Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. Ankle Arthroplasty in Patients Younger and Older than 50 Years: A Prospective Series with Long-term Follow-up Outcome After Single Technique Ankle Arthrodesis in Patients With Rheumatoid Arthritis Prospective Controlled Trial of STAR Total Ankle Replacement versus Ankle Fusion: Initial Results Functional Evaluation of the Scandinavian Total Ankle Replacement Anterior ankle arthrodesis with cross-screw fixation. A dowel graft method used in 20 cases. Short-Term Results of Our First 49 Scandanavian Total Ankle Replacements (STAR) A retrospective study of posterior malleolus fractures Total ankle replacement. Early experiences with STAR prosthesis. Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis. Infectious and Healing Complications after Elective Orthopaedic Foot and Ankle Surgery during Tumor Necrosis Factor-Alpha Inhibition Therapy Gait analysis in ankle osteoarthritis and total ankle replacement. Treatment of osteoarthritis of the ankle by intra-articular injections of hyaluronic acid: a prospective study. Management of ankle sprains: a randomised controlled trial of the treatment of inversion injuries using an elastic support bandage or an Aircast ankle brace Scandinavian Total Ankle Replacement (STAR). Outcomes after shoulder replacement: comparison between reverse and anatomic total shoulder arthroplasty. Interrater and intrarater reliability in the measurement of ankle joint dorsiflexion is independent of examiner experience and technique used. Impacts of foot orthoses on pain and disability in rheumatoid arthritics. Comparison of the Results of Bilateral Total Knee Arthroplasty with and without Patellar Replacement for Rheumatoid Arthritis. A Follow-up Note* Lateral Transmalleolar Approach and Miniscrews Fixation for Displaced Posterolateral Fragments of Posterior Malleolus Fractures in Adults: A Consecutive Study A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years. Radiographic damage in large joints in early rheumatoid arthritis: relationship with radiographic damage in hands and feet, disease activity, and physical disability. A randomised controlled trial of total hip arthroplasty versus resurfacing arthroplasty in the treatment of young patients with arthritis of the hip joint
BACKGROUND Interest in mobile-bearing total ankle arthroplasty  has increased in recent years . However , to our knowledge , no study has focused exclusively on patients with the diagnosis of inflammatory joint disease or has provided a detailed analysis of the risk factors for failure . METHODS A prospect i ve observational study of the results of cementless mobile-bearing total ankle arthroplasty  in patients with inflammatory joint disease ( mainly rheumatoid arthritis ) was conducted at two centers . Ninety-three total ankle arthroplasties were performed . The LCS ( low contact stress ) prosthesis was used initially , in nineteen ankles , between 1988 and 1992 , and a modification of the LCS prosthesis , the Buechel-Pappas design , was used in seventy-four ankles between 1993 and 1999 . Clinical and radiographic follow-up was performed at yearly intervals . Three clinical scoring systems were used , and any complication was recorded throughout follow-up . Actuarial survival ( with revision as the end point ) , multivariate analysis , and a competing risk approach were used to describe the long-term outcome . RESULTS The clinical result at one year after surgery showed a significant improvement in the scores on all three scoring systems ( p < 0.05 ) . Ankle dorsiflexion ( mean , 7 degrees ) also improved significantly ( p < 0.05 ) compared with the preoperative state . The most frequent complication was a malleolar fracture , which occurred in twenty ankles . Only when it occurred in combination with a deformity in the frontal plane did this complication have an adverse effect on the end result . At a mean follow-up of eight years , seventeen patients ( twenty-one ankles ) had died and fifteen ankles had been revised because of aseptic loosening ( six ankles ) , primary or secondary axial deformity with edge-loading ( six ankles ) , deep infection ( two ankles ) , and a severe wound-healing problem ( one ankle ) , leaving fifty-seven ankles ( 61 % ) that were evaluated . The mean overall survival rate at eight years was 84 % . An increased failure rate was encountered in ankles with a preoperative deformity in the frontal plane of > 10 degrees ( p = 0.03 ) and in ankles in which an undersized tibial component had been implanted ( p = 0.02 ) . CONCLUSIONS Mobile-bearing total ankle arthroplasty is a valid treatment option for the rheumatoid ankle if proper indications are used . Aseptic loosening and persistent deformity are the most important modes of failure One hundred consecutive cases treated with ankle arthroplasty for osteoarthritis ( OA ) or rheumatoid arthritis were followed prospect ively and annually for up to 15 years . Survivorship analysis was performed , with the endpoint being prosthesis revision or change to arthrodesis .  