MedWorm: Ankle Replacement

Haemophilic arthropathy of the ankle treated by total ankle replacement: a case series

Haemophilia — Tue, 16 Mar 2010 00:00:00 +0100

The objective of this prospective study was to evaluate the mid-term outcome in patients treated with total ankle replacement using an unconstrained three-component ankle implant. Ten haemophilic ankles in eight patients (mean age: 43.2 years, range 26.7[ndash]57.5) treated with total ankle replacement were followed up for a minimum of 2.7 years (mean: 5.6, range 2.7[ndash]7.6). The outcome was measured with clinical and radiological evaluations. There were no intra- or peri-operative complications. The AOFAS-hindfoot-score increased from 38 (range 8[ndash]57) preoperatively to 81 (range 69[ndash]95) postoperatively. All patients were satisfied with the results. Four patients became pain free; in the whole patient cohort pain level decreased from 7.1 (range 4[ndash]9) preoperatively to 0.8...

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Surgery on joints

BBC News | Health | UK Edition — Sat, 06 Mar 2010 00:25:19 +0100

Patient benefits from rare ankle replacement (Source: BBC News | Health | UK Edition)

Heel raises versus prefabricated orthoses in the treatment of posterior heel pain associated with calcaneal apophysitis (Sever's disease): study protocol for a randomised controlled trial

Journal of Foot and Ankle Research — Tue, 02 Mar 2010 00:00:00 +0100

This study seeks to compare the clinical efficacy of some currently employed treatment options for the relief of disability and pain associated with posterior heel pain in children.MethodDesign: Factorial 2x2 randomised controlled trial with monthly follow-up for 3 months.Participants: Children with clinically diagnosed posterior heel pain possibly associated with calcaneal apophysitis/Sever's disease (n = 124).Interventions: Treatment factor 1 will be two types of shoe orthoses: a heel raise or prefabricated orthoses. Both of these interventions are widely available, mutually exclusive treatment approaches that are relatively low in cost. Treatment factor 2 will be a footwear prescription/replacement intervention involving a shoe with a firm heel counter, dual density EVA midsole and rear...

Conversion of painful ankle arthrodesis to total ankle arthroplasty. Surgical technique.

The Journal of Bone and Joint Surgery. American volume — Mon, 01 Mar 2010 00:00:00 +0100

CONCLUSIONS: For patients with pain at the site of a failed ankle arthrodesis, conversion to total ankle arthroplasty with the use of a three-component ankle implant is a viable treatment option that provides reliable intermediate-term results. Key factors for the success of this procedure may be the intrinsic coronal plane stability provided by the ankle implants and the use of wider talar implants. PMID: 20194344 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Soft Tissue Management of War Wounds to the Foot and Ankle

Foot and Ankle Clinics — Fri, 26 Feb 2010 15:09:52 +0100

This article details the experiences of United States military reconstructive surgeons in the soft tissue management of war wounds of the foot and ankle resulting from the conflicts in Iraq and Afghanistan. War wounds from this conflict are commonly caused by blast and fragmentation, and are characteristically extensive, heterogeneous, and severe. Multiple serial débridement episodes are routinely necessary because of deterioration of the wounds over time, which is in contrast to civilian trauma wherein fewer débridement episodes are generally required. Wound therapy adjuncts, such as subatmospheric wound dressing and synthetic dermal replacement, have been used extensively with favorable results. Pedicled flaps, such as the distally based sural neurofasciocutaneous flap, are reliable, a...

REMOVED: Retraction notice to The Use of a Femoral Distractor to Aid Distal Tibial Resection During Total Ankle Arthroplasty

Journal of Foot and Ankle Surgery — Thu, 25 Feb 2010 15:05:37 +0100

This article has been removed consistent with Elsevier Policy on Article Withdrawal. The Publisher apologises for any inconvenience this may cause. (Source: Journal of Foot and Ankle Surgery)

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Analysis of Ankle Range of Motion and Functional Outcome Following Total Ankle Arthoplasty

Journal of Foot and Ankle Surgery — Thu, 25 Feb 2010 15:05:35 +0100

Abstract: The success of ankle joint replacement has primarily been reviewed with respect to patient morbidity and survivorship rather than patient satisfaction. A retrospective review was performed of 95 patients who had undergone a total ankle replacement and who had completed both postoperative range of motion fluoroscopy and a subjective patient score sheet. Collected data included age, body mass index, length of follow-up, presence of complications, performance of adjunctive procedures, range of motion, and the etiology of the end-stage arthritis. These variables were then compared with patient satisfaction to see if there were any predictive conditions of successful outcomes. Patients older than 60 years and those with a body mass index (BMI) less than 30 demonstrated a significant p...

Total ankle replacement: a population-based study of 515 cases from the Finnish Arthroplasty Register.

Acta Orthopaedica — Wed, 24 Feb 2010 00:00:00 +0100

Authors: Skyttä ET, Koivu H, Eskelinen A, Ikävalko M, Paavolainen P, Remes V Background and purpose Although total ankle replacement (TAR) is a recognized procedure for treatment of the painful arthritic ankle, the best choice of implant and the long-term results are still unknown. We evaluated the survival of two TAR designs and factors associated with survival using data from the nationwide arthroplasty registry in Finland. Methods 573 primary TARs were performed during the period 1982-2006 because of rheumatic, arthritic, or posttraumatic ankle degeneration. We selected contemporary TAR designs that were each used in more than 40 operations, including the S.T.A.R. (n = 217) and AES (n = 298), to assess their respective survival rates. The mean age of the patients was 55 (1...

Salvage arthrodesis for failed total ankle arthroplasty.

Acta Orthopaedica — Mon, 22 Feb 2010 00:00:00 +0100

Authors: Doets HC, Zürcher AW Background and purpose Total ankle arthroplasty (TAA) has gained popularity in recent years. If it fails, however, salvage arthrodesis must be reliable as a rescue procedure. We therefore investigated the clinical, radiographic, and subjective outcome after salvage arthrodesis in a consecutive group of patients, and concentrated on the influence of the method of fixation on union rate and on salvage in inflammatory joint disease. Patients and methods Between 1994 and 2005, salvage arthrodesis was performed on 18 ankles (18 patients). Diagnosis was inflammatory joint disease (IJD) in 15 cases and osteoarthritis (OA) in 3. Tibio-talar fusion was performed in 7 ankles, and tibio-talocalcaneal fusion in 11. Serial radiographs were studied for time to unio...

Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up

Knee Surgery, Sports Traumatology, Arthroscopy — Thu, 04 Feb 2010 06:59:27 +0100

Abstract We determined whether the early improvement in symptoms and function after microfracture in the management of articular cartilage defects of the talus is maintained at mid term follow-up. Factors influencing outcome and postoperative magnetic resonance imaging were also evaluated. We performed data collection prospectively using the Hannover Scoring System for the ankle (HSS) and a Visual Analog Scale (VAS) for pain and function preoperatively, at 1 ± 0.1 year (45 ankles), 2 ± 0.4 years (45 ankles), and at an average of 5.8 ± 2.0 years (39 ankles) postoperatively. MRI was used to assess cartilage repair tissue based on the following variables: degree of defect repair and filling of the defect, integration to border zo...

Pigmented villonodular synovitis of the elbow treated with the tsuge wide joint exposure technique.

Orthopedics — Mon, 01 Feb 2010 00:00:00 +0100

This article describes a case of a 29-year-old woman with PVNS of the right elbow who was treated by total synovectomy using the Tsuge technique. Tsuge reported a new surgical technique for debridement arthroplasty using a posterolateral approach to the elbow in 1987. He has also reported using this procedure during arthroplasty for posttraumatic stiff elbow and for synovectomy in rheumatoid arthritis. This approach permits easy dislocation of the elbow and provides a good view of the whole joint. Although the recurrence rate of PVNS of the elbow is high, our patient has retained good elbow function with no evidence of local recurrence at 30 months postoperatively. PMID: 20192154 [PubMed - in process] (Source: Orthopedics)

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Influences of anti-tumour necrosis factor agents on postoperative recovery in patients with rheumatoid arthritis

Clinical Rheumatology — Wed, 13 Jan 2010 06:43:44 +0100

Abstract The aim of this study is to investigate the influences of the anti-tumour necrosis factor (TNF) agents infliximab and etanercept on the postoperative recovery of patients with rheumatoid arthritis (RA). We also investigated the effects of biologics on wound healing. Patients with RA were split into a TNF group (n = 39) that underwent 39 operations and were treated with anti-TNF agents, and a non-TNF group (n = 74) that underwent 74 operations and were treated only with conventional disease-modifying antirheumatic drugs. Operations included ankle arthrodesis and total arthroplasty of the hip, knee, elbow, shoulder and ankle. Adverse events (AEs) of surgical wounds, time for complete wound healing, febrile period after operation and recovery parameters after o...

Total ankle replacement by the Ankle Evolution System: MEDIUM-TERM OUTCOME.

The Journal of Bone and Joint Surgery. British volume — Fri, 01 Jan 2010 00:00:00 +0100

We present the outcomes in 38 consecutive patients who had total ankle replacement using the Ankle Evolution System with a minimum follow-up of four years. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and regular standardised anteroposterior and lateral weight-bearing radiographs were obtained. Patient satisfaction and complications were recorded and the survival of the implants was demonstrated by the Kaplan-Meier method. The mean follow-up was for 57.8 months (48 to 80). The cumulative survival rate at six years was 94.7% (95% confidence interval 80.3 to 98.7). The mean total AOFAS score was 88.1 (53 to 100). The mean score for pain was 35.8 (20 to 40). Ten patients presented with edge-loading of whom nine had corrective surgery. Two...

Moje First Metatarsophalangeal Replacement—A Case Series with Functional Outcomes Using the AOFAS-HMI Score

Journal of Foot and Ankle Surgery — Sat, 26 Dec 2009 14:45:41 +0100

We report the functional results of a case series of Moje first metatarsophalangeal total joint replacements carried out between February 2001 and November 2006. All patients who underwent Moje arthroplasty under the care of a single surgeon were included; outcome scores and complications were recorded annually. A total of 32 joints in 29 consecutive patients were followed for a mean duration of 34 (range 6 to 74) months, and the mean patient age at the time of operation was 56 (range 38 to 79) years. Hallux rigidus was the primary diagnosis in 28 (87.5%) of the cases. The mean American Orthopaedic Foot & Ankle Society Hallux-Metatarsophalangeal-Interphalangeal score at final follow-up was 74/100 (range 9 to 100), with 13 (40.63%) joints rated good to excellent. Two (6.25%) joints were rev...

[Peripheral arterial disease in women.]

Presse Medicale — Mon, 14 Dec 2009 00:00:00 +0100

Authors: Aboyans V, Salazar J, Lacroix P The widespread use of the ankle-brachial index (ABI) enabled to reveal the high prevalence of lower extremities peripheral arterial disease (PAD) in women, even higher than in men in several series. Nonetheless, the use of a same ABI threshold for men and women may overestimate the prevalence of subclinical PAD in women. Conversely, the clinical manifestations of PAD are more often atypical in women, with as a result, a delayed diagnosis and management. The level of association between cardiovascular disease risk factors and PAD is similar in both genders. To date, there is no evidence for any association between PAD and different hormonal events in women. Despite an inverse association between hormonal replacement therapy (HRT) after menopause ...

Mid-term results of joint-preserving procedures by a modified Mann method for big toe deformities in rheumatoid patients undergoing forefoot surgeries

Modern Rheumatology — Fri, 11 Dec 2009 06:52:51 +0100

This study aimed to evaluate joint-preserving procedures by a modified Mann method for rheumatoid forefoot deformities and their functional outcomes in the mid-term. Eleven feet in seven patients underwent forefoot surgery using a modified Mann method for the big toe, combined with offset osteotomy or resection arthroplasty of the lesser toes. The mean follow-up period was 3.6 years. The mean score on the Japanese Society for Surgery of the Foot scale for rheumatoid arthritis foot and ankle joints improved from 44.0 to 72.0. The mean hallux valgus angle improved from 39.4° to 20.5° and the mean M1M5 angle improved from 31.1° to 25.8°. However, deformities involving a hallux valgus angle of more than 25.0° recurred in three feet at the latest follow-up, although the patients...

