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Eidmann A, Kraftborn K, Walcher MG, Fraißler L, Rudert M, Stratos I. [Arthroscopically assisted arthrodesis of the upper ankle joint]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2025:10.1007/s00064-025-00899-5. [PMID: 40186024 DOI: 10.1007/s00064-025-00899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 11/11/2024] [Indexed: 04/07/2025]
Abstract
OBJECTIVE To obtain a pain-free, fully weight-bearing ankle joint in a functional position through minimally invasive arthrodesis. INDICATIONS Symptomatic osteoarthritis of the upper ankle joint, which is no longer treatable conservatively or by joint-preserving surgical procedures. CONTRAINDICATIONS Revision arthrodesis, infections in the surgical area, circulatory disorders; extensive malalignment, large bony defects (relative contraindications). SURGICAL TECHNIQUE Anteromedial and anterolateral standard portal to the upper ankle joint. Soft tissue debridement and, if necessary, removal of large ventral osteophytes and free joint bodies. Removal of the remaining tibiotalar articular cartilage using curettes, sharp spoons, chisels, or reamers. Opening of the subchondral bone with bone awls or chisels to expose the former joint surfaces. Anatomical adjustment of the joint, transfixation with 2 to 3 Kirschner wires for percutaneous stabilization with cannulated double-threaded screws or cancellous bone screws with short threads under X‑ray control. POSTOPERATIVE MANAGEMENT Postoperative immobilization in an orthosis or plaster cast with unloading for 6 weeks; after X‑ray control, gradual increase in weight-bearing over a further 2-6 weeks. RESULTS In all, 30 arthroscopically assisted arthrodeses of the ankle joint performed between 2014 and 2017 were retrospectively evaluated. Of these, 22 patients were very satisfied, 5 patients were satisfied, and only 2 patients were not satisfied with the surgical outcome. The evaluation using postoperative scores (American Orthopaedic Foot and Ankle Society Score [AOFAS], Foot and Ankle Outcome Score [FAOS], Visual Analogue Scale Foot and Ankle [VAS-FA]) also yielded good results on average. The complication rates were comparable to those in the literature, with 2 pseudarthroses, 3 superficial wound healing disorders, and 2 irritations caused by the osteosynthesis material.
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Affiliation(s)
- Annette Eidmann
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland.
| | - Katharina Kraftborn
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland
| | | | - Lukas Fraißler
- Privatordination für Fuß- und Sprunggelenkchirurgie, Privatklinikum Hansa, Graz, Österreich
| | - Maximilian Rudert
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland
| | - Ioannis Stratos
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland
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Ko S, Oh J, Park K, Oh S, Jeon YD. Excellent clinical and radiological outcomes after arthroscopic reduction and double row-suture bridge for large-sized greater tuberosity fractures of the humerus. Knee Surg Sports Traumatol Arthrosc 2025; 33:1500-1506. [PMID: 39403795 PMCID: PMC11948161 DOI: 10.1002/ksa.12506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 08/02/2024] [Accepted: 08/05/2024] [Indexed: 03/28/2025]
Abstract
PURPOSE Currently, there is limited information on the clinical outcomes of arthroscopic reduction and double-row suture bridge fixation for large greater tuberosity fractures of the proximal humerus. This study aimed to evaluate the radiological and clinical outcomes of arthroscopic reduction and double-row suture bridge fixation for these fractures, hypothesizing that arthroscopic reduction and double-row suture bridge fixation is a safe, effective and minimally invasive treatment for large greater tuberosity fractures. METHODS This retrospective study analysed patients with large greater tuberosity fractures (fracture fragment ≥30 mm in diameter) who underwent arthroscopic reduction and double-row suture bridge fixation and had a follow-up period exceeding 2 years. The anatomic reduction was confirmed by assessing the step-off on radiographs immediately after surgery, and the radiologic union time was recorded. At the final follow-up, range of motion and functional outcome scores were evaluated. Additionally, any surgery-related complications were evaluated. RESULTS Fifteen patients with a mean follow-up of 57.7 ± 23.1 months were included in the study. The mean fracture fragment size was 32.5 ± 2.4 mm, with a mean displacement of 5.1 ± 1.6 mm. Immediately postsurgery, 13 of 15 patients (86.7%) had a fracture step-off of <3 mm, with an average union time of 3 months. At the final follow-up, patients demonstrated excellent outcomes, with an average forward flexion of 167 ± 9.7° and external rotation of 70 ± 16.3. Functional outcome scores showed significant improvement compared with preoperative scores (p < 0.001). No major surgery-related complications were reported. CONCLUSIONS Arthroscopic reduction and double-row suture bridge fixation for large-sized greater tuberosity fractures is safe and shows good fracture reduction and excellent clinical outcomes. Therefore, this surgical method can be considered an alternative to open reduction for large greater tuberosity fractures. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sang‐Hun Ko
