bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.