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Journal of the American Academy of... May 2024Graft materials available to supplement hindfoot and ankle arthrodesis procedures include autologous (autograft) or allogeneic bone graft (allograft) but also bone graft... (Review)
Review Comparative Study
Graft materials available to supplement hindfoot and ankle arthrodesis procedures include autologous (autograft) or allogeneic bone graft (allograft) but also bone graft substitutes such as demineralized bone matrix, calcium sulfate, calcium phosphate, and tricalcium phosphate/hydroxyapatite. In addition, biologic agents, such as recombinant human bone morphogenetic protein-2 or recombinant human platelet derived growth factor-BB (rhPDGF-BB), and preparations, including platelet-rich plasma or concentrated bone marrow aspirate, have been used to facilitate bone healing in ankle or hindfoot arthrodesis. The purpose of this review was to summarize the available clinical evidence surrounding the utilization and efficacy of the above materials and biological agents in ankle or hindfoot arthrodesis procedures, with emphasis on the quality of the existing evidence to facilitate clinical decision making.
Topics: Humans; Arthrodesis; Bone Transplantation; Bone Substitutes; Ankle Joint; Calcium Phosphates
PubMed: 38704857
DOI: 10.5435/JAAOSGlobal-D-23-00216 -
Foot and Ankle Surgery : Official... Dec 2022Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and subsequent re-operations compared to ankle arthrodesis. The aim of this systematic review and meta-analysis is to generate an overview of complications of TAA surgery.
METHODS
PubMed, EMBASE and the Cochrane library were searched between 2000 and 2020 to identify all papers reporting on complications in TAA surgery. Meta-analysis was conducted based on type of complication in TAA surgery. Pooled estimates of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates was rated and described according to the recommendations of the GRADE working group.
RESULTS
One hundred twenty-seven studies were included in this systematic review. All combined, they reported on 16.964 TAAs with an average follow-up of 47.99 ± 29.18 months. Complications with highest reported pooled incidence were intra-operative fracture 0.06 (95 %CI 0.04-0.08) (GRADE Very low) and impingement 0.06 (95 %CI 0.04-0.08) (GRADE low) respectively.
CONCLUSION
Reported complication incidence of TAA surgery is still high and remains a significant clinical problem that can be severely hampering long-term clinical survival of the prosthesis. The results of this systematic review and meta-analysis can help guide surgeons in informing their patient about complication risks. Implementation of more stringent patient selection criteria might contribute to diminishing TAA complication rates.
Topics: Humans; Retrospective Studies; Arthroplasty, Replacement, Ankle; Arthrodesis; Ankle Joint; Reoperation; Treatment Outcome
PubMed: 35872118
DOI: 10.1016/j.fas.2022.07.004 -
BMC Musculoskeletal Disorders Apr 2024Arthrodesis of finger joints is often the last line of treatment of severe pain due to osteoarthritis, rheumatoid arthritis, or mallet finger. At the Department of...
BACKGROUND
Arthrodesis of finger joints is often the last line of treatment of severe pain due to osteoarthritis, rheumatoid arthritis, or mallet finger. At the Department of Orthopedic and Hand Surgery, Örebro University Hospital (ÖUH) in Sweden, the Kirschner-wire technique was standard until 2020, when the headless compression screw technique was introduced as a complement. There is no consensus on which method is superior. The purpose of this study was to examine the outcomes and complications associated with distal interphalangeal (DIP) joint and thumb interphalangeal (IP) joint arthrodesis, and to see whether these correlated with patient-dependent and treatment-related factors.
METHODS
In a retrospective cohort study, we evaluated a total of 149 consecutive arthrodeses (118 DIP joint and 31 thumb IP joint) performed between 2012 and 2022. The primary outcome was risk factors for complications after arthrodesis.
RESULTS
Osteoarthritis was the most common indication (56%) for arthrodesis. The majority of the patients were females (74%), and the median age was 62 (range 18-86). The complication frequency was 35%, with infection being the most common (25%). Time to completed follow up was < 12 weeks in the majority of the cases (58%). There were no significant differences in complication rate between the 136 joints operated using Kirschner wire and the 13 joints operated using headless compression screws. There was no significant increased risk of complications among smokers or patients with rheumatoid arthritis. Diabetes and surgeon experience had a significant influence on the risk of complication (p = 0.036 and p = 0.006, respectively).
CONCLUSIONS
Osteoarthritis was the most common indication for arthrodesis and postoperative complications occurred at a rate similar to that reported in the existing literature. Diabetes and surgeon experience were identified as factors increasing the risk of postoperative complications in these DIP/thumb IP joint arthrodeses. However, there was no significant difference between the two techniques (Kirschner wire and headless compression screws) regarding complications. Further studies are needed in order to determine the optimal type of operation and choice of implant.