Patients who were younger than 50 years at the first implantation constituted one group ( group A , 30 ankles ) . The other group ( group B , 70 ankles ) consisted of patients aged 50 years or older at the first implantation . All patients were assessed clinical ly according to the Kofoed Ankle Score . The distribution of OA/rheumatoid arthritis in group A was 18/12 , and in group B it was 43/27 ( not significant ) . The median age in group A was 46 years ( range , 22–49 years ) , and in group B it was 63 years ( range , 51–83 years ) . In group A , one case was revised , and three cases were converted to  arthrodesis  after a median of 5 years ( range , 5–9 years ) . In group B , four cases were revised , and four cases were converted to  arthrodesis  after a median of 5.5 years ( range , 2–8 years ) . The results of cases with traumatic OA did not differ between groups A and B. It was concluded that the results of ankle arthroplasty were of equal quality in patients younger than 50 years and those who were older The established treatment for severe rheumatoid arthritis in the ankle is arthrodesis . Numerous reports in the literature describe outcomes in patients with degenerative and posttraumatic arthrosis and rheumatoid disease . This has led to results that are difficult to interpret . In addition , in the few studies that have evaluated patients with rheumatoid disease many techniques of arthrodesis are reported , further confounding assessment of one fusion method . One technique of 20 ankle fusions in patients with rheumatoid disease was evaluated . A modified Wagner arthrodesis was used through a transfibular approach using parallel compression screws . The scoring systems of Mazur et al , Moran et al , and the Short-Form-36 were used to evaluate the outcome . The mean time to followup was 3 years 10 months . Eighteen of 20 fusions obtained a solid talocrural union ( 90 % ) . No correlation was found between the scores of Mazur et al and Moran et al. Correlation was achieved between the scores for the Short Form-36 and Moran et al. The modified Wagner ankle arthrodesis is a simple , reliable , reproducible technique with a 90 % union rate . The value of the technique has been confirmed in patients with rheumatoid arthritis by evaluating the outcome using a scoring system that is vali date d and relevant to this population Background : Mobile-bearing ankle replacements have become popular outside of the United States over the past two decades . The goal of the present study was to perform a prospect i ve evaluation of the safety and efficacy of a mobile-bearing prosthesis to treat end stage ankle arthritis . We report the results of three separate cohorts of patients : a group of Sc and anavian Total Ankle Replacement ( STAR ) patients and a control group of ankle fusion patients ( the Pivotal Study Groups ) and another group of STAR total ankle patients ( Continued Access Group ) whose surgery was performed following the completion of enrollment in the Pivotal Study . Material s and Methods : The Pivotal Study design was a non-inferiority study using ankle fusion as the control . A non-r and omized multi-centered design with concurrent fusion controls was used . We report the initial perioperative findings up to 24 months following surgery . For an individual patient to be considered an overall success , all of the following criteria needed to be met : a ) a 40-point improvement in total Buechel-Pappas ankle score , b ) no device failures , revisions , or removals , c ) radiographic success , and d ) no major complications . In the Pivotal Study ( 9/00 to 12/01 ) , 158 ankle replacement and 66 arthrodesis procedures were performed ; in the Continued Access Study ( 4/02 to 10/06 ) , 448 ankle replacements were performed , of which 416 were at minimum 24 months post-surgery at time of the data base closure . Results : Major complications and need for secondary surgical intervention were more common in the Pivotal Study arthroplasty group than the Pivotal Study ankle fusion group . In the Continued Access Group , secondary procedures performed on these arthroplasty patients decreased by half when compared with the Pivotal Arthroplasty Group . When the Pivotal Groups were compared , treatment efficacy was higher for the ankle replacement group due to improvement in functional scores . Pain relief was equivalent between fusion and replacement patients . The hypothesis of non-inferiority of ankle replacement was met for overall patient success . Conclusion : By 24 months , ankles treated with STAR ankle replacement ( in both the Pivotal and Continued Access Groups ) had better function and equivalent pain