-
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 -
International Orthopaedics 1997The indications, surgical techniques, results and complications of shoulder fusion are described. The indications are bacterial infection, paralytic disorders in... (Review)
Review
The indications, surgical techniques, results and complications of shoulder fusion are described. The indications are bacterial infection, paralytic disorders in infancy, combined deltoid and rotator cuff paralysis, post-traumatic brachial plexus lesions, inflammatory arthritis with severe rotator cuff involvement, failed arthroplasty, recurrent dislocation, after resection of tumours, irreparable rotator cuff tear, painful arthritis in a patient whose activities require power but not movement, the immunocompromised patient, and tuberculosis. Satisfactory results are achieved in children with isolated shoulder paralysis, but in adults loss of glenohumeral movement is associated with about 50% loss of function. The best results are obtained in cases of isolated shoulder paralysis with a normal arm and hand distally. The most frequent complications are nonunion (5-20%), fracture of the ipsilateral humerus (10-15%) and infection (3-5%). Other causes of failure are functional limitation, fusion in malposition, functional involvement of the distal joints, acromioclavicular dislocation, suprascapular traction neuritis, failure or migration of an internal fixation device, epiphyseal problems, and the complications of using an allograft. Shoulder replacement is most likely to be chosen for most destructive shoulder disorders, but fusion is useful in certain cases.
Topics: Adult; Arthrodesis; Arthroplasty; Child; Child, Preschool; Contraindications; Humans; Prognosis; Range of Motion, Articular; Shoulder Joint
PubMed: 9266304
DOI: 10.1007/s002640050151 -
European Journal of Orthopaedic Surgery... Dec 2023Several studies demonstrated a considerable complication rate for open ankle or TTC arthrodesis in patients with diabetes, revision surgery and ulceration. Extensive...
BACKGROUND
Several studies demonstrated a considerable complication rate for open ankle or TTC arthrodesis in patients with diabetes, revision surgery and ulceration. Extensive approaches in combination with multimorbide patients have been suggested as the rationale behind the increased complication rate.
METHODS
Single-centre, prospective case-control study compared arthroscopic vs. open ankle arthrodesis in patients with Charcot Neuro-Arthropathy of the foot. 18 patients with septic Charcot Neuro-Arthropathy Sanders III-IV received an arthroscopic ankle arthrodesis with TSF (Taylor Spatial Frame®) fixation combined with different additional procedures required for infect treatment and hindfoot realignment. The ankle arthrodesis was required for the realignment of the hindfoot in Sanders IV patients, arthritis or in case of infection. 12 patients were treated with open ankle arthrodesis and TSF fixation combined with various additional procedures.
RESULTS
A significant improvement has been shown in radiological data in both groups. A significant lower complication rate has been registered in arthroscopic group. A significant correlation was seen between major complications and therapeutic anticoagulation as well as smoking.
CONCLUSION
In high-risk patients with diabetes and plantar ulceration excellent results could be demonstrated in arthroscopically performed ankle arthrodesis with midfoot osteotomy using TSF as fixation devise.
Topics: Humans; Ankle; Case-Control Studies; Ankle Joint; Arthropathy, Neurogenic; Arthrodesis; Retrospective Studies; Diabetes Mellitus
PubMed: 37245183
DOI: 10.1007/s00590-023-03592-0 -
The Journal of Foot and Ankle Surgery :... 2023The use of subtalar arthrodesis procedures has been widely implemented to relieve hindfoot issues after failure of conservative treatments; however, fusion failures...
The use of subtalar arthrodesis procedures has been widely implemented to relieve hindfoot issues after failure of conservative treatments; however, fusion failures persist in some patients with certain risk factors. Currently, surgeons utilize cannulated screws in these arthrodesis procedures to immobilize the subtalar joint. Recent clinical studies have demonstrated improved fusion outcomes in at-risk patients using sustained dynamic compression devices in the tibiotalocalcaneal complex. These devices utilize pseudoelastic nitinol which enables sustained dynamic compression when faced with postoperative bone resorption, joint settling, and bone relaxation. While the clinical success of these devices has been established in the tibiotalocalcaneal complex, the ability of sustained dynamic compression devices to apply joint compression in the subtalar joint has not been quantified. As such, the goals of this study were to (1) compare the ability of static compression devices and sustained dynamic compression devices to apply joint compression and (2) assess the impact of device trajectory on joint compression. A custom mechanical testing fixture was utilized to test the compression applied across the subtalar joint by one sustained dynamic compression device (in anterior and posterior trajectories) as compared to 2 cannulated screws (in both parallel and diverging trajectories). Testing revealed the sustained dynamic compression devices generated 53% greater compression as compared to the static compression devices, despite single versus dual device usage, respectively. Additionally, both types of devices applied joint compression forces in an insertion trajectory-independent manner. These data illustrate the ability of a single SDC device to maintain significantly improved joint compressive forces as compared to 2 static cannulated screws, regardless of insertion trajectory. These SDC devices may be of particular interest for at-risk patients or in revision cases.
