bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Lag Screw Retightening Improve Compression in Hindfoot Arthrodesis?
Authors: Rugg Amanda , Requist Melissa , Johnson Brooks , Son Michelle , Alvarez Alicia , Latt L. Daniel
Published: November 2020

Category:

Hindfoot; Ankle; Ankle Arthritis

Introduction/Purpose:

Non-union and delayed union are common complications following hindfoot arthrodesis. The failure to obtain and maintain compression at the arthrodesis site may be a causative factor. Partially threaded cannulated ‘lag’ screws are commonly used for fixation in hindfoot arthrodesis; however, the ability of these screws to maintain compression in the hindfoot bones has not been well-characterized. The goals of this work were to: 1) quantify the stress relaxation response of hindfoot bones when compressed with a lag screw, particularly compression change upon screw retightening, and 2) compare the results to prior studies on stress relaxation in direct bone compression.

Methods:

12 pairs of calcaneus, talus and tibia bone cylinders, 25mm in diameter, were cut with a keyhole saw from fresh thawed cadaveric feet. The bone cylinders were prepared for simulated arthrodesis by removing the cartilage and flattening the subchondral surface with an oscillating saw. A Futek LTH 300 donut load cell and two metal washers were sandwiched between the two bone cylinders. An 8.0mm partially threaded cannulated lag screw (Smith and Nephew) was placed from the posterior- inferior aspect of the calcaneus cylinder to the anterior-superior aspect of the talus cylinder to simulate subtalar arthrodesis, or from the superior aspect of the tibia cylinder to the inferior aspect of the talus cylinder. Compression was recorded continuously as the screws were tightened by three-quarters of a turn and left untouched for 3 minutes. Recording continued as the screws were retightened one quarter-turn and then left untouched for 30 additional minutes.

Results:

Both initial and subsequent compression with a lag screw demonstrated a stress relaxation pattern, with increased maximum compression and slowed decay upon retightening. Maximum compression after three quarter-turns and retightening averaged 284 N and 351 N, respectively (n=12; t=-2.55; p=0.0136). Time to decay to 80% of maximum compression after three quarter-turns and retightening averaged 34 and 528 (n=9; t=-2.59; p=0.0159) seconds, respectively, compared to 21 seconds for direct compression. Compression loss 30 minutes after retightening averaged 25.5% (SD=8.8%), compared to 34.3% for direct compression.

Conclusion:

The maximum compression attained following retightening was significantly greater than the maximum compression attained after initial tightening. The time required to reach 80% of maximum compression was significantly longer after subsequent compared to initial maximum compression. These findings suggest that screw retightening before surgical wound closure may slow compression loss, which could increase the likelihood of successful arthrodesis. Lag screw compression resulted in a lower percent compression loss and loss rate compared to direct compression, which was previously used to describe bone viscoelasticity.
Revision Total Ankle Replacement using the Inbone 2 System, Nottingham Experience
Authors: Salem-Saqer Hatem , Raglan Martin , Dhar Sunil
Published: November 2020

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The Inbone Total Ankle Replacement System (Wright) is a modular stemmed ankle replacement, it is marketed as for both primary and revision TAR, it has been in use at Nottingham since 2016 mainly for revisions, we are reporting our experience with this system and our early results.

Methods:

This is a retrospective study with prospective collected data. We identified 27 (18M/9F) patients who had Inbone 2 TAR for revision surgery during the period August 2016 -March 2019. The mean follow up was 21 months (7-38months). Mean age of 69 years (51-81).All ankle revisions were a single-stage revision apart from 1 patient who had a 2 stage revision as at the first stage infection was suspected, it was left with a cement spacer and when all samples came back negative the second stage was carried out.All patients had follow up appointments at 6 weeks, 3,6 and 12 months. Patients were required to fill in MOXFQ questioner and all had weight-bearing radiographs on every follow up appointment.The indication for the surgery was aseptic Loosening 23, Malalignment 1 Insert wear 2 and heterotopic ossification 1.

Results:

20 patients had concurrent procedure during the surgery(Table 1). There was 1 deep wound infection that required DAIR procedure 3 weeks after the revision surgery and has gone to make full recovery, no other complication were reported.Improvement in clinical outcome and PROMS data was noted on follow up, MOXFQ for Pain improved from 70 pre op to 34 at 6 months and 32 at 1 year(p<0.001 paired t test),The outcome for Walking improved from 69 pre op to 41 at 6 months and 40 at 1 year(p<0.001 paired t test).Radiological alignment was maintained in all ankles both in the coronal and the sagittal plain, posterior heterotopic ossification was noted in 8(29%), No loosening or signs of failure at any follow up appointment

Conclusion:

This is one of the largest series of this implant used in revision TAR. Our early results show considerable improvement in patient outcomes with very low complications and no failures.This implant provides a good option as a revision implant and our view that it is a superior solution to ankle fusions for failed total ankle replacements [Table: see text]
Prospective Comparison of Ankle Replacement and Ankle Arthrodesis 4 Years After Surgery
Authors: Satngeorzan Bruce J. , Norvell Daniel , Ledoux William R. , Coetzee J. Chris , Davitt James S. , Shofer Jane , Anderson John G. , Bohay Donald R. , Houghton Michael J. , Maskill John D. , Brage Michael E.
Published: November 2020

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

The objective of this study was to compare physical and mental function, ankle-specific function, pain intensity, and rates of revision surgery and minor complications between ankle replacement and ankle arthrodesis in a prospective cohort study with minimum 4 year follow up after surgery.