- Department of Orthopaedic Surgery, University of Ulsan College of MedicineUlsan University HospitalUlsanRepublic of Korea
| | - Jaemin Oh
- Department of Orthopaedic Surgery, University of Ulsan College of MedicineUlsan University HospitalUlsanRepublic of Korea
| | - Ki‐Bong Park
- Department of Orthopaedic Surgery, University of Ulsan College of MedicineUlsan University HospitalUlsanRepublic of Korea
| | - Sangheon Oh
- Department of Orthopaedic Surgery, University of Ulsan College of MedicineUlsan University HospitalUlsanRepublic of Korea
| | - Young Dae Jeon
- Department of Orthopaedic Surgery, University of Ulsan College of MedicineUlsan University HospitalUlsanRepublic of Korea
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Nakasa T, Ikuta Y, Kawabata S, Sakurai S, Moriwaki D, Adachi N. Effect of a compression staple on correction of varus deformity during arthroscopic ankle arthrodesis. J Orthop Sci 2025; 30:113-118. [PMID: 38519380 DOI: 10.1016/j.jos.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/23/2023] [Accepted: 03/11/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Arthroscopic ankle arthrodesis (AAA) has become popular because of its higher rate of bone union, lower invasiveness, and shorter hospital stays compared to those of open arthrodesis. However, postoperative malalignment is often observed for severe varus deformity, which can cause nonunion, pain, and adjacent joint arthrosis. A compression staple can provide a persistent, strong compressive force on the bone surface. This study aimed to clarify the difference in alignment correction in AAA by comparing a compression staple and screws fixation with screws-only fixation pre- and postoperatively. METHODS Seventy ankles in 67 patients undergoing AAA were retrospectively reviewed. AAA with three screws through the distal tibia was performed in 53 ankles, and 17 ankles underwent AAA with a compression staple and two screws. After the preparation of the joint surface arthroscopically, patients in the S group had three canulated cancellous screws inserted through the medial tibia. Patients in the CS group had a compression staple placed at the lateral aspect of the tibiotalar joint and two screws inserted through the medial side. Clinical scores and pre-and postoperative alignment on plain radiographs were compared between the two procedures. RESULTS There were no significant differences in the pre-and postoperative Japanese Society for Surgery of the Foot scale. One ankle in the S group exhibited nonunion. There were no significant differences in talar tilt and tibiotalar angles between the groups. The tibial plafond angle in the CS group was significantly lower than that in the S group (p < 0.05). Postoperatively, talar tilt and tibiotalar angles on the coronal image, and the lateral tibiotalar angle in the CS group were significantly lower than those in the S group (p < 0.05). CONCLUSION AAA with a compression staple and two-screw fixations could obtain more optimal alignments than AAA with screw-only fixation, even in cases with severe varus deformity.
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoru Sakurai
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Dan Moriwaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Ertan MB, Özbek EA, Yoğun Y, Kocaoğlu H, Güngör E, Akmeşe R. Tibiotalocalcaneal ankle arthrodesis with posterior approach arthroscopic-assisted hindfoot nailing. J Orthop Surg (Hong Kong) 2024; 32:10225536241264623. [PMID: 38881517 DOI: 10.1177/10225536241264623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
PURPOSE End-stage ankle arthrosis causes severe pain and limited movement. Tibiotalocalcaneal arthrodesis with arthroscopy-assisted hindfoot nailing can be used to achieve a high union rate and low complication rate. We aimed to examine the early- and mid-term results of patients treated with this technique from various perspectives and to evaluate them by comparing them with the current literature. METHODS Data were collected from 25 patients who met the established criteria and underwent TTCA with arthroscopic-assisted hindfoot nailing. In addition to the demographic data of the patients, their clinical and pain scores were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS). Additionally, the union time and complication data during the follow-up period were examined. RESULTS When the AOFAS and VAS scores of the 25 patients were examined, a significant improvement was observed in the preoperative period and early postoperative period comparisons (p < .001). No significant change was observed between the comparison of the postoperative 12th month and last postoperative control clinical scores. While the union rate of the patients was observed to be 92%, the average union time was 13.1 ± 3.5 weeks. During follow-up, peri-implant fracture, deep infection, and non-union were observed in one patient each (12%). CONCLUSION The early- and mid-term postoperative results of patients treated with TTCA surgery with posterior approach arthroscopic-assisted hindfoot nailing show that this technique may be an option with low complication and high union rates for the appropriate group of patients planned for ankle arthrodesis.