Topics: Humans; Subtalar Joint; Bone Screws; Pressure; Arthrodesis; Risk Factors; Ankle Joint
PubMed: 37088274
DOI: 10.1053/j.jfas.2023.04.005 -
The Journal of Foot and Ankle Surgery :... 2022Fusion remains the gold standard for post-traumatic osteoarthritis after ankle fractures in many institutes. Patient-reported outcomes on long-term quality of life and...
Functional Outcomes and Quality of Life in Patients With Post-Traumatic Arthrosis Undergoing Open or Arthroscopic Talocrural Arthrodesis-A Retrospective Cohort With Prospective Follow-Up.
Fusion remains the gold standard for post-traumatic osteoarthritis after ankle fractures in many institutes. Patient-reported outcomes on long-term quality of life and functionality of talocrural arthrodesis remain relatively unknown. In literature, low patient numbers and inadequate outcome measures provide a poor foundation for patient expectation management. Additionally, the surgical approach is often omitted. This study presents a retrospective cohort of patients who underwent open or arthroscopic talocrural arthrodesis for post-traumatic arthritis between 2008 and 2019 with prospective follow-up by questionnaire. Participants completed the EuroQol 5-dimensional 3-level questionnaire (EQ-5D-3L), EuroQol Visual Analogue Scale (EQ-VAS), Foot and Ankle Outcome Score Dutch Language Version (FAOS-DLV), and 4 additional questions. Thirty-five patients were included in the cohort and 32 were included for follow-up. Trauma mechanism was mainly a low fall or motor vehicle accident causing a talocrural fracture-dislocation in most cases. For open versus arthroscopic treatment respectively, patients reported a median EQ-5D-3L index of 0.775 and 0.775, EQ-VAS of 80 and 88, FAOS-DLV of 57.0 and 63.9, and satisfaction of 90 and 88 out of 100 after a median of 6.0 and 6.5 years. This study is unique as it is the largest series on patient-reported outcomes in patients with post-traumatic arthrosis with validated questionnaires. In general, patients were satisfied with relatively high questionnaire scores, especially concerning pain and daily living. These functional scores are of importance when setting patient expectations regarding talocrural arthrodesis and recovery. Additionally, the subscale values may help preoperatively in weighing the intervention's advantages and disadvantages for individual patients.
Topics: Arthrodesis; Follow-Up Studies; Humans; Osteoarthritis; Prospective Studies; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 34801377
DOI: 10.1053/j.jfas.2021.10.022 -
Orthopaedics & Traumatology, Surgery &... Oct 2017Glenohumeral arthrodesis is a rare salvage procedure for selected patients with different shoulder pathologies. Among a variety of surgical techniques, compression...
INTRODUCTION
Glenohumeral arthrodesis is a rare salvage procedure for selected patients with different shoulder pathologies. Among a variety of surgical techniques, compression screws or plate fixation are most widely used. Minimally invasive screw fixation has become more popular, although it has been shown to be biomechanically inferior to plate arthrodesis.
HYPOTHESIS
Screw arthrodesis would lead to a higher revision rate than plate arthrodesis.
MATERIAL AND METHODS
Twenty-seven plate and 7 screw arthrodesis of the glenohumeral joint in 19 male and 15 female patients of a mean age of 50years (range, 16-85years) were reviewed in a retrospective multicenter study with at a follow-up of 43months (range, 11-152months) to compare their clinical and radiographic outcome with special focus on revision rate.
RESULTS
Constant score did not change, but its subscore for pain significantly improved from 4.5 points (range, 0-15 points) to 11 points (range, 6-15 points). The subjective shoulder value increased significantly from 19% (range, 0-70%) to 41% (range, 10-80%) and 81% of the patients were satisfied. In 14 patients (41%), the arthrodesis had to be revised either for non-union (11) or malunion (3) at a mean of 12months (range, 0-47months). The 2 groups did not differ in terms of demographic data, nor of preoperative and postoperative clinical data. There were more revisions after screw than plate fixation. If revision was performed for non-union, this difference was significant.