Methods:

This prospective cohort study enrolled subjects from May 2012 to May 2015 included 517 subjects from 6 centers. Inclusion criteria ensured patients were suitable for both treatments while exclusion criteria were those with disabilities or diseases other than OA that effected ambulatory function including metabolic, neurologic, or musculoskeletal diseases such as hip or knee OA Outcomes were measured pre-treatment and 4-7 years after surgery. Linear mixed effects regression was used to determine if there were differences in postoperative improvement in each continuous outcome by surgical procedure. The primary outcomes included the Foot and Ankle Ability Measure (FAAM), and the FAAM sport, the Short Form-36 (SF-36) Physical and Mental Component Summary (PCS and MCS) scores, the Chronic Pain Grade (CPG) including average pain, worst pain and pain interference. Data were collected by study coordinators who were not involved in the surgery.

Results:

Of the 517 patients (414 receiving TAA, 103 receiving AA) with baseline assessment, 400 (325 TAA and 75 AA) were followed to 4 years. Pre-treatment, the two groups were not significantly different by sex, race, marital status, education, severity of OA. Data were adjusted, BMI, age. Patients demonstrated mean improvement in the FAAM and CPG outcomes at 1 year and maintained improvement out to 4 years (p<.001) regardless of surgery. TAA patients had significantly greater improvement in FAAM ADL score at all post-op visits compared to AA patients, with improvement at 4 year post-op 10 points greater (95% confidence interval 4, 17, p<.001). Similar differences in improvement occurred for the FAAM Sports and worst pain outcomes, although these differences were not statistically significant at all follow-ups.

Conclusion:

At 4 years post treatment, patients who were treated by ankle arthrodesis and ankle arthroplasty had sustained significant improvement. Patients treated with ankle replacement had greater improvement in FAAM and pain compared to those treated with arthrodesis. There was no difference in adverse events in the two groups
The UK INFINITY Study - Early Experience and Complications of a Multicenter series of 504 Total Ankle Arthroplasties.
Authors: Townshend David N. , Kakwani Rajesh , Aradhyula Murty N. , Mckinley John C. , Shalaby Hisham , Smith Robert , Davenport James H. , Karski Michael , Clough Timothy , Blundell Chris , Davies Howard , Raglan Martin , Dhar Sunil , Hepple Steve , Taylor Heath , Davis James , Sharpe Ian T. , Bing Andrew J. , Goldberg Andrew J.
Published: November 2020

Category

Ankle Arthritis; Ankle

Introduction/Purpose:

This is the first report from the UK INFINITY study. This is a multicentre, non-inventor, prospective observational study of 504 INFINITY fixed bearing total ankle arthroplasties. We report our early experience, complications, radiographic and functional outcomes of this prosthesis.

Methods:

Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiographic, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire and Euroquol 5D-5L) were collected preoperatively, at 6 months (454 patients), 1 year (328 patients) and 2 years (104 patients). The average age was 67.8 (range 23.9 to 88.5) and average BMI 29.9 (18.9 to 48.0). The COFAS grading system was used to stratify deformity. There were 259 (51.4%) COFAS Type 1, 122 (24.2%) COFAS Type 2, 32 (6.3%) COFAS 3 and 87 (17.3%) COFAS type 4. 38 patients (7.54%) presented with inflammatory arthritis. 101 (20.0%) of implantations utilised patient specific instrumentation (Prophecy). 169 (33.5%) of patients underwent an additional procedure at the time of surgery. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts and/or subsidence.

Results:

There was a significant (p<0.01) improvement across all functional outcome scores at 6 months, which was sustained at one and two years. There was no significant difference with the use of patient specific instrumentation. 167 (33.1%) underwent additional procedures at index surgery. At the latest follow up 3 implants (0.6%) have been revised. One patient at 6 weeks for deep infection, one patient at 6 months for subsidence and one patient at 18 months for loosening. There were an additional 13 reoperations (2.6%) at the latest follow up.

Conclusion:

The UK INFINITY study is the largest reported multicentre study of a Total Ankle Arthroplasty to date. This study has shown a low early revision rate and high functional outcomes of the INFINITY prosthesis.
Geographic Distribution of Foot and Ankle Orthopaedic Surgeons Throughout the United States
Authors: Zhang Hui , Fanelli Matthew G. , Cush Coleman , Wagner Benjamin , Grandizio Louis C. , Young Amanda , Maddineni Bhumika , Cush Gerard J.
Published: November 2020

Category:

Other

Introduction/Purpose:

Orthopaedic Surgery has become increasingly subspecialized since fellowships were established in the 1970s. Previous investigations within hand and urologic surgery have demonstrated an uneven geographic distribution within these subspecialties. Economic factors can influence surgeon distribution within a particular geographic region. At present, the geographic distribution of orthopaedic foot and ankle (OFA) surgeons in the US is poorly defined. The purpose of this investigation is to determine the geographic distribution of OFA surgeons in the US. We hypothesize that there will be substantial differences in OFA surgeon density throughout the US and that economic factors may play a role in access to subspecialty OFA care.