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Affiliation(s)
- Mehmet Batu Ertan
- Department of Orthopedics and Traumatology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Emre Anıl Özbek
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
| | - Yener Yoğun
- Department of Orthopedics and Traumatology, Hand Surgery Unit, Van Training and Research Hospital, Van, Turkey
| | - Hakan Kocaoğlu
- Department of Orthopedics and Traumatology, Ankara University, Ankara, Turkey
| | - Erdal Güngör
- Department of Orthopedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey
| | - Ramazan Akmeşe
- Department of Orthopedics and Traumatology, Halic University, Istanbul, Turkey
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Mizera MM, Wilson S, Seref-Ferlengez Z, Levy IM. Validation of Two Novel and Complementary Training Platforms for Small Joint Arthroscopy. J Hand Surg Am 2024; 49:61.e1-61.e9. [PMID: 35843761 DOI: 10.1016/j.jhsa.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/29/2022] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE We developed 2 complementary low-fidelity models to be used to create the tool skills needed to perform small joint arthroscopy. The purpose of the study was to establish the face and construct validity of the 2 models. METHODS The "foundation model" was constructed from lemon and radish sections, and the "advanced model" was constructed from a chicken knee. Using both models, novice, intermediate, and experienced participants were asked to perform specific tasks and were timed and scored on their performance. The experienced surgeons were given a 16-item survey to rate how closely each model emulated reality to determine face validity. RESULTS For the foundation model, the mean total time for the completion of tasks was 1,138 seconds for novices, 1,059 seconds for intermediates, and 631 seconds for experienced, with significant differences between the groups for time to complete 2 of the tasks. With a maximum possible score of 50 points for the correct performance of all tasks, the mean total performance score was 23 for novices, 31.8 for intermediates, and 42.2 for experienced operators. For the advanced model, the mean total time for completion was 266 seconds for novices, 147 seconds for intermediates, and 72 seconds for experienced participants. With a maximum possible score of 31 points for the correct performance of all tasks, the mean total performance score was 1.9 for novices, 15.0 for intermediates, and 24.3 for experienced participants. The average scores for the face validity surveys using a 5-point Likert scale were 4.2 and 4.5 of 5 possible points for the foundation and advanced models, respectively. CONCLUSIONS Experienced operators completed the tasks more quickly and had higher performance scores than the operators in other groups. This correlation between experience and performance suggests that both models have construct validity. The face validity scores were on the upper end of the scale, suggesting that both models emulate reality for experienced operators. CLINICAL RELEVANCE These novel models provide low-cost, available and valid simulations conducive to high-repetition training.
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Affiliation(s)
- Megan M Mizera
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY
| | - Sean Wilson
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY.
| | | | - I Martin Levy
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY
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Abstract
Despite the increasing popularity of total ankle replacement, ankle arthrodesis remains the gold standard for the treatment of end-stage ankle arthritis. Historically, open techniques have been utilized for ankle arthrodesis. There have been many variations and techniques described, including transfibular, anterior, medial, and miniarthrotomy. Inherent disadvantages to these open techniques include postoperative pain, delayed or nonunion, wound complications, shortening, prolonged healing times, and prolonged hospital stays. Arthroscopic ankle arthrodesis provides the foot and ankle surgeon with an alternative to the traditional open techniques. Arthroscopic ankle arthrodesis has demonstrated faster union rates, decreased complications, reduced postoperative pain, and shorter hospital stays.
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Affiliation(s)
- Michael S Lee
- Capital Orthopaedics & Sports Medicine, 12499 University Avenue, Suite 210, Clive, IA 50325, USA.
