bluuebunny/crossref_metadata_2025 huggingface dataset:
Altered Gait in Charcot Neuropathic Mice: A Kinematic Analysis
Authors: Alwine Shelby , Fye Nicole M. , Milne Indigo G. , Koroneos Zachary A. , Stauch Christopher , Saloky Kaitlin L. , Aynardi Michael
Published: December 2023

Category:

Diabetes; Hindfoot

Introduction/Purpose:

Charcot arthropathy is known to cause neurodegenerative as well as physical skeletal changes that can affect gait. A verified model of inducing Charcot arthropathy in mouse hindlegs exists, but clinical data has yet to be gathered from this model. This is a pilot study with the purpose of gathering clinical data on mouse gait and joint reactive forces that occur over time as a result of Charcot arthropathy utilizing MatLab software.

Methods:

Eleven wild-type 25-week-old C57BL/6J were included in this study. Group A (n= 6) was fed a high-fat 60% kcal diet starting at the age of 6 weeks and underwent a verified running protocol to induce microtrauma leading to hind-paw Charcot-type arthropathy. Sensory testing and fasting blood glucose levels confirmed the presence of hyperglycemia and neuropathy in Group A. Group B (n= 5) was fed a normal diet and did not complete a running protocol. At week 0 and week 16 of the study, brightly colored dots were placed on mice hindlimbs to mark the hip, knee, ankle, and tarsal joints. The mice were placed on the treadmill at a constant speed of 10 m/sec and were recorded in slow motion for 2-3 full gait cycles. MATLAB was used to measure gait angles and coordinates in space by following the corresponding colored dot for each joint on the mouse (Figure 1).

Results:

The control mice did not have significant changes in range of motion of the knee, ankle, or midfoot while walking between weeks 0 and 16. In contrast, the mice fed a high-fat diet had statistically significant differences in ankle range of motion (p=0.0275), nearly significant differences in knee range of motion (p=0.0991), and insignificant differences in midfoot range of motion between weeks 0 and 16. In addition, the differences between range of motion of the knee of the control vs. C57BL/6J mice were significantly different between groups at both weeks 0 (p=0.0016) and 16 (p=0.0201). In the ankle, the difference was statistically significant at week 0 (p=0.0275) but not week 16 (p=0.7066), presumably due to a large standard deviation in ankle range of motion.

Conclusion:

Results of this gait analysis indicate that mice with Charcot-like arthropathic changes demonstrated gait differences that affected the range of motion of the knees and ankles of the mice, but not the midfoot. These changes could be due to the neuropathic abnormalities induced in mouse feet that would cause gait changes. Future studies will include a larger sample size of mice with gait analysis done at intermediate time points to further quantify how gait changes over time with Charcot arthropathy.
The Impact of Surgical Timing After Ankle Fracture on Clinical and Long-Term Patient Reported Outcomes
Authors: McCrosson Matthew J. , Scheinberg Mila , Sanchez Thomas , Shah Ashish
Published: December 2023

Category:

Trauma; Ankle

Introduction/Purpose:

The goal of this study is to evaluate the effect of time-to-surgery following closed ankle fractures on long- term patient reported outcomes, fracture healing, and wound complications. To date, little research has been done focusing on the impact “time to definitive fixation” has on patient reported outcomes.

Methods:

We performed a retrospective analysis of 215 patient records who underwent open reduction and internal fixation (ORIF) for an ankle fracture from July 2011 to July 2018. A total of 86 patients completed the patient reported outcome measurement information systems (PROMIS) survey at long term follow up. Primary outcomes were the rate of delayed union, postoperative wound complications, Patient Reported Outcome Measurement Information System (PROMIS) Pain Interference (PI), and Physical Function (PF) scores.

Results:

No differences were found when comparing time to surgery on a continuous scale with rates of delayed union, nonunion, or wound complications (p=0.84, 0.47, and 0.63, respectively). PROMIS scores were collected at a median of 4.5 years (2.0 interquartile range (IQR), Range 2.5 to 12.3) postoperatively. The time from ankle fracture to surgery was independently associated with worse PROMIS PI scores (Unstandardized β .38, 95% CI 0.07 to 0.68) but not PROMIS PF scores. Severe Lauge- Hansen injuries were independently associated with decreased PROMIS PF scores (Unstandardized β -7.02, 95% CI -12.0 to -2.04). Increased time to surgical intervention and severe Lauge Hansen injuries were independently associated with worse long-term patient reported outcomes. Surgical timing did not impact union rates or wound complications.

Conclusion:

Surgeons should be aware that delaying ankle fracture repair beyond 12 days after injury may negatively affect long- term patient reported pain scores.
Wear Rates of Highly Cross-Linked Polyethylene in Total Ankle Arthroplasty at Mean 7-Year Follow- up
Authors: McCahon Joseph , Thalody Hope , Radack Tyler , Bridges Tiffany N. , Lencer Adam , Parekh Selene G. , Daniel Joe
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Polyethylene (PE) wear particles have been shown to be a contributing factor of osteolysis and aseptic loosening. The use of highly cross-linked polyethylene (HXLPE) liners has been proven to reduce wear rates in hip and knee arthroplasty. To date, no clinical study has investigated the in vivo wear rates of HXLPE in total ankle arthroplasty (TAA). Therefore, the purpose of our study was to evaluate mid- and long-term outcomes and HXLPE wear rates in primary TAA.

