bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Cigarette Use Associated with Increased Complication Rates and Worse Functional Outcomes Following Total Ankle Arthroplasty?
Authors: Lampley Alexander J. , Gross Christopher E. , Green Cynthia , DeOrio James K. , Adams Samuel B. , Easley Mark E. , Nunley James A. 
Published: October 2016

Category: Ankle Introduction/Purpose: Tobacco use is a known risk factor for increased perioperative complications rates and having worse functional outcomes in many orthopaedic procedures. To date, no study has elucidated the effect of cigarette smoking on complications or functional outcomes scores after total ankle arthroplasty (TAA). The purpose of this study is to compare the rate of perioperative complications and outcome scores in nonsmokers, former smokers, and current smokers. Methods: We retrospectively reviewed the records of 642 patients who had TAA between June 2007 and February 2014 with a known smoking status. These patients were separated into three groups based on their smoking status: 34 current smokers, 249 former smokers, and 359 nonsmokers. Outcome scores and perioperative complications which included wound complications, talar component subsidence, periprosthetic infection, and periprosthetic bone cyst were compared between the groups. Results: When compared to nonsmokers, active smokers had a statistically significant increased risk of wound complications (Hazard ratio [HR] 3.5; p=0.03). Although the active smokers had an increased rate of talar component subsidence (HR 1.6; p=0.66) and persistent pain (HR 1.4; p=0.35), these findings were not statistically significant. Although all groups demonstrated improvement in outcome scores at 1 year and 2 year follow up compared to their preoperative scores, the active smokers showed statistically significant less improvement in their outcome scores than the nonsmokers and former smokers at 1 and 2 year follow up. Furthermore, there was no significant difference in the outcome scores or complications when comparing the nonsmokers to the former smokers. Conclusion: Patients with tobacco use undergoing TAA have a higher rate of perioperative complications and worse outcome scores compared to nonsmokers and former smokers. Furthermore, tobacco cessation appears to reverse the effects of smoking which allows TAA to be an effective and safe procedure for providing pain relief and improving function in former smokers as they have perioperative complication rates and outcomes similar to nonsmokers.
Noninvasive Measurement of Normal Foot and Ankle Joint Reaction Force
Authors: Ho Bryant S. , Maqsoodi Noorullah , Vasconcellos Daniel , Osman Walid , Fowler Xavier , Elfar John C. , Olles Mark , Ketz John , Flemister Adolph S. , Oh Irvin C. 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: Various biomechanical studies have examined pressure changes across the foot and ankle joints. However, most of these studies disrupted the capsuloligamentous complex surrounding the joint to insert pressure sensors, compromising the integrity of the natural joint structure and the accuracy of biomechanical assessments. This is the first noninvasive study to report measurement of natural joint reaction forces (JRF) across the foot and ankle while preserving all soft tissue structures. Since articular surfaces experience equal and opposing compression forces, we aimed to evaluate the distraction force needed to overcome these compression forces. Methods: Ten fresh-frozen cadavers of the lower extremity were obtained that were disarticulated at the knee joint. Steinmann pins were percutaneously placed across the distal tibia, and the center of the talus, navicular, cuboid, and calcaneus while preserving all surrounding soft tissues. A custom fixation device was utilized in conjunction with a tensile testing machine to allow distraction in line with the axis of the tibiotalar, subtalar, talonavicular (TN), and calcaneocuboid (CC) joints. Displacement was measured as distance between Steinmann pins on either side of the joint examined. Under progressive axial distraction, displacement and force were measured. Best-fit polynomials were calculated to fit the force-displacement curves. The inflection point, representing the joint reaction force (JRF) where distraction forces across the joint equal the compression forces, was calculated for each curve. Results: All force-displacement curves demonstrated an inflection point. Prior to the inflection point, relatively large increases in distraction force resulted in minimal displacement. Once the inflection point was reached, relatively small increases in distraction force resulted in large increases in displacement. Each cadaver was measured three times with high reproducibility. The mean JRF were tibiotalar 33.8 N [standard deviation (SD) 10], subtalar 18.2 N (SD 12), TN 13.3 N (SD 4), and CC 14.7 N (5.8). Conclusion: We present the first application of a reliable and noninvasive method of measuring JRF of the foot and ankle joints. In the medium or small joints, dissection of the capsule and surrounding ligaments can significantly alter joint stability and biomechanics. By preserving all the periarticular soft tissues, this experimental model will allow future investigation of biomechanical changes of pathologic states and efficacy of surgical intervention under conditions that most accurately reflect the in vivo state.
