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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_13 | Pages 9 - 9
17 Jun 2024
Mason L Mangwani J Malhotra K Houchen-Wolloff L
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Introduction

VTE is a possible complication of foot and ankle surgery, however there is an absence of agreement on contributing risk factors in the development of VTE. The primary outcome of this study was to analyse the 90-day incidence of symptomatic VTE following foot and ankle surgery and to determine which factors may increase the risk of VTE.

Methods

This was a national, multi-centre prospective audit spanning a collection duration of 9 months (2022/2023). Primary outcomes included incidence of symptomatic VTE and VTE related mortality up to 90 days following foot and ankle surgery and Achilles tendon rupture, and analysis of risk factors.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_13 | Pages 10 - 10
17 Jun 2024
Malhotra K Patel S Cullen N Welck M
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Background

The cavovarus foot is a complex 3-dimensional deformity. Although a multitude of techniques are described for its surgical management, few of these are evidence based or guided by classification systems. Surgical management involves realignment of the hindfoot and soft tissue balancing, followed by forefoot balancing. Our aim was to classify the pattern of residual forefoot deformities once the hindfoot is corrected, to guide forefoot correction.

Methods

We included 20 cavovarus feet from adult patients with Charcot-Marie-Tooth who underwent weightbearing CT (mean age 43.4 years, 14 males). Patients included had flexible deformities, with no previous surgery. Previous work established majority of rotational deformity in cavovarus feet occurs at the talonavicular joint, which is often reduced during surgery. Using specialised software (Bonelogic 2.1, Disior) a 3-dimensional, virtual model was created. Using data from normal feet as a guide, the talonavicular joint of the cavovarus feet was digitally reduced to a ‘normal’ position. Models of the corrected position were exported and geometrically analysed using Blender 3.6 to identify anatomical trends.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_13 | Pages 21 - 21
17 Jun 2024
Jamjoom B Malhotra K Patel S Cullen N Welck M Clough T
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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.

Methods

A 2 centre retrospective review of consecutive series of 32 patients undergoing hindfoot fusions with impaction bone grafting of morselised femoral head allograft to fill large bony void defects was performed. Union was assessed clinically and with either plain radiography or weightbearing CT scanning. Indications included failed total ankle replacement (24 patients), talar osteonecrosis (6 patients) and fracture non-union (2 patients). Mean depth of the defect was 29 ±10.7 mm and mean maximal cross-sectional area was 15.9 ±5.8 cm2. Tibiotalocalcaneal (TTC) arthrodesis was performed in 24 patients, ankle arthrodesis in 7 patients and triple arthrodesis in 1 patient.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_12 | Pages 15 - 15
10 Jun 2024
Goodall R Borsky K Harrison C Welck M Malhotra K Rodrigues J
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Background

The Manchester-Oxford Foot Questionnaire (MOxFQ) is a condition specific patient reported outcome measure (PROM) for foot and ankle surgery. It consists of 16 items across three subscales measuring distinct, but related traits: walking/standing ability, pain, and social interaction. Although it is the most used foot and ankle PROM in the UK, initial MOxFQ validation involved analysis of only 100 individuals undergoing hallux valgus surgery. This project aimed to establish whether an individual's response to the MOxFQ varies with anatomical region of disease (measurement invariance), and to explore structural validity of the factor structure (subscale items) of the MOxFQ.

Methods

This was a single-centre, prospective cohort study involving 6640 patients (mean age 52, range 10–90 years) presenting with a wide range of foot and ankle pathologies between 2013 and 2021. Firstly, to assess whether the MOxFQ responses vary by anatomical region of foot and ankle disease, we performed multi-group confirmatory factor analysis. Secondly, to assess the structural validity of the subscale items, exploratory and confirmatory factor analyses were performed.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_11 | Pages 7 - 7
4 Jun 2024
Sangoi D Ranjit S Bernasconi A Cullen N Patel S Welck M Malhotra K
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Background

The complex deformities in cavovarus feet may be difficult to assess and understand. Weight-bearing CT (WBCT) is increasingly used to evaluate complex deformities. However, the bone axes may be difficult to calculate in the setting of severe deformity. Computer-assisted 3D-axis calculation is a novel approach that may allow for more accurate assessment of foot alignment / deformity. The aim of this study was to assess differences in measurements done manually on 2D slices of WBCT versus 3D computer models in normal and cavus feet.

Methods

We retrospectively analyzed WBCT scans from 16 normal and 16 cavus feet in patients with Charcot-Marie Tooth. Eight measurements were assessed: Talus-1st metatarsal angle (axial plane), Forefoot arch angle (coronal plane), and Meary's angle, calcaneal pitch, cuneiform to floor, cuneiform to skin, navicular to floor and navicular to skin distance (sagittal plane). 2D measurements were performed manually and 3D measurements were performed using specialised software (BoneLogic, DISIOR).


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_11 | Pages 10 - 10
4 Jun 2024
Houchen-Wollof L Mason L Mangwani J Malhotra K
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Objectives

The primary aim was to determine the differences in COVID-19 infection rate and 30 day mortality in patients undergoing foot and ankle surgery between different treatment pathways over the two phases of the UK-FALCON audit, spanning the first and second national lockdowns.

Design

Multicentre retrospective national audit.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_11 | Pages 18 - 18
4 Jun 2024
Najefi AA Alsafi M Katmeh R Zaveri AK Cullen N Patel S Malhotra K Welck M
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Introduction

Recurrence after surgical correction of hallux valgus may be related to coronal rotation of the first metatarsal. The scarf osteotomy is a commonly used procedure for correcting hallux valgus but has limited ability to correct rotation. Using weightbearing computed tomography (WBCT), we aimed to measure the coronal rotation of the first metatarsal before and after a scarf osteotomy, and correlate these to clinical outcome scores.

