bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Propensity Score Matched Analysis Comparing Outpatient and Short-Stay Hospitalization to Standard Inpatient Hospitalization Following Total Ankle Arthroplasty
Authors: Plantz Mark A. , Sherman Alain E. , Kadakia Anish R. 
Published: November 2020

Category: Ankle Introduction/Purpose: The number of total ankle arthroplasties (TAAs) performed annually has continued to increase over the last two decades. Given the current challenges of healthcare cost-control, the trend towards minimizing hospitalization and length of stay (LOS) after various procedures, including joint replacement, has become an area of interest. Currently, there are no large sample, propensity score matched analyses to assess the safety of ‘short-stay’ versus standard inpatient hospitalization following TAA. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) was used to identify 1,141 patients who underwent primary and revision TAA between 2007 and 2017. Propensity score matching was used to compare the risk of 30-day unplanned readmission, reoperation, mortality, discharge destination, and several medical and surgical complications in patients with outpatient or short-stay inpatient hospitalization (LOS <= 1 day) versus standard inpatient hospitalization (LOS > 1 day). Patients were matched in a 1:1 ratio based on several factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and several comorbidities (diabetes, smoking, COPD, congestive heart failure, hypertension, dialysis, and chronic steroid use). The incidence of various 30-day complications were compared between the two propensity score matched groups to assess for any differences in short-term outcomes after controlling for confounding risk factors. Results: A total of 892 patients were included in the propensity-score matched analysis, with 446 patients per group. The shorter LOS group had a significantly lower rate of medical complications (0.2% vs. 2.8%, p = 0.004) and non-home discharge (1.3% vs. 12.1%, <0.001). Additionally, the shorter LOS group had lower rates of unplanned readmission (0.4% vs. 1.1%, p = 0.256), reoperation (0.2% vs. 0.4%, p = 0.564), return to the OR (0.2% vs. 0.9%, p = 0.179), and surgical complications (0.4% vs. 2.0%, p = 0.057), although these results were not statistically significant. Conclusion: Propensity score matched comparative analysis demonstrated that outpatient and short-stay inpatient hospitalization can be just as safe as standard inpatient hospitalization after TAA. Length of stay should be dictated by the overall risk of complication. Outpatient or short-stay TAA should be considered for patients with low risk of short-term complications. [Table: see text]
Do Total Ankle Replacements have Worse Outcomes when Compared to Total Knee and Hip Replacements at 10 Years Post-Operatively? A Prospective Clinical Study
Authors: Ramaskandhan Jayasree Ramas , Siddique Malik S. , Smith Karen 
Published: November 2020

Category: Ankle Arthritis; Ankle Introduction/Purpose: There is paucity of literature comparing patient reported outcomes (PROMs) between total joint arthroplasties. There is a need to study the PROMS data to understand outcomes of treatment and factors affecting outcomes. We aimed to to study the PROMs data for total ankle replacement (TAR) to 10 years. To study how PROMS outcomes of TAR compare to total hip replacement (THR) and total knee replacement (TKR) at 10 years Methods: This is a prospective data collection from local hospital joint registry. 10 year follow up data was collected from patients who underwent a total joint replacement (Hip, Knee or ankle), provided informed consent for their data. Patients who refused consent, or had cognitive language problems were not approached for participation in the registry. Self-administered questionnaire data included WOMAC scores, Foot and ankle outcomes scores (FAOS), SF-36 scores and patient satisfaction data. Data was collected at pre-op, 3 years, 5 years and 10 years post operatively. Statistical tests including ANOVA, GLM univariate tests and chi-square tests were used for analysis. Results: There were 119 patients who underwent TAR for the duration of 2006-2009. 74 patients were male (62.18%). Average age of patients was 59.1 yrs. Data was available on 2672 THR and 3520 TKR patients. At 5 years, TAR patients reported lower scores for stiffness, similar outcomes to THR and TKR for mental health score, similar to TKR for ¾ physical domains (p<0.05), but lower satisfaction rates for ADL and recreation when compared to THR (p<0.05). We are currently processing the questionnaires for 10 year mailing returns (completion expected March 2020). Conclusion: The outcomes for TAR were similar to outcomes reported by TKR patients at 10 years but lower than THR. The lower score of TAR was due to stiffness and recreational activity comparing to THR. We aim to present the complete set of results if the abstract is accepted (data completion March 2020).
2020 IFFAS Award for Excellence Winner: Outcomes and Complications of Open versus Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study
Authors: Rungprai Chamnanni , Jaroenarpornwatana Aekachai , Sripanich Yantarat , Chaiprom Nusorn 
Published: November 2020

