MedWorm: Ankle Replacement

Compatibility of the HINTEGRA prostheses with Korean ankles as evaluated on the basis of cadaveric measurements

Clinical Anatomy — Thu, 02 Feb 2012 05:00:00 +0100

AbstractThe purpose of this study was to obtain anatomical measurements of the distal tibia and talus of Korean ankles and to evaluate, based on those measurements, the compatibility of the HINTEGRA prostheses in the context of total ankle replacement (TAR). We measured the length, width, height, and angles of the distal tibia and talus of 51 cadavers and compared these measurements with the corresponding dimensions of the HINTEGRA prostheses. The male ankles were larger than the female ones as was expected, but their overall shapes did not differ, which fact validates use of the prostheses irrespective of patients' sex. The dimensions of the talus itself did not differ significantly from those previously reported for American whites and blacks and South African whites. This might suggest ...

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Osteotomy, Arthrodesis, and Arthroplasty for Complex Multiapical Deformity of the Leg

HSS Journal — Tue, 24 Jan 2012 06:45:19 +0100

We report two cases of multiapical deformity of the tibia, both of which were secondary to a distant history of tibial fracture with resultant knee and ankle joint degeneration and deformity. Both cases had three levels of deformity that were addressed with tibial osteotomy, ankle fusion, and total knee replacement. Initial presentation, problem lists, surgical treatment, and subsequent results are reviewed. Literature Review Treatment of a post-traumatic three-level deformity has never specifically been addressed in the literature, although the principles of treatment are the same as for less complex deformities. Purposes and Clinical Relevance These two cases present a treatment approach for complex, multiapical deformity of the tibia. The same...

High Revision and Reoperation Rates Using the Agility(TM) Total Ankle System.

Clinical Orthopaedics and Related Research — Tue, 24 Jan 2012 05:00:00 +0100

CONCLUSION: TAA had high revision and reoperation rates. Patients who retained their implant had only moderate pain relief and function. TAA must be approached with caution. More research is needed to elucidate the role of contemporary TAA. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID: 22270469 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Intermediate to Long-Term Outcomes of the STAR Total Ankle Replacement: The Patient Perspective.

The Journal of Bone and Joint Surgery. American volume — Wed, 04 Jan 2012 05:00:00 +0100

CONCLUSIONS: Total ankle arthroplasty with the Scandinavian Total Ankle Replacement prosthesis was associated with significant improvements in terms of pain, function, and quality of life after intermediate to long-term follow-up. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID: 22218381 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

The anatomical location of the flexor hallucis brevis as it pertains to implant arthroplasty.

Journal of the American Podiatric Medical Association — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions: This study provides precise anatomical data that can be used by foot and ankle surgeons when considering the use of implant arthroplasty for the treatment of hallux limitus/rigidus and the ability to maintain the insertion point of the flexor hallucis brevis muscle. PMID: 22232314 [PubMed - in process] (Source: Journal of the American Podiatric Medical Association)

Announcements

Arthroscopy — Thu, 29 Dec 2011 03:44:12 +0100

The Arthroscopy Association of North America 2012 Master's Experience Courses will be held at the Orthopaedic Learning Center, Rosemont, Illinois: January 12-15, 2012 (fundamentals resident); January 20-21, 2012 (knee: patellofemoral surgery from instability to arthroplasty); January 27-29, 2012 (hip); February 23-26, 2012 (fundamentals resident); March 9-11, 2012 (knee ligament); March 23-25, 2012 (hip); April 27-29, 2012 (shoulder); June 2-3, 2012 (wrist & elbow); June 8-10, 2012 (Society of Military Orthopaedic Surgeons/shoulder); July 20-22, 2012 (hip); September 7-9, 2012 (shoulder); September 29-30, 2012 (foot & ankle); October 5-7, 2012 (knee cartilage); October 19-21, 2012 (shoulder); December 6-9, 2012 (fundamentals resident). For more information, visit www.aana.org (Source: Arth...

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Do Patient-specific Guides Improve Coronal Alignment in Total Knee Arthroplasty?

Clinical Orthopaedics and Related Research — Tue, 20 Dec 2011 05:00:00 +0100

CONCLUSIONS: TKAs with patient-specific instrumentation restoring the mechanical axis had a similar number of outliers as conventional instrumentation with both groups having more varus outliers than TKAs with patient-specific instrumentation restoring kinematic axis, which had more valgus outliers. Therefore, additional studies are needed to determine whether patient-specific instrumentation improves clinical function or patient satisfaction and whether their routine use can be justified in primary TKA. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. PMID: 22183477 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Total ankle arthroplasty versus ankle arthrodesis. Comparison of sports, recreational activities and functional outcome

International Orthopaedics — Thu, 15 Dec 2011 16:47:32 +0100

Conclusions Our study revealed no significant difference between the groups concerning activity levels, participation in sports activities, UCLA and AOFAS score. After AAD the number of patients participating in sports decreased. However, this change was not statistically significant. Content Type Journal ArticleCategory Original PaperPages 1-8DOI 10.1007/s00264-011-1455-8Authors Reinhard Schuh, Department of Orthopaedics, Medical University of Vienna, Vienna, AustriaJochen Hofstaetter, Department of Orthopaedics, Medical University of Vienna, Vienna, AustriaMartin Krismer, Department of Orthopaedic Surgery, Innsbruck Medical University, Innsbruck, AustriaRoberto Bevoni, Department of Orthopaedics, Istituto Ortopedico Rizzoli, Bologna, ItalyReinhard Windhager, Depar...

Total Ankle Replacement in Ankle Arthritis with Varus Talar Deformity: Pathophysiology, Evaluation, and Management Principles

Foot and Ankle Clinics — Wed, 14 Dec 2011 05:00:00 +0100

VMAA is common in end-stage ankle arthritis with varying and poorly described etiologies. With a greater understanding of VMAA, it is becoming apparent that its pathology has both hereditary and environmental factors that follow several different pathways, all resulting in a varus coronal plane deformity of the talus. Multiple surgical methods to correct VMAA have been proposed, based primarily on the degree of deformity in the coronal plane. However, focusing exclusively on the talar coronal plane deformity is an oversimplification of a complex problem. The multidimensional nature of VMAA needs to be appreciated by the treating surgeon such that appropriate interventions can be planned in advance of the surgery. The purpose of this article is to describe the current understanding of the v...

[Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail.]

Operative Orthopadie und Traumatologie — Fri, 09 Dec 2011 05:00:00 +0100

Authors: El Attal R, Hansen M, Rosenberger R, Smekal V, Rommens PM, Blauth M Abstract OBJECTIVE: Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare and to maintain joint mobility. Good bony healing in closed and open fractures. INDICATIONS: Closed and open fractures of the tibia and complete lower leg fractures distal to the isthmus (AO 42), extraarticular fractures of the distal tibia (AO 43 A1/A2/A3), segmental fractures of the tibia with a fracture in the distal tibia, and certain intraarticular fractures of the distal tibia without impression of the joint line with the use of additional implants (AO 43 C1) CONTRAINDICATIONS: ...

Treatment of Posttraumatic Varus Ankle Deformity with Supramalleolar Osteotomy

Foot and Ankle Clinics — Thu, 08 Dec 2011 05:00:00 +0100

The most common cause of end-stage ankle arthritis is trauma. Factors contributing to the development of posttraumatic ankle arthritis are the initial cartilage damage, malreduction, nonunion, infections, and instability. In a retrospective study, Valderrabano and colleagues found that 55% of patients with posttraumatic ankle arthritis presented with a varus malalignment, whereas 8% had valgus malalignment. Malalignment leads to altered load distribution across the joint, interfering with normal cartilage metabolism. In young patients this interference can lead to early ankle joint arthritis, for which ankle fusion or joint replacement may not provide a lifetime solution. Therefore, supramalleolar osteotomies have gained increasing popularity to address sequelae of posttraumatic ankle join...

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Effect of Graft Height Mismatch on Contact Pressures With Osteochondral Grafting of the Talus

The American Journal of Sports Medicine — Tue, 06 Dec 2011 05:00:00 +0100

Conclusion: Flush graft placement can restore near-normal joint contact pressure. Elevated graft placement leads to significant increases in joint contact pressure at the graft site. Recessed graft placement leads to a transfer of pressure from the graft site to the opposite facet of the talus. Clinical Relevance: Osteochondral grafts in the talus should be placed flush if possible or else slightly recessed. (Source: The American Journal of Sports Medicine)

Planning Correction of the Varus Ankle Deformity with Ankle Replacement

Foot and Ankle Clinics — Mon, 05 Dec 2011 05:00:00 +0100

The technology and techniques of total ankle replacement have improved significantly over the last few decades. With these advances, the indications for ankle replacement have similarly expanded. Previously, ankle replacement was primarily indicated for patients with minimal coronal plane deformity. This excluded many patients from ankle replacement, because the most common pathology leading to ankle replacement is posttraumatic arthritis and this is frequently associated with a varus deformity. (Source: Foot and Ankle Clinics)

Announcements

Arthroscopy — Thu, 01 Dec 2011 05:00:00 +0100

Fall incidence and risk factors in patients after total knee arthroplasty

Archives of Orthopaedic and Trauma Surgery — Wed, 16 Nov 2011 18:01:03 +0100

Conclusion Elderly people who underwent TKA are considered more likely to fall compared with healthy elderly people. For patients with limited knee flexion and ankle plantar flexion, improvement of ROM by exercise therapy and patient education regarding the prevention of falls and fractures are considered necessary. Content Type Journal ArticleCategory Knee ArthroplastyPages 1-9DOI 10.1007/s00402-011-1418-yAuthors Hiromi Matsumoto, Rehabilitation Division, Hakuai Hospital, Ryomitsuyanagi 1880, Yonago, Tottori 683-0853, JapanMakoto Okuno, Department of Orthopedic Surgery, Hakuai Hospital, Yonago, JapanTatsuhiko Nakamura, Department of Orthopedic Surgery, Hakuai Hospital, Yonago, JapanKichizo Yamamoto, Department of Orthopedic Surgery, Hakuai Hospital, Yonago, JapanHi...

Comparison of the tibiofemoral rotational alignment after mobile and fixed bearing total knee arthroplasty

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 05 Nov 2011 17:09:32 +0100

Conclusion The unpredictable change in the rotational axis of the tibia and its broad variability after rotating platform mobile bearing TKA may provide a warning against the use of a fixed landmark for establishing tibial rotational alignment. Level of evidence Prospective comparative study, Level II. Content Type Journal ArticleCategory KneePages 1-9DOI 10.1007/s00167-011-1750-3Authors Dongwook Kim, Department of Orthopaedic Surgery, The Armed Forces Capital Hospital, 2 Yul-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-040, KoreaSang Cheol Seong, Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744 KoreaMyung Chul Lee, Department of Orthopaedic Surgery, Seoul National University C...

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The effect of three-component total ankle replacement malalignment on clinical outcome: pain relief and functional outcome in 317 consecutive patients.

The Journal of Bone and Joint Surgery. American volume — Wed, 02 Nov 2011 04:00:00 +0100

Conclusions:The anteroposterior offset ratio may be a useful predictor of outcome in patients with total ankle replacement with regard to both pain and function.Level of Evidence:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID: 22048091 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Heterotopic ossification after total ankle arthroplasty.

The Journal of Bone and Joint Surgery. British volume — Tue, 01 Nov 2011 04:00:00 +0100

This study indicates that caution should be observed in attributing symptoms and functional limitation to the presence of heterotopic ossification in the posterior ankle joint when considering excision of heterotopic bone after total ankle replacement. PMID: 22058303 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. British volume)

[Unilateral purpura of a limb revealing a periprosthetic abscess in an HIV-infected patient].

Annales de Dermatologie et de Cenereologie — Tue, 01 Nov 2011 04:00:00 +0100

CONCLUSION: This case report describes a unilateral purpura revealing a periprosthetic abscess. Dermatologists must be aware of this sign as a potential indicator of prosthetic infection. PMID: 22078036 [PubMed - in process] (Source: Annales de Dermatologie et de Cenereologie)

[Ankle arthrodesis after failed total ankle replacement.]

Der Orthopade — Fri, 21 Oct 2011 04:00:00 +0100

Authors: Espinosa N, Wirth SH Abstract Despite recent anatomical and biomechanical improvements the longevity of current total ankle replacements remains limited. Once total ankle replacement has failed conversion into ankle arthrodesis provides a viable option and should therefore be considered. However, due to the massive bone loss, precarious soft tissues and in order to preserve leg length, this kind of surgical treatment is considered to be technically demanding with potential impairment of the quality of life and decreased global foot and ankle function as well. The present article focuses on salvage ankle arthrodesis after failed total ankle replacement and seeks to provide a usable treatment algorithm. PMID: 22011840 [PubMed - as supplied by publisher] (Source: Der Orth...

