bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved Survival Rates with Fixed Bearing Total Ankle Arthroplasty
Authors: Nadeau Elizabeth K. , Ottofaro Trevor D. , Morningstar Joshua L. , Gross Christopher E. , Scott Daniel 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: With increasing numbers of total ankle arthroplasty (TAA) procedures being performed and a plethora of new survivorship data available, an updated literature review is needed to better understand the impact of different types of implants on outcomes of TAA. The purpose of this study is to compare the outcomes of fixed vs mobile bearing TAAs in the literature. Methods: A comprehensive search of MEDLINE for all articles published between 2004 and 2021 was conducted with a minimum two-year mean follow-up. Two reviewers evaluated each study to determine whether it was eligible for inclusion and abstracted the data of interest. Meta-analytic pooling of group results across studies was performed, examining implant survival and component failure. Seventy-three implant groups met inclusion criteria (only 3rd and 4th generation implants), composed of STAR (20), Salto (mobile bearing) (10), Salto Talaris (11 ), Hintegra (8), Zimmer (6), INBONE II (6), INBONE I (4), Infinity (4), Cadence (4). 41 groups (56.2%) were implanted with mobile bearing devices and 32 (43.8%) with fixed bearing implants. In total, 6498 subjects were included with a mean age of 61.77 years and mean BMI of 28.5 kg/m2. At mean follow-up of 62.2 months, the overall reoperation rate was 21.13% and metal component revision rate was 10.16%. Results: The mean follow-up of mobile bearing TAA studies (N=41) was 77.8 (range 24-188.4) months and fixed bearing studies (N=32) was 45.3 (range 24-85.2) months. Multivariate analysis of bearing type, controlling for follow-up duration, found fixed bearing implants had statistically significantly higher metal component survival rates (fixed=96.1%, mobile=87.9%, p=.001) ; however, there were no statistically significant differences in rates of reoperation (fixed=17.0%, mobile=24.8%, p=.768). When examining specifically tibial and talar component failure rates, there was no statistically significant difference between bearing type (fixed tibial=1.46%, mobile tibial=2.95%, p=.472) (fixed talar=2.19%, mobile talar=2.79%, p=.966). Overall implant survival rate at one, two, five, and ten years was 96.4%, 96.0%, 92.7%, and 79.4%, respectively, and did not differ by bearing type (Table 1). Conclusion: Implant survival was statistically significantly better for 3rd and 4th generation fixed bearing TAAs as compared to mobile bearing TAAs, controlling for length of follow-up. There was no statistically significant difference in total reoperation rate. This suggests that fixed bearing implants may offer improved implant survival compared to mobile bearing implants, though further research is needed to confirm these findings.
Increased Hospital Length of Stay for Obesity Class II and III Patients After Primary Total Ankle Arthroplasty: A NSQIP Analysis
Authors: Peairs Emily M. , Kim Billy I. , Anastasio Albert T. , Adams Samuel 
Published: December 2023

Category: Ankle Arthritis Introduction/Purpose: Obesity is a well-established risk factor for complications after total hip and knee arthroplasty. The incidence of total ankle arthroplasty (TAA) continues to grow, but few studies have evaluated TAA outcomes in patients with obesity. The present study sought to measure the impact of obesity on TAA outcomes using a national database. Methods: The 2012-2020 National Surgical Quality Improvement Program (NSQIP) database was queried for primary TAA (CPT:27002). 1,610 patients were identified and stratified by preoperative body mass index (BMI): non-obese (18 5-29.9kg/m2, n=760), obesity class I (30.0-34.9kg/m2, n=455), and class II and III (>35.0kg/m2, n=395). Preoperative and perioperative patient data, operative time, hospital length of stay (LOS), and 30-day complications were compared using univariable statistics. Multivariable analyses controlling for patient characteristics were employed to measure the effect of obesity on operative time and LOS. Results: Compared to the non-obese group, obesity class II and III patients were younger (61.9 versus 65.6 years;p < 0.001), more female (57.2% versus 42.0%;p < 0.001), higher ASA class (p < 0.001) and had more comorbidities such as hypertension, diabetes, and dyspnea (p < 0.001). Mean preoperative albumin was lower (p=0.013) and white blood count was higher (p < 0.001) in the obesity class II and III group. Home discharge rate was lowest in class II and III patients (88.6%;p=0.017). Multivariable regression revealed longer hospital LOS for obesity class II and III (μ=0.21; p=0.005) relative to the non-obese group. Obesity group was not associated with operative time or 30-day readmissions and reoperations. Conclusion: Obesity class II and III patients undergoing TAA had more comorbidities and longer hospital LOS compared to lower BMI patients. Despite the well-established association between obesity and postoperative complications after hip and knee arthroplasty, the present NSQIP analysis of 1,610 TAA patients did not find a greater burden of acute complications among patients with obesity.