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Human Immunodeficiency Virus Disclosure and Patient Confidentiality in Orthopaedic Procedures

JBJS [Am] — Tue, 01 Dec 2009 18:02:03 +0100

A thirty-two-year-old man with hemophilia whose chief complaint was knee pain was referred by his hematologist for consideration of a total knee arthroplasty. On his initial visit, the patient was seen and evaluated with his pregnant wife and their infant child present in the examination room at his request. During the review of systems and past medical history, the treating surgeon inquired into the status of his human immunodeficiency virus (HIV) viral load and CD4 count. At that point, the patient denied ever testing positive for HIV. Later, in a private discussion, the patient confirmed his HIV-positive status. He admitted that his wife was unaware of his history, and he stated that he did not wish her to know. The surgeon explained to the patient that his HIV history posed a major hea...

Skin, muscle and joint disease from the 17th century: scurvy

APLAR Journal of Rheumatology — Mon, 23 Nov 2009 00:00:00 +0100

We report three cases of scurvy, with differing musculoskeletal presentations, from a tertiary teaching hospital in Sydney, Australia. Case 1 was a man with cerebral palsy who presented with knee swelling following a minor injury. In Case 2, a patient with thalassaemia major presented with purpuric rash, difficulty walking and distal thigh swelling and ecchymosis. Case 3 was a man with Down's syndrome who presented with acute ankle arthritis. Scurvy in Cases 1 and 3 were related to abnormal dietary preferences, whereas in Case 2, scurvy was thought to be related to thalassaemia. All three cases responded rapidly to vitamin C replacement. The subjects did not appear malnourished as they had adequate carbohydrate and protein intake. (Source: APLAR Journal of Rheumatology)

Is the Wii Fit a new-generation tool for improving balance, health and well-being? A pilot study.

Climacteric — Thu, 12 Nov 2009 00:00:00 +0100

Conclusion Activity fostered by Wii Fit showed an immediate effect on balance and strength that needs confirmation by statistically powered studies. PMID: 19905991 [PubMed - as supplied by publisher] (Source: Climacteric)

Oxygen tensiometry as a predictor of wound healing in total ankle arthroplasty.

Acta Orthopaedica et Traumatologica Turcica — Sun, 01 Nov 2009 00:00:00 +0100

CONCLUSION: Oxygen tensiometry is not thought to be useful for predicting patients at risk for postoperative wound healing complications after TAA, suggesting that, if adequate pulses are present before surgery, the trauma of using excessive superficial traction on the skin during surgery is more responsible for wound healing problems than the underlying blood supply. PMID: 19881316 [PubMed - in process] (Source: Acta Orthopaedica et Traumatologica Turcica)

Gallery of uncommon orthopedic implants: a guide for emergency radiologist

Emergency Radiology — Mon, 26 Oct 2009 18:00:19 +0100

Abstract The purpose of this gallery of orthopedic implants was to provide a reference for emergency radiologists to quickly identify uncommon devices in the shoulders, hips, and extremities. The cases presented in this exhibit will include unusual arthroplasties and prostheses as well as bone graft implants (including allograft and autograft). Bone grafts are frequently used for the treatment of bone defects, which may be caused by trauma, infection, or avascularity. Autogenous cancellous, corticocancellous, or cortical bone grafts are often used, either free or vascularized [1]. Alternative bone graft substitutes are also used. An obvious complication of bone grafts is the failure of incorporation. Joint arthroplasty is the most frequently performed orthopedic procedure a...

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Long-term clinical results of the Oxford medial unicompartmental knee arthroplasty

International Orthopaedics — Fri, 16 Oct 2009 18:00:49 +0100

Abstract The purposes of this study were to investigate the mode of failure and survivorship of an independently performed series of medial Oxford unicompartmental knee arthroplasties. The study included 43 knees in 40 patients with a mean follow-up of 14.88 years: 13 knees (11 patients) had revision surgery (30%), and ten patients required conversion to total knee prosthesis. The mean International Knee Society (IKS) scores at the time of the revision were 145.52 [standard deviation (SD): 39.90, range: 167–200]. The overall alignment of the knee was restored to neutral, with a hip-knee-ankle (HKA) angle average of 178° (SD: 3.21°, range: 170–186°). Survivorship, as defined by an endpoint of failure for any reason, showed that the survival rate at five year...

Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty

Knee Surgery, Sports Traumatology, Arthroscopy — Wed, 14 Oct 2009 05:58:49 +0100

This study evaluated a static progressive stretching device as a treatment method for patients who had refractory knee stiffness after total knee arthroplasty. Twenty-five patients who had knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3–16 weeks), the median increase in range of motion was 25° (range, 8–82°). The median gain in knee active flexion was 19° (range, 5–80°). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after total knee arthroplasty. Content Type Journal...

Managing Medical Errors

JBJS [Am] — Thu, 01 Oct 2009 17:01:57 +0100

A patient with severe arthritis of the hip and shortening of the ipsilateral extremity undergoes hip replacement surgery with correction of the limb-length discrepancy. At the time of the postoperative examination, he is found to have a complete foot drop. (Source: JBJS [Am])

Endoprosthetic reconstruction of the distal tibia and ankle joint after resection of primary bone tumours.

The Journal of Bone and Joint Surgery. British volume — Wed, 30 Sep 2009 23:00:00 +0100

We report the outcome of six patients treated between 1981 and 2007. There were four males and two females, with a mean age of 43.5 years (15 to 75), and a mean follow-up of 9.6 years (1 to 27). No patient developed a local recurrence or metastasis. Two of the six went on to have a below-knee amputation for persistent infection after a mean 16 months (1 to 31). The four patients who retained their endoprosthesis had a mean musculoskeletal tumour society score of 70% and a mean Toronto extremity salvage score of 71%. All were pain free and able to perform most activities of daily living in comfort. A custom-made endoprosthetic replacement of the distal tibia and ankle joint is a viable treatment option for carefully selected patients with a primary bone tumour. Patients should, however, be ...

Opening wedge tibial osteotomy for large varus deformity with CeraverTM resorbable beta tricalcium phosphate wedges

International Orthopaedics — Wed, 30 Sep 2009 18:19:27 +0100

Abstract The results in 53 knees that had been treated by proximal tibial opening-wedge osteotomy for large varus deformity and osteoarthritis of the medial compartment were evaluated after a mean length of follow-up of ten years (range, 8–12 years). We used a porous beta-tricalcium phosphate (β-TCP) wedge because it is resorbable and osteoinductive. All osteotomies were completely consolidated and complete osseointegration of the remnant of the β-TCP wedge took place. However, after a mean maximum follow-up of ten years none of the cases showed complete resorption. After ten years, 40 (81%) of the 53 knees had an excellent or good result, and in 13 knees there was recurrent pain for which six had an arthroplasty. Although the results deteriorated with time, t...

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Bone Graft Substitutes and Allografts for Reconstruction of the Foot and Ankle

Clinics in Podiatric Medicine and Surgery — Thu, 24 Sep 2009 17:56:49 +0100

In reconstructive foot and ankle surgery, the use of bone graft is common. Whether for trauma, acquired or congenital deformities, arthrodeses, joint replacement, bone loss from infection, or bone tumor resection, the foot and ankle surgeon must be knowledgeable about current bone grafting options to make informed decisions. Innovation and technologic advances have produced an impressive and exciting array of options, advancing us closer to mimicking the gold standard: autograft. However, the sheer volume of available products makes it challenging for the foot and ankle surgeon to stay abreast of current bone graft technology. The purpose of this article is to simplify and classify current bone grafting options, discuss advantages and disadvantages, and provide relevant clinical examples. ...

Biologic Resurfacing of the Ankle and First Metatarsophalangeal Joint: Case Studies with a 2-Year Follow-Up

Clinics in Podiatric Medicine and Surgery — Thu, 24 Sep 2009 17:56:49 +0100

The goal of biologic resurfacing is to provide a smooth joint surface with a low coefficient of friction, which allows the joint to function with near normal biomechanics, as well as provide intermittent pressure, to the subchondral and cancellous bone. This unique combination often results in the formation of a “neocartilage-like” structure that can reduce pain and restore biomechanics. As well as giving a brief history of cutis arthroplasty, this article describes cases in which the ankle and first metatarsophalangeal joint underwent biologic resurfacing, with a 2-year postoperative follow up. (Source: Clinics in Podiatric Medicine and Surgery)

Sports activities after lower limb osteotomy

British Medical Bulletin — Wed, 02 Sep 2009 23:00:00 +0100

Introduction Active sports participation can be important in some patients with degenerative joint disease in the lower limb. We investigated whether this is possible after an osteotomy for osteoarthritis of the hip, knee and ankle joints. Sources of data We performed a literature search using Medline, Cochrane, CINAHL and Google Scholar with no restriction to time period or language using the keywords: ‘osteotomy and sports’. Eleven studies (all level IV evidence) satisfied our inclusion and exclusion criteria. Nine reported on high tibial osteotomies, one on periacetabular osteotomies and one on distal tibial osteotomies. The Coleman Methodology Score to assess the quality of studies showed much heterogeneity in terms of study design, patient characteristics, management meth...

Total ankle replacement in moderate to severe varus deformity of the ankle.

The Journal of Bone and Joint Surgery. British volume — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Kim BS, Choi WJ, Kim YS, Lee JW Our study describes the clinical outcome of total ankle replacement (TAR) performed in patients with moderate to severe varus deformity. Between September 2004 and September 2007, 23 ankles with a varus deformity > or = 10 degrees and 22 with neutral alignment received a TAR. Following specific algorithms according to joint congruency, the varus ankles were managed by various additional procedures simultaneously with TAR. After a mean follow-up of 27 months (12 to 47), the varus ankles improved significantly in all clinical measures (p < 0.0001 for visual analogue scale and American Orthopaedic Foot and Ankle Society score, p = 0.001 for range of movement). No significant differences were found between the varus and neutral groups regardin...

Which Are the Most Frequently Used Outcome Instruments in Studies on Total Ankle Arthroplasty?

Clinical Orthopaedics and Related Research — Tue, 11 Aug 2009 23:00:00 +0100

Authors: Naal FD, Impellizzeri FM, Rippstein PF The number of studies reporting on outcomes after total ankle arthroplasty is continuously increasing. As the use of valid outcome measures represents the cornerstone for successful clinical research, we aimed to identify the most frequently used outcome instruments in ankle arthroplasty studies and to analyze the evidence to support their use in terms of different quality criteria. A systematic review of the literature identified 15 outcome instruments reported in 79 original studies. The most commonly used measures were the American Orthopaedic Foot and Ankle Society hindfoot score (n = 41), the Kofoed ankle score (n = 21), a visual analog scale assessing pain (n = 15), and the generic SF-36 (n = 6). Eight additional instruments were us...

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Conversion of Painful Ankle Arthrodesis to Total Ankle Arthroplasty

JBJS [Am] — Sun, 02 Aug 2009 23:00:00 +0100

(Source: JBJS [Am])

Conversion of Painful Ankle Arthrodesis to Total Ankle Arthroplasty

JBJS [Am] — Sun, 02 Aug 2009 23:00:00 +0100

(Source: JBJS [Am])

Conversion of painful ankle arthrodesis to total ankle arthroplasty.

The Journal of Bone and Joint Surgery. American volume — Fri, 31 Jul 2009 23:00:00 +0100

Authors: Kini SG PMID: 19651973 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Wear behaviour in total ankle replacement: A comparison between an in vitro simulation and retrieved prostheses

Clinical Biomechanics — Wed, 29 Jul 2009 23:00:00 +0100

Abstract: Background: To minimise wear of the meniscal component in total ankle replacement, a three-component artificial joint has recently been developed. This new prosthesis has convex spherical tibial and anticlastic talar metal components with non-anatomic but ligament-compatible shapes in the sagittal plane, and a fully conforming ultra-high-molecular-weight-polyethylene meniscal component inserted in between. The in vitro wear of meniscal components can be assessed using a four-station joint simulator. The study was aimed at comparing wear patterns obtained in vitro with those observed in implant retrievals with the same design.Methods: The wear tests were run in a joint wear simulator at a frequency of 1.1Hz for two million cycles. Three bearings within corresponding metal componen...

