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Hand (New York, N.Y.) Sep 2022Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion...
BACKGROUND
Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion rate and risk factors for reoperation after STT arthrodesis in the Veterans Affairs Department patient population. The purpose of our study was to assess the long-term nonunion rate following STT arthrodesis and to identify factors associated with reoperation.
METHODS
The national Veterans Health Administration Corporate Data Warehouse and Current Procedural Terminology codes identified STT arthrodesis procedures from 1995 to 2016. Frequencies of total wrist arthrodesis (TWA) and secondary operations were determined. Univariate analyses provided odds ratios for risk factors associated with complications.
RESULTS
Fifty-eight STT arthrodeses were performed in 54 patients with a mean follow-up of 120 months. Kirschner wires (K-wires) were the most common fixation method (69%). Six wrists (10%) required secondary procedures: 5 TWAs and 1 revision STT arthrodesis. Four patients underwent additional procedures for nonunion (7%). Twenty-four patients required K-wire removal, 8 (14%) of these in the operating room, which were not included in regression analysis. Every increase in 1 year of age resulted in a 15% decrease in likelihood of reoperation (95% confidence interval: 0.77-0.93; < .0001). Opioid use within 90 days before surgery ( = 1.00), positive smoking history ( = 1.00), race ( = .30), comorbidity count ( = .25), and body mass index ( = .19) were not associated with increased risk of reoperation.
CONCLUSIONS
At a mean follow-up of 10 years, patients undergoing STT arthrodesis have a 10% risk of reoperation, and this risk decreases with older patient age. There was a symptomatic nonunion rate of 7%, similar to prior published rates. Patient demographics, comorbidity, smoking history, and opioid use did not appear to increase risk of reoperation.
Topics: Analgesics, Opioid; Arthrodesis; Follow-Up Studies; Humans; Retrospective Studies; Wrist
PubMed: 33106027
DOI: 10.1177/1558944720964972 -
The Journal of Hand Surgery, European... Apr 2022We investigated the reliability of the 4Fusion® quadripodal memory staple in a consecutive series of 59 four-corner arthrodeses in a single centre. Forty-one patients... (Review)
Review
We investigated the reliability of the 4Fusion® quadripodal memory staple in a consecutive series of 59 four-corner arthrodeses in a single centre. Forty-one patients (46 wrists) had a radiological and clinical assessment at a mean follow-up of 7.4 years. Thirteen patients (13 wrists) were lost to follow-up. Bone union was achieved in all but one patient. Seven patients were reoperated, six for device removal and one for nonunion. Most patients were satisfied, had a functional range of wrist mobility, good strength and were free of pain, comparable with the best previously reported series. IV.
Topics: Arthrodesis; Hand Strength; Humans; Range of Motion, Articular; Reproducibility of Results; Retrospective Studies; Scaphoid Bone; Wrist Joint
PubMed: 34851782
DOI: 10.1177/17531934211063614 -
Orthopaedic Surgery Feb 2017"Lisfranc joint injury" is comprised of a tarsometatarsal joint-complex injury. The Lisfranc complex injury is always a challenge for orthopedists, and the optimum... (Comparative Study)
Comparative Study
OBJECTIVE
"Lisfranc joint injury" is comprised of a tarsometatarsal joint-complex injury. The Lisfranc complex injury is always a challenge for orthopedists, and the optimum treatment is still up for debate. Anatomic reduction and stable internal fixation prove to have no satisfactory outcomes. This research aims to compare the clinical curative effects, complications and radiographic features of arthrodesis and non-fusion of the Lisfranc joint in the follow-up of the patients who suffered Lisfranc injuries.
METHODS
A comparative retrospective study of 25 patients with acute or subacute Lisfranc complex injuries was conducted between September 2013 and March 2015 in the First Affiliated Hospital of Soochow University. All patients were classified by Myerson classification. Eight patients were treated with arthrodesis, while 17 patients received non-fusion operations. The clinical curative effects, complications and image differences were compared between the two groups. American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, Short Form-36 (SF-36) and Visual Analogue Scale (VAS) score were evaluated for each patient during the follow-up. All statistics were analyzed using the SPSS software system.