Methods:

A current membership list was obtained from the American Orthopaedic Foot & Ankle Society (AOFAS). Active AOFAS members were categorized relative to states and US House of Representatives Congressional Districts. Using publicly available census data, we recorded the population within each state and district as well as the percentage of families and people with income below the federally defined poverty level. Descriptive statistics were utilized for demographic information. The relationship between income level and the number of surgeons was determined using a Pearson correlation. These data were used to generate OFA surgeons per capita at a state and congressional district level. This information was also used to generate choropleth maps comparing surgeon density and poverty.

Results:

We identified a list of 1,103 active AOFAS members with 1,311 practice addresses. There was an average of 21.2 OFA surgeons per state. There was an average of 0.38 and 0.40 OFA surgeons per 100,000 people in each state and congressional district respectively. The District of Columbia, VT, WY, and NE had the highest OFA surgeon density. WV, KY, NM, RI had the lowest density. 75 congressional districts had no OFA surgeons. There was a statistically significant negative relationship demonstrating that regions with higher levels of poverty had fewer OFA surgeons, with a Pearson correlation coefficient of -0.14, (P-value = 0.008). This relationship is further illustrated in Figure 1.

Conclusion:

There is wide geographic variation of OFA surgeon density throughout the US. Regions with higher levels of poverty have less access to OFA surgeons compared to regions with lower poverty levels. Understanding these trends may aid in developing both recruitment and referal strategies for complex foot and ankle care in underserved regions.
Clinical Outcomes of 3D Printed Titanium Cage Implantation for Foot and Ankle Surgery
Authors: Abar Bijan , Allen Nicholas B. , Gall Ken , Adams Samuel B.
Published: November 2020

Category

Ankle; Trauma

Introduction/Purpose:

Critical Sized Defects (CSD) defined as bone loss greater than 1-2 cm in length or greater than 50% loss in circumference of bone remains a significant challenge in orthopaedic surgery. Patients can acquire these defects through trauma, nonunion post fracture, tumor removal, avascular necrosis, and congenital abnormalities. Custom 3D printed porous Titanium scaffolds are increasingly being used to treat CSD in Foot and Ankle Surgery. Implantation of 3D printed cages is considered a salvage procedure offered after the patient has failed other procedures. Implants fill the space of the defect, provide mechanical strength and provide opportunity for osseous integration. As implementation of this surgical technique is relatively new, further research is needed to assess surgical outcomes and inform future surgical decision making.

Methods:

This is a retrospective chart review study which examines surgical outcomes after using 3D printed Titanium cages. Patients who received a 3D printed Titanium cage between 1/1/2013 and 11/01/2018 with at least 1 year follow-up were included in this study. Primary outcome is device failure defined as removal of implant for any reason. If applicable, mechanism of failure was recorded for each case. Patient specific factors such as age, gender, race, BMI, diabetes status, Charlson Comorbidity Index, tobacco use, number of foot and ankle surgeries, prior limb infections and laterality of defect were recorded in addition to surgical variables including geometry of implant, duration of surgery, and perioperative antibiotics

Results:

18 patients who received custom 3D printed Titanium cages were included in this study. Of the 18 patients, 5 patients (27.8%) had device failure, defined as removal of implant. Of the 5 failures, 2 were removed due to infection while the other 3 were removed due to hardware failure including fractured cage, broken screw and loose fixation.

Conclusion:

Custom 3D printed Titanium was successfully implemented in 72.2% of patients. Implants were only removed due to infection (2 patients) or mechanical failure of device (3 patients). Future studies need to be powered to determine if certain patient specific factors are associated with device failure. Data from this study and subsequent studies can be used to design better implants, decide who is a good surgical candidate, and create preoperative therapies to improve modifiable risk factors
The Rise of Predatory Journals in Foot and Ankle Surgery: Propitious or Detrimental?
Authors: Adeyemo Adeshina , Aydogan Umur
Published: November 2020

Category

Other

Introduction/Purpose:

In the world of foot and ankle surgery, much like other surgical fields, research has always been a strong foundation for advancing the field and making strides into improving our knowledge base, perfecting surgical techniques and discovering ways of improving patient outcomes. In recent years, there has been the advent of predatory journals in orthopaedic surgery, though many clinicians may not be familiar with what predatory journals are. The aim of our study is to objectively analyze F&A surgery predatory journals and compare them to higher impact journals in F&A surgery and dispute whether or not predatory journals are beneficial or detrimental to the field of F&A.

Methods:

Our inclusion criteria involved all existing foot and ankle journals that were considered to be predatory according to Beall’s criteria. Our authors viewed Beall’s online archive, in addition to a recent publication by Yang et al (4), in which we were able to gather a list of several predatory journals related to the field of foot and ankle surgery. After discussion with the authors, it was decided to select three of the higher impact well-known foot and ankle journals to use as a comparison to the predatory journals. The journals that were selected were the Foot and Ankle International journal (AOFAS), Foot and ankle specialist, and the European Foot and ankle specialist (EFAS). Many journal demographics factors (ISSN, peer review process, PubMed indexig, etc) were compared between both types of journals.