TRIAL REGISTRATION
Researchweb CRIS #280,998, 26th of July 2023.
Topics: Female; Humans; Middle Aged; Male; Thumb; Retrospective Studies; Treatment Outcome; Osteoarthritis; Finger Joint; Arthrodesis; Arthritis, Rheumatoid; Postoperative Complications; Diabetes Mellitus
PubMed: 38566141
DOI: 10.1186/s12891-024-07361-w -
BMC Musculoskeletal Disorders May 2022The axial headless compression screw (AHCS) technique is a widely used method for distal interphalangeal joint (DIPJ) and thumb IPJ arthrodesis. However, it might not be...
Distal interphalangeal joint arthrodesis with nonaxial multiple small screws: a biomechanical analysis with axial headless compression screw and clinical result of 15 consecutive cases.
BACKGROUND
The axial headless compression screw (AHCS) technique is a widely used method for distal interphalangeal joint (DIPJ) and thumb IPJ arthrodesis. However, it might not be suitable for cases over 10° flexion of fusion angle and extremely small-sized phalanx. Here, the authors describe the nonaxial multiple small screws (NMSS) technique, compare the mechanical strength of the NMSS technique with the AHCS technique, and suggest clinical outcomes of the NMSS technique.
METHODS
DIPJ and thumb IPJ arthrodesis models were simulated in the 4th generation composite bone hand. Fixation with three 1.5 mm cortical screws (NMSS) or one HCS (AHCS) was performed in each pair of the phalanx. The bending stiffness and load to failure were tested in 10 pairs of each specimen, and the torsional stiffness and torque to failure were tested in seven pairs of each specimen. Moreover, 15 consecutive clinical DIPJ and thumb IPJ arthrodesis cases were reviewed retrospectively.
RESULTS
The NMSS specimens showed significantly higher bending load to failure, torsional stiffness, and torque to failure than the AHCS specimens. All 15 arthrodesis cases were united without severe complications. The mean fusion angle was 16.3° for the nine cases of the flexed target position.
CONCLUSIONS
The NMSS technique showed biomechanical stability comparable to that of the AHCS technique in DIPJ and thumb IPJ arthrodesis. Thus, the NMSS technique could be used as a feasible option in DIPJ and thumb IPJ arthrodesis, especially when a small finger is indicated and a significant flexion angle is required.
Topics: Arthrodesis; Bone Screws; Finger Joint; Humans; Retrospective Studies; Thumb
PubMed: 35624461
DOI: 10.1186/s12891-022-05473-9 -
Knee Surgery, Sports Traumatology,... Apr 2023Knee arthrodesis is an established procedure for limb salvage in cases of recurrent infection, total knee arthroplasty soft tissue defect, poor bone stock or a deficient...
PURPOSE
Knee arthrodesis is an established procedure for limb salvage in cases of recurrent infection, total knee arthroplasty soft tissue defect, poor bone stock or a deficient extensor mechanism. Surgical options include compression plate, external fixator and arthrodesis nail. Different types of nail exist: long fusion nail, short modular nail and bridging nail. This study presents the results on knee arthrodesis using different types of intramedullary nails. The aim is to assess if a specific type of nail has a better fusion rate, clinical outcome and lower complication rate.
METHODS
A mono-centric retrospective study of 48 knees arthrodesis was performed between 2000 and 2018. 15 T2 Arthrodesis Nail, 6 OsteoBridge Knee Arthrodesis and 27 Wichita fusion nail were used. The mean clinic and radiological follow-up was 9.8 ± 3.8 years (2.6-18 years).
RESULTS
Fusion rate was 89.6%. Time to fusion was 6.9 months. Mean Parker score was 6.9/9 points. Visual Analogic Scale was 1.9. The Wichita fusion nail showed better results in terms of fusion, time to fusion and clinical outcome measured by Parker score and VAS but without statistical significance. The early revision rate was 10.4% and 20.8% presented a late complication requiring a surgery, due to nonunion or infection. 93.3% of infection was cured. Two patients live with a fistula (4.2%) and 1 was amputated (2.1%).
CONCLUSION
Although burdened by a big complication rate, knee arthrodesis with an intramedullary nail provides satisfactory results and is a good alternative to above-knee-amputation. The Wichita fusion nail shows a tendency to better results compared to the two other nails.
LEVEL OF EVIDENCE
Case series, level IV.