DISCUSSION/CONCLUSION
In selected patients, glenohumeral arthrodesis can significantly reduce pain and achieve at best a reasonable function and subjective satisfaction rate. Revision rates favor plate over isolated screw fixation.
LEVEL OF EVIDENCE
IV retrospective series.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arthrodesis; Bone Plates; Bone Screws; Female; Follow-Up Studies; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Reoperation; Retrospective Studies; Shoulder Joint; Young Adult
PubMed: 28669920
DOI: 10.1016/j.otsr.2017.05.021 -
European Journal of Medical Research Dec 2023The purpose of this study is to use three-dimensional finite-element analysis to better understand the biomechanical features of various internal fixators for ankle...
BACKGROUND
The purpose of this study is to use three-dimensional finite-element analysis to better understand the biomechanical features of various internal fixators for ankle arthrodesis.
METHODS
We used finite-element analysis to compare four different types of internal fixations in ankle arthrodesis: Group A had three crossed screws (Ø6.5 mm); Group B had two crossed screws (Ø6.5 mm) and an anterior plate (Ø2.7 mm); Group C only had an anterior anatomical plate (Ø3.5 mm); Group D had one anterior anatomical plate (Ø3.5 mm) and one posterior-lateral screw (Ø6.5 mm). We adopted Ansys 21.0 software to analyze and compare the four types in terms of the displacement of the arthrodesis surface and the stress peak and stress distribution of these models under intorsion, extorsion, dorsiflexion torque, and neutral vertical load.
RESULTS
① Displacement of the arthrodesis surface: In Group A, the maximum displacement was larger than Group D under neutral vertical load and dorsiflexion torque but less than it under intorsion and extorsion torque. In Group B, the maximum displacement against dorsiflexion, neutral vertical load, intorsion, and extorsion was less than that in the other three fixation models. In Group C, the maximum displacement against the above four loading patterns were significantly higher than that in another three fixation models. ② Stress peak and stress distribution: based on the stress distribution of the four models, the peak von Mises stress was concentrated in the central sections of the compression screws, plate joints, and bending parts of the plates.
CONCLUSIONS
The fixation model consisting of two crossed screws and an anterior outperformed the other three fixation models in terms of biomedical advantages; thus, this model can be deemed a safe and reliable internal fixation approach for ankle arthrodesis.
Topics: Humans; Ankle; Ankle Joint; Fracture Fixation, Internal; Bone Plates; Arthrodesis; Biomechanical Phenomena
PubMed: 38066608
DOI: 10.1186/s40001-023-01554-0 -
Archives of Orthopaedic and Trauma... Aug 2023Ankle arthrodesis (AA) is often fixed using cannulated screws. The irritation from metalwork is a relatively common complication, but there is no consensus regarding the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Ankle arthrodesis (AA) is often fixed using cannulated screws. The irritation from metalwork is a relatively common complication, but there is no consensus regarding the need to remove the screws on a systematic basis. The aim of this study was to determine (1) the proportion of screws removed after AA and (2) whether predictors of screw removal could be identified.
METHODS
This PRISMA-compliant systematic review was part of a larger previous protocol registered on the PROSPERO platform. Multiple databases were searched including studies in which patients undergone AA using screws as exclusive fixation method were followed. Data were harvested regarding the cohort, the study design, the surgical technique, the nonunion and complication rate at the longest follow-up. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS).
RESULTS
Forty-four series of patients from thirty-eight studies (1990 ankles, 1934 patients) were selected. The average follow-up was 40.8 months (range 12-110). In all studies, hardware was removed due to symptoms reported by patients and related to the screws. The pooled proportion of removal of metalwork was 3% (95% CI 2-4). The pooled proportion of fusion was 96% (95%CI 95-98), while the pooled proportion of complications and reoperations (excluding the removal of metalwork) stood at 15% (95% CI 11-18) and 3% (95% CI 2-4), respectively. The mean mCMS (50.8 ± 8.1, range 35-66) revealed only an overall fair quality of studies. The univariate analysis and the multivariate model showed that the year of publication (R = - 0.004; p = 0.01) and the number of screws (R = 0.08; p = 0.01) were associated with the screw removal rate. Specifically, we found that over time the removal rate decreased by 0.4% per year and that the use of three screws instead of two reduced the risk of removal of metalwork by 8%.