Results:

Of 7 predatory journals, only 2 (28.6%) responded to an online message in regard to the demographics of their journal. Of the journals that responded, none of the journals directly answered all of the questions that were asked. Only 4 of the 7 journals (57%) disclosed their impact factor, and they ranged from 1.508 to 2.52. 2 journals (28.6%) had an editorial board, while one (14%) did not have an editorial board. Information regarding the editorial board was unable to be gathered from 4 journals, as they did not respond to online messages. 4 journals disclosed an article processing fee ranging from $360-$2145.

Conclusion:

With financial incentives and job promotions being based on research publications, more and more predatory journals are being created to allow authors in the field to publish. However, this rise in predatory journals is detrimental. With a lack of a thorough peer review for some journals, sky-high article processing fees, and hidden peer review processes, these journals are a threat to the next generation of researchers who are not savvy in literature review. We must make a push to have more stringent criteria to critique and index articles.
Improving the Management of Adult Patients with Acute Ankle Fractures in Malawi: An Examination of Providers’ Knowledge and Treatment Strategies
Authors: Agarwal-Harding Kiran J. , Kapadia Ami , Banza Leonard , Chawinga Mabvuto , Mkandawire Nyengo , Kwon John Y.
Published: November 2020

Category:

Trauma; Ankle; Other

Introduction/Purpose:

The burden of trauma is growing worldwide, especially in low-income countries. In Malawi, ankle fractures are common and may receive inadequate treatment due to limited surgical capacity and provider knowledge of evidence- based treatment guidelines. We sought to examine ankle fracture management in Malawi, identify providers’ knowledge gaps, and address these knowledge gaps in ways that were relevant to the Malawian context.

Methods:

This study had three phases. First, we performed a baseline assessment of orthopaedic providers’ knowledge of anatomy, injury identification, and ideal treatment methods. Second, we observed providers’ treatment strategies while they cared for adult patients with ankle fractures over a five-week period at a large central hospital. We performed blinded, post-hoc reviews of patient x-rays and compared our treatment recommendations to the plans and rationales of Malawian providers. Third, we implemented an educational course addressing the knowledge gaps we identified, performed pre- and post-course knowledge assessments, and launched a standardized protocol for ankle fracture management in Malawi.

Results:

In our baseline assessment, we identified significant knowledge gaps in identification of common injuries on x-ray and ideal treatment practices. In our observations of treatment practices, 17/49 patients (35%) met operative criteria based on evidence-based guidelines but did not receive operative treatment by Malawian providers. For 7/17 (41%) of these patients, Malawian providers believed nonoperative treatment was ideal. In our educational course, 51/61 participants (84%) performed better between the pre- and post-course assessments. Overall scores improved from a mean of 66% to 77%, an improvement of 5.2/49 questions (95% CI 3.8-6.6, p<0.001). Providers could identify one more injury correctly out of 6 that were tested (95% CI 0.6-1.6, p<0.001), and identify one more ideal treatment out of 7 (95% CI 0.5-1.4, p<0.001).

Conclusion:

In Malawi, ankle fractures are common, and most are treated non-operatively. This is partly due to resource limitations, but also due to gaps in provider knowledge and lack of treatment standardization. Here we demonstrated a comprehensive approach to examining the challenges to providing adequate care, as well as the successful implementation of an intervention to improve care capacity nationwide.
The Clinical Outcomes After a Novel Mini-Open Achilles Tendon Repair
Authors: Akoh Craig C. , Fletcher Amanda N. , Parekh Selene G. , Sharma Akhil
Published: November 2020

Category:

Sports; Other

Introduction/Purpose:

Achilles tendon ruptures are a common sporting injury, mostly occurring in men over the age of 40. Operative repair of Achilles tendon can lead to earlier return to activity and improved function in the active population. Mini-open repairs have recently been described for effective treatment of Achilles tendon ruptures. We aim to describe our unique mini- open Achilles tendon repair technique and to report our clinical outcomes.

Methods:

We retrospectively reviewed charts of patients from January 2010 and July 2019 who underwent a 3cm mini-open Achilles tendon repairs, without additional targeting devices, for closed acute Achilles tendon ruptures. Patients were followed up for a minimum of one year. We recorded pre- and postoperative Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS) scores. Subgroup analysis were performed for acute repairs (< 2 weeks) and subacute (2-6 weeks). Two-sided student’s t-test to compare preoperative and postoperative outcomes for continuous variables. Chi-square analyses were used to determine the strength of correlation between categorical variables. A p-value of < .05 was considered significant for all statistical analyses.

Results:

A total of 33 patients met the inclusion criteria and are included in this study. The mean age of our cohort was 43.8 years old (range 22-78) and 78.8% of patients were male. The mean length of follow-up was 4.4 years (range 1.0-9.8 years). The mean time from injury to surgery was 15.6 days (1-45 days). Patients reported a mean return to their previous level of activity at a mean of 5.6 months (range 1.7-22.1). The mean pre- and postoperative outcomes scores improved significantly for both the acute and subacute repair groups (p < 0.05). There were no significant differences for postoperative outcomes scores between the acute and subacute Achilles repair groups (p > 0.05). There were no reported complications in our patient cohort.