relief as ankles treated with fusion . Level of Evidence : II , Prospect i ve Controlled Comparative Surgical The purpose of this study was to evaluate the function of the ankle joint during walking before and after  Sc and inavian Total Ankle Replacement ( STAR ) . Nine patients ( six males and three females ) with an average age of 65 years , scheduled for unilateral total ankle replacement for osteoarthritis and rheumatoid arthritis , were evaluated both preoperatively and postoperatively in a gait analysis laboratory . Arthroplasty patients showed reduced range of motion at the ankle compared to normal controls . Postoperative arthroplasty subjects had significantly improved external ankle dorsiflexion moment , the moment that affects the plantarflexor muscles , when compared to their preoperative status . The moment in arthroplasty patients was increased , indicating improved function of the ankle joint We report a new method of ankle arthrodesis which combines an anterior approach with a dowel technique of bone grafting and screw fixation . In 20 ankles of 20 patients , ten with osteoarthritis , eight with rheumatoid arthritis and two others , we achieved 19 solid bony fusions  and one painless fibrous ankylosis . The average time to union was 12.5 weeks . Patient satisfaction was high and the functional results were as good as for other reported methods , with fewer complications Background : Forty-seven consecutive patients treated for ankle arthritis with a Sc and inavian total ankle replacement ( STAR ) by one surgeon were investigated retrospectively . Material s and Methods : A modification of the Foot Function Index ( FFI ) , which scores pain and task difficulties , was followed prospect ively . Patients were assessed clinical ly and radiologically . Failure was defined as revision of the prosthesis or arthrodesis for any reason . Results : In 47 patients ( 16 male , 31 female ) 49 total ankle replacements were carried out between May 1999 and June 2004 . Indication for surgery was end stage arthritis for rheumatoid arthritis in 29 cases , post-traumatic arthritis in 12 , osteoarthritis in five and arthritis secondary to degenerative flatfoot in three . Mean followup time was 28 ( 12 to 67 ) months . The modified FFI ( range , 0 to 100 , a high score meaning more pain and disability ) improved significantly from 59 before to 35 after surgery . The mean postoperative Kofoed ankle score was 68 . Sixteen procedures were complicated by fractures or temporary neurological damage . At the time of followup , 45 prostheses survived , while four replacements had failed . Radiological examination at followup showed radiolucent lines , osteolysis , and malposition of the components in 31 cases . Conclusion : Our results are comparable with those reported in the literature . The clinical outcome improved significantly . Due to aseptic and septic loosening , 8.2 % of the prosthesis failed Purpose In this retrospective study , we evaluated the treatment effect of  ankle joint fracture surgery involving the posterior malleolus , and discuss relevant factors influencing the occurrence of traumatic arthritis of the ankle joint . Methods A total of 102 cases of ankle joint fractures involving the posterior malleolus in five large-scale skeletal trauma centres in China , from January 2000 to July 2009 , were retrospectively analysed in terms of surgical treatment and complete follow-up . Ankle joint mobility , posterior malleolus fragment size , articular surface evenness , Ankle-Hindfoot Scale of the American Orthopedic Foot and Ankle Society ( AOFAS ) score , and imaging scale score for arthritis were recorded . The degree of fracture pain during rest , active movement , and weight-bearing walking , and satisfaction with treatment were evaluated using a visual analogue scale ( VAS ) . Results The average AOFAS score was 95.9 , excellence rate was 92.2 % , and average VAS scores for degree of fracture pain during rest , active movement , and weight-bearing walking were 0.15 , 0.31 , and 0.68 , respectively . Thirty-six cases showed arthritic manifestations . Ankle joint mobility along all directions on the injured side was lower than that on the unaffected side . There was no obvious difference in treatment effect between the fixed and unfixed posterior malleolus fragment groups for all and for fragment size of < 25 % ; between fixing the posterior malleolus fragment from front to back or from back to front ; or between elderly patients ( ≥60 years old ) and young patients ( < 60 years old ) . There was a distinct difference in the treatment effect between articular surface evenness and unevenness for all and for fragment size of ≥25 % . Conclusions For all 102 cases of ankle joint fracture involving the posterior malleolus , the treatment effect was satisfactory . Restoration of an even articular surface , especially when fragment size ≥25 % , should be attempted during treatment Early design s of Total Ankle Replacement ( TAR ) had a high failure rate . More recent experience with the 3-piece , meniscal bearing , total ankle replacement has been more promising . We report a review of the early results of our first 22 prostheses in 20 patients undergoing Sc and inavian Total Ankle Replacement ( STAR ) in Northern Irel and . There was a mean follow-up time of 26 months . Seventeen patients are pain-free at the ankle joint during normal daily activities . Two of the early cases have required revision surgery due to technical errors . Other complications have included malleolar fractures , poor wound healing and postoperative stiffness . These early results show high levels of patient satisfaction , and we are encouraged to continue with total ankle arthroplasty . There is a steep initial learning curve and use of TAR should be restricted to foot and ankle surgeons . ImagesFig 1Figs 2a and bFigs 2 c and BACKGROUND This pilot study investigated whether semi-rigid and soft orthoses had an effect on pain , disability and functional limitation in participants with chronic rheumatoid hindfoot involvement . METHODS Participants with chronic hindfoot pain were r and omly assigned to 2 groups , commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses . The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention , which lasted for 3 months . Following a 2 week washout period , each group was switched over to the other type of orthoses . RESULTS Nine female participants ( mean age 52.2years ( SD 9.1 ) ; mean weight 71 kg ( SD 12.64 ) ; mean height 160 cm ( SD 5.18 ) ) with a mean RA duration of 11.7years ( SD 7.83 ) , and a mean ankle/subtalar joint pain duration of 5.7years ( SD 2.62 ) , completed the programme . Mean improvement in FFI score for both orthoses result ed in the same statistical significance ( p=0.001 ) . Statistically significant reduction in pain , disability and functional limitation was observed for both interventions , together with improvement in the Ritchie Articular Index score . CONCLUSION Both Subortholene and EVA orthoses significantly reduced pain , disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis Background : Biologic response modifiers are assuming a larger role in the management of patients with rheumatoid arthritis . The tumor necrosis factor-alpha ( TNF-α ) inhibitors etanercept and infliximab improve patient symptoms and function . However , these agents have been associated with a risk for healing and infectious complications due to systemic blockade of TNF-α , a ubiquitous mediator required in the normal inflammatory response in tissue healing and infection surveillance . This study analyzed the risk of healing/infectious complications in patients undergoing elective foot and ankle surgery while being treated with TNF-α inhibitors etanercept and infliximab . Methods : Patients with rheumatoid arthritis undergoing elective foot and ankle surgery over a 12-month period were prospect ively followed for the development of complications in the postoperative period . All patients continued their antirheumatic medication schedule unaltered in the perioperative period . Data collected included sex , age , all medications used to treat rheumatoid arthritis , smoking history , and number of orthopaedic foot and ankle procedures performed . Patients were then stratified into two groups based on the use of immunomodulation via TNF-α inhibition ( group 1 ) versus patients who did not receive TNF-α inhibition therapy ( group 2 ) . Groups 1 and 2 were followed and compared for the development of infectious/healing complications . Results : Thirty-one patients were enrolled in the study . Group 1 ( n = 16 ) and group 2 ( n = 15 ) patients were comparable for sex distribution , number of orthopaedic procedures performed , and use of steroids , methotrexate , leflunamide , and nonsteroidal anti-inflammatory drugs . Group 1 contained six times the number of smokers in group 2 . At mean follow-up of 10.6 months ( group 1 ) and 9.7 months ( group 2 ) , healing or infectious complications were similar in both groups . However , when total complications ( healing + infection ) were analyzed , group 1 ( TNF-α inhibition , “ higher risk ” ) patients demonstrated a lower complication rate ( p = .033 ) . Conclusions : The data suggest that in patients with rheumatoid arthritis undergoing elective foot and ankle surgery , the use of TNF-α inhibition agents may be safely undertaken in the perioperative period without increasing the risk of healing or infectious complications BACKGROUND Little information is available about gait changes in ankle osteoarthritis and total ankle replacement , and also about  total ankle replacement patients ' rehabilitation in the first year after surgery . METHODS Thirty subjects were included in this study : 15 unilateral post-traumatic ankle osteoarthritis patients and 15 age-/gender-matched control subjects . Patients were followed prospect ively : preoperatively , at 3 , 6 , 9 , and 12 months after total ankle replacement . The clinical -functional level was assessed by the American Orthopaedic Foot and Ankle Society ankle and the Short-Form-36 health survey score . 