[Total ankle replacement in rheumatoid arthritis.]

Der Orthopade — Thu, 20 Oct 2011 04:00:00 +0100

Authors: Rippstein PF, Naal FD Abstract Rheumatoid arthritis is a systemic disease directly involving multiple joints and indirectly damages bone due to specific medicinal therapy. When deciding on the optimal surgical treatment of inflammatory ankle arthritis (fusion versus arthroplasty), specific factors have to be considered. This review discusses the advantages and disadvantages of total ankle arthroplasty for patients with rheumatoid arthritis and highlights important surgical aspects related to this disease. PMID: 22009497 [PubMed - as supplied by publisher] (Source: Der Orthopade)

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[Total ankle arthroplasty in valgus ankle osteoarthritis.]

Der Orthopade — Thu, 20 Oct 2011 04:00:00 +0100

Authors: Valderrabano V, Frigg A, Leumann A, Horisberger M Abstract Ankle osteoarthritis (OA) is often associated with deformities. Valgus OA is less frequent than varus OA and causes of valgus OA include medial ligament instability, flat foot and posttraumatic situations, e.g. fractures of the fibula or lateral tibial plafond. The importance of the mechanical axis is generally accepted in orthopedic surgery. In cases of implantation of total ankle replacements the normal biomechanics need to be restored in order to have a correct and pain-free functioning total ankle replacement both in the short and long-term. The two most important criteria are (1) an anterior tibio-talar angle of about 90° and (2) a neutral hindfoot position. The hindfoot position is measured with the hindfoot...

Changes in gait following the scandinavian total ankle replacement.

The Journal of Bone and Joint Surgery. American volume — Wed, 19 Oct 2011 04:00:00 +0100

Conclusions:This study demonstrated that, at the time of intermediate-term follow-up and in comparison with the effects of ankle arthrodesis on gait as reported in previous studies, total ankle arthroplasty was associated with a more normal ankle function and a more normal gait, both kinetically and in terms of temporal-spatial parameters. More importantly, the study demonstrated marked improvement in multiple, objective parameters of gait following total ankle arthroplasty as compared with the patient's own preoperative function. The long-term maintenance of the gait improvements will require further study.Level of Evidence:Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. PMID: 22012526 [PubMed - in process] (Source: The Journal of Bo...

Simultaneous bilateral total ankle replacement using a 3-component prosthesis.

Acta Orthopaedica — Mon, 17 Oct 2011 04:00:00 +0100

Authors: Barg A, Henninger HB, Knupp M, Hintermann B Abstract Background and purpose Total ankle replacement is an established surgical procedure in patients with end-stage ankle osteoarthritis. We analyzed complications and medium-term results in patients with simultaneous bilateral total ankle replacement. Patients and methods 10 women and 16 men, mean age 60 (SD 13) years, were followed for a median of 5 (2-10) years. Results There were no intraoperative or perioperative complications, with the exception of 1 patient with prolonged wound healing. Major revision surgery was necessary in 6 of the 52 ankles, including 4 revisions of prosthetic components. The average pain score decreased from 6.9 (4-10) to 1.8 (0-4) points. The American Orthopaedic Foot and Ankle Society hindfoo...

[Total ankle replacement for varus deformity.]

Der Orthopade — Sun, 16 Oct 2011 04:00:00 +0100

Authors: Knupp M, Bolliger L, Barg A, Hintermann B Abstract Coronal plane deformity has been found to be one of the main risk factors for poor clinical results, higher complication rates and failure of total ankle replacements. Initially, many authors considered a malalignment of more than 10° to be a contraindication for total ankle replacement, however, several publications later underlined the usefulness of the distinction of different etiologies of hindfoot malalignment. This subsequently led to suggestions for additional procedures in order to avoid early implant failure.The aim of the present article is to illustrate the different causes of varus malaligned arthritic ankles and to present procedures to balance these ankles at the time of replacement. PMID: 22002209 [PubM...

[Revision arthroplasty of the ankle joint.]

Der Orthopade — Sat, 15 Oct 2011 04:00:00 +0100

Authors: Hintermann B, Barg A, Knupp M Abstract In the last 20 years total ankle replacement has become a viable alternative to arthrodesis for end-stage osteoarthritis of the ankle. Numerous ankle prosthesis designs have appeared on the market in the past and attracted by the encouraging intermediate results reported in the literature, many surgeons have started to perform this procedure. With increased availability on the market the indications for total ankle replacement have also increased in recent years. In particular, total ankle replacement may now be considered even in younger patients. Therefore, despite progress in total ankle arthroplasty the number of failures may increase. Up to now, arthrodesis was considered to be the gold standard for salvage of failed ankle prost...

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Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure.

BMC Musculoskeletal Disorders — Thu, 13 Oct 2011 04:00:00 +0100

Conclusions: Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient. (Source: BMC Musculoskeletal Disorders)

[Medial pain syndrome in patients with total ankle replacement.]

Der Orthopade — Thu, 13 Oct 2011 04:00:00 +0100

Authors: Barg A, Suter T, Zwicky L, Knupp M, Hintermann B Abstract Total ankle replacement is an increasingly recommended treatment for patients with end-stage ankle osteoarthritis. The increasing experience with this procedure explains its acceptance as a therapeutic option in complex cases as part of reconstruction surgery. However, the complication rate including failure of the prosthesis should not be underestimated. Previous studies have shown that most patients developed ankle osteoarthritis secondary to previous trauma. Patients with posttraumatic osteoarthritis often have varus or valgus misalignment of the hindfoot. In cases with incorrectly addressed hindfoot misalignment and/or incorrectly positioned prosthesis components, pain may remain postoperatively because of biome...

[Ankle joint prosthesis for bone defects.]

Der Orthopade — Thu, 13 Oct 2011 04:00:00 +0100

Authors: Lampert C Abstract Large defects of the talus, i.e. due to tumors, large areas of osteolysis in total ankle replacement (TAR) and posttraumatic talus body necrosis are difficult to manage. The gold standard in these circumstances is still tibiocalcaneal arthrodesis with all the negative aspects of a completely rigid hindfoot. We started 10 years ago to replace the talus by a custom-made, all cobalt-chrome implant (laser sintering). The first patient with a giant cell tumor did very well but the following patients showed all subsidence of the metal talus into the tibia due to missing bony edges. Therefore, we constructed a custom-made talus (mirrored from the healthy side) and combined it with a well functioning total ankle prosthesis (Hintegra). So far we have implanted t...

Duke Medical Minute: Samuel Adams, MD, on Ankle Arthritis and Ankle Replacement

DukeHealth.org: Duke Health Features — Wed, 12 Oct 2011 18:12:58 +0100

Duke Medical Minutes are produced by local sports radio affiliates, and allow Duke specialists to give a brief snapshot into health offerings at Duke. In this episode, Samuel B. Adams Jr., MD, director of foot and ankle research at Duke Orthopaedics, answers questions about ankle arthritis and ankle replacement. Listen to the Podcast (Download audio) Podcast Transcript Announcer: We're talking with Dr. Samuel Adams, assistant professor of orthopaedic surgery at Duke, also director of foot and ankle research. A lot of our listeners might have had a traumatic experience with their ankle, whether it was a sprain, a fracture -- perhaps they've had surgery on that. But time passes, and the body gets older, and what should they be looking out for? Adams: They should be concerned about ankl...

Effect of total arthroplasty combined with anti-tumor necrosis factor agents in attenuating systemic disease activity in patients with rheumatoid arthritis

Modern Rheumatology — Fri, 07 Oct 2011 05:48:13 +0100

Abstract We assessed the effect of total large-joint arthroplasty combined with anti-tumor necrosis factor (TNF) therapy for rheumatoid arthritis (RA). We studied 45 RA patients (age 57.91 ± 12.74 years, RA duration 13.43 ± 8.28 years) who underwent total arthroplasty (35 knees, 19 hips, 3 elbows, and 1 ankle) between August 2002 and November 2009. All patients received anti-TNF agents (infliximab, 22; etanercept, 33; adalimumab, 3) during the period of the study (that is, they were being treated with the agents when operated on and postoperatively). The disease activity score 28 (DAS28)-erythrocyte sedimentation rate (mean ± standard deviation) in all patients improved significantly from baseline (just before the operation; 4.32&n...

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Radiographic Results of an Accelerometer-based, Handheld Surgical Navigation System for the Tibial Resection in Total Knee Arthroplasty.

Orthopedics — Thu, 06 Oct 2011 12:30:03 +0100

The objective of this study was to determine the accuracy of an accelerometer-based, handheld surgical navigation system in obtaining a postoperative tibial component alignment within 2° of the intraoperative goal in both the coronal and sagittal planes. A total of 151 TKAs were performed by 2 surgeons using a handheld surgical navigation system to perform the tibial resection. Postoperatively, standing anteroposterior hip-to-ankle radiographs and lateral knee-to-ankle radiographs were performed to determine the varus/valgus alignment and the posterior slope of the tibial components relative to the mechanical axis in both the coronal and sagittal planes. Findings showed that 95.3% of the tibial components were placed within 2° of the intraoperative goal in the coronal plane and 96.1% of ...

A Multicenter Retrospective Review of Outcomes for Arthrodesis, Hemi-Metallic Joint Implant, and Resectional Arthroplasty in the Surgical Treatment of End-Stage Hallux Rigidus

Journal of Foot and Ankle Surgery — Mon, 03 Oct 2011 04:00:00 +0100

Abstract: This is a retrospective, multicenter study examining the long-term results for the treatment of end-stage hallux rigidus using 3 different surgical procedures. A total of 158 subjects (105 females and 53 males) were included in the present study. They had undergone 1 of the following surgical procedures: arthrodesis, hemi-implant, or resectional arthroplasty. The long-term results for the subjective assessment of pain, function, and alignment, as well as objective radiographic and physical findings, were examined. The median interval to postoperative follow-up for the 3 procedure groups was 159 weeks. No statistically significant difference was found in age or the number of subjects included in the 3 treatment groups (p = .11 and p = .16, respectively). The body mass index was si...

Corrective supramalleolar osteotomy for malunited pronation-external rotation fractures of the ankle.

The Journal of Bone and Joint Surgery. British volume — Sat, 01 Oct 2011 04:00:00 +0100

Authors: Hintermann B, Barg A, Knupp M Abstract We undertook a prospective study to analyse the outcome of 48 malunited pronation-external rotation fractures of the ankle in 48 patients (25 females and 23 males) with a mean age of 45 years (21 to 69), treated by realignment osteotomies. The interval between the injury and reconstruction was a mean of 20.2 months (3 to 98). In all patients, valgus malalignment of the distal tibia and malunion of the fibula were corrected. In some patients, additional osteotomies were performed. Patients were reviewed regularly, and the mean follow-up was 7.1 years (2 to 15). Good or excellent results were obtained in 42 patients (87.5%) with the benefit being maintained over time. Congruent ankles without a tilted talus (Takakura stage 0 and 1) were...

Cytosolic phospholipase A2 induction and prostaglandin E2 release by interleukin‐1β via the myeloid differentiation factor 88–dependent pathway and cooperation of p300, Akt, and NF‐κB activity in human rheumatoid arthritis synovial fibroblasts

Arthritis and Rheumatism — Fri, 30 Sep 2011 00:22:05 +0100

ConclusionIL‐1β–induced cPLA2 expression is mediated through activation of the MyD88/c‐Src, MMP/HB‐EGF, EGFR/PI 3‐kinase/Akt, p300, and NF‐κB pathways. These results provide insights into the mechanisms underlying IL‐1β–enhanced joint inflammatory responses in RA and may inspire new targeted therapeutic approaches. (Source: Arthritis and Rheumatism)

With help from UCLA, teenage cancer patient begins to make strides

UCLA Newsroom: Health Sciences — Tue, 13 Sep 2011 23:23:00 +0100

The doctors told Allie Newman that the pain in her right thigh was tendonitis, nothing to worry about. A little physical therapy and she'd be as good as new. Just months later, in January 2011, the 16-year-old avid skier and soccer player was diagnosed with an aggressive osteosarcoma in her thigh bone. Her dad, Bob Newman, broke the news to his only daughter as she lay on her bed doing homework, just like she did on any other regular night. Tonight, though, everything would change. "Just a few days before, she was skiing on a family trip and playing soccer, and now I had to sit and explain a cancer diagnosis to her," Newman said. "I ran the gamut of emotions from shock to surprise to disbelief and anger." Cancer? At 16? She'd just gotten her driver's license and...