RESULTS
All fractures healed for both the arthrodesis group and the non-fusion group. Patients in the arthrodesis group had a higher AOFAS score compared with patients in the non-fusion group (94.00 vs. 88.58, P = 0.034). Complications occurred in eight patients (8/17, 47%) in the non-arthrodesis group, including the second and third phalanx abduction (1), talipes cavus (2), eversion deformity of front foot (3), eversion deformity of calcaneus (1), as well as postoperative infection (1). Only two patients (2/8, 25%) in the arthrodesis group suffered complications. One was a limitation of motion of the front foot and pain during walking; the other was an eversion deformity of front foot.
CONCLUSION
Primary arthrodesis has advantages compared to primary open reduction and internal fixation (ORIF): reduced foot deformity rates, sustained biomechanical morphology of the feet, reduced complications, higher level of function recovery, shorter time of surgical procedures, fewer complications, higher AOFAS score and fewer frequency of complications. According to our research, primary arthrodesis may be a better choice for treating Lisfranc injury.
Topics: Adolescent; Adult; Aged; Arthrodesis; Female; Foot Joints; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Humans; Male; Middle Aged; Pain, Postoperative; Postoperative Care; Radiography; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 28276650
DOI: 10.1111/os.12316 -
Orthopaedics & Traumatology, Surgery &... Sep 2022In patients with knee infection, arthrodesis by external fixation is a limb-salvage procedure appropriate in highly selected patients. No hardware that might lead to... (Observational Study)
Observational Study
BACKGROUND
In patients with knee infection, arthrodesis by external fixation is a limb-salvage procedure appropriate in highly selected patients. No hardware that might lead to infection is left in situ. However, the fusion rate is limited. Use of a device that applies compression in the coronal plane has been suggested in combination with sagittal external fixation to increase the fusion rate but has not been the focus of published studies. The objectives of this retrospective study were to determine: 1) the fusion rate and, 2) the rate of infection eradication.
HYPOTHESIS
Knee arthrodesis using an external fixator and a compression clamp provides higher fusion rates compared to reports of external fixation without compression.
MATERIAL AND METHODS
We retrospectively studied 30 patients who underwent knee arthrodesis using external fixation and a compression clamp. The reason for arthrodesis was recurrent infection after total knee arthroplasty in 18 patients and septic arthritis in 12 patients. There were 16 females and 14 males with a mean age of 66.0±11.6 years (range, 30-83 years). Mean follow-up was 42.5±23.6 months (range, 24-106 months).
RESULTS
Fusion was achieved in 25 (83%) patients, after a mean of 7.5 months (range, 6-12 months). Of the 8 patients with severe bone loss (≤25% bone contact), 4 experienced non-union, compared to 1 of the 22 patients whose bone loss was moderate or mild (50% and >50% bone contact, respectively) (p=0.01). After at least 2 years of follow-up, the infection was eradicated in 28 (93%) patients. Complications occurred in 9 patients and consisted of pin-site infection managed by lavage (n=3), recurrent infection requiring revision surgery for debridement and lavage combined with material exchange and antibiotic therapy (n=2), and femoral shaft fracture (n=3) or traumatic fracture of the arthrodesis (n=1) treated by changing the clamp and fixator assembly.
DISCUSSION
The fusion rate achieved using this combined technique is high and better than obtained with external fixation alone. Our results confirm that infection eradication is obtained more often than with nailing. This one-stage, simple, reproducible procedure does not leave any foreign material in situ.
LEVEL OF EVIDENCE
IV, retrospective observational cohort study.
Topics: Aged; Arthrodesis; External Fixators; Female; Humans; Male; Middle Aged; Prosthesis-Related Infections; Reinfection; Reoperation; Retrospective Studies
PubMed: 35597544
DOI: 10.1016/j.otsr.2022.103330 -
Orthopaedics & Traumatology, Surgery &... Nov 2022In posttraumatic wrist arthritis of intermediate severity, two main palliative procedures are used to preserve some mobility in the wrist: proximal row carpectomy (PRC)... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
In posttraumatic wrist arthritis of intermediate severity, two main palliative procedures are used to preserve some mobility in the wrist: proximal row carpectomy (PRC) and scaphoid excision followed by four corner arthrodesis (4CA). Despite satisfactory overall results, the debate continues about which one provides the best results and long-term outcomes, particularly prevention of arthritis progression. Recent comparative studies now provide us with information about mid- and long-term results. The aim of this study was to compare the clinical results, complications, conversion rate to total wrist arthrodesis and progression to osteoarthritis of PRC versus 4CA in the medium and long term.