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Marciano GF, Ferlauto HR, Confino J, Kelly M, Surace MF, Vulcano E. Clinical Outcomes Following Percutaneous Ankle Fusion With Bone Graft Substitute. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231178781. [PMID: 37332629 PMCID: PMC10272655 DOI: 10.1177/24730114231178781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Background Percutaneous ankle fusion is an emerging technique with minimal published outcome data. The goal of the present study is to retrospectively review clinical and radiographic outcomes following percutaneous ankle fusion and provide technique tips to perform percutaneous ankle fusion. Methods Patients >18 years of age, treated by a single surgeon, from February 2018 to June 2021, who underwent primary isolated percutaneous ankle fusion supplemented with platelet-derived growth factor B (rhPDGF-BB) and beta-tricalcium phosphate, with at least 1-year follow-up were included. Surgical technique consisted of percutaneous ankle preparation followed by fixation with 3 headless compression screws. Pre- and postoperative visual analog scale (VAS) and Foot Function Index (FFI) were compared using paired t tests. Fusion was assessed radiographically by the surgeon on postoperative radiographs and computed tomography (CT) at 3 months postoperatively. Results Twenty-seven consecutive adult patients were included in the study. Mean follow-up was 21 months. Mean age was 59.8 years. Mean preoperative and postoperative VAS scores were 7.4 and 0.2, respectively (P < .01). Mean preoperative FFI pain domain, disability domain, activity restriction domain, and total score were 20.9, 16.7, 18.5, and 56.4, respectively. Mean postoperative FFI pain domain, disability domain, activity restriction domain, and total score were 4.3, 4.7, 6.7, and 15.8, respectively (P < .01). Fusion was achieved in 26 of 27 patients (96.3%) at 3 months. Four patients (14.8%) had complications. Conclusion We found in this cohort with surgery performed by a surgeon highly experienced in minimally invasive surgery that percutaneous ankle fusion augmented with a bone graft supplement achieved a high rate of fusion (96.3%) and a significant improvement in pain and function postoperatively while associated with minimal complications. Level of Evidence Level IV, case series.
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Affiliation(s)
- Gerard F. Marciano
- Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Harrison R. Ferlauto
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jamie Confino
- Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Meghan Kelly
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ettore Vulcano
- Department of Orthopedics, Mount Sinai Medical Center, Miami, FL, USA
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Patient reported outcome measures in ankle replacement versus ankle arthrodesis - A systematic review. Foot (Edinb) 2022; 51:101874. [PMID: 35461152 DOI: 10.1016/j.foot.2021.101874] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Compare the functional outcomes of comparative studies of ankle arthrodesis (AA) and total ankle replacements (TAR). DESIGN Systematic review using PRISMA guidelines. DATA SOURCES Medline, Cochrane and EMBASE databases in July 2020. ELIGIBILITY CRITERIA Studies that directly compared TAR and AA which reported patient reported outcomes measures (PROMs) of pain, function and quality of life. DATA EXTRACTION AND SYNTHESIS Two authors independently reviewed all papers. PROMs were allocated into pain, function or quality of life domains. Two summary statistics were created to allow for analysis of the PROMs. These statistics were the mean difference in post-operative score and the mean difference in the change of score. RESULTS 1323 papers were assessed of which 20 papers were included. 898 ankle arthrodesis and 1638 ankle replacements were evaluated. The mean follow up was 3.3 years (range 0.5-13.0 years). AA patients had a mean age of 55.7 (range 20-82) and TAR 62.5 (range 21-89). There was major heterogeneity in outcomes used. We were unable to find a significant difference between the reported change in PROMs following TAR and AA. 29.3% of PROMs and their subscores showed TAR had better outcomes, 68.7% showed no significant difference and only 2.0% showed AA to have better outcomes. CONCLUSIONS The majority of published studies found equality in patient reported outcomes following TAR and AA although the quality of the studies was of low-level evidence. There is an urgent need for randomised controlled studies to definitively answer this important clinical question.
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van den Heuvel SBM, Penning D, Schepers T. Open Ankle Arthrodesis: A Retrospective Analysis Comparing Different Fixation Methods. J Foot Ankle Surg 2022; 61:233-238. [PMID: 34362652 DOI: 10.1053/j.jfas.2021.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
A wide variation of surgical options, complications, and union rates are reported in the treatment of end-stage ankle arthritis. However, open ankle arthrodesis remains the golden standard for ankle arthritis. The purpose of this study was to evaluate the union rate and complication rate as well as identify potential risk factors for different methods of fixation in patients with end-stage ankle arthritis of different etiology. In total, 42 ankles of 41 patients with ankle osteoarthritis were included for this single-center retrospective study. The mean age was 50 years (range 22-75 years). Twenty patients were treated with screw-fixation, 14 with plate(s) and 8 with intramedullary nail. The results of this study showed an overall union rate of 97.6% (41 of the 42 operated ankles) and an overall complication rate of 21.4% (9 events). The mean follow-up time was 16 months (range 2.5-83.0 months). Complications consisted of 1 nonunion, 4 deep infections, 2 cases of wound dehiscence, 1 delayed union and 1 malalignment of the ankle joint. The plate-fixation group demonstrated significantly higher infections when compared with screw and intramedullary nail fixation (p = .017). There were no other significant variables for incidence of complications between patients in the uncomplicated and complicated group. This study achieved good clinical results for different methods of fixation in open ankle arthrodesis. In specific, the use of intramedullary nail provides excellent results for end-stage ankle arthritis with high union rate and a low complication rate.
