bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison total joint replacement (Roto-Glide) with arthrodesis of the 1st metatarsophalangeal joint – clinical follow-up study including pedography
Authors: Richter Martinus , Zech Stefan 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the 1st metatarsophalangeal joint (MTP1). The aim of this study was to compare outcome (clinical and pedographic) of JTR (Roto-Glide, Implants International, Thornaby-On-Tees, UK) and A of MTP1. Methods: All patients that completed follow-up of at least 24 months after TJR and A of MTP1 before November 5, 2017 were included in the study. The data was extracted from a prospectively acquired database starting November 1, 2011 including all operatively treated patient at the authors´ institution. Exclusion criteria were bilateral treatment (n=24), additional procedures at other toes (n=34), A for revision of TJR (n=12), TJR exchange (n=5), and not completed minimum-24-month-follow-up (n=20). Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at 1st metatarsal/1st toe from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and MTP1 range of motion for dorsi-/plantarflexion (ROM) were registered. All parameters were compared between TJR and A and between preoperatively and follow-up. Results: From November 24, 2011 until October 31, 2015, 19 TJR and 38 A were performed. Parameters (average values if not stated otherwise) for TJR/A were preoperatively: mean age 59/60 years; 5(26%)/10(26%) male; height 167/166 cm; weight 73/74 kg; degree degenerative changes 3.3/3.1; ROM 10.3/0/18.8°//10.8/0/19.2°; percentage force 1st metatarsal/1st toe 7.8/14.5//8.4/15.2; VAS FA 45.5/44.9. Follow-up time on average 37.4/32.6 and range 25.3-71.3/24.1-67.1 months. VAS FA at follow-up was 71.7/69.4; percentage force 1st metatarsal/1st toe 15.6/5.5//16.5/10.5; ROM 35.4/0/20.5°//10.2/0/0. Parameters did not differ between TJR and A (each p>.05) except higher force percentage 1st toe and lower ROM for A at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05). Conclusion: TJR and A were performed in similar patient cohorts regarding demographic parameter, degree of degenerative changes, ROM, pathological pedographic pattern, and validated clinical scores (VAS FA). Both improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different to physiological pattern) than A. TJR was similar to A except better ROM and better pedographic pattern. Survival rate of TJR was 100% up to 6 years. In this study, TJR was a valuable alternative to A for treatment of severe MTP1 osteoarthritis.
Comparison Total Joint Replacement (STAR) with Arthrodesis of the Ankle
Authors: Richter Martinus , Zech Stefan 
Published: September 2018

Category: Ankle Arthritis Introduction/Purpose: Total joint replacement (TJR) and arthrodesis (A) are treatment options for severe osteoarthritis of the ankle. The aim of this study was to compare outcome (clinical and pedographic) of JTR (STAR, Stryker, Airview Boulevard, MN, USA) and A of the ankle. Methods: All patients that completed follow-up of at least 24 months after TJR and A of the ankle before November 5, 2017 were included in the study. The data was extracted from a prospectively acquired database starting November 1, 2011 including all operatively treated patient at the authors´ institution. Exclusion criteria were bilateral treatment (n=14), extensive additional procedures such as arthrodesis at other joints (n=54), A for revision of TJR (n=8), TJR exchange (n=10), and not completed minimum-24-month-follow-up (n=26). Preoperatively and at follow-up, radiographs and/or weight-bearing computed tomographies were obtained. Degenerative changes were classified in four degrees. Standard dynamic pedography was performed (percentage force at hindfoot and forefoot from force of entire foot). Visual-Analogue-Scale Foot and Ankle (VAS FA) and ankle range of motion for dorsi-/plantarflexion (ROM) were registered. All parameters were compared between TJR and A and between preoperatively and follow-up. Results: From October 11, 2011 until October 31, 2015, 36 TJR and 28 A were performed. Parameters (average values if not stated otherwise) for TJR/A were preoperatively age 61/52 years; 20(56%)/14(50%) male; height 171/175 cm; weight 83/87 kg; degree degenerative changes 3.5/3.6; ROM 5.6/0/22.8°//4.8/0/22.1°; percentage force hindfoot/forefoot 45.5/38.3//48.4/34.5; VAS FA 43.8/40.3. Follow-up time on average 35.8/33.1 and range 25.4-66.4/24.1-71.3 months. VAS FA at follow-up was 68.6/61.3; percentage force hindfoot/forefoot 64.3/22.3//53.5/28.5; ROM 15.4/0/33.6°//0/0/0. Parameters did not differ between TJR and A (each p>.05) except lower age for A, higher VAS FA, hindfoot force percentage and ROM for TJR at follow-up (each p<.05). VAS FA and pedography parameters improved for TJR and A between preoperatively and follow-up, ROM increased for TJR and decreased for A (each p<.05). Conclusion: TJR and A were performed in similar patient cohorts regarding demographic parameter (except lower age for A), degree of degenerative changes, ROM, pathological pedographic pattern, and validated clinical scores (VAS FA). Both improved pathological pedographic pattern and VAS FA at minimum follow-up of 24 months. TJR additionally improved ROM and showed better pedographic pattern (and not different than physiological pattern) and VAS FA than A. TJR resulted in better clinical outcome including ROM and pedographic pattern. Survival rate of TJR was 100% up to 5.5 years. In this study, TJR outperformed A for treatment of severe ankle osteoarthritis.