Weight Bearing Compliance after Foot and Ankle Surgery
Authors: Gershkovich Grigory , Arango Dillon , Shaffer Gene W. , Ndu Anthony 
Published: October 2016

Category: Other Introduction/Purpose: Patients are frequently required to maintain a non-weight bearing (NWB) status after foot and ankle surgery in order to prevent post op complications. Adherence to these instructions is of paramount importance and lack of compliance may lead to wound breakdown, loss of fracture fixation, or hardware failure. Unfortunately due to a number of factors, patients are frequently unable to comply with their weight bearing (WB) requirements. Lack of compliance has recently been demonstrated in studies as it relates to either partial or NWB instructions. This study examined rates of non-compliance in a socioeconomically disadvantaged population with results showing an 88% non-compliance rate. We present preliminary data on WB compliance and further seek to identify demographic data and risk factors possibly contributing to this epidemic. Methods: Pressure sensing films (70-350 PSI) were used for this study. When pressure is applied, the film turns an intense pink color. After lower extremity surgery is performed patients are placed in a short leg plaster splint. The sensor is placed superficial to the plaster/webril. One sensor is placed beneath both the forefoot and one beneath the hind foot and the splint is then marked with an “S” to indicate study participation. Once the patient follows up, either the attending physician or a certified cast technician will retrieve the sensors for documentation. An additional sensor is placed on a non-weight bearing portion of the anterior tibia to serve as a control. After retrieval of sensors, results are analyzed by at least 4 team members to decide on WB compliance. Pink coloration of 30% or more is considered positive in our study. Results: At the time of this abstract, 25 patients had returned for follow up. 22/25 (88%) patients were found to have at least 1 out of 2 sensors positive. 13/25 (52%) had both forefoot and hind foot sensors positive. 3 patients had both sensors without any pressure changes. 5 patients had lost at least 1 sensor. Conclusion: To date, 88% of our patients have been found to be non-compliant with their weight bearing status instructions. The results of this study agree with previous studies demonstrating a high rate of non-compliance even after education and instruction. Our study exhibited a higher rate of non-compliance when compared to other studies, possibly due to patient demographics. More data is needed to ascertain the effect of certain risk factors in order to identify the proper method of patient education/instruction and to possibly create a standardized weight bearing compliance educational program.
Can Preoperative Risk Factors be used to Predict Unplanned Admission or Readmission Rates? A Study of Foot and Ankle Patients
Authors: Rofaiel James R. , Lau Johnny , Katchky Ryan , Rampersaud Raja 
Published: October 2016

Category: Other Introduction/Purpose: In the current health care climate, there is an increasing focus on cost savings and resource management. As such, there is an emphasis on decreasing length of stay and performing surgery on an outpatient basis. Consequently, some patients will have unanticipated intra-operative or post-operative adverse events that will necessitate an unplanned post-operative hospital admission or a readmission after discharge. These unplanned admissions or readmissions represent an increased burden on health care systems and can cause cancellation of other scheduled procedures. The purpose of this study is to investigate whether pre-operative patient risk factors or intra-operative events could predict unplanned admission or readmission following discharge in patients undergoing either elective or emergency foot and ankle surgery. Methods: Data was prospectively collected on a total of 889 patients. The patients were divided into two groups: patients without readmissions (N=791) and patients who had an unplanned admission or readmission (N=98). We also collected and analyzed the following variables: age, gender, BMI, diabetes, ASA class, surgery start time, length of surgery, regional vs. general anesthetic, elective vs. trauma surgery and type of procedure. Logistic regression models were used to identify risk factors that could independently predict unplanned admissions or readmissions to hospital following foot and ankle surgery. Results: Factors that could be used to independently predict readmission were length of surgery (p 0.0154, Odds Ratio 1.004) and trauma surgery (0.0167; 1.978). For every 1-hour increase in length of surgery, the odds of unplanned admission/readmission increase by 1.27 times. The odds of patients undergoing surgery for acute traumatic injuries getting readmitted are 1.978 times higher than for elective surgery patients. Conclusion: In conclusion, our study showed that pre-operative patient risk factors including BMI, diabetes, and ASA status were unable to predict whether patients would have an unplanned admission or readmission. The two factors that were able to predict whether patients would have an unplanned admission or readmission were length of the procedure and trauma surgery – both of which are not readily modifiable. Our results showed that in spite of institutional measures to ensure timely discharge, only 11% of patients required an unplanned admission or readmission.