Topics: Humans; Retrospective Studies; Bone Nails; Arthroplasty, Replacement, Knee; Knee; Reoperation; Arthrodesis; Treatment Outcome; Prosthesis-Related Infections
PubMed: 34458941
DOI: 10.1007/s00167-021-06693-7 -
Journal of Orthopaedic Surgery (Hong... Aug 2010To evaluate functional outcomes and complications following resection and arthrodesis of the knee for giant cell tumours (GCTs) of bone, in comparison to treatment by... (Comparative Study)
Comparative Study
PURPOSE
To evaluate functional outcomes and complications following resection and arthrodesis of the knee for giant cell tumours (GCTs) of bone, in comparison to treatment by endoprosthetic replacements reported elsewhere.
METHODS
18 men and 14 women aged 18 to 40 (mean, 28) years underwent resection and arthrodesis of the knee for GCTs of bone involving the distal femur (n=17) and proximal tibia (n=15). After wide resection, 2 struts were fashioned from the harvested fibula/ fibulae and inserted into the medullary canal at the resected ends of the tibia and femur. The corresponding ends of the struts were inserted into peg holes made in the unaffected condyles in a divergent fashion. The knee was arthrodesed in 5 to 10 degrees of flexion, with the limb kept 1 cm short. A 95-degree AO condylar bladeplate (10-12 holes) was fixed at the resected ends, with a minimum of 8 cortices purchase. Cancellous bone grafts were placed transversely along the struts and circumferentially over the host-graft junctions. Outcomes and complications were evaluated and compared with those of endoprosthetic arthroplasty reported elsewhere.
RESULTS
Patients were followed up for a mean of 8 (range, 3-12) years. The mean size of the tumours was 10x8x6 cm. All patients achieved arthrodesis and full weight bearing without pain within 6 to 10 (mean, 6) months. No shortening, loss of alignment, loosening, implant breakage ensued. One patient had a deep infection and absorption at the host-graft junction. Another had a stress fracture of the fibular strut after plate removal. Two patients had a transient peroneal nerve palsy. One patient had local recurrence and extensive fungation and underwent amputation. The mean functional score was 26 (87% of the full score), compared to 66 to 85% in endoprosthetic arthroplasty reported elsewhere.
CONCLUSION
Arthrodesis is a viable alternative to customised arthroplasty and provides a long-lasting and cost-effective reconstruction for average patients in developing countries.
Topics: Adolescent; Adult; Arthrodesis; Bone Neoplasms; Bone Plates; Bone Transplantation; Female; Fibula; Follow-Up Studies; Giant Cell Tumor of Bone; Humans; Knee Joint; Male; Retrospective Studies; Time Factors; Treatment Outcome; Young Adult
PubMed: 20808014
DOI: 10.1177/230949901001800215 -
Hand (New York, N.Y.) May 2022Scaphoid excision and 4-corner fusion is a standard procedure for advanced carpal collapse. The purpose of this study was to evaluate its effectiveness using a specific...
BACKGROUND
Scaphoid excision and 4-corner fusion is a standard procedure for advanced carpal collapse. The purpose of this study was to evaluate its effectiveness using a specific designed locking plate of the latest generation.
METHODS
Between October 2012 and December 2015, 12 patients underwent this procedure using the Flower (KLS Martin Group, Tuttlingen, Germany) circular locking plate. The surgical technique is standardized. Three patients were affected by a scapholunate advanced collapse and 9 patients by a scaphoid nonunion advanced collapse. All patients underwent a computed tomographic scan to study the real achievement of the fusion.
RESULTS
Only 2 patients did not show complete fusion. All the patients with successful fusion returned to previous work and manual activities.
CONCLUSIONS
Four-corner arthrodesis with circular locking plate is an alternative surgical treatment for carpal arthritic collapse.
Topics: Arthrodesis; Bone Plates; Humans; Scaphoid Bone; Wrist Joint
PubMed: 32844681
DOI: 10.1177/1558944720948238 -
Scientific Reports Sep 2019Ankle arthrodesis and total ankle arthroplasty are the two primary surgeries for treatment of end-stage degenerative ankle arthritis. The biomechanical effects of them...
Ankle arthrodesis and total ankle arthroplasty are the two primary surgeries for treatment of end-stage degenerative ankle arthritis. The biomechanical effects of them on the inner foot are insufficient to identify which is superior. This study compared biomechanical parameters among a foot treated by ankle arthrodesis, a foot treated by total ankle arthroplasty, and an intact foot using computational analysis. Validated finite element models of the three feet were developed and used to simulate the stance phase of gait. The results showed total ankle arthroplasty provides a more stable plantar pressure distribution than ankle arthrodesis. The highest contact pressure, 3.17 MPa, occurred in the medial cuneonavicular joint in the total ankle arthroplasty foot. Neither of the surgeries resulted in contact pressure increase in the subtalar joint. The peak stress in the metatarsal bones was increased in both surgical models, especially the second and third metatarsals. This study enables us to get visual to the biomechanics inside of an intact foot, and feet treated by total ankle arthroplasty and ankle arthrodesis during walking.
