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Ankle fusion complications

James Richman, Adam Cota, Steven Weinfeld
BACKGROUND: Surgical strategies to address deformities of the ankle and hindfoot in patients with Charcot arthropathy include the use of retrograde intramedullary nails and ring fixators. The literature has not shown superiority of one technique over the other. This study presents a single surgeon's case series of Charcot arthropathy patients treated with either a ring fixator or retrograde intramedullary nail to achieve tibiotalocalcaneal arthrodesis. METHODS: We performed a retrospective analysis of 27 consecutive patients with Charcot arthropathy who underwent a tibiotalocalcaneal arthrodesis using either a retrograde intramedullary (IM) nail (n = 16 patients) or a ring fixator (RF) (n = 11 patients) by a single surgeon...
October 2, 2016: Foot & Ankle International
Andrew J Goldberg, Razi Zaidi, Claire Thomson, Caroline J Doré, Simon S Skene, Suzie Cro, Jeff Round, Andrew Molloy, Mark Davies, Michael Karski, Louise Kim, Paul Cooke
INTRODUCTION: Total ankle replacement (TAR) or ankle arthrodesis (fusion) is the main surgical treatments for end-stage ankle osteoarthritis (OA). The popularity of ankle replacement is increasing while ankle fusion rates remain static. Both treatments have efficacy but to date all studies comparing the 2 have been observational without randomisation, and there are no published guidelines as to the most appropriate management. The TAR versus arthrodesis (TARVA) trial aims to compare the clinical and cost-effectiveness of TAR against ankle arthrodesis in the treatment of end-stage ankle OA in patients aged 50-85 years...
September 6, 2016: BMJ Open
Ji-Cheng Gong, Bing-Hua Zhou, Xu Tao, Cheng-Song Yuan, Kang-Lai Tang
BACKGROUND: Tibiotalocalcaneal arthrodesis with headless compression screws has not been previously reported. We hypothesized that these screws could be suitable for tibiotalocalcaneal arthrodesis because of their special design. This study aimed to evaluate the clinical outcomes of patients undergoing tibiotalocalcaneal arthrodesis with headless compression screws for the treatment of severe arthropathy of the ankle and subtalar joint. METHODS: From 2010 to 2015, 23 patients with severe ankle and subtalar arthropathy underwent tibiotalocalcaneal arthrodesis...
2016: Journal of Orthopaedic Surgery and Research
Byung-Ki Cho, Kyoung-Jin Park, Seung-Myung Choi, Sang-Woo Kang, Hyung-Ki Lee
BACKGROUND: Although a ball and socket ankle deformity is usually congenital and asymptomatic, abnormal inversion and eversion mobility can result in recurrent ankle sprain and osteoarthritis. This retrospective study was performed to evaluate the clinical and radiologic outcomes of ankle fusion combined with calcaneal sliding osteotomy for severe arthritic ball and socket ankle deformity. METHODS: Fourteen patients with severe arthritic ball and socket ankle deformity were followed for more than 3 years after operation...
August 16, 2016: Foot & Ankle International
Carlo Biz, Bramir Hoxhaj, Roberto Aldegheri, Claudio Iacobellis
The aim of the present longitudinal prospective study was to evaluate the clinical, functional, and radiologic outcomes and patient satisfaction of those who had undergone minimally invasive surgery (MIS) for tibiotalocalcaneal arthrodesis with an intramedullary nail. The 28 patients, who had consecutively undergone surgery with the MIS technique, were evaluated clinically and radiographically at 1, 2, 3, and 6 months after surgery and at last follow-up examination. For the clinical evaluation, the American Orthopaedic Foot and Ankle Society scale and visual analog scale for the foot and ankle were used in the preoperative and final follow-up examinations...
August 11, 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
N Vasukutty, V Kumar, M Diab, W Moussa
This is a retrospective review of 80 intra-articular calcaneal fractures treated with open reduction and internal fixation by a specialist team under supervision of a single surgeon in a tertiary centre between 2005 and 2014. The fractures were evaluated with plain radiography and computed tomography, and graded using the Eastwood-Atkins classification. A lateral approach was used and all fractures were fixed with calcaneal plates. All patients had clinical and radiological follow-up. Clinical assessment included foot and ankle disability index, SF-36(®) and Kerr-Atkins scores...
