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.

Background

Ankle and hindfoot fusion in the presence of large bony defects represents a challenging problem. Treatment options include acute shortening and fusion or void filling with metal cages or structural allograft, which both have historically low union rates. Impaction grafting is an alternative option.

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.

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.

Introduction

Arthroplasty for treatment of end stage hallux rigidus is controversial. Arthrodesis remains the gold-standard, but this procedure is not without complications, with up to 10% non-union, 14% re-operation and 10% transfer metatarsalgia rates reported.

The aim of this study was to analyse the outcome of the double-stemmed silastic implant (Wright-Medical) for end stage hallux rigidus.

Aim

To examine the mid-term survival, clinical and patient reported outcomes of the silastic 1^st metatarsophalangeal joint replacement for the treatment of end stage hallux rigidus.

Background

We compared platelet rich plasma (PRP) injection to cortisone (40mg triamcinolone) injection in the treatment of chronic plantar fasciitis resistant to traditional nonoperative management. The aims were to compare early and long term efficacy of PRP to that of Steroid (3, 6 and 12 months after injection).

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.

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.

Introduction

Whilst most cases of plantar fasciitis can be resolved with existing conservative established treatment options, a few intractable cases can be difficult to resolve. New biologic treatments have been proposed for a variety of soft tissue tendon problems. We evaluated the results of PRP in the treatment of recalcitrant chronic cases of plantar fasciitis.

Background

Short term results of silastic implant of first MTPJ are successful. However reservations exist regarding long term results. The aim of this study is to evaluate long term outcome of silastic implant prosthesis in treatment of hallus rigidus.

We reviewed 108 feet in 83 patients who were operated on between 1988 and 2003. Mean age at operation = 55(SD 8.1). Mean follow up = 8.31 years (SD 3.3). Patients were assessed using the American Orthopaedic Foot and Ankle Scoring system (AOFAS). Passive and active arc of motion were measured. To assess patients' satisfaction they are asked if they would repeat the procedure and also using a visual analogue scale (VAS) to express their overall satisfaction with the outcome. All the patients had anteroposterior and oblique views. Radiographs were assessed for loosening and osteolysis.

Introduction: Deep postoperative infection in patients who have had surgery for fractured neck of femurs (NOF) has high morbidity and mortality. There is a reported incidence of 0.6–1.1% despite perioperative antibiotic prophylaxis (Co-Amoxiclav in our institution). The commonest causative organism reported is Staphylococcus aureus.

Method: We designed a retrospective study over a 6 month period in 2008. All patients having surgery for NOF were reviewed for positive bacterial growth on post-operative wound swabs.

Results: 143 patients had surgery and were included in our study. The mean ASA grade was 3. Over 90% of wounds were closed with clips. The average stay in hospital was 36 days. Mortality from postoperative infection was 1.41%., with 5 patients readmitted for treatment post discharge. Only 17 patients (11.9%) had positive wound swabs, and of these, 6 were asymptomatic and clinically well, 6 developed deep infections of the hip (4.23%), and 5 had superficial wound infections (3.53%). Signs of infection began on average 12 days post-operatively, with a delay of 4.5 days before starting treatment. Discharge from the wound was the most common sign (89%), followed by erythema (65%), and pyrexia (36.4%). The average white cell count (WCC) was normal (10.2 x 109 cells/L), but C-Reactive Protein was found to be raised. Antibiotics were given for an average of 34 days. All deep infections had surgical washouts after an average 4.6 days post diagnosis. Two patients who developed infection required a girdlestone operation (one died). The main bacteria isolated in 65% of cases were coliforms, pseudomonas and enterococci. Only one patient grew Staphylococcus aureus. All cultures were sensitive to ciprofloxacin and Tazocin, however, penicillin and benzyl-penicillin were started empirically in all cases according to local hospital policy.

