bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midterm Outcome of Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis
Authors: Yuasa Takahito , Maezawa Katsuhiko , Nozawa Masahiko , Kaneko Kazuo 
Published: October 2016

Purpose. To compare the midterm outcome in 12 women who underwent total hip arthroplasty (THA) for rapidly destructive coxarthrosis (RDC) and in 12 controls who underwent THA for osteoarthritis. Methods. Records of 12 women aged 50 to 80 (mean, 72.3) years who underwent THA for RDC after a mean of 9 (range, 4–11) months since symptom onset were reviewed. They were compared with 12 age-and sex-matched controls who underwent THA for primary or secondary osteoarthritis. Acetabular bone deficiency of the 12 RDC patients was classified as type I (n=7), type II (n=4), or type III (n=1). Type I was treated with cementless THA, and types II and III were treated with THA with a cemented acetabular component. The femoral component was cementless. Pre- and post-operative Harris Hip Score was assessed. Radiographs of the hip were evaluated for implant migration, osteolysis, and periprosthetic radiolucency in the acetabulum and proximal femur. Results. The 12 women who underwent THA for RDC and the 12 controls who underwent THA for osteoarthritis were comparable in terms of pre-, intra-, and post-operative parameters. After a mean follow-up of 9.3 years, the mean Harris Hip Score improved from 38.3 to 81.1 in RDC patients and from 43.6 to 84.2 in controls (p=0.13). One RDC patient had dislocation but did not require revision surgery. One RDC patient developed a radiolucent line <2 mm in zones 1 and 7 of the femoral component, but no migration occurred. No patient had progression of bony destruction, loosening, osteolysis, migration, or radiolucency of the acetabular component. Conclusion. Despite the rapid destruction of the acetabulum and femoral head in RDC patients, cemented or cementless THA achieved a good midterm outcome comparable to that for patients with primary or secondary osteoarthritis.
Bone-Peg Grafting for Osteochondritis Dissecans of the Humeral Capitellum
Authors: Maruyama Masahiro , Harada Mikio , Satake Hiroshi , Uno Tomohiro , Takagi Michiaki , Takahara Masatoshi 
Published: October 2016

Purpose. To review the outcome of bone-peg grafting for osteochondritis dissecans (OCD) grade II lesions of the humeral capitellum. Methods. Records of 10 male adolescent baseball players aged 10 to 15 (mean, 12.3) years who underwent bone-peg grafting for OCD grade II lesions of the humeral capitellum of the dominant arm were reviewed. The mean time from symptom onset to presentation was 11 (range, 1–36) months. The mean duration of conservative treatment was 5 (range, 1–25) months. The mean time from symptom onset to surgery was 17 (range, 3–39) months; it was >6 months in 6 patients. The mean size of the lesions was 13×14 mm. Patients were assessed for elbow pain, range of elbow and forearm motion, Timmerman-Andrews elbow score, return to sports activity level, and radiographic evidence of healing, osteoarthritic changes, and radial head hypertrophy. Results. The mean follow-up period was 25 (range, 10–52) months. Postoperatively, elbow pain was absent in 6, mild in 2, and moderate in 2 patients. The mean range of elbow motion changed from 136° to 139° (p=0.80). The mean Timmerman-Andrews elbow score improved from 163 to 189 (p=0.014); it was excellent in 7, good in 2, and fair in one patient. The mean extent of lesion healing was 71% (range, 33–100%). Five patients achieved complete healing after a mean of 5.2 (range, 5–6) months and returned to sports at a competitive level. The other 5 achieved partial healing of 33 to 56% (mean, 41%) that occurred laterally but not medially. Two of them returned to sports at a competitive level: one changed the throwing side and another had radial head hypertrophy. The remaining 3 underwent arthroscopic debridement of the unhealed lesion at 5, 10, and 15 months. One patient developed secondary osteoarthritis and further underwent costal osteochondral autografting 10 months later. None of the 5 patients with partial healing versus 4 of the 5 patients with complete healing underwent surgery within 6 months of symptom onset. All 3 patients with a dot at the interface versus 2 of the 6 patients with a line at the interface between the fragment and the lesion on MRI had complete healing. Conclusion. Bone-peg grafting is a viable option for OCD grade II lesions of the humeral capitellum when performed within 6 months of symptom onset and when the interface between the fragment and the lesion appears as a dot (rather than a line) on MRI.