Long-Term Outcomes After Total Ankle Arthroplasty: A Systematic Review
Authors: Lee Michael , Mathson Lucas , Andrews Clark , Jimenez Andrew , Law Brian 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: There is a paucity of aggregate literature reporting on long-term patient-reported outcomes (PROs) and implant failure after total ankle arthroplasty (TAA). The purpose of this study is to report an aggregate of literature on minimum 10-year patient-reported outcomes after total ankle arthroplasty. Methods: A systematic review on minimum 10-year PROs of TAA was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Pubmed, Scopus, and Cochrane Trials were queried on December 28th, 2022, with the following keywords: (ankle) AND (replacement or arthroplasty) AND (long-term or 10-year). Primary research articles were included if they reported minimum 10-year PROs for patients undergoing primary TAA and written in English. Forest plots with heterogeneity were created for PROs reported preoperatively and postoperatively in three or more studies. Long-term was defined as minimum 10-year follow-up. Survivorship was defined by implant failure which was determined uniquely by each study. Results: Six studies met the inclusion criteria with all 6 studies being level IV. A total of 277 ankles with average age range of 54-60.9 years were included in the study with follow up ranging from 10 to 24 years. The primary indication for total ankle replacement was osteoarthritis. Two of the six studies reported significant improvement in PROs following surgery. The remaining 4 studies also demonstrated improvement in PRO however no p values were reported. A forest plot was generated for the AOFAS score and I2 of 67% was calculated. Survivorship at a minimum of 10 year follow up ranged from 66-94.4%. Average time to implant failure ranged from 54.7-166 months. Conclusion: Patients undergoing primary TAA demonstrated improved outcomes at minimum 10-year follow-up. However, they demonstrated variable rates of survivorship ranging from 66-94.4% with average time to implant failure ranging from 54.7 – 166 months.
Long-Term Patient Outcomes for Treatment of Difficult Osteochondral Lesions of the Talus with Particulated Juvenile Allograft Cartilage Implantation with and without Calcaneal Autograft
Authors: Manzi Joseph , Manchanda Kshitij , Nasra Matthew , Sudah Suleiman , Coladonato Carlo , Quan Theodore , Wishman Mark , Moran Jay , Murray Daniel P. , Chapman Cary 
Published: December 2023

Category: Ankle; Other Introduction/ Purpose: Osteochondral lesions of the talus (OCLT) are common injuries that can be difficult to treat. To date, long-term patient reported outcome measures (PROMs) of patients with particulated juvenile allograft cartilage implantation with or without calcaneal autograft have not been compared. Methods: From 2010-2012, thirteen patients with difficult to treat OCLTs underwent arthroscopic-assisted implantation of particulated juvenile allograft cartilage (DeNovo NT®) with or without autogenous calcaneal bone grafting by a single surgeon. Calcaneal bone graft use was determined by lesion size >150 mm2 and/or deeper than 5 mm. Patients were evaluated using physical examination, patient interviews, and PROMs. Pre-operative and post-operative PROMs were compared with a Mann Whitney test. Results: When comparing patients in regards to calcaneal bone graft implantation, no difference in age, BMI, pre-operative PROMs, or follow-up was noted, however, calcaneal bone graft patients did have a significantly larger lesion size (188.5±50.9 vs. 118.7±29.4mm2 respectively; p-value=0.027). VAS and FAAM ADL scores during final follow-up improvement did not significantly differ between cohorts. The FAAM Sports score improved significantly more for the DeNovo alone group compared to the bone graft cohort (p-value=0.032). The AOFAS score improvement did not differ between cohorts (p-value=0.944), however, the SF-36 PCS improved significantly more for the DeNovo alone group compared to the bone graft cohort (p-value=0.038). No intraoperative/perioperative complications were observed with calcaneal bone grafting. Conclusion: While patients followed over the course of ~8 years after implantation of particulated juvenile allograft cartilage (DeNovo NT®) with/without autogenous calcaneal bone graft had positive post-operative PROMs, patients without calcaneal bone graft had significantly greater improvement in functional outcome scores. Whether these differences are due to graft incorporation or larger lesion size is unclear.