Conclusion:

Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There were no significant difference in outcomes for acute versus subacute repairs. Our mini-open Achilles tendon repair, which required no additional targeting instrumentation, has shown favorable mid-term results.
Was Mark Reiley Right? A Outcome Analysis of Intramedullary Versus Extramedullaryalignment Referencing for Total Ankle Replacement
Authors: Akoh Craig C. , Fletcher Amanda N. , Kadakia Rishin J. , Chen Jie , Park Young-uk , Kim Hyong Nyun , Wang Juntao , Easley Mark E. , Nunley James A.
Published: November 2020

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The purpose of this study was to report on the radiographic outcomes, clinical outcomes, and implant survivorship following extramedullary-referenced (EMr) versus intramedullary-referenced (IMr) total ankle replacement (TAR).

Methods:

From May 2007 to February 2018, a consecutive series of patients with end-stage tibiotalar osteoarthritis undergoing TAR for primary arthritis, post-traumatic arthritis, and inflammatory arthritis was enrolled in this study. Analyses were performed comparing IMr versus EMr components for patient-reported outcomes data, pre and postoperative radiographic ankle alignment, concomitant procedures, and complications. Kaplan-Meier survivorship analyses served to determine implant reoperation and revision surgery. Data was prospectively collected and retrospectively analyzed. A p-value of < 0.05 was considered significant for all statistical analyses.

Results:

A total of 340 TARs were included with 105 IMr TAR and 235 EMr TAR. The mean follow-up was 5.3 years ( +- 2.5, range 2-12). The absolute value for preoperative coronal alignment was significantly greater for IMr compared to EMr TAR (13.0 vs 6.4 degrees; p < 0.0001), but both groups achieved near neutral alignment postoperatively (1.4 vs 1.5 degrees; p=0.6655). The odds of having a concomitant procedure was 2.7 times higher in patients with an IMr TAR (OR 2.7, CI 1.7-4.4; p-value <0.0001). There were similar improvements in patient-reported outcome scores at one year and final follow up (all p > 0.05). The 5-year implant survivorship was 98.6.% for IMr versus 97.5% for EMr at final follow-up.

Conclusion:

Despite the IMr TAR group having more severe preoperative coronal and sagittal malalignment, both IMr and EMr TAR components had comparable postoperative alignment, patient-reported outcome scores, and complications. Among the patients with preoperative varus, valgus, or anterior distal tibial slope, the IMr patients achieved greater correction than the EMr patients. Although the 5-year implant survivorship was similar between the two cohorts with 98.6% survival for IMr TAR and 97.5% for EMr TAR, impending failures were greater for the mobile-bearing EMr TAR.
Total Ankle Arthroplasty Results Using Fixed Bearing CT-Guided Implants in Post-Traumatic Versus Non-Traumatic Arthritis
Authors: Albagli Assaf , Ge Susan M. , Park Patrick , Cohen Dan , Chaytor E. Ruth , Volesky Monika
Published: November 2020

Category:

Ankle; Ankle Arthritis; Trauma

Introduction/Purpose:

The majority of ankle osteoarthritis are post-traumatic in etiology. Previous studies have shown that patients with post-traumatic ankle osteoarthritis are less satisfied, experience significantly more pain during normal activities and have higher revision rates. However, these studies were performed with older generation implants. The objective of this study was to compare patients hat had undergone total ankle arthroplasty secondary to either post-traumatic or non-traumatic etiologies using patient specific, third generation fixed bearing implants and compare clinical as well as radiographic outcomes.

Methods:

A retrospective chart review was conducted on 41 patients who had undergone total ankle arthroplasty using a third- generation fixed bearing implant with CT-based patient specific cutting guides from July 21, 2015 to December 13, 2017 performed by 2 foot and ankle surgeons. Demographic and operative data was collected. Etiology was determined based on clinical notes, operative notes, and x-rays. Clinical outcomes were obtained using the Foot and Ankle Ability Measure questionnaire. Radiographic assessment of the coronal and sagittal alignments were carried out to assess implant migration or loosening.

Results:

We had 26 patients in the post-traumatic group and 15 in the non-traumatic group with a mean follow-up of 32.5 months and 30.4 months respectively. There was no significant difference between both groups in terms of FAAM ADL subscore with the post-traumatic group did slightly better with 7 patients scoring ‘nearly normal’ (26.9%) and 18 patients scoring ‘normal’ (69.2%). Whereas in the non-traumatic group 5 patients score ‘nearly normal’ (33.3%) and 9 patients score ‘normal’ (60%). In terms of the self-rated subjective functioning score, mean score of 79.2% and 73.4% respectively. On radiographs, there was no subsidence or significant implant movement for both groups at mean follow-up of 28.3 months for the post-traumatic group and 26.3 months for the non-traumatic group.