Category: Hindfoot Introduction/Purpose: Open subtalar arthrodesis is a standard treatment for subtalar joint arthritis. Recently, posterior arthroscopic subtalar arthrodesis (PASTA) has been introduced and gained increasing popularity due to fasten recovery time and better cosmesis. However, there is limited current studies to report outcomes and complications between the two techniques. The purpose of this study is to compare outcomes and complications between open and PASTA techniques. Methods: A prospective, randomized collected data of 56 consecutive patients who were diagnosed with isolated subtalar arthritis and underwent either open (28 patients) or PASTA (28 patients) between 2016 and 2019 were enrolled in this study. The minimum follow-up time to be included in this study was 12 months. The primary outcome was union rate which was confirmed by post-operative CT scan. The secondary outcomes were union time, VAS, SF-36, FAAM, tourniquet times, and complications. A paired sample t-test was used to assess statistical differences between pre- and post-operative functional outcomes (VAS, SF-36, and FAAM) in the same group of both open and PASTA techniques while an independent t-test was used to compare functional outcomes (VAS, SF-36, and FAAM) between the two techniques. Results were significance at p < 0.05. Descriptive statistics were used for the demographic variables. Results: There were 56 patients (44 male and 12 female) with mean follow-up time was 17.7 months and 17.5 months for open and PASTA. The union time was significantly shorter in PASTA (9.4 vs 12.8 weeks, p<0.05). PASTA demonstrated significantly fasten recovery times (p<0.05 all) including time to return to ADL (8.4 vs 10.8 weeks), work (9.4 vs 12.8 weeks), and sports (9.4 vs 12.8 weeks). Both Open and PASTA techniques demonstrated significant improvement of all functional outcomes (FAAM, SF- 36, and VAS (p<0.01 all)); however, there was no significant difference between the two techniques. Other outcomes were not significant difference including tourniquet times (55.8 vs 67.2 minutes) and union rates (96.3 vs 100%) and complications. Conclusion: Both open and PASTA techniques demonstrated significant improvement of pain and function for treatment of patients with isolated subtalar joint arthritis. Although there was no significant difference of short-term of functional outcomes and complications, PASTA technique was better in term of shorten time to union and fasten time to return to sports.
Establishing Maximal Subjective Outcome Improvement after Total Ankle Arthroplasty
Authors: Agarwalla Avinesh , Yao Kaisen , Gowd Anirudh , Cody Elizabeth , Nunley James A. , Amin Nirav , Liu Joseph 
Published: November 2020

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty is considered one of the most common treatments for end stage osteoarthritis of the ankle. This procedure results in significant long-term improvements in pain and function while preserving pre-operative range of motion. Patients also demonstrate improvements in patient reported outcome measures (PROMs) - a modality that quantifies patient’s subjective well-being. Understanding the time to maximal subjective medical improvement (MMI) following total ankle arthroplasty can help guide resource allocation and manage patient expectations. The purpose of this investigation is to establish when patients perceive MMI according to PROMs following total ankle arthroplasty. Methods: A systematic review was conducted on the PubMed database to identify studies on total ankle arthroplasty which reported consecutive PROMs for at least two years postoperatively. Pooled analysis was done at 3-months, 6-months, 12-months, and 24-months postoperatively. The minimal clinically important difference (MCID) was established by a distribution-based method, which is one-half of the standard deviation of outcome score change for a given instrument. Clinically significant improvement was determined between pairs of intervals that exceeded the MCID. Results: A total of 12 studies and 1514 patients met the inclusion criteria for this review. Clinically significant improvement was seen up to 6 months postoperatively in both the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS) and Visual Analog Scale (VAS) scoring systems but was not demonstrated at later intervals. The Short Musculoskeletal Function Assessment (SMFA) Function and Bother subsections were scored individually and both demonstrated clinically significant improvement until 1 year postoperatively. Conclusion: After total ankle arthroplasty, the maximal subjective medical improvement based on PROMs is seen until one year postoperatively, with clinically insignificant improvement beyond one year. The SMFA scoring system may offer greater sensitivity to subjective improvements compared to the AOFAS or VAS scales. This trajectory may help guide patients in managing their expectations in their functional outcomes during preoperative patient education.
Adverse Events Involving Hallux Metatarsophalangeal Joint Implants: Comprehensive Analysis of US Food and Drug Administration Data from 2010 to 2018
Authors: Akoh Craig C. , Kadakia Rishin J. , Chen Jie , Park Young-uk , Kim Hyong Nyun , Wang Juntao , Adams Samuel B. 
Published: November 2020

