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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_13 | Pages 20 - 20
17 Jun 2024
Jagani N Harrison W Davenport J Karski M Ring J Smith R Clough T
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Aims

Retrospective review of a consecutive series of 1,168 total ankle replacements (TAR) performed at Wrightington, to analyse modes of failure and clinical outcomes following TAR failure.

Methods

All patients undergoing TAR between November 1993 – June 2019 were collated (4–25 year follow-up; mean 13.7 years). 6 implants were used (300 STAR, 100 Buechal Pappas, 509 Mobility, 118 Zenith, 41 Salto and 100 Infinity). 5 surgeons, all trained in TAR, performed the surgery. Modes of failure were collated and clinical and radiological outcomes recorded for the revisional surgery following failure of the TAR.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_11 | Pages 2 - 2
4 Jun 2024
Townshend D Bing A Clough T Sharpe I Blundell C Davenport J Davies H Davis J Dhar S Goldberg A Karski M Hepple S Kakwani R McKinley J Murty A Ragland M Shalaby H Smith R Taylor H
Full Access

Introduction

This is a multi-centre, prospective, observational study of 503 INFINITY fixed bearing total ankle arthroplasties. We report the minimum two-year results of this prosthesis which was introduced to the UK Market in 2014 and is now the most used ankle arthroplasty in the National Joint Registry of England and Wales.

Methods

Patients were recruited from 11 centres in the United Kingdom between June 2016 and November 2019. Demographic, radiographic, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Foot Ankle Questionnaire and Euroquol 5D-5L) were collected preoperatively, at 6 months, 1 year and 2 years and 5 years. The average age was 67.8 (range 23.9 to 88.5) and average BMI 29.3 (18.9 to 48.0). The COFAS grading system was used to stratify deformity. There were 261 (51.9%) COFAS Type 1, 122 (24.2%) COFAS Type 2, 31 (6.2%) COFAS 3 and 89 (17.7%) COFAS type 4. 38 patients (7.6%) presented with inflammatory arthritis. 99 (19.7%) implantations utilised patient specific instrumentation. Complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts and/or subsidence.


Bone & Joint Open
Vol. 2, Issue 8 | Pages 631 - 637
10 Aug 2021
Realpe AX Blackstone J Griffin DR Bing AJF Karski M Milner SA Siddique M Goldberg A

Aims

A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two surgical procedures was set up to obtain high-quality evidence of effectiveness. However, the trial faced recruitment challenges and struggled to maintain recruitment rates over 30%, although this is not unusual for surgical trials. We conducted a qualitative study with the aim of gathering information about recruitment practices to identify barriers to patient consent and participation to an orthopaedic trial.

Methods

We collected 11 audio recordings of recruitment appointments and interviews of research team members (principal investigators and research nurses) from five hospitals involved in recruitment to an orthopaedic trial. We analyzed the qualitative data sets thematically with the aim of identifying aspects of informed consent and information provision that was either unclear, disrupted, or hindered trial recruitment.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_21 | Pages 25 - 25
1 Dec 2017
Ring J Davenport J Karski M Smith R Divercha H Clough T
Full Access

Introduction

Traditional treatment for end-stage ankle arthritis has been ankle arthrodesis, however ankle arthroplasty is becoming an accepted alternative.

The Zenith Ankle (Corin, UK) is 3rd generation implant with a mobile bearing design. In the NJR 2016 report, the Zenith was the commonest ankle prosthesis implanted in the UK. However, compared to other ankle implants, there's little published data on its performance and survival. The aim of this study was to analyse outcome in a consecutive series from a non-designer centre.

Method

We conducted a retrospective review of a consecutive series of 118 Zenith Ankle replacements implanted in our Unit (December 2010 to May 2016). Data was collected from our National Joint Registry entries, research databases, patient notes, PACS and PROMS.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_17 | Pages 3 - 3
1 Nov 2014
Akkena S Karim T Clough T Karski M Smith R
Full Access

Introduction:

The aim of this study was to identify the rate of complications of total ankle replacement in a single Centre to help with informed patient consent.