Conclusion:

Unlike in previous studies in older implants where clinical outcomes were worse in post-traumatic ankle arthritis, our study showed that those receiving total ankle arthroplasty due to post traumatic osteoarthritis do slightly better than those with non-traumatic osteoarthritis, with more patients reporting normal levels of activity. These results may help quantify improvements in newer generation patient specific implants as well as to gain insight into how different implant designs affect post- operative outcomes based on etiology of ankle osteoarthritis.
Level of Evidence and Authorship Trends in Foot and Ankle Related Trauma Publications
Authors: Alexander Bradley , Jones James R. , Solar Spaulding F. , Agarwal Abhinav , Cage Benjamin B. , Greco Elise M. , Shah Ashish
Published: November 2020

Category:

Other

Introduction/Purpose:

Evidence-based research in the field of foot and ankle related trauma surgery has increased significantly over the past two decades and considerable emphasis is being put on publication quality and level of evidence (LOE). With foot and ankle surgery being a relatively new and growing field of orthopedics, minimal analysis has been performed on the LOE and authorship trends in foot and ankle related trauma publications. The purpose of this study is to evaluate LOE and authorship characteristics in foot and ankle related trauma publications in three different high impact factor journals.

Methods:

All of the foot and ankle related trauma publications from the years 1997, 2002, 2007, 2012, and 2017 in Foot and Ankle International (FAI), Journal of Trauma (JOT), and The Journal of Bone and Joint Surgery (American and British volumes) (JBJS) were analyzed. LOE of each article was determined by two external reviewers based on the JBJS LOE grading system. Country of origin for the first, last, and corresponding author of each article was evaluated, and fellowship data was obtained from a database for all United States authors. LOE, authorship, and publication trends were compared between both journals and publication year.

Results:

Over the 15-year period therapeutic studies were the prominent studies in all three journals. JBJS published the highest quality level of evidence and did not publish any level V evidence. The median number of authors was highest in JBJS. JOT publishes a majority of articles from North America (65%) while JBJS publishes more internationally (48% North American). Number of authors increased over time from a median of 3 in 1997 to a median of 5 in 2017. When evaluating the articles with available authorship fellowship data, JBJS and JOT had the highest percentage of articles with a trauma fellowship trained author at 77% and 53%, respectively. FAI had the highest percentage of articles with a foot and ankle fellowship trained author at 34%.

Conclusion:

From 1997 to 2017, there has been an increase in level 3 evidence foot and ankle related trauma publications and an emphasis on studies being conducted by fellowship trained authors. While the percentage of authors with MDs per publication remained similar over time, this study shows that publications have gradually increased the number of authors over time. There are key differences between the journals including level of evidence. [Table: see text]
Cross-Cultural Adaptation and Validation of an Arabic Version of the American Orthopaedic Foot & Ankle Society Score (AOFAS)
Authors: Alhadhoud Meshal A. , Alsiri Najla F. , Alsaffar Maryam M. , Glazebrook Mark A.
Published: November 2020

Category:

Ankle

Introduction/Purpose:

The evaluation process is essential to optimize the management of patients with foot and ankle pathologies and disorders. The study aimed to translate and culturally adapt the four scoring systems of the American Orthopaedic Foot & Ankle Society Score (AOFAS) into Arabic and explore related psychometric properties.

Methods:

A multicenter observational design was used, following the forward-backward translation method. One hundred and twenty patients with foot and ankle problems were included. Construct validity and test-retest reliability were analyzed using Intra-class correlation coefficients; internal consistency was analyzed with Cronbach’s alpha, and the responsiveness was analyzed using a paired-sample test.

Results:

The validity ranged from 0.303-0.542 and from 0.018-0.753 when correlated to the SF-12 physical and mental component scores, respectively. Test-retest reliability ranged from 0.727-0.974; from 0.826-0.983 for internal consistency and from 0.001-0.182 for sensitivity.

Conclusion:

The AOFAS’s four systems were successfully translated and culturally adapted into Arabic with sufficient psychometric properties.
Intramedullary Fixation of Calcaneal Fractures: Early US Experience
Authors: Anderson Kevin C.
Published: November 2020

Category:

Hindfoot; Trauma

Introduction/Purpose:

The fixation of displaced intraarticular fractures of the calcaneus have posed many challenges for the surgeon, including an anatomic reduction, fracture stabilization, and soft tissue concerns. The extensible lateral and sinus tarsi approaches must be delayed until soft tissues concerns resolve and despite this are susceptible to wound necrosis and skin infections. Intramedullary fixation allows immediate fixation without soft tissue compromise.

Methods:

The retrospective case series is comprised of 23 patients; 19 intramedullary fixation of the calcaneus and 4 primary arthrodesis with the FH Orthopedics CalcaNail. Fracture classification, timing to surgery, accuracy of reduction, complications, and outcome were recorded.

Results:

There were zero wound complications. Bohler’s angle was restored as well as articular surface. One patient required implant removal after healing seconding to prominent hardware. One patient required conversion to a subtalar arthrodesis. There were no implant mechanical failures.