Quantitative Assessment of Type-1 Collagen in Charcot Neuroarthropathy with Use of Harmonic Generation and Multiphoton Microscopy
Authors: Saloky Kaitlin , Aynardi Michael , Walley Kempland , Juliano Paul , Matchik Heather , Abraham Thomas 
Published: September 2018

Category: Diabetes Introduction/Purpose: Diabetic Charcot neuroarthropathy is characterized by rapid loss of bone with accompanied disruption to the surrounding joints and is often in the absence of trauma or infection. Previous research has demonstrated neuropeptide release and osteoclast activation in addition to increased collagen turnover. Currently, there is limited understanding on the impact of the disease on type-1 collagen within the joint synovium. The purpose of this study was to analyze qualitative and quantitative differences in type-1 collagen between diabetic, neuropathic patient controls and those with Charcot neuroarthropathy. Methods: A prospective case-control study using routinely discarded surgical waste synovial tissue from diabetic, neuropathic patients with and without Charcot. The tissue was prepared in the laboratory for analysis. Microscopy was performed using multiphoton excitation fluorescence (MPEF) and second harmonic generation (SHG) microscopy techniques, utilizing a mode locked femto-second i: Sapphire Tsunami (Spectra-Physics, Mountain View, CA) synchronously pumped by a Millenia Xs J (Spectra-Physics) diode-pumped solid state laser. Qualitative and quantitative microscopic analysis was performed on Charcot specimens and controls. A statistical analysis was performed to detect a quantitative difference in type-1 collagen. Results: An analysis was performed on 8 samples; 4 neuropathic controls and 4 Charcot neuroarthropathy samples. There was a statistically significant difference between the amount, the quality and organization of type-1 collagen (p<0.0001). The Charcot group had significantly less type-1 collagen when compared to the control (p<0.0001). Qualitative analysis was performed using a mean intensity value. The control group’s mean intensity was 2561.4 nm while the Charcot group’s was 884.1 nm. The Charcot group had a significantly smaller mean intensity indicating poorer quality of collagen (p<0.0001). Orientation index was used to assess the organization of type-1 collagen in the synovium. A smaller orientation index signifies an increase in disorganization. The Charcot group had a significantly smaller orientation index of 16.5 compared to the control group’s 27.8 (p<0.0001). Conclusion: Charcot neuroarthropathy leads to significant abnormalities in type-1 collagen within the joint synovium when compared to the diabetic controls. Further research will determine if these differences are attributable to neuropeptide release and osteoclastic activation.