Methods:

Between 2008 and 2012, 202 total ankle replacements (TARs) were performed by 4 surgeons at our Institute. Data was collected on all patients; demographics, arthritic disease, pre-operative deformity, prosthesis and all early and late complications.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_2 | Pages 32 - 32
1 Jan 2014
Clough T Talbot C Siney P Karski M
Full Access

Introduction:

The Scandinavian Total Ankle Replacement (STAR) is a three-component, uncemented implant in widespread use throughout Europe. STAR has achieved encouraging results with short and medium term outcome. We present the long term (13–19 year) results of a consecutive series of 200 STAR ankles.

Methods:

Between November 1993 and February 2000, a total of 200 consecutive STARs were carried out in 184 patients. Patients were followed up both clinically and radiologically, until death or failure, with time to decision to revision or fusion as the endpoint. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 300 - 300
1 Jul 2011
Bayam L Karski M Soteriadou S Henderson A
Full Access

Objectives: To report the outcome and comparison of calcaneum fracture managements for intra-articular fractures.

Methods: A prospective study of the patients with intra-articular calcaneum fractures in the foot& ankle unit of a busy trauma hospital. All the patients were followed up with the calcaneal fracture score. We compared the outcome of surgical management Sanders type-2 and type-3 fractures with conservative treatment at 2 years and then, the medium term (> 5 years) outcomes of type-2 and type-3 surgical groups were assessed. Conservative group was a consecutive series of patients recruited to the study later than surgical groups, hence the smaller number in that group.

Results: 126 patients were included in our study. There were 70 in group type-2 and 38 in group type-3 with surgical management, while only 18 in the group with conservative management. The mean age for surgical type-2 = 46.2, type-3= 46.3 and conservative group = 51.7. Mean follow-ups for the groups were type-2=6y, type-3 =5.5y and conservative one =2.34y. Mean two-year scores for the surgical groups were type-2=68.13, type-3=63.78, while conservative one =51.36.

There was a statistically significant differences in their score between type-2 surgical and conservative groups (P=0.0006), and between type-3 surgical and conservative ones (P=0.04), but no significant difference between type-2 and type-3 surgical groups.

At medium-term follow-up, the scores for type-2 and type-3 surgical groups were 77.06 and 63.66 respectively, with significant increase in type-2 while type-3 remains similar comparing to two-year scores. There were 7 deep, 5 superficial infections and 32 metalwork removals in total.

Conclusion: On comparing the medium term outcome to the two-year one, surgical type-2 group of patients showed some improvement, while type-3 stayed the same.

In this series, contrary to published articles, there was a better outcome at two years with surgical treatment than conservative treatment.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 213 - 214
1 May 2011
Bayam L Karski M Soteriadou S Henderson A
Full Access

Objectives: To report the outcome and comparison of calcaneum fracture managements for intra-articular fractures.

Methods: A prospective study of the patients with intra-articular calcaneum fractures in the foot& ankle unit of a busy trauma hospital. All the patients were followed up with the calcaneal fracture score.

We compared the outcome of surgical management Sanders type 2 (Group A) and type 3 (group B) fractures with conservative treatment (group C) at 2 years and assessed the medium term outcomes of groups A and B. Group C were a consecutive series of patients recruited to the study later than A and B, hence the smaller number in that group.

Results: 126 patients were included in our study. There were 70 in group A, 38 in group B, and 18 in group C. Mean follow-ups for the groups were A=6y, B=5.5y and C=2.34y. Mean two-year scores for the groups were A=68.13, B=63.78, and C=51.36, with statistically significant differences between groups A and C (P=0.0006), and between groups B and C (P=0.04), but no significant difference between groups A and B.

At medium-term follow-up (> 5 years), the scores for group A and B were 77.06 and 63.66 respectively.

There were 7 deep, 5 superficial infections and 32 metalwork removals in total.

Conclusion: On comparing the medium term outcome to the two-year one, group A showed some improvement and group B stayed the same.