Conclusion:

The intramedullary fixation of calcaneus fractures has been performed extensively outside the US with documented success. This series of early US experience exhibits similar utility. The ability to reduce the fracture intrafocally and stabilize with a minimally invasive approach have proven useful with no incidence of wound complications. Not to mention no delay from time of injury to surgery is needed.
Safe Level for the Syndesmotic Stabilization: A Simulated MRI Study
Authors: Angthong Chayanin
Published: November 2020

Category:

Trauma; Sports

Introduction/Purpose:

Great saphenous vein and saphenous nerve were reported as the high risk of injury from the syndesmotic stabilization. However, little is known about the safe level and area of the syndesmotic stabilization regarding the risks on the great saphenous neurovascular structures. This study was to demonstrate the safe level of syndesmotic stabilization via a simulated MRI study.

Methods:

A total of 10 living volunteers with intact conditions of syndesmosis on their ankle MRI was recruited in this study. Each volunteer’s ankle MRI was divided into 3 groups as 15-mm, 20-mm, and 25-mm level above the ankle joint line. The simulated reduction and fixation (stabilization) line was created through the tibiofubular syndesmosis at each level in accordance with the direction guidance by Phisitkul et al. The distance between great saphenous neurovascular structures and simulated line was measured in each level of simulated stabilization for each subject. The statistical analyses using IBM SPSS version 22 were performed to demonstrate the differences among the three groups (pair 1: 15-mm vs 20 mm groups; pair 2: 20-mm vs 25-mm; pair 3: 15-mm vs 25-mm level above the ankle joint line).

Results:

The mean distances between great saphenous neurovascular structures and simulated line of syndesmotic stabilization were shown in an attached picture. The syndesmotic stabilization at the 15-mm level above the joint line demonstrated the closest distance to the mentioned neurovascular structures. For the comparison among the three groups, pairs 2 and 3 showed the statistically significant differences at p-values as 0.004 and 0.001 respectively. A pair 1 did not show the significant difference at p- value as 0.260.

Conclusion:

Based on the results of this study, all levels of syndesmotic stabilization above the ankle joint line are safe for the great saphenous neurovascular structures. However, a 25-mm level above the joint line was the safest level for the syndesmotic stabilization when compared to other lower levels. Mini-open incision is recommended during the syndesmotic reduction and fixation on the tibial side to prevent the iatrogenic injury to the great saphenous neurovascular structures especially on the 1.5- mm and 2-mm level above the ankle joint line. [Table: see text][Table: see text]
Accuracy and Reproducibility of a Patient-Specific Instrumentation in Total Ankle Arthroplasty
Authors: April Pierre-Marc , Champagne Philippe Hugo , Angers Magalie , Lalonde Karl-Andre R. , Meulenkamp Brad , Martinez Adriana P. , Seidel Angela
Published: November 2020

Category:

Ankle Arthritis

Introduction/Purpose:

Ankle arthritis (OA) is a frequent and debilitating disease with the two primary surgical options being ankle arthrodesis or total ankle arthroplasty (TAA). TAA has the advantages maintenance of range of motion (ROM), a more normalized gait and potentially improved functional outcome over arthrodesis. Malaligned protheses have been demonstrated to have increased peak component pressures, potentially leading to component loosening, failure and overall worse outcomes. One TAA system uses pre-op CT to build patient-specific surgical instrumentation, with purported benefit of more reliable and accurate component positioning. The goal of this study is to evaluate reproducibility and accuracy of this system by surgeons without affiliation with the prosthesis design team.

Methods:

A retrospective radiological study was performed including two centers with four fellowship-trained foot and ankle surgeons using the patient-specific TAA system. All patients operated on between 2015-2018 were included. The primary outcome was alignment of the tibial implant in coronal and sagittal orientation relative to the tibia anatomic axis. All measurements were performed in duplicate an orthopaedic foot and ankle fellow and a musculoskeletal fellowship-trained radiologist. Secondary outcomes included accuracy of prediction of tibial and talar component size implanted compared to the engineered pre-operative plan, rate of prosthesis revision (at least one component) and overall re-operation rate.

Results:

79 patients were included in the final review. The mean absolute deviation of the tibial component from tibial anatomical axis was 1.31° +/- 1.14in the coronal plane and 2.68°+/- 1.74 in sagittal alignment. 94.7 % of the implants were implanted within 3°of varus or valgus and 73.7% within 3°of dorsiflexion or plantiflexion. 86 % of the implanted tibial component were of the size predicted by the pre-op plan whereas it was found to be the case in 63 % of the talar component.At a mean follow-up of 22 months(3-52), two TAA (2.5%) have been revised due to aseptic tibial implant loosening.

Conclusion:

The patient-specific guide has been found to be a reliable system for coronal tibial implant alignment but less in the sagittal plane in the hand of surgeons not involved in the design of any TAA system. Accuracy of prediction of the tibial component size is high, moderate on the talar side. In this series there was a low rate of early component revision (2.5 %).
Kinematics after Syndesmotic Injury: Assessing the Magnitude of Talus and Fibula Rotation and Displacement
Authors: Bartolomei Jonathan , Bowers Mark W. , Hunt Kenneth J.
Published: November 2020

Category:

Ankle; Sports; Other

Introduction/Purpose:

High ankle sprains, or injuries to the distal tibiofibular syndesmosis, are predictive of long-term ankle dysfunction. Our objectives were to evaluate ankle mortise stability, radiographically, and kinematically, using a cadaveric model with a simulated syndesmotic injury. We also measured the ability of a suture-button system to restore natural joint motion.