Topics: Ankle Joint; Arthritis; Arthrodesis; Arthroplasty, Replacement, Ankle; Biomedical Engineering; Female; Gait; Humans; Stress, Mechanical; Subtalar Joint; Walking
PubMed: 31527781
DOI: 10.1038/s41598-019-50091-6 -
Medicina (Kaunas, Lithuania) May 2022No gold standard exists for treating persistent periprosthetic knee infections. Knee arthrodesis represents one treatment concept for extensive bone defects and...
No gold standard exists for treating persistent periprosthetic knee infections. Knee arthrodesis represents one treatment concept for extensive bone defects and extensor system insufficiencies. It has already been shown that knee arthrodesis leads to a significant reduction in one's quality of life. The aim of this survey was to assess the influence of knee arthrodesis on the neighboring joints on the basis of gait analysis data. Our hypothesis is that the hip and ankle joints are negatively influenced by knee arthrodesis in the process of walking. We performed six pedobarographic and four gait analytical measurements in six patients 2.4 ± 1.6 years after receiving knee arthrodesis at the operating ages of 69.1 ± 9.2 years. Gait analysis consisted of time-distance parameters/minute (number of steps, double support, cycle time, standing phase, step length, gait speed). A healthy group of test subjects (n = 52) was included as the control cohort. Gait analysis was conducted using a three-dimensional movement system and three force-measuring platforms to determine the ground reaction force. Foot pressure was measured using a pedography platform. Five of six patients presented an incomplete rolling movement over the toes on the side that was operated on, presenting with a gait line ending in the forefoot area. All of the patients bore less weight on the side that was operated on. Three of six patients demonstrated a pathological gait line with a healthy opposite side ending in the forefoot area. All of the patients exhibited a reduction in gait speed and step length and a lower number of steps. All of the patients had a prolonged double support/cycle time. Isolated knee arthrodesis is associated with reduced forefoot repulsion, restricted movement on the side receiving the operation, and reduced movement in the ankle/knee joint. The hip showed norm deviations in the hip moment/angle. Knee arthrodesis causes reduced gait kinetics/kinematics. Our survey shows that the relative joint moments of the ankle joint and hip are often reduced. The ankle joint is more affected compared to the hip.
Topics: Aged; Ankle; Ankle Joint; Arthrodesis; Biomechanical Phenomena; Gait; Hip Joint; Humans; Knee Joint; Middle Aged; Quality of Life; Range of Motion, Articular
PubMed: 35743959
DOI: 10.3390/medicina58060696 -
Hand (New York, N.Y.) Sep 2022Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies...
INTRODUCTION
Dysfunction of the distal radioulnar joint (DRUJ) can be significantly debilitating. The Sauve-Kapandji (S-K) procedure can be indicated to address multiple etiologies of DRUJ dysfunction. The purpose of this study was to review our institution's results performing the S-K procedure for DRUJ dysfunction in terms of clinical and radiographic outcomes, as well as complications and reoperations.
METHODS
A retrospective review of S-K procedures performed at 2 institutions between 1998 and 2017 with a minimum of 1-year follow-up was performed. Preoperative and postoperative visual analog scale (VAS) pain, grip strength, and wrist range of motion were reviewed. Radiographs were reviewed for DRUJ healing, carpal translation, and radiocarpal degenerative changes.
RESULTS
The cohort included 35 patients. The mean age was 51 years. The mean follow-up was 49.5 months. The postoperative range of motion was unchanged in regard to pronation, supination, and wrist extension. There was a decrease in wrist flexion from 43 degrees to 34 degrees. Successful union was noted in 100% of the wrists. There was 1 case (2.8%) of progressive ulnar translation and 4 major complications (11.3%).
CONCLUSION
The S-K procedure has several theoretical benefits compared to other procedures for DRUJ dysfunction with results of this study demonstrating excellent pain relief, improved postoperative grip strength, retained wrist pronation, supination, and extension, high rate of successful arthrodesis and low rate of major complications.
LEVEL OF EVIDENCE
Level IV.
Topics: Arthrodesis; Humans; Middle Aged; Pain, Postoperative; Supination; Ulna; Wrist Joint
PubMed: 33225741
DOI: 10.1177/1558944720966725