Analysis of joint laxity after total ankle arthroplasty: Cadaver study

Clinical Biomechanics — Sun, 26 Jul 2009 23:00:00 +0100

Abstract: Background: Clinical results of total ankle arthroplasty with early designs were disappointing. Recently-developed ankle prostheses have good mid-term results; however, limited information is available regarding effects of total ankle arthroplasty on ankle laxity.Methods: Eight cadaveric lower extremities were tested with a custom device which enabled measurement of multi-axial forces, moments, and displacement during applied axial, shear, and rotational loading. Tests consisted of anterior–posterior and medial–lateral translation and internal–external rotation of the talus relative to the tibia during axial loads on the tibia simulating body weight (700N) and an unloaded condition (5N). Tests were performed in neutral, dorsiflexion, and plantarflexion. Laxity was determine...

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UEMedical plans orthopedics center

Healthcare — Sun, 19 Jul 2009 08:27:17 +0100

Abu Dhabi-based United Eastern Medical (UEMedical) has inked an agreement with New York-based Hospital for Special Surgery (HSS) to establish a regional Centre of Excellence for Orthopedics and Rheumatology in Abu Dhabi. HSS' areas of expertise include joint replacement, spine surgery, sports medicine, orthopedic trauma, hand surgery, foot and ankle surgery and rheumatology. (Source: Healthcare)

How Successful are Current Ankle Replacements?: A Systematic Review of the Literature.

Clinical Orthopaedics and Related Research — Fri, 17 Jul 2009 23:00:00 +0100

Authors: Gougoulias N, Khanna A, Maffulli N Total ankle arthroplasty provides an alternative to arthrodesis for management of ankle arthritis. What is the outcome of total ankle arthroplasty implants currently in use? We conducted a systematic literature search of studies reporting on the outcome of total ankle arthroplasty. We included peer-reviewed studies reporting on at least 20 total ankle arthroplasties with currently used implants, with a minimum followup of 2 years. The Coleman Methodology Score was used to evaluate the quality of the studies. Thirteen Level IV studies of overall good quality reporting on 1105 total ankle arthroplasties (234 Agility, 344 STAR, 153 Buechel-Pappas, 152 HINTEGRA((R)), 98 Salto, 70 TNK, 54 Mobility) were included. Residual pain was common (range, 2...

The Scandinavian Total Ankle Replacement: Survivorship at 5 and 8 Years Comparable to Other Series.

Clinical Orthopaedics and Related Research — Wed, 15 Jul 2009 23:00:00 +0100

Authors: Karantana A, Hobson S, Dhar S Ankle arthroplasty is increasingly used to treat advanced ankle arthritis. Earlier prostheses have given way to second-generation implants, on which we are accumulating medium-term data. The Scandinavian Total Ankle Replacement (STAR) is a three-component uncemented implant in wide use in Europe and the only mobile-bearing prosthesis with conditional approval in the United States. We retrospectively reviewed 45 patients (52 ankles) who had primary total ankle replacements using STAR prostheses, in order to assess survivorship and add to the pool of clinical data provided by independent practitioners required to establish this treatment as a viable alternative to arthrodesis. The minimum followup was 60 months (range, 60-110 months). Clinical outco...

Metabolic cost and mechanical work for the step-to-step transition in walking after successful total ankle arthroplasty.

Human Movement Science — Wed, 08 Jul 2009 23:00:00 +0100

Authors: Doets HC, Vergouw D, Veeger HE, Houdijk H The aim of this study was to investigate whether impaired ankle function after total ankle arthroplasty (TAA) affects the mechanical work during the step-to-step transition and the metabolic cost of walking. Respiratory and force plate data were recorded in 11 patients and 11 healthy controls while they walked barefoot at a fixed walking speed (FWS, 1.25m/s) and at their self-selected speed (SWS). At FWS metabolic cost of transport was 28% higher for the TAA group, but at SWS there was no significant increase. During the step-to-step transition, positive mechanical work generated by the trailing TAA leg was lower and negative mechanical work in the leading intact leg was larger. Despite the increase in mechanical work dissipation durin...

The Use of a Femoral Distractor to Aid Distal Tibial Resection During Total Ankle Arthroplasty

Journal of Foot and Ankle Surgery — Fri, 03 Jul 2009 00:00:00 +0100

We describe the technique below and have now adopted it as a commonplace stage in our ankle replacements. (Source: Journal of Foot and Ankle Surgery)

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The Financial Impact of Orthopaedic Fellowship Training

JBJS [Am] — Tue, 30 Jun 2009 23:00:00 +0100

Conclusions: The financial return of an orthopaedic fellowship varies on the basis of the specialty chosen. While reasons to pursue fellowship training vary widely, and many are not financial, there are positive and negative financial incentives. Therefore, the decision to pursue fellowship training is best if it is not made on the basis of financial incentives. This information may assist policy makers in analyzing medical education economics to ensure the training of orthopaedic surgeons in all specialties and subspecialties. (Source: JBJS [Am])

Severe periprosthetic osteolytic lesions after the Ankle Evolutive System total ankle replacement.

The Journal of Bone and Joint Surgery. British volume — Tue, 30 Jun 2009 23:00:00 +0100

Authors: Koivu H, Kohonen I, Sipola E, Alanen K, Vahlberg T, Tiusanen H Between 2002 and 2008, 130 consecutive ankles were replaced with an hydroxyapatite (HA) and titanium-HA-coated Ankle Evolutive System total ankle prosthesis. Plain radiographs were analysed by two independent observers. Osteolytic lesions were classified by their size and location, with cavities > 10 mm in diameter considered to be 'marked'. CT scanning was undertaken in all patients with marked osteolysis seen on the plain radiographs. Osteolytic lesions were seen on the plain films in 48 (37%) and marked lesions in 27 (21%) ankles. The risk for osteolysis was found to be 3.1 (95% confidence interval 1.6 to 5.9) times higher with implants with Ti-HA porous coating. Care should be taken with ankle arthroplasty u...

The financial impact of orthopaedic fellowship training.

The Journal of Bone and Joint Surgery. American volume — Tue, 30 Jun 2009 23:00:00 +0100

CONCLUSIONS: The financial return of an orthopaedic fellowship varies on the basis of the specialty chosen. While reasons to pursue fellowship training vary widely, and many are not financial, there are positive and negative financial incentives. Therefore, the decision to pursue fellowship training is best if it is not made on the basis of financial incentives. This information may assist policy makers in analyzing medical education economics to ensure the training of orthopaedic surgeons in all specialties and subspecialties. PMID: 19571105 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Relationship between cutting errors and learning curve in computer-assisted total knee replacement

International Orthopaedics — Wed, 10 Jun 2009 10:01:29 +0100

Abstract Computer-assisted total knee replacement (TKR) has been shown to improve radiographic alignment. Continuous feedback from the navigation system allows accurate adjustment of the bone cuts, thus reducing errors. The aim of this study was to determine the impact of experience both with computer navigation and knee replacement surgery on the frequency of errors in intraoperative bone cuts and implant alignment. Three homogeneous patient groups undergoing computer assisted TKR were included in the study. Each group was treated by one of three surgeons with varying experience in computer-aided and knee replacement surgery. Surgeon A had extensive experience in knee replacement and computer-assisted surgery. Surgeon B was an experienced knee replacement surgeon. A gener...

Why Don't All Insurance Plans Cover Ankle Replacements When The FDA Has Approved Them?

Health News from Medical News Today — Sat, 06 Jun 2009 07:00:00 +0100

It's been a decade since the U.S. Food and Drug Administration approved the first total ankle-replacement system for patients with severe ankle arthritis. But several insurance companies still deny coverage, Loyola University Health System orthopaedic surgeon Dr. (Source: Health News from Medical News Today)

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The FDA has approved ankle replacements, so why don't all insurance plans cover them?

EurekAlert! - Social and Behavioral Science — Thu, 04 Jun 2009 04:00:00 +0100

(Loyola University Health System) It's been a decade since the US Food and Drug Administration approved the first total ankle-replacement system for patients with severe ankle arthritis. But several insurance companies still deny coverage, orthopaedic surgeon Dr. Michael Pinzur writes in Foot & Ankle International, the official journal of the American Orthopaedic Foot and Ankle Society. (Source: EurekAlert! - Social and Behavioral Science)

The effect of body mass index on outcomes after total ankle replacement.

Ir Med J — Sun, 31 May 2009 23:00:00 +0100

We report the first series solely focussing on the impact of BMI on TAR. Forty five consecutive patients were identified and followed up using the SF-36 and VAS-FA. All patients had their BMI collected prospectively and BMI at latest follow-up was calculated. There was an average 5-year follow-up with just 9 (20%) lost to follow-up. At final follow-up 8 (17.7%) patients were deceased, none of the deaths were attributable to their previous ankle surgery. We did not find an association between high BMI and reduced outcomes or need for secondary surgery. In addition there was no significant change in BMI after surgery. PMID: 19722359 [PubMed - in process] (Source: Ir Med J)

FDA Approves SBi's S.T.A.R.(R) Total Ankle Replacement System

Health News from Medical News Today — Sun, 31 May 2009 07:00:00 +0100

Small Bone Innovations, Inc. (SBi), a leading provider of innovation, products, technology and education for the small bone & joint segment of the orthopedics industry, announced that the U.S. Food and Drug Administration (FDA) has approved SBi's Scandinavian Total Ankle Replacement (S.T.A.R.®) system to treat U.S. patients. S.T.A.R. (Source: Health News from Medical News Today)

FDA Approves New Total Ankle Replacement System

Health News from Medical News Today — Fri, 29 May 2009 07:00:00 +0100

The U.S. Food and Drug Administration approved a total ankle replacement system for arthritic or deformed ankles that may preserve some range of motion in the joint. The new prosthesis is a mobile-bearing device, which relies on bearings that move across a surface of polyethylene, a flexible plastic. The device is the first of its type. (Source: Health News from Medical News Today)

Ankle Replacement System Lets Feet Move

MedicineNet Chronic Pain General — Fri, 29 May 2009 07:00:00 +0100

Title: Ankle Replacement System Lets Feet MoveCategory: Health NewsCreated: 5/29/2009 7:00:00 AMLast Editorial Review: 5/29/2009 (Source: MedicineNet Chronic Pain General)

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Ankle Replacement System Lets Feet Move

MedicineNet Senior Health General — Fri, 29 May 2009 07:00:00 +0100

Title: Ankle Replacement System Lets Feet MoveCategory: Health NewsCreated: 5/29/2009 7:00:00 AMLast Editorial Review: 5/29/2009 (Source: MedicineNet Senior Health General)

Ankle Replacement System Lets Feet Move

MedicineNet Rheumatoid Arthritis General — Fri, 29 May 2009 07:00:00 +0100

Title: Ankle Replacement System Lets Feet MoveCategory: Health NewsCreated: 5/29/2009 7:00:00 AMLast Editorial Review: 5/29/2009 (Source: MedicineNet Rheumatoid Arthritis General)

FDA Approves New Total Ankle Replacement System

MedlinePlus Health News — Fri, 29 May 2009 04:37:00 +0100

Source: Food and Drug Administration (Source: MedlinePlus Health News)

GAIT analysis in patients operated with a novel total ankle prosthesis

Gait and Posture — Thu, 28 May 2009 23:00:00 +0100

Abstract: A new three-part total ankle prosthesis was designed recently to restore natural joint motion while maintaining full congruity of the articulating surfaces. This was achieved by replicating natural function for the ligaments. Early functional recovery was assessed in the present study in patients who underwent replacement with this prosthesis. This was undertaken using the AOFAS clinical scoring system and gait analysis, performed preoperatively and at 6 and 12 months from surgery. The 10 patients had, at the time of operation, a mean age of 57.4 years (range 45–72), and BMI 25.8 (range 20.4–34.1). A recently proposed protocol for three-dimensional and anatomically based analysis of joint kinematics and kinetics was used. The AOFAS score rose from 44.3 pre-op to 81.5 and 81.0...

