Aim and Purpose of the study. The authors evaluate the efficacy of athrodiatasis as possible alternative to arthrodesis or arthroplasty in the treatment of ankle arthritis in young patients. They present the long term results (average 19 years) of a small series of patients (10 cases) treated with a monolateral transarticular external fixator associated to different open or athroscopic procedures. Material and Methodology. The patients have been revaluated with the Kitaoka scoring scale associated to the x-ray evaluation. The authors will compare these results with those reported for the same series at an early evaluation (2,5 y of follow up) and with those published in literature. Discussion. Arthrodiatasis of the ankle with distraction and movement of the joint under weightbearing can guarantee an intermittent Hydrostatic pressure that has a trophyc effect on residual cartilage. In 1995 a new interest in ankle distraction was promoted by a very active Duch group which in few years demonstrated that there was still space for this indication as alternative to the arthrodesis in very young and active patients because the functional and physical impairment, the pain and mobility of this joint can be improved also after the first year of follow up. Our good results with the same approach seems to confirm their conclusions after a long term follow –up even if there is no correlation between the functional and radiological findings. It is important to underline that frequently is necessary to associate to arthrodiatasis other ancillary arthroscopic or open procedures in order to optimise the results. Conclusion. Arthodiatasis as possible alternative to arthrodesis or arthroplasty in the treatment of ankle arthritis is still a valid option in selected cases because can guarantee good functional results even at a long term follow-up

We report a cost-effectiveness analysis of Primary Total Ankle Replacements (TAR). In addition, we looked for factors that could be predictors of increased gain in Quality-Adjusted Life Years (QALYs). Pre-operative and six-month post-operative data for TAR was obtained over seven-and-a-half-years in NHS Lothian. The EuroQol general health questionnaire (EQ-5D-3L) measured health-related Quality of Life and the Manchester-Oxford Foot Questionnaire (MOXFQ) measured joint function. Predictors, tested for significance with QALYs gained, were pre-operative scores and demographic data including age, gender, BMI and Deprivation category. Continuous variables were assessed with Pearson correlation coefficients, Deprivation and BMI categories with Boxplots and gender with the Mann-Whitney U test. The 74-patient cohort [Mean age 68.03 (SD 8.61), 60.8% male] had 49% classed as obese or higher. Cost per QALY gained was £3841, rising to £9202 when annual 3.5% reduction in health gains and 1.9% revision rates were included. Lower pre-operative EQ-5D-3L index correlated significantly with increased QALYs gained (p <0.01), all other predictors returned insignificant results (p >0.05). Primary TAR has proven very cost-effective in treating end-stage ankle arthritis. Pre-operative EQ-5D-3L is the most promising predictor of QALYs gained identified

Introduction. End-stage ankle osteoarthritis is a debilitating condition that results in functional limitations and a poor quality of life. Ankle arthrodesis (AAD) and total ankle replacement (TAR) are the major surgical treatment options for ankle arthritis. The purpose of the present study was to compare preoperative and postoperative participation in sports and recreational activities, assesses levels of habitual physical activity, functional outcome and satisfaction of patients who underwent eighter AAD or TAR. Methods. 41 patients (mean age: 60.1y) underwent eighter AAD (21) or TAR (20) by a single surgeon. At an average follow-up of 30 (AAD) and 39 (TAR) months respectively activity levels were determined with use of the University of California at Los Angeles (UCLA) activity scale. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, patients's satisfaction and pre- and postoperative participation in sports were assessed as well. Results. In the AAD group 90% and in the TAR group 76% were active in sports preoperatively. Postoperatively in both groups 76% were active in sports (AAD p=0.08). The UCLA score was 7.0 (± 1.9) in the AAD group and 6.8 (± 1.8) in the TAR group (p=0.78). The AOFAS score reached 75.6 (± 14) in the AAD group and 75.6 (± 16) in the TAR group (p=0.97). Conclusion. Our study revealed no significant difference between the groups concerning activity levels, participation in sports activities, UCLA and AOFAS score. After AAD the number of patients participating in sports decreased. However, this change was not statistically significant

Background. Total ankle replacement (TAR) is increasingly offered as an alternative to ankle fusion for the management of severe ankle arthritis. As with all other types of joint arthroplasty, there are risks involved and complications that occur; these increase with case complexity. We present the complications and management from a single-centre series. Results. Since 2006, we have performed 150 Mobility TARs with up to 4 years' follow-up. We have excluded 16 that are part of a separate RCT and 10 with less than 3 months' follow-up. 124 TARs were included in our study (117 patients). Three ankles (2.4%) had superficial wound infections treated successfully with antibiotics. One ankle (0.8%) required an arthroscopic washout and débridement but the implant was retained. 11 ankles (8.9%) had a periprosthetic fracture: One was intra-operative; 10 were post-operative (2 fixed). Four patients (3.2%) developed CRPS. One ankle required fusion surgery (following subsidence of the talar component) with another one pending revision (ligament instability causing implant displacement). No patient had a symptomatic deep vein thrombosis or thromboembolic event. Discussion. Our figures are comparable with other series. Our complication rate has not changed significantly over time. Our results, at present, suggest that most complications (98%) with the Mobility TAR can be satisfactorily managed without having a detrimental effect on the implant. There have been proven and promising results with total ankle replacement. However, there is a significant complication rate that must be made clear to the patient via informed consent; the rate still remains higher than for hip and knee arthroplasty