August 11, 2016: Annals of the Royal College of Surgeons of England
Christopher W DiGiovanni, Sheldon S Lin, Timothy R Daniels, Mark Glazebrook, Peter Evangelista, Rafe Donahue, William Beasley, Judith F Baumhauer
BACKGROUND: Nonunion, an important complication following foot and ankle arthrodesis, causes substantial morbidity and disability. In patients undergoing hindfoot and ankle arthrodesis, autogenous bone graft (autograft) or a suitable alternative is often used to promote osseous fusion across the joint. This study assessed the importance of adequate graft material in the fusion space to achieve joint fusion during ankle and hindfoot arthrodesis. METHODS: This study used data from a previously published clinical trial of grafting material (recombinant human platelet-derived growth factor-BB with beta-tricalcium phosphate [rhPDGF-BB/β-TCP] or autograft) for healing in hindfoot and ankle arthrodesis to correlate the amount of graft fill at 9 weeks with ultimate healing...
August 3, 2016: Journal of Bone and Joint Surgery. American Volume
Benwen Wu, Guofeng Huang, Zhenqi Ding
OBJECTIVE: To summarize the progress in the application of ankle and hindfoot arthrodesis. METHODS: The domestic and foreign related literature about the application of ankle and hindfoot arthrodesis was reviewed, summarized, and analyzed. RESULTS: Ankle and hindfoot arthrodesis include the multi-joint fusion and the single joint fusion, and they involve tibiotalar joint, subtalar joint, talonavicular joint, and calcaneocuboid joint. The methods of fixation include screw, plate, intramedullary nail, and external fixation...
April 2016: Chinese Journal of Reparative and Reconstructive Surgery
Beau J Kildow, Christopher E Gross, Samuel D Adams, Selene G Parekh
: Background Tibiotalocalcaneal arthrodesis is a salvage procedure for patients with complex disease of the ankle and subtalar joints. Despite the clinical efficacy and mechanical advantage of intramedullary nails, complications, such as nonunion, are common. It may be possible to sustain compression in the face of bone resorption and implant loosening over the course of healing using a novel pseudoelastic intramedullary nail with an internal nitinol element. Methods We identified 15 patients with average age of 54...
July 7, 2016: Foot & Ankle Specialist
Troy M Gorman, Timothy C Beals, Florian Nickisch, Charles L Saltzman, Mikayla Lyman, Alexej Barg
BACKGROUND: Previous hindfoot surgeries present a unique challenge to hindfoot arthrodesis, as the patients may have multiple incisions around the hindfoot. In high-risk patients with compromised soft tissues, a posterior approach can provide an alternative for a fresh soft tissue plane for the surgery. The use of a blade plate construct is widely accepted; however, there are limited data supporting the use of a posterior approach. QUESTIONS/PURPOSES: We asked (1) what proportion of patients treated with this technique achieved osseous union; (2) what complications were observed; (3) were any patient-demographic or health-related factors associated with the likelihood that a patient would have a complication develop? METHODS: Between December 2001 and July 2014, 42 patients received a posterior blade plate...
October 2016: Clinical Orthopaedics and related Research
Braden Criswell, Kenneth Hunt, Todd Kim, Loretta Chou, Andrew Haskell
BACKGROUND: Surgeons disagree about the safety of adding adjuvant procedures requiring separate incisions during total ankle replacement (TAR). This study tested the hypothesis that complication rates for patients in the first year after TAR would be greater when combined with procedures through separate incisions. METHODS: A retrospective review was performed on a consecutive series of 124 patients who underwent total ankle replacement between 2007 and 2013. Demographics, case-specific data, and postoperative complications over the first year were collected...
June 8, 2016: Foot & Ankle International
Gregory F Alvine, Franklin G Alvine
BACKGROUND: Ankle fusion has been the traditional treatment of choice for failed total ankle arthroplasties or arthritic conditions that preclude the use of primary implants. A custom stemmed agility talar component was designed to be used in these conditions. METHODS: The first 30 cases by a single surgeon were reviewed at two intervals. The study was a retrospective chart review with data including ankle diagnosis, deformity, bone loss and other factors that may have an impact on ankle arthroplasty...