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Affiliation(s)
- Stein B M van den Heuvel
- Medical Doctor, Trauma Unit, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Diederick Penning
- Medical Doctor, Trauma Unit, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tim Schepers
- Trauma Surgeon, Trauma Unit, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Guo H, Zeng C. Technique Tip: Correcting Malalignment of the Talus Using a Pin-Based Distracter During Arthroscopic Ankle Arthrodesis. J Foot Ankle Surg 2022; 61:434-437. [PMID: 34896009 DOI: 10.1053/j.jfas.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
It is technical demanding work to perform arthroscopic ankle arthrodesis to treat end-stage ankle osteoarthritis with excessive talar tilt. This article aimed to provide an effective technique tip for the treatment of Takakura stage 3b ankle osteoarthritis with a talar tilt angle more than 15 degrees under arthroscopy. A conventional anterior arthroscopic approach is used. After arthroscopic examination and debridement, one pin which is parallel to the distal tibial surface is inserted into the tibial side of the ankle, the other pin which is parallel to the talar dome surface is inserted into the talar side of the ankle, both at the coronal plane. Then a distracter is used in the medial side to open the interspace of the tibiotalar joint and correct the talar tilt through the 2 pins, under which circumstance the tibiotalar joint surface can be well prepared. Next an anti-distracter is used in the lateral side to close the tibiotalar interspace and correct the talar tilt through the 2 pins, in which condition 3 fully threaded cannulated lag screws can be inserted through guide pins in a cross pattern to fix the ankle joint. We used the pin-based distracter to open and close tibiotalar interspace, correct the talar tilt and maintain a good mechanical axis for fusion, and the outcomes were good.
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Affiliation(s)
- Hao Guo
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, P.R. China
| | - Canjun Zeng
- Department of Foot and Ankle Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, P.R. China.
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Abstract
Open ankle arthrodesis remains a reliable solution for ankle arthritis, especially in the setting of deformity. Careful preoperative evaluation needs to be performed, both clinically and radiographically. The specific deformity present helps determine the approach used and the fixation choices. Deformity is most commonly seen intraarticularly, though deformity can also be present anywhere along the lower extremity, including compensatory deformity in the foot. Multiple different techniques can be used to address both the deformity and achieve a successful ankle arthrodesis. Patient outcomes reported in the literature are generally good, with high union rates and improved functional outcomes.
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12
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Morelli F, Princi G, Cantagalli MR, Rossini M, Caperna L, Mazza D, Ferretti A. Arthroscopic vs open ankle arthrodesis: A prospective case series with seven years follow-up. World J Orthop 2021; 12:1016-1025. [PMID: 35036344 PMCID: PMC8696599 DOI: 10.5312/wjo.v12.i12.1016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/27/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The osteoarthritis of the ankle, although less common than other joints, is associated with severe functional limitation. Surgical options are ankle arthroscopic debridement, osteotomies, ankle arthrodesis and ankle arthroplasty. Ankle arthroplasty is increasingly used thanks to the new implants design, but ankle arthrodesis still represents the most used technique and it can be performed arthroscopically or with an open procedure.
AIM To compare mid-term results of arthroscopic vs open ankle arthrodesis of patients affected by end-stage ankle arthritis.
METHODS This study enrolled 23 patients, which underwent ankle arthrodesis. The patients were divided into 2 groups: group A (open procedure; n = 11) and group B (arthroscopic procedure, n = 12), the two groups were homogeneous with regard to age and body mass index (P = 0.347). The American Orthopaedic Foot and Ankle score (AOFAS), Freiburg Ankle score (FAS) and visual analogue scale for pain intensity were evaluated preoperatively, at six months and at final follow-up of 7.6 years in group A and 7.3 years in group B (P = 0.364).
