Aims

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

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.

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.

Purpose

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

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.

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.

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.

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.

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.