Reducing potential for needle-stick injuries in the operating room
Authors: Saltzman Eliana , Scott Daniel 
Published: September 2018

Category: Other Introduction/Purpose: The CDC estimates that at least 385,000 sharps injuries occur annually among US healthcare workers, which may even be as high as 800,000. Traditionally, wound closure demands the OR scrub tech to pre-load suture needles onto needle drivers that are presented to the surgeon and then passed back once the needle has been used. With frequent passing of contaminated needles, needle-stick injuries occur commonly in the OR. Operative Armour (Sharp Fluidics®, LLC) incorporates a novel needle trap that enables surgeons to independently self-secure and self-dispense suture needles during closure (Fig. 1). We hypothesized that the use of Operative Armour as compared to the standard technique of sequentially passed needles would reduce the number of sutures passes. Methods: Three cadaveric specimens were dissected in this study. A 12 cm long incision was made through an anterior and posterior approach to the ankle joint in each specimen. The incisions were cross-hatched at 1 cm intervals with a surgical marking pen to indicate closure points. Two layers, subcuticular and skin, were closed. All three participants were orthopedic foot and ankle fellows at our institution. All wound closures were done with interrupted suture technique using 2-0 vicryl pop-off suture (Covidien), containing 5 needles per pack. Group A used traditional suture passing from the scrub tech vs the Operative Armour in Group B. The participants completed three trials for each group first through the anterior and then through the posterior approach. Outcome measures included number of needle passes, dropped needles, and closure time. Results: Suture passes averaged 52±8.9 for Group A compared to 5.3±0.7 in Group B (p<0.05). There were 24 needle handoffs in Group A, in Group B only three suture packs were passed. Overall closure time was 16:35±0.2 minutes in Group A and 16:33±0.1 minutes for Group B (p= 0.8). No needles were dropped in either group. For the anterior incision, suture passes averaged 56±11.3 in Group A compared to 5.6±0.9 in Group B (p<0.05). The closure time for Group A was 16:51±0.2 minutes and 16:13±0.1 minutes for Group B (p<0.05). For the posterior incision, suture passes averaged 48±0.0 in Group A compared to 5±0.0 in Group B (p<0.05). The closure time for Group A was 16:18±0.2 minutes and 16:53±0.1 minutes in Group B (p=0.05). Conclusion: Use of the Operative Armour compared to standard technique demonstrated a statistically significant decreased number of suture passes, but no change in total closure time. Given the large reduction in sutures passes, the use of the Operative Armour could lead to a significant reduction in the number of needle sticks in the OR during wound closure. Also, while not measured in this study, the use of Operative Armour could reduce the demand on the scrub tech for assistance with wound closure and could thus decrease OR turnaround time and enhance operating room efficiency.
Outcomes following 3D Printed Total Talus Arthroplasty
Authors: Scott Daniel , Parekh Selene 
Published: September 2018

Category: Hindfoot Introduction/Purpose: Many patients with talar avascular necrosis have limited treatment options to manage their symptoms. Historically, surgical options have included pan-talar fusions, tibio-talar-calcaneal fusions, and revascularization procedures. Unfortunately, these treatment options can leave patients with little ankle and hind-foot motion, can increase adjacent joint arthritis, and have significant failure rates. Recently, the use of custom 3D printed total talar replacements has arisen as a treatment option for these patients. Theoretically, this allows for better preservation of hind-foot motion as well as possibly less adjacent joint arthritis. Methods: We retrospectively reviewed 15 patients who underwent a 3D printed total talus replacement by a single surgeon over 2 years. Each patient had pre-operative CT scans of both the affected and non-affected talus. Custom 3D printed implants were made in two sizes based on templating performed on the contralateral talus. All total talus replacements were performed through a direct anterior approach. Patient outcomes were reviewed pre and post-operatively including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, as well as VAS scores, range of motion, and number of additional or subsequent procedures. Results: The average patient age was 45. 6/15 patients had previously undergone surgery on the ipsilateral hind-foot/ankle. There was a statistically significant decrease in VAS pain scores from 7.0 pre-operatively to 2.5 at final follow up. There was a statistically significant increase in both ankle and sub-talar motion at final follow up when compared to pre-op. Average follow-up was 8.4 months, with a minimum follow up of 3 months. Of the four patients with 1 year or longer follow up (average 13.3 months), VAS scores and ROM were similar to patients with shorter follow up duration. 3 patients had concomitant procedures, most commonly tendo-achillies lengthening. One patient required an additional procedure (incision and drainage) for treatment of wound dehiscence. Conclusion: 3D printed total talus replacements represent an exciting treatment options for patients with significant talar avascular necrosis. At early follow up, patients showed good improvement in VAS pain scores and actually improved their hindfoot and ankle motion. Certainly, longer term follow-up will be needed to evaluate the longevity of these implants. However, these implants represent an intriguing option for patients that lack an ideal surgical solution and show promise at very early follow up.
