Aim. Surgical options for management of a failed ankle arthroplasty are currently limited; typically conversion to fusion is recommended with only a few patients being considered for revision replacement surgery. This paper presents our experience of revision ankle replacements in a cohort of patients with failed primary replacements. Method. A total of 18 revision TAR in 17 patients were performed in patients with aseptic loosening. The technique was performed by a single surgeon (CSK) over a 4 year period between July 2014 and August 2018 using the Inbone total ankle replacement system. Patient demographics and clinical outcomes were collected retrospectively using - MOXFQ, EQ5D, VAS pain score and patient satisfaction questionnaires.
Background. Iatrogenic hallux varus is a rare complication after hallux valgus surgery. Operative treatment comprises a wide variety of techniques, of which the reversed transfer of the abductor hallucis tendon is the most recent described technique. Methods. This paper will present the long-term clinical results of the reversed transfer of the abductor hallucis longus. Therefore, we performed a prospective clinical observational study on 16 female patients. Our hypothesis is that the tendon transfer will persist in a good alignment and patient satisfaction on long term. There is a 100% follow-up rate with a range from 10 to 101 months. Patients were subjected to a clinical examination, three questionnaires and their general satisfaction.
Background. Disability and slow return to sport and work after tendon rupture are major challenges. Platelet Rich Plasma (PRP) is an autologous supraphysiological concentration of platelets from whole blood that has demonstrated positive cellular and physiological effects on healing in laboratory conditions but evidence from adequately powered robust clinical trials is lacking. We aimed to determine the clinical efficacy of PRP for treatment of acute Achilles tendon rupture. Methods. In a placebo-controlled, participant- and assessor-blinded, trial at 19 NHS hospitals we randomly assigned 230 adults starting acute Achilles rupture non-surgical management to PRP injection or dry-needle insertion (placebo) to the rupture gap under local anaesthetic. Patients with confounding or contraindicated concurrent medical conditions were excluded. The primary outcome was muscle-tendon function, assessed by the limb symmetry index (LSI, uninjured limb/injured limb × 100, higher scores better) of the work (Joules) performed during the heel-rise endurance test at 24 weeks. Secondary outcomes were: Achilles Tendon Rupture Score (ATRS, 0–100, higher scores better), quality of life (SF-12), pain, and goal attainment. Trial registration: ISRCTN54992179.
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. Setting. This was a combined retrospective (Phase 1) and prospective (Phase 2) national audit of foot and ankle procedures in the UK in 2020. Participants. All adult patients undergoing foot and ankle surgery in an operating theatre during the study period included from 46 participating centres in England, Scotland, Wales and Northern Ireland. Patients were categorised as either a green pathway (designated COVID-19 free) or blue pathway.
Background. Ankle fractures are extremely common but unfortunately, over 20% fail to obtain good to excellent recovery. For those requiring surgical fixation, usual-care post-surgery has included six-weeks cast immobilisation and non-weightbearing. Disuse atrophy and joint stiffness are detrimental sequelae of this management. While rehabilitation, starting at two-weeks post-surgery is viewed as safe, the literature contains methodological flaws and a lack of focus on early exercise, perpetuating the controversy over the effectiveness of early exercise interventions. Objectives. Our objectives were to determine if following operative fixation for Weber B fracture, the physiotherapy intervention, early motion and directed exercise (EMADE), applied in the clinical setting, were superior to Usual-care at 12-weeks (primary outcome) and 24-weeks. Design and Methods. We undertook a pragmatic-RCT, recruiting 157 surgically fixed Weber B ankle fracture patients, to establish if EMADE was superior to the Usual-care of 6-weeks immobilisation. The EMADE physiotherapy intervention (between week-2 and 4 post-surgery) utilised a removable cast and combined non-weightbearing progressive home exercises with manual therapy, advice and education. The primary outcome measure was the OMAS at 12-weeks.
Introduction. Flexor Hallucis Longus (FHL) tendon transfer is a well-recognised salvage operation for irreparable tendon Achilles (TA) ruptures and intractable Achilles tenonopathy. Several case series describes the technique and results of arthroscopic FHL tendon transfers. We present a comparative case series of open and arthroscopic FHL tendon transfers from Southmead Hospital, Bristol, UK. Methods. For the arthroscopic FHL transfers in most cases the patients were positioned semi prone with a tourniquet. A 2 or 3 posterior portal technique was used and the tendon was secured using an RCI screw. The rehabilitation was similar in both groups with 2 weeks in an equinus backslab followed by gradual dorsiflexion in a boot over the following 6 weeks. Anticoagulation with oral aspirin for 6 weeks was used. A retrospective case note review was performed.
Introduction. The Mobility™ prosthesis [Depuy] is the most extensively used TAR in the UK, though there are few published results. We present our complete experience of the Mobility prosthesis in a diverse population. Methods. From March 2005 to December 2009, 84 consecutive Mobility ankle replacements were performed by the senior author, in 79 patients (28 female, 51 male) with mean age 64.5 years (43–80). This complete cohort included the first and last cases with this implant. Mean follow-up was 50.1±18.2 months (range 14–86). Patients with ankle replacements in situ, were reviewed clinically and radiologically. Clinical outcome measures were: AOFAS score, MOXFQ (adapted for the ankle), and VAS for pain. Post-operative radiographs were reviewed to assess component position and examine for zones of lucency.
