Aims. Revision rates for
Introduction. When
Introduction. While advances in joint-replacement technology have made total ankle arthroplasty a viable treatment for end-stage arthritis, revision rates for
Introduction. Postoperative pain following the 3 component
Purpose: 1/ To compare patients treated with both
Abstract: The early stages of
After catastrophic failure of first generation, joint replacement as treatment option for ankle osteoarthritis is undergoing a revival with improved second generation designs. Short to mid-term results reportedly equal those of ankle arthrodesis in terms of complications and revision, but preserving joint motion and protecting neighbouring midfoot joints from overuse and consecutive osteoarthritis. However, most reports derive from developers centres excluding the learning curve. We present clinical results and subjective outcome of an initial patient series undergoing
Background. Postoperative pain following (Mobility TM)
Aim. A prospective cohort of patients undergoing total ankle arthroplasrty for arthritis following pilon fractures was included in the present study. This group of patients generally have poor soft tissue envelope and have had previous surgical interventions prior to the
Introduction.
Introduction.
Total ankle replacement (TAR) is increasingly used in the treatment of end-stage ankle arthropathy, but much debate exists about the clinical result. The goals of present study are: 1) to provide an overview of the clinical outcome of 58 TAR's in a single centre and 2) to assess the association between radiological characteristics and clinical outcome. We reviewed a prospective included cohort of 58 TAR's in 54 patients with a mean age of 66.9 (range 54–82) and a mean follow-up of 21.6 months (range 1.45–66.0). The TAR's where performed by a single surgeon in a single centre (MUMC) between 2010 and 2015, using the CCI
As an alternative to
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. 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.Aims
Methods
The effect of BMI on patient-reported outcomes following total ankle replacement (TAR) is uncertain and the change in BMI experienced by these patients in the 5 years following surgery has not been studied. We report a series of 106 patients with complete 5-year data on BMI and patient-reported outcome scores. Patients undergoing TAR between 2006 and 2009, took part in the hospital joint registry, which provides routine clinical audit of patient progress following total joint arthroplasty; therefore, ethics committee approval was not required for this study. Data on BMI, Foot and Ankle Score (FAOS) and SF-36 score were collected preoperatively and annually postoperatively. Patients who were obese (BMI >30) had lower FAOS scores pre-operatively and at 5 years, however this did not reach significance. Both obese (p = 0.0004) and non-obese (p < 0.0001) patients demonstrated a significant improvement in FAOS score from baseline to 5 years. This improvement was more marked for the non-obese patients. No significant differences were seen for SF36 scores between obese and non-obese patients either at baseline or 5 years. There was a trend for improved score in both groups. Mean pre-operative BMI was 28.49. Mean post-operative BMI was 28.33. The mean difference between pre- and post-operative BMI was −0.15, which was not statistically significant (p=0.55). There were no significant differences in revisions in the obese (2) and non-obese (1 and one awaited) groups at 5 years. This data supports use of TAR in the obese population, as significant increases in mean FAOS score were seen in this group at 5 years. Obesity did not have a significant influence on patients' overall health perceptions, measured by the SF36 and a trend for improvement was seen in both obese and non-obese patients. TAR cannot be relied upon to result in significant post-operative weight-loss without further interventions.
Worldwide, total ankle replacement is being offered more often as an alternative to ankle fusion. Most reports in the literature come from single centers with surgery performed by ‘high volume’ foot and ankle surgeons. We describe the New Zealand experience with the Scandinavian Total Ankle Replacement (STAR). Ethical approval was gained for the study. Using the national joint register we identified all STARs performed in New Zealand. Patients were contacted by mail and consented to participate in the study. We retrospectively reviewed patient notes and x-rays. Patients were asked to complete and return an Oxford Ankle Score, WOMAC score, and SF-12. Fifty two STARs were implanted in 49 patients between 1998 and 2005. Eleven surgeons performed between one and 13 operations. Forty one STARs in 39 patients were available for follow-up at an average of 58 months. Eight STARs had been revised (19.5%) at an average of 22 months post surgery. In patients with the implant still in-situ the average oxford score was 24.9, WOMACs core 17.3, SF-12 physical component 44.1, and SF-12 mental component 54. X-rays were available for review in 30 ankles. Most components were implanted in a good position. Intra-operative malleolar fracture was noted in six ankles. The tibial component was undersized in 5 patients and the talar component was oversized in three patients. Two cases of talar subsidence and 3 cases of tibial subsidence (one requiring revision) were noted on follow-up x-rays. In New Zealand, the Scandinavian Total Ankle Replacement has a high revision rate at five years’ post surgery. A significant number of intra-operative malleolar fractures and component mal-sizing was noted. Patients who have not required revision mostly report acceptable ankle specific, and quality of life outcomes.
The purpose of this study was to compare the clinical outcome of patients treated surgically for end stage ankle arthritis using a total ankle arthroplasty or ankle arthrodesis. This is a multicentered prospective clinical outcome study of the surgical treatment of patients with EAA using an ankle arthrodesis (n= 117) or total ankle arthroplasty (n= 210). Clinical outcome was assessed using health related quality of life (SF36v2) and joint specific (Foot Function Index, Ankle Osteoarthritis Scale, American Orthopedic Foot and Ankle Hindfoot Scale and the AAOS Foot and Ankle Baseline Questionnaire(version 2000)) outcome scores. Preoperatively, all patients had significant physical and psychological morbidity. All symptom and functional SF36 subscales were approximately two standard deviations below normal population scores. Approximately 25% of patients were three standard deviations below population values, indicating increased risk of mortality. There was no evidence that age or gender influenced the level of disability. There was a significant improvement in the health related quality of life and the joint specific clinical outcome scores at six and twelve months follow up but no consistent difference was noted between the two cohorts. This is the first multicentered prospective clinical outcome study that demonstrates equal efficacy for early follow up of patients treated for EAA with total ankle arthroplasty or ankle arthrodesis.