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Bone & Joint Open
Vol. 4, Issue 9 | Pages 704 - 712
14 Sep 2023
Mercier MR Koucheki R Lex JR Khoshbin A Park SS Daniels TR Halai MM

Aims

This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures.

Methods

Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed. Propensity score matching was conducted between COVID-19-positive and -negative patients. Multivariable regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-day postoperative adverse events.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 192 - 192
1 Sep 2012
Pedersen E Pinsker E Glazebrook M Penner MJ Younger AS Dryden P Daniels TR
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Purpose

The failure rate of total ankle arthroplasty (TAA) in rheumatoid patients may be higher than in osteoarthritis patients due to the medications used to treat rheumatoid arthritis and the comorbidities associated with this disease. The purpose of this study was to prospectively look at the intermediate-term outcomes of TAA in patients with rheumatoid arthritis and to compare the results to a matched cohort of patients with ankle osteoarthritis undergoing TAA.

Method

This study is a prospective, multicentre comparison study of patients two to eight years post-TAA. A cohort of 57 patients with rheumatoid arthritis was identified from the prospective national database of TAAs (RA group). Matched controls were identified in the database using age, type of prosthesis, and follow-up time as matching criteria (OA group). The following data was collected: demographic information, previous and additional surgeries at the time of TAA and major and minor complications including revisions. Generic and disease specific, validated outcome scores collected include the Short-Form 36 (SF36) and Ankle Osteoarthritis Score (AOS).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 54 - 54
1 Sep 2012
Trajkovski T Cadden A Pinsker E Daniels TR
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Purpose

Coronal plane malalignment at the level of the tibiotalar joint is not uncommon in advanced ankle joint arthritis. It has been stated that preoperative varus or valgus deformity beyond 15 degrees is a relative contraindication and deformity beyond 20 degrees is an absolute contraindication to ankle joint replacement. There is limited evidence in the current literature to support these figures. The current study is a prospective clinical and radiographic comparative study between patients who underwent total ankle arthroplasty with coronal plane varus tibiotalar deformities greater than 10 degrees and patients with neutral alignment, less than 10 degrees of deformity.

Method

Thirty-six ankles with greater than 10 degrees of varus alignment were compared to thirty-six ankles which were matched for implant type, age, gender, and year of surgery. Patients completed preoperative and yearly postoperative functional outcome scores including the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores, the Ankle Osteoarthritis Scale (AOS) and the Short Form-36 Standard Version 2.0 Health Survey. Weightbearing preoperative and postoperative radiographs were obtained and reviewed by four examiners (AC, AQ, TD, TT) and measurements were taken of the degree of coronal plane deformity.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 188 - 188
1 Sep 2012
Amin A Pinsker E Mayich J Daniels TR
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Purpose

To investigate the effect of obesity on functional outcome following total ankle arthroplasty.

Method

We identified 43 obese patients (46 ankles) (BMI > 30kg/m2), using a prospectively collected database of total ankle arthroplasties. Inclusion criteria included: (a) Post-traumatic or inflammatory arthritis; (b) Minimum two-year follow-up, (c) Coronal plane deformity less than 10 degrees. Exclusion criteria: (a) Co-morbidity affecting physical function; (b) Recent total joint arthroplasty.

American Orthopaedic Foot and Ankle Society (AOFAS), Ankle Osteoarthritis Scale (AOS) and SF-36 questionnaires were used preoperatively and at latest follow-up. Revision was defined as any intervention requiring replacement of part or whole of the prosthesis.

A control group of non-obese individuals (BMI 18.5–29.9kg/m2) was devised matching for age within 10 years, gender, diagnosis, implant and length of follow-up (within 1 year). From the original group of 46 ankles, we matched 28 ankles, thereby constructing two groups for comparison (matched obesity and control).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVIII | Pages 183 - 183
1 Sep 2012
Amin A Sproule JA Chin T Daniels TR Younger AS Boyd G Glazebrook M
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Purpose

Total Ankle Replacement (TAR) is increasingly being offered to patients as an alternative to arthrodesis for the operative management of debilitating end-stage ankle arthritis. The Mobility Total Ankle System is a third-generation design consisting of a three component, cementless, unconstrained, mobile-bearing prosthesis. This study reports the early results of a multi-centre prospective study of the Mobility prosthesis. This is the first such report by independent researchers.

Method

The senior authors implanted 86 consecutive Mobility prostheses. The underlying diagnosis was primary OA in 24 ankles, secondary OA in 47 ankles and inflammatory arthritis in 15 ankles. There were 41 males (Mean age 67 / Range 51–87) and 44 females (Mean age 60 / Range 29–72). The mean BMI was 28 (Range 22–36) for males, and 28 (Range 20–39) for females. Previous ankle operations were performed in 24 patients, 22 of which were for fracture fixation.