Sarcopenia increases the risk for mortality in patients who undergo amputation for diabetic foot
Authors: Seo Sang Gyo , Park EunSoo 
Published: September 2018

Category: Diabetes Introduction/Purpose: Although there have been reports that diabetes affects the prevalence of sarcopenia, no studies have examined the relationship between sarcopenia and mortality in patients undergoing leg amputation. The purpose of this study is to determine whether sarcopenia affects the survival and functional outcome of patients undergoing diabetic foot amputation. Methods: From among patients who underwent limb amputation for diabetes complications, this study included 167 patients who underwent abdominal CT within 1 year of amputation. We defined sarcopenia using sex-specific cut-off points for the L3 skeletal muscle index. The 5-year survival rate was analyzed. All patients were divided into two groups and compared according to the presence of sarcopenia. We measured the functional activity of the survivors using the Foot and Ankle Ability Measure (FAAM). Differences in FAAM scores were evaluated. The survival rate according to sarcopenia was assessed via the Kaplan-Meier method and log-rank test. Results: Among the total of 167 patients, the overall 5-year survival rate was 47.3%. Of the 112 patients with sarcopenia, the 5-year survival rate was 39.3%. Of the 55 patients without sarcopenia, the 5-year survival rate was 63.6%. Kaplan-Meier analysis showed a high mortality of the sarcopenia group in the univariate (p=0.016) and multivariate (p=0.047) analysis. There was no significant difference in FAAM score between two groups (p=0.500). Conclusion: Our study is the first to analyze the relationship between diabetic amputation and sarcopenia. Sarcopenia increases the risk of mortality in patients with amputation for diabetic foot. Therefore, the role of sarcopenia and exercise training should be studied in the future to define what role they have in improving functional outcomes in patients who undergo diabetes related amputations.
Staple versus Suture Closure for Ankle Fracture Fixation
Authors: Shah Ashish , Lehtonen Eva , Patel Harshadkumar , Pinto Martim , Phillips Sierra , Naranje Sameer , Pitts Charles , Kalra Rishi , Huntley Samuel 
Published: September 2018

Category: Trauma Introduction/Purpose: Ankle fractures are commonly treated fractures by orthopaedic surgeons with unique challenges to skin closure due to the lack of subcutaneous support. Metallic staples are a commonly accepted method of skin closure in other specialties, though the use of staples in orthopaedics, and more specifically in foot and ankle surgery, remains a topic of debate. Proponents of staples report several potential advantages to using staples instead of sutures, including reduced closure time, faster and less painful removal, or improved cosmetic appearance. This study aimed to compare outcomes of suture versus staple closure as well as to evaluate the safety of staple closure after open fixation of acute traumatic ankle fractures. Methods: The medical records of 94 patients treated at our institution with open fixation of an acute traumatic ankle fracture by a single surgeon between January 2011 and June 2017 were retrospectively reviewed. Demographics, preoperative characteristics, relevant comorbidities, operative characteristics, and postoperative outcomes were compared between patients who received superficial skin closure using staples versus suture techniques. Statistical analysis was performed using chi-squared test and Fisher’s exact test. Results: The staple and suture group patients were demographically similar at baseline. Of the 94 patients included in this study, 10 patients developed local wound related complications postoperatively, including 5 with wound dehiscence, 4 with superficial wound infections, and 1 deep infection . Eight patients required revision surgery due to infection or wound dehiscence. Four patients in the suture group developed superficial wound infections, compared with zero in the staple group. One patient in the staple group developed a deep infection. With the numbers available, no significant differences could be detected in the incidence of postoperative infections, local wound related complications and revision surgeries between two wound closure groups. Conclusion: Our data suggests that there is no statistical difference in outcomes between staple and suture closure after open fixation of acute ankle fractures. Because there was no difference in morbidity with possible benefits of reduced closure time, faster removal, and improved cosmetic appearance, we conclude that staple closure may be a safe alternative to sutures for superficial skin closure. This study adds evidence to a growing body of literature and suggests that staples can be used in some instances, clinical decision making, surgeon preference, and technique proficiency should remain the cornerstone of closure in ankle fracture surgery.