April 2016: South Dakota Medicine: the Journal of the South Dakota State Medical Association
Ryan T Anderson, Douglas J Pacaccio, Christopher M Yakacki, R Dana Carpenter
Tibio-talo-calcaneal (TTC) arthrodesis is an end-stage treatment for patients with severe degeneration of the ankle joint. This treatment consists of using an intramedullary nail (IM) to fuse the calcaneus, talus, and tibia bones together into one construct. Poor bone quality within the joint prior to surgery is common and thus the procedure has shown complications due to non-union. However, a new FDA-approved IM nail has been released that houses a nickel titanium (NiTi) rod that uses its inherent pseudoelastic material properties to apply active compression across the fusion site...
September 2016: Journal of the Mechanical Behavior of Biomedical Materials
S Popelka, A Sosna, P Vavřík, D Jahoda, V Barták, I Landor
UNLABELLED: PURPOSE OF THE STUDY Total joint replacement is one of the options in surgical treatment of advanced ankle arthritis. It allows the ankle to remain mobile but, unfortunately, it does not provide the same longevity as total knee or hip replacements. Therefore, decisions concerning the kind of treatment are very individual and depend on the clinical status and opinion of each patient. MATERIAL AND METHODS A total of 132 total ankle replacements were carried out in the period from 2004 to 2015...
2016: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Kyle S Peterson, W Drew Chapman, Christopher F Hyer, Gregory C Berlet
Tibiotalocalcaneal arthrodesis is a salvage procedure for severe hindfoot/ankle deformities, arthritis, avascular necrosis of the talus, failed total ankle replacement, and Charcot neuroarthropathy. The methods for fixation include anterior and lateral plates, screws, retrograde intramedullary nails, and external fixation. The purpose of the present report was to describe the short-term radiographic outcomes and technique using a posterior approach with an anatomic-specific locking plate for tibiotalocalcaneal arthrodesis...
September 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
William P Huntington, W Hodges Davis, Robert Anderson
UNLABELLED: Background Nonunion of an ankle arthrodesis is associated with significant pain and morbidity. Revision arthrodesis presents greater short-term morbidity and long-term sequelae. 1-6 Recent reports have demonstrated the feasibility of converting a symptomatic nonunion of an ankle arthrodesis to a total ankle arthroplasty.7-9 The objective of the present study was to evaluate the short-term outcome associated with take down of symptomatic nonunions of ankle arthrodeses and conversion to a fixed bearing, intramedullary total ankle arthroplasty...
August 2016: Foot & Ankle Specialist
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
Kathie J Whitt, Sarah A Rincker, Christopher F Hyer
Ninety percent of patients with rheumatoid arthritis will display foot and ankle pathologic features, including hallux valgus, lesser metatarsophalangeal (MTP) joint subluxation/dislocation, and hammertoe deformity. Recently, a trend has ensued toward joint preservation with distal metatarsal osteotomies and various bunion corrective procedures. However, the reference standard remains first MTP joint fusion, lesser metatarsal head resection, and lesser proximal interphalangeal joint fusion. The present retrospective study followed the results of 4 different surgeons who had performed the reference standard rheumatoid forefoot reconstruction from August 2008 to August 2012 on patients with rheumatoid arthritis...
May 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Alexander D Shearman, Kyriacos Iordanis Eleftheriou, Akash Patel, Rajib Pradhan, Peter Francis Rosenfeld
Arthrodesis of the ankle and hindfoot in the setting of major deformity is challenging and associated with substantial risks. Patients often have significant comorbidities that lead to unforgiving soft tissues, poor vascularity, and poor bone quality. This creates the high-risk scenario of poor wound healing and poor implant fixation. Complications can be devastating, leading to loss of the limb and sepsis. The use of locking plate technology might provide biomechanical and operative technique advantages in such patients...
May 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
(no author information available yet)
Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications...
February 2016: Drug and Therapeutics Bulletin
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