In this series, there was a better outcome at two years with surgical treatment than conservative treatment.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 14 - 14
1 Mar 2008
Giannikas K Karski M Khan A Buckley J Wilkes R Hutchinson C Freemont A
Full Access

While the early period of distraction osteogenesis has been extensively investigated, there are very few data describing the long-term morphology of the regenerate. We performed magnetic resonance scans in ten adults (men age 35+− 11 yr), seven of whom had bone transport for an iatrogenic osseous defect while further three had tibial lengthening for limb length discrepancy. Follow-up ranged between 14 and 43 months (mean : 28 + − 10 months) following the removal of the external fixator. The perimeter, cross- sectional area, volume and the mean signal intensity was calculated from the obtained T1 weighted axial images. Values were compared with the contralateral tibia that acted as control. All cases that had bone transport increased the volume of the tibia from 15.3% up to 50.8%. The regenerated segment was noted to have expanded significantly (p< 0.0001) in all cases. Mean signal intensity in the regenerate decreased in seven cases significantly (p< 0.0001) suggesting increase content of unhydrated tissue such as bone and collagen. The cross-sectional surface of the transported segment was increased in all cases (p< 0.008). Finally in cases that underwent bone transport, the docking site was noted to be obstructed by unhydrated tissue. Contrary to previous claims, the post-distraction osteogenesis tibia is far from normal, consisting of areas with potentially different biomechanical properties. Recognition of these changes is essential not only for appropriate pre-operative counselling but also for considering treatment modalities in case of a fracture.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 27 - 27
1 Mar 2008
Karski M Giannikas K Khan A Maxwell H
Full Access

We present our technique for arthrodesis of the failed Keller’s excisional arthroplasty and the results of postoperative follow-up in a series of eight patients [nine feet].

Arthrodesis of the first metatarsophalangeal joint was performed with a tricortical interposition bone graft stabilised between the first metatarsal and proximal phalanx with a mini dental plate. In all cases the indication for the procedure was for chronic pain at the first meta-tarsophalangeal joint and transfer metatarsalgia of the lateral rays. Post-operative follow-up ranged from 13– 70 months and patients were evaluated using a custom-made satisfaction questionnaire, clinical examination and evaluation of pre-and post-operative x-rays.

All patients were female. The mean age of the patients was 53.2 years [range 32–69]. The post- operative questionnaire revealed that five patients [six cases] were highly satisfied with the surgery. However, we do report complications associated with the procedure including one case of deep infection and four cases in total of radiological non-union of the graft.

The majority of patients were highly satisfied with the surgery, but this technique for the revision of failed Keller’s procedures has a significant risk of complications, so patients should receive appropriate counselling pre-operatively. Although the mini dental plate was low profile, its decreased rigidity may have been responsible for the four cases of non-union.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 273 - 273
1 Mar 2004
Konstantinos GA Wilkes R Karski M Khan A Buckle J Hutchinson C
Full Access

Introduction: While the early period of distraction osteogenesis has been extensively investigated, there are no data describing the long-term morphology of the regenerate. Patients and Methods: We performed MRI scans to ten adults, seven of which had bone transport for an osseous defect while further three had lengthening for limb length discrepancy. Follow up ranged between 14 and 43 months (mean: 29 months) following the removal of the external fixator. The perimeter, cross sectional area, volume and the mean signal intensity was calculated from the obtained T1 weighted axial images. Values were compared with the contralateral tibia that acted as control. Results: All cases that had bone transport increased the volume of the tibia from 15.3% up to 50.8%. The regenerated segment was noted to have expanded significantly (p< 0.0001) in all cases. Mean signal intensity in the regenerate decreased in seven cases significantly (p< 0.0001) suggesting increase content of unhydrated tissue such as bone and collagen. The cross sectional surface of the transported segment was increased in all cases (p< 0.008), which associated increase in the signal intensity (p< 0.003). Finally in cases that underwent bone transport, the docking site was noted to be obstructed by unhydrated tissue. Conclusions: Contrary to previous claims, the post-distraction osteogenesis tibia is far from normal, consisting of areas with potentially different biomechanical properties. Recognition of these changes is essential not only for appropriate preoperative counselling but also for considering treatment modalities in case of a fracture.