3D ankle-hindfoot kinematic-kinetic analysis  was performed using a motion analysis and a two-plate force-platform system . Statistics included repeated measures analysis of variances , independent sample and paired Student 's t-tests ( significance alpha=0.05 ) . FINDINGS Compared to normal subjects , ankle osteoarthritis caused significant reduction of the American Orthopaedic Foot and Ankle Society and Short-Form-36 score . In gait analysis , ankle osteoarthritis showed a significant deficiency in six of seven spatiotemporal variables , a decrease of the tri-planar ankle movement , a decrease of the second active maximal vertical and the maximal medial ground reaction force , a reduction of the sagittal and transverse ankle joint moments , a reduction of the ankle joint power . Three months after total ankle replacement surgery patients experienced a worsening of gait . At 12 months follow-up , all spatiotemporal variables were not different from the normal subjects ( full rehabilitation ) ; in six of 11 kinematic and kinetic variables there was a partial rehabilitation . INTERPRETATION This study provides data for the clinical -biomechanical underst and ing of the normal , arthritic , and total ankle replacement treated ankle during walking and the first year of rehabilitation BACKGROUND Treatment of  osteoarthritis of the ankle is similar to that of any other large joint and includes conservative and surgical options . Surgical treatment in severe cases is fusion or joint replacement , whereas conservative treatment is limited and includes mainly ankle supports and physiotherapy . Hyaluronic acid was discovered by Meyer and Palmer in 1934 and has recently been widely used in the treatment of knee osteoarthritis . We evaluated the efficacy of an intra-articular preparation containing sodium hyaluronate in the treatment of osteoarthritis of the ankle . METHODS We studied 16 patients aged 31 to 79 years ( mean age , 43 years ) with symptomatic ankle osteoarthritis of 9 months ' to 27 years ' duration . The radiographic severity of the ankle osteoarthritis was grade d II , III , or IV according to Kellgren and Lawrence . Arthritic ankles underwent intra-articular injections of 25 mg of sodium hyaluronate for 5 consecutive weeks . Follow-up visits were performed 4 , 8 , 11 , 17 , and 32 weeks after treatment and included clinical evaluation and objective scoring . RESULTS Global assessment showed improvement in 13 of 15 patients who completed the study . There was improvement by 20 % in range of motion and a significant reduction in pain assessed by visual analog scale and ankle-hindfoot scores , all statistically significant . Seven months after treatment , no decrease in efficacy was shown . Two patients did not show any significant improvement in global assessment after treatment . One patient was dropped from follow-up owing to concurrent back surgery . CONCLUSIONS Symptomatic relief of signs and symptoms of osteoarthritis of the ankle was achieved by injection of an intra-articular preparation containing sodium hyaluronate . There were significant improvements , in objective and subjective parameters , that lasted for more than 7 months . Ankle intra-articular injection of sodium hyaluronate is a valid conservative treatment for ankle osteoarthritis Background : Lateral ligament ankle sprains are the single most common sports injury . Objective : To determine the functional outcome of the ankle joint after a moderate or severe inversion injury , comparing st and ard treatment with an elastic support b and age against an Aircast ankle brace . Design : Prospect i ve , r and omised controlled trial . Setting : Two accident and emergency departments . Method : Fifty patients presenting consecutively were r and omised into two equal groups : one group was treated with an elastic support b and age and the other with an Aircast ankle brace . All patients were given a st and ardised advice sheet referring to rest , ice , compression , and elevation . Patients were review ed after 48–72 hours , 10 days , and one month . Primary outcome measure : Ankle joint function assessed at 10 days and one month using the modified Karlsson scoring method ( maximum score 90 ) . Secondary outcome measure : The difference in ankle girth ( swelling ) and pain score at 10 days . Results : Seventeen patients in the elastic support b and age group ( six defaulted , two excluded ) and 18 patients in the Aircast ankle