FDA Approves First Mobile-Bearing Total Ankle Replacement System

Medscape Today Headlines — Thu, 28 May 2009 16:11:46 +0100

The new total ankle replacement system allows more mobility in the ankle joint compared with other replacement procedures and devices. Medscape Medical News (Source: Medscape Today Headlines)

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FDA Okays Ankle Replacement Device

MedPage Today Product Alert — Thu, 28 May 2009 15:46:11 +0100

WASHINGTON (MedPage Today) -- The FDA has approved a system for replacing ankle joints deformed by arthritis that may preserve a greater range of motion than fusion surgery. (Source: MedPage Today Product Alert)

FDA Approves New Total Ankle Replacement System

Medical Design Online News — Thu, 28 May 2009 03:46:00 +0100

The U.S. Food and Drug Administration recently approved a total ankle replacement system for arthritic or deformed ankles that may preserve some range of motion in the joint. (Source: Medical Design Online News)

FDA Approves New Total Ankle Replacement System

Food and Drug Administration — Wed, 27 May 2009 04:00:00 +0100

The U.S. Food and Drug Administration today approved a total ankle replacement system for arthritic or deformed ankles that may preserve some range of motion in the joint. (Source: Food and Drug Administration)

Elderly women with 'dowager's hump' may be at higher risk of earlier death

UCLA Newsroom: Health Sciences — Thu, 21 May 2009 16:20:00 +0100

This study focused on women, though hyperkyphosis also affects men; measurements for vertebral fractures were based only on height ratios, which could lead to misclassification of other causes of height ratio decreases, such as Scheuermann disease; and the timing of the assessments could have affected the results, though it's unlikely to have made much difference. However, this study demonstrates a possible association between hyperkyphosis and increased risk for earlier death independent of the number and severity of vertebral fractures or osteoporosis in older women, the researchers write. "These results add to the growing literature that suggests that hyperkyphosis is a clinically important finding. Because it is readily observed and is associated with ill health in ol...

Varus Gonarthrosis Predisposes to Varus Malalignment in TKA

HSS Journal — Wed, 20 May 2009 06:25:14 +0100

Abstract Postoperative alignment is a predictor for long-term survival of total knee arthroplasty (TKA). The purpose of this study was to evaluate whether or not preoperative deformities predispose to intraoperative malposition of TKA components. A retrospective radiographic analysis of 53 primary TKA cases was performed. Preoperative AP hip to ankle and lateral knee radiographs were compared with postoperative views to evaluate component positioning. The following angles were measured: the hip–knee–ankle (HKA) angle expressing the mechanical axis of the leg, the mechanical lateral distal femur angle (mLDFA), the medial proximal tibia angle (MPTA), the posterior distal femur angle (PDFA), and the posterior proximal tibia angle (PPTA). Postoperative measurement of the H...

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First Metatarsal Head Osteoarticular Transfer System for Salvage of a Failed Hemicap-Implant: A Case Report

Journal of Foot and Ankle Surgery — Sun, 17 May 2009 23:00:00 +0100

We present a case of a 54-year-old man who presented with a failed hemicap implant of the first metatarsal head. Seven months after his initial implant surgery, the patient was still experiencing pain and limited function despite conservative treatment efforts. In an effort to salvage the joint, an osteoarticular transfer system procedure was undertaken. After removal of the 12-mm hemicap implant, a 15 × 12 mm osteochondral plug was taken from the ipsilateral femoral condyle and press fit into the defect in the first metatarsal head. At 6 weeks postoperatively, complete consolidation of the graft was observed radiographically. By 6 months postoperatively, the patient was able to walk more than 15 miles per week without pain while wearing regular shoes. He was subsequently discharged at 1-...

Survivorship of the bio-action metatarsophalangeal joint arthroplasty for hallux rigidus: 5-year follow-up

Foot and Ankle Surgery — Thu, 14 May 2009 00:00:00 +0100

Discussion: Despite some success in relieving symptoms in patients, we have abandoned this procedure because of the high and increasing rate of failure, as demonstrated both clinically and radiologically. (Source: Foot and Ankle Surgery)

Revision of STAR total ankle replacement to hybrid AES–STAR total ankle replacement—A report of two cases

Foot and Ankle Surgery — Mon, 04 May 2009 00:59:36 +0100

We report early results of two cases in which Scandinavian Total Ankle Replacements (STAR) were revised to hybrid AES (Ankle Evolution System)–STAR replacements for aseptic loosening of the tibial components. We are not aware of any similar case report in the literature reporting hybrid total ankle replacements. (Source: Foot and Ankle Surgery)

Complication Rates Following Open Reduction and Internal Fixation of Ankle Fractures

JBJS [Am] — Fri, 01 May 2009 04:00:00 +0100

Conclusions: By analyzing a large, diverse patient population, the present study clarifies the risks associated with open reduction and internal fixation of ankle fractures. Open injury, diabetes, and peripheral vascular disease were strong risk factors predicting a complicated short-term postoperative course. Fracture type was a strong predictor of reoperation for ankle fusion or replacement. Hospital volume did not play a significant role in the rates of short-term or intermediate-term complications. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

Multicenter Collaboration in Observational Research: Improving Generalizability and Efficiency

JBJS [Am] — Fri, 01 May 2009 04:00:00 +0100

Utilizing a multicenter approach in observational clinical research allows for improved generalizability of the results, a larger sample size, and, consequently, improved efficiency. This paper highlights important issues with regard to the organization of multicenter observational studies in orthopaedic research. Specifically, we emphasize the development of trial committees, stress the importance of having a methods center for the purpose of coordinating day-to-day study activities, and describe the roles of the participating clinical sites. The successful conduct of multicenter studies requires careful study organization, a dedicated and experienced methods center, and motivated participating surgeons and study staff at the clinical sites. To illustrate the organization of a multicenter...

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Qualitative Research: A Review of Methods with Use of Examples from the Total Knee Replacement Literature

JBJS [Am] — Fri, 01 May 2009 04:00:00 +0100

Qualitative research is a useful approach to explore perplexing or complicated clinical situations. Since 1996, at least fifteen qualitative studies in the area of total knee replacement alone were found. Qualitative studies overcome the limits of quantitative work because they can explicate deeper meaning and complexity associated with questions such as why patients decline joint replacement surgery, why they do not adhere to pain medication and exercise regimens, how they manage in the postoperative period, and why providers do not always provide evidence-based care. In this paper, we review the role of qualitative methods in orthopaedic research, using knee osteoarthritis as an illustrative example. Qualitative research questions tend to be inductive, and the stance of the investigator ...

Complication rates following open reduction and internal fixation of ankle fractures.

The Journal of Bone and Joint Surgery. American volume — Thu, 30 Apr 2009 23:00:00 +0100

CONCLUSIONS: By analyzing a large, diverse patient population, the present study clarifies the risks associated with open reduction and internal fixation of ankle fractures. Open injury, diabetes, and peripheral vascular disease were strong risk factors predicting a complicated short-term postoperative course. Fracture type was a strong predictor of reoperation for ankle fusion or replacement. Hospital volume did not play a significant role in the rates of short-term or intermediate-term complications. PMID: 19411451 [PubMed - indexed for MEDLINE] (Source: The Journal of Bone and Joint Surgery. American volume)

Total ankle replacement in patients with significant pre-operative deformity of the hindfoot.

The Journal of Bone and Joint Surgery. British volume — Wed, 01 Apr 2009 04:00:00 +0100

Authors: Hobson SA, Karantana A, Dhar S We carried out 123 consecutive total ankle replacements in 111 patients with a mean follow-up of four years (2 to 8). Patients with a hindfoot deformity of up to 10 degrees (group A, 91 ankles) were compared with those with a deformity of 11 degrees to 30 degrees (group B, 32 ankles). There were 18 failures (14.6%), with no significant difference in survival between groups A and B. The clinical outcome as measured by the post-operative American Orthopaedic Foot and Ankle Surgeons score was significantly better in group B (p = 0.036). There was no difference between the groups regarding the post-operative range of movement and complications. Correction of the hindfoot deformity was achieved to within 5 degrees of neutral in 27 ankles (84%) of grou...

Conversion of painful ankle arthrodesis to total ankle arthroplasty.

The Journal of Bone and Joint Surgery. American volume — Wed, 01 Apr 2009 04:00:00 +0100

CONCLUSIONS: For patients with pain at the site of a failed ankle arthrodesis, conversion to total ankle arthroplasty with the use of a three-component ankle implant is a viable treatment option that provides reliable intermediate-term results. Key factors for the success of this procedure may be the intrinsic coronal plane stability provided by the ankle implants and the use of wider talar implants. PMID: 19339569 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Conversion of Painful Ankle Arthrodesis to Total Ankle Arthroplasty

JBJS [Am] — Wed, 01 Apr 2009 04:00:00 +0100

Conclusions: For patients with pain at the site of a failed ankle arthrodesis, conversion to total ankle arthroplasty with the use of a three-component ankle implant is a viable treatment option that provides reliable intermediate-term results. Key factors for the success of this procedure may be the intrinsic coronal plane stability provided by the ankle implants and the use of wider talar implants. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

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MRI Evaluation of Ankle Distraction: A Preliminary Report

Clinics in Podiatric Medicine and Surgery — Wed, 01 Apr 2009 04:00:00 +0100

Ankle joint distraction has been shown to be a viable alternative to ankle arthrodesis or ankle replacement. The authors' approach to ankle joint preservation includes articulated ankle joint distraction, resection of blocking osteophytes, release of muscle and joint contractures, and realignment osseous ankle procedures. In a previous study that used this technique, 78% of patients maintained their ankle range of motion and had none to occasional moderate pain that could be managed generally with nonsteroid anti-inflammatory drugs alone. The rationale as to why joint distraction is successful is largely unknown. Therefore, the purpose of this study was to evaluate pre- and postoperative ankle MRI scans of patients who underwent hinged ankle joint distraction with external fixation. (Sourc...

Ankle Arthrodiastasis

Clinics in Podiatric Medicine and Surgery — Wed, 01 Apr 2009 04:00:00 +0100

Ankle joint distraction, or arthrodiastasis, has emerged as a viable treatment alternative for recalcitrant ankle arthritis. This joint salvage procedure avoids the potential complications associated with joint arthrodesis or joint arthroplasty in the young patient population typically affected by posttraumatic ankle arthritis. The treatment is predicated on the knowledge that osteoarthritic ankle cartilage is capable of repair. The reparative capacity of the ankle chondrocyte is enhanced through the mechanical offloading of the joint and maintenance of intra-articular fluid pressure changes. Scientific data demonstrate positive biochemical and biomechanical intra-articular changes associated with joint distraction, facilitating an environment for cartilage repair. Clinical studies, althou...

Arthroscopic Ankle Arthrodesis

Clinics in Podiatric Medicine and Surgery — Wed, 01 Apr 2009 04:00:00 +0100

This article reviews the literature on the subject and discusses the procedure's indications and contraindications, and surgical technique. It concludes that while total ankle replacement continues to grow in popularity, arthroscopic ankle arthrodesis is a viable alternative for management of the end-stage arthritic ankle. (Source: Clinics in Podiatric Medicine and Surgery)

Total Ankle Arthroplasty: Indications and Avoiding Complications

Clinics in Podiatric Medicine and Surgery — Wed, 01 Apr 2009 04:00:00 +0100

New designs and a better understanding of kinematics, patient selection, and surgical techniques have lead to a rejuvenated interest in total ankle arthroplasty (TAA). Although improved design has decreased the frequency of revision, the causes and inherent difficulty associated with TAA remain challenging. Surgeon experience and proper patient selection are consistently the most important factors in fostering favorable outcomes. (Source: Clinics in Podiatric Medicine and Surgery)

Job Loss Means Fewer Americans Have Health Care Coverage: How Will The Economic Downturn Affect The Small-Joint Implant Market?

