Purpose

Educational handouts designed for patients are promoted as a tool to educate, increase satisfaction, and potentially improve outcome. However, the value of these educational handouts as an adjunct to standard surgical care has not been formally assessed after ankle fracture. The purpose of this study was to compare standard post-operative care following surgically treated rotational ankle fracture to care supplemented with the use of adjunctive educational handouts.

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: Intraoperative frozen section analysis in which the number of cells per high powered field (CPHF) are used to predict the presence or absence of infection has been found to be a very useful test in the setting of revision total joint arthroplasty. The purpose of this retrospective review was to determine the usefulness of this same test at the time of implantation of a total hip arthroplasty (THA) following the failure of hip fracture fixation.

Method: A retrospective review from 1999 – 2007 of twenty-two consecutive patients who had THA performed as a result of failed hip fracture fixation. The mean age of patients was seventy-two years. The number of CPHF was correlated with the results of intraoperative cultures, and other pre-operative and post-operative parameters. The mean duration of follow-up was 14 months.

Results: Two patients had a culture-proven infection (Staphylococcus aureus in one patient, and staphylococcus epidermidis and propionibacterium acnes in the other.) Both of these patients had a positive test for infection based on the frozen section having greater than ten CPHF by the pathologist. (100% agreement) Four out of the six specimens that were graded as 10 CPHF by the pathologist had negative intra-operative cultures (33% agreement). With the CPHF limit set at 10 CPHF, the sensitivity of frozen section analysis in this clinical setting was 100%, while the specificity was 19%. The positive predictive value was calculated to be 33%, and the negative predictive value was 100%. With the cutoff of 5 CPHF or greater, the sensitivity of 100% and a specificity of 52% as well as a positive predictive value of 17% and a negative predictive value of 100%.

Conclusion: Although the results are preliminary, and further study is warranted, it seems that CPHF is a useful test to rule out the presence of infection when revising failed fracture fixation to Total Hip Replacement..