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Orthopaedics & Traumatology, Surgery &... Nov 2022The severity of a foot or ankle deformity is a major prognostic factor for the success of ankle replacement. Varus deformity is at once the most arthrogenic and the most...
INTRODUCTION
The severity of a foot or ankle deformity is a major prognostic factor for the success of ankle replacement. Varus deformity is at once the most arthrogenic and the most frequent.
HYPOTHESIS
The severity of preoperative varus is a negative factor for ankle replacement survival.
MATERIAL AND METHOD
A retrospective study compared results in a continuous series of 57 Salto-Talaris® ankle replacements according to preoperative varus: 31 moderate (5-15̊) and 26 severe (> 15̊). Radiological and clinical assessment at a minimum 1 year focused on complications, revision and implant exchange and on AOFAS score, range of motion and tibiotalar angle at last follow-up.
RESULTS
At a mean 2.4 years' follow-up, implant survival in the moderate and severe varus groups was respectively 83% and 92%. Postoperative AOFA score and range of motion improved significantly in both groups, without significant difference. Analysis of cumulative survival showed no significant intergroup difference.
DISCUSSION
Severity of preoperative varus did not impact implant survival. Only postoperative alignment and stability emerged as survival factors. These results were related to the quality of associated procedures aiming to reduce deformity and to achieve ligament balance.
LEVEL OF EVIDENCE
IV, retrospective comparative study.
Topics: Humans; Retrospective Studies; Ankle; Treatment Outcome; Arthroplasty, Replacement, Ankle; Ankle Joint
PubMed: 35944869
DOI: 10.1016/j.otsr.2022.103390 -
Orthopaedic Surgery Oct 2022To evaluate the clinical curative effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
OBJECTIVE
To evaluate the clinical curative effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
METHODS
From June 2013 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution. Conventional double-feet standing X-ray films were taken before and after operation. The tibiotalar angle on X-ray image was measured to evaluate the degree of talipes varus and valgus. The Foot and Ankle pain score of American Orthopaedics Foot and Ankle Society (AOFAS) and Visual Analog Scale (VAS) were compared by using paired t-test to evaluate the functional recovery.
RESULTS
All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All patients were included in the analysis, among which 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). All ankles achieved bony fusion; the clinical healing time was 12.7 weeks on average (11-18 weeks). The AOFAS score was 45.36 ± 6.43 preoperatively and 80.25 ± 9.16 at 12 months post-operation, with a statistically significant difference (p < 0.0001). The VAS score was 8.56 ± 1.85 on average preoperatively and 2.72 ± 0.83 at 12 months post-operation, with a statistically significant difference (p < 0.0001). The tibiotalar angle was 101.93° ± 4.12° preoperatively and 94.45° ± 2.37° at 12 months post-operation, with a statistically significant difference (p < 0.0001). The results of the functional evaluation indicated that 44 patients (61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.
CONCLUSION
Our study demonstrated that it is possible to obtain satisfactory outcome with Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.
Topics: Aged; Ankle; Ankle Joint; Arthritis; Arthrodesis; External Fixators; Female; Humans; Ilizarov Technique; Male; Retrospective Studies; Treatment Outcome
PubMed: 36001696
DOI: 10.1111/os.13399 -
Journal of Orthopaedic Research :... Oct 2022The first goal of this study was to develop reliable three-dimensional definitions of alignment for the ankle, subtalar, and hindfoot joints. These alignments are based...
The first goal of this study was to develop reliable three-dimensional definitions of alignment for the ankle, subtalar, and hindfoot joints. These alignments are based on three-dimensional morphological features derived from renderings of the bones obtained from weightbearing computer tomography. The second goal was to establish a database quantifying the alignment of the ankle, subtalar, and hindfoot joints in a healthy population during weightbearing bilateral standing. This level 1 study was performed on 95 normal subjects in which random subjects were recruited into a control group. Weightbearing computed tomography scans of the leg were collected in neutral, bilateral, standing posture. In 30 of the subjects, both the left and right leg was scanned. Six alignment parameters for each joint were calculated from morphological measurements conducted on three-dimensional renderings of the bones. Intra- and intertester reliability was assessed from repeated measurements by several testers. Analysis of variance statistics of the alignment parameters showed no statistical differences due to age, gender, or foot side. Intraclass correlation coefficient analysis showed excellent inter- and intratester reliability. It was concluded that the alignment process is comprehensive and reliable. Therefore, without classification by gender or age, it may be used as a foundation for quantifying abnormal alignment associated with various ankle deformities. Clinical significance: The alignment methodology and control database may be used to diagnose ankle, subtalar, and hindfoot misalignment. It can also serve as basis for surgical planning designed to restore normal alignment in various hindfoot pathologies, such as ankle realignment in total ankle replacement.