Category: Midfoot/Forefoot; Other Introduction/Purpose: The prevalence of osteoarthritis of the hallux metatarsophalangeal joint (MTPJ) is estimated to affect 1 in 40 people over the age of 50. Surgical treatment options for MTPJ arthritis include joint preservation, joint resurfacing, and salvage arthrodesis. Arthroplasty of the great toe MTPJ has evolved over the past several decades. The aims of this study were to examine the MAUDE database to determine reported adverse events for hallux MTPJ arthroplasty. Methods: The US Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was reviewed from 2010-2018 to determine reported adverse events for approved implants. We recorded and categorized the type of adverse event and excluded duplicate reports and those extracted from already published literature. Results: Among 64 unique hallux MTPJ implant adverse events, the most common modes of failure were component loosening (34%), component fracture (9.4%), inflammation (9.4%), infection (14.1%), and allergic reaction (7.8%). In regards to implant type, synthetic implants (Cartiva) had the highest percentage of adverse events (23.4%), followed by Arthrosurface ToeMotion (20.3%), Ascension MGT (12.5%), Arthrosurface HemiCAP (10.9%), Futura primus (9.4%), and Osteomed Reflexion (6.3%). The number of adverse events reported increased substantially after 2016. Conclusion: Our study of the MAUDE database demonstrated that component loosening and infection are the most common modes of adverse events for hallux MTPJ implants. Cartiva accounted for one-fourth of the implant-related adverse events during our study period, followed by ToeMotion and Ascension MGT implants. Given that the adverse events for hallux MTPJ implants are underreported, improved reporting mechanisms should be utilized to improve our understanding on long-term effects of various hallux MTPJ implants. [Table: see text]
Applying the Periprosthetic Joint Infection Consensus Definition to a Case Series of Revision Foot and Ankle Implant-Associated and Infection-Suspected Procedures to Assess Diagnosis
Authors: Baker Erin A. , Harley Jackson , Gehrke Corinn , Ciufo David J. , Fortin Paul T. , Vaupel Zachary M. 
Published: November 2020

Category: Other Introduction/Purpose: Periprosthetic joint infection (PJI) affects 2-3% of all total joint replacement cases. In 10-30% of these cases, the organism is unidentifiable, which may impact treatment planning and outcomes. In this study, suspected periprosthetic infections of foot and ankle procedures treated by four foot and ankle-trained orthopaedic surgeons were retrospectively reviewed to determine culture status and applicability of the 2018 International Consensus Meeting on Orthopaedic Infections (ICM) Revision classification system. Methods: Under an IRB-approved protocol, cases of suspected infection, based on ICD-9/10 codes, from cases performed at a Level 1, private, academic hospital from October 2014 to November 2019 were reviewed for demographic, surgical, and infection-related data. Results: Of the 210 revision cases coded for infection, 82 met the inclusion criteria of the study; cases included removal of an implant and were not wound infection-related only. Preoperatively and intraoperatively, 10 (12%) and 59 (72%) cases were culture-positive, respectively. In this series, 21 (26%) cases met the ICM Revision major criteria and 36 (44%) cases met the threshold for ICM Revision minor criteria; overall, 43 (52%) cases were defined as infected by the 2018 ICM Revision classification system. Conclusion: This study reviewed and identified culture status and infection by the 2018 ICM classification system. In this series of 82 cases, approximately half of the cases met the criteria for infection diagnosis, according to the most recently revised ICM classification system, although nearly three-quarters of the population had at least one positively-identified intraoperative culture. Further data analysis is ongoing to assess the correlation between ICM scoring with pre/postoperative treatment and outcomes. [Table: see text]
Comparative Evaluation of the Presence of Insertion Enthesophyte in the Achilles Tendon by X-Ray and Magnetic Resonance Imaging: Intra and Inter Observer Reliability
Authors: Baumfeld Tiago S. , Silva Thiago A. , Benevides Wilel A. , Silveira Dário M. , Baumfeld Daniel 
Published: November 2020