Background. Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint (MTPJ) of the great toe, which can result in significant pain and stiffness. Treatment using joint replacement, either by means of hemiarthroplasty or total arthroplasty of the metatarsophalangeal joint is becoming an increasingly popular option for patients with severe disease. Aim. To evaluate mid-term functional and radiological outcomes of a widely used first generation resurfacing arthroplasty system in the treatment of hallux rigidus. Method. Prospective review of patients from 2009 onwards. All patients were operated on by the senior author using the same first generation hemiarthroplasty prosthesis (HemiCAP®, Arthrosurface, USA) and surgical technique. Radiological and clinical outcomes were assessed at 3, 6, 12 and 24 months post-operatively. Patients were assessed pre- and post-operatively on an outpatient basis for MTPJ range of motion as well as outcomes using AOFAS and visual analogue scale scores.
Introduction. Isolated Weber B fractures usually heal uneventfully but traditionally require regular review due to the possibility of medial ligament injury allowing displacement. Following recent studies suggesting delayed talar shift is uncommon we introduced a functional treatment protocol and present the early results. Methods. 141 consecutive patients presenting acutely with Weber B fractures without talar shift between January and December 2015 were included. Patients were splinted in a removable boot and allowed to weight bear. ED notes and radiographs were reviewed by an Orthopaedic consultant. Patients without signs of medial injury were discharged with an information leaflet and advice. If signs of medial ligament injury were noted or the medial findings were not documented the patient was reviewed in fracture clinic at 4 weeks post-injury. If talar shift developed the patient was to be converted to operative treatment. Olerud and Molander scores were collected between 6 and 12 months post-injury.
Introduction:. Plantar Fasciitis is an extremely common and challenging problem that presents itself to foot and ankle practitioners. Many different treatment modalities are available for this condition, with little proven benefit. ECSWT was approved for use by the FDA for the treatment of chronic proximal plantar fasciitis in 2002 and NICE published guidance in 2009 recommending its use in refractory cases. Methods:. Patients who diagnosed with ultrasound scan, and for whom other treatments were unsuccessful, underwent treatment on an outpatient basis. They had three 4–5 minute sessions, once a week. A Spectrum machine was used delivering 10 Hz waves in 500 preset pulses at 2 bar pressure, followed by 2000 preset pulses at 2.5 bar pressure. Pre- and 3 month post-treatment pain levels were recorded using a 10 point Visual Analogue Scale.
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. Methods. Patients with plantar fasciitis that had not responded to a minimum of 8 months standard conservative management (eccentric stretching, physiotherapy, cortisone injection, night splints) were offered PRP therapy. The injection into the tender spot at the proximal plantar fascial insertion was performed in theatre as a day case. Roles Maudsley (RM) scores, Visual analogue scores (VAS) for pain, AOFAS scores and ‘would have injection again’ were collated pre-operatively, at three and six months.
The ZenithTM total ankle replacement (Corin, Cirencester) is a mobile-bearing implant based on the Buechal Pappas design. Key features are the simple fully-jigged instrumentation aiming to improve accuracy and reproducibility of implant positioning, cementless calcium phosphate coated surfaces for improved early osseointegration, and titanium nitride-coated bearing surfaces to resist wear. We present early to mid-term survival data for 155 total ankle replacements implanted by three surgeons in our institute. Case records of all patients undergoing ZenithTM Total Ankle Replacement by three senior surgeons, including a member of the design team, between 2007 and 2014 were examined. Patients were examined clinically and radiographically annually after the early postoperative period. The primary outcome measure was implant survival. Secondary outcome measures included complication rates, parameters of radiographic alignment, and radiographic evidence of cysts and loosening. One hundred and fifty-five cases were performed for a mixture of primary pathologies, predominantly primary or posttraumatic arthrosis. Mean follow-up was 50 months. Implant survival was 99.0% at 3 years (n=103), 94.0% at 5 years (n=50), and 93.8% at 7 years (n=16). One patient was revised to arthrodesis for aseptic loosening, one arthrodesis was performed for periprosthetic infection with loosening, and one below-knee amputation was performed for chronic pain. Three cases underwent further surgery to address cysts, and 7 malleolar fractures were reported. Medial gutter pain was experienced by 9% of patients. Overall, our data show excellent early and mid-term survivorship for the ZenithTM Total Ankle Replacement. Simple fully-jigged instrumentation allows accurate and reproducible implant alignment.