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A systematic review of outcome and failure rate of uncemented Scandinavian total ankle replacement

International Orthopaedics — Wed, 31 Aug 2011 15:55:35 +0100

Conclusions We found that STAR prosthesis achieved encouraging results in terms of intermediate to long-term outcome. The five and ten year survival rates were acceptable. However, the failure rate was still high. The major reasons for implant failure were aseptic loosening and malalignment. Maybe the increase of surgeons’ experience and patient selection could improve outcomes and decrease failure rate. Content Type Journal ArticleCategory Review ArticlePages 1-8DOI 10.1007/s00264-011-1339-yAuthors Hongmou Zhao, Department of Orthopaedic Surgery, Tongji Hospital of Tongji University, Foot and Ankle Center of Tongji University, Shanghai, 200065 ChinaYunfeng Yang, Department of Orthopaedic Surgery, Tongji Hospital of Tongji University, Foot and Ankle Center of Ton...

Gelfoam first metatarsophalangeal replacement/interposition arthroplasty—A case series with functional outcomes

The Foot — Tue, 30 Aug 2011 03:02:25 +0100

Abstract: Reported below are the functional results of a case-series of Gelfoam®-based first metatarsophalangeal total joint replacements using an interposition arthroplasty technique carried out between April 1997 and December 2007. All patients who underwent Gelfoam-based arthroplasty under the care of a single surgeon were included; outcome scores and complications were recorded. A total of 31 joints in 31 consecutive patients were followed for a mean duration of 64 (range 24–150) months, and the mean patient age at the time of operation was 48±9 (range 35–80) years. Hallux rigidus was the primary diagnosis in all of the cases except one in which a failed chevron ostetomy was the indication for treatment. The mean American Orthopaedic Foot & Ankle Society Hallux-Metatarsophalangea...

Arthroplasty versus arthrodesis for end-stage ankle arthritis: decision analysis using Markov model

International Orthopaedics — Fri, 19 Aug 2011 15:52:31 +0100

Conclusions Based on current evidence, total ankle arthroplasty was found to be a better treatment than arthrodesis for ankle arthritis. Future development in the implant materials, improved understanding of ankle biomechanics, and surgical techniques will further enhance the clinical outcome of total ankle arthroplasty. Content Type Journal ArticleCategory Original PaperPages 1-7DOI 10.1007/s00264-011-1336-1Authors Dae Gyu Kwon, Department of Orthopaedic Surgery, Inha University Hospital, 3 Sinhung-Dong, Jung-Gu, Inchon 400-711, Republic of KoreaChin Youb Chung, Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Sungnam, Kyungki 463-707, Republic of KoreaMoon Seok Park, Department of Orthopaedic Surgery, Seoul ...

Early Clinical Results of the BOX Ankle Replacement Are Satisfactory: A Multicenter Feasibility Study of 158 Ankles

Journal of Foot and Ankle Surgery — Tue, 16 Aug 2011 04:00:00 +0100

Abstract: A new design for a 3-part ankle replacement was developed in an effort to achieve compatibility with the naturally occurring ligaments of the ankle by allowing certain fibers to remain isometric during passive motion. In order to test the design concept clinically, 158 prostheses were implanted in 156 patients within a 9-center trial and were followed up for a mean of 17 (range 6 to 48) months. The mean age at the time of surgery was 60.5 (range 29.7 to 82.5) years. Outcome measures included the American Orthopaedic Foot & Ankle Surgery hindfoot-ankle score and range of motion measured on lateral radiographs of the ankle. The preoperative American Orthopaedic Foot & Ankle Surgery score of 36.3 rose to 74.6, 78.6, 76.4, and 79.0, respectively, at 12, 24, 36, and 48 months. A signi...

The painful knee after TKA: a diagnostic algorithm for failure analysis

Knee Surgery, Sports Traumatology, Arthroscopy — Sat, 06 Aug 2011 05:52:52 +0100

Abstract Pain after total knee arthroplasty (TKA) represents a common observation in about 20% of the patients after surgery. Some of these painful knees require early revision surgery within 5 years. Obvious causes of failure might be identified with clinical examinations and standard radiographs only, whereas the unexplained painful TKA still remains a challenge for the surgeon. It is generally accepted that a clear understanding of the failure mechanism in each case is required prior considering revision surgery. A practical 10-step diagnostic algorithm is described for failure analysis in more detail. The evaluation of a painful TKA includes an extended history, analysis of the type of pain, psychological exploration, thorough clinical examination including spine,...

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Metal-reinforced Cement Augmentation for Complex Talar Subsidence in Failed Total Ankle Arthroplasty

Journal of Foot and Ankle Surgery — Fri, 05 Aug 2011 04:00:00 +0100

In this report, we describe a unique method of restoring talar support and preserving ankle function after failed TAA with major talar bone loss and component subsidence. Talar reconstruction using metal-reinforced bone cement augmentation is combined with the Inbone (Wright Medical Technology, Inc., Arlington, TN) total ankle system to restore talar height and ligamentous support. This technique has been used successfully in the last 4 years for various patterns of talar bone loss and obviates the need for custom components. When successfully performed, the revision technique results in restoration of mechanical alignment, anatomic height, and component support, in addition to providing substantial symptomatic relief. (Source: Journal of Foot and Ankle Surgery)

Results of total ankle arthroplasty.

The Journal of Bone and Joint Surgery. American volume — Wed, 03 Aug 2011 04:00:00 +0100

Authors: Easley ME, Adams SB, Hembree WC, Deorio JK Abstract Most published reports related to total ankle arthroplasty have a fair to poor-quality level of evidence.Comparative studies with a fair to good-quality level of evidence suggest that total ankle arthroplasty provides equal pain relief and possibly improved function compared with ankle arthrodesis.On the basis of the current literature, survivorship of total ankle arthroplasty implants, when measured as the retention of metal components, ranges from 70% to 98% at three to six years and from 80% to 95% at eight to twelve years.Several investigators have argued that, in the evolution of total ankle arthroplasty, some obligatory reoperation without removal of the metal implants is anticipated; examples of reoperation include...

Total ankle replacement with use of a new three-component implant.

The Journal of Bone and Joint Surgery. American volume — Wed, 03 Aug 2011 04:00:00 +0100

Conclusions:The short-term clinical and radiographic results after Mobility total ankle arthroplasty are encouraging and are at least comparable with those associated with other modern three-component implants. The minimum duration of follow-up of one year is short, and studies with longer follow-up are needed to confirm our findings.Level of Evidence:Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. PMID: 21915548 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

Computer-assisted techniques versus conventional guides for component alignment in total knee arthroplasty: a randomized controlled trial.

The Journal of Bone and Joint Surgery. American volume — Wed, 03 Aug 2011 04:00:00 +0100

Conclusions:This study provides evidence that the implant alignment with computer-assisted total knee arthroplasty, as measured with radiography and computed tomography, is significantly improved compared with that associated with conventional surgery with intramedullary or extramedullary guides. This finding adds to the body of evidence showing an improved radiographic outcome with computer-assisted surgery compared with that following conventional total knee arthroplasty.Level of Evidence:Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence. PMID: 21915542 [PubMed - in process] (Source: The Journal of Bone and Joint Surgery. American volume)

(iv) Hindfoot arthritis

Orthopaedics and Trauma — Mon, 01 Aug 2011 04:00:00 +0100

Abstract: Ankle and subtalar arthritis are commonly encountered by foot and ankle surgeons, but their prevalence is not as common as arthritis of the hip or knee.Trauma is the most common aetiology for both, but primary osteoarthritis and inflammatory arthropathies are also encountered.Clinical and radiological assessments are vital for correct diagnosis and for formulating an appropriate management plan. The recognition of abnormal alignment is particularly important as failure to do so will result in poor clinical outcomes of treatment.Both conditions can be managed using non-operative and operative treatment. Ankle arthritis in particular has generated much controversy with regards to the definitive treatments of arthrodesis and arthroplasty. (Source: Orthopaedics and Trauma)

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Total Ankle Replacements: An Overview

Clinics in Podiatric Medicine and Surgery — Mon, 01 Aug 2011 04:00:00 +0100

One of the most widely debated topics amongst foot and ankle surgeons is the treatment of end stage arthritis. With the advent of the newer generation of total ankle replacement (TAR), a viable option over an arthrodesis is now available for patients with end-stage ankle arthritis. When compared with an ankle arthroplasty, recent reports suggest the ankle arthrodesis has poor long-term outcomes (20 years+) and can experience short- and long-term complications. Proper training, strict patient selection, and proper implant contribute to a successful outcome. As advances continue to be made in both implant design and surgical technique, the benefits of a TAR appears to provide the foot and ankle surgeon a good alternative for the appropriate patient. (Source: Clinics in Podiatric Medicine and...

Total First Metatarsophalangeal Joint Implant Arthroplasty: A 30-year Retrospective

Clinics in Podiatric Medicine and Surgery — Mon, 01 Aug 2011 04:00:00 +0100

The first metatarsophalangeal (MTP) joint is a frequent diseased-affected articulation encountered by the foot and ankle surgeon. Arthroplasty remains a favorable option for surgeons, because it preserves motion of the joint. The authors' focus at the Weil Foot and Ankle Institute has been on using double-stem silicone implants with titanium grommets, which may be a viable solution for affected articulations. The authors present their clinical results from over 30 years of experience with total first MTP joint implant arthroplasty at the Weil Foot and Ankle Institute. (Source: Clinics in Podiatric Medicine and Surgery)

Navigation-assisted total knee arthroplasty in knees with osteoarthritis due to extra-articular deformity

Knee Surgery, Sports Traumatology, Arthroscopy — Thu, 28 Jul 2011 15:59:44 +0100

Conclusions The general value of navigation systems in achieving accurate bone cuts and restoring the mechanical axis has been established in the literature for standard TKA but not yet for extra-articular deformity. Our findings at mid-term follow-up on a large cohort of these patients showed that these systems used for intra-articular resection are a very effective alternative to previous techniques. Level of evidence Prospective study, Level IV. Content Type Journal ArticlePages 1-6DOI 10.1007/s00167-011-1602-1Authors Fabio Catani, Orthopaedic Department, University of Bologna, Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, 40136 Bologna, ItalyVitantonio Digennaro, Orthopaedic Department, University of Bologna, Istituto Ortopedico Rizzoli, Vi...

Position of the prosthesis components in total ankle replacement and the effect on motion at the replaced joint

International Orthopaedics — Mon, 25 Jul 2011 15:44:20 +0100

Conclusions Correlation, though weak, was found between motion at the replaced ankle and possible residual subluxation and inclination of the components. However, a satisfactory range of motion was also achieved in those patients where recommended locations for the components could not be reached because of the size of the original joint deformity. Content Type Journal ArticlePages 1-8DOI 10.1007/s00264-011-1323-6Authors Francesco Cenni, Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, ItalyAlberto Leardini, Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, ItalyAndrea Cheli, Movement Analysis Laboratory, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Ital...

Lateral Unicompartmental Knee Arthroplasty Relieves Pain and Improves Function in Posttraumatic Osteoarthritis.

Clinical Orthopaedics and Related Research — Mon, 11 Jul 2011 23:00:00 +0100

CONCLUSIONS: Despite the limited number of indications and technical considerations, our observations suggest lateral UKA is a reasonable option for treating lateral arthritis secondary to malunited fractures. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID: 21748514 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

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Joint health and functional ability in children with haemophilia who receive intensive replacement therapy

Haemophilia — Thu, 30 Jun 2011 23:00:00 +0100

Summary. Joint physical examination is an important outcome in haemophilia; however its relationship with functional ability is not well established in children with intensive replacement therapy. Boys aged 4–16 years were recruited from two European and three North American treatment centres. Joint physical structure and function was measured with the Haemophilia Joint Health Score (HJHS) while functional ability was measured with the revised Childhood Health Assessment Questionnaire (CHAQ38). Two haemophilia‐specific domains were created by selecting items of the CHAQ38 that cover haemophilia‐specific problems. Associations between CHAQ, HJHS, cumulative number of haemarthroses and age were assessed. A total of 226 subjects – mean 10.8 years old (SD 3.8) – participated; ...

Risk factors for symptomatic deep-vein thrombosis in patients after total ankle replacement who received routine chemical thromboprophylaxis.