Methods:

We retrospectively identified 49 patients who underwent primary TAA with HXLPE liners at a minimum of 5-year follow up. The average age was 65 years, 57.1% female, and average body mass index was 28.7 kg/m2. Polyethylene wear rates at final follow up were assessed using anteroposterior ankle radiographs and a validated computer assisted software. In addition, overall implant survivorship and complications were recorded.

Results:

The average polyethylene linear wear rate was 0.073 mm/year (SD, +/- 0.027) at mean 7.6 year (range, 5.1 to 12.2) follow up. Further analysis of patients with greater than 10 year follow up (n=8) demonstrated a linear wear rate of 0.06 mm/year (SD, +/- 0.02) at mean 11.1 year (range, 10.0 to 12.2). There were no instances of linear fracture or dissociation. Survivorship was 98.0% with 1 patient requiring removal of hardware and revision TAA secondary to failure of distal tibial osteotomy which was performed at index procedure. The rate of reoperation was 12.2% (n=6) with the most common indication being symptomatic ankle impingement treated with peri-implant cyst excision, exostectomy, and debridement (n=4).

Conclusion:

Highly crosslinked polyethylene liners in primary TAA demonstrated low in vivo wear rates and no cases of liner mechanical failures. In addition, our cohort demonstrated low complication and reoperation rates and exceptional survivorship at mid to long-term follow up. Therefore, the use of HXLPE liners is a viable option for surgeons performing TAA.
Arthroscopic Broström-Gould Repair Has Comparable Radiological and Clinical Outcomes Compared to Traditional Open Broström-Gould Repair in High-Demand Patients
Authors: Jeong Bi O , Jung Cheol Hyun
Published: December 2023

Category:

Arthroscopy; Sports

Introduction/Purpose:

This study sought to confirm whether traditional open Broström–Gould repair and arthroscopic Broström–Gould repair for chronic ankle instability (CAI) would produce comparable radiological and clinical outcomes in high- demand patients.

Methods:

This retrospective case–cohort study included high-demand patients, as determined by a pre-injury Tegner Activity Level ≥ 6, who underwent Broström–Gould repair and were followed up for ≥ 2 years. Patients were divided into the arthroscopic Broström–Gould repair group (AS Group) and the open Broström–Gould repair group (Open Group). Perioperative radiological assessments were performed. The Tegner Activity Levels, Foot and Ankle Outcome Scores (FAOSs), Karlsson and Peterson (K– P) scores, and American Orthopaedic Foot and Ankle Society ankle–hindfoot (AOFAS) scores were evaluated clinically.

Results:

A total of 65 patients (31 from the AS Group and 34 from the Open Group) were included in the study. There were no differences in age, sex, body mass index, preoperative anterior talar translation, talar tilt, signal-to-noise ratio, FAOS, K–P score, or AOFAS score between the two groups (n.s.). The preinjury median Tegner Activity Level was 7 and unchanged at the final follow-up in both groups. Postoperative stress radiographs showed improvement; however, the groups did not differ significantly. The FAOS, K–P scores, and AOFAS scores improved in each group (P < 0.001). However, the clinical scores did not differ between the groups (all n.s.).

Conclusion:

Traditional open and arthroscopic Broström–Gould repair for CAI in high-demand patients had comparable radiological and clinical outcomes. Clinically, arthroscopic Broström–Gould repair may represent a viable surgical alternative to open Broström–Gould repair in high-demand patients.
Comparison of Intraoperative Radiation Exposure Between Minimally Invasive Chevron Akin (MICA) and Open Procedures for Hallux Valgus Correction
Authors: Kim C. James , Tsai Justin , Pedowitz David I. , Moncman Tara G.
Published: December 2023

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

The minimally-invasive Chevron-Akin (MICA) procedure for hallux valgus correction is an increasingly popular technique that has yielded comparable radiographic and clinical outcomes to open procedures3–5. Intraoperative radiation dosages for certain foot and ankle surgeries have been reported relative to the international occupational radioprotection thresholds6. In particular, the mean intraoperative radiation exposure during the MIS Scarf osteotomy has been reported to be 14-times greater than open osteotomy7. However, no study to date has reported on the intraoperative radiation exposure during MICA procedures in relation to that of open procedures.

Methods:

This is a retrospective comparative study from a single institution. Patients underwent a MICA (n=25) or open (n=40) hallux valgus correction by a single foot and ankle fellowship trained surgeon. To account for the learning curve8, the number of intraoperative fluoroscopy shots for the first 50 consecutive MICA procedures were analyzed, and the first 25 procedures were excluded. Four data points were retrieved from the mini C-arm, including 1) number of fluoroscopy shots taken; 2) total fluoroscopy time (s); 3) total radiation dose (mGy); and 4) total dose area product (DAP; mGy*cm2). Preoperative and postoperative radiographs were referenced to measure the hallux valgus (HVA) and intermetatarsal angles (IMA) as previously described.9 Categorical variables were compared using the chi-square test, and continuous variables were compared using Student’s t-test or the Mann-Whitney U test. Analysis of variance was used to determine the statistical significance of differences in the fluoroscopy data between groups.