Topics: Ankle; Ankle Joint; Female; Humans; Male; Posture; Reproducibility of Results; Subtalar Joint; Weight-Bearing
PubMed: 35067973
DOI: 10.1002/jor.25267 -
Journal of Orthopaedic Surgery (Hong... 2022To evaluate the outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy.
OBJECTIVE
To evaluate the outcomes of intermediate stage varus ankle arthritis treated by supramalleolar osteotomy.
METHODS
Clinical data of 57 patients with varus arthritis who underwent supramalleolar osteotomy at our hospital between March 2018 and December 2019 were retrospectively analyzed. The patients were grouped according to the Takakura classification, and assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and the Visual Analogue Score (VAS). Tibial anterior surface (TAS) angle and talar tilt (TT) angle were measured at the weight-bearing anteroposterior view. Tibial lateral surface (TLS) angle was measured at the weight-bearing lateral view. The differences in the above indicators of patients with different stages of varus ankle arthritis before and after treatment were analyzed.
RESULTS
The patients were followed up for an average of 31.9 ± 5.8 months. Upon the last follow-up, the AOFAS score was 84.1 ± 9.7, the VAS score 2.2 ± 1.3, the TAS angle 92.4 ± 5.5°, the TLS angle 79.3 ± 5.3°, and the TT angle 3.7±3.4°, which were significantly different from the preoperative levels (64.2 ± 14.6, 4.5 ± 1.8, 80.5 ± 6.7°, 74.9 ± 4.6°, and 5.2 ± 64.1°, respectively) ( < .05). There were significant differences in AOFAS and VAS scores before surgery and upon the last follow-up in each group ( < .05). The postoperative TT angle was significantly different from the preoperative level in stage IIIb patients ( = .003).
CONCLUSIONS
Supramalleolar osteotomy achieved good short-to mid-term clinical outcomes for intermediate stage varus ankle arthritis. This procedure could significantly improve the TAS and TLS angles of the patients at any stage and the TT angle of stage IIIb patients.
Topics: Ankle; Ankle Joint; Humans; Osteoarthritis; Osteotomy; Retrospective Studies
PubMed: 36197148
DOI: 10.1177/10225536221132769 -
Folia Medica Cracoviensia Sep 2022The aim of this article is to describe surgical technique and early results of Total Ankle Replacement (TAR) from lateral approach using Zimmer TM prosthesis. The study... (Review)
Review
The aim of this article is to describe surgical technique and early results of Total Ankle Replacement (TAR) from lateral approach using Zimmer TM prosthesis. The study uses theoretical knowledge which is the result of research conducted by other authors, and practical knowledge due to the fact that our center performs that type of operation. Arthrodesis as the current standard in the treatment of advanced degenerative ankle disease, apart from its advantages, also has many disadvantages. The relative durability and reduction of the patients' pain have been achieved at the expense of the adjacent joints. Their accelerated arthrosis is the result of compensatory loads as a consequence of change in foot biomechanics. That determined implementation of solutions that will guarantee elimination of pain in the ankle joint, preserve its motor function and improve gait, while having no negative impact on the mobility of adjacent joints.
Topics: Humans; Arthroplasty, Replacement, Ankle; Ankle; Treatment Outcome; Ankle Joint; Prostheses and Implants; Pain
PubMed: 36309832
DOI: 10.24425/fmc.2022.142369 -
In Vivo (Athens, Greece) 2019The aim of this study was to evaluate the clinical and radiographic success of arthrolysis surgery and the risk of progression of osteoarthrosis at the ankle joint.
BACKGROUND
The aim of this study was to evaluate the clinical and radiographic success of arthrolysis surgery and the risk of progression of osteoarthrosis at the ankle joint.
MATERIALS AND METHODS
In a retrospective clinical and radiological study, with a minimum follow-up of 24 months, the pain level and quality of living were evaluated.
RESULTS
Following arthrolysis of the ankle joint, 16% of patients required ankle fusion within 2 years. Women had a higher quality-of-life in terms of Foot Function Index. Younger patients scored higher in both quality-of-life and function scores. Radiographic osteoarthrotic changes and the specific follow-up interval did not correlate with clinical outcome.
CONCLUSION
Fewer than 20% of patients required ankle fusion. Female gender and young age had a positive impact. Preoperative radiography and the postsurgical interval are poorly predictive for the progression of osteoarthrosis.