The Journal of Bone and Joint Surgery. British volume — Thu, 30 Jun 2011 12:03:19 +0100

Authors: Barg A, Henninger HB, Hintermann B The aim of this study was to identify the incidence of post-operative symptomatic deep-vein thrombosis (DVT), as well as the risk factors for and location of DVT, in 665 patients (701 ankles) who underwent primary total ankle replacement. All patients received low-molecular-weight heparin prophylaxis. A total of 26 patients (3.9%, 26 ankles) had a symptomatic DVT, diagnosed by experienced radiologists using colour Doppler ultrasound. Most thrombi (22 patients, 84.6%) were localised distally in the operated limb. Using a logistic multiple regression model we identified obesity, a previous venous thromboembolic event and the absence of full post-operative weight-bearing as independent risk factors for developing a symptomatic DVT. The incidence...

Arthroplasty or Arthrodesis

Journal of Foot and Ankle Surgery — Tue, 28 Jun 2011 01:03:33 +0100

Until recently, the gold standard intervention for advanced ankle arthrosis was arthrodesis. Advancements in total ankle replacement (TAR) techniques, however, have moved arthroplasty forward to become a legitimate alternative to fusion. On the one hand, the traditional advantages of fusion include the relative ease of the technique, the ready availability of implants and instruments, and a long track record of success, particularly for pain relief. On the other hand, TAR preserves or even improves motion while providing relief from pain. When one considers the basic goals of most reconstructive surgical procedures—namely, pain relief, improved function, and deformity correction—the fact that TAR is associated with improved ankle motion makes it easy to understand why successful arthro...

cPLA2 induction and PGE2 release by IL‐1β via the MyD88‐dependent and cooperation of p300, Akt, and NF‐κB pathway in human rheumatoid arthritis synovial fibroblasts

Arthritis and Rheumatism — Wed, 22 Jun 2011 23:00:00 +0100

Conclusion:IL‐1β‐induced cPLA2 expression is mediated through activation of MyD88/c‐Src, MMP/HB‐EGF, EGFR/PI3K/Akt, p300, and NF‐κB pathways. These results provide insights into the mechanisms underlying IL‐1β‐enhanced joint inflammatory responses in RA and may inspire new targeted therapeutic approaches. (Source: Arthritis and Rheumatism)

[Total ankle arthroplasty for rheumatoid arthritis.]

Zeitschrift fur Rheumatologie — Tue, 21 Jun 2011 23:00:00 +0100

Authors: Schill S, Wetzel R Modern second generation total ankle arthroplasty is now a serious alternative to ankle fusion in patients with rheumatoid arthritis after careful assessment of the indications. The midterm results with 10-year survival rates between 70% and 90% and the possible revision for implant exchange or arthrodesis are the reasons for the increasing importance of ankle arthroplasty. Patients with rheumatoid arthritis in particular with generally lower physical requirements can expect a pain-free function of the operated ankle for 8-10 years. In comparison to fusion ankle arthroplasty allows a significantly faster remobilization and reserves the correction capabilities of the ankle. Arthrodesis remains a valuable therapeutic alternative for severe bony destruction and...

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Interval Changes in Postoperative Range of Motion of Salto-Talaris Total Ankle Replacement

Journal of Foot and Ankle Surgery — Thu, 16 Jun 2011 23:00:00 +0100

Abstract: The purpose of the present study was to identify changes in the range of motion during the first year after placement of the Salto-Talaris total ankle implant. The first 97 cases were assessed throughout the year at 6 weeks and 3, 6, and 12 months. Data were extracted through retrospective chart review, operative reports, and electronic goniometry of the implant in maximal dorsiflexion and plantarflexion. The range of motion incrementally improved through the treatment course, with the greatest increases occurring between 6 weeks and 6 months. The mean range of motion at 6 weeks was 11.85° ± 0.824° standard error, which had increased by 3.07° ± 0.862° to 14.92° (p < .0001) at 3 months postoperatively. From 3 to 6 months, it increased 3.96° ± 0.981° to 18.88° (p < .0001...

Multifocal Epithelioid Hemangioma with Reactive Bone Formation

Diagnostic and Therapeutic Endoscopy — Mon, 06 Jun 2011 14:54:08 +0100

A healthy 16-year-old male patient presented with several weeks of right ankle pain on weight-bearing, worsened with sporting activities, and relieved with rest. Radiographs demonstrated multiple well-marginated lytic lesions in the right distal tibia, and talar head and neck, with a further small intracortical lesion in the mid-to-distal anterior tibia. MRI showed multiple rounded low T1 and high T2 signal intensity lesions within the distal tibia and talus, with marked associated bone marrow edema. The radiologic diagnoses included multifocal hemangioendothelioma, multifocal hemangioma, angiosarcoma, atypical infection, Langerhans cell histiocytosis, or osteoblastomatosis. Histology showed sheets of epithelioid cells lining vascular structures in a hobnailed “tombstone-like” ...

Hemiarthroplasty augmented with bone graft for the failed hallux metatarsophalangeal Silastic® implant

Foot and Ankle Surgery — Sun, 05 Jun 2011 23:00:00 +0100

We describe a case in which reconstruction was achieved by using a porous coated metatarsophalangeal hemiarthroplasty augmented with bone graft with good early results. This previously unreported technique may offer an additional surgical option for reconstruction, maintaining joint movement without compromising future arthrodesis or excision arthroplasty as salvage measures. Long term follow up is required to confirm the success of this technique. (Source: Foot and Ankle Surgery)

Joint Replacement Arthroplasty – Basic Science, Elbow and Shoulder. Fourth Centennial Edition

Orthopaedics and Trauma — Tue, 31 May 2011 23:00:00 +0100

The publication of the fourth edition of this textbook coincides with the 100th year anniversary of the Orthopaedic Department at the Mayo Clinic. It is the first of two volumes with the second volume concerning hip, knee and ankle arthroplasty due for publication in 2011. Although online access to the full text and image bank is included via an access code printed on the inside of the front cover, it was not yet operational at the time of this review. Nevertheless, this promises to be a valuable resource when it is up and running. (Source: Orthopaedics and Trauma)

Arthroscopic Ankle Arthrodesis

Clinics in Podiatric Medicine and Surgery — Tue, 31 May 2011 23:00:00 +0100

Arthroscopic ankle arthrodesis provides the surgeon with an alternative to traditional open techniques. Arthroscopic ankle arthrodesis has demonstrated faster union rates, decreased complications, reduced postoperative pain, and shorter hospital stays. Adherence to sound surgical techniques, particularly with regard to joint preparation, is critical for success. Although total ankle replacement continues to grow in popularity, arthroscopic ankle arthrodesis remains a viable alternative for the management of end-stage arthritic ankle. (Source: Clinics in Podiatric Medicine and Surgery)

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Combined Total Ankle Replacement and Modified Bridle Tendon Transfer for End-stage Ankle Joint Arthrosis with Paralytic Dropfoot: Report of an Unusual Case

Journal of Foot and Ankle Surgery — Sun, 29 May 2011 23:00:00 +0100

In this report, we describe the unconventional combination of total ankle replacement in an adult patient with concomitant paralysis that was addressed by means of tendon transfer. (Source: Journal of Foot and Ankle Surgery)

Health Net Plan Members Gain Access to STAR(TM) Total Ankle Replacement System

HSMN NewsFeed — Wed, 25 May 2011 17:32:53 +0100

NEW YORK--(Healthcare Sales & Marketing Network)-- Small Bone Innovations, Inc. (SBi) announced today that approximately 1.4 million members of health insurance plans sponsored by Health Net in the Northeast tri-state region, Arizona, California, Georgia a... Devices, Orthopaedic, ReimbursementSmall Bone Innovations, STAR Total Ankle, Total Ankle (Source: HSMN NewsFeed)

Angiographic findings in patients with postoperative soft tissue defects following total knee arthroplasty

Knee Surgery, Sports Traumatology, Arthroscopy — Tue, 24 May 2011 15:46:30 +0100

Conclusions We suggest to rule out peripheral occlusive disease among patients undergoing TKR at best prior to orthopedic surgery using pulses and, if in doubt ankle-brachial index and doppler sonography Consequently, if vascular occlusions are then confirmed by angiography, dilatation and stenting or revascularization should be performed, to ameliorate perfusion. Level of evidence Retrospective case series with no comparison groups, Level IV. Content Type Journal ArticlePages 1-5DOI 10.1007/s00167-011-1532-yAuthors Christian Herold, Hannover, GermanyAndreas Steiert, Hannover, GermanyKarsten Knobloch, Hannover, GermanyMarc N. Busche, Hannover, GermanyMehmet A. Altintas, Hannover, GermanyPeter M. Vogt, Hannover, Germany Journal Knee Surgery,...

Tornier Introduces Porous Coated Affiniti Stem For Shoulder Joint Replacement Surgery

Medical Design Online News — Thu, 19 May 2011 21:05:00 +0100

Tornier Inc. the operating subsidiary of Tornier N.V., a leading global medical device company focused on serving extremities specialists who treat orthopedic conditions of the shoulder, elbow, wrist, hand, ankle and foot, today announced the introduction of the Porous Coated Affiniti Stem for shoulder joint replacement surgery (Source: Medical Design Online News)

[Ankle arthroplasty : Indications and current state.]

Der Orthopade — Thu, 12 May 2011 23:00:00 +0100

Authors: Lechler P, Grifka J, Köck FX Antecedent trauma is a major risk factor for the development of osteoarthritis of the ankle. Chronic inflammatory diseases, osteonecrosis and idiopathic arthritis are further important causes for ankle joint degeneration. Joint fusion represents the classic operative treatment of symptomatic ankle arthritis. The first attempts in total ankle replacement in the early 1970s led to high complication and revision rates. It was not until modern prosthesis designs respected the complex biomechanical conditions of the ankle joint that an alternative to joint fusion was available. Today a variety of models with specific advantages and disadvantages are available. Critical factors in ankle arthroplasty are proper patient selection and meticulous implantati...

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Wright Medical Group, Inc. Announces Launch Of The INBONE(R) II Total Ankle System

Health News from Medical News Today — Wed, 11 May 2011 12:00:00 +0100

Wright Medical Group, Inc. (NASDAQ: WMGI), a global orthopaedic medical device company, today announced the full commercial launch of the INBONE® II Total Ankle Replacement System. This new addition to the INBONE® Ankle System provides surgeons with a broader implant offering and further improves the system's highly precise surgical instrumentation. The INBONE® II Total Ankle System builds on the success of the original INBONE® System, which has been used clinically since 2006... (Source: Health News from Medical News Today)

Wright Medical Group, Inc. Announces Launch Of The INBONE II Total Ankle System

Medical Design Online News — Tue, 10 May 2011 20:30:00 +0100

Wright Medical Group, Inc., a global orthopaedic medical device company, today announced the full commercial launch of the INBONE II Total Ankle Replacement System. This new addition to the INBONE Ankle System provides surgeons with a broader implant offering and further improves the system's highly precise surgical instrumentation (Source: Medical Design Online News)

Summary Information for: Scandinavian Total Ankle Replacement System (STAR Ankle)

Food and Drug Adminstration (FDA): CDRHNew — Tue, 10 May 2011 04:00:00 +0100

Labeling, Approval Order, and Summary of Safety and Effectiveness for Scandinavian Total Ankle Replacement System (STAR Ankle) (P050050). (Source: Food and Drug Adminstration (FDA): CDRHNew)

Consumer Information on: Scandinavian Total Ankle Replacement System (STAR Ankle) - P050050

Food and Drug Adminstration (FDA): CDRHNew — Tue, 10 May 2011 04:00:00 +0100

The STAR Ankle is a non-constrained, total ankle replacement, surgically implanted to replace an ankle joint. The STAR Ankle is non-constrained because the bearing can be free to move in more than one plane along the tibial component. (Source: Food and Drug Adminstration (FDA): CDRHNew)

Scandinavian Total Ankle Replacement System (STAR Ankle)

Medical Device Approvals — Tue, 10 May 2011 04:00:00 +0100

The STAR Ankle is a non-constrained, total ankle replacement, surgically implanted to replace an ankle joint. The STAR Ankle is non-constrained because the bearing can be free to move in more than one plane along the tibial component. (Approved: 5/27/2009) (Source: Medical Device Approvals)

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Alternation of trunk movement after arthroplasty in patients with osteoarthritis of the knee

Journal of Orthopaedic Science — Fri, 06 May 2011 16:24:12 +0100

Conclusion The recovery of hip adduction during the standing phase caused by improvement of knee alignment contributed the reduction of trunk movement to the operated side. In the early post-arthroplasty period, the reduction of trunk movement in the coronal plane is beneficial to maintain trunk balance and prevent falls. Functional recovery of the lower extremities is a long-term process, and sustained functional training is necessary. Content Type Journal ArticlePages 1-7DOI 10.1007/s00776-011-0066-yAuthors Qi Zhong Chang, Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, JapanMakoto Sohmiya, Division of Rehabilitation Medicine, Gunma University Hospital, Maebashi, JapanNaoki Wada, Divisi...