Bones / Orthopaedics News From Medical News Today — Wed, 25 Mar 2009 10:00:00 +0100

According to Millennium Research Group's (MRG's) US Markets for Small-Joint Implants 2009 report, which includes arthroplasty implants (shoulder, elbow, digit, ankle, and wrist) and arthrodesis devices (ankle, digit, and wrist), the double-digit market growth seen in recent years will continue despite the global economic downturn. (Source: Bones / Orthopaedics News From Medical News Today)

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Hyaluronic acid as a treatment for ankle osteoarthritis

Current Reviews in Musculoskeletal Medicine — Fri, 13 Mar 2009 09:45:05 +0100

Abstract Viscosupplementation refers to the concept of synovial fluid replacement with intra-articular injections of hyaluronic acid (HA) for the relief of pain associated with osteoarthritis (OA). Intra-articular viscosupplementation was approved by the Food and Drug Administration (FDA) in 1997. It is currently indicated only for the treatment of pain associated with knee OA. However, OA can occur in several of the weight-bearing joints of the foot and ankle. Ankle OA produces chronic disability that directly impacts the quality of life. There is only limited published literature relating to the use of HA in the ankle. This paper will review the authors’ experience, indications, clinical outcomes, and complications of viscosupplementation therapy in patients with ankle...

SBi's S.T.A.R. Total Ankle Replacement System Receives FDA Approvable Letter

Health News from Medical News Today — Fri, 06 Mar 2009 10:00:00 +0100

Small Bone Innovations, Inc. (SBi), a single-source provider of innovation, products, technology and education for the small bone & joint sector of the orthopedics industry, announced today that an 'Approvable Letter' has been received from the U.S. Food and Drug Administration (FDA) for the Scandinavian Total Ankle Replacement system (S.T.A.R. Ankle). (Source: Health News from Medical News Today)

History and evolution in total ankle arthroplasty

British Medical Bulletin — Mon, 02 Mar 2009 05:00:00 +0100

Conclusions Results show that ankle arthroplasty is a viable alternative for the management of ankle arthritis in selected patients. (Source: British Medical Bulletin)

Realignment surgery for valgus ankle osteoarthritis.

Operative Orthopadie und Traumatologie — Sun, 01 Mar 2009 05:00:00 +0100

Authors: Pagenstert G, Knupp M, Valderrabano V, Hintermann B OBJECTIVE: Improvement of joint congruence, reduction of pain, slowdown of osteoarthritis progression, and prevention or delay of total ankle arthroplasty or ankle fusion. INDICATIONS: Active patients with lateral valgus ankle joint degeneration. CONTRAINDICATIONS: Patients in poor general condition. Inability to adhere to postoperative non-weight-bearing rehabilitation. Distinct cartilage degeneration of more than half of tibiotalar joint surface. Systemic joint disease. Insufficiency of the deltoid ligament with tibiotalar subluxation malalignment. SURGICAL TECHNIQUE: Depending on stage of deformity: Stage I--collapse of the lateral tibia plafond and/or lateral malleolar gutter with subsequent valgus ankle arthritis: medial...

Surgical Management of Hallux Rigidus: Cheilectomy and Osteotomy (Phalanx and Metatarsal)

Foot and Ankle Clinics — Sun, 01 Mar 2009 05:00:00 +0100

Cheilectomy has long been the standard treatment in the orthopedic community for mild to moderate cases of hallux rigidus, with established long-term excellent results. Osteotomies of the proximal phalanx and first metatarsal have been described mainly in the podiatric literature; they have shown good outcomes in small patient groups with short-term follow-up. Proper patient selection is critical to obtaining favorable outcomes with any of the joint-sparing procedures. Patients with severe arthritic changes and pain in the midrange arc of motion have poorer outcomes with these procedures and are better served with joint-destructive procedures, such as arthroplasty or arthrodesis. (Source: Foot and Ankle Clinics)

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Hallux Rigidus: Surgical Treatment with the Crescentic Oblique Basilar Resection Arthroplasty (COBRA)

Foot and Ankle Clinics — Sun, 01 Mar 2009 05:00:00 +0100

The treatment of advanced hallux rigidus in an older, more sedentary population with poor bone stock or comorbidities that may make corrective osteotomy, fusion, and implant fixation more problematic has frequently been an issue for orthopedic surgeons. The traditional Keller resection arthroplasty has not fared well because of various problems. Crescentic oblique basilar resection arthroplasty is a viable surgical treatment alternative for older, more sedentary patients who have advanced hallux rigidus with or without hallux valgus. This may also be a good alternative procedure in a more active patient who wishes to avoid fusion of the joint while maintaining some first MTP motion. (Source: Foot and Ankle Clinics)

Hallux Rigidus: MTP Implant Arthroplasty

Foot and Ankle Clinics — Sun, 01 Mar 2009 05:00:00 +0100

This article discusses various implant options along with clinical outcomes and complications. (Source: Foot and Ankle Clinics)

Conventional knee films hamper accurate knee alignment determination in patients with varus osteoarthritis of the knee

The Knee — Sun, 01 Mar 2009 05:00:00 +0100

Abstract: Surgical therapeutic procedures such as knee osteotomy and knee replacement depend on proper knee alignment assessment. The aim of this study was to evaluate if femorotibial (FT) measurement on short knee films may be used in clinical settings. The study population comprised 68 patients with symptomatic medial compartmental knee osteoarthritis. We measured the FT angle with the use of mid-diaphyseal lines (FTa), and the knee joint centre (FTb) to determine anatomical knee alignment on a short knee image. Then, the accuracy of alignment was compared to the gold standard Hip–Knee–Ankle (HKA) angle on a full-limb view. FTa angle assessment correlated well (r=0.65) with the HKA angle. However, this method showed poor inter-observer agreement (ICC=0.37). 3% of patients were incorr...

Meta-analysis of First Metatarsophalangeal Joint Implant Arthroplasty

Journal of Foot and Ankle Surgery — Sun, 01 Mar 2009 05:00:00 +0100

Management of late-stage degenerative joint disease of the first metatarsophalangeal joint (MPJ) is a complex topic that is frequently the source of debate among foot and ankle surgeons. Several surgical interventions have been described to treat this condition. One of the most contested of these treatments is implant arthroplasty of the first MPJ.The primary aim of this meta-analysis was to evaluate the clinical benefit of first MPJ implant arthroplasty in regard to patient satisfaction. Reviewers formally trained in meta-analysis abstraction techniques searched databases and indices using medical subject heading terms and other methods to identify all relevant studies published since 1990. Initially, 3874 citations were identified and evaluated for relevance. Abstract screening produced ...

Delivery May Affect Arterial Elasticity in Women.

Circulation Journal — Tue, 17 Feb 2009 05:00:00 +0100

Conclusions: Pregnancy followed by delivery may decrease arterial stiffness and prevent the progress of atherosclerosis in women. The contribution of such a pregnancy followed by delivery-related decrease in arterial stiffness to the reduction of cardiovascular disease in women should be further evaluated. PMID: 19225209 [PubMed - as supplied by publisher] (Source: Circulation Journal)

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Small Bone Innovations, Inc. Completes Acquisition Of S.T.A.R. Total Ankle Replacement System

Medical Design Online News — Tue, 03 Feb 2009 16:06:00 +0100

Small Bone Innovations, Inc. (SBi), a single-source provider of innovation, products, technology and education for the small bone & joint sector of the orthopedics industry, announced recently that it has completed the acquisition of Link America, Inc., d/b/a Link Orthopaedics, The Scandinavian Total Ankle Replacement system, known as the 'S.T.A.R. Ankle', and certain assets related to the S.T.A.R. Ankle from DERU GmbH and Waldemar Link GmbH & Co. KG of Hamburg, Germany ('Waldemar Link') (Source: Medical Design Online News)

Unicompartmental knee arthroplasty with use of novel patient-specific resurfacing implants and personalized jigs.

The Journal of Bone and Joint Surgery. American volume — Sun, 01 Feb 2009 05:00:00 +0100

Authors: Fitz W This paper describes the surgical technique with a patient-specific resurfacing unicompartmental knee arthroplasty. The patient-specific implant is currently designed on the basis of data from preoperative computed tomography. The implant is provided with a set of patient-specific, disposable cutting jigs. Biomechanical and anatomic axes are factored into jigs from a scan obtained through the hip, knee, and ankle, effectively achieving pre-navigation of the cut planes without the need for a navigation system. The surgical technique is reduced to five simple, reproducible steps. After removing the articular cartilage, the knee is balanced to determine the correct amount of tibial resection; this is followed by femoral preparation, verification of balancing and tibial pre...

Unicompartmental Knee Arthroplasty with Use of Novel Patient-Specific Resurfacing Implants and Personalized Jigs

JBJS [Am] — Fri, 30 Jan 2009 05:00:00 +0100

This paper describes the surgical technique with a patient-specific resurfacing unicompartmental knee arthroplasty. The patient-specific implant is currently designed on the basis of data from preoperative computed tomography. The implant is provided with a set of patient-specific, disposable cutting jigs. Biomechanical and anatomic axes are factored into jigs from a scan obtained through the hip, knee, and ankle, effectively achieving pre-navigation of the cut planes without the need for a navigation system. The surgical technique is reduced to five simple, reproducible steps. After removing the articular cartilage, the knee is balanced to determine the correct amount of tibial resection; this is followed by femoral preparation, verification of balancing and tibial preparation, and trial ...

Habitual Physical Activity and Sports Participation After Total Ankle Arthroplasty

The American Journal of Sports Medicine — Fri, 02 Jan 2009 05:00:00 +0100

Conclusion Two-thirds of the patients were active in sports after total ankle arthroplasty, and the majority of the patients met current health-enhancing physical activity recommendations. The clinical outcome as determined by AOFAS scores and the patient satisfaction were favorable. The present study found no association between sports participation, increased physical activity levels, and the appearance of periprosthetic radiolucencies 3.7 years after total ankle arthroplasty. However, these results have to be confirmed after longer follow-up, in particular of those patients regularly participating in sports with higher impact. (Source: The American Journal of Sports Medicine)

Habitual Physical Activity and Sports Participation After Total Ankle Arthroplasty

The American Journal of Sports Medicine — Fri, 02 Jan 2009 05:00:00 +0100

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Pan–Metatarsophalangeal Joint Arthrodesis for the Severe Rheumatoid Forefoot Deformity

Clinics in Podiatric Medicine and Surgery — Thu, 01 Jan 2009 05:00:00 +0100

The standard approach for correction of severe painful rheumatoid forefoot deformities has involved resection of the metatarsal heads with realignment of the lesser toe deformities and first metatarsophalangeal joint (MTPJ) arthrodesis. Modifications of this procedure may include a pan–metatarsal head resection, including the first metatarsal head, or resection of the lesser metatarsal heads in conjunction with an interpositional arthroplasty of the first MTPJ. The authors describe a novel surgical approach that involves the correction of severe rheumatoid forefoot deformities through a pan-MTPJ arthrodesis. Arthrodesis of all five MTPJs for the surgical treatment of the painful rheumatoid forefoot deformity with chronic plantar callosities and dislocated digits has yet to be reported in...

A randomised, controlled trial of two mobile-bearing total ankle replacements.

The Journal of Bone and Joint Surgery. British volume — Sat, 20 Dec 2008 19:54:21 +0100

We describe the results of a randomised, prospective study of 200 ankle replacements carried out between March 2000 and July 2003 at a single centre to compare the Buechel-Pappas (BP) and the Scandinavian Total Ankle Replacement (STAR) implant with a minimum follow-up of 36 months. The two prostheses were similar in design consisting of three components with a meniscal polyethylene bearing which was highly congruent on its planar tibial surface and on its curved talar surface. However, the designs were markedly different with respect to the geometry of the articular surface of the talus and its overall shape. A total of 16 ankles (18%) was revised, of which 12 were from the BP group and four of the STAR group. The six-year survivorship of the BP design was 79% (95% confidence interval (CI)...