Methods

We retrospectively analyzed 16 feet (15 patients) who had a WBCT before and after scarf osteotomy for hallux valgus correction. On both scans, hallux valgus angle (HVA), intermetatarsal angle, and anteroposterior/lateral talus-first metatarsal angle were measured using digitally reconstructed radiographs. Metatarsal pronation (MPA), alpha angle, sesamoid rotation angle and sesamoid position was measured on standardized coronal CT slices. Preoperative and postoperative(12 months) clinical outcome scores(MOxFQ and VAS) were captured.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_10 | Pages 2 - 2
23 May 2024
Oswal C Patel S Malhotra K Sedki I Cullen N Welck M
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Introduction

Severe, multiplanar, fixed, pantalar deformities present a challenge to orthopaedic surgeons. Surgical options include limb salvage or amputation. This study compares outcomes of patients with such deformities undergoing limb preservation with either pantalar fusion (PTF) or talectomy and tibiocalcaneal fusion (TCF), versus below knee amputation (BKA).

Methods

Fifty-one patients undergoing either PTF, TCF and BKA for failed management of severe pantalar deformity were evaluated retrospectively. Twenty-seven patients underwent PTF, 8 TCF and 16 BKA. Median age at surgery was 55.0 years (17 to 72 years) and median follow-up duration was 49.9 months (18.0 to 253.7 months). Patients with chronic regional pain syndrome, tumour, acute trauma or diabetic Charcot arthropathy were excluded. Clinical evaluation was undertaken using the MOxFQ, EQ-5D and Special Interest Group in Amputee Medicine score (SIGAM). Patients were also asked whether they were satisfied with their surgical outcome and whether they would have the same surgery again.


Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_10 | Pages 4 - 4
23 May 2024
Houchen-Wollof L Malhotra K Mangwani J Mason L
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Objectives

The primary objective was to determine the incidence of COVID-19 infection and 30-day mortality in patients undergoing foot and ankle surgery during the global pandemic. Secondary objectives were to determine if there was a change in infection and complication profile with changes introduced in practice.

Design

Multicentre retrospective national audit.


Bone & Joint Open
Vol. 2, Issue 4 | Pages 216 - 226
1 Apr 2021
Mangwani J Malhotra K Houchen-Wolloff L Mason L

Aims

The primary objective was to determine the incidence of COVID-19 infection and 30-day mortality in patients undergoing foot and ankle surgery during the global pandemic. Secondary objectives were to determine if there was a change in infection and complication profile with changes introduced in practice.

Methods

This UK-based multicentre retrospective national audit studied foot and ankle patients who underwent surgery between 13 January and 31 July 2020, examining time periods pre-UK national lockdown, during lockdown (23 March to 11 May 2020), and post-lockdown. All adult patients undergoing foot and ankle surgery in an operating theatre during the study period were included. A total of 43 centres in England, Scotland, Wales, and Northern Ireland participated. Variables recorded included demographic data, surgical data, comorbidity data, COVID-19 and mortality rates, complications, and infection rates.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 100 - 100
1 Jan 2013
Malhotra K Pai S Radcliffe G
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Aims

Compartment syndrome (CS) is a well-recognised, serious complication of long bone fractures. The association between CS and tibial shaft fractures is well documented in adult patients and in children with open or high velocity trauma. There is, however, little literature on the risk of developing CS in children with closed tibial fractures. In a number of units these children are routinely admitted for elevation and monitoring for CS.

We audited our experience of managing paediatric tibial fractures to ascertain whether it may be safe to discharge a sub-group of these children.

Methods

We audited all children up to the age of 12 years admitted to our hospital over a 5 year period. We reviewed radiographs and clinical notes to determine fracture pattern, modality of treatment, and complications.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 89 - 90
1 May 2011
Malhotra K Kim W
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Aims: Limb length discrepancy is a recognised complication of total hip arthroplasty (THA). Cementless THAs are increasingly being used, but in order to achieve rotational and axial stability larger implants may be required than originally templated for. This could potentially result in greater limb length discrepancy. Our objective was to determine if limb length discrepancy exists to a greater degree in cementless THA.

Methods: 166 consecutive patients undergoing elective THA between June 2007 and May 2008 were included in this retrospective study. Post-operative, digital radiographs (PACS, Centricity®) were examined for each of these patients to determine limb length. Limb length discrepancy was calculated as the difference between the perpendicular distance between the inter-teardrop line and the most prominent points on the lesser trochanter of each limb. Magnification was determined from the measured radiographic diameter of the prosthetic heads and their actual diameters.

Results: Of the 166 patients included in this study 128 had cementless THA and 38 had cemented. The average magnification was calculated as 30%. Limb length discrepancy was found post-operatively in 93% of cases. In 65% of patients the operated limb was longer (by 0 – 29 mm) and in 28% it was shorter (by 0 – 23 mm). The mean limb length discrepancy, corrected for magnification, was 6.21 mm for cemented THA and 6.22 mm for cementless THA. A student’s T-test demonstrated no significant difference in limb length discrepancy between these operations (p = 0.996).

Conclusions: The incidence of limb length discrepancy after THA is high. However, no significant differences were demonstrated between cemented and cementless THAs in our series. Accurate and careful pre-operative templating is important in THA to minimise the risk of clinically significant limb length discrepancy.