Ankles were classified according to the COFAS end-stage ankle arthritis classification system. Coronal plane deformity was quantified pre-operatively. Clinical outcome was assessed using the AOFAS hindfoot score. Radiological assessment was performed from weight-bearing radiographs, documenting post-operative alignment, osseous integration, edge-loading and heterotopic bone formation. The mean follow-up time was 40 months (Range 30–60).

Survival analysis was calculated according to the Kaplan-Meier method. Failure was defined as exchange of any component of the TAR, arthrodesis or amputation.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 584 - 584
1 Nov 2011
Daniels TR Penner MJ Mayich DJ Bridge M
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Purpose: The global utilization of total ankle arthroplasty (TAR) has been increasing over the past decade; however there are a limited number of published prospective studies assessing intermediate and long term outcomes. The purpose of this clinical series is to prospectively review the mid-term clinical and radiographic outcomes of the Scandinavian Total Ankle Replacement (STAR) performed at two Academic Canadian University Centres.

Method: Between 1998 and 2005, 113 STARs were implanted into 99 patients at two Canadian centres. Prospective clinical and radiographic follow-up was performed. Validated and non-validated outcome questionnaires consisting of the AAOS foot and ankle questionnaire (a composite questionnaire made up of unaltered versions of the SF-36), AOFAS Hindfoot score, Foot Function Index (FFI), Ankle Osteoarthritis Scale (AOS) were completed in one arm (63/113 implanted TARs). In the other arm, (50/114) the patients were followed retrospectively with the same measures. Both groups had prospective radiographic follow-up using measures described by Wood et al.

Results: The average follow-up for both groups was 46.3 ± 17.6 months (or 3.8 years). Of the 113 implanted STARs, 33 (29.2%) required a re-operation. Of those, 20 (17.7%) went on to be revised. Six patients had repeat revision operations for a total of 26 revision operations. Of the 26 revision operations 14 (54%) were polyethylene liner exchanges, and 12 (46%) were revision of the metallic components. The median time to revision was 39.5 months. Three prosthesis (2.6%) went on to have a deep infection of their STAR. All three were effectively managed without requiring explantation of the STAR. One patient had infection in their revision IM Nail. Of the 113 initially implanted prostheses, 101 (89.3%) of the original TARs remained implanted at the conclusion of the study. Sustained benefit, across questionnaires, from the STAR was observed to persist to final follow up. 115/116 (99%) ankles followed showed evidence of osteolysis at the last STAR follow-up. The osteolysis was found to occur more commonly around the talar component, but occurred, for the most part, in a recognizable pattern around both the talus and the tibia. No significant differences between the two centers in pre-operative or intra-operative data were identified.

Conclusion: The STAR, in the mid-term, shows acceptable survival and revision rates. There are, however, some concerning findings on radiographic follow-up. It appears, upon initial investigation, that initial component position may be a factor that predicts concerning radiographic changes. Further investigation is required to substantiate this.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 581 - 581
1 Nov 2011
Daniels TR Haene R Story R Pinsker E
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Purpose: The treatment of large osteochondral lesions of the talus (OLT) remains a challenge. Fresh Osteo-chondral Allograft is a method that has been used for the treatment of larger lesions, with the advantage of transplanting living cartilage that is biologically attached to the subchondral bone. The purpose of this clinical series is to prospectively review the clinical and radiographic outcomes of patients that have undergone a Fresh Osteochondral Allograft.

Method: Between January 2003 and January 2007, 17 feet in 8 male and 8 female patients at a mean age of 35.8 (15–53) years underwent fresh osteochondral talar allo-grafting by a single surgeon. Data was prospectively collected, including preoperative and postoperative AOFAS, AOS, AAOS foot & ankle worksheets and SF-36 scores. Statistical analysis consisted of one tailed student T-test with alpha set a 5%. All patients were followed up clinically and radiographically by x-ray and CT scan.

Results: Average follow up was 3.2 (0.9–6.2) years. All scoring systems showed significant improvement postoperatively, except for AAOS shoe comfort scores, and the Mental Component Summary of the SF-36 questionnaire. The AOFAS score improved significantly (p=0.0001) from a mean score of 53.4 (30–71) to 86.3 (72–96). AOS pain scores improved significantly (p=0.0053) from a mean score of 45.4 (8.7–72.2) to 24.1 (4.2–58.9). AOS disability score improved significantly (p=0.0013) from a mean of 53.8 (7.8–77.3) to 25.9 (6.6 – 62.5). The AAOS foot & ankle core scale (standardized mean) improved significantly (p=0.0015) from a mean of 52.3 (21–81) to 80.1 (56–99). The AAOS foot & ankle core scale (normative score) improved significantly (p=0.0016) from a mean of 16.9 (−9 to 40) to 39.5 (20–55). The SF-36 Physical Component Summary improved significantly from a mean of 34.9 (24.2–43.8) to 47.3 (36.6–59.8). There was successful osseous graft incorporation in 16/17 feet (94%) verified on CT scan. Of the 16 grafts which had successfully incorporated, radiographic follow up showed 4/16 feet (25%) had signs of progressive OA and 3/16 feet (19%) had developed new osteolysis around the graft.