HYPOTHESIS
The null hypothesis was that there is no significant difference between PRC and 4CA in the clinical results, complications, conversion to total wrist arthrodesis and arthritis progression.
MATERIALS AND METHODS
A systematic literature review was carried out by following the PRISMA guidelines. Included were studies comparing 4CA and PRC for the treatment of post-traumatic wrist arthritis secondary to scapholunate dissociation (SLAC) and scaphoid nonunion (SNAC) with a mean follow-up of 5 years. A search was performed of the MEDLINE, EMBASE and Cochrane databases that identified 831 articles. After removing 230 duplicates and excluding 595 articles based on their title and/or abstract, and then adding 1 article manually, 7 articles were included in our analysis. Parameters analyzed were range of motion (ROM), pain, grip strength, functional scores, complications, conversion to total wrist arthrodesis, and arthritis progression.
RESULTS
In the 7 articles, 1059 wrists - 582 PRC and 477 4CA - were analyzed with follow-up ranging from 5.2 to 18 years. PRC produced significantly better ROM in flexion (weighted mean difference [WMD]=10.0°; p<0.01) and in ulnar deviation (WMD=8.7°; p<0.01) along with significantly lower complication rates (OR=0.3; p<0.01) and reoperation rates (OR=0.1; p<0.01). There was no significant difference in the conversion rate, grip strength, extension, radial deviation, pain, DASH and PRWE scores. The progression of osteoarthritis could not be analyzed due to lack of data.
DISCUSSION
This meta-analysis was the first to include recently published mid- and long-term studies comparing PRC and 4CA. The main finding is that PRC is superior overall with better ROM and a lower complication rate. Another important finding was the absence of differences in grip strength and the conversion rate to total wrist arthrodesis. Unfortunately, the lack of systematic studies on arthritis progression leaves this question unanswered. Our findings must be interpreted cautiously because it was impossible to stratify the cases by etiology and osteoarthritis stage.
LEVEL OF EVIDENCE
III; systematic review and meta-analysis.
Topics: Humans; Carpal Bones; Wrist; Treatment Outcome; Arthrodesis; Scaphoid Bone; Wrist Joint; Osteoarthritis; Range of Motion, Articular; Hand Strength; Pain
PubMed: 35940440
DOI: 10.1016/j.otsr.2022.103373 -
Orthopaedics & Traumatology, Surgery &... Sep 2022Scapulothoracic arthrodesis may be proposed to patients having facio-scapulohumeral dystrophy to achieve gains in shoulder motion and pain relief. This study aimed to...
ScapuloThoracic Arthrodesis for Facio-Scapulo-Humeral Dystrophy: Outcomes at mean 7.3 years [3.5-13] follow-up. CT measurement of the fixation position of the arthrodesis and radioclinical correlations.
INTRODUCTION
Scapulothoracic arthrodesis may be proposed to patients having facio-scapulohumeral dystrophy to achieve gains in shoulder motion and pain relief. This study aimed to assess shoulder motion, pain and functional scores at last follow-up and to present a method of computed tomography measurements of the position of the scapulothoracic arthrodesis and study their correlations with shoulder motion.
PATIENTS AND METHODS
Seven patients (11 arthrodesis) were included. Shoulder motion, pain, respiratory function and deltoid strength were compared with preoperative values and Constant, Brooke and Vignos scores were assessed at last follow-up. The elevation/depression and upward/downward position of the scapula were measured by performing postoperative 3D CT reconstruction. The protraction/retraction position was measured with 2D CT reconstructions on axial view. Correlations between these measurements and shoulder flexion and abduction were analysed. All complications were searched.
RESULTS
We found a significant improvement in mean VAS (from 3±2 to 1±1, p=0,008) shoulder flexion (64°± 11 to 113°±20, p=0,003) and abduction (from 63°±9 to 92°±13°, p=0,004). Postoperative external rotation wasn't significantly different (from 49°±19 to 43°±10, p=0,112) and on internal rotation, the hand reached on average the 9th thoracic vertebra (S1-T2). Scapulothoracic arthrodesis was mainly positioned in regard to the 1 and the 6 rib. The mean protraction/retraction position was 38,5°±8° and the mean scapular upward/downward rotation position was 92°±15°. No correlations were found between the scapular position and shoulder flexion and abduction.