RESULTS Patients in the arthroscopic group showed better results at six-month follow-up compared to the open group at the AOFAS (group A, 62.2; group B, 78.5; P < 0.05) and the FAS (group A, 61.1; group B, 70.3; P = 0.015) scores. Pain relief was achieved in both groups at six-month follow-up (group A, 1.4; group B, 0.9; P = 0.162). Both open and arthroscopic groups showed improved clinical outcomes from baseline to final follow-up (P > 0.05). Hospital stay was shorter in group B than in group A (P = 0.001). More complications were reported in the open group than in the arthroscopic group (P = 0.459).
CONCLUSION The arthroscopic and the open arthrodesis are valid and safe options for the treatment of ankle arthritis on the basis of clinical outcomes at 7 years follow-up. Moreover, the arthroscopic treatment shows faster improvement at six-month follow-up in comparison with the open group.
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Affiliation(s)
- Federico Morelli
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | - Giorgio Princi
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | | | - Marco Rossini
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | - Ludovico Caperna
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | - Daniele Mazza
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
| | - Andrea Ferretti
- Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma 00189, Italy
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Shibuya N, McAlister JE, Prissel MA, Piraino JA, Joseph RM, Theodoulou MH, Jupiter DC. Consensus Statement of the American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Ankle Arthritis. J Foot Ankle Surg 2021; 59:1019-1031. [PMID: 32778440 DOI: 10.1053/j.jfas.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Naohiro Shibuya
- Professor, College of Medicine, Texas A&M University, Temple, TX.
| | | | - Mark A Prissel
- Faculty, Advanced Foot and Ankle Reconstruction Fellowship Program, Orthopedic Foot and Ankle Center, Worthington, OH
| | - Jason A Piraino
- Associate Professor, Department of Orthopaedic Surgery and Rehabilitation, University of Florida Health, Gainesville, FL
| | - Robert M Joseph
- Chairman, Department of Podiatric Medicine & Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University, North Chicago, IL
| | - Michael H Theodoulou
- Chief, Division of Podiatric Surgery, Cambridge Health Alliance, Instructor of Surgery, Harvard Medical School, Cambridge, MA
| | - Daniel C Jupiter
- Associate Professor, Department of Preventive Medicine and Community, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX
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14
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Teramoto A, Nozaka K, Kamiya T, Kashiwagura T, Shoji H, Watanabe K, Shimada Y, Yamashita T. Screw Internal Fixation and Ilizarov External Fixation: A Comparison of Outcomes in Ankle Arthrodesis. J Foot Ankle Surg 2021; 59:343-346. [PMID: 32131001 DOI: 10.1053/j.jfas.2019.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 09/04/2019] [Accepted: 09/05/2019] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare the mid-term clinical outcomes between screw internal fixation and Ilizarov external fixation in patients who underwent ankle arthrodesis and to elucidate the differences between the 2 fixation methods. This study investigated 43 ankles in 41 patients who underwent ankle arthrodesis at 1 of the 2 study institutions. There were 15 men and 26 women, and their mean age was 66.2 (range 49 to 87) years. The primary disease included osteoarthritis (OA) (79%), rheumatoid arthritis (RA) (16.3%), and Charcot joint (4.7%). Patients were divided into 2 groups depending on the surgical approach: the screw group (S) and the Ilizarov group (I). The following items were evaluated and compared between the 2 groups: patient characteristics, Tanaka-Takakura classification based on preoperative plain X-ray images, duration of surgery, blood loss, surgical complications, time to start weightbearing, and the Japanese Society of Surgery of the Foot (JSSF) standard rating system for the ankle-hindfoot. Duration of surgery was significantly shorter in the S group (162.3 versus 194.9 min), and the amount of blood loss was also significantly lower in the S group (29.2 versus 97.5 ml). Preoperative JSSF scale was significantly lower in the I group (44.8 versus 33), but postoperative JSSF scale was not significantly different between the 2 groups (82.1 versus 77.9). The S group had satisfactory clinical outcomes with a shorter duration of surgery and smaller amount of blood loss than the I group. However, severe patients in the I group achieved similar treatment outcomes.
