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Triple arthrodesis revision

R P Walter, R W Walker, M Butler, S Parsons
BACKGROUND: Subtalar arthrodesis through an open approach carries significant risk of complications. An arthroscopic approach aims to minimise damage to the soft tissue envelope to improve recovery, union and complication rates. A two portal approach through the sinus tarsi was used. METHODS: A retrospective review of all patients undergoing isolated arthroscopic arthrodesis was performed. RESULTS: Seventy-seven procedures were performed. Successful arthrodesis was achieved in 75 (97...
April 23, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Jeffrey D Seybold
Malunion remains a common complication after triple arthrodesis, with rates as high as 6% in the reported literature. Careful patient evaluation is critical to determine the location and degree of bony deformity. A stepwise systematic approach to correct hindfoot and midfoot deformity is presented in this article. Few studies have been published to guide foot and ankle surgeons with this difficult clinical scenario, but reports have demonstrated high success rates and low rates of complications after revision triple arthrodesis...
September 2017: Foot and Ankle Clinics
Alexandra I Stavrakis, Nelson F SooHoo
BACKGROUND: This study provides an updated comparison of the reoperation rates following primary ankle arthrodesis and total ankle replacement on the basis of observational, population-based data from California. We previously reported data from 1995 to 2004, and our current study includes new data from 2005 to 2010. Our hypothesis was that total ankle replacement would demonstrate increasing utilization and lower complication rates given advances in implant design and growth in surgeon experience...
September 7, 2016: Journal of Bone and Joint Surgery. American Volume
Christopher E Gross, John S Lewis, Samuel B Adams, Mark Easley, James K DeOrio, James A Nunley
BACKGROUND: While it is thought that stresses through the subtalar and talonavicular joints will be decreased after total ankle replacement (TAR) relative to ankle fusion, progressive arthritis or deformity of these joints may require a fusion after a successful TAR. However, after ankle replacement, it is unknown how hindfoot biomechanics and blood supply may be affected. Consequently, subsequent hindfoot joint fusion may be adversely affected. METHODS: We retrospectively identified a consecutive series of 1001 primary TARs performed between January 1998 and December 2014...
July 2016: Foot & Ankle International
Timothy R Daniels, D Joshua Mayich, Murray J Penner
BACKGROUND: The Scandinavian Total Ankle Replacement (STAR) prosthesis has been in clinical use since 1981, with investigational use in the U.S. since 1998. Few studies of the North American version of the STAR are available. This prospective cohort study analyzed intermediate to long-term outcomes of total ankle arthroplasty with use of the STAR prosthesis at two Canadian centers. METHODS: Consecutive patients who received the STAR prosthesis between 2001 and 2005 were enrolled at two large, urban teaching hospitals...
June 3, 2015: Journal of Bone and Joint Surgery. American Volume
N Hartig, S Krenn, H-J Trnka
BACKGROUND: Because of extensive bone loss and the associated complex instability and deformity of the feet, Charcot arthropathy or neuroosteoarthropathy is a challenge for the orthopedic surgeon. Ulcerations offer entry of various bacteria; thus, infections are a frequent serious issue and complication. The careful choice of treatment is not only very important for the correct alignment of the foot and the loading capacity, but also contributes significantly to the prevention of skin irritation or the healing of existing ulcers...
January 2015: Der Orthopäde
James D Michelson, Raymond A Addante, Mark D Charlson
BACKGROUND: Multimodal postoperative analgesia employs multiple medications given perioperatively to block the generation and perception of pain at different points in the nociceptive pathway. This retrospective study examines its effect on the length of stay for patients undergoing hindfoot and ankle fusions. METHODS: All patients operated upon by the senior authors between 2007 and 2011, inclusive, underwent ankle fusion, subtalar fusion, pantalar arthrodesis, triple arthrodesis, or combined ankle/subtalar fusions...