Predicting the Potential Complications of Lateral Column Lengthening: A Cadaveric Biomechanical Study
Authors: Zhu Mingjie , Maher Moustafa A. , Baldini Todd , Keeter Carson , Hunt Kenneth , Myerson Mark , Li Shuyuan 
Published: December 2023

Category: Hindfoot; Other Introduction/ Purpose: Lateral column lengthening calcaneus osteotomy is a common procedure used to treat flatfoot deformity. However, the incidence of subtalar joint impingement and sinus tarsi pain presents a concern related to this treatment. The hypothesis of this study was with opening of the osteotomy, the anterior fragment of the calcaneus anterior process moves anteriorly, while the posterior fragment simultaneously moves posteriorly which can compromise the outcome as well as cause subtalar joint impingement. The goal of this study was to observe movements of the anterior and posterior fragments with an osteotomy of different sizes. Methods: Eight fresh frozen cadaveric feet were used. A vertical calcaneus osteotomy was designed 1.5cm posterior to the calcaneocuboid joint. Optical markers were attached on each side of the osteotomy to measure movements of the anterior and posterior segments during the lengthening procedure. Three more markers were placed for reference purposes with one on the lateral process of the talus, one on the table, and one on the base of the 3rd metatarsal (Figure 1). Following the osteotomy 4mm, 6mm, 8mm, 10mm and 12mm of lengthening was obtained for each specimen using a lamina spreader. The exact lengthening achieved was measured with a micro-caliper. Movements of the anterior and posterior fragments were recorded using a Sentech model STC-MBCM401U3V camera and calculated with MaxTRAQ motion analysis software. Mixed linear regression analyses were performed using R Studio. Results: With the open osteotomy, the anterior fragment moved anteriorly, while the posterior fragment moved posteriorly (Table 1, 2). The anterior movement was larger than the posterior one. There was no difference in the amount of anterior movements during each attempted 2mm lengthening, however, the amount of the posterior movement peaked at 6mm-8 mm and went down at 8mm-10mm and 10mm-12mm, which was caused by subtalar joint impingement and limited the posterior excursion. Starting at 6mm lengthening there was a linear regression relationship between the anterior & posterior movement and the lengthening (anterior movement = -4.80 + 1.06 × Lengthening of the Lateral Column, posterior Movement = -1.26 + 0.22 × Lengthening of the Lateral Column) (Figure 2,3). 1mm lengthening induced 1.06mm anterior (p < 0.05), and 0.22mm posterior shift (p < 0.05). Conclusion: Lateral lengthening causes the calcaneus to move both anteriorly and posteriorly which not only compromises the power of the procedure, but also can cause subtalar impingement. The findings of this study provide our colleagues with more insight into the correlation between the size of the lengthening, results, and potential complications.
Recurrent Toe Walking in Pediatric Orthopedic Patients: Idiopathic vs Concomitant Sensory Processing Disorders
Authors: Zide Jacob R. , Riccio Anthony I. , Zak Taylor , Minopoli Anthony , Polk Jordan L. , Shivers Claire 
Published: December 2023

Category: Other Introduction/Purpose: The purpose of this study is to compare rates of recurrent toe-walking following operative intervention between idiopathic toe walkers and toe walkers with associated sensory processing/autism spectrum disorders. Methods: An IRB-approved retrospective review of patients at a single pediatric institution who underwent surgical treatment for toe-walking over a 12-year period was conducted. Children with peripheral or central neurologic disorders, muscle disorders, congenital foot/extremity deformities, prior ankle/foot surgery, and those not managed with an isolated triceps surae procedure were excluded. The remaining patients were divided into those with idiopathic toe-walking (ITW Group) and those with toe- walking associated with sensory processing/autism spectrum disorders (SPD Group). Recurrence of toe walking and need for additional surgery for recurrence were compared between cohorts. Recurrence rates and subsequent operations were assessed for each group. Multivariate regression and Fischer exact test were used to evaluate differences in group characteristics. Results: 106 patients met inclusion criteria. 29 patients (27%) had an associated sensory processing disorder, the remaining 77 patients comprised the ITW group. There were no differences between groups in length of follow-up (p=0.08) or type of initial surgery performed (p=0.48). The SPD group contained a significantly greater percentage of males (75% vs 56%, p=0.01) and were younger at the age of index surgery (8.5 vs 10 years, p=0.03). At an average follow-up time of 1.2 years, 11 patients (10%) developed clinical recurrence, of whom, 4 underwent a subsequent intervention. The SPD group had significantly higher rates of recurrence than idiopathic toe walkers (24% vs 5%, p=0.009). Multivariate regression analysis demonstrated that an underlying sensory processing disorder was an independent predictor of recurrence (p=0.018, OR=7.5). Conclusion: Clinical recurrence following the surgical treatment of toe-walking is over seven times greater in children with autism spectrum and/or other sensory processing disorders than idiopathic counterparts.