Impact of Complications in Total Ankle Replacement and Ankle Arthrodesis Analyzed with a Validated Outcome Measurement

JBJS [Am] — Tue, 03 May 2011 23:00:00 +0100

Conclusions: At the time of follow-up, at a minimum of two years postoperatively, the outcomes of total ankle replacement and ankle arthrodesis, with regard to pain relief and function, were comparable. While the rate of complications was significantly higher following total ankle replacement, the impact of complications on outcome was clinically relevant in both groups. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

STAR Ankle Joint Replacements Last Long Term And Provide Relief For Patients

Health News from Medical News Today — Tue, 03 May 2011 08:00:00 +0100

A report on the STAR™ Ankle prosthesis published in the journal, Foot & Ankle International (May 2011 edition, Volume 32 #5 © American Orthopaedic Foot & Ankle Society) is the first long term U.S. prospective study of the three-part STAR total ankle joint replacement following the Pre Market Approval (PMA) by the FDA (U.S. Food and Drug Administration) in May 2009. Foot and ankle surgeons, Jeffrey A. Mann MD, Roger A. Mann MD and Eric Horton MD of Oakland, CA reported that 91 percent of prostheses remain implanted at an average follow-up of 9.1 years... (Source: Health News from Medical News Today)

Comparative Study of the Quality of Life Between Arthrodesis and Total Arthroplasty Substitution of the Ankle

Journal of Foot and Ankle Surgery — Mon, 02 May 2011 23:00:00 +0100

In conclusion, arthrodesis and arthroplasty represent good options in the surgical treatment of ankle arthrosis, providing both a significant improvement in function and in the health perception and quality of life of the patient. New-generation total ankle substitution arthroplasty provides an improvement in the quality of life and perception of general health of the patient with arthrosis of this joint, when this technique is compared with surgical fusion. (Source: Journal of Foot and Ankle Surgery)

Heterotopic Ossification After Primary Total Ankle Arthroplasty

JBJS [Am] — Tue, 19 Apr 2011 23:00:00 +0100

Conclusions: This study demonstrates that the prevalence of heterotopic ossification following primary total ankle arthroplasty is considerable, and that heterotopic ossification is associated with reduced ankle motion and a poor clinical outcome at a mean of two years postoperatively. Care is needed to attempt to reduce the occurrence of heterotopic ossification. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

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Pedicle and Free Flaps for Painful Nerve

Foot and Ankle Clinics — Sun, 17 Apr 2011 23:00:00 +0100

Treatment of the chronic painful nerve by pedicled or free tissue transfer is a complex surgical procedure, requiring specialized microsurgical training and technique. This procedure is indicated only in patients who have had repeated failure of simpler, conventional procedures. Patients with chronic painful peripheral nerves may be potentially salvaged by external neurolysis and circumferential wrapping of the involved segments of nerve with well-vascularized pedicled or free flaps of fascia, subcutaneous fatty tissue, omentum or muscle, or by the replacement of superficial hypersensitive cutaneous areas and nerves with the same tissues. (Source: Foot and Ankle Clinics)

Postoperative Limb Alignment and Its Determinants After Minimally Invasive Oxford Medial Unicompartmental Knee Arthroplasty

The Journal of Arthroplasty — Sun, 17 Apr 2011 23:00:00 +0100

Abstract: One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee arthroplasties in 109 patients were evaluated for postoperative limb alignment and the influence of factors such as preoperative limb alignment, age, body mass index, sex, insert thickness, and surgeon's experience. The mean mechanical preoperative hip-knee-ankle (HKA) angle of 172.2° ± 3.1° improved to 177.1° ± 2.9° postoperatively. In 75% of the limbs, the HKA angle was restored to within an acceptable alignment of 177° ± 3°, 14% of the limbs were in excessive varus (180°). Only preoperative HKA angle was predictive of postoperative HKA angle. Although most of the limbs had acceptable limb alignment after unicompartmental knee arthroplasty, limbs with more severe preopera...

Coventry Health Care Latest To Provide Access To SBi's STAR™ Total Ankle Replacement System

Health News from Medical News Today — Tue, 12 Apr 2011 12:00:00 +0100

Small Bone Innovations, Inc. (SBi) announced today that 1.7 million people nationwide covered by Coventry Health Care (NYSE: CVH) will have access to SBi's STAR™ Total Ankle Replacement system following a policy revision issued last week by the insurer. STAR is the only total ankle replacement approved through the FDA's rigorous pre-market approval (PMA) process... (Source: Health News from Medical News Today)

Midterm Results of Osteochondral Lesions of the Talar Shoulder Treated with Fresh Osteochondral Allograft Transplantation

JBJS [Am] — Tue, 05 Apr 2011 23:00:00 +0100

Conclusions: These midterm results in a small group of patients indicate that structural fresh-frozen allograft transplantation can be a successful surgical option in the treatment of large osteochondral defects of the talar shoulder. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

In‐hospital rehabilitation after multiple joint procedures of the lower extremities in haemophilia patients: clinical guidelines for physical therapists

Haemophilia — Sun, 03 Apr 2011 23:00:00 +0100

Summary. This project aimed to develop guidelines for use during in‐hospital rehabilitation after combinations of multiple joint procedures (MJP) of the lower extremities in persons with haemophilia (PWH). MJP are defined as surgical procedures on the ankles, knees and hips, performed in any combination, staged, or during a single session. MJP that we studied included total knee arthroplasty, total hip arthroplasty and ankle arthrodesis. Literature on rheumatoid arthritis demonstrated promising functional results, fewer hospitalization days and days lost from work. However, the complication rate is higher and rehabilitation needs optimal conditions. Since 1995, at the Van Creveldkliniek, 54 PWH have undergone MJP. During the rehabilitation in our hospital performed by experienced phys...

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Stresses in the ankle joint and total ankle replacement design

Foot and Ankle Surgery — Sun, 03 Apr 2011 23:00:00 +0100

Abstract: The ankle is a highly congruent joint with a surface area of 11–13cm2. Total ankle replacements have been attempted since the early 1970s and design has continually evolved as the early designs were a failure. This was because the stresses involved and the mutiaxial motion of the ankle has not been understood until recently. It has been shown that the talus slides as well as rolls during the ankle arc of motion from plantarflexion to dorsiflexion. Furthermore, the articular surfaces and the calcaneofibular and tibiocalcaneal ligaments have been shown to form a four bar linkage dictating ankle motion. A new design ankle replacement has been suggested recently which allows multiaxial motion at the ankle while maintaining congruency throughout the arc of motion. The early results ...

A review of the STAR prosthetic system and the biomechanical considerations in total ankle replacements

Foot and Ankle Surgery — Sun, 03 Apr 2011 23:00:00 +0100

Abstract: The ankle is a complex joint, anatomically and biomechanically. Pathologically diseased ankle joints, which require surgical intervention, now have the option of a total ankle replacement system rather than the long-standing arthrodesis procedure, first described by Albert in 1878. The anatomical features and forces acting across the joint are important when designing total ankle replacement (TAR) systems. This review discusses the history and evolution of TAR prosthetic systems and considers how the ankle's normal physiology and biomechanics is incorporated into their design. The Scandinavian total ankle replacement (STAR) is a three component prosthetic system and this review concludes that its size, shape and surgical insertion technique allows the biomechanical requirements o...

Ankle fusion using a 2-incision, 3-screw technique.

Operative Orthopadie und Traumatologie — Fri, 01 Apr 2011 23:00:00 +0100

Authors: Hendrickx RP, Kerkhoffs GM, Stufkens SA, van Dijk CN, Marti RK OBJECTIVE: Reliable fusion and optimal correction of the alignment of the ankle joint using a 2-incision, 3-screw technique. INDICATIONS: Symptomatic osteoarthritis of the ankle joint after insufficient other treatment, severe deformity of the osteoarthritic ankle joint, or salvation procedure after failed arthroplasty. CONTRAINDICATIONS: Active osteomyelitis, very poor soft tissues, or severe peripheral arterial occlusive disease. SURGICAL TECHNIQUE: Osteotomy and excision medial malleolus. Osteotomy, dislocation, and denudation of the distal fibula. Osteotomy of distal tibia and talus in the desired position for optimal alignment. Temporary tibiotalar fixation with two Weber reposition clamps. Final tibiotalar fi...

Venous thromboembolic events following foot and ankle surgery in the English National Health Service.

The Journal of Bone and Joint Surgery. British volume — Thu, 31 Mar 2011 23:00:00 +0100

Authors: Jameson SS, Augustine A, James P, Serrano-Pedraza I, Oliver K, Townshend D, Reed MR Diagnostic and operative codes are routinely collected for every patient admitted to hospital in the English NHS. Data on post-operative complications following foot and ankle surgery have not previously been available in large numbers. Data on symptomatic venous thromboembolism events and mortality within 90 days were extracted for patients undergoing fixation of an ankle fracture, first metatarsal osteotomy, hindfoot fusions and total ankle replacement over a period of 42 months. For ankle fracture surgery (45 949 patients), the rates of deep-vein thrombosis (DVT), pulmonary embolism and mortality were 0.12%, 0.17% and 0.37%, respectively. For first metatarsal osteotomy (33 626 patients), DVT...

TRICARE(R) Armed Forces Health Care Program To Provide Access To SBi's STAR™ Total Ankle Replacement System

Health News from Medical News Today — Tue, 29 Mar 2011 12:00:00 +0100

Small Bone Innovations, Inc. (SBi) announced today the 9.6 million beneficiaries of the US Department of Defense TRICARE® health care program, which covers armed forces personnel, retirees and their families, will now have access to SBi's STAR™ Total Ankle Replacement system. The STAR is the only total ankle replacement approved through the FDA's rigorous pre-market approval (PMA) process... (Source: Health News from Medical News Today)

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Blue Cross And Blue Shield Companies To Reimburse SBi's Star™ Total Ankle Replacement

Health News from Medical News Today — Thu, 24 Mar 2011 13:00:00 +0100

Small Bone Innovations, Inc. (SBi) announced today that 38 of the 39 independent member companies of the BlueCross and BlueShield Association will cover SBi's STAR™ Total Ankle Replacement system to benefit an estimated 98.5 million insured in 49 states. SBi is an orthopedics company focused exclusively on serving patients and their physicians with technologies and treatments for joint replacement (arthroplasty) and post-traumatic reconstruction of the small bones & joints of the thumb, fingers, hand, wrist, elbow, toes, foot and ankle... (Source: Health News from Medical News Today)

Blue Cross and Blue Shield Companies to Reimburse SBis STAR(TM) Total Ankle Replacement

HSMN NewsFeed — Thu, 24 Mar 2011 00:12:57 +0100

NEW YORK--(Healthcare Sales & Marketing Network)-- Small Bone Innovations, Inc. (SBi) announced today that 38 of the 39 independent member companies of the BlueCross and BlueShield Association will cover SBis STAR Total Ankle Replacement system to benefi... Devices, Orthopaedic, ReimbursementSmall Bone Innovations, STAR Total Ankle Replacement, total ankle (Source: HSMN NewsFeed)

Radiographic Analysis of a Hand-Held Surgical Navigation System for Tibial Resection in Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 14 Mar 2011 04:00:00 +0100

Abstract: Tibial intramedullary or extramedullary alignment guides have not been shown to be highly accurate in performing the tibial resection in total knee arthroplasty (TKA). Since May 2010, a total of 42 knees underwent a TKA using a hand-held, accelerometer-based surgical navigation system for performing the tibial resection (KneeAlign; OrthAlign Inc, Aliso Viejo, Calif). Postoperative standing anteroposterior hip-to-ankle and lateral knee-to-ankle radiographs demonstrated that 97.6% of the tibial components were placed within 90° ± 2° to the mechanical axis in the coronal plane, and 96.2% of the components were placed within 3° ± 2° to the mechanical axis in the sagittal plane. The KneeAlign greatly improves the accuracy of tibial component alignment in TKA. (Source: The Journa...

Is Total Ankle Arthroplasty A Cost-effective Alternative to Ankle Fusion?