The Tarsal Navicular Stress Fracture Revisited
Authors: Torg Joseph S. , Pavlov Helene , Roberts Matthew M. , Eremus Joseph , Drakos Mark C. , Arnoczky Steven P. 
Published: October 2016

Category: Sports. Introduction/Purpose: The purpose of this paper is to both refute and condemn the current practice of open reduction and internal fixation in the treatment of both uncomplicated partial and complete tarsal navicular stress fractures. It will deal with issues that have violated the basic principals of clinical based evidence and resulted in unnecessary surgery, patient injury, and excessive costs. Methods: Ten cases managed by the senor author as well as a meta-analysis 250 cases in 19 published reports in the peer reviewed literature will be reported vis-a- vis surgical vs. conservative management. Management of the dorsal transverse fragment will be discussed, The large cost disparity between operative and non-operative management will be emphasized. The vascular and biomechanical factors will be presented. Results: The 10 cases of TNSF reported & treated by the senior author successfully healed by non-surgical, non-weight management. The meta-analysis of 250 reported cases treated conservatively had 96% successful outcomes. Conversely, those cases treated surgically with screw fixation had a 19% to 26% failure / major complication rates with repeat surgery and some with years of disability, Conclusion: Surgical management of TNSFs has resulted in a 19% to 26% non-union +/or morbidity rate, a marked increase in costs and is contra-indicated in the management of all non-displaced lesions. Non-weight bearing immobilization is indicated for both partial and complete sagittal fractures. Treatment should be based on established evidence based data and not on economic or remuneration factors. Orthopedic surgeons should subscribe to the concept of self regulation in dealing with this situation.
Functional Parameters of Gait Following Total Ankle Arthroplasty
Authors: Kane Justin M. , Brodsky James W. , Daoud Yahya , Coleman Scott C. 
Published: October 2016

Category: Ankle Introduction/Purpose: Numerous studies have attempted to study outcomes after total ankle arthroplasty (TAA). The majority of these studies are clinical in nature. There have been some reports that rheumatoid patients have better outcomes after TAA although there are papers that are contradictory. Objective outcome studies of gait after TAA usually measure outcome against a control group or ankle arthrodesis. No studies have attempted to measure objective outcomes of TAA based upon the preoperative diagnosis. Without objectively studying outcomes for patients with osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis, it is unclear whether a difference exists in outcomes after TAA. This study aims to answer the question: Is preoperative diagnosis predictive of outcome after total ankle arthroplasty? Methods: A retrospective review of 75 patients who underwent isolated TAA with a minimum one-year follow-up, including patient demographics, pre-operative diagnosis, and pre and postoperative gait studies was conducted. Gait function was evaluated for postoperative improvement using multivariate analysis to determine the influence of patient variables on parameters of gait. ANOVA was conducted to compare improvement in gait based on preoperative diagnosis. P-values of < 0.05 were considered statisticallysignificant. Results: Outcomes/p-values are listed in table 1. While not reaching statistical significance, a meaningful clinically important difference was seen across numerous parameters. Temporal Spatial Parameters Patients with RA had the slowest preoperative cadence the fastest postoperative cadence. They also had the greatest improvement in walking speed. Patients with osteoarthritis had the greatest increase in walking speed. KinematicParameters Patients with RA had the greatest improvement in maximum plantarflexion and the least improvement in maximum dorsiflexion. Patients with osteoarthritis had the least improvement in maximum plantarflexion and the most improvement in mean maximum dorsiflexion. Patients with osteoarthritis had the greatest improvement in total ROM. Kinetic Parameters Patients with RA had the greatest improvement in peak ankle power while patients with osteoarthritis had the greatest post-operative power. Conclusion: There is a lack of data supporting the optimal candidate for TAA. While statistical significance was not reached across a number of the parameters of gait analysis, a number approached statistical significance. Given the relatively small sample size, it is possible that a larger cohort would reach statistical significance. Patients with osteoarthritis generally had superior preoperative and postoperative parameters of gait while patients with RA had the greatest improvement in parameters of gait. Patients with post-traumatic arthritis consistently had less improvement than patients with either osteoarthritis or RA.
