Orthopedics

Raikin, S. M., K. Sandrowski, J. M. Kane, D. Beck and B. S. Winters (2017). “Midterm outcome of the agility total ankle arthroplasty.” Foot Ankle Int 38(6): 662-670.

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BACKGROUND: Ankle arthritis is a debilitating condition that causes severe functional impairment. While arthrodesis has been the gold standard of surgical treatment for this condition, significant improvements in total ankle arthroplasty have made it a viable alternative. The purpose of this study was to look at the midterm follow-up of the Agility total ankle. METHODS: A retrospective review of prospectively collected data was conducted on 127 consecutive Agility total ankles implanted between 2002 and 2009. Charts were reviewed to collect patient demographics. In addition, coronal alignment, overall arc of motion, tibiotalar component motion, syndesmotic fusion, zones of osteolysis, and subsidence were determined. A Kaplan-Meier survival and linear regression analysis were used to predict implant failure. A multivariate regression analysis was used to assess whether radiographic measures were predictive of patient satisfaction. RESULTS: Ninety (78.2%) of 115 patients retained their primary implant, of which 105 were available for evaluation, with an average follow-up of 9.1 years. Twenty-five had their implant removed. The average score for the Foot and Ankle Ability Measure (FAAM) activities of daily living subscale was 82.4, FAAM sport subscale 55.3, postoperative visual analog scale (VAS) for pain 12.7, and Short Form-12 (SF-12) Health Survey physical component 45.8 and SF-12 mental component 56.1. Average arc of motion across the implant was 22.3 and 6.3 degrees in adjacent joints. Osteolysis most commonly occurred in zones 1 and 6. No statistical differences were found in the rate or location of subsidence. Linear regression analysis demonstrated that age at the time of surgery was predictive of failure ( P = .036). Inflammatory and atraumatic arthritis demonstrated higher likelihoods of revision. No correlation was detected between radiographic parameters and outcomes scores ( P > .05; rho >0.2). A significant reduction in mean VAS pain scores by 67.6% was maintained at an average of 8 years. DISCUSSION: Our results were improved over the nondesigner outcomes published in the current literature. Survivorship approached 80% at 9 years, with Kaplan-Meier 14-year survival calculated at 70.4%. Patients with their original implant were functioning with a high level of satisfaction based on statistically validated outcome scores, which was independent of the radiographic appearance of their implant. Age at the time of surgery and inflammatory/atraumatic arthritis were predictive of failure.

Kane, J. M., S. Coleman and J. W. Brodsky (2017). “Kinematics and function of total ankle replacements versus normal ankles.” Foot Ankle Clin 22(2): 241-249.

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End-stage ankle arthritis produces severe functional disability, quantifiable by gait abnormalities. In all categories of gait parameters, total ankle arthroplasty (TAA) satistically significantly improves function, compared to patients’ preoperative function. There are increases in step length, cadence and velocity; in sagittal plane motion of the ankle, as well has hip and knee motion, and in ankle power and moment. These functional gait improvements correspond to clinical improvements of pain relief and satisfaction. Although these improvements fail to reach the functional performance of healthy controls, the improvement over preoperative function is clinically meaningful and statistically significant.

Garofalo, R., E. Ceccarelli, A. Castagna, V. Calvisi, B. Flanagin, M. Conti and S. G. Krishnan (2017). “Open capsular and ligament reconstruction with semitendinosus hamstring autograft successfully controls superior and posterior translation for type v acromioclavicular joint dislocation.” Knee Surg Sports Traumatol Arthrosc: Apr [Epub ahead of print].

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PURPOSE: Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures. METHODS: Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique. The median time from injury to surgery was 45 days (range 24-90). The average median postoperative clinical and radiographic follow-up time was 30 months (range 24-33). Clinical outcomes measures included the ASES score, the visual analog score (VAS), and subjective patient satisfaction score. Minimum follow-up was 2 years. RESULTS: ASES score increased from a median of 38.2 +/- 6.2 preoperative to 92.1 +/- 4.7 postoperatively (p

Martin, H. D. (2017). “Corr insights(r): The femoro-epiphyseal acetabular roof (fear) index: A new measurement associated with instability in borderline hip dysplasia?” Clin Orthop Relat Res 475(3): 870-871.

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Wyatt and colleagues compared the novel Femoro-Epiphyseal Acetabular Roof (FEAR) Index, which uses principles of bone growth to create a new radiographic parameter [2, 3, 4, 5], with the LCEA and acetabular index. The FEAR Index was shown to have excellent reliability and it enhanced the authors’ ability to distinguish unstable hips from stable hips with borderline dysplasia.

Gotha, H. E. and J. R. Zide (2017). “Current controversies in management of calcaneus fractures.” Orthop Clin North Am 48(1): 91-103.

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Displaced intraarticular fractures of the calcaneus represent a technically challenging injury. Although there is conflicting evidence regarding advantages and disadvantages of operative versus nonoperative treatment, a growing body of literature suggests operative management with near-anatomic reduction of the posterior facet and restoration of overall calcaneal morphology offers greater potential for superior short- and long-term outcomes. A thorough understanding of calcaneal anatomy, fracture pattern, and associated injuries, along with careful selection of surgical approach and timing to surgery are critical to minimize the risk of complication and maximize potential for optimal outcomes.