Category: Other; Sports Introduction/Purpose: To evaluate the intra and interobserver variation on the presence of enthesophyte in patients with Achilles insertional tendinopathy and the clinical radiological correlation of x-ray (X-ray) and magnetic resonance images (MRI). Methods: We selected Lateral X-ray images of the calcaneus and videos of ankle MRI in which we showed the entire thickness of the calcaneus in the coronal, sagittal and axial views, in both T1 and T2 weightings, of 20 patients with Achilles insertional tendinopathy. 5 foot and ankle surgeons and 5 musculoskeletal radiologists, with varied experience time, analysed the images. Intra and Interobserver correlations were studied with the kappa index. Results: The average Ƙ intraobserver of the results of the MRI analyzes was 0.49, and the average Ƙ interobserver of the results of the MRI analyzes was 0.47. The mean Ƙ intraobserver values of the results of the X-ray analyzes were 0.61, while the Ƙ interobserver had a value of 0.60. We also observed that the group of less experienced surgeons and radiologists showed a worse Ƙ intraobserver than the more experienced ones. Conclusion: The values are in agreement with previous studies, confirming moderate intraobserver and interobserver reproducibility in MRI exams and good or substantial interobserver and interobserver reliability in X-ray exams.
Evaluation of Ankle Mobility Loss in Patients Undergoing Subtalar Arthrodesis
Authors: Baumfeld Tiago S. , Pinto Roberto Zambelli de A. , Lopes Fernando Araujo S. , Baumfeld Daniel , Tavares Camilo 
Published: November 2020

Category: Hindfoot Introduction/Purpose: Objective: To evaluate and quantify the loss of ankle mobility in patients undergoing subtalar arthrodesis compared to the contralateral side, through physical examination. Methods: A total of 12 patients who had only the subtalar arthrodesis procedure from various causes in one foot were selected. The same foot and ankle surgeon performed all measurements of bilateral tibiotarsal range of motion, with loaded closed-chain and unloaded open-chain tests. Then, to assess whether there was a difference between the operated and the non-operated side, statistical analysis was performed with the Mann-Whitney test (Hollander and Wolfe 1999). Results: On the loaded closed-chain test, the operated side had a significantly lower range of motion than the contralateral side, with a mean difference of 5.4 degrees for dorsal flexion and 7.6 degrees for plantar flexion. The open-chain tests showed non- significant differences of 3 degrees for dorsal flexion and 5.3 degrees for plantar flexion. Conclusion: Subtalar joint arthrodesis was shown to cause a loss of mobility in the ipsilateral ankle, which is greater in plantar flexion movement.
Long Term Autograft Harvest Site Pain after Ankle and Hindfoot Arthrodesis
Authors: Baumhauer Judith F. , Glazebrook Mark A. , Younger Alastair S. , Fitch David , Quiton Jovelyn , Daniels Timothy R. , DiGiovanni Christopher W. 
Published: November 2020