Methods:

Eight cadaveric specimens underwent serial sectioning of the anterior-inferior tibiofibular (AITFL), interosseous (IOL), posterior-inferior tibiofibular (PITFL), and deltoid ligaments. Specimens underwent external rotation and lateral translation testing after ligament release to obtain kinematic data (using a validated infrared LED motion capture system) and radiographic measurements. We then repeated external rotation and lateral translation testing after implementing a suture-button system. Repeated measures ANOVA with a Bonferroni/Dunn post-hoc test calculated the interspecimen comparisons.

Results:

Sectioning of each ligament, beginning with the AITFL, significantly increased talar external rotation. After releasing the AITFL and IOL, fibular external rotation increased significantly. Posterior displacement of the fibula began following the release of AITFL. Significant radiographic widening of the medial clear space and the syndesmosis occurred only after the release of the deltoid ligament. Syndesmotic and medial clear space widening was not significantly different from the intact state under lateral translation until after the release of the deltoid ligament. Placement of the suture-button system successfully reduced the medial clear space but was unable to restore the native stability of the ankle joint.

Conclusion:

This project addresses rotational and kinematic changes in the ankle after syndesmotic injury by quantifying the effect of ligamentous disruption on the tibiotalar articulation. The change in joint kinematics may explain why patients with moderate-to-severe syndesmosis injuries take longer to heal and develop long-term dysfunction. Significant talar rotation and posterior fibular displacement occur during external rotation, even with moderate syndesmosis injury, and before the disruption of the deltoid ligament. Stress radiography does not appear to be a reliable indicator of mild or moderate syndesmosis injuries.
Brazilian Experience with Zennith – Corin System Total Ankle Replacement
Authors: Baumfeld Daniel , Lemos André V. , Baumfeld Tiago S. , Godoy-Santos Alexandre L. , Nery Caio A.
Published: November 2020

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty is already a reality in Brazil, although there are few publications of clinical outcomes in our country. The objective of this publication is to evaluate the results of TAA in a series of patients treated with corin system total ankle replacement

Methods:

26 TAA were implanted from Jan / 13 to Aug / 16, (26 patients - 15F: 58% / 11M: 42%) (mean age: 55 years: min 37a / max 69a) using the implants Zennith from Corin (UK). Data from the clinical status (VAS, AOFAS, ADM), implant positioning and osteotomies (LTS, tibial slope, Alpha, Beta and Teta angles and distances ‘a’ and ‘b’) were evaluated in addition to the qualitative bone evolution (Peri-prosthetic cysts, sagging and wear of the components). Immediate and late information of associated surgeries, complications, and re-interventions were collected. Figure 1 present pre and post operative image

Results:

At 31 months of follow-up (min 4m: max 48m), there was a significant improvement in VAS (pre 8: post 2), AOFAS score (pre 37: post 77) and tibio-talar movement arch (pre 12: post 25 ) (P <0.001). There were some complications: 7 (27%) had peri-prosthetic cysts, 3 (12%) talar subsidence, 2 (8%) tibial subsidence and 2 (8%) poly wear. 8 patients (31%) had associated surgeries (19%: malleolar fracture). As major complications: 1 (4%) postoperative infection, 3 (12%) skin complications and 2 failures (8%).

Conclusion:

Despite the high morbidity, total ankle replacement represents a valuable therapeutic resource.
Brazilian Total Ankle Replacement Experience
Authors: Baumfeld Daniel , Lemos André V. , Martins César E. , Nery Caio A.
Published: November 2020

Category:

Ankle Arthritis

Introduction/Purpose:

Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early TAR generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience, Brazilian surgeon could not participate in the development of the technique and implants designs during all these years. This paper present the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed.

Methods:

Data since the first series of TARs in Brazil were colect from university institution, personal data base from surgeons and previous publication, survivalship, complications, number of each implant and implant availability were recorded.

Results:

In Brazil, indications for TAR are not so different from around the world, the data we had access demonstrate 65% of post-traumatic arthritis, 26 % of inflammatory arthritis, 2% post-infectious arthritis and 7 % of primary arthritis. In fortheen years 263 surgeries were performed, in different parts of the country, but only one surgeon performed 43 cases (27,3% of the total). Table 1 demonstrate the number of procedures performed per year. Survivor rate of each implant available in the country in the first year were 94%, 86,19% in the second year, 82,84% in the third year, 81,62% in the fourth year and 71,47% in the fifth year.

Conclusion:

In Brazil there are limited and different ankle arthroplasty systems available for use. The procedure itself continues to be technically demanding and require surgical sophistication and expertise. A national registry to justify the procedure indication; report the outcomes and survivorship has not been developed. This procedure is growing around the county, as well as the surgeon experience, but we should remember that TAR is not for every patient and that the appropriate indication, based on the evidence available, is fundamental to obtaining durable and predictable outcomes. [Table: see text]