Is the Canadian Orthopaedic Foot and Ankle Society Ankle Arthritis Score (COFAS AAS) Associated with the Need for Revision Surgery?
Authors: Wing Kevin , Croft Stephen , Daniels Timothy R. , Glazebrook Mark A. , Dryden Peter , Younger Alastair S. , Penner Murray J. , Sutherland Jason M. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: There has been limited evidence to support the effective use of a patient reported outcome measure (PROM) for patients that have undergone surgical treatment for end-stage ankle arthritis (ESAA). This study used longitudinally collected patient-data from a cohort of patients in the Canadian Orthopaedic Foot and Ankle Society (COFAS) ankle arthritis study to evaluate whether the post-operative COFAS Ankle Arthritis Score (COFAS AAS), a patient-reported outcome (PROs), was associated with need for revision surgery. Methods: Between 2001 and 2010, a cohort of 623 patients and 653 ankles undergoing total ankle replacement or ankle arthrodesis were enrolled in a multicenter prospective ankle reconstruction study. At pre-surgical baseline, key patient level variables were collected including demographics, body mass index, and comorbidities. The COFAS AAS, a patient-reported outcome measure was collected at baseline and annually post-surgically. Time to revision surgery was modeled using a proportional hazards model which controlled for age, sex, BMI, diabetic status, smoking status, inflammatory arthritis, and surgery on the right or left side and time varying PROs. Results: 531 ankles in 509 patients with complete pre and post-operative data were included. Seventy of the cohort underwent metal component revision procedures during the follow up time period . The remaining 461 unrevised ankles had a minimum 2 year follow up (average of 3.4 years). Baseline COFAS AAS, age, sex, side, BMI, diabetic status, smoking status, and inflammatory arthritis were not statistically associated with the need for revision surgery. However, revision surgery was found to be associated with a higher post-operative COFAS AAS, and with a longer follow-up. The hazard ratio for the COFAS AAS indicates that for every one-point increase in the score, the rate of revision surgery was one percentage point higher at each post-operative time point. Conclusion: This study demonstrated that patients who reported higher levels of post-operative functional impairment, as indicated by a higher COFAS AAS, were more likely to undergo a revision surgery. This finding is also based on duration of follow-up, with the risk of revision surgery rising with length of follow up. This study provides further evidence for the utility of the COFAS AAS in the clinical setting. Further investigation is warranted to better understand the COFAS AAS’s ability to measure clinically meaningful change in an individual patient not requiring revision surgery.
Predictors of Long-Term Functional Outcome in Operative Ankle Fractures
Authors: Dean Daniel M. , Ho Bryant S. , Lin Albert B. , Fuchs Daniel , Ochenjele George , Kelikian Armen , Kadakia Anish R. 