Return to Alpine Sport and Physical Activity After First Metatarsophalangeal Joint Arthrodesis
Authors: Buckley Sara E. , Garcia Stefan , Jamieson Marissa , Hewitt Michael A. , Hanson Romney B. , Hunt Kenneth 
Published: December 2023

Category: Midfoot/Forefoot; Sports Introduction/Purpose: First metatarsophalangeal (MTP) arthrodesis is an effective procedure to alleviate pain and correct deformity. The unique location of our academic center allows us to study an extremely active patient population with high rates of participation in impact sports and particularly alpine specific sports, including Nordic and alpine skiing, snowboarding, hiking, trail running and biking. There is limited literature regarding these specific activities with regards to a 1st MTP arthrodesis. The goal of the study is to better define the ability to return to physical activity, with a focus on alpine and mountain sports. This will help physicians counsel patients appropriately when discussing surgical options. Methods: Patients over 18 years old who underwent MTP arthrodesis with minimum 1 year follow up were identified using CPT code 27850. Patients undergoing concomitant forefoot and hindfoot procedures were excluded. Demographic data and complications were recorded by retrospective chart review. A custom sports questionnaire, PROMIS Physical Function (PF), PROMIS Pain Interference (PI), and Foot and Ankle Ability Measure (FAAM) scores were administered to patients. Postoperative radiographs were analyzed for time to union and fusion position. Results: 96 patients were eligible for analysis. Preliminarily, 34 have completed the follow-up survey. Most common activities were walking, hiking, alpine skiing, biking and running. Compared to preoperatively, patients rated 70.5% of activities as less difficult, 20.5% as the same, and 9.0% as more difficult. 74% of patients returned to their activities by 6 months and 62% of patients reached their maximum level of activity by 9 months postoperatively. Patients who participated in skiing/snowboarding were all able to ski the same level of terrain compared to before surgery, but nearly half (46%) of patients required boot modifications. 43% of patients were able to increase incline when hiking/trail running, and 48% of patients were able to increase their running/walking mileage. Average PROMIS PF was 51.9 (±6.20). Conclusion: Patients are able to participate in a variety of high impact and alpine related sports after 1st MTP arthrodesis. The majority of patients are able to function at similar or increased levels when returning to hiking, walking, skiing and snowboarding. Up to 25% of patients may not reach maximum level of activity until 1 year postoperatively. Additional investigation is required to identify potential risk factors for patients that may experience difficulty returning to activity. Continued survey participation is underway to strengthen these results. Patient counseling on activity participation following hallux MTP arthrodesis is important to optimize outcomes and patient satisfaction.
Rising Patient Out-of-Pocket Costs for Common Outpatient Orthopaedic Foot and Ankle Surgeries
Authors: Goldfarb Sarah I. , Xu Amy L. , Gupta Arjun , Mun Frederick , Durand Wesley M. , Gonzalez Tyler , Aiyer Amiethab A. 