Results:

The average total dose absorbed (4.00 vs. 1.34 mGy, p< 0.001), total fluoroscopy time (226 vs. 48.5 s, p< 0.001), and number of fluoroscopy shots (125 vs. 22.3, p< 0.001) were 2.9, 4.6, and 5.6 times greater in the MICA versus the open group, respectively. The total DAP (4.22 vs. 2.56 mGy*cm2, p=0.175) was 1.6 times greater in the MICA group but the difference was not statistically significant. The mean preoperative and postoperative HVA and IMA were greater in the MICA cohort compared to the open cohort. However, there was no statistical difference in change in HVA (MICA -17.43 vs. Open -20.05, p=0.125) or IMA (MICA -8.08 vs. open -9.31, p=0.11) between the two cohorts, with each resulting in normal postoperative angles.

Conclusion:

In this single surgeon series, the MICA procedure demonstrated significantly greater dose absorbed, total fluoroscopy time, and number of fluoroscopy shots compared to the open procedure. The extent of radiation exposure to the surgeon and the patient in relation to the radioprotection thresholds must be closely monitored to specify the health risks involved with this procedure.
Does Shoe Type Impact Ankle Injury Risk or Outcomes in Professional Basketball Players?
Authors: Tansey Patrick J. , Robbins Jordan , Saucedo Levi , Chen Jie
Published: December 2023

Category:

Sports; Ankle

Introduction/Purpose:

Ankle injuries are common in professional basketball. Despite their significance to the sport, little is known about the impact of basketball shoe type on ankle injury risk and severity. The purpose of this study is to describe the frequency and impact of ankle injuries in National Basketball Association players wearing low, mid, or high-top shoes.

Methods:

Players appearing in ≥1 NBA game during the 2020-2021 season were included. Shoewear data per-player per-game was collected. Low, mid, or high-top shoes were defined as ending below the ankle, at, or above the ankle. Significant injuries were defined as those occurring in-game that required ≥1 missed games. Shoewear, performance statistics and injury data were obtained from open access databases. The risk of ankle injury per group was calculated using chi-squared tests. Baseline anthropometric demographics and in-game performance statistics including points, rebounds, assists, steals, blocks, turnovers, field goal shooting percentage, three-point shooting percentage and net scoring per game were compared between groups with analysis of variance (ANOVA) testing. Two-sided t-tests were performed to analyze performance within individual shoe groups before and after injury. Subgroup analysis was performed for primary vs repeatedly injured players

Results:

There were 25,009 player appearances during the 2020-2021 NBA season. The overall prevalence of low, mid, and high top wear was 61%, 33% and 6%, respectively. 77 significant ankle injuries among 66 players caused a total of 713 days missed during the 2020-2021 NBA season. 48% of injured players had a reported ankle injury prior to the 2020-2021 season. The average injured player was 1.1 years older than uninjured players. Shoe choice did not have a significant impact on baseline player production. There was no difference in first time or repeat injury rate between shoe groups. There was no difference in days missed or individual productivity statistics between groups. There was no difference in performance amongst players with primary vs repeat injury.

Conclusion:

Ankle injuries are a common cause of missed playing time. There was no difference in injury rate, post-injury performance, or recovery time by shoe type. As shoe category appears to have negligible impact on healthy performance, injury risk or injury outcomes, team physicians and trainers should advocate for athletes to use shoes they feel most comfortable in.
Patient Reported Outcome Measures and Complication Rates after Minimally Invasive vs Open Calcaneal Osteotomy
Authors: Phillips Tammy , Hall SarahRose , Encinas Rodrigo , Edelman David , Jackson J. Benjamin , Gonzalez Tyler
Published: December 2023

Category:

Hindfoot; Other

Introduction/Purpose:

Minimally invasive (MIS) percutaneous calcaneal osteotomy has been increasingly investigated as a potentially safe alternative to open calcaneal osteotomy due to reduced postoperative complication and decreased pain compared to an open procedure. This retrospective chart review aims to evaluate the postoperative outcomes and complication rates of patients undergoing MIS vs. open calcaneal osteotomy.

Methods:

IRB approval was obtained. The study was performed by 2 fellowship-trained orthopaedic foot and ankle surgeons. 20 patients underwent MIS percutaneous calcaneal osteotomy, and 33 patients underwent open calcaneal osteotomy. All cases were completed between March 2021 and February 2023. Patient charts were reviewed for outcome data including complication rate, union rate, revision rate, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.

Results:

Average follow up for the MIS group was 130.4 days and 258.2 days for the open group. The MIS group was found to have a lower rate of revision, infection, and sural neuritis (0%, 5%, and 10%) compared to the open group (3%, 13.3%, and 16.7%). All participants achieved union. Average preoperative PROMIS scores in the domains of physical function, pain interference, and mobility for the MIS group were 36.8 (28.6-46), 67.1 (54.3-78), and 34.6 (25-40). Average postoperative PROMIS scores for the MIS group were 35.7 (21-76), 62.3 (39-76), and 33.4 (16-75). In the open group, preoperative PROMIS scores in these same domains were 37.0 (22.4-49.8), 65.2 (54.3-77.8), and 35.0 (19-56), whereas they were 39.6 (19-56), 60.0 (39-72), and 37.4 (16-53) postoperatively.

