Aim and Purpose of the study. The authors evaluate the efficacy of athrodiatasis as possible alternative to arthrodesis or arthroplasty in the treatment of
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
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
Background. Total ankle replacement (TAR) is increasingly offered as an alternative to ankle fusion for the management of severe
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
INTRODUCTION. Fresh bipolar shell osteochondral allograft (FBOA) is a controversial treatment option for post-traumatic
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