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Affiliation(s)
- Atsushi Teramoto
- Assistant Professor, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
| | - Koji Nozaka
- Assistant Professor, Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Tomoaki Kamiya
- Assistant Professor, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Kashiwagura
- Orthopaedic Surgeon, Department of Orthopedic Surgery, Akita City Hospital, Akita, Akita, Japan
| | - Hiroaki Shoji
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Kota Watanabe
- Professor, Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Hokkaido, Japan
| | - Yoichi Shimada
- Professor, Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Toshihiko Yamashita
- Professor, Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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15
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Hess MC, Abyar E, McKissack HM, Strom S, Johnson MD. Applications of the transfibular approach to the hindfoot: A systematic review and description of a preferred technique. Foot Ankle Surg 2021; 27:1-9. [PMID: 32061502 DOI: 10.1016/j.fas.2020.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/01/2020] [Accepted: 01/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The indications and technique for the transfibular approach to the tibiotalar joint have evolved since its initial popularization in 1942. The purpose of this systematic review is to assess the indications, techniques, and postoperative outcomes among procedures performed with the transfibular approach. METHODS A comprehensive search of PubMed, Medline, and Embase databases from 1942 to 2018 was performed in accordance with PRISMA guidelines. After an initial broad search of transfibular approach indications, articles were stratified into 4 major surgical categories for assessment: (1) tibiotalar arthrodesis (2) tibiotalocalcaneal arthrodesis (3) total ankle replacement and (4) distal tibial tumor excision. Data was analyzed according to these 4 categories. RESULTS A total of 32 studies (874 ankles) were included. Fibular non-union rates were 0.7 % (5 of 672) across all studies, 0.6% (2 of 329) for tibiotalar arthrodesis, 0.0% (0 of 12) for tibiotalocalcaneal arthrodesis, 1.0 % (3 of 296) for total ankle arthroplasty and 0.0% (0 of 15) for other procedures. Rates of deep infection were 2.5% (23 of 903) across all studies, 3.2% (15 of 466) for tibiotalar arthrodesis, 3.7% (4 of 106) for tibiotalocalcaneal arthrodesis, 1.3% (4 of 296) for total ankle arthroplasty, and 0.0% (0 of 15) for other procedures. CONCLUSIONS The transfibular approach is useful for cases requiring extensile exposure of the tibiotalar joint. This study provides evidence that the transfibular approach yields satisfactory results, with low complication and infection rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthew C Hess
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
| | - Eildar Abyar
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
| | - Haley M McKissack
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
| | - Shane Strom
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
| | - Michael D Johnson
- The University of Alabama at Birmingham, 1313 13th Street South, Birmingham, AL, 35205, USA.
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16
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Imhoff FB, Wirth SH, Camenzind RS, Viehöfer AF, Lampert CP. RETRACTED ARTICLE: Arthrodesen zur Behandlung der Sprunggelenkarthrose. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-019-00326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Yang TC, Tzeng YH, Wang CS, Chang MC, Chiang CC. Arthroscopic Ankle Arthrodesis Provides Similarly Satisfactory Surgical Outcomes in Ankles With Severe Deformity Compared With Mild Deformity in Elderly Patients. Arthroscopy 2020; 36:2738-2747. [PMID: 32497657 DOI: 10.1016/j.arthro.2020.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/12/2020] [Accepted: 05/22/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the surgical outcome in terms of radiographic measurements, functional outcomes, and complications following arthroscopic ankle arthrodesis (AAA) in patients 60 years of age or older, and to compare the results of patients with mildly deformed ankle with those of patients with severely deformed ankle. METHODS We retrospectively reviewed patients who underwent AAA with 3 cannulated screws between January 2008 and December 2017 and followed postoperatively for at least 24 months. All included patients were 60 years of age or older. Demographic data and radiographic and functional outcomes were compared between patients with coronal deformity of less than 15° (group I) and those with a deformity equal to or greater than 15 degrees (group II). RESULTS A total of 41 patients with a mean age of 70.6 years were included (group I, n = 26; group II, n = 15) and mean follow-up was 51.4 months. Group II had significantly more severe preoperative coronal deformity of tibiotalar angle than group I (20.1 ± 2.9 vs 6.6 ± 4.1°, P < .01). Near-normal tibiotalar alignment was achieved postoperatively in both groups (group I, 3.4 ± 3.3 vs group II, 4.7 ± 3.1°, P = .227). Union was achieved in 39 (95.1%) patients with 2 cases in group I experiencing non-union. Union rate, mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and visual analog scale pain scores were not significantly different between the 2 groups at final follow-up. CONCLUSIONS AAA is a reliable procedure for end-stage ankle arthritis in patients 60 years of age or older resulting in a high union rate, encouraging radiographic and functional outcomes, and a low complication rate, even in cases with severe preoperative deformity. In addition, arthroscopic intra-articular malleolar osteotomy was a useful technique for correcting severe coronal deformity in our series. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Tzu-Cheng Yang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Hsuan Tzeng
- Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taipei, Taiwan; Department of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Shun Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Ching Chiang