Conclusion: Deep postoperative infection following a NOF repair is common and associated with mortality and morbidity. ASA grades were higher in such patients. WCC is not a reliable indicator in the early stages. Staphylococcus aureus was not found to be the predominant bacteria causing infection, although this may be due to penicillin prophylaxis. We have changed our empirical antibiotics for hip wound infections.

Aims: This study reports the mid-term results of a prospective series of 200 ankle replacements using the Scandinavian Total Ankle Replacement (STAR). 105 patients were more than five years since surgery.

Method: 200 patients; 85 male, 115 female; mean age 60 years (18–83) underwent primary replacement. The mean follow-up was 54 months (4–110). The diagnosis was inflammatory joint disease (IJD) for 119 patients and osteoarthritis (OA) for 81.

Results: 144 patients had a good outcome and uncomplicated recovery. A further 18 patients had a complication, which resolved with non-operative treatment (three prolonged wound healing, 15 malleolar fractures, either at surgery or at a later date). A further eight patients were clinically satisfactory but the x-rays showed adverse features (five aseptic loosening and three recurrent deformity). Five patients have a poor outcome due to persistent pain and stiffness but have not required further surgery. A further nine patients had a complication necessitating surgery (three calcaneal osteotomy and lateral ligament reconstruction, one tibial osteotomy to improve alignment, one autogenous bone graft for osteolysis, one for late medial malleolar fracture, one split skin graft for delayed healing, two for removal of heterotopic bone). At two years the AOFAS score for pain improved from 0 to 35 (maximum 40) and the functional score from 28 to 35 (maximum 60). There were 16 total failures that required fusion (11) or revision (five). The causes were nine aseptic loosening, three recurrent deformity, two fracture malleolus, one deep infection, one persistent pain. The cumulative five-year survival rate was 89% (95% CI 81% to 96%), with time to decision to revision or fusion as the endpoint.

Conclusions: There was no difference in survival between ankle replacement for OA or IJD. Ten out of the 16 failures occurred early (< two years), which we attribute to technical error or attempting replacement of ankles with severe deformity. The failure rate after two years is approximately 1% per annum.

Aim: To demonstrate the pattern and mechanism of injury of alpine skiing and snowboarding, and to evaluate the potential risk factors.

Methods: We analysed prospectively all cases of orthopaedic injuries requiring hospital admission that were the result of snowboarding or skiing accidents in the winter of 2000. This included four popular skiing facilities in the South Island of New Zealand.

Results: Seventy-six patients were reviewed. Of those, 30 cases were the results of accidents from snowboarding and 44 cases were from skiing. In addition to appropriate medical evaluations and medical care, a detailed examination was performed on every patient to determine various factors, including demographics, their level of experience and the cause and mechanism of the accident. There were 47 males and 29 females, with an average age of 28 (range: seven to 62)years. Snowboarders tended to be younger men with an average age of 23 years compared with 31 years in skiers. Males constituted 77% of snowboarders and 54% of skiers.

There were 14 patients in the beginners’ group, 32 intermediate, 20 advanced and nine at an extreme-skill level. Thirty-eight patients sustained injuries of the lower extremities, 24 of the upper extremities, 13 of the spine, and one of the pelvis. Lower extremity injuries were more common in skiers (59% of lower limbs, versus 25% of upper limbs), while in snow boarding upper extremity injuries were more common (43% upper limbs versus 36% lower limbs). Ulnar collateral ligament injuries of the metacarpophalangeal joint of the thumb, were far more common in skiers (six in skiers versus one on snowboard). Sixteen patients (nine skiers and six snow-boarders) sustained diaphyseal fractures of their tibiae. In all nine patients in the skiing group, the mechanism of injury was failure of the binding to release resulting in a twisting force to the leg, while in the snowboarding group, three patients (50%) fractured their tibiae on landing badly from a jump and in the other three on colliding with another person or a fixed object.

Conclusions: Lower extremity, equipment-related injuries are common in alpine skiing. The data suggested that currently used bindings are insufficient. Research, technical developments and optimal adjustment of binding are required.