Published: December 2023

Category: Other Introduction/Purpose: The purpose of this study is to characterize out-of-pocket (OOP) cost trends in both elective and trauma foot and ankle surgeries for commercially insured patients. Secondarily, we sought to compare the OOP costs of these surgeries between hospital-based outpatient departments (HOPDs) and ambulatory surgical centers (ASCs), as well as insurance plan types. Methods: Adult patients who underwent elective or trauma foot and/or ankle surgeries between 2010 and 2020 were identified using the MarketScan Database. Demographic, procedural, and financial data were recorded. The primary outcome was OOP costs, which were defined as the sum of the deductible, coinsurance, and copayment for each episode of care. Monetary data were adjusted to 2020 dollars. General linear regression, Kruskal-Wallis test, and Wilcoxon-Mann-Whitney test were used for analysis, as appropriate. Alpha was set at 0.05. Results: A total of 966,095 patients (806,707 elective and 159,388 trauma) underwent common outpatient foot and ankle surgeries between 2010 and 2020. Trauma surgeries generated significantly higher mean OOP costs than elective procedures ($1438.79 versus 1058.53, P< 0.001). OOP costs were significantly lower for procedures performed in ASCs compared to HOPDs ($1071.09 vs $1126.96, P< 0.001). This trend was driven by significantly higher coinsurance for HOPDs ($727.98) versus ASCs ($622.95) (P < 0.001). Of the insurance plans studied, high deductible health plans had the highest average OOP costs. Average OOP costs for common outpatient foot and ankle surgeries increased by 55.2% from $875.11 in 2010 to $1357.86 in 2020. Conclusion: OOP costs for foot and ankle surgeries have increased significantly since 2010. Average OOP costs from surgeries performed in ASCs were less than in HOPDs. Patients enrolled in HDHPs tended to incur the greatest average OOP costs. As direct costs for patients increase over time, it is critical to be aware of this financial burden and work towards improving access to necessary care.
The Effect of Body Mass Index on Short-Term Complications and Patient-Reported Outcomes in Patients with Surgically-Repaired Achilles Tendon
Authors: Kim C. James , Tsai Justin , Pedowitz David I. , O’Neil Joseph T. , Fuchs Daniel , Shakked Rachel , Winters Brian S. , Daniel Joe 
Published: December 2023

Category: Ankle; Other Introduction/Purpose: Obesity has shown to be associated with postoperative wound complications, infection, VTE, and wound dehiscence in patients undergoing surgical repair of the Achilles tendon1–3. Obesity is often defined as body mass index (BMI) greater than 30kg/m2. The Center for Disease Control defines adult BMI ranges as follows: underweight ( < 18.5kg/m2), healthy (18.5 to 25 kg/m2), overweight (25 to 30kg/m2), Class I obesity (30 to 35 kg/m2), Class II obesity (35 to 40 kg/m2), Class III obesity (40 kg/m2 and above)4. The purpose of this study is to compare the postoperative complications and FAAM-VAS scores between patients with surgically-repaired Achilles tendon according to their BMI ranges. Methods: Patients with mid-substance Achilles tendon rupture surgically repaired between 2016 and 2021 were identified. Chart notes were reviewed up to the 2-year postoperative period for wound complications and infection. Age, sex, Type II diabetes, rheumatoid arthritis, smoking status, and body mass index at the time of surgery were collected. Foot and Ankle Ability Measure and Visual Analog Pain Scales (FAAM-VAS) were collected preoperatively and at 6 months, 1 year, and 2 years postoperative time points. A total of 116 patients were identified and stratified into four groups based on their body mass index4: 18.5kg/m2 - 25kg/m2 (Group 1; n=24), 25kg/m2 - 30kg/m2 (Group 2; n=50), 30kg/m2 - 35kg/m2 (Group 3; n=20), and >35kg/m2 (Group 4;n=22). Analysis of Variance Testing or Kruskal-Wallis Testing was used to calculate p-values for continuous data and Chi-Square testing was used to calculate p-values for categorical data. Pairwise testing was also conducted when appropriate. Results: The difference in rates of infection resulting in wound dehiscence or abscess drainage was not statistically significant across groups (p=0.362). No patient experienced re-rupture of the ipsilateral Achilles tendon. Group 4 patients reported the highest preoperative FAAM Overall, FAAM-ADL, and VAS scores. Their postoperative FAAM-Overall and FAAM-ADL scores were the lowest at all postoperative time points. Compared to patients in Group 2, patients in Group 4 demonstrated significantly less improvement in FAAM Overall score at 6 months (p= 0.029), 1-year (p=0.006), and 2-years (p=0.039) from surgery. The improvement in FAAM-ADL and VAS pain scores were not significantly different across BMI groups. However, the magnitude of improvement in FAAM-ADL was the lowest for patients in Group 4 at all postoperative time points. Conclusion: BMI was not significantly correlated with postoperative wound complication, infection, or re-rupture rates, but patients with BMI >35kg/m2 reported significantly less improvement in FAAM Overall scores at the 6-month, 1-year, and 2-year postoperative periods compared to those with BMI between 25 and 30kg/m2.