Category: Ankle; Hindfoot; Other Introduction/Purpose: Autologous bone has traditionally been the gold standard for grafting material during foot or ankle arthrodesis. While autograft use has been effective, its harvest does present certain distinctive risks to the patient including persistent harvest site pain. Previous studies have examined harvest site pain, but most have focused on the iliac crest and none provide longer term follow-up. The purpose of this study was to examine long-term (7-10 year) donor site pain from four lower extremity harvest site locations in subjects undergoing autograft harvest for hindfoot or ankle arthrodesis. Methods: All subjects in the control arm of a previously conducted Level 1 clinical trial comparing autologous bone with a synthetic bone graft substitute for hindfoot or ankle arthrodesis were invited back for a single visit at a minimum of 5 years following their initial surgery. Autograft was harvested from either the proximal tibia (51.7%), iliac crest (17.2%), calcaneus (15.5%), distal tibia (6.8%), or other location (8.6%). Harvest site pain, fusion site pain, and weight-bearing pain were evaluated using a 100-point visual analog scale (VAS), with clinically significant pain considered as any score greater than 20 (Todd et al., 1996). Results: Of the 130 subjects receiving autograft in the original trial, 58 returned for assessment at a mean follow-up of 9.0 years (Table 1). The mean harvest site VAS at final follow-up was 4.4 (range, 0.0-97.0) with 37.9% of subjects reporting some level of pain. The percentage of subjects who reported clinically significant pain was 35.7%, 21.4%, 18.2%, 10.5%, 8.9%, and 5.2% at 2, 6, 12, 24, 52 weeks, and final follow-up, respectively. Of those subjects reporting clinically significant pain at final follow-up, two had undergone harvest from the proximal tibial and one from the iliac crest. A significant correlation was found between harvest site pain and both weight-bearing and fusion site pain, but not between harvest site pain and the volume of graft harvested. Conclusion: This study is the first to examine persistence of long-term harvest site pain following autologous bone graft harvest during hindfoot or ankle arthrodesis. Over one-third of patients still reported persistent pain at an average follow-up of 9 years, with 5% experiencing clinically significant pain. The proximal tibia harvest site had the greatest incidence of reported pain. These data suggest that harvesting autologous bone does carry inherent risk of persistent, long-term pain. This factor should be considered when informing patients of procedural risks and when choosing between autograft or graft substitute during arthrodesis surgery. [Table: see text]
Long-term Outcomes of Immediate Weightbearing with Anchorless Achilles Debridement and Secondary Reconstruction for Insertional Achilles Tendonopathy
Authors: Bemenderfer Thomas B. , Boersma Jacob B. , Maskill John D. , Anderson John G. , Bohay Donald R. 
Published: November 2020

Category: Hindfoot; Sports Introduction/Purpose: Achilles debridement and secondary reconstruction is a widely accepted procedure for treatment of insertional Achilles tendonopathy with or without Haglund resection, calcaneus exostectomy, retrocalcaneal bursectomy, and possible flexor hallucis longus tendon transfer. When less than 50% of the tendon is pathologic and elevated from the calcaneus, primary reconstruction with or without bony fixation (bone tunnels or anchors) has been advocated. Postoperative protocols demonstrate wide variability in the orthopaedic literature. This study is the first to evaluate clinical and radiographic outcomes in patients with insertional Achilles tendonopathy who underwent soft tissue only Achilles debridement and secondary reconstruction with immediate plantigrade weightbearing in plantigrade foot ankle stabilizer (FAS) high walking boot. Methods: All patients with symptomatic insertional Achilles tendonopathy who failed conservative management underwent Achilles debridement and secondary reconstruction with or without Haglund resection, calcaneus exostectomy, and retrocalcaneal bursectomy by a single senior foot and ankle surgeon at a single tertiary center between January 2006 to December 2013 were included in our retrospective case series. Patients with greater than 50% involvement of the tendon requiring flexor hallucis longus transfer were excluded. Demographics, clinical outcomes, patient comorbidity information, and Coughlin satisfaction scores were collected. The primary outcome was change in visual analog scale (VAS) pain score. Secondary outcomes were reoperation, minor complications (local wound care, use of antibiotics, and skin dehiscence). Results: From 2006 to 2013, 66 patients (40.9% male, 59.1% female) at an average age of 53.6 years (range 19 to 78) underwent Achilles debridement and secondary reconstruction. At final average follow up of 4.3 years, average VAS score improved from 5.9 to 2.3 preoperatively to postoperatively. There were a total of 10 reoperations in 9.1% of patients (n=6). Minor complications were present in 12.1% of patients (n=8; 3 local wound care, 8 use of antibiotics, and 5 skin dehiscence). Physical therapy desensitization was utilized in 25.8% of patients (n=17). Conclusion: The present study demonstrates a significant improvement in VAS pain scores following Achilles debridement and secondary reconstruction for treatment of insertional Achilles tendonopathy with immediate plantigrade weightbearing in plantigrade FAS high walking boot. This technique appears to be safe and effective.