Conclusion:

MIS percutaneous calcaneal osteotomy appears to be an efficacious and safe treatment with lower rates of revision, infection, and nerve injury compared to an open procedure. Early outcome measures show comparable PROMIS scores in all three domains of physical function, pain interference, and mobility following MIS percutaneous calcaneal osteotomy when compared to standard open calcaneal osteotomy. Surgeons may consider MIS percutaneous calcaneal osteotomy as an alternative to open calcaneal osteotomy when treating hindfoot deformities.
The 10-Year Patient-Reported and Clinical Outcomes of a Series of 156 Mobile-Bearing Total Ankle Replacements and the Effects of Patient Age
Authors: Nicolas Andrea Pujol , Hakeem Samir , Ramaskandhan Jayasree R. , Harris-Douglas Matthew , Abdul Nicole , Siddique Malik
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total Ankle Replacement (TAR) is an established treatment option for end-stage ankle arthritis. We analysed at minimum, 10-year patient-reported and clinical outcomes of 156 TARs from a single centre. We specifically compared outcomes between patients under 60 and over 60 at time of surgery.

Methods:

Data was collected retrospectively from our departmental patient database. It included all patients who underwent a TAR by a single surgeon between 2006 and 2010 and patients were divided into those under 60 and those over 60 at the time of surgery. Patient reported outcomes (PROMs), including WOMAC, SF-36 and patient satisfaction scores and complications were analysed preoperatively and at one, two, five and over 10 years postoperatively.

Results:

There were 156 patients included in this analysis, 61 were under 60 (mean age 50.29) and 95 were over 60 (mean age 69.12). A total of 12 patients had revision surgery, (nine in the under 60 group) and 52 patients were deceased at the time of analysis (10 in the under 60 group). At one year the over 60 group had less pain and better functional scores (p=0.02, p=0.017). At two, five and ten years there was no statistical difference in pain and function between groups. At two years the over 60s reported less stiffness and quicker return to activities of daily living (p=0.007, p=0.001). However, at five and 10 years there was no statistical difference in any domain.

Conclusion:

This study demonstrates that age does not correlate with a significant difference in pain or functional outcomes in patients who have TAR, at over 10 years follow up. The higher revision rates in the younger group may correlate with higher functional demand and lower mortality rate.
The Density-Weighted Foot Center Is Different to the Geometric Foot Center
Authors: Lintz François , Bernasconi Alessio , de Cesar Netto Cesar , Fernando Céline , Chabrand Patrick R.
Published: December 2023

Category:

Basic Sciences/Biologics; Hindfoot

Introduction/Purpose:

It has become a reality with the advent of weight bearing CT (WBCT) that weight bearing (WB) is a significant element to be considered when analyzing foot and ankle images. Some knowledge has begun to accumulate on the effect of WB on bone positioning, but the effect of WB on bone mineral density (BMD) distribution, apart from being a long for accepted truth since the works of Julius Wolff, could not until now be visualized other than on the biological level. Now, Hounsfield Units allow for bone density analysis on WBCT. The objective of the study was to compare the relative positions of the geometric foot center (GC) and the density-weighted foot center (DC). We hypothesized those to be different.

Methods:

Ethics approval was obtained. Thrity two feet from our WBCT database were retrospectively randomly selected (Curvebeam Pedcat, Hatfield PA, USA). Datasets were analyzed using Bonelogics software (Disior, Paragon 28, USA). Bone segmentation was performed to obtain all bone orientations and volumes excluding tibia and fibula and all phalanges. The data was computed to obtain the geometric centers (from bone surface coordinates), which were considered as reference and were given a value of 0. Therefore density-weighted centers (from all bone data including density) were calculated. The difference between the two centers represented the shift which was assessed along the sagittal axis (anterior shift), transversal axis (lateral shift) and craniocaudal axis (upward shift). Statistical analysis was conducted using STATA package.

Results:

The mean age and Body Mass Index of the cohort were 57.2 ± 9.6 years and 22.2 ± 2.8 kg/m2, respectively. The 3D displacement vector between GC and DC had a norm of 10.01 mm. We found that DC was significantly shifted anteriorly by 8.9 ± 0.3 mm (range, 5.6 mm to 13.4 mm), medially by 0.4 ± 0.8 mm (range, -1.3 mm to 0.3 mm) and upwardly by 4.2 ± 0.14 mm (range, 2.8 mm to 5.9 mm) (p < 0.001 in all cases).

Conclusion:

Our hypothesis was confirmed: the geometric and weighed foot centers were different. DC was more anteriorly and slightly medially situated. Both centers were situated at the interface between the talus and cuboid. The more anterior position may be explained by the fact that human foot is responsible for anteriorly orientated longitudinal movement on average. We deem that BMD is a significant dimension in WBCT datasets that cannot be ignored in the development of new measurement tools that are not currently standardized. Alignment based purely on bone outer shape without considering BMD may not be representative of their true biomechanical state.
A Novel Application of Neural Networks to Identify Potentially Effective Combinations of Biologic Factors for Enhancement of Bone Fusion/Repair
Authors: Anastasio Albert T. , Zinger Bailey S. , Anastasio Thomas J.
Published: December 2023

Category:

Basic Sciences/Biologics; Other

Introduction/Purpose:

The use of biologic adjuvants (orthobiologics) is becoming commonplace in orthopaedic surgery. Amongst other applications, biologics are often added to enhance fusion rates in spinal surgery and to promote bone healing in complex fracture patterns. Generally, orthopaedic surgeons use only one biomolecular agent (ie allograft with embedded bone morphogenic protein-2) rather than several agents acting in concert. Bone fusion, however, is a highly multifactorial process and it likely could be more effectively enhanced using biologic factors in combination, acting synergistically. We used artificial neural networks to identify combinations of orthobiologic factors that potentially would be more effective than single agents.