We re-examined clinically and radiologically 88 patients with a fracture of the lower leg at a mean follow-up of 15 years. Forty-three fractures (49%) had healed with malalignment of at least 5°. More arthritis was found in the knee and ankle adjacent to the fracture than in the comparable joints of the uninjured leg. Malaligned fractures showed significantly more degenerative changes. Eighteen patients (20%) had symptoms in the fractured leg. There was a significant correlation between symptoms in the knee and arthritis but not between symptoms and ankle arthritis or malalignment. We conclude that fractures of the lower leg should be managed so that the possibility of angular deformity and thereby late arthritis is minimised

INTRODUCTION. Fresh bipolar shell osteochondral allograft (FBOA) is a controversial treatment option for post-traumatic ankle arthritis. Immunological response to transplanted cartilage may play a role in failure. Aim of the study is to compare two groups of patients who received FBOA in association or not to immunosuppressive therapy. METHODS. 2 groups, of 20 patients each, underwent FBOA. Only one group (group-B) received immunosuppressive therapy. Pre-operative and follow-up evaluation were clinical (AOFAS) and radiographical (X-Rays, CT- scan, MRI). Bioptic samples harvested during II look were examined by histochemical, immunohistochemical (ICRS II score) and by genetic typing analyses. RESULTS. Group-A pre-operative AOFAS score improved from 28.2 ± 10.9, to 69.9 ± 18.2 at 24 months follow-up(p<0.005), while Group B improved from 26.2 ± 6.8 to 71.4 ± 7.3 (p<0.005). Comparison of clinical outcomes between the groups was non-significant. Group B showed better morphology of the grafts (ICRS II score mean of 68%) compared to Group A (mean of 40%) (p<0.05). Genetic typing showed a mixed recipient/donor DNA presence. Kendall ordinal correlation between groups and ICRS score was found. All the samples rated as 100 were in group B, while all the samples rated 0 were in group A (=0.506, p=0.008). CONCLUSIONS. Although clinical results were comparable in the two groups, better histological score in Group B evidentiated hyaline cartilage significatively better preserved. Genetic typing showed the presence of cells of the host into the transplanted cartilage suggesting a possible colonization of transplanted cartilage by host cells never described before

Background. The recommended indications for total ankle replacement (TAR) are limited, leaving fusion as the only definitive alternative. As longer-term clinical results become more promising, should we be broadening our indications for TAR?. Materials and Methods. Our single-centre series has 133 Mobility TARs with 3–48 months' follow-up. 16 patients were excluded who were part of a separate RCT. The series was divided into two groups. ‘Ideal’ patients had all of the following criteria: age >60y, BMI <30, varus/valgus talar tilt <10°, not diabetic, not Charcot, not post-traumatic. The ‘Not ideal’ group contained those who did not fit any single criteria. We compared complications and outcome scores between both groups. Results. The ‘Ideal’ group contained 44 ankles vs. 80 in the ‘Not ideal’ group (124 ankles in 117 patients). Complications were (‘Ideal’ vs. ‘Not ideal’): infection: 1 (deep) vs. 3; DVT/PE: 0; periprostheticfracture: 4 vs. 7; CRPS: 2 vs. 2; revision: 0 vs. 2. AOFAS scores showed variable significance (mean values). Pre-op: 27.9 vs. 25.7 (p = 0.459); 3months: 79.4 vs. 73.2 (p = 0.041); 6 months: 79.9 vs. 75.4 (p = 0.053); 12 months: 79.7 vs. 75.8(p = 0.228), 36 months: 77.3 vs. 79.0 (p = 0.655). Further subgroup analysis has been performed. Discussion. Our results show that indications for TAR can be widened without further morbidity. Each case must be treated individually and accounted for other factors. Varus/valgus tilt can be corrected with appropriate calcaneal osteotomy +/- tendon transfers as a staged or combined procedure. TAR may be considered in younger patients based on functional and occupational demands. We may no longer be able to deter patients on BMI alone. Diabetic patients do not appear to have a higher complication rate. Conclusion. We have increasing evidence that we should now be considering TAR as the primary treatment for disabling ankle arthritis rather than fusion