This project highlights the red flags in postoperative rehabilitation of total ankle replacement (TAR) patients managed with two different postoperative rehab regimes. 20 TAR patients were recruited for a pilot RCT between 2008 and 2011; they were randomized to 2 groups (immobilisation in a below knee plaster cast for 6 weeks vs. early mobilisation following TAR); all patients underwent a graded outpatient Physiotherapy program until 12 weeks postoperatively. Assessments included questionnaires, complications, American Orthopaedic Foot and Ankle Score (AOFAS) done preoperatively, 3 and 6 months after surgery.
Minimally Invasive foot surgery remains controversial. Potential benefits include a reduced incidence of wound complications, faster return to employment and normal footwear. There are no studies published regarding the results of minimally invasive dorsal cheilectomy. Patients and Methods. Thirty eight patients with painful grade I hallux rigidus underwent dorsal cheilectomy between April 2006 and June 2010. Minimally invasive cheilectomy (MIC) was introduced in August 2009. AOFAS scores, satisfaction, return to normal shoes and employment were assessed.
Introduction. Total ankle replacement (TAR) surgery remains a reasonable alternative to arthrodesis in a select group of patients with end stage ankle joint arthritis. We describe the early results of a prospective study of the first 50 Zenith total ankle replacements performed by a single surgeon (SKG). Methods. Demographic details, Visual Analogue Score (VAS) for pain (0, no pain; 10, worst possible pain), AOFAS scores, ‘would have surgery again’ and satisfaction levels were collated, pre-operatively and at their most recent outpatient review. Any post-operative complications were noted. Radiographs were also assessed for evidence of loosening, progressive osteolysis, subsidence and overall alignment of the implant.
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. Methods:. Between November 1993 and February 2000, a total of 200 consecutive STARs were carried out in 184 patients. Patients were followed up both clinically and radiologically, until death or failure, with time to decision to revision or fusion as the endpoint. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score.
Background. Salvage procedures on the 1st MTPJ following failed arthroplasty, arthrodesis or hallux valgus surgery are difficult and complicated by bone loss. This results in shortened first ray and transfer metatarsalgia. We present our experience of using tri-cortical interposition grafts to manage this challenging problem. Methods. Between 2002 and 2009 our department performed 21, 1st MTPJ arthrodeses using a tri-cortical iliac crest interposition graft. Surgical fixation was achieved with a compact foot plate. We performed a retrospective review from the medical notes and radiographs along with American Foot and Ankle scores which were collected prospectively. We analysed the following parameters: time to radiological, requirement for further surgery, lengthening of 1st ray and any post operative complications.
The purpose of this study was to evaluate the early functional outcome of this new modification of the Brostrom-Gould lateral ligament reconstruction using suture anchors and triple breasting of ATFL. AOFAS hindfoot scoring system was the primary outcome measure used. Between January 2008 and May 2011, data was collected prospectively, pre and postoperatively. Surgery for all patients included ankle arthroscopy plus whatever other minor procedure was indicated and was performed by the senior author. Postoperatively at 3 months and 12 months and in May 2011 patients were asked to attend a research clinic and their scores were obtained. Anterior drawer laxity and patient satisfaction, activity resumption and complications were some of the other information recorded. A mean follow up of 25 months on 18 ankles is presented which is amongst the longest in the literature for this procedure. Comparing pre and postoperative AOFAS scores revealed a statistically significant mean improvement of 39 points p < 0.05 with mean preoperative score being 53 and at 25 months being 89. All ankles felt clinically stable on repeated anterior drawer testing. 8 patients had resumed normal pre-injury level of activities (including sports), 8 had some reduction in normal level of activity and 2 did not carry out physical prior to operation. One patient complained of scar tenderness otherwise no complications were noted. 13 patients were extremely satisfied with results of surgery, 4 were very satisfied and 1 was moderately satisfied. The mid-term results of our modification show it to be safe, reproducible and highly successful in producing clinically and functionally stable ankles with high patient satisfaction. This includes a statistically significant improvement in AOFAS scores. This exceeds the results in the published literature.
Akins original description of his osteotomy did not describe the use of any metal work. Today the osteotomy is most commonly held and fixed with either a staple or screw. We describe the results obtained with a simple suture technique. Methods Data was collected prospectively on 125 patients undergoing an Akin osteotomy. 111 of the patients were female and 14 male. The average age at time of surgery was 49 years. 104 cases were in conjunction with We describe a quick, easy, implant free method of fixing the Akin osteotomy. There is no need for metalwork removal and in today's world of austerity and the current climate of widespread budget constraints we describe a cost effective method which is clinically just as effective as methods requiring a staple or screw.
TMTJ fusion is performed for arthritis or painful deformity. K-wire and trans-articular screws are usually used to stabilize the joints. We present our experience with LP for TMTJ fusion in first 100 joints. Patients and methods. 100 TMTJ in 74 patients were fused and stabilised with LP between January 2007 and December 2010. The indication was Lisfranc arthritis and hallux valgus. Iliac crest bone autograft was used in 64 joints. Auto graft was used in 22/53 first TMT fusions. All patients post-operatively had below knee plaster immobilization and protected weight bearing walking for first 6 weeks. Clinical and radiological surveillance continued until bone. AOFAS midfoot scale was used as outcome measure.
