021.04.014 -
Hand Surgery & Rehabilitation Feb 2022Total wrist arthrodesis in severe wrist flexion deformities (greater than 60°) due to spasticity represents a valid therapeutic option. It aims to improve the hand's...
Total wrist arthrodesis in severe wrist flexion deformities (greater than 60°) due to spasticity represents a valid therapeutic option. It aims to improve the hand's appearance, hygiene, function and to prevent the deformity from getting worse. The objective of this study is to evaluate the clinical and anatomical results of wrist shortening arthrodesis using a classic volar plate in the dorsal position in functional surgery for central spastic hands. We conducted a single-center analysis of a series of patients who underwent this shortening arthrodesis. The review at a minimum 1-year follow-up included a clinical evaluation (House score, INOM score, patient satisfaction and complications), and anatomical evaluation (arthrodesis position, bone healing and carpometacarpal arthropathy). Twenty-eight patients with a mean age of 40.6 years (18-74) were included at a mean follow-up of 30.6 months (12-75). The fusion rate was 100%. No carpometacarpal arthropathy was noted. The mean position of the fused wrist was 11° extension and 15° ulnar tilt. There were two complications (7%): one postoperative hematoma and one case of discomfort due to impingement that required plate removal. The House score was significantly improved postoperatively (2.4 (0-5) versus 1.8 (0-4), p < 0.001), as was the INOM score (45 (12-64) versus 63 (36-84), p < 0.001). The patient satisfaction rate was 93%. The use of a simple and common material (volar plate in dorsal position) during this challenging surgery (spastic wrist contracture), provides good anatomical results and high patient satisfaction. LEVEL OF EVIDENCE: Level 4, case series, therapeutic study.
Topics: Adult; Arthrodesis; Contracture; Humans; Muscle Spasticity; Retrospective Studies; Supine Position; Wrist
PubMed: 34688950
DOI: 10.1016/j.hansur.2021.10.313 -
Foot & Ankle International Aug 1998Forty-eight isolated subtalar arthrodeses in 44 patients with an average follow-up of 59.5 months were retrospectively reviewed. Original diagnoses included...
Forty-eight isolated subtalar arthrodeses in 44 patients with an average follow-up of 59.5 months were retrospectively reviewed. Original diagnoses included talocalcaneal coalition, healed calcaneal fracture with subtalar arthrosis, acquired flatfoot because of posterior tibial tendon dysfunction, degenerative subtalar arthrosis, subtalar instability, and psoriatic arthritis. Ninety-three percent of patients were very satisfied or satisfied with their treatment. Pain and function improved significantly, and the American Orthopaedic Foot and Ankle Society ankle-hindfoot score at follow-up was 89. There were six unsatisfactory results: three feet had calcaneal fractures and three were malpositioned. Union was achieved in all cases. Transverse tarsal motion was diminished by 40%, dorsiflexion by 30%, and plantarflexion by 9%. There was a 36% and 41% incidence of mild radiographic progression of arthrosis in the ankle and transverse tarsal joint, respectively. Isolated subtalar arthrodesis provided a highly successful result in the disease presented, and this study provides support for the use of a selected hindfoot fusion procedure for specific indications.
Topics: Adolescent; Adult; Aged; Arthrodesis; Calcaneus; Female; Follow-Up Studies; Foot Diseases; Humans; Joint Diseases; Male; Middle Aged; Patient Satisfaction; Retrospective Studies; Subtalar Joint
PubMed: 9728697
DOI: 10.1177/107110079801900802 -
Der Orthopade Apr 1996In the era of successful total hip replacement, hip arthrodesis has become an infrequent surgical procedure. Current indications are severe deterioration of the hip... (Review)
Review
In the era of successful total hip replacement, hip arthrodesis has become an infrequent surgical procedure. Current indications are severe deterioration of the hip joint with a painful, reduced range of motion in young patients, such as disorders subsequent to sepsis of the hip joint, slipped capital epiphysis, Perthes' disease and trauma with contraindications for a total joint replacement. Another important indication is paralysis or musculature loss. From 1980 to 1990, 20 consecutive patients underwent a hip arthrodesis with a cobra plate and were evaluated. None of the patients was lost for follow-up; complications occurred in 5 out of 25 cases (20%). All patients had radiographic evidence of union, 2 patients required re-osteosynthesis and bone grafting. In two cases infection occurred. In one case the position of the fused join went into abduction. Thirteen patients were able to walk free of pain; however, 5 patients were disappointed with the arthrodesis result because of the handicap involved with a fused hip. Hip arthrodesis using the cobra plate is a technically demanding operation, but immediate mobilization and partial weight bearing are facilitated. There is little risk of non-union compared to other surgical procedures. If the technique is correct functional problems will be rare.
Topics: Adolescent; Adult; Arthrodesis; Bone Plates; Bone Screws; Female; Hip Joint; Humans; Joint Diseases; Male; Middle Aged; Patient Satisfaction; Postoperative Complications; Radiography
PubMed: 8692566
DOI: No ID Found -
Neurosurgery Feb 2023Changes in reimbursement policies have been demonstrated to correlate with clinical practice.
BACKGROUND
Changes in reimbursement policies have been demonstrated to correlate with clinical practice.
OBJECTIVE
To investigate trends in physician reimbursement for anterior, posterior, and combined anterior/posterior (AP) lumbar arthrodesis and relative utilization of AP.
METHODS
We queried the American College of Surgeons National Surgical Quality Improvement Project registry for anterior, posterior, and AP lumbar arthrodeses during 2010 and 2020. Work relative value units per operative hour (wRVUs/h) were calculated for each procedure. Trends in reimbursement and utilization of the AP approach were assessed with linear regression. Subgroup analyses of age and underlying pathology of AP arthrodesis were also performed.