November 2013: Foot & Ankle International
Lawrence P Hsu, Luciano S Dias, Vineeta T Swaroop
BACKGROUND: It has been demonstrated that an important component of clubfoot deformity is related to pathologic external rotation of the talus with respect to the remainder of the foot. The purpose of the present study was to review the long-term results for a cohort of patients with idiopathic clubfoot who were managed by a single surgeon with a uniform surgical protocol consisting of extensive posterior medial-lateral release in addition to the use of a temporary Kirschner wire to derotate the talus prior to fixation...
March 6, 2013: Journal of Bone and Joint Surgery. American Volume
Martinus Richter, Stefan Zech
Lengthening osteotomy of the calcaneus (LO) and flexor digitorum longus tendon (FDL) transfer to the navicular is one option for the treatment of flexible flatfoot deformity (FD). The aim of the study was to analyse the amount of correction and clinical outcome including pedographic assessment. In a prospective consecutive non-controlled clinical followup study, all patients with FD that were treated with LO and FDL from September 1st 2006 to August 31st, 2009 were included. Assessment was performed before surgery and at 2-year-followup including clinical examination (with staging of posterior tibialis insufficiency) weight bearing radiographs (Talo-1st metatarsal angles (TMT)), pedography (increased midfoot contact area and force) and Visual Analogue Scale Foot and Ankle (VAS FA)...
March 2013: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Shane M Hollawell
This report summarizes the radiographic results of Osteocel Plus in 20 hindfoot and ankle fusions at a single center. The patient population was 40% female with an average age of 57.9 ± 16.1 years. Average body mass index was 33.8 ± 9.1. Risk factors included 3 smokers and 6 patients with diabetes. Primary surgical indications included trauma (50%), Charcot arthropathy (15%), foot drop with osteoarthritis (20%), primary osteoarthritis (10%), and total talar extrusion (5%). Nine patients had a history of prior hindfoot surgery in the same foot; however, only 2 of the cases reported in this series were revisions due to a failed prior surgery; the remaining 7 were treated for correction of a traumatic deformity (n = 5) or diagnosis at a new site in the same foot (n = 2)...
March 2012: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
William T DeCarbo, Gregory C Berlet, Christopher F Hyer, W Bret Smith
A philosophical shift toward more joint-sparing procedures has led to increased use of isolated subtalar joint (STJ) versus triple arthrodesis. Union rates for STJ fusion range from 47% to 100%, leading to controversy regarding the optimal type, orientation, and amount of internal fixation. The purpose of this study was to determine if single-screw fixation is a predisposing factor to nonunion. Single-screw fixation is parallel to the STJ axis and may result in motion. It is hypothesized that higher nonunion rates will be observed in single-screw versus 2-screw fusions...
August 2010: Foot & Ankle Specialist
M Lampasi, C Bettuzzi, M Palmonari, O Donzelli
A total of 38 relapsed congenital clubfeet (16 stiff, 22 partially correctable) underwent revision of soft-tissue surgery, with or without a bony procedure, and transfer of the tendon of tibialis anterior at a mean age of 4.8 years (2.0 to 10.1). The tendon was transferred to the third cuneiform in five cases, to the base of the third metatarsal in ten and to the base of the fourth in 23. The patients were reviewed at a mean follow-up of 24.8 years (10.8 to 35.6). A total of 11 feet were regarded as failures (one a tendon failure, five with a subtalar fusion due to over-correction, and five with a triple arthrodesis due to under-correction or relapse)...
February 2010: Journal of Bone and Joint Surgery. British Volume
David H Kim, Mark Berkowitz, Edward Pino, Edward Bruck
Nonunion after foot arthrodesis is a difficult clinical problem to solve. This article presents a case of a patient who underwent 3 unsuccessful attempts at calcaneocuboid joint arthrodesis. This problem was salvaged with interpositional arthroplasty of the joint with successful clinical outcome. A 49-year-old woman with longstanding rheumatoid arthritis underwent triple hindfoot arthrodesis. Although the talonavicular joint and the talocalcaneal joints achieved successful arthrodesis, the calcaneocuboid joint did not unite...