Conclusion: Although patients’ functional outcome can be substantially improved with the use of fresh osteochondral allografts the early radiographic findings are of concern with 43% demonstrating progression of arthritis or osteolysis of the graft during the process of graft incorporation.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 259 - 260
1 Jul 2011
Daniels TR Pinsker E Inrig T Warmington K Beaton D
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Purpose: The objective of this study is to compare items from patient-reported questionnaires measuring musculoskeletal outcomes with items generated by pre-and post-operative ankle arthrodesis and arthroplasty patients using the Patient-Specific Index (PSI-P). The International Classification of Functioning, Disability and Health (ICF) was used as an external reference.

Method: A literature review identified six questionnaires that assess lower extremity outcomes (AAOS, patient-reported portion of AOFAS, FFI, LEFS, SMFA, WOMAC). Surgical patients (n=142) from an orthopaedic surgeon’s practice completed the patient-selected items from PSI-P. Items from questionnaires and PSI-P were coded by three reviewers and linked to the ICF. The ICF is divided into four components (Body Functions and Structures, Activities and Participation, Environmental Factors, and Personal Factors) which are then further divided into second level categories. A higher number of second level categories would indicate a questionnaire that captures a broader range of experiences.

Results: Patient’s responses from PSI-P identified 690 meaningful concepts that were linked to 45 second level ICF categories. Most PSI-P responses fell into Activities and Participation (60.6%) and Body Functions and Body Structures (35.2%) including the second level categories Walking (19.1%), Pain (16.5%), and Recreation and Leisure (15.4%). There was no statistical difference between arthrodesis and arthroplasty patients nor between pre-operative versus postoperative patients in terms of the proportion of patient responses that fell into each ICF component. A total of 237 meaningful concepts were identified in the 6 questionnaires studied and linked to 38 second level ICF categories. Overall, SMFA addressed the most number of second level categories and had the closest proportion of Body Function (23.0%) and Activities and Participation (68.9%) concepts as compared to PSI-P. The patient-reported portion of AOFAS addressed the fewest categories. LEFS only contained items from Activities and Participation. AAOS was the only questionnaire to address the issue of ‘swelling’, though it represented 4.9% of all PSI-P responses.

Conclusion: Questionnaires differ largely in their content and no single questionnaire captured all of the concerns identified by PSI-P. This analysis will guide us in the development of a new and more comprehensive instrument for evaluating ankle outcomes following fusion or replacement.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 260 - 260
1 Jul 2011
Copithorne P Daniels TR Glazebrook M
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Purpose: For patients with moderate to severe hallux valgus with increased intermetatarsal angle, correction with a proximal first metatarsal osteotomy is indicated. The purpose of this study is to compare the opening-wedge osteotomy of the proximal first metatarsal the proximal chevron osteotomy in the treatment of moderate to severe hallux valgus with increased intermetatarsal angle.

Method: This prospective, randomized, multi-centered study is being conducted at three centers in Canada. Approximately 75 adult patients with hallux valgus are being randomized to either the proximal metatarsal opening-wedge osteotomy with plate fixation or the proximal chevron osteotomy. Patient functional scores using the SF-36, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot metatarsophalangeal inter-phalangeal score and Visual Analogue Scale (VAS) for pain, activity & patient satisfaction, are assessed prior to surgery and 3, 6, 12 and 24 months. Surgeon preference is being evaluated based on a questionnaire and actual surgical times. Radiologic measurements (inter-metatarsal angle correction, hallux valgus angle correction, sagital talus-first metatarsal (Meary’s) angle, metatarsal length and union) will also be assessed.

Results: Preliminary results demonstrate that patients who undergo the opening-wedge osteotomy have less pain at 3 months (ave. VAS pain reduction 2.9, SE±1.0) than those with the chevron (ave. VAS pain reduction 2.4, SE±1.2). VAS for activity demonstrates greater improvements with the chevron osteotomy at 3 months (0.8, SE±0.8) versus the opening-wedge (0.1, SE±1.0). AOFAS scores improve on average 18.3 (SE±8.6) with the opening wedge compared to 20.8 (SE±7.4) with the chevron at 3 months. Average hallux valgus angle correction for opening-wedge and chevron osteotomies are 11.0 degrees (SE±2.5) and 19.0 degrees (SE±3.1) respectfully. Average intermetatarsal angle correction for opening-wedge and chevron osteotomies are 6.5 (SE±1.3) and 4.3 (SE±1.7) respectfully. Both procedures are effective at maintaining metatarsal length. The opening-wedge osteotomy takes on average 60.9 minutes (SE±3.9) to complete compared to 69.1 minutes (SE±5.1) for the chevron ostetotomy. Surgeon response to the new opening-wedge osteotomy is favorable.

Conclusion: Opening-wedge and proximal chevron osteotomies have comparable pain, function and radiographic outcomes. Opening wedge osteotomy is technically less demanding and requires less surgical time.