Content Relevance of the Foot and Ankle Ability Measure in Patients with Achilles Tendon Diseases
Authors: Reb Christopher W. , Pedowitz David I. , Raikin Steven , Daniel Joseph N. 
Published: October 2016

Category: Sports Introduction/Purpose: The Foot and Ankle Ability Measure (FAAM) is a widely used evaluative, region-specific patient reported outcome measure. Its construct validity, test-retest reliability, and responsiveness are reasonably well supported in patients with a variety of lower extremity musculoskeletal conditions. However, since its development, the FAAM’s content relevance has never been subject to patient assessment. Therefore, this study was designed to assess the content relevance of the FAAM among patients with Achilles tendon diseases. Methods: IRB-approved, prospective, observational study of patients with Achilles tendon diseases. Subjects gave informed consent to complete a standard FAAM and a FAAM content relevance questionnaire. For each item of the relevance questionnaire, the standard FAAM’s visual analogue scale was replaced by a categorical scale asking subjects to rank the individual item as 1-Not Relevant, 2-Somewhat Relevant, or 3-Very Relevant to their lower extremity condition. The same was asked regarding both the entire ADL and Sports subscales, respectively. Descriptive statistics (mean, standard deviation) were calculated using pooled individual question scores and then 95% confidence intervals were constructed. Any individual item or subscale with a mean score above 2.0 was considered to have substantial content relevance. Floor and ceiling effects were deemed to have been present if 20% or more of patients gave all items of a subscale either the lowest or highest possible scores, respectively. Results: There were 59 respondents with mean age of 52.6 years (range, 28 to 79 years). Mean time from presentation to content relevance assessment was 19.6 weeks (range, 1 to 100 weeks). There were 39 (66%) surgical patients and 20 (34%) nonsurgical patients. Diagnoses included 28 (47%) rupture, 18 (31%) tendinosis, and 13 (22%) paratenonitis. 10 (17%) were pre- treatment and 49 (83%) post-treatment. For each individual item and subscale, the mean relevance was above 2.0 indicating substantial relevance. The 95% confidence interval crossed below this threshold for only one item, ‘Personal Care’ (mean 2.02, 95% CI 1.79 to 2.24). No floor effects were detected. Ceiling effects were apparent for only the Sports subscale (n=25,42.4%). Conclusion: These findings demonstrate that the FAAM has substantial item and subscale-level content relevance in patients with Achilles tendon diseases. Future work should aim to provide additional psychometric data specific to patients with Achilles tendon diseases in order to allow more precise use of the FAAM in this specific patient population.