February 2009: Orthopedics
Tuukka Niinimäki, Susanna Yli-Luukko, Hannu Syrjälä, Outi Kaarela, Juhana Leppilahti
BACKGROUND: Triple arthrodesis can be used to correct hindfoot deformities in rheumatoid patients. Postoperative deep infections after triple arthrodesis are challenging to treat often requiring both operative debridement and antimicrobial therapy. The purpose of the present study was to review the treatment of deep infections in the sinus tarsi region in rheumatoid patients after triple arthrodesis using antimicrobial therapy and Papineau bone grafting or local muscle flap. MATERIALS AND METHODS: Seven rheumatoid patients out of 97 who underwent triple arthrodesis between January 1997 and June 2006 had a deep postoperative infection in the sinus tarsi region...
November 2008: Foot & Ankle International
Markus Knupp, Anne Skoog, Hans Törnkvist, Sari Ponzer
BACKGROUND: Few studies have focused on the long-term results of triple arthrodesis in patients with rheumatoid arthritis. We retrospectively reviewed fusion rate, arthritis of the adjacent joints, clinical outcome, and patient satisfaction. MATERIALS AND METHODS: Between 1990 and 1998, 28 patients with rheumatoid arthritis were managed with a total of 32 triple arthrodeses. Of the 28 patients, 20 (24 cases) had been followed for 5.2 (range, 4 to 7) years. Fusion was performed with rigid staple fixation and autologous bone graft...
March 2008: Foot & Ankle International
Vincent J Sammarco, Edward G Magur, G James Sammarco, Mahesh R Bagwe
BACKGROUND: Triple arthrodesis has long been used for the treatment of painful malalignment or arthritis of the hindfoot. However, the effect of fusion on adjacent joints has sparked interest in a more limited arthrodesis in patients without involvement of the calcaneocuboid joint. METHOD: Results of 16 feet in 14 patients who had a modified double arthrodesis for symptomatic flatfoot, cavovarus deformity, or hindfoot arthritis were reviewed retrospectively with a minimum followup of 18 (range 18 to 93) months...
September 2006: Foot & Ankle International
Caroll P Jones, Michael J Coughlin, Paul S Shurnas
BACKGROUND: The reported fusion rates of revision arthrodesis for hindfoot nonunions are relatively low compared to primary procedures. Exogenous ultrasound has been shown to accelerate the healing process of acute fractures and fracture nonunions but has not been previously evaluated for the treatment of hindfoot pseudarthroses. The purpose of this study was to evaluate the clinical and radiographic outcomes of revision hindfoot arthrodeses treated with postoperative low-intensity ultrasound...
April 2006: Foot & Ankle International
Ronald W Smith, Wen Shen, Sarah Dewitt, Stephen F Reischl
BACKGROUND: The triple arthrodesis was developed to treat sequelae of neurologic disorders affecting the hindfoot. Today, the typical adult patient undergoing this procedure has degenerative disease, usually not related to a neurologic disorder. The purpose of this study was to investigate the long-term outcome of triple arthrodesis in this patient population. METHODS: Twenty-seven adult patients (thirty-one feet) who had undergone triple arthrodesis for the treatment of chronic hindfoot pain and had been followed for a minimum of ten years completed an outcomes questionnaire, and twenty-two patients (twenty-six feet) were available for physical examination, radiographs, and functional testing...
December 2004: Journal of Bone and Joint Surgery. American Volume
Brian C Toolan
BACKGROUND: This investigation reviewed the clinical and radiographic results of a biplanar opening-closing wedge osteotomy of the midfoot to revise failed triple arthrodeses with severe rocker-bottom deformity. Five cases were reviewed to determine if this osteotomy corrects the rocker-bottom deformity, improves function and provides satisfaction to the patient. METHODS: American Orthopaedic Foot and Ankle Society (AOFAS) clinical ratings scores obtained before and after the procedure were compared to assess the functional outcome...
July 2004: Foot & Ankle International
Richard R Perez, Walter W Strash
Malalignment of a triple arthrodesis can pose significant challenges to the foot and ankle surgeon. Lack of a plantigrade foot will not be well tolerated by the patient and will often require revision of the original surgery. This article presents a review of the treatment algorithm used to address this unique problem. A case study based on this approach is also presented.
July 2004: Clinics in Podiatric Medicine and Surgery
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