Clinical Orthopaedics and Related Research — Fri, 11 Mar 2011 00:00:00 +0100

CONCLUSION: Despite more costly implants and longer followup, TAA remains a cost-effective alternative to ankle fusion in a 60-year-old cohort with end-stage ankle arthritis. LEVEL OF EVIDENCE: Level II, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence. PMID: 21394559 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

WellPoints UniCare Subsidiary Revises Its Coverage Policy on Total Ankle Replacement to Cover SBis STAR(TM) Ankle

HSMN NewsFeed — Thu, 10 Mar 2011 21:34:43 +0100

NEW YORK--(Healthcare Sales & Marketing Network)-- Small Bone Innovations, Inc. (SBi), an orthopedics company focused exclusively on serving patients and their physicians with technologies and treatments for joint repair (arthroplasty) and trauma reconstru... Devices, Orthopaedic, ReimbursementSmall Bone Innovations, Total Ankle Replacement (Source: HSMN NewsFeed)

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In vivo kinematics of two-component total ankle arthroplasty during non-weightbearing and weightbearing dorsiflexion/plantarflexion

Journal of Biomechanics — Thu, 10 Mar 2011 00:00:00 +0100

Abstract: Relatively high rates of loosening and implant failure have been reported after total ankle arthroplasty, especially in first and second generation implants. Abnormal kinematics and incongruency of the articular surface may cause increased loads applied to the implant with concomitant polyethylene wear, resulting in loosening and implant failure. The purpose of this study was to measure three-dimensional kinematics of two-component total ankle arthroplasty during non-weightbearing and weightbearing activities, and to investigate incongruency of the articular surfaces during these activities. Forty-seven patients with a mean age of 71 years were enrolled. Radiographs were taken at non-weightbearing maximal dorsiflexion and plantarflexion, and weightbearing maximal dorsiflexion, pl...

Dynamic hip joint stiffness in individuals with total hip arthroplasty: Relationships between hip impairments and dynamics of the other joints

Clinical Biomechanics — Thu, 10 Mar 2011 00:00:00 +0100

Abstract: Background: Little is known about hip joint stiffness during walking (dynamic joint stiffness) and the effect of hip impairments on biomechanical alterations of other joints in patients with total hip arthroplasty.Methods: Twenty-four patients (mean age 61.7years) who underwent unilateral (n=12) or bilateral total hip arthroplasty (n=12) and healthy subjects (n=12) were recruited. In addition to kinematic and kinetic variables, dynamic hip joint stiffness which was calculated as an angular coefficient of linear regression of the plot of the hip flexion moment vs. hip extension angle during the late stance of gait, was measured. Group differences were compared using one-way ANOVA and Tukey's post-hoc test, and relationships between primary hip impairments and secondary gait impair...

Total ankle arthroplasty.

Bulletin of the NYU Hospital for Joint Diseases — Tue, 08 Mar 2011 13:15:03 +0100

Authors: Park JS, Mroczek KJ Although ankle arthrodesis has been considered the gold standard for treatment of symptomatic end stage arthritis, recent improvements in arthroplasty designs and instrumentation have led to a resurgence in interest in ankle arthroplasty. While frst generation arthroplasty systems had high failure rates due to cemented techniques or highly constrained designs, newer generations of ankle replacements have introduced more anatomic and pressft techniques. Early results have been promising, with improved functional outcomes versus ankle arthrodesis. However, complication rates are still substantial, and the procedure should be restricted to properly indicated patients. Long-term follow-up studies are necessary, but total ankle arthroplasty has become a viable o...

Ankle Replacement Provides Pain Relief in Gouty Arthritis

Modern Medicine — Mon, 07 Mar 2011 00:00:00 +0100

Total ankle replacement provides significant pain relief and good functional results in patients with painful gouty ankle arthritis, and it is associated with a low risk of complications, according to a study published in the Feb. 16 issue of The Journal of Bone & Joint Surgery. (Source: Modern Medicine)

Career Plans of Current Orthopaedic Residents with a Focus on Sex-Based and Generational Differences

JBJS [Am] — Wed, 02 Mar 2011 00:00:00 +0100

Conclusions: We should continue efforts to collect workforce data and be proactive to avert or minimize the effect of impending orthopaedic workforce shortages on our patients. Given the trend toward an increasing proportion of female orthopaedists and the higher likelihood that they will reduce their work hours during portions of their career, policymakers should consider training more orthopaedists to ensure patient access to timely, quality orthopaedic care. (Source: JBJS [Am])

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Revision rates after total joint replacement: CUMULATIVE RESULTS FROM WORLDWIDE JOINT REGISTER DATASETS.

The Journal of Bone and Joint Surgery. British volume — Tue, 01 Mar 2011 00:00:00 +0100

Authors: Labek G, Thaler M, Janda W, Agreiter M, Stöckl B In a systematic review, reports from national registers and clinical studies were identified and analysed with respect to revision rates after joint replacement, which were calculated as revisions per 100 observed component years. After primary hip replacement, a mean of 1.29 revisions per 100 observed component years was seen. The results after primary total knee replacement are 1.26 revisions per 100 observed component years, and 1.53 after medial unicompartmental replacement. After total ankle replacement a mean of 3.29 revisions per 100 observed component years was seen. The outcomes of total hip and knee replacement are almost identical. Revision rates of about 6% after five years and 12% after ten years are to be expected...

Regenerative Tissue Matrix as an Interpositional Spacer Following Excision of a Cuboid-Navicular Tarsal Coalition: A Case Study

Journal of Foot and Ankle Surgery — Tue, 01 Mar 2011 00:00:00 +0100

This article describes the use of an acellular human dermal regenerative tissue matrix as an interpositional spacer to maintain the distance between the cuboid and navicular, and to prevent recurrence, following surgical excision of a cuboid-navicular tarsal coalition in an adult female. The use of this acellular matrix as an interpositional spacer has previously been documented for use in association with arthroplasty for the treatment of hallux rigidus. After more than 3 years of follow-up, the patient was progressing well and there was no evidence of recurrent coalition or consolidation of the resection site. To the best of our knowledge, this is the first report of the use of this material for the treatment of tarsal coalition, published in the peer-reviewed literature. (Source: Journa...

Brewster M. “Does total joint replacement or arthrodesis of the first metatarsophalangeal joint yield better functional results? A systematic review of the literature”

Journal of Foot and Ankle Surgery — Tue, 01 Mar 2011 00:00:00 +0100

Dear Editor: I read with interest the recent review article by Mark Brewster, MBChB, comparing the functional results of total joint replacement versus arthrodesis of the first metatarsophalangeal joint. After reading the systematic review, I think several points need further clarification. (Source: Journal of Foot and Ankle Surgery)

Reply

Journal of Foot and Ankle Surgery — Tue, 01 Mar 2011 00:00:00 +0100

Thank you for your interest and detailed analysis of my article published in The Journal of Foot & Ankle Surgery (Brewster M. Does total joint replacement or arthrodesis of the first metatarsophalangeal joint yield better functional results? A systematic review of the literature. J Foot Ankle Surg 49:546–552, 2010). I shall address each point you raised in order. (Source: Journal of Foot and Ankle Surgery)

Natural distribution of the femoral mechanical–anatomical angle in an osteoarthritic population and its relevance to total knee arthroplasty

The Knee — Mon, 28 Feb 2011 05:00:00 +0100

This study analysed 174 pre-operative hip–knee–ankle radiographs of osteoarthritic knees (157 patients, 87 female and 70 male, mean age 70years and mean BMI 31.8). Measurements of mechanical femorotibial (MFT) and FMA angles were made. The mean FMA angle was 5.7° (SD 1.2°, range 2° to 9°). There was a statistically significant difference between the FMA angle for males and females with males tending to have larger FMA angles (p (Source: The Knee)

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Immediate effects of different ankle pushoff instructions during walking exercise on hip kinematics and kinetics in individuals with total hip arthroplasty

Gait and Posture — Mon, 21 Feb 2011 00:00:00 +0100

Abstract: Residual hip impairments, such as decreased hip muscle moment and power during walking, have been reported in patients with total hip arthroplasty (THA). Meanwhile, greater ankle power has also been reported in these patients. We investigated the interaction between hip and ankle joints during walking to determine the effects of different ankle pushoff instructions on hip biomechanics in patients with THA. Twenty-four women (age, 60.8±5.5 years) were randomly assigned to walking exercise groups with either decreased pushoff or increased pushoff. Patients in the decreased pushoff group and increased pushoff group were given the instructions “push less with your foot when you walk” and “push more with your foot when you walk,” respectively. Exercises lasted approximately 1...

Characterization of a mixed MRSA/MRSE biofilm in an explanted total ankle arthroplasty

FEMS Immunology and Medical Microbiology — Sat, 19 Feb 2011 00:00:00 +0100

AbstractBacterial biofilms have been observed in many prosthesis‐related infections, and this mode‐of‐growth renders the infection both difficult to treat, and especially difficult to detect and diagnose by standard culture methods. We (1) tested a novel coupled PCR‐mass spectroscopic assay (the Ibis T5000) on an ankle arthroplasty that was culture negative on pre‐operative aspiration, and then (2) confirmed that the Ibis assay had in fact detected viable multi‐species biofilm by further micrographic and molecular examinations, including confocal microscopy using Live/Dead stain, bacterial fluorescent in situ hybridization (FISH), and reverse‐transciptase‐PCR (RT‐PCR) assay for bacterial messenger RNA. The Ibis technology detected Staphylococcus aureus, Staphylococcus epi...

Total Ankle Replacement in Patients with Gouty Arthritis

JBJS [Am] — Wed, 16 Feb 2011 00:00:00 +0100

Conclusions: Total ankle replacement in patients with painful gouty ankle arthritis is associated with a low risk of intraoperative and postoperative complications and leads to significant pain relief, high patient satisfaction, and good functional results. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

Small Bone Innovations, Inc. Receives US FDA 510(k) Clearance For Radial Head (rHead™) Extended Stem

Health News from Medical News Today — Wed, 26 Jan 2011 09:00:00 +0100

Small Bone Innovations, Inc. (SBi), an orthopedics company focused exclusively on serving patients and their physicians with technologies and treatments for joint repair (arthroplasty) and trauma reconstruction around the small bones & joints of the thumb, fingers, hand, wrist, elbow, toes and foot & ankle announced that it has received 510(k) pre-market clearance notification from the U.S. Food and Drug Administration (FDA) for the radial Head (rHead™) Extended Stem to be used in the correction of complex elbow instabilities and/or elbow reconstruction... (Source: Health News from Medical News Today)

Small Bone Innovations, Inc. Receives US FDA 510(k) Clearance For Radial Head (rHead) Extended Stem

Medical Design Online News — Mon, 24 Jan 2011 20:18:00 +0100

Small Bone Innovations, Inc. (SBi), an orthopedics company focused exclusively on serving patients and their physicians with technologies and treatments for joint repair (arthroplasty) and trauma reconstruction around the small bones & joints of the thumb, fingers, hand, wrist, elbow, toes and foot & ankle announced that it has received 510(k) pre-market clearance notification from the U.S. Food and Drug Administration (FDA) for the radial Head (rHead) Extended Stem to be used in the correction of complex elbow instabilities and/or elbow reconstruction (Source: Medical Design Online News)

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Anterior border of the tibia as a landmark for extramedullary alignment guide in total knee arthroplasty for varus knees

Journal of Orthopaedic Research — Fri, 21 Jan 2011 00:00:00 +0100

AbstractA disadvantage to using extramedullary alignment guides of the tibia for total knee arthroplasty (TKA) is difficulty in correctly identifying the ankle center. The anterior border of the tibia is easily palpable, as it is not covered by muscles and its shape is convex anteriorly. We hypothesized that appropriate points exist along the anterior border that can be used as landmarks for extramedullary guides. Prior to TKA, computed tomographic images of the entire tibia were obtained from 101 osteoarthritic knees with varus deformities. The relationship between the lines connecting two points on the anterior border and the mechanical axis was evaluated using 3D imaging software. The mean angles between each of 10 determined axes and the mechanical axis varied from 3.2° varus to 2.1°...

Why I Won't Tune In for Next Week's Episode of HEAVY

Psychology Today Addiction Center — Wed, 19 Jan 2011 20:42:42 +0100

It wasn't my idea to watch the premier of A&E's new reality series in the first place. I was commanded to and I approached the hour with the strong sense that I would be seeing a lot of skinny people being mean to fat people who would be weeping from the strain of trying to do as they were told.At least, I told myself, Heavy would not pit one person against another. No one would get thrown off the show for being the weakest link.The program is preceded by another addiction-intensive series, Intervention, and I was interested that the promos were, um, heavy on the addiction aspect of the particpants' obesity and eating.In one ad, a female voice-over says, "His addiction is the worst I've ever seen. Ever." Another, this time male, voice-over, asserts, "This is mor...