A New Surgical Method for the End-Stage Ankle Arthritis–Total Ankle Arthroplasty with Artificial Talus
Authors: Tanaka Yasuhito , Takakura Yoshinori , Taniguchi Akira , Kurokawa Hiroaki 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is a popular surgical treatment for the patients with end-stage ankle arthritis. Along with development of the implant, indication for TAA has been extended to the severe deformity due to osteoarthritis or rheumatoid arthritis. However, a certain rate of complication after TAA is still remaining. The main reasons for failed TAA are the complications of talar component such as aseptic loosening or subsidence. We developed artificial talar prosthesis and indicated for the patient with idiopathic necrosis of the talus. This time we applied this new implant combined with tibial component of the TAA for the patient with end-stage ankle arthritis having severe collapse of the talus. The purpose of this study is to evaluate the outcomes of TAA with artificial talus. Methods: 【Materials】Thirteen patients (13 ankles) treated by TAA with artificial talus since 2007 to 2014 were investigated. The mean duration of follow-up was 35 months (range; 12 to 66 months). Twelve patients (12 ankles) were suffering from osteoarthritis of the ankle, and 1 was from rheumatoid arthritis. The mean age at the surgery was 71 year-old(range; 61 to 81 year-old). 【Methods】Clinical outcomes were evaluated by Visual Analog Scale (VAS) scores. Functional outcomes were assessed by scoring system produced by the Japanese Society for Surgery of the Foot (JSSF ankle-hindfoot scale) before surgery and at the final follow- up. Results: Postoperative VAS was improved from 8.9 to 2.3. Postoperative JSSF scale were improved from 41 to 87. There were no case that required the revision surgery due to implant failure or deep infection. Conclusion: The ankle has small joint surface compared with other weight-bearing joints, that causes the complications of talar component. For the patients with severe deformity or osteonecrosis of the talus, indications of TAA should be applied carefully. Patients of end-stage ankle arthritis with poor bone stock in the talus may have been unsatisfied with use of previous implant models of TAA. The artificial talus could be a possible option to solve this problem. In the current study, TAA with artificial talus remained favorable clinical and functional results for the patient with severe deformity or poor bone stock in the talus.
Comparative Analysis of Quality of Life, and Sport Activities, After Lower-Limb Joint Replacement
Authors: Besse Jean-Luc , Lomberget-Daubie Marie-Caroline , Bourdin Muriel , Chouteau Julien , Fessy Michel-Henry 
Published: October 2016

Category: Other Introduction/Purpose: For 30 years THA and TKA have been gold standards for severe osteoarthritis. Results are not better in TAA than in ankle arthrodesis according to meta-analysis. Ten year TAA survivorship improved from 80 to 90% but is still worse than in THA and TKA. It is generally thought that THA has better results than TKA and TAA but there have been few quality of life comparative studies. The present study compared functional results, quality of life (QoL) and sports capacity following ankle (TAA), hip (THA) and knee arthroplasty (TKA). Methods: Three continuous series (69 TAA, 716 THA, 121 TKA) operated on by 3 senior surgeons, from 2006 to 2011, were matched for age and follow-up. Patients older than 80 years, multiple arthroplasty in different joints, rheumatoid arthritis and revision of components were excluded. Questionnaires on general quality of life (SF-36, WOMAC, Bonnin's sports questionnaire) and specific function (AOFAS, FAAM, IKS function, Harris) were sent to 3 series (42 TAA, 132 THA and 60 TKA). Statistical analysis used JMP Pro 9.0.0 software. 95% of TAA (42 patients, FU 35±16.2 months, age 63±10.1 years), 82.9% of THA (132 patients, FU 31.5±6.7 months, age 64±8.4 years) and 86.6% of TKA patients (60 patients, FU 31.4±9.4 months, age 71.8±6.7 years) responded. Results: 76.3% of TAA, 90.2% of THA and 84.6% of TKA patients were very satisfied or satisfied. Global SF-36 scores were 58.5±18.5 (TAA), 64.5±16 (THA) and 55.3±17.4 (TKA). Le Global WOMAC scores (/96pts. the higher the more severe) were 25.3±18.3 (TAA), 14.2±16.7 (THA), and 21.4±24.5 (TKA). Functional results were good or excellent in 60.6% of TAAs (AOFAS score), 78.3% of THAs (Harris score) and 48.7% of TKAs (IKS score). Activity of Daily Living FAAM subscales (/84pts) were 54.9±22.5; Sports FAAM subscales (/32pts) 8.2±9.1. Sporting activity was frequent: 86.8% (TAA), 86.9% (THA) and 74.4% (TKA), and pain-free in 44%, 66.8% and 62.9% respectively. TAA patients practiced a mean 3.3 sports, THA patients 2.5 and TKA patients 1.9. Conclusion: QoL on SF36 was better in THA, and equivalent between TAA and TKA. Specific scores were less relevant than general scores. Sports activities were most restricted in TKA. This encourages the use of TAA. There is still work to do to improve specific scores.