Calcaneus replacement after total calcanectomy via vascularized pelvis bone.

Critical Care Clinics — Thu, 18 Dec 2008 07:22:28 +0100

We report a case of calcaneus replacement by vascularized iliac crest bone. PMID: 19083646 [PubMed - in process] (Source: Critical Care Clinics)

Controlling balance decline across the menopause using a balance-strategy training program: a randomized, controlled trial.

Climacteric — Thu, 04 Dec 2008 05:00:00 +0100

Conclusion These results provide evidence that this physiotherapist-designed program preserves/reverses the balance decline associated with age and leads to adoption of a more active lifestyle. PMID: 19058060 [PubMed - as supplied by publisher] (Source: Climacteric)

Shapiro family donates $2M to establish two chairs at Geffen School of Medicine

UCLA Newsroom: Health Sciences — Wed, 03 Dec 2008 08:00:00 +0100

The Shapiro Family Charitable Foundation has pledged $2 million to The UCLA Foundation to fund two endowed chairs, both of which will greatly enhance the research, teaching, patient care and public service mission of the David Geffen School of Medicine at UCLA. The endowed Shapiro Family Chair in Child Development Studies and Cerebral Palsy, funded by a $1 million endowment, will support the teaching and research activities of a distinguished faculty member in the department of pediatrics who is dedicated to improving outcomes for children with developmental and behavioral problems. Examples would include working with children who have cerebral palsy, those who have parents with substance abuse problems and those who have experienced environmental deprivation. Studies will evaluat...

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[Two Cases of Vancomycin-intermediate Staphylococcus aureus Isolated from Joint Tissue or Wound.]

The Korean Journal of Laboratory Medicine — Mon, 01 Dec 2008 05:00:00 +0100

Authors: Hong KH, Park JS, Kim EC Since its first isolation in 1997, vancomycin-intermediate Staphylococcus aureus (VISA) has been a clinical concern because it may lead to treatment failure. Up to the present, there were two reports of clinical VISA cases in Korea. We now report two additional cases of VISA with the minimum inhibitory concentration (MIC) of 4 microg/mL. The first patient was a 59 yr-old man who had undergone total hip replacement arthroplasty in 1999 due to avascular necrosis of femur heads. He had recurrent episodes of infected hip caused by methicillin-resistant Staphylococcus aureus (MRSA) and was treated with vancomycin. He underwent replacement operation of prosthesis. Cultures of joint fluid and joint tissue grew S. aureus. Vancomycin MIC as determined by a brot...

[Two cases of vancomycin-intermediate Staphylococcus aureus isolated from joint tissue or wound]

The Korean Journal of Laboratory Medicine — Mon, 01 Dec 2008 05:00:00 +0100

Second toe proximal phalanx interposition bone graft to correct a failed Keller's arthroplasty. A new technique

Foot and Ankle Surgery — Fri, 14 Nov 2008 00:00:00 +0100

We present a case report of a novel salvage technique for a failed Keller's arthroplasty using nonvascularised phalanx transfer from the second toe to the hallux on the same foot. The technique restores length, function and relieves pain. (Source: Foot and Ankle Surgery)

Good ankle prostheses survival rates reported in RA patients

MedWire News - Bone Health — Wed, 05 Nov 2008 18:20:48 +0100

A long-term follow-up study of rheumatoid arthritis patients with a total ankle replacement has shown a good prosthesis survival rate. (Source: MedWire News - Bone Health)

The incidence of symptomatic venous thromboembolic events in orthopaedic surgery when using routine thromboprophylaxis.

VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases — Sat, 01 Nov 2008 04:00:00 +0100

Conclusions: When using routine thrombopropylaxis with LMWH in orthopaedic surgery the rate of symptomatic VTE is low. PMID: 19003746 [PubMed - in process] (Source: VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases)

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Postoperative imaging of the total ankle arthroplasty.

Radiologic Clinics of North America — Sat, 01 Nov 2008 04:00:00 +0100

Authors: Bestic JM, Bancroft LW, Peterson JJ, Kransdorf MJ Promising results reported with currently available total ankle arthroplasty designs have led to an increased use of such devices as an alternative to ankle arthrodesis. Despite recent improvements in implant design and surgical technique, complications associated total ankle arthroplasty devices continue to be reported. Postoperative evaluation of total ankle arthroplasties relies on a combination of clinical and radiologic assessment. Familiarity with commonly used current total ankle arthroplasty devices and appropriate postoperative imaging techniques is imperative for effective characterization of the expected postoperative imaging appearances of such devices and facilitating detection of potential postoperative complicati...

Is there a need of custom-made prostheses for total hip arthroplasty? Gait analysis, clinical and radiographic analysis of customized femoral components

Archives of Orthopaedic and Trauma Surgery — Fri, 31 Oct 2008 07:20:13 +0100

Conclusion Compared to a conventional cementless hip prosthesis the custom-made device did not improve the mid-term clinical and radiographic outcome. Despite the individualized reconstruction of the biomechanical hip geometry objective gait analysis failed to show a benefit. Content Type Journal ArticleCategory Orthopaedic Outcome AssessmentDOI 10.1007/s00402-008-0717-4Authors Christian Götze, University Hospital of Muenster Department of Orthopaedics Albert-Schweitzer-Str. 33 48149 Muenster GermanyDieter Rosenbaum, University Hospital of Muenster Department of Orthopaedics Albert-Schweitzer-Str. 33 48149 Muenster GermanyJan Hoedemaker, University Hospital of Muenster Department of Orthopaedics Albert-Schweitzer-Str. 33 48149 Muenster GermanyFriedrich Bottner, Unive...

The effects of total ankle replacement on gait disability: Analysis of energetic and mechanical variables.

Gait and Posture — Fri, 31 Oct 2008 04:00:00 +0100

CONCLUSIONS: Many studies have shown that improved clinical outcomes can be expected with the new generation of prostheses and this was as confirmed by our study. However, no previous study has investigated the effect of TAR on the functional limitations of gait as represented by mechanical and energetic variables. PMID: 18977660 [PubMed - as supplied by publisher] (Source: Gait and Posture)

Long-term follow-up on 33 TPR ankle joint replacements in 26 patients with rheumatoid arthritis

Foot and Ankle Surgery — Mon, 27 Oct 2008 00:00:00 +0100

Conclusions: The long-term survival of this first generation type of TAR adds some optimism to the development of TAR. (Source: Foot and Ankle Surgery)

Three-dimensional Analysis of Computed Tomography–Based Navigation System for Total Knee Arthroplasty: The Accuracy of Computed Tomography–Based Navigation System

The Journal of Arthroplasty — Thu, 09 Oct 2008 23:00:00 +0100

Abstract: We evaluated the postoperative alignment of 37 primary total knee arthroplasties performed using a computed tomography–based navigation system (Vector Vision Knee 1.5; Brain Lab, Germany) with a new 3-dimensional analysis. The mean coronal femoral angle was 89.0° ± 1.4° (85.5°-92.8°), and the coronal tibial component was 89.2° ± 1.0° (87.4°-91.6°). The hip-knee-ankle angle was observed to be 178.2° ± 1.5° (173.9°-181.8°). The external rotational alignment of the femoral component relative to the surgical epicondylar axis was −0.5° ± 1.7° (−3.2° to 3.4°). The results demonstrated that a computed tomography–based navigation system provided a reasonably satisfactory component alignment. The discrepancy between the 2-dimensional and 3-dimensional evaluatio...

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What Medications Are Recommended for Adolescents Who Are Quitting Smoking?

PediatricEducation.org — Tue, 07 Oct 2008 12:43:17 +0100

Discussion Tobacco use is a pediatric problem. In 2006, ~3.3 million adolescents between 12-17 years currently used tobacco products and 2.6 million were current cigarette smokers. Each day, ~ 4,000 adolescents and children < 18 years of age smoke their first cigarette. Unfortunately, nicotine dependence is established rapidly and many children and adolescents go on to continue to smoke. Counseling helps adolescents quit and continue to remain abstinent. Adolescents enrolled in tobacco cessation programs are 2 times more likely to quit and remain abstinent. Pediatric health care providers should discuss parental smoking as well as part of routine care, as children and adolescents benefit because of decreased second hand smoking exposure. Treatment of patients willing to quit consist...

Salto Talaris Total Ankle Replacement

Operative Techniques in Orthopaedics — Wed, 01 Oct 2008 04:00:00 +0100

This article aims to describes the surgical technique for the Salto Talaris total ankle replacement. (Source: Operative Techniques in Orthopaedics)

Correction of Varus Talar Deformities in Ankle Joint Replacement

Operative Techniques in Orthopaedics — Wed, 01 Oct 2008 04:00:00 +0100

This article reviews 32 patients with a varus talar deformity of >10°, who underwent a total ankle replacement. Of the 32 ankles, 15 had a varus talar deformity of >15°. The importance of appropriate preoperative assessment and a stepwise intraoperative approach is described in detail. With an average follow-up of 17 months, a satisfactory radiographic correction was obtained in 94% (30/32) of the ankles. It is noted that 75% (24/32) of patients required ancillary procedures after ankle replacement to obtain a plantigrade foot. This review will demonstrate that correction of moderate to severe varus talar deformities is possible when considering a total ankle replacement for the management of end-stage ankle arthritis. (Source: Operative Techniques in Orthopaedics)

[Clinical and epidemiological research] Orthopaedic surgery in patients with rheumatoid arthritis over 20 years: prevalence and predictive factors of large joint replacement

Annals of the Rheumatic Diseases — Fri, 12 Sep 2008 04:00:00 +0100

Conclusion: In this cohort of patients with RA monitored from early disease stage, orthopaedic surgical procedures were performed in more than half of the patients. This included first large joint replacements in 24% of the cases. Easily available measures were identified as predictors of such joint replacements. This study could serve as a reference for comparison with cohorts of patients with RA recruited today, in which new more efficacious treatments are used. (Source: Annals of the Rheumatic Diseases)

Orthopaedic and Rehabilitation Devices Panel Advisory Meeting, April 24, 2007 - Minutes

Food and Drug Adminstration (FDA): CDRHNew — Thu, 04 Sep 2008 04:00:00 +0100

The committee will discuss, make recommendations and vote on a premarket approval application (PMA) for the Scandinavian Total Ankle Replacement System, sponsored by Link America, Inc. This system is intended for use as a non-cemented implant to repl... (Source: Food and Drug Adminstration (FDA): CDRHNew)

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"Surgery Is Certainly One Good Option": Quality and Time-Efficiency of Informed Decision-Making in Surgery

JBJS [Am] — Mon, 01 Sep 2008 04:00:00 +0100

Conclusions: In this study, which we believe is the first to focus on informed decision-making in orthopaedic surgical practice, we found opportunities for improvement but we also found that excellent informed decision-making is feasible and can be accomplished in a time-efficient manner. (Source: JBJS [Am])

Quadriceps-Sparing, Minimal-Incision Total Knee Arthroplasty: A Comparative Study

The Journal of Arthroplasty — Sun, 31 Aug 2008 23:00:00 +0100

Abstract: Our study was conducted to compare radiographic alignments and functional outcomes with 2 approaches to minimal-incision total knee arthroplasty (TKA): the minimal-incision medial parapatellar (MP) approach and the quadriceps-sparing (QS) approach with side-cutting instruments. Sixty patients (80 knees) with primary osteoarthritis were randomly assigned to receive MP or QS TKA. Postoperative alignment of the femoral component was significantly less valgus, and postoperative alignment of the tibial component was significantly more varus with the QS approach than with the MP approach. One tibial outlier and 3 femoral outliers were observed with QS TKA. The overall postoperative hip-knee-ankle axis was more varus, and surgical time was longer with QS TKA. Short-term isokinetic peak ...