CONCLUSIONS
Scapulothoracic arthrodesis for facioscapulohumeral dystrophy improved pain, shoulder flexion and abduction and provided good functional outcomes at 3,5 to 13 years of follow up. A method of CT assessment of the position of the arthrodesis is presented to analyse precisely the position of the scapula but no correlations with shoulder motions were found. Preoperative evaluation of deltoid function and scapular winging seemed to be the most important predictors of shoulder motions gains after this procedure.
LEVEL OF EVIDENCE
III, Retrospective cohort study.
Topics: Arthrodesis; Follow-Up Studies; Humans; Muscular Dystrophy, Facioscapulohumeral; Pain; Range of Motion, Articular; Retrospective Studies; Scapula; Shoulder Joint; Tomography, X-Ray Computed
PubMed: 35597545
DOI: 10.1016/j.otsr.2022.103331 -
The Journal of Bone and Joint Surgery.... Nov 2012Most problems encountered in complex revision total knee arthroplasty can be managed with the wide range of implant systems currently available. Modular metaphyseal... (Review)
Review
Most problems encountered in complex revision total knee arthroplasty can be managed with the wide range of implant systems currently available. Modular metaphyseal sleeves, metallic augments and cones provide stability even with significant bone loss. Hinged designs substitute for significant ligamentous deficiencies. Catastrophic failure that precludes successful reconstruction can be encountered. The alternatives to arthroplasty in such drastic situations include knee arthrodesis, resection arthroplasty and amputation. The relative indications for the selection of these alternatives are recurrent deep infection, immunocompromised host, and extensive non-reconstructible bone or soft-tissue defects.
Topics: Amputation, Surgical; Arthrodesis; Arthroplasty; Arthroplasty, Replacement, Knee; Humans; Knee Prosthesis; Prosthesis-Related Infections; Recurrence; Reoperation; Treatment Outcome
PubMed: 23118402
DOI: 10.1302/0301-620X.94B11.30620 -
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 -
Journal of Orthopaedic Surgery and... May 2017The surgical treatment of end-stage tibiotalar arthritis continues to be a controversial topic. Advances in surgical technique and implant design have lead to improved... (Comparative Study)
Comparative Study Review
BACKGROUND
The surgical treatment of end-stage tibiotalar arthritis continues to be a controversial topic. Advances in surgical technique and implant design have lead to improved outcomes after both ankle arthrodesis (AA) and total ankle arthroplasty (TAA), yet a clear consensus regarding the most ideal form of treatment is lacking. In this study, the outcomes and complications following AA and TAA are compared in order to improve our understanding and decision-making for care and treatment of symptomatic tibiotalar arthritis.
METHODS
Studies reporting on outcomes and complications following TAA or AA were obtained for review from the PubMed database between January 2006 and July 2016. Results from studies reporting on a minimum of 200 total ankle arthroplasties or a minimum of 80 ankle arthrodesis procedures were reviewed and pooled for analysis. All studies directly comparing outcomes and complications between TAA and AA were also included for review. Only studies including modern third-generation TAA implants approved for use in the USA (HINTEGRA, STAR, Salto, INBONE) were included.
RESULTS
A total of six studies reporting on outcomes following TAA and five reporting on outcomes following AA met inclusion criteria and were included for pooled data analysis. The adjusted overall complication rate was higher for AA (26.9%) compared to TAA (19.7%), with similar findings in the non-revision reoperation rate (12.9% for AA compared to 9.5% for TAA). The adjusted revision reoperation rate for TAA (7.9%) was higher than AA (5.4%). Analysis of results from ten studies directly comparing TAA to AA suggests a more symmetric gait and less impairment on uneven surfaces after TAA.
CONCLUSIONS
Pooled data analysis demonstrated a higher overall complication rate after AA, but a higher reoperation rate for revision after TAA. Based on the existing literature, the decision to proceed with TAA or AA for end-stage ankle arthritis should be made on an individual patient basis.
Topics: Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Postoperative Complications; Reoperation; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 28521779
DOI: 10.1186/s13018-017-0576-1 -
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