Methods:

Available data on the outcomes associated with various orthopaedic biologic agents, electrical stimulation, and pulsed ultrasound were curated from the literature and assembled into a form suitable for machine learning. The best among many different types of neural networks was chosen for its ability to generalize over this dataset, and that network was used to make predictions concerning the expected efficacy of 2400 medically feasible combinations of 9 different agents and treatments.

Results:

The most effective combinations were high in the bone-morphogenic proteins (BMP) 2 and 7 (BMP2, 15mg; BMP7, 5mg), and in osteogenin (150ug). Some of the most effective combinations included bone marrow aspirate concentrate. In some others, electrical stimulation could substitute for osteogenin. BMP2 and BMP7 appear to have the strongest pairwise linkage of the factors analyzed in this study.

Conclusion:

Artificial neural networks are powerful forms of artificial intelligence that can be applied readily in the orthopeadic domain, but neural network predictions improve along with the amount of data available to train them. This study provides a starting point from which networks trained on future, expanded datasets can be developed. Yet even this initial model makes specific predictions concerning potentially effective combinatorial therapeutics that should be verified experimentally. Furthermore, our analysis provides an avenue for further research into the basic science of bone healing by demonstrating agents that appear to be linked in function.
Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in Chondral Defects of the First Metatarsophalangeal Joint: 5-Year Follow-up
Authors: Richter Martinus , Zech Stefan , Meissner Stefan A. , Naef Issam
Published: December 2023

Category:

Other

Introduction/Purpose:

The aim of the study was to assess the 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral defects at the first metatarsophalangeal joint (MTP1).

Methods:

In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at MTP1 that were treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual- Analogue-Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2-year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro- Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue.

Results:

One hundred and ninety-eight patients with 238 chondral defects were included. In 21% of patients no deformities in the forefoot were registered. The average degree of osteoarthritis was 2.2. The chondral defect size was 1.0 cm2 on average. The most common location was metatarsal dorsal (33%), and in most patients one defect was registered (74%). Corrective osteotomy of the first metatarsal was performed in 79%. 176 (89%)/164 (83%) patients completed 2FU/5FU. VAS FA/EFAS Score were preoperatively 46.8/11.9 and improved to 74.1/17.1 at 2FU and 75.0/17.3 at 5FU on average. No parameter significantly differed between 2FU and 5FU.

Conclusion:

AMIC+PBC as treatment for chondral defects at MTP1 as part of joint preserving surgery led to improved and high validated outcome scores at 2FU and 5FU. The results between 2FU and 5FU did not differ.
Early Osteolysis and Component Revision of CADENCE Total Ankle Arthroplasty at Midterm Follow Up
Authors: Mendez Gabriella , Hyer Christopher , Vacketta Vincent G. , Perkins Jacob
Published: December 2023

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total ankle arthroplasty (TAA) for the treatment of end-stage ankle arthritis has continued to grow in popularity as a favorable alternative to ankle arthrodesis. Amongst the fourth-generation implants released over the past decade is the CADENCE Total Ankle System (CTAS) which became available for clinical use in 2016. Our previous publication revealed a concerning incidence of radiographic osteolysis of the CADENCE tibial component interface at short-term follow-up of 24 months. Though there were limited cases of symptomatic loosening or component revision in this report, there was concern this trend may worsen with longer follow-up. The purpose of this study was to evaluate the radiographic and clinical outcomes of TAA with the CTAS, with a minimum of 1-year follow-up.

Methods:

This single-center retrospective study evaluated 63 consecutive patients who underwent TAA with the CTAS between August 2016 and October 2021 by a single fellowship-trained foot and ankle surgeon and co-design surgeon. Patients were included in our study on the basis of at least one year of clinical and radiographic follow-up; there were no other exclusion criteria.

Results:

Fifty-four TAA cases utilizing the CTAS in 50 patients were included in the current study. Preoperatively, eleven ankles had neutral alignment, 18 ankles demonstrated varus alignment, and 25 ankles demonstrated valgus alignment. Twelve patients underwent staged procedures for management of severe coronal plane deformity. Radiographic parameters changed significantly preoperatively to postoperatively. At final follow-up, PPL was demonstrated in 39 (72.2%) ankles in this cohort. Symptomatic PPL was present in 13.0% of ankles in this cohort. Talar subsidence was observed in 7 ankles within our cohort. Nine ankles underwent subsequent operations related to TAA complications. Seven ankles underwent revision procedures, resulting in a final implant survivorship of 87.0%. Four ankles, 7.4% underwent non-revision reoperations. No additional complications were encountered within this cohort.