Arthroscopic Treatment of Chronic Osteochondral Lesions of the Talus: Long-term Results

The American Journal of Sports Medicine — Wed, 27 Aug 2008 04:00:00 +0100

Conclusion: Arthroscopic treatment of chronic symptomatic osteochondral lesions of the talus results in good clinical outcomes in the majority of patients. However, pain and functional limitation may persist in some patients, especially those noted to have unstable osteochondral defects at the time of arthroscopy. (Source: The American Journal of Sports Medicine)

Risk Factor Treatment in Veteran Women at Risk for Cardiovascular Disease1

Journal of Surgical Research — Tue, 26 Aug 2008 00:00:00 +0100

Conclusions: Our findings show a high prevalence of CVD risk factors and low knowledge levels among ambulatory veteran women. There is a need for improvement in recognition and aggressive management of CVD risk factors, including the use of noninvasive studies as surrogate markers for early diagnosis. Continued efforts to educate women and providers about CVD risk factors, heart-healthy behaviors, screening, and treatment are vital to improve the current state of women's health and decrease future adverse cardiac event rates. (Source: Journal of Surgical Research)

Cardiac troponin T predicts occult coronary artery stenosis in patients with chronic kidney disease at the start of renal replacement therapy

Nephrology Dialysis Transplantation — Mon, 18 Aug 2008 04:00:00 +0100

Conclusion. We concluded that cTnT should be measured as part of a strategy for detecting asymptomatic CAS, especially multi-vessel disease in patients with CKD at the start of RRT. (Source: Nephrology Dialysis Transplantation)

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Shape of the joint gap for 90° and 120° knee flexion after total knee arthroplasty

Journal of Orthopaedic Science — Tue, 12 Aug 2008 07:36:23 +0100

Conclusions The joint gap was trapezoidal with a wider lateral side at 120° flexion even though it was almost rectangular at 90° flexion after TKA. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00776-008-1247-1Authors Ryuji Nagamine, Yoshizuka Hayashi Hospital Department of Orthopaedic Surgery 7-6-29 Yoshizuka, Hakata-ku Fukuoka 812-0041 JapanKeiichi Kondo, Yoshizuka Hayashi Hospital Department of Orthopaedic Surgery 7-6-29 Yoshizuka, Hakata-ku Fukuoka 812-0041 JapanHiroshi Nomura, Yoshizuka Hayashi Hospital Department of Orthopaedic Surgery 7-6-29 Yoshizuka, Hakata-ku Fukuoka 812-0041 JapanKoichi Kanekasu, Saiseikai Takaoka Hospital Department of Orthopaedic Surgery Takaoka JapanMotoki Sonohata, Saga University Hospital Department of Orthopaedic ...

Bi-unicompartmental versus total knee arthroplasty: a matched paired study with early clinical results

Archives of Orthopaedic and Trauma Surgery — Tue, 12 Aug 2008 07:28:55 +0100

Conclusions The results of this 48 months follow-up study suggest that Bi-UKR is a viable option for bicompartmental tibio-femoral arthritis at least as well as TKR but maintaining a higher level of function. Content Type Journal ArticleCategory Orthopaedic SurgeryDOI 10.1007/s00402-008-0713-8Authors N. Confalonieri, C.T.O. Hospital, Istituti Clinici di Perfezionamento Ist Orthopaedic Department Milan ItalyA. Manzotti, C.T.O. Hospital, Istituti Clinici di Perfezionamento Ist Orthopaedic Department Milan ItalyP. Cerveri, Politecnico di Milano Bioengineering Department Milan ItalyE. De Momi, Politecnico di Milano Bioengineering Department Milan Italy Journal Archives of Orthopaedic and Trauma SurgeryOnline ISSN 1434-3916Print ISSN 0936-8051 (Source: Archives ...

Successful Management of Foot Drop by Nerve Transfers to the Deep Peroneal Nerve

Journal of Reconstructive Microsurgery — Tue, 05 Aug 2008 00:54:11 +0100

We present an alternative strategy for reanimation of foot drop following deep peroneal nerve palsy, successfully restoring voluntary movement. Fourteen consecutive patients with deep peroneal nerve injuries resulting in foot drop underwent nerve transfer of functional fascicles of either the superficial peroneal nerve or of the tibial nerve as donor for deep peroneal-innervated muscle groups. Eleven cases had successful restoration of British motor grade 3+ to 4+/5 ankle dorsiflexion, one case had restoration of grade 3 ankle dorsiflexion, and two cases had no restoration of dorsiflexion. Nerve transfer to the deep peroneal nerve is a feasible and effective method of treating deep peroneal nerve injuries of less than 1-year duration.[...]© Thieme Medical PublishersGet connected:Table of ...

Computer-assisted and conventional total knee replacement: A COMPARATIVE, PROSPECTIVE, RANDOMISED STUDY WITH RADIOLOGICAL AND CT EVALUATION.

The Journal of Bone and Joint Surgery. British volume — Fri, 01 Aug 2008 04:00:00 +0100

Authors: Lützner J, Krummenauer F, Wolf C, Günther KP, Kirschner S After obtaining informed consent, 80 patients were randomised to undergo a navigated or conventional total knee replacement. All received a cemented, unconstrained, cruciate-retaining implant with a rotating platform. Full-length standing and lateral radiographs and CT scans of the hip, knee and ankle joint were carried out five to seven days after operation. No notable differences were found between computer-assisted navigation and conventional implantation techniques as regards the rotational alignment of the femoral or tibial components. Although the deviation from the transepicondylar axis was relatively low, there was a considerable range of deviation for the tibial rotational alignment. There was no stat...

The evaluation of post-operative alignment in total knee replacement using a CT-based navigation system.

The Journal of Bone and Joint Surgery. British volume — Fri, 01 Aug 2008 04:00:00 +0100

Authors: Mizu-Uchi H, Matsuda S, Miura H, Okazaki K, Akasaki Y, Iwamoto Y We compared the alignment of 39 total knee replacements implanted using the conventional alignment guide system with 37 implanted using a CT-based navigation system, performed by a single surgeon. The knees were evaluated using full-length weight-bearing anteroposterior radiographs, lateral radiographs and CT scans. The mean hip-knee-ankle angle, coronal femoral component angle and coronal tibial component angle were 181.8 degrees (174.2 degrees to 188.3 degrees ), 88.5 degrees (84.0 degrees to 91.8 degrees ) and 89.7 degrees (86.3 degrees to 95.1 degrees ), respectively for the conventional group and 180.8 degrees (178.2 degrees to 185.1 degrees ), 89.3 degrees (85.8 degrees to 92.0 degrees ) and 89.9 degrees (8...

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[Short-term results after STAR total ankle replacement.]

Der Orthopade — Wed, 16 Jul 2008 04:00:00 +0100

CONCLUSION: The early results after implantation of the STAR ankle prosthesis are encouraging. With correct indication, a high rate of pain reduction and patient satisfaction can be achieved. The long-term benefit of this procedure has yet to be determined. PMID: 18629468 [PubMed - as supplied by publisher] (Source: Der Orthopade)

Ankle surgery in haemophilia with special emphasis on arthroscopic debridement

Haemophilia — Mon, 14 Jul 2008 04:00:00 +0100

Summary. Various conservative options are available to treat ankle problems in haemophilia, which achieve a high rate of satisfactory results in the majority of cases. They are usually employed in combination and include the use of patellar tendon bearing (PTB) orthoses and radiosynoviorthesis. The effect of the PTB orthoses is that it allows the patient to walk without weight bearing of the ankle. Radiosynoviorthesis can be performed in cases of haemophilic arthropathy of the ankle, provided there is at least a minimal degree of synovitis within the joint, with a 75% of satisfactory results. If the conservative options fail, surgical intervention can be indicated. Alternatives to total ankle arthroplasty or arthrodesis include arthroscopic debridement, removal of osteophytes of the anteri...

A technique of fusion for failed total replacement of the ankle: TIBIO-ALLOGRAFT-CALCANEAL FUSION WITH A LOCKED RETROGRADE INTRAMEDULLARY NAIL.

The Journal of Bone and Joint Surgery. British volume — Tue, 01 Jul 2008 04:00:00 +0100

We describe a technique for restoring talar height using an allograft from the femoral head compressed by an intramedullary nail. Three patients with aseptic loosening were treated successfully by this method with excellent symptomatic relief at a mean follow-up of 32 months (13 to 50). PMID: 18591597 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)

Total Ankle Replacement With No Metal

ScienceDaily Headlines — Mon, 30 Jun 2008 07:19:33 +0100

Patients suffering from severe arthritis now have an option for total ankle replacement that offers increased mobility and pain relief without permanent metal implants. This technique is the first in the U.S to offer arthritis sufferers a non-metal, biological ankle replacement. (Source: ScienceDaily Headlines)

Total Ankle Replacement With No Metal

Bones / Orthopaedics News From Medical News Today — Wed, 25 Jun 2008 09:00:00 +0100

Patients suffering from severe arthritis now have an option for total ankle replacement that offers increased mobility and pain relief without permanent metal implants. Pioneered by Daniel K. Lee, D.P.M., F.A.C.F.A.S., at UC San Diego Medical Center, this technique is the first in the U.S to offer arthritis sufferers a non-metal, biological ankle replacement. (Source: Bones / Orthopaedics News From Medical News Today)

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Comparison between resection arthroplasty alone and resection arthroplasty with arthrodesis of the first MTP joint for rheumatoid forefoot deformities

Modern Rheumatology — Mon, 23 Jun 2008 05:32:09 +0100

In this report, we compare the clinical and radiological outcomes of resection arthroplasty alone (the first method) and resection arthroplasty with arthrodesis of the first MTP joint (the second method) for the treatment of forefoot deformities of RA patients. On clinical assessment, the American Orthopaedic Foot and Ankle Society (AOFAS) scale score significantly improved in both methods; however, the second method gave better results than the first method in relation to the footwear and alignment components. On radiographic assessment, in the first method there were no significant changes in the valgus angle (H–V angle) and the fifth metatarsal bone (M1/5) angle between preoperation and last follow-up. In contrast, these angles were decreased in the second method. One of the mos...

Hospital Characteristics Associated with Success in a Pay-for-Performance Program in Orthopaedic Surgery

JBJS [Am] — Sun, 01 Jun 2008 04:00:00 +0100

Conclusions: Teaching hospitals that perform a high volume of hip and knee replacements will tend to succeed should pay-for-performance programs be enacted nationwide. (Source: JBJS [Am])

Total Ankle Replacement

Medical Headlines From Ivanhoe.com — Wed, 28 May 2008 05:00:00 +0100

One-point-three million Americans live with rheumatoid arthritis. (Source: Medical Headlines From Ivanhoe.com)

Spare the Joint, Spoil the Surgery

dukehealth.org: Health Features — Fri, 16 May 2008 00:57:11 +0100

Duke joint expert notes a few ways to avoid the path to ankle replacement surgery (Source: dukehealth.org: Health Features)

Get the Facts: Ankle Replacement Surgery

dukehealth.org: Health Features — Fri, 16 May 2008 00:55:57 +0100

Duke orthopaedic surgeon James DeOrio, MD, untangles a few misconceptions about ankle replacement surgery. (Source: dukehealth.org: Health Features)

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All About Ankles

dukehealth.org: Health Features — Fri, 16 May 2008 00:54:49 +0100

Duke specialists in joint replacement discuss the advances in ankle replacement therapy (Source: dukehealth.org: Health Features)

Total ankle replacement: MEDIUM-TERM RESULTS IN 200 SCANDINAVIAN TOTAL ANKLE REPLACEMENTS.

The Journal of Bone and Joint Surgery. British volume — Thu, 01 May 2008 04:00:00 +0100

We describe the medium-term results of a prospective study of 200 total ankle replacements at a single-centre using the Scandinavian Total Ankle Replacement. A total of 24 ankles (12%) have been revised, 20 by fusion and four by further replacement and 27 patients (33 ankles) have died. All the surviving patients were seen at a minimum of five years after operation. The five-year survival was 93.3% (95% confidence interval (CI) 89.8 to 96.8) and the ten-year survival 80.3% (95% CI 71.0 to 89.6). Anterior subluxation of the talus, often seen on the lateral radiograph in osteoarthritic ankles, was corrected and, in most instances, the anatomical alignment was restored by total ankle replacement. The orientation of the tibial component, as seen on the lateral radiograph, also affects the posi...