CONCLUSIONS
In this review, removal of metalwork after ankle arthrodesis using cannulated screws was needed in 3% of cases at an average follow-up of 40.8 months. It was indicated only in case of symptoms related to soft tissue irritation from screws. The use of three screws was paradoxically related to a reduced risk of removal of screws as compared to two-screw constructs.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV.
Topics: Humans; Ankle; Ankle Joint; Bone Screws; Arthrodesis; Retrospective Studies
PubMed: 36795152
DOI: 10.1007/s00402-023-04813-1 -
Clinical Orthopaedics and Related... Apr 2016While successful subtalar joint arthrodesis provides pain relief, resultant alterations in ankle biomechanics need to be considered, as this procedure may predispose the...
BACKGROUND
While successful subtalar joint arthrodesis provides pain relief, resultant alterations in ankle biomechanics need to be considered, as this procedure may predispose the remaining hindfoot and tibiotalar joint to accelerated degenerative changes. However, the biomechanical consequences of isolated subtalar joint arthrodesis and additive fusions of the Chopart's joints on tibiotalar joint biomechanics remain poorly understood.
QUESTIONS/PURPOSES
We asked: What is the effect of isolated subtalar fusion and sequential Chopart's joint fusions of the talonavicular and calcaneocuboid joints on tibiotalar joint (1) mechanics and (2) kinematics during loading for neutral, inverted, and everted orientations of the foot?
METHODS
We evaluated the total force, contact area, and the magnitude and distribution of the contact stress on the articular surface of the talar dome, while simultaneously tracking the position of the talus relative to the tibia during loading in seven fresh-frozen cadaver feet. Each foot was loaded in the unfused, intact control condition followed by three randomized simulated hindfoot arthrodesis modalities: subtalar, double (subtalar and talonavicular), and triple (subtalar, talonavicular, and calcaneocuboid) arthrodesis. The intact and arthrodesis conditions were tested in three alignments using a metallic wedge insert: neutral (flat), 10° inverted, and 10° everted.
RESULTS
Tibiotalar mechanics (total force and contact area) and kinematics (external rotation) differed owing to hindfoot arthrodeses. After subtalar arthrodesis, there were decreases in total force (445 ± 142 N, 95% CI, 340-550 N, versus 588 ± 118 N, 95% CI, 500-676 N; p < 0.001) and contact area (282 mm(2), 95% CI, 222-342 mm(2), versus 336 ± 96 mm(2), 95% CI, 265-407 mm(2); p < 0.026) detected during loading in the neutral position; these changes also were seen in the everted foot position. Hindfoot arthrodesis also was associated with increased external rotation of the tibiotalar joint during loading: subtalar arthrodesis in the neutral loading position (3.3° ± 1.6°; 95% CI, 2°-4.6°; p = 0.004) and everted loading position (4.8° ± 2.6°; 95% CI, 2.7°-6.8°; p = 0.043); double arthrodesis in neutral (4.4° ± 2°; 95% CI, 2.8°-6°; p = 0.003) and inverted positions (5.8° ± 2.6°; 95% CI, 3.7°-7.9°; p = 0.002), and triple arthrodesis in all loaded orientations including neutral (4.5° ± 1.8°; 95% CI, 3.1°-5.9°; p = 0.002), inverted (6.4° ± 3.5°; 95% CI, 3.6°-9.2°; p = 0.009), and everted (3.6° ± 2°; 95% CI, 2°-5.2°; p = 0.053) positions. Finally, after subtalar arthrodesis, additive fusions at Chopart's joints did not appear to result in additional observed differences in tibiotalar contact mechanics or kinematics with the number of specimens available.
CONCLUSIONS
Using a cadaveric biomechanical model, we identified some predictable trends in ankle biomechanics during loading after hindfoot fusion. In our tested specimens, fusion of the subtalar joint appeared to exert a dominant influence over ankle loading.
CLINICAL RELEVANCE
A loss or deficit in function of the subtalar joint may be sufficient to alter ankle loading. These findings warrant consideration in the treatment of the arthritic hindfoot and also toward defining biomechanical goals for ankle arthroplasty in the setting of concomitant hindfoot degeneration or arthrodesis.
Topics: Aged; Ankle Joint; Arthrodesis; Biomechanical Phenomena; Cadaver; Female; Humans; Male; Middle Aged; Postoperative Complications; Stress, Mechanical; Weight-Bearing
PubMed: 26689585
DOI: 10.1007/s11999-015-4671-5