Conclusion:

In this study of 54 CADENCE TAA, we observed a high rate of component loosening and bone interface osteolysis over time. This ultimately led to poorer implant survivorship over time and a higher than acceptable revision rate. Though the lead author is a co-designer of the CADENCE implant, we believe it prudent to share our clinical findings and experience as we all gain further knowledge and understanding about implant design and TAA. Based upon our results, we have abandoned use of this prosthesis as the midterm results fail to achieve parity with other TAA systems available on the market.
Narcotic Use and Prescribing Trends Among Workers Compensation Patients Undergoing Foot and Ankle Surgery
Authors: Goodwin Tyler , Murray Richard D. , Doty Jesse F.
Published: December 2023

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

Previous studies have shown that workers compensation patients (WC) have worse outcomes, and higher complications rates after orthopaedic surgery. Despite orthopaedic surgeons being the third highest prescribers of narcotic pain medication in the United States there have been no studies to specifically evaluate narcotic use among the WC population. The purpose of this study was to investigate narcotic use among WC patients who underwent foot or ankle operative procedures compared with a procedure matched control group.

Methods:

A retrospective review was conducted for WC and non-WC patients ages 18 to 70 years old who underwent foot (CPT 28001-28899) or ankle (CPT 27600-27899) procedures in an orthopaedic surgery practice from October 2017 through January 2020. Data collection included demographics, social, surgical, perioperative follow-up and complications. Outcomes measures were timing and number of narcotic prescriptions, total morphine milligram equivalents (MME), and procedure type. Data analysis was performed with SPSS version 28. Comparisons were conducted with Mann-Whitney U test, chi square test, or Fisher’s exact test. Power analysis determined sample size with a 0.05 alpha level, 0.80 power, and 0.5 effect size.

Results:

142 total patients met inclusion criteria, with 71 WC patients and 71 non-WC patients. There were no differences regarding the type of foot or ankle procedure performed (p=0.598). WC patients had double the number of overall narcotic prescriptions (median 2 vs 1; p < 0.001). WC patients were prescribed in total 1,125 oxycodone MME and 871.8 hydrocodone MME (P < 0.001), versus 750 oxycodone MME and 450 hydrocodone MME among the non-WC group (p < .008). There was no difference in the number of tramadol prescriptions (p = 0.571). WC patients experienced more days between the date of last narcotic prescription and both index surgery date (median 27 vs 1, p = 0.001) and initial clinic visit date (median 105 vs 49, p = 0.002).

Conclusion:

This data demonstrates that WC patients portend worse outcomes and utilize narcotics at twice the rate and for longer periods of time post-operatively than non-WC patients. Increased narcotic use may potentiate narcotic dependence and likely leads to worse outcomes. Treating physicians must be aware of these trends in order to best manage these patients. Physicians may need to have longer discussions with WC patients regarding narcotic use post operatively as well as about outcomes and goals of surgery. Physicians should set early expectations with WC patients and clear limits on the amount of narcotics they are willing to prescribe postoperatively.
Disparity in Medicare Reimbursement Between Female and Male Vitreoretinal Surgeons
Authors: Gilson Aidan S. , Adelman Ron A.
Published: December 2023

Purpose: To quantify the Medicare reimbursement disparity between female and male vitreoretinal surgeons. Methods: Reimbursement reports were obtained from the US Center for Medicare and Medicaid Services from 2013 through 2020, which detail all Medicare Part B services. A vitreoretinal surgeon was defined as any provider with at least 10 charges of a Healthcare Common Procedure Coding System code related to vitrectomy or retinal detachment repair. Providers were grouped by sex, and the average total reimbursement rate and additional secondary statistics to quantify the reimbursement disparity were identified. Results: On average, female vitreoretinal surgeons were reimbursed 65% that of their male counterparts in 2020, $1.66 million to $2.56 million. The percentage of the average male vitreoretinal specialist’s total reimbursement that the average female vitreoretinal specialist received decreased 8.8% from 2013 to 2020, from 73.8% to 65.0%. Conclusions: The reimbursement that the average female vitreoretinal surgeon receives from Medicare is only two thirds that of the average male vitreoretinal surgeon. In addition, there was no identifiable improvement in this disparity over the study period. Further efforts must be taken to establish concerted efforts to improve the reimbursement disparity and to identify the systematic inequities that led to its presence in the first place.
A functional dynamic framework for understanding new government-market relationships of smart energy transitions in China
Authors: Ngar-yin Mah Daphne , Wang Aijia , Wai-hei Siu Andy
Published: December 2023