Wright Medical Group, Inc. Announces IDE Approval For Calcaneal Stem Fixation For The INBONE(R) Total Ankle System

Health News from Medical News Today — Thu, 13 Jan 2011 09:00:00 +0100

Wright Medical Group, Inc. (NASDAQ: WMGI), a global orthopaedic medical device company, announced that it has received approval from the U.S. Food and Drug Administration (FDA) to conduct an Investigational Device Exemption (IDE) clinical study to investigate use of the INBONE® Total Ankle Replacement with Calcaneal Stem for treatment of end stage ankle arthritis or revision of a failed ankle replacement with subtalar joint insufficiency. Thomas H. Lee, M.D... (Source: Health News from Medical News Today)

Patient specific ankle-foot orthoses using rapid prototyping

Journal of NeuroEngineering and Rehabilitation — Wed, 12 Jan 2011 00:00:00 +0100

Conclusions: The rapidly prototyped orthoses fabricated in this study provided good fit of the subject's anatomy compared to a prefabricated AFO while delivering comparable function (i.e. mechanical effect on the biomechanics of gait). The rapid fabrication capability is of interest because it has potential for decreasing fabrication time and cost especially when a replacement of the orthosis is required. (Source: Journal of NeuroEngineering and Rehabilitation)

Wright Medical Group, Inc. Announces IDE Approval For Calcaneal Stem Fixation For The INBONE Total Ankle System

Medical Design Online News — Tue, 11 Jan 2011 21:30:00 +0100

Wright Medical Group, Inc., a global orthopaedic medical device company, today announced that it has received approval from the U.S. Food and Drug Administration (FDA) to conduct an Investigational Device Exemption (IDE) clinical study to investigate use of the INBONE Total Ankle Replacement with Calcaneal Stem for treatment of end stage ankle arthritis or revision of a failed ankle replacement with subtalar joint insufficiency (Source: Medical Design Online News)

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Salvage of Chronic Instability of the Syndesmosis with Distal Tibiofibular Arthrodesis: Functional and Radiographic Results

JBJS [Am] — Wed, 05 Jan 2011 00:00:00 +0100

Conclusions: The significant improvements in the radiographic and functional measures of outcome that were observed in this small cohort suggest that chronic syndesmotic instability after ankle fracture can be salvaged with reduction and arthrodesis of the distal tibiofibular articulation. Furthermore, the reconstruction of an incongruous and arthritic ankle is an alternative to and may postpone the subsequent need for ankle arthrodesis or arthroplasty. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

The value of immediate preoperative vascular examination in an at-risk patient for total knee arthroplasty.

Orthopedics — Sat, 01 Jan 2011 00:00:00 +0100

This article presents a case of an immediate preoperative vascular examination, performed at the time of surgical site marking, in an at-risk patient prior to TKA. We detail the clinical course of a patient with peripheral vascular disease and indwelling superficial femoral artery stent, who developed stent thrombosis in the 2-week period between his last clinic visit and date of surgery, with no change in symptoms. This restenosis was detected on routine preoperative physical examination and resulted in cancellation of the TKA in the preoperative area, allowing the patient to undergo emergent revascularization. We emphasize the importance of an immediate preoperative vascular examination in the setting of TKA and provide a comprehensive review of the literature with guidelines on the peri...

Total Ankle Replacement in the Varus Ankle

Journal of Foot and Ankle Surgery — Tue, 28 Dec 2010 22:20:31 +0100

In conclusion, surgical treatment of the varus ankle arthrosis with TAR can be successful. (Source: Journal of Foot and Ankle Surgery)

Pigmented Villonodular Synovitis of the Ankle—Radiation Therapy as a Primary Treatment to Reduce Recurrence: A Case Report with 8-year Follow-up

Journal of Foot and Ankle Surgery — Tue, 28 Dec 2010 22:20:31 +0100

We present a case of PVNS where the patient was treated in 2 stages: surgical resection of the tumor with arthroplasty of the ankle joint followed by radiation therapy. A retrospective review of the chart, radiographs, and MRIs was conducted for a 36-year-old, African American female who had been treated and followed for 8 years. Pathologic examination of the tumor confirmed the diagnosis of PVNS. No evidence of recurrent PVNS was identified in the long-term postoperative MRI examination. The fact that ancillary imaging examinations failed to reveal evidence of recurrence and that the patient expresses a very high patient satisfaction supports the potential benefit of adjunctive radiation therapy for this condition. (Source: Journal of Foot and Ankle Surgery)

Open Posterior Approach for Tibiotalar Arthrodesis

Foot and Ankle Clinics — Thu, 23 Dec 2010 00:00:00 +0100

This article discusses the application of the posterior approach to complete a tibiotalar and tibiotalocalcaneal arthrodesis as well as its use for converting a failed total ankle arthroplasty to an arthrodesis. (Source: Foot and Ankle Clinics)

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Outcome evaluation of ankle osteoarthritis treatments: Plantar pressure analysis during relatively long-distance walking

Clinical Biomechanics — Mon, 20 Dec 2010 00:00:00 +0100

This study aimed to use plantar pressure analysis in relatively long-distance walking for objective outcome evaluation of ankle osteoarthritis treatments, i.e., ankle arthrodesis and total ankle replacement.Methods: Forty-seven subjects in four groups: three patient groups and controls, participated in the study. Each subject walked twice in 50-m trials. Plantar pressure under the pathological foot was measured using pressure insoles. Six parameters: initial contact time, terminal contact time, maximum force time, peak pressure time, maximum force and peak pressure were calculated and averaged over trials in ten regions of foot. The parameters in each region were compared between patient groups and controls and their effect size was estimated. Besides, the correlations between pressure par...

Simultaneous bilateral versus unilateral total ankle replacement: A PATIENT-BASED COMPARISON OF PAIN RELIEF, QUALITY OF LIFE AND FUNCTIONAL OUTCOME.

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

Authors: Barg A, Knupp M, Hintermann B The aim of this study was to compare the outcome of bilateral sequential total ankle replacement (TAR) with that of unilateral TAR. We reviewed 23 patients who had undergone sequential bilateral TAR under a single anaesthetic and 46 matched patients with a unilateral TAR. There were no significant pre-operative differences between the two groups in terms of age, gender, body mass index, American Society of Anaesthesiologists classification and aetiology of the osteoarthritis of the ankle. Clinical and radiological follow-up was carried out at four months, one and two years. After four months, patients with simultaneous bilateral TAR reported a significantly higher mean pain score than those with a unilateral TAR. The mean American Orthopaedic Foot...

Total ankle arthroplasty.

Orthopedics — Wed, 01 Dec 2010 00:00:00 +0100

Authors: Raikin SM PMID: 21117563 [PubMed - in process] (Source: Orthopedics)

Persistent Hindfoot Valgus Causes Lateral Deviation of Weightbearing Axis after Total Knee Arthroplasty.

Clinical Orthopaedics and Related Research — Wed, 01 Dec 2010 00:00:00 +0100

CONCLUSIONS: Accurate restoration of limb alignment after TKA may be associated with persistent hindfoot valgus alignment with the ground mechanical axis passing lateral to the center of the knee. This could have implications on long-term survival of the implant owing to possible excessive loading laterally and needs further investigation. PMID: 21120711 [PubMed - as supplied by publisher] (Source: Clinical Orthopaedics and Related Research)

Introduction

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

The ankle is one of the most commonly injured major joints in the human body, and the joint whose cartilage undergoes the greatest amount of biomechanical stress per square inch, yet the prevalence of arthritis involving the ankle is significantly lower than that of the knee or hip joints. When arthritis does occur, it is most frequently secondary to trauma to the joint, and symptomatic end-stage ankle arthritis has been shown to result in mental and physical disability at least equal to that of people experiencing end-stage hip arthritis. (Source: Seminars in Arthroplasty)

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Ankle Arthritis: Etiology and Epidemiology

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

The ankle joint is subject to symptomatic arthritis at a much lower rate than the other major weight-bearing joints in the lower extremity. When degenerative changes do occur, they are most commonly secondary to trauma, chronic ankle malalignment, ankle instability, inflammatory conditions, infection, recurrent hemarthrosis, neuropathic and neoplastic conditions. (Source: Seminars in Arthroplasty)

Comparison of Gait Biomechanics: Ankle Fusion Versus Ankle Replacement

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

We present a summary of the available literature on this topic, with the goal of illuminating the differences in gait biomechanics between ankle fusion and ankle replacement. (Source: Seminars in Arthroplasty)

Supramalleolar Osteotomies as Joint Sparing Management of Ankle Arthritis

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

A 36-year-old man presented approximately 4 years status post a tibial Pilon fracture because of a motorcycle accident. The initial fracture had been treated conservatively because of other life-threatening injuries from which he has recovered without consequences. The fracture healed in a varus alignment (). Upon presentation, the patient complained of pain with ambulation or activity and decreased range of motion. He did not respond to conservative treatment consisting of bracing and wedging, activity modification, and anti-inflammatory medications and was seeking surgical treatment options because the pain affected his quality of life significantly. (Source: Seminars in Arthroplasty)

Tibiotalar Arthrodesis

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

Arthrodesis remains an acceptable and reliable treatment for recalcitrant ankle arthritis. Although historically stabilized with the use of casts, internal fixation with compression screws is now the norm. Cases with minimal deformity can be approached in a minimally invasive fashion. Advanced deformity or a failed total ankle replacement necessitates a lateral or anterior approach. The overall fusion rate in the modern literature exceeds 90%, especially with minimally invasive techniques. Potential complications include nonunion, malunion, infection, and adjacent joint arthritis and can be minimized with careful attention to surgical technique, including rigid internal fixation and proper alignment of the fusion. (Source: Seminars in Arthroplasty)

Total Ankle Arthroplasty as Current Treatment for Ankle Arthritis

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

Arthritis of the ankle can cause pain, joint incongruence, diminished motion, and functional disability. The traditional surgical treatment for ankle arthritis that has failed nonsurgical management is joint arthrodesis. However, ankle arthrodesis is not without shortcomings, which include the development of gait dysfunction and adjacent joint arthritis. Such problems promoted interest in total ankle arthroplasty (TAA) as early as the 1970s. In contrast to arthrodesis, TAA can have a wider variety of complications rather than ones that are worse. It is critical to view the shortcomings of modern TAA with a careful analysis of the literature. Several studies suggest that surgeon factors may play a role in certain complications. Other texts conclude that patient characteristics may be relate...

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The Current Status of Fresh Osteochondral Allograft Transplantation for Ankle Arthritis

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

The use of fresh osteochondral allografts for total ankle replacement has been sporadically reported in the literature. Survival rates at (Source: Seminars in Arthroplasty)

Mobility Characteristics of Total Ankle Replacements

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

Follow-up studies of the first generation of total ankle replacements indicate failure rates between 52% and 95% at 10 years, mainly attributable to prosthetic loosening linked to compromised subtalar joint motion and excessive intrinsic constraint. Contemporary designs claim to withstand forces across the ankle and minimize loosening by allowing functional motion without excessive constraint. A dynamic testing system was used to measure the anteroposterior, medial-lateral, and internal-external rotational constraints for 4 contemporary total ankle designs under normal gait loads. The force-displacement curves were analyzed for component sliding and tibiotalar surface geometry-generated shear forces. Two designs, with essential soft-tissue load sharing and no mechanical stops on the talar ...