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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18
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Woo BJ, Lai MC, Ng S, Rikhraj IS, Koo K. Clinical outcomes comparing arthroscopic vs open ankle arthrodesis. Foot Ankle Surg 2020; 26:530-534. [PMID: 31257043 DOI: 10.1016/j.fas.2019.06.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/14/2019] [Accepted: 06/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Over the last twenty years, minimally invasive ankle arthrodesis has evolved into a well-tolerated and safe procedure. It has grown in favor to open ankle arthrodesis due to shorter length of stay and fewer complications recorded. This paper aims to compare the clinical outcomes of arthroscopic vs open ankle arthrodesis at 24-months followup. METHODS From 2004 to 2015, we reviewed a prospectively collected database in a tertiary hospital foot and ankle registry. 28 feet that underwent arthroscopic ankle arthrodesis were matched to 56 feet that underwent open ankle arthrodesis for age, sex and body mass index (BMI). Visual analogue scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-hindfoot Scores and Short Form Health Survey (SF-36) were obtained to assess clinical outcomes. These parameters were collected before surgery, at 6months and 24months after surgery. RESULTS The arthroscopic group demonstrated significant less pain in the perioperative period (arthroscopic: 1.9±1.2, open: 3.8±1.1, p<0.001) and shorter length of hospitalization stay (arthroscopic: 2.1±0.7 open: 3.5±1.7, p<0.001). Patients who underwent arthroscopic ankle arthrodesis also reported a higher SF-36 score on physical functioning at 6months (arthroscopic: 58.4±27.1, open: 47.1±24.0, p<0.05) and higher AOFAS Ankle-hindfoot Scale score at 24-months (arthroscopic: 78.9±18.9, open: 68.9±24.7, p<0.05). There were no postoperative complications in the arthroscopic group but 11 in the open group, including 9 which required followup operations. There was no significant difference in length of operative procedure between both groups. CONCLUSIONS We conclude that the arthroscopic group displayed better clinical outcomes compared to the open group at the 24months followup. The advantages of arthroscopic ankle arthrodesis include significantly less perioperative pain, higher AOFAS Ankle-hindfoot scores at 24months, shorter length of stay, fewer postoperative complications and followup operations. LEVEL OF EVIDENCE Level III, retrospective comparative series.
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Affiliation(s)
- Bo Jun Woo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mun Chun Lai
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Sean Ng
- Department of Orthopaedic Surgery, Mount Elizabeth Hospital, Singapore, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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19
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Mok TN, He Q, Panneerselavam S, Wang H, Hou H, Zheng X, Pan J, Li J. Open versus arthroscopic ankle arthrodesis: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:187. [PMID: 32448398 PMCID: PMC7247192 DOI: 10.1186/s13018-020-01708-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2020] [Indexed: 12/26/2022] Open
Abstract
Background Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis. Methods For the systematic review, a literature search was conducted in 4 English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Three prospective cohort studies and 7 retrospective cohort studies, enrolling a total of 507 patients with ankle arthritis, were included. Results For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003). Conclusion In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, and shorter length of hospitalisation than open surgery.
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Affiliation(s)
- Tsz Ngai Mok
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.,International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Qiyu He
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.,International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | | | - Huajun Wang
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Huige Hou
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Xiaofei Zheng
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China
| | - Jinghua Pan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
| | - Jieruo Li
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
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20
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Lampert C, Buchhorn T. Arthroskopische Arthrodese des Sprunggelenks. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00350-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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21
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Abstract
Ankle arthritis is a major source of morbidity impacting a younger working age population than hip and knee arthritis. Unlike the hip and knee, more than 70% of ankle arthritis cases are post-traumatic, with the remainder being inflammatory or primary arthritis. Nonoperative treatment begins with lifestyle and shoe-wear modifications and progresses to bracing, physical therapy, anti-inflammatory medications, and intra-articular injections. Ankle arthrodesis and total ankle arthroplasty are the 2 main surgical options for end-stage ankle arthritis, with debridement, realignment osteotomy, and distraction arthroplasty being appropriate for limited indications.
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Affiliation(s)
- Vu Le
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Andrea Veljkovic
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Peter Salat
- Department of Radiology, University of Calgary, Alberta, Canada
| | - Kevin Wing
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Murray Penner
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Alastair Younger
- Department of Orthopaedics, University of British Columbia, Faculty of Medicine, St. Paul’s Hospital, Vancouver, British Columbia, Canada
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