In vivo three-dimensional kinematics of the normal knee during active extension under unloaded and loaded conditions using single-plane fluoroscopy.

Medical Engineering and Physics — Mon, 14 Apr 2008 04:00:00 +0100

This study measured the 3D knee kinematics of eight normal subjects during active knee extension for unloaded and loaded conditions using a voxel-based method for the registration of fluoroscopic images with CT bone data. The knee kinematics during unloaded conditions were found to be similar to previous findings. A mass of 5kg at the ankle did not affect the joint angles but significantly altered the lateral contact positions during knee extension, especially at knee flexion angles higher than 75 degrees , and also reduced the asymmetry of the surface kinematics between the medial and lateral condyles. The results of the current study may be useful for knee replacement design and for developing guidelines for the use of KEEs for the rehabilitation of patients with knee disorders. PMID...

[Musculoskeletal Imaging] Postoperative Evaluation of the Total Ankle Arthroplasty

American Journal of Roentgenology — Thu, 20 Mar 2008 04:00:00 +0100

CONCLUSION. Postoperative evaluation of the total ankle arthroplasty necessitates a familiarity with the various designs currently in use. Radiography serves as an integral component in the postoperative evaluation of such devices, with CT offering further characterization of radiographic abnormalities. (Source: American Journal of Roentgenology)

Total ankle replacement gaining foothold in upstate New York

News-Medical News Feed — Thu, 13 Mar 2008 09:00:00 +0100

A procedure aimed at not only relieving pain from arthritic ankles, but providing new-found mobility for patients, is gaining a foothold in upstate New York. (Source: News-Medical News Feed)

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Comparison of Health-Related Quality of Life Between Patients with End-Stage Ankle and Hip Arthrosis

JBJS [Am] — Sat, 01 Mar 2008 05:00:00 +0100

Conclusions: The mental and physical disability associated with end-stage ankle arthrosis is at least as severe as that associated with end-stage hip arthrosis. Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

[Osteotomies of the distal tibia and hindfoot for ankle realignment.]

Der Orthopade — Thu, 21 Feb 2008 05:00:00 +0100

This article presents general considerations for osteotomies around the osteoarthritic ankle and elaborates a rationale for the technical procedure. Additional measures for correcting the deformed and malaligned hindfoot are also elucidated.As a principle, opening-wedge and closing-wedge osteotomies are possible in one or more planes. In some instances, inframalleolar osteotomies are also necessary to achieve proper alignment of the foot. If present, imbalance of soft tissues, such as incompetence of ligaments and insufficiency of tendons, must also be addressed.Our results have shown that osteotomies above and beneath the ankle joint are able to correct deformities and incongruencies at the tibiotalar joint over the years, thus avoiding further cartilage wear. In some patients, the tibiot...

Evaluation of anatomic references for tibial sagittal alignment in total knee arthroplasty

Knee Surgery, Sports Traumatology, Arthroscopy — Wed, 13 Feb 2008 16:09:47 +0100

Abstract The authors aimed to demonstrate the relationship between the sagittal mechanical axis of the tibia and other reference axes of the tibia and fibula in patients with advanced osteoarthritis of the knee joints, and then to identify a reliable landmark in order to minimize posterior tibial slope measurement errors. We evaluated 133 osteoarthritic knees with neutral or varus deformity in 64 female and 8 male patients. Axial computed tomographic images of whole tibiae including knee and ankle joints were obtained and reconstructed using 3-dimensional imaging software. Angles between the mechanical axis (MA), the tibial anatomical axis (TAA), the anterior tibial cortex (ATC) and the fibular shaft axis (FSA) were measured, and then medial and lateral tibial slope angles...

Total ankle replacement for end-stage arthropathy in patients with haemophilia

Haemophilia — Sat, 02 Feb 2008 19:57:29 +0100

Haemophilia, Volume 0, Issue 0, Page ???, May 2004. (Source: Haemophilia)

Picomm-Issue 37

Podiatry Internet Communications — Sat, 02 Feb 2008 00:07:33 +0100

Orthosphere Arthroplasty for Fifth Tarsal Metatatarsal Arthritis: A Case Presentation The Foot & Ankle Journal Original article:A case describing the use of the Orthosphere® Zirconia Ceramic Implant (Wright Medical Technology, Arlington, TN) is presented. The tarso-metatarsal joints in the foot are common sites for degenerative arthritis and pain secondary to trauma and biomechanical abnormalities. Often, [...] (Source: Podiatry Internet Communications)

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Gait kinematics of age-stratified hip replacement patients-A large scale, long-term follow-up study.

Gait and Posture — Thu, 31 Jan 2008 05:00:00 +0100

This study reveals that even the youngest hip replacement patients do not attain normal gait kinematics 10-year post-operatively and that muscle atrophy and residual stiffness may influence patient kinematics many years post-operation. PMID: 18242996 [PubMed - as supplied by publisher] (Source: Gait and Posture)

Small Bone Innovations, Inc. to Acquire S.T.A.R. Total Ankle Replacement Technology

HSMN NewsFeed — Tue, 29 Jan 2008 15:51:12 +0100

S.T.A.R. Ankle is a mobile-bearing total ankle system SBi to be first into the US market upon final FDA approval More than 10,000 implanted in 27 countries NEW YORK--(HSMN NewsFeed)--Small Bone Innovations, Inc. (SBi), a single-source provider of ... Devices, Orthopaedic, AcquisitionsSmall Bone Innovations, Waldemar Link, S.T.A.R. Ankle, total ankle (Source: HSMN NewsFeed)

Functional outcome of meniscal-bearing total ankle replacement: a gait analysis study.

Journal of the American Podiatric Medical Association — Tue, 01 Jan 2008 05:00:00 +0100

Conclusions: This study showed that TAR yields satisfactory, but not outstanding, general functional results at nearly 3 years' follow-up. These gait analysis results highlight the importance of integrating in vivo measurements with the standard clinical assessments of patients who underwent TAR while they perform activities of daily living. These results also emphasize the importance of evaluating the functional outcome of TAR over time. PMID: 18202330 [PubMed - in process] (Source: Journal of the American Podiatric Medical Association)

Photodynamic therapy using talaporfin sodium for synovial membrane from rheumatoid arthritis patients and collagen-induced arthritis rats

Clinical Rheumatology — Sat, 08 Dec 2007 19:03:41 +0100

In conclusion, PDT using talaporfin sodium might be a new method for synovectomy in patients with RA. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10067-007-0794-8Authors Eiji Torikai, Hamamatsu University School of Medicine Department of Orthopaedic Surgery 1-20-1 Handayama Hamamatsu 431-3125 JapanYasunori Kageyama, Hamamatsu University School of Medicine Department of Orthopaedic Surgery 1-20-1 Handayama Hamamatsu 431-3125 JapanEiji Kohno, Hamamatsu University School of Medicine Department of Photon Medical Research Center 1-20-1 Handayama Hamamatsu JapanToru Hirano, Hamamatsu University School of Medicine Department of Photon Medical Research Center 1-20-1 Handayama Hamamatsu JapanYukio Koide, Hamamatsu University School of Medicine Department of Microbiology ...

[Ankle arthrodesis with interposition graft as a salvage procedure after failed total ankle replacement]

Operative Orthopadie und Traumatologie — Sat, 01 Dec 2007 05:00:00 +0100

Authors: Schill S OBJECTIVE: Restoration of painless function to the lower limb by ankle fusion after failure of total ankle arthroplasty. INDICATIONS: Loose total ankle replacement. Severe ankle destruction and axial deviation in rheumatoid patients. Severe osteoarthritis in the subtalar and ankle joints. CONTRAINDICATIONS: Infected total ankle replacement. Severe arterial occlusive disease of the affected extremity. SURGICAL TECHNIQUE: Transfibular approach to the subtalar and ankle joints. Osteotomy and resection of the distal fibula 7-8 cm proximal to the tip of the lateral malleolus. Removal of the prosthetic components, synovectomy, and revitalization of the remaining bone surface. Removal of any residual articular cartilage from the subtalar joint surfaces. Determination of the ...

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[Management of posttraumatic osteoarthritis of the upper ankle joint by implantation of the S.T.A.R. ankle prosthesis]

Operative Orthopadie und Traumatologie — Sat, 01 Dec 2007 05:00:00 +0100

Authors: Rzesacz EH, Gossé F OBJECTIVE: Treatment of posttraumatic osteoarthritis of the upper ankle joint by implantation of an uncemented total ankle joint prosthesis. INDICATIONS: Painful osteoarthritis of any kind affecting the upper ankle joint with adequate joint stability, without significant bone deformity of the ankle axes (deviation of the lower leg axis in the distal third in the horizontal and sagittal planes < or = 20 degrees ), without manifest osteoporosis, with normal peripheral vascularity, correct alignment of the hindfoot, minimal sports expectations on the part of the patient, and good residual range of motion. CONTRAINDICATIONS: Avascular talus necrosis > or = 25%. Degenerative neuropathic joint disease (Charcot's joint). Acute or chronic ankle joint inf...

[Supramalleolar, subtractive valgus osteotomy of the tibia in the management of ankle joint degeneration with varus deformity]

Operative Orthopadie und Traumatologie — Sat, 01 Dec 2007 05:00:00 +0100

Authors: Neumann HW, Lieske S, Schenk K OBJECTIVE: The aim of supramalleolar osteotomy of the tibia in the management of varus deformity of the upper ankle joint is to shift load bearing away from the severely degenerated medial part of the joint to the lateral part and thus restore physiological alignment of the hindfoot and a plantigrade foot. The intention is to reduce pain and to postpone the need for total endoprosthesis or arthrodesis. INDICATIONS: Painful degeneration of the ankle joint with varus deformity that has proven resistant to conservative treatment, i.e., > 15 degrees axial malalignment of the tibiotalar joint axis. CONTRAINDICATIONS: Severe ankle joint degeneration that restricts movement. Florid infections. Extensive bone and soft-tissue defects. Osteonecrosis of ...

[Sports participation after joint arthroplasty]

Annales de Readaptation et de Medecine Physique — Sat, 01 Dec 2007 05:00:00 +0100

DISCUSSION: According to the subjective orthropedic surgeon's opinion, the objective results based on the joint load studied and the percentage of arthroplasty revision, sport is beneficial for the individual health but perhaps not for the arthroplasty survey. However, aerobic and leisure activities are recommended (walking, swimming, cycling) in agreement with the demand of the patients recently operated with a TKA. TKA differs from Total Hip Arthroplasty for jogging because of knee joint constraints during the knee flexion. A single study reports sports possibilities after shoulder arthroplasty and ankle arthroplasty and no study reports results after elbow arthroplasty. PMID: 17996322 [PubMed - indexed for MEDLINE] (Source: Annales de Readaptation et de Medecine Physique)

Tibial Wedge Osteotomy for Osteochondral Transplantation in Talar Lesions

International Journal of Sports Medicine — Sat, 01 Dec 2007 02:00:56 +0100

Int J Sports MedDOI: 10.1055/s-2007-989232AbstractBetween 1999 and 2002, 16 patients with osteochondral lesions on the central and posterior talar dome underwent osteochondral autografting. A new approach with temporary removal and replacement of a tibial bone block from the anterior tibial plafond was adopted. Inclusion criteria were joint stability, an age between 18 and 50 years, and osteochondral lesions stages 3 and 4 according to the radiological classification of Loomer, for which previous arthroscopic treatment was not successful. All patients underwent clinical and MRI evaluation after 12, 35 and 59 months. The AOFAS Ankle Hindfoot score improved significantly between the preoperative period and 1 year (p < 0.001), between 1 and 3 years (p < 0.001), but not between 3 and 5 y...