Hemi vs. Total joint arthroplasty for hallux rigidus
Authors: Shah Ashish , Stibolt Robert , Patel Harshadkumar , Lehtonen Eva , DeBell Henry , Naranje Sameer , Lee Sung , Huntley Samuel , Moon Andrew , Buddemeyer Katherine 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: Advanced-stage arthritis of the first metatarsophalangeal joint (MTPJ), or “Hallux Rigidus” (HR) is a common forefoot pathology. When surgery is indicated, arthroplasty is an alternative to arthrodesis, which aims to preserve MTPJ dorsiflexion. Since it is unclear whether total-toe or hemi-toe devices are preferred implants in MTPJ arthroplasty, we completed a systematic review of the literature and did a meta analysis to test which type of implants clinically outperform in hallux rigidus. Methods: A systematic review of MTPJ arthroplasty was performed using Pubmed, EMBASE, SCOPUS, and Cochrane library for the years 2000 to 2017. Data was extracted from articles containing both preoperative and postoperative endpoints for either hemi or total MTPJ arthroplasty cases. To be eligible for inclusion, studies must have had a mean follow-up window of at least 24 months and standard deviation of outcome. Total eleven studies were included for review, seven studies with hemi replacement and six studies with total arthroplasty. Pooled mean values were calculated, and a forest plot was created comparing pre-and post-operative American Orthopedic Foot and Ankle Score (AOFAS), visual analogue scale (VAS), and range of motion (ROM) results for both hemi-toe and total-toe arthroplasty. Statistical analysis was performed using SPSS. Results: Mean postoperative AOFAS scores in patients undergoing hemiarthroplasty improved by 50.7 points (95%CI: 48.5, 52.8), which was higher than the mean postoperative AOFAS improvement of 40.6 points (95%CI: 38.5, 42.8) seen in total-toe patients. Mean postoperative VAS improvement in hemiarthroplasty was 6.05 points (95%CI: 5.92, 6.18), which was comparable to the mean VAS improvement of 6.29 points (95%CI: 6.02, 6.55) seen in total arthroplasty. Mean postoperative MTPJ ROM improved by 43.0 degrees (95%CI: 39.3, 46.6) in hemi-toe patients, which exceeded the mean ROM improvement of 32.5 degrees (95%CI: 29.9, 35.1) found in total-toe cases. A meta-analysis of the data revealed non-significant statistical trends for AOFAS and ROM in favor of hemiarthroplasty. Conclusion: Hemi-surface implants in MTPJ arthroplasty may improve postoperative AOFAS and ROM results to a greater extent than total-toe devices. High-quality randomized controlled studies are needed to confirm long-term surgical outcomes in these patients.
Long-term evaluation of Primary Osteochondral Autograft Transfer System (OATS) for large cystic type osteochondral lesion of talus
Authors: Shim Dong Woo , Hwang Yeokgu , Park Kwang Hwan , Lee Jin Woo , Han Seung Hwan 
Published: September 2018

Category: Ankle Introduction/Purpose: Osteochondral lesions of talus (OLTs) are often treated primarily by fragment excision, abrasion, drilling, or microfracture. However, OLT accompanying with large cyst has been challenged to yield good outcome nevertheless of many surgical options. Recent study showed significant high failure rate of arthroscopic marrow stimulation treatment larger than 150mm2. The current study is to investigate the outcome of the primary osteochondral autograft transfer system (OATS) for large cystic type OLT (>150mm2). Methods: This retrospective analysis included 19 talus (19 patients) with diagnosed large cystic type OLT (>150mm2) who received primary OATS between September 2009 and March 2013. Defect size area was measured on magnetic resonance imaging (MRI) by the ellipse formula from coronal and sagittal length. The patients completed the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) score preoperatively and at follow-up. Plain radiographs were used to show the improvement of radiolucency postoperatively. Results: The mean follow up period was 83.9 months (57 – 99) and the average defect size area was 169.4 mm2 (151.3 – 392.6). The Mean VAS score decreased from 6.95 preoperatively to 2.6 postoperatively. Average AOFAS score improved from 66.8 preoperatively to 88.7 postoperatively. Eighty percent of patients rated their result excellent or good. The radiolucent area of the cysts disappeared on the plain radiographs in all cases. Conclusion: Long-term clinical results of primary OATS in large cystic type OLT showed good outcomes and patients could significantly benefit from this surgery.