Topics: Adult; Aged; Ankle; Ankle Joint; Arthrodesis; Female; Follow-Up Studies; Humans; Male; Middle Aged; Osteoarthritis; Pain; Pain Management; Pain Measurement; Radiography; Treatment Outcome
PubMed: 30804138
DOI: 10.21873/invivo.11507 -
Scientific Reports Aug 2021Individuals post-stroke experience persisting gait deficits due to altered joint mechanics, known clinically as spasticity, hypertonia, and paresis. In engineering,... (Clinical Trial)
Clinical Trial
Individuals post-stroke experience persisting gait deficits due to altered joint mechanics, known clinically as spasticity, hypertonia, and paresis. In engineering, these concepts are described as stiffness and damping, or collectively as joint mechanical impedance, when considered with limb inertia. Typical clinical assessments of these properties are obtained while the patient is at rest using qualitative measures, and the link between the assessments and functional outcomes and mobility is unclear. In this study we quantify ankle mechanical impedance dynamically during walking in individuals post-stroke and in age-speed matched control subjects, and examine the relationships between mechanical impedance and clinical measures of mobility and impairment. Perturbations were applied to the ankle joint during the stance phase of walking, and least-squares system identification techniques were used to estimate mechanical impedance. Stiffness of the paretic ankle was decreased during mid-stance when compared to the non-paretic side; a change independent of muscle activity. Inter-limb differences in ankle joint damping, but not joint stiffness or passive clinical assessments, strongly predicted walking speed and distance. This work provides the first insights into how stroke alters joint mechanical impedance during walking, as well as how these changes relate to existing outcome measures. Our results inform clinical care, suggesting a focus on correcting stance phase mechanics could potentially improve mobility of chronic stroke survivors.
Topics: Adult; Ankle; Ankle Joint; Biomechanical Phenomena; Chronic Disease; Female; Gait; Humans; Male; Middle Aged; Stroke; Walking; Walking Speed
PubMed: 34408174
DOI: 10.1038/s41598-021-95737-6 -
Archives of Orthopaedic and Trauma... Oct 2023Ankle instability in children due to soft tissue injury usually resolves after non-operative treatment. However, some children and adolescents with chronic instability...
INTRODUCTION
Ankle instability in children due to soft tissue injury usually resolves after non-operative treatment. However, some children and adolescents with chronic instability require surgical treatment. A rarer cause of developing ankle instability is injury to the ligament complex in the presence of os subfibulare, an accessory bone inferior to the lateral malleolus. The aim of this study was to assess the results of operative management of chronic ankle instability in children with os subfibulare.
MATERIALS AND METHODS
16 children with os subfibulare and chronic ankle instability who failed non-operative treatment were enrolled prospectively into the study. One child was lost to follow-up and excluded from analysis. The mean age at the time of the surgery was 14 years and 2 months (range 9.5-17 years). The mean follow-up time was 43.2 months (range 28-48 months). Surgical treatment in all cases involved removal of os subfibulare and a modified Broström-Gould lateral complex reconstruction with anchors. Ankle status was assessed before and after surgery with The 100 mm Visual Analogue Scale and Foot and Ankle Outcome Score questionnaire.
RESULTS
The mean Foot and Ankle Outcome Score improved from 66.8 to 92.3 (p < 0.001). Pain level improved from 67.1 preoperatively to 12.7 (p < 0.001). All children reported improvement in their ankle stability. There was one case of scar hypersensitivity that improved during observation and one superficial wound infection that resolved with oral antibiotics. One child reported intermittent pain without symptoms of instability following another injury.
CONCLUSIONS
Ankle joint sprain with associated injury to os subfibulare complex can lead to chronic instability in children. If conservative management fails, then surgical treatment with modified Broström-Gould technique and excision of accessory bone is a safe and reliable method.
Topics: Adolescent; Child; Humans; Ankle; Ankle Injuries; Ankle Joint; Chronic Pain; Joint Instability; Lateral Ligament, Ankle; Retrospective Studies
PubMed: 37246999
DOI: 10.1007/s00402-023-04905-y -
Orthopaedic Surgery Aug 2022Total ankle replacement (TAR) and ankle arthrodesis (AA) are two common surgical treatment options for end-stage ankle osteoarthritis. However, few reports compare the...
Simultaneous Total Ankle Replacement and Contralateral Ankle Arthrodesis for Bilateral Ankle Osteoarthritis: A Retrospective Study Focused on Clinical Outcomes and Cost-effectiveness.