RESULTS
During 2010 and 2020, AP arthrodesis was associated with significantly higher average wRVUs/h compared with anterior and posterior arthrodesis (AP = 17.4, anterior = 12.4, posterior = 14.5). The AP approach had a significant yearly increase in wRVUs/h (coefficient = 0.48, P = .042), contrary to anterior (coefficient = -0.01, P = .308) and posterior (coefficient = -0.13, P = .006) approaches. Utilization of AP approaches over all arthrodeses increased from 7.5% in 2010 to 15.3% in 2020 (yearly average increase 0.79%, P < .001). AP fusions increased significantly among both degenerative and deformity cases (coefficients 0.88 and 1.43, respectively). The mean age of patients undergoing AP arthrodesis increased by almost 10 years from 2010 to 2020. Rates of major 30-day complications were 2.7%, 3.1%, and 3.5% for AP, anterior, and posterior arthrodesis, respectively.
CONCLUSION
AP lumbar arthrodesis was associated with higher and increasing reimbursement (wRVUs/h) during the period 2010 to 2020. Reimbursement for anterior arthrodesis was relatively stable, while reimbursement for posterior arthrodesis decreased. The utilization of the combined AP approach relative to the other approaches increased significantly during the period of interest.
Topics: Humans; Child; Spinal Fusion; Treatment Outcome; Arthrodesis; Lumbosacral Region; Lumbar Vertebrae; Retrospective Studies
PubMed: 36637267
DOI: 10.1227/neu.0000000000002194 -
Clinics in Podiatric Medicine and... Jul 1999The current literature clearly supports the use of subtalar and triple arthrodeses for the treatment of end-stage PTTD. There is debate, however, regarding whether or... (Review)
Review
The current literature clearly supports the use of subtalar and triple arthrodeses for the treatment of end-stage PTTD. There is debate, however, regarding whether or not an isolated fusion is preferable to the triple arthrodesis. Complete evaluation of the patient's deformity and symptoms is imperative before choosing to perform a rearfoot fusion. If the deformity can be isolated to the STJ, then perhaps a limited fusion is appropriate. With the close interrelationship of the subtalar and midtarsal joints, however, it is the authors' opinion that chronic dysfunction of the posterior tibial tendon infrequently causes isolated STJ pathology. Perhaps earlier intervention in the process of tendon degeneration, before multiple joint adaptations, would warrant an isolated fusion. We anticipate further research into the advantages of STJ and double arthrodeses over the triple arthrodesis. Clearer identification of the patients in whom these limited fusions are warranted is necessary, especially with respect to adult flatfoot secondary to PTTD. Currently, isolated and combined hindfoot fusions continue to be valuable salvage procedures in the treatment of end-stage arthritic deformities.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ankle; Arthrodesis; Flatfoot; Foot; Humans; Middle Aged; Muscular Diseases; Subtalar Joint; Tarsal Joints; Tendons
PubMed: 10470513
DOI: No ID Found -
The Veterinary Clinics of North... Apr 2008To repair equine fractures successfully, surgeons traditionally have done aggressive open approaches with maximal internal fixation to achieve adequate stability and... (Review)
Review
To repair equine fractures successfully, surgeons traditionally have done aggressive open approaches with maximal internal fixation to achieve adequate stability and comfort. Although the need for stability is unquestionable, newer technologies and imaging modalities have allowed improvement in the biology of internal fixation in selected fractures and arthrodeses.
Topics: Animals; Arthrodesis; Fracture Fixation; Fracture Fixation, Internal; Fractures, Bone; Horses; Minimally Invasive Surgical Procedures; Treatment Outcome; Weight-Bearing
PubMed: 18314042
DOI: 10.1016/j.cveq.2007.11.004 -
Clinics in Podiatric Medicine and... Oct 2007Arthrodesis continues to be the procedure of choice in treatment of the end-stage adult acquired flatfoot. Its goals are to provide pain relief, correct the deformity,... (Review)
Review
Arthrodesis continues to be the procedure of choice in treatment of the end-stage adult acquired flatfoot. Its goals are to provide pain relief, correct the deformity, and improve function and stability. A better understanding of anatomy and operative technique has led to significant refinements and advances in fixation. These devices have proved useful in arthrodesing and tenodesing procedures. The principles in achieving a sound arthrodesis and the various forms of fixation are discussed in detail.
Topics: Adult; Arthrodesis; Bone Transplantation; Flatfoot; Foot Deformities, Acquired; Humans; Orthopedic Fixation Devices; Platelet-Rich Plasma
PubMed: 17908645
DOI: 10.1016/j.cpm.2007.07.001 -
The Journal of Foot Surgery 1976Arthrodesis, the surgical fusion of a joint or joints when motion is undesirable, is one of the most exacting surgical procedures performed on the foot. In this article,...
Arthrodesis, the surgical fusion of a joint or joints when motion is undesirable, is one of the most exacting surgical procedures performed on the foot. In this article, the authors discuss arthrodesing techniques from the earliest attempts in 1878 to the more sophisticated and more successful corrective procedures of the present day. Their preference of the two surgical techniques used for triple arthrodesis is the method which involves two incisions--a 12-cm. incision on the medial aspect of the foot and an 8-cm. incision on the lateral aspect of the foot.
Topics: Adolescent; Arthrodesis; Casts, Surgical; Child; Female; Foot; Humans; Joint Diseases; Sutures
PubMed: 1025196
DOI: No ID Found