brace group ( six defaulted , one excluded ) completed the study . There were no significant differences between the two groups at presentation in terms of age ( mean 35.3 and 32.6 years respectively ) , sex , dominant leg , left or right ankle injured , previous injury , time to presentation ( median three and four hours respectively ) , difference in ankle girth ( mean 14.5 and 14.3 mm respectively ) , and pain scores ( mean 6.2 and 5.8 respectively ) . The Karlsson score was significantly higher in the Aircast ankle cast group than in the elastic b and age group at 10 days ( mean 50 v 35 , p = 0.028 , 95 % confidence interval ( CI ) 1.7 to 27.7 ) and one month ( mean 68 v 55 , p = 0.029 , 95 % CI 1.4 to 24.8 ) ( Student ’s t test ) . There was no difference between the groups in the secondary outcome measures ( swelling , p = 0.09 ; pain , p = 0.07 ) . When hierarchical multiple regression analysis was used to correct for possible baseline confounding factors , the Aircast ankle brace group was significantly associated with higher Karlsson scores at 10 days ( p = 0.009 ) and one month ( p = 0.024 ) . Conclusion : The use of an Aircast ankle brace for the treatment of lateral ligament ankle sprains produces a significant improvement in ankle joint function at both 10 days and one month compared with st and ard management with an elastic support b and age Fifty-eight patients with either rheumatoid arthritis or osteoarthritis were treated with meniscal-bearing ankle prostheses .  The concept was to mobilize , align , and stabilize the ankle before resurfacing it . Cement was used for prostheses fixation in 33 patients ( 1986 - 1989 ) and 25 patients had fixation without cement ( 1990 - 1995 ) . All patients in one prospect i ve series were followed up yearly with radiographs and with a clinical scoring system giving a maximum of 100 points . This allowed for a patient-controlled prospect i ve study . No patients were lost to followup . The only detectable difference in the treatment was the fixation mode . For the purpose of comparing patients with cemented and uncemented prostheses , the patients who had surgery between 1986 and 1989 were not followed up after 1997 , and patients who had surgery between 1990 and 1995 were not followed up after 2002 . The mean followup was 9.4 years . Failure was defined as prosthesis revision or change to arthrodesis for any reason . In the cemented group , nine of 33 patients had revision surgery or fusion . In the uncemented group , one of 25 patients had revision surgery . Survivorship analysis for 12 years based on life tables showed a 70 % survival rate ( confidence limit , 60.3 - 78.5 ) for the cemented group and 95.4 % survival rate ( confidence limit , 91.0 - 99.9 ) for the uncemented group . The average clinical scores at the latest followup were 74.2 + /- 19.3 for the cemented group and 91.9 + /- 7.4 points for the uncemented group . Therefore , unconstrained meniscal-bearing ankle prostheses should be uncemented BACKGROUND Anatomic total shoulder arthroplasty ( TSA ) and reverse total shoulder arthroplasty ( RTSA ) are increasingly common procedures employed to treat arthritic conditions . Although TSA is a widely accepted procedure for glenohumeral arthritis with intact rotator cuff , concerns about RTSA persist because of variable complication rates and outcomes . METHODS This is a prospect i ve , case-control study comparing outcomes and complications after TSA and RTSA . The study included 47 patients undergoing TSA for glenohumeral arthritis and 53 patients undergoing RTSA for rotator cuff tear arthropathy . Average clinical follow-up was more than 2 years in both groups . Major complications included infection , periprosthetic fracture , instability , glenoid loosening , and need for revision surgery . Patient outcome measures included the American Shoulder and Elbow Surgeons score , pain visual analog scale score , and goniometer-measured range of motion . Plain radiographs were review ed to assess for degree of glenoid lucency in TSA and scapular notching in RTSA . RESULTS At 2 years , there were no differences in rate of major complications  ( TSA , 15 % ; RTSA , 13 % ; P = .808 ) or revision surgeries  ( TSA , 11 % ; RTSA , 9 % ) . Outcomes assessed by the American Shoulder and Elbow Surgeons score and visual analog scale were also similar between the 2 groups . TSA patients had greater external rotation than RTSA patients did ( 53 ° vs 38 ° ; P = .001 ) . Otherwise , forward flexion , abduction , and internal rotation were comparable in range of motion . CONCLUSIONS TSA and RTSA  have similar complication rates , need for revision , patient-reported outcomes , and range of motion at 2 years of follow-up . The use of side-by-side cohorts in this study allows st and ardized comparison between these 2 shoulder arthroplasty procedures BACKGROUND