Published: October 2016

Category: Trauma Introduction/Purpose: Risk factors associated with short-term functional outcomes in patients with operative ankle fractures have been established. However, no previous studies have reported on the association between these risk factors and long-term functional outcomes. Using the Patient Reported Outcomes Measurement System (PROMIS) physical function (PF) and pain interference (PI) measures, we attempt to identify predictors of long-term functional outcome in patients with operative ankle fractures. Methods: We retrospectively reviewed a multicenter cohort of patients aged ≥18 years old who underwent operative management of a closed ankle fracture from 2001-2013 with a minimum of 2 years follow-up. Patients with posterior pilon variants, Maisonneuve fractures, prior ankle surgery, and chronic ankle fractures were excluded from the study. Patients meeting inclusion criteria were contacted and evaluated using the PROMIS PF and PI computerized adaptive tests. PROMIS scores are standardized to a US population with a mean of 50 and a standard deviation of 10. Higher PF scores represent increased physical function, while increased PI scores are indicative of higher pain. Patient risk factors including sex, age, diabetes, smoking, ASA class, BMI, education level, ankle dislocation, energy of injury, and fracture pattern were obtained through a retrospective chart review. Univariate and multivariate regression models were developed to determine independent predictors of physical function and pain at long-term follow up. Results: In total, 199 patients met inclusion criteria. Of those, 142 patients (64 females, 78 males) with a mean age of 52.7 years (SD=14.7) averaging 6.3 years of follow-up (range 2 – 14) participated. Patients had a mean PF score of 51.9 (SD=10.0) and a mean PI score of 47.8 (SD=8.45). Multivariate analysis demonstrated that independent predictors of decreased PF score included higher age (B=0.16, p=0.03), higher ASA class (B =10.3, p < 0.01) and higher BMI (B=0.44, p < 0.01). Predictors of decreased PI score included higher ASA class (B=11.5, p < 0.01) and lower BMI (B=0.41, p < 0.01). Sex, presence of diabetes, smoking status, education level, presence of ankle dislocation, energy of injury mechanism, and fracture pattern did not independently impact long- term pain or functional outcomes. Conclusion: At long-term follow-up of operative ankle fractures, increased ASA class, increased BMI, and higher age at time of surgery are independently predictive of decreased physical function. Factors that are associated with increased pain at long-term follow-up include lower BMI and higher ASA class. ASA class had the strongest effect on both physical function and pain.
Radiographic Evaluation of Medial Arch Correction of the Flexible Flatfoot Using the Cotton Osteotomy
Authors: Aiyer Amiethab , Dall Graham , Shub Jeffrey , Myerson Mark S. 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: The opening wedge cuneiform (Cotton osteotomy) has been used to correct forefoot supination in flexible flatfoot deformity reconstruction. The purpose of this study was to identify the radiographic effects of the Cotton osteotomy on the medial column joints, the 1st tarsometatarsal (TMT) and naviculocuneiform (NC) joints). Methods: We retrospectively analysed 67 patients who underwent a Cotton osteotomy as part of a routine flatfoot reconstructive procedure which included a calcaneus osteotomy, peroneus brevis to longus transfer, flexor digitorum longus transfer and gastrconemius recession. The indications for use of the Cotton osteotomy included fixed forefoot varus after operative hindfoot correction, in the absence of severe medial column instability or midfoot arthritis where an arthrodesis would have been selected. We evaluated 12 radiographic parameters including the articular surface angles of the foot, Meary’s angle and a newly defined Medial Arch Sag Angle (MASA), (Fig 1). A matched cohort of 28 patients of patients who underwent a similar flatfoot reconstruction but did not undergo a Cotton osteotomy were compared to the Cotton osteotomy study group patients to identify the effects of the osteotomy. Results: In all patients who underwent a Cotton osteotomy, there were statistically significant changes in the articular surface angles and medial arch height (p < 0.05). No radiographic secondary sag of the medial column was seen at final follow up. Compared to 28 matched controls, the use of the Cotton osteotomy did not statistically significantly alter the postoperative Meary’s angle but it did significantly improve the MASA by 6.5 degrees (p=0.002) . Sag of the medial arch was improved via plantarflexion through the TMT and NC joints. Arch height was also improved with use of the Cotton osteotomy, but this was not statistically significant. Conclusion: The data indicates that the MASA is a useful radiographic measurement for assessing midfoot collapse, in the setting of pes planovalgus. The current study demonstrated the corrective capacity of the Cotton osteotomy on the MASA, with increased plantar flexion through both the NC and 1st TMT joints, although the effect was more noticeable at the 1st TMT joint. The current study demonstrates that either a TMT or NC arthrodesis may not be routinely warranted for medial column stabilization in the setting of flatfoot reconstruction.
Are Hindfoot Procedures More Painful than Forefoot – A Prospective Cohort Study in Foot and Ankle Reconstructive Surgery?