Agility Low Profile: Short-Term Update and Representative Case Presentation

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

The Agility LP (low profile) total ankle prosthesis is the most recent refinement of the Agility total ankle system (DePuy orthopedics, Wausau, IN). This prosthesis was developed in an effort to address several problems encountered during the history of the Agility. Reliance on the cortical support of the fibula associated with fusion of the distal tibiofibular syndesmosis and semiconstrained design remains the cornerstones of the long-term success of this system. Short-term observation demonstrates the changes in the LP have proven to decrease the complication/reoperation rate and, when necessary, make revision easier. (Source: Seminars in Arthroplasty)

The Scandinavian Total Ankle Replacement (STAR) System

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

The Scandinavian total ankle replacement (STAR) system is a mobile-bearing design that has been used both in the United States and Europe to treat advanced arthrosis of the tibiotalar joint. The purpose of this study was to review the history of the implant, describe its design, highlight important aspects of its surgical technique, and assess the available results after STAR implantation in the literature. In the STAR, surgeons resect only minimal bone and permit motion in multiple planes without causing undue stress at the bone-implant interface. Although the results to date are promising, longer-term efficacy needs to be assessed in future studies. (Source: Seminars in Arthroplasty)

The Salto Talaris Total Ankle Arthroplasty System: A Review and Report of Early Results

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

This article aims to provide historical background, describe surgical technique, and present relevant clinical data to better understand the potential role of the Salto Talaris ankle replacement system in providing symptomatic relief and optimal range of motion, and hence improving quality of life in patients with end-stage ankle arthritis. (Source: Seminars in Arthroplasty)

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INBONE Total Ankle Arthroplasty

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

This article details the techniques used for its insertion. (Source: Seminars in Arthroplasty)

Canadian Experience in Total Ankle Arthroplasty

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

Total ankle arthroplasty is one form of operative treatment for arthritis of the tibiotalar joint. The two main design concepts are fixed and mobile bearing. The trend in Canada has been to move away from the Agility prosthesis and move toward the 3 component mobile design. The majority of these implants are the STAR, the Hintergra and the Mobility ankle replacements. A review of the literature pertaining to these implants is presented. Canadian outcome studies reviewing these implants are forth coming. (Source: Seminars in Arthroplasty)

The Role of Arthroplasty in Combined Hind Foot and Ankle Arthritis

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

Novel surgical techniques and design improvements of total ankle arthroplasty implants have expanded the indications of motion-sparing procedures over arthrodesis in the treatment of arthritic conditions of the ankle and hind foot. The purpose of this article is to review the challenging clinical scenario of combined ankle and subtalar arthritis. The pathogenesis and biomechanics of combined ankle and subtalar arthritis, the approach to management, and available treatment options are presented with an emphasis on the role of arthroplasty. (Source: Seminars in Arthroplasty)

Management of Specific Complications After Revision Total Ankle Replacement

Seminars in Arthroplasty — Wed, 01 Dec 2010 00:00:00 +0100

Total ankle replacements (TAR) have enjoyed a resurgence in popularity recently. As surgeons become more familiar with the appropriate indications and the operative technique, the numbers performed each year continue to increase. However, despite a much greater understanding of the kinematics of the ankle and much more sophisticated prostheses, complications still occur at variable rates. Proper recognition of the problem as well as a systematic and diligent approach to management is imperative to achieve a successful outcome. This review addresses various complications that may arise after total ankle replacement, including infection, osteolysis, and subsidence. Surgical techniques in cases of component migration, hind foot malalignment and intraoperative balancing are discussed. We also ...

Treatment of ankle osteoarthritis: arthrodesis versus total ankle replacement

European Journal of Trauma and Emergency Surgery — Sat, 13 Nov 2010 06:43:55 +0100

Abstract While ankle arthrodesis has remained the gold standard treatment for symptomatic primary, secondary, and posttraumatic ankle arthritis, more recently, total ankle replacement (TAR) has seen considerable improvement in terms of biomechanics, function, and complication rates. However, while in the long-term degeneration of the adjacent joints is almost always found on radiographs after ankle arthrodesis, the longevity of TAR is still insufficient and does not match that of total knee and hip joints. The current review article focuses on the treatment of ankle arthritis by means of arthrodesis and TAR. Content Type Journal ArticleDOI 10.1007/s00068-010-0058-1Authors N. Espinosa, Department of Orthopaedic Surgery, University of Zurich Hospital, University of Zuri...

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Use of a trabecular metal implant in ankle arthrodesis after failed total ankle replacement.

Acta Orthopaedica — Thu, 11 Nov 2010 00:00:00 +0100

Authors: Henricson A, Rydholm U Background and purpose Arthrodesis after failed total ankle replacement is complicated and delayed union, nonunion, and shortening of the leg often occur-especially with large bone defects. We investigated the use of a trabecular metal implant and a retrograde intramedullary nail to obtain fusion. Patients and methods 13 patients with a migrated or loose total ankle implant underwent arthrodesis with the use of a retrograde intramedullary nail through a trabecular metal Tibial Cone. The mean follow-up time was 1.4 (0.6-3.4) years. Results At the last examination, 7 patients were pain-free, while 5 had some residual pain but were satisfied with the procedure. 1 patient was dissatisfied and experienced pain and swelling when walking. The implant-bone inter...

[Algorithm for the treatment of the haemophilic arthropathia of the upper ankle joint.]

Hamostaseologie — Tue, 02 Nov 2010 00:00:00 +0100

Authors: Berdel P, Pagenstert G, Randau T, Schott D, Taubner A, Oldenburg J, Seuser A, Wirtz DC, Gravius S The upper ankle joint is one of the target-joints of the haemophilic patient. Therefore, the secondary arthritis of the upper ankle joint is one of the most frequent forms of haemophilic arthropathy. It is a secondary form of arthritis not only because of chronic synovitis and cartilage injury resulting from chronic recurrent intraarticular bleeds, but also due to the misalignment of the joint and abnormal joint stress. The consequences are manifest even in young patients and finally lead to upper ankle joint arthritis. In such clinical situations, the upper ankle joint-arthroplasty is a viable alternative to arthrodesis. After several years of bleeding of the upper ankle joint ma...

CAMBODIA: Access to Drugs A Life Saver for People with HIV

IPS Inter Press Service - HIV/AIDS — Mon, 01 Nov 2010 11:20:57 +0100

The monsoon rains soaked the ground beneath Mon Hol's home until it turned to ankle-deep mud. The aged thatched-leaf roof of his hut, badly in need of replacement, provided little protection. (Source: IPS Inter Press Service - HIV/AIDS)

Opening- or closing-wedged high tibial osteotomy: A meta-analysis of clinical and radiological outcomes

The Knee — Mon, 01 Nov 2010 04:00:00 +0100

Abstract: High tibial osteotomy (HTO) has been advocated for the treatment of isolated medial compartment osteoarthritis of the knee. Debate remains over the superiority of performing a medial opening-wedge or lateral closing-wedge HTO. The purpose of this study was to compare the clinical and radiological outcomes, and complications of patients following opening-wedge compared to closing-wedge HTO. A systematic review was undertaken of published and unpublished literature databases from their inception to May 2010. Twelve papers reporting nine clinical trials were found to be suitable for meta-analysis comparing 324 opening-wedge HTOs to 318 closing-wedge HTOs. There was no difference in the incidence of infection, deep vein thrombosis, peroneal nerve palsy, non-union or revision to knee ...

Total ankle replacement in association with hindfoot fusion: OUTCOME AND COMPLICATIONS.

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

We report the clinical and radiological outcome of total ankle replacement performed in conjunction with hindfoot fusion or in isolation. Between May 2003 and June 2008, 60 ankles were treated with total ankle replacement with either subtalar or triple fusion, and the results were compared with a control group of 288 ankles treated with total ankle replacement alone. After the mean follow-up of 39.5 months (12 to 73), the ankles with hindfoot fusion showed significant improvement in the mean visual analogue score for pain (p < 0.001), the mean American Orthopaedic Foot and Ankle Society score (p < 0.001), and the mean of a modified version of this score (p < 0.001). The mean visual analogue pain score (p = 0.304) and mean modified American Orthopaedic Foot and Ankle Society score ...

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Dimensionality of Measures for Severe Unilateral Ankle Arthritis

PM and R — Mon, 01 Nov 2010 00:00:00 +0100

Conclusions: Findings suggest that various outcome measures for the ankle capture different dimensions and should be considered when evaluating the presence of disability or long-term change in outcome. (Source: PM and R)

Clinical Outcomes after Isolated Periarticular Osteotomies of the First Metatarsal for Hallux Rigidus: A Systematic Review

Journal of Foot and Ankle Surgery — Fri, 29 Oct 2010 20:48:43 +0100

Abstract: Isolated periarticular osteotomy of the first metatarsal has been proposed for treatment of hallux rigidus due to the perceived ability to “decompress” the first metatarsophalangeal joint through axial shortening, as well as plantar displacement of the first metatarsal head to correct purported elevation. Additionally, isolated periarticular osteotomy of the first metatarsal has been proposed for treatment of hallux rigidus because of the perceived safety and efficacy. Furthermore, it has been proposed that undergoing isolated periarticular osteotomy of the first metatarsal does not prevent the ability to perform revision surgery. The author undertook a systematic review of electronic databases and other relevant sources to identify material relating to the clinical outcomes ...

Does Total Joint Replacement or Arthrodesis of the First Metatarsophalangeal Joint Yield Better Functional Results? A Systematic Review of the Literature

Journal of Foot and Ankle Surgery — Fri, 29 Oct 2010 20:48:42 +0100

Abstract: As first metatarsophalangeal joint arthrodesis is generally considered to be a successful procedure for the treatment of hallux rigidus, many surgeons question the usefulness of total joint replacement. In an effort to elucidate the clinical evidence, we undertook a systematic review of the literature comparing the functional outcomes of arthrodesis and joint replacement in first metatarsophalangeal surgery. Using multiple search engines and medical subject headings, 10 articles were eligible for inclusion: 5 featured arthrodesis and 5 featured total joint replacement. The American Orthopaedic Foot and Ankle Society–Hallux metatarsophalangeal-interphalangeal score was used in all articles. The mean age at operation was 53 years for joint replacement patients and 55 for those un...

Surgical treatment of post-traumatic malalignment of the ankle

Injury — Fri, 29 Oct 2010 20:48:24 +0100

Abstract: Post-traumatic malalignment is evident in cases of malunion of ankle fractures. This condition predisposes to the development of chronic pain, functional impairment, and finally post-traumatic arthritis. The aim of this paper is to present a joint-saving surgical treatment of post-traumatic ankle malalignment. It is based on the review of a series of patients who developed fracture malunion and were treated with articular reconstruction.Twenty-two ankle fractures, which malunited and resulted into valgus deformity and fibular shortening are presented. Pre-reconstruction and mid-term follow-up evaluation included the AOFAS score and standard weight-bearing radiographs. Surgical treatment consisted in articular reconstruction with malleolar osteotomies. Post-operatively, the non-we...

Prospective review of medium term outcomes following interpositional arthroplasty for hammer toe deformity correction

Foot and Ankle Surgery — Mon, 25 Oct 2010 04:00:00 +0100

Conclusions: Overall we demonstrate good to excellent results with this surgical tactic allowing pain relief, early mobilisation and a low risk of infection. (Source: Foot and Ankle Surgery)

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Altered inter-joint coordination during walking in patients with total hip arthroplasty

Gait and Posture — Fri, 15 Oct 2010 00:00:00 +0100

Abstract: The purpose of this study was to investigate the pattern and variability of inter-joint coordination for both surgical and non-surgical limbs during walking in patients before and after total hip arthroplasty (THA). Gait analysis of THA patients (n=20) and age-matched controls (n=10) was performed. THA patients were tested at pre-surgery, 6-week and 16-week post surgery. Continuous relative phase (CRP) was used to assess the inter-joint coordination pattern and variability. Variability of coordination for each subject was calculated over a gait cycle with the deviation phase (DP). Between-subject group differences in CRP patterns were examined with cross-correlation measures and root-mean-square (RMS) differences. The surgical limb demonstrated significantly higher DP values comp...

RA May Raise Complication Risk After Ankle Arthroplasty

Modern Medicine — Sun, 26 Sep 2010 23:00:00 +0100

Underlying inflammatory connective-tissue disease, primarily rheumatoid arthritis, is associated with an increased risk for major incision complications and additional surgery for patients who have undergone total ankle arthroplasty, according to research published in the Sept. 15 issue of the Journal of Bone & Joint Surgery. (Source: Modern Medicine)

Risk Factors for Incision-Healing Complications Following Total Ankle Arthroplasty

JBJS [Am] — Wed, 15 Sep 2010 17:31:07 +0100

Conclusions: We recommend that caution be used when selecting and educating patients with inflammatory arthritic conditions who are potential candidates for total ankle arthroplasty. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence. (Source: JBJS [Am])

First metatarsophalangeal joint replacement: Long-term results of a double stemmed flexible silicone prosthesis

Foot and Ankle Surgery — Thu, 09 Sep 2010 04:00:00 +0100

Conclusion: The prosthesis shows good results concerning pain relief and a reasonable to good function (>30° range of motion) of the FMTP joint in most patients. Reactive bone areas around the implant decreased by the use of grommets. (Source: Foot and Ankle Surgery)