The urgency for China to attain carbon neutrality has driven the world’s largest carbon-emitting nation to seek more effective climate and energy policies. The adoption of smart grid (SG) technologies, aimed at enabling and accelerating the shift from fossil fuel-dependent energy systems to more sustainable ones, has garnered mounting policy interest in China. However, the full potential of SG development has yet to be realised amidst the ongoing electricity market reforms in the country. A key but largely unanswered question pertains to how and the extent to which the evolving dynamics between the government and the market have influenced SG advancements. This paper aims to develop and apply an integrated framework of policy mixes and functional dynamics for smart energy transitions, and apply it to reanalyse a case study of SG policy developments in China. Our study entails a synthesis of primary research findings, shedding light on how electricity market reforms create institutional contexts within which new government-market dynamics emerge and condition the progress of SGs in China. Our study reveals that the Chinese government has adopted a controlled dynamic approach to modulate the relationships between the government and the market within the power sector. This approach has both facilitated the creation of an enabling policy environment and imposed certain barriers to SG developments. The dominance of state-owned incumbents have on the one hand created state-driven market demand, reduction in technology costs and the influence of utility-led policy networks, but on the other hand, placing constraints on the growth of SG technologies. Our policy recommendations: China needs to formulate and implement SG policies which can effectively overcome key barriers which include under-developed regulatory frameworks, utilities’ disincentives to invest in renewable energy, and insufficiency in end-user engagements.
Risk of infectious adverse events of venetoclax therapy for hematologic malignancies: a systematic review and meta-analysis of RCTs
Authors: Prosty Connor , Katergi Khaled , Nguyen Alex , Luo Owen Dan , Sorin Mark , Cherniak Vladimir , Sebag Michael , Demir Koray , McDonald Emily G. , Lee Todd C. , Cheng Matthew P.
Published: December 2023

Venetoclax is a small molecule inhibitor of BCL-2 used in the treatment of acute myelogenous leukemia (AML) and chronic lymphocytic leukemia (CLL). Recent postmarketing studies of ibrutinib, another small molecule inhibitor, suggested that these agents may predispose to opportunistic infections. We sought to systematically review the randomized controlled trial (RCT) evidence of venetoclax to assess whether it predisposes patients to infectious adverse events (IAEs) and neutropenia. We systematically reviewed RCTs comparing venetoclax therapy with active or placebo controls for patients with hematologic malignancies. Data on IAEs and neutropenia were pooled by Bayesian meta-analysis, and we computed the probability of any increased risk (P[risk ratio (RR) > 1]) of IAEs or neutropenic complications. Seven RCTs were included, comprising 2067 patients. In CLL (n = 1032), there was a low probability of increased risk of high-grade (P[RR > 1] = 71.2%) and fatal IAEs (P[RR > 1] = 64.5%) and high-grade neutropenia (P[RR > 1] = 63.4%). There were insufficient data to perform a meta-analysis of IAEs in AML; however, 1 trial suggested an increased risk of IAEs with venetoclax. Furthermore, in AML (n = 642), venetoclax was associated with a high probability of increased risk of high-grade neutropenia (P[RR > 1] = 94.6%) and febrile neutropenia (P[RR > 1] = 90.6%). Our results suggest that venetoclax has a low probability of increased risk of IAEs or neutropenia in CLL. By contrast, there is likely increased risk of high-grade neutropenia and febrile neutropenia in AML. Importantly, our analyses did not identify any specific IAEs that would benefit from routine antimicrobial prophylaxis or pre-emptive testing.
A Slow-Exchange Interstitial Fluid Compartment in Volunteers and Anesthetized Patients: Kinetic Analysis and Physiology
Authors: Hahn Robert G. , Dull Randal O.
Published: December 2023

BACKGROUND:

Physiological studies suggest that the interstitial space contains 2 fluid compartments, but no analysis has been performed to quantify their sizes and turnover rates.

METHODS:

Retrospective data were retrieved from 270 experiments where Ringer’s solution of between 238 and 2750 mL (mean, 1487 mL) had been administered by intravenous infusion to awake and anesthetized humans (mean age 39 years, 47% females). Urinary excretion and hemoglobin-derived plasma dilution served as input variables in a volume kinetic analysis using mixed-models software.

RESULTS:

The kinetic analysis successfully separated 2 interstitial fluid compartments. One equilibrated rapidly with the plasma and the other equilibrated slowly. General anesthesia doubled the rate constants for fluid entering these 2 compartments (from 0.072 to 0.155 and from 0.026 to 0.080 min–1, respectively). The return flows to the plasma were impeded by intensive fluid therapy; the rate constant for the fast-exchange compartment decreased from 0.251 to 0.050 when the infusion time increased from 15 to 60 minutes, and the rate constant for the slow-exchange compartment decreased from 0.019 to 0.005 when the infused volume increased from 500 to 1500 mL. The slow-exchange compartment became disproportionately expanded when larger fluid volumes were infused and even attained an unphysiologically large size when general anesthesia was added, suggesting that the flow of fluid was restrained and not solely determined by hydrostatic and oncotic forces. The dependence of the slow-exchange compartment on general anesthesia, crystalloid infusion rate, and infusion volume all suggest a causal physiological process.

CONCLUSIONS:

Kinetic analysis supported that Ringer’s solution distributes in 2 interstitial compartments with different turnover times. The slow compartment became dominant when large amounts of fluid were infused and during general anesthesia. These findings may explain why fluid accumulates in peripheral tissues during surgery and why infused fluid can remain in the body for several days after general anesthesia.
The Communist Closet: Secrecy, Sexuality, and Ideology in the Cuban Cold War
Authors: Lambe Jennifer L.
Published: December 2023

Why were homosexuality and Communism so closely knit together in the discursive logic of the Cold War? This article explores the convergence of sexuality and ideology in scholarly and popular conversations about the Cuban Revolution. These included a transnational panic over the purported links between homosexuality and Communism, psychiatric efforts in Cuba and the Cuban exile community to link homosexuality to suspicious ideological affiliations (Communist or anti-Communist), and a shared concern with rooting out covert political threats on both sides of the Florida Straits. Situating Cuba in hemispheric perspective, I propose that secrecy itself was at issue in the widespread and conjoined preoccupation with ideology and sexuality. This turned the closet, on the one hand, and coming out, on the other, into all-purpose, politically charged signifiers in Cuban culture writ large.
Revolutionary Transnationalism in the Persian Gulf
Authors: Shamshiri Marral
Published: December 2023