Instability of the Medial Column Post Triple Arthrodesis for Stage III Posterior Tibial Tendon Dysfunction
Authors: Lee Wei Ting , Avila Adriana , Han Qin Ling , Myerson Mark S. 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Triple arthrodesis remains the ideal procedure for management of painful rigid flatfoot deformity. While concurrent extended medial column arthrodesis of either the cuneonavicular joint or the 1st tarsometatarsal joint is occasionally required, they are not routinely performed. We hypothesized that following triple arthrodesis, there will be minimal change in the alignment of the medial column joints. The aim of this study was to examine the effect of the triple arthrodesis on the stability and alignment of the medial column joints. Methods: This was a retrospective review of 212 consecutive patients who underwent triple arthrodesis between 2002-2013 for correction of painful Stage III flatfoot deformity. Radiographs of the feet were obtained preoperatively, at 6 weeks, 6 months, 1 year, 3 years and 5 years following surgery. The post operative stability and alignment of the medial column was determined by comparing the radiographs over time. Five radiological parameters were studied: medial cuneiform-calcaneus angle (CCA), medial cuneiform-1st metatarsal angle (MCA), 1st/2nd inter metatarsal angle (IMA), medial cuneiform-navicular distance (NCD) and calcaneal pitch angle. These measurements determined the presence of instability in the sagittal plane (CCA and MCA) and coronal plane (NCD and IMA) of the medial cuneonavicular (NC) joint, and the 1st tarsometatarsal(TMT) joint. Results: Our study demonstrated the presence of medial column instability after triple arthrodesis. This instability was most apparent in the sagittal plane of the NC joint (P < 0.001), and was associated with a decreased in the calcaneal pitch (P < 0.001). There was a slight decrease in the IMA(P < 0.001) as well. The coronal plane of the NC joint, and the sagittal plane of the 1st TMT joint remained stable throughout the measurements. The instability is best appreciated in Fig(B) where there is a reduction in the CCA and calcaneal pitch compared to the X-ray in Fig(A) taken 15 months earlier. Conclusion: The triple arthrodesis procedure corrects the foot deformity, but it is associated with subsequent instability of the medial column mild at the NC joint and abduction of the forefoot at the TMT joints. However, the clinical significance of this instability is not apparent from the study. Since very few patients required subsequent treatment for TMT and NC pathologies after a successful triple arthrodesis, we found insufficient justification for extending the triple arthrodesis distally.
Metatarsalgia After Hallux Valgus Correction is Associated with Relative First Metatarsal Length
Authors: Fukushi Jun-ichi , Nakagawa Satoru , Nakagawa Takeshi , Mizu-uchi Hideki , Iwamoto Yukihide 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: Metatarsalgia of the lesser metatarsal heads are frequently associated with hallux valgus. The aim of this study was to evaluate how the relative length and the position of the first metatarsal head influences the prognosis of metatarsalgia and plantar callosities beneath the lessor metatarsal heads. Methods: A retrospective analysis of the clinical data and radiographs of 102 cases was performed at a mean follow-up period of 16 months after biplane interlocking osteotomies. Clinical evaluation was made using the Japanese Society for Surgery of the Foot (JSSF) hallux scale. Radiological evaluation was made with standard weight-bearing AP radiographs, and the hallux valgus angle (HVA), inter-metatarsal 1-2 angle (IMA), distal metatarsal articular angulation (DMAA), and the sesamoid position were evaluated. Relative first metatarsal length (RML) was determined according to Nilsonne/Morton’s technique. Results: The mean preoperative HVA decreased from 37 to 3 degrees, and the mean IMA from 17 to 4 degrees. The mean JSSF- hallux score improved from 56 to 96 points. The mean preoperative area of plantar callosities decreased from 3.1 to 1.5 mm2. Sixty percent of metatarsalgia improved, and 85% of painless callosities disappeared postoperatively. Among radiological parameters, postoperative RML was most significantly associated with JSSF score (P < .0001) and the presence of postoperative metatarsalgia (P < .0001). ROC analysis revealed that the RML cut-off point was -3 mm for avoiding metatarsalgia, with an area under the curve of 0.884, a specificity of 88%, and a sensitivity of 85%. Conclusion: Preservation of RML during first metatarsal osteotomy is important to prevent postoperative metatarsalgia.