Authors: Qasim Sultan N. , Gulati Ash , Alcorn Edward G. , Venturini Sara , Gaur Atul , Mangwani Jitendra 
Published: October 2016

Category: Other Introduction/Purpose: Several variables are thought to have an effect on the post-operative pain relief after reconstructive foot and ankle surgery. In the past decade, the role of regional nerve blocks in the management of post-operative pain has become established. The technique(s) of regional blocks varies between centers and the published literature on this subject is inconsistent. More recently, image guided regional nerve blocks for post-op pain relief in F&A surgery have gained popularity. Traditionally, hindfoot reconstructive procedures are deemed to be more painful than the surgery involving the rest of the foot. This prospective study was carried out to examine this question. Methods: 143 patients undergoing elective foot and ankle surgery were prospectively studied. In addition to the demographics, the details of the anaesthetic used were also recorded. 70 patients received peripheral nerve blockade with guidance either by a nerve stimulator or ultrasonography. The procedures were categorised into those belonging to the forefoot, midfoot, hindfoot or combined. The magnitude of pain was recorded immediately post-operatively, at 6 hours and at 24 hours after the surgery, using the visual analog scale (VAS, 0 as ‘no pain’ and 10 as ‘ the worst possible pain’). All adverse effects were recorded. The patients’ satisfaction at two weeks after surgery was also assessed. Kruskal-Wallis test was used to perform non-parametric analysis between the groups. For categorical data, Pearson’s Chi-square test was used. Significant difference was demonstrated by a p-value < 0.05. Results: There was no difference in post-operative, 6 hours or 24 hours VAS in the patients having the hindfoot surgery or those having surgery involving the rest of the foot. Although patients who underwent peripheral nerve block had a satisfactory initial pain relief, they experienced significantly more pain at 24 hours than those who did not have a block (Table 1). There was no significant difference in the hospital stay or patient satisfaction at two weeks. In total, 94% patients were satisfied with their anaesthetic and would not mind having it again. Conclusion: This study provides evidence that contrary to the popular belief, hindfoot surgery is not more painful than the surgery involving the rest of the foot. Our results showed that patients who received peripheral nerve block probably had rebound pain at 24 hours after the surgery. Further studies are needed to explore this relationship. The detailed information provided by this study about the mean (and SD) VAS at various time points after surgery can be used to predict post-operative pain based on various pre-operative surgical and anaesthetic parameters.
Minimally Invasive Lateral Ligaments Reconstruction With Autograft in Patients With Chronic Ankle Instability
Authors: Maccario Camilla , Grassi Miriam , Usuelli Federico G. , Manzi Luigi 
Published: October 2016

Category: Sports Introduction/Purpose: Persistent instability following an acute lateral ankle sprain has been reported to vary in incidence from 15% to 48. Many surgical procedures have been described to reestablish lateral ankle stability, varying from direct in situ repair of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) to augmented reconstructions with either autograft or allograft tissue. Anatomic reconstructions for lateral ankle instability utilizing tissue augmentation have gained recent popularity. The purpose of this retrospective study was to assess the results of a novel surgical percutaneous technique for the treatment of chronic lateral ankle instability using a free semitendinosus tendon transfer to reconstruct anatomically the anterior talofibular and calcaneofibular ligaments. Methods: Between November 2011 and January 2014, 18 patients (18 ankles) underwent an anatomic reconstruction of the lateral ankle ligaments for chronic ankle instability. Patients were clinically assessed preoperatively and at 6 and 12 months postoperatively and annualy there after (range, 12-49 months). Radiographic examination included pre-operative MRI and weight- bearing plain radiographs and post-operative weight-bearing plain radiographs scan obtained 3 months after surgery. Outcomes were assessed by comparison of preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, the Sf-12 score and visual analog pain score. Results: Eighteen patients (18 ankles) (100%) returned for final evaluation. Good or excellent outcome was noted on physical examination, radiographs, visual anlog pain score, SF-12 score and AOFAS score at final follow-up in all patients. Ankle range of motion was not affected by lateral ankle reconstruction. Conclusion: In the present study, lateral ankle reconstruction with a free semitendinosus tendon graft augmentation performed percutaneously resulted in a high percentage of successful results, excellent ankle stability with a minimal loss of ankle or hindfoot motion, and marked reduction of pain at a minimum follow-up of 12 months.