OBJECTIVE
Total ankle replacement (TAR) and ankle arthrodesis (AA) are two common surgical treatment options for end-stage ankle osteoarthritis. However, few reports compare the outcomes of simultaneous TAR and contralateral AA for bilateral ankle osteoarthritis. The aim of this study was to assess changes in pain, joint range of movement (ROM), functional outcomes, patient satisfaction, and cost-effectiveness following simultaneous TAR and contralateral AA.
METHODS
A retrospective study was conducted on 12 patients with bilateral end-stage ankle osteoarthritis who underwent simultaneous TAR and contralateral AA in our institution between May 2016 and August 2018, and who had a minimum of two-year follow-up data. Clinical and radiological follow-up data for all patients were collected after 4 months, 1 year and 2 years. The results were assessed clinically on a visual analogue scale (VAS) and included ROM, American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score, and satisfaction questionnaire. The total hospital costs of patients were also recorded. Independent sample t tests were conducted to compare continuous variables between groups. Paired sample t-tests were conducted to compare changes from the preoperative to postoperative evaluations within each group.
RESULTS
Both surgical groups presented with pain reduction (P < 0.001) at the one-year postoperative session, which was generally consistent until the two-year follow-up. There was a significant increase (P < 0.001) in the mean AOFAS score postoperatively in both ankles. The functional outcomes at the one- and two-year follow-up were significantly better in patients in the TAR group than in those in the AA group (P < 0.001). Joint ROM differences were observed between the two groups after surgery (decreased ankle ROM in arthrodesis, P < 0.001; increased ankle ROM in arthroplasty, P < 0.001). The mean satisfaction score was 2 (range, 1-4) for the TAR group and 3 (range, 1-5) for the AA group. A significant difference in the satisfaction score was observed between the two groups (P = 0.036). Simultaneous TAR and contralateral AA was 34.1% less expensive than simultaneous bilateral TAR. No intraoperative complications were noted in either group. Wound healing occurred without problems within 2 weeks after surgery. No symptomatic deep venous thrombosis was found during follow-up.
CONCLUSION
TAR had better patient-perceived post-operative function and preserves more anatomic sagittal plane motion compared to ankles undergoing AA. In addition, simultaneous TAR and contralateral AA are more cost-effective than simultaneous bilateral TAR, with lower costs for the average patient.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Cost-Benefit Analysis; Humans; Osteoarthritis; Retrospective Studies; Treatment Outcome
PubMed: 35822619
DOI: 10.1111/os.13390 -
The Journal of Arthroplasty Jun 2022Several studies have investigated the distribution of hip-knee-ankle (HKA) angle in healthy populations; however, few have evaluated this metric in patients undergoing...
BACKGROUND
Several studies have investigated the distribution of hip-knee-ankle (HKA) angle in healthy populations; however, few have evaluated this metric in patients undergoing total knee arthroplasty (TKA). The purpose of this study is to compare HKA angle distribution in early and advanced knee osteoarthritis (OA) patients.
METHODS
Full limb radiographs were used to measure HKA angle for 983 subjects from the Osteoarthritis Initiative (OAI) cohort and 4,901 pre-TKA patients from an institutional cohort. Measurements were made using a previously validated deep learning algorithm. Linear regression models were used to determine the association of HKA alignment angle with patient characteristics.
RESULTS
The mean ± standard deviation HKA angle was -1.3° ± 3.2° in the OAI cohort and -4.1° ± 6.1° in the pre-TKA cohort. In the OAI cohort, normal alignment (64%) was the most common knee alignment followed by varus (29%), and valgus (7%). In pre-TKA patients, the most common alignment was varus (62%), followed by normal (27%) and valgus (11%). In pre-TKA patients, mean HKA angle in primary knee OA, post-traumatic knee OA, and rheumatoid arthritis patients were -4.3° ± 6.1°, -3.2° ± 6.4°, and -2.9° ± 6.1°, respectively. HKA angle was strongly associated (P < .001) with gender and body mass index.
CONCLUSION
TKA patients have a wider alignment distribution and more severe varus and valgus alignment than individuals "at risk" for knee OA from the OAI cohort. These epidemiologic findings improve our understanding of HKA angle distribution and its correlation with demographic characteristics in early and late-stage arthritis.
Topics: Ankle; Ankle Joint; Arthroplasty, Replacement, Knee; Humans; Knee Joint; Osteoarthritis, Knee; Retrospective Studies
PubMed: 35210147
DOI: 10.1016/j.arth.2021.12.009