This article analyzes the material networks, connections, and solidarities formed between revolutionary Iranian and Arab organizations in the Persian Gulf in the 1970s. In the context of decolonization and the Cold War, it explores how the Iranian Left engaged with the Dhufar Revolution (1965–76), which was crushed by a British-led colonial war that the shah of Iran and his forces supported. Using Persian, Arabic, and English sources, the author shows how a radical internationalism was forged through regional networks, a praxis of guerrilla warfare, and a common political struggle against imperialism and reactionary Gulf monarchs, tying together revolutionaries from both sides of the Gulf.
Navigating Legal Landscapes
Authors: Garbett Lucy
Published: December 2023

This article is about an ownership dispute between two Palestinian families in the West Bank. The dispute moves between Palestinian and Israeli forums while drawing upon the legal patchwork of Ottoman, British, and Jordanian land laws, and Israeli military amendments. The multilayered legal terrain coupled with the jurisdictional tension allowed some legal maneuvering. The article explores how the families maneuvered the legal landscape, but it complicates the use of forum shopping in the Palestinian context by adding how settler-colonial domination and political economy play into this phenomenon. Settler colonialism has served to intensify the Palestinian land market through a curated land scarcity, all while managing the distribution of relative “security” and risk of land title. This has affected land value, land availability, and land use. When the settler legal system is known to render Palestinian ownership insecure, why would some Palestinians still choose Israeli registration as a forum in which to register their lands, considering these risks? The article argues that land ownership is a process through which layers of unevenness are inscribed and reproduced. In focusing on the process, the article adds to sociolegal scholarship to explore the role knowledge and capital play in forum shopping.
HajjHumanitarianism
Authors: Shankar Shobana
Published: December 2023

This article explores how pilgrimage to Arabia became the catalyst for Northern Nigerian Muslim leaders to develop a kind of humanitarianism for the poor to expand their political power in the era of independence from Britain and postcolonial Afro-Arab alliance-making. Muslim elites forced the British to provide welfare for poor pilgrims who conducted the pilgrimage over land through Sudan and then undertook their own relief and reform as means to resist national integration with Southern Nigeria and bolster their reputation and influence in the Muslim world. Muslim West Africans did not simply side with Sudanese or Saudi Arabian officials in the matter of hajj but instead critiqued Arab racism and enslavement of Africans while also playing on British and American fears of communism in Africa and attempts to use Islam and religious discourse more broadly to create alliances with Muslim Nigerians. Hajj humanitarianism reveals careful Nigerian negotiations of global politics during the Cold War and non-Western involvement in international humanitarianism, which has been treated as a largely Euro-American phenomenon.
“This Camp Is Full of Hujaj!”
Authors: Alnajada Heba
Published: December 2023

Historically, Islamic sharia courts across the Ottoman empire used a document called a hujja for registering property transactions. In present-day Jordan hujaj are illegal, yet in Palestinian refugee camps hujaj continue to be used for inheritance, buying and selling houses, and demonstrating occupancy. This is particularly true in camps unrecognized by the United Nations Relief and Works Agency for Palestine Refugees in the Near East and deemed “squatter settlements” by Jordanian host authorities. This article contributes to the emerging study of property rights in Palestinian camps by focusing on the links between Ottoman property regimes, contemporary territorial claims, and legal pluralism. Using the case of a Palestinian camp built on land owned by the descendants of Ottoman Circassian refugees, the article illustrates how, on the one hand, Palestinians use hujaj to facilitate inhabitation of the camp; and how, on the other hand, private property rights intersect with the competing claims of refugees and the state, whose overriding power changed after the events of Black September in 1970. By historicizing the material processes of refugee land tenure and property creation, the article challenges the assumption that contested camps are part of the “informal” growth of Middle Eastern cities, thus, bringing so-called squatter settlements back into refugee studies, Palestine studies, and Ottoman studies.
“Woman” and Diasporic Kurdish Identity in the United States
Authors: Thangaraj Stanley
Published: December 2023

There is a growing literature on gender and feminist theory in the Middle East now. However, there has been little work on Kurdish diasporas and gender in the United States. This article examines how US diasporic Kurdish performances of gender and narrations of gender work to create the figure of the “Kurdish woman.” Instead of falling into the trap of Orientalist constructions of womanhood, Kurdish diasporas imagine “Kurdish woman” as a way to challenge nation-state assimilation projects and erasure by practicing identity at the intersections of ethnicity, religion, gender, and race. The category of “woman” becomes an important venue to manage statelessness, create an important archive for Kurds, challenge ongoing colonialism in Kurdistan, and challenge US imperialism. Therefore “Kurdish woman” constitutes an important spatial and historical terrain for Kurdish women and Kurdish men to manage their racialization across national contexts and partake in the racialization of “others.” “Woman” is activated in the service of difference as a means to showcase the heterogeneity within Kurdish communities and expound on the relations Kurds in the US diaspora have with nation, religion, history, and resistance.