Goniometric measurement is currently being used as a diagnostic and outcomes assessment tool for ankle joint dorsiflexion . Despite its common use , its interrater and intrarater reliability has been question ed . METHODS This is a prospect i ve study examining whether the experience of the examiner or the technique used affects the interrater and intrarater reliability for measuring ankle joint dorsiflexion . Fourteen asymptomatic individuals ( 8 male and 6 female ) with a mean age of 28.2 years ( range , 23 - 52 ) were enrolled into this study . The years of clinical experience of the five examiners averaged 10.4 years ( range , 0 - 26 ) . Four examiners used a modified  Root , Weed and Orien method of measuring ankle joint dorsiflexion . The fifth examiner utilized a nonst and ardized technique . A st and ard goniometer was used for bilateral measurements of ankle joint dorsiflexion with the knee extended and flexed . All five examiners repeated each measurement three times during each of the three sessions , with each session spaced at least 1 week apart . RESULTS The interclass correlation coefficient reveals a moderate intrarater and poor interrater reliability in ankle joint dorsiflexion measurements using a st and ard goniometer . More importantly , further analysis indicates that the use of a st and ardized technique for measurement of ankle joint dorsiflexion or years of clinical experience does not increase the intrarater or interrater reliability . CONCLUSIONS The utility of the goniometric measurement of ankle joint dorsiflexion may be limited Rheumatoid arthritis ( RA ) frequently causes  foot pain and swelling that affect ambulation . Pharmaceutical management of pain and disability is st and ard in clinical practice . The use of functional posted foot orthoses , as an adjunct to pharmaceutical treatment , is a promising treatment for managing  foot pain and disability in RA . Its effectiveness , however , has not been rigorously evaluated . We performed a double-blind clinical trial using foot orthoses vs. placebo orthoses in the management of the rheumatoid arthritic foot , while subjects continued customary treatment . On the basis of findings of no effect on disability and pain measures , this study indicates no benefit of functional posted foot orthoses over placebos Simultaneous bilateral total knee arthroplasty was performed in twenty-six patients who had rheumatoid arthritis , and a patellar replacement was performed concurrently in one r and omly selected knee in each patient . A lateral retinacular release was performed in all knees . The patients were followed for at least six years ( mean , 6.6 years ; range , 6.0 to 7.5 years ) , and the postoperative status of the patients was evaluated with the knee score of The Hospital for Special Surgery .  Pain on st and ing and on ascending or descending stairs as well as tenderness of the patellofemoral joint also were assessed . The over-all score and the individual scores for pain , function , range of motion , muscle strength , flexion contracture , and instability were not significantly different between the knees that had had a patellar replacement and those that had not . However , pain on st and ing and on ascending or descending stairs as well as tenderness of the patellofemoral joint were only noted in knees that had not had a patellar replacement . These findings suggest that , in order to diminish pain on st and ing and on using stairs , replacement of the patella during total knee arthroplasty is preferable for patients who have rheumatoid arthritis Objectives : To evaluate the lateral transmalleolar ( LTM ) approach for a displaced posterolateral fragments of a posterior malleolus fracture . Design : Prospect i ve , consecutive . Setting : Level 1 trauma center . Patients : Thirty-six patients . Outcome Measures : The x-rays , evaluation of arthritic changes of the ankle joint , range of motion , and Short Musculoskeletal Function Assessment question naire ( SMFA ) . Intervention : The LTM approach followed by multiple interfragmentary miniscrew-only fixation . Results : No patients experienced intraoperative or postoperative complications that required a revision operation . All fractures healed . There were no infections , and no patient required implant removal . The median range of motion showed no significant difference as compared with the uninjured side . Patients achieved a mean SMFA dysfunction index of 8.2 ± 2.4 points and a mean SMFA bother index of 3.2 ± 1.2 points . All patients performed normal daily life activities at averagely 3 ( range , 2–5 ) months postoperatively . Conclusions : Direct visualization with the LTM approach followed by fixation with multiple miniscrews may be an alternative option for the treatment of ankle fractures with a posterolateral fragment associated with a posterior malleolar fracture . Level of Evidence : Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence BACKGROUND Durable long-term independent results with the Low Contact Stress rotating-platform ( mobile-bearing ) and the Insall Burstein-II ( fixed-bearing ) total knee prostheses have been reported , but no studies describing either the mid-term or long-term results and comparing the two prostheses are available , to our knowledge . METHODS Thirty-two patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion on both sides and who agreed to have one knee replaced with a mobile-bearing total knee design and the other with a fixed-bearing design were prospect ively evaluated . Comparative analysis of both design s was done at a mean follow-up period of six years , minimizing patient , surgeon , and observer-related bias . Clinical and radiographic outcome , survival , and complication rates were compared . RESULTS Patients with osteoarthritis had better function scores and range of motion compared with patients with rheumatoid arthritis . However , with the numbers available , no benefit of mobile-bearing over fixed-bearing design s could be demonstrated with respect to Knee Society scores , range of flexion , subject preference , or patellofemoral complication rates . Radiographs showed no difference in prosthetic alignment . Two knees with a mobile-bearing prosthesis required a reoperation : one had an early revision because of bearing dislocation and another required conversion to an arthrodesis to treat a deep infection . CONCLUSIONS We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at mid-term follow-up . The risk of bearing subluxation and dislocation in knees with the mobile-bearing prosthesis is a cause for concern and may necessitate early revision . LEVEL OF EVIDENCE Therapeutic Level II An assessment of the onset of radiographic damage in the large joints ( hip , knees , shoulders , elbows , ankles and tarsus ) in patients with early rheumatoid arthritis , and the relationship of the progression of large joint damage with joint damage in h and s and feet , with physical disability , and with cumulative disease activity , was performed in a prospect i ve 6 yr follow-up study . Large joint damage appeared to be an early phenomenon with 20 % of the patients having some damage in at least one large joint within 1 yr , and 50 % of the patients within 6 yr after disease onset . Radiographic damage in large joints was significantly related to the damage in h and s and feet , the physical disability index , and the cumulative disease activity . The initial disease activity at study entry was the only prognostic factor that reached significance Background Hip replacement ( arthroplasty ) surgery is a highly successful treatment for patients with severe symptomatic arthritis of the hip joint . For older patients , several design s of Total Hip Arthroplasty have shown excellent results in terms of both function and value for money . However , in younger more active patients , there is approximately a 50 % failure rate at 25 years for traditional implants . Hip resurfacing is a relatively new arthroplasty technique . In a recent review of the literature on resurfacing arthroplasty it was concluded that the short-term functional results appear promising but some potential early disadvantages were identified , including the risk of femoral neck fracture and collapse of the head of the femur . The aim of the current study is to assess whether there is a difference in functional hip scores at one year post-operation between Total Hip Arthroplasty and Resurfacing Arthroplasty . Secondary aims include assessment of complication rates for both procedures as well cost effectiveness . Methods / design All patients medically fit for surgery and deemed suitable for a resurfacing arthroplasty are eligible to take part in this study . A r and omisation sequence will be produced and administered independently . After consenting , all patients will be clinical ly review ed and hip function , quality of life and physical activity level will be assessed through question naires . The allocated surgery will then be performed with the preferred technique of the surgeon . Six weeks post-operation hip function will be assessed and complications recorded . Three , six and 12 months post-operation hip function , quality of life and physical activity level will be assessed . Additional information about patients ' out-of-pocket expenses will also be collected . Trial registration Current Controlled Trials IS RCT N33354155UKCLRN portfolio ID
Regardless of the method ological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other
Background While arthrodesis is the st and ard treatment of a severely arthritic ankle joint , total ankle arthroplasty has become a popular alternative .
This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis .