Background. Occasionally, patients experience new or increased ankle pain following total knee arthroplasty (TKA). The aims of this study were to determine (1) how the correction of varus malalignment of the lower limb following TKA affected changes in alignment of the ankle and hindfoot, (2) the difference in changes in alignment of the ankle and hindfoot between patients with and without
Until recently, surgical treatments for advanced
Introduction. Deformity of knee joint causes deviation of mechanical axis in the coronal plane, and the mechanical axis deviation also could adversely affect biomechanics of the ankle joint as well as the knee joint. Particularly, most of the patients undergoing total knee arthroplasty (TKA) have significant preoperative varus malalignment which would be corrected after TKA, the patients also may have significant changes of ankle joint characteristics after the surgery. This study aimed 1) to examine the prevalence of coexisting
Power production in the terminal stance phase is essential for propelling the body forward during walking and is generated primarily by ankle plantarflexion. Osteoarthritis (OA) of the ankle restricts joint range of motion and is expected to reduce power production at that ankle. This loss of power may be compensated for by unaffected joints on both the ipsilateral and contralateral limbs resulting in overloading of the asymptomatic joints. Total ankle arthroplasty (TAA) has been shown to reduce pain and has the potential to restore range of motion and therefore increase ankle joint power, which could reduce overloading of the unaffected joints and increase walking speed. The purpose of this study was to test the hypothesis that ankle OA causes a loss of power in the affected ankle, compensatory power changes in unaffected lower limb joints, and that TAA will increase ankle power in the repaired ankle and reduce compensatory changes in other joints. One hundred and eighty-three patients (86 men, 97 women with average ages 64.1 and 62.4 years respectively) requiring surgical intervention for ankle OA were prospectively enrolled. Implant selection of either a fixed (INBONE or Salto Talaris) or mobile (STAR) bearing implant was based on surgeon preference. Three-dimensional kinematics and kinetics were collected prior to surgery and one year post-operatively during self-selected speed level walking using an eight-camera motion capture system and a series of force platforms. Subject walking speed and lower extremity joint power during the last third of stance at the ankle, knee, and hip were calculated bilaterally and compared before and after surgical intervention across the entire group and by implant type (fixed vs. mobile), and gender using a series of ANOVAs (JMP SAS, Cary, NC), with statistical significance defined as p < 0 .05. There were no gender differences in age, walking speed, or joint power. All patients increased walking as a result of surgery (0.87 m/s±0.26 prior to surgery and 1.13 m/s±0.24 after surgery, p < 0 .001) and increased total limb power. Normalized to total power (which accounts for changes in speed and distribution of power production across joints), prior to surgery the affected ankle contributed 19%±10% of total power while the unaffected ankle contributed 42%±12% (P < 0 .001). After surgery, the affected ankle increased to 25%±9% of total power and the unaffected ankle decreased to 38%±9% of total (P < 0.001). Other joints showed no significant power changes following surgery. Fixed bearing implants provide greater surgical ankle power improvement (61% versus 29% increase, p < 0 .002). Much of that change was due to the fact that those that received fixed-bearing implants had significantly lower walking speed and power before surgery. Ankle OA reduced ankle power production, which was partially compensated for by the unaffected ankle. TAA increases walking speed and power at the affected ankle while lowering power production on the unaffected side. The modifications in power production could lead to increased physical activity and reduced overloading of asymptomatic joints.
Preoperative talar valgus deformity increases the technical difficulty of total ankle replacement (TAR) and is associated with an increased failure rate. Deformity of ≥15° has been reported to be a contraindication to arthroplasty. The goal of the present study was to determine whether the operative procedures and clinical outcomes of TAR for treatment of end-stage ankle arthritis were comparable for patients with preoperative talar valgus deformity of ≥15° as compared to those with <15°. We will describe the evolving surgical technique being utilized to tackle these challenging cases. Fifty ankles with preoperative coronal-plane tibiotalar valgus deformity of ≥15° “valgus” group) and 50 ankles with valgus deformity of <15° (“control” group) underwent TAR. The cohorts were similar with respect to demographics and components used. All TARs were performed by a single surgeon. The mean duration of clinical follow-up was 5.5 years (minimum two years). Preoperative and postoperative radiographic measurements of coronal-plane deformity,
Ankle arthrodesis and replacement are the widely accepted options in managing end-stage ankle arthritis. Ankle replacement as an alternate treatment option for ankle arthritis is relatively new and this is in large part to the successes observed with hip and knee arthroplasty for arthritis. Relative benefits of ankle replacement and arthrodesis remains a contentious topic. We conducted a multicenter pilot randomized controlled trial, first of its kind, comparing the clinical outcomes of ankle arthrodesis and ankle replacement in managing ankle arthritis. We hypothesized that clinical outcomes would be similar for both. Patients recruited for this study were part of Canadian Orthopaedic Foot and Ankle Society (COFAS) Database. Canadian orthopaedic surgeons with fellowship training in foot and ankle surgery or extensive experience in the surgical treatment of end stage ankle arthritis determined whether the patient met the criteria for randomization, skeletal maturity, symptomatic ankle arthritis no longer amenable to non-operative management, and ability to give informed consent. Data was collected on patient demographics, follow-up time period, complication rates, and
A significant portion of ankle arthroplasty and ankle arthrodesis procedures performed in British Columbia are funded by the public medical services plan (MSP). However, some patients are treated privately through self-pay or by the workers compensation board (WCB), with the latter two groups being more likely to receive treatment sooner. The potential effect of payer on patient-reported outcomes and reoperation rates has not been previously explored. A retrospective chart review was performed using data from the Canadian Orthopaedic Foot and Ankle Society Prospective Ankle Reconstruction Database. N=443 patients (393 MSP, 26 self-pay, 24 WCB), treated with total ankle replacement or ankle arthrodesis by three subspecialty-trained surgeons in Vancouver from 1999–2003, were analyzed. Outcomes were compared, by payer, preoperatively and at long-term follow-up (6.3 years, range 2–14 years). Function was assessed using the
Purpose. The failure rate of total ankle arthroplasty (TAA) in rheumatoid patients may be higher than in osteoarthritis patients due to the medications used to treat rheumatoid arthritis and the comorbidities associated with this disease. The purpose of this study was to prospectively look at the intermediate-term outcomes of TAA in patients with rheumatoid arthritis and to compare the results to a matched cohort of patients with
Purpose. The purpose of this study was to assess the clinical outcomes over two years for total ankle arthroplasty (TAA) using Short Form-36, Foot Function Index and
Researchers and clinicians measuring outcomes following total ankle replacement (TAR) are challenged by the wide range of outcome measures used in the literature without consensus as to which are valid, reliable, and responsive in this population. This review identifies region- or joint-specific outcome measures used for evaluating TAR outcomes and synthesises evidence for their measurement properties. A standard search strategy was conducted of electronic databases MEDLINE, EMBASE and CINAHL (to June 2015) to identify foot/ankle measures in use. A best evidence synthesis approach was taken to critically appraise measurement properties [COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)] of identified measures. The review was restricted to English publications and excluded cross-cultural adaptations. Measurement properties collected from each article were coded for validity, reliability, responsiveness, or interpretability. Clinimetric evidence exists for identified measures tested in non-TAR populations, but were not the focus of this review. The search identified 14 studies to include in the best evidence synthesis with 32 articles providing clinimetric evidence for eight of the measures (one CBO, seven PRO), however only five measures were tested in a TAR population (Foot Function Index,
Patients often comment on swelling after foot and ankle surgery. However the relationship between swelling and outcome (pain and function) has not previously been outlined. A recent study by Pinsker and Daniels demonstrated that while swelling was rated as important by patients it was rarely included in outcome scores. The purpose of this paper was to determine the relationship between swelling and outcome after ankle fusion or replacement. A secondary purpose was to determine how this relationship changed in time, how swelling score changed before and after surgery, and determine differences in swelling score between total ankle replacement (TAR), open ankle arthrodesis (OAA) and arthroscopic ankle arthrodesis (AAA). The COFAS prospective ankle arthritis database enrolls patients in 4 centers undergoing surgery by one of 6 surgeons since 2002. The MODEMS outcomes package from AAOS was used, with the validated
End-stage ankle arthritis (ESAA) is a debilitating disease that does not affect all individuals equally. Gender differences have been identified in patients with end-stage hip and knee arthritis and have stimulated research to explain these findings. The present study was undertaken to examine if gender has a significant effect on pre-operative disability and post-operative outcomes in patients with ESAA. Patients undergoing ankle arthrodesis (AA) or total ankle replacement (TAR) with minimum 2-year follow-up were identified in the Canadian Orthopaedic Foot and Ankle Society prospective ankle reconstruction database. Demographic data, revision data, patient satisfaction questionnaires, and outcome data using the
Introduction. The incidence of osteochondral lesions following ankle fractures varies in the literature between 17-70%. They are commonly associated with chronic pain and swelling in patients diagnosed with such pathology. There is less evidence about the relationship between OCL and the development of post-traumatic osteoarthritis, the most common type of ankle arthritis. Methods. Through the use of MRI 8 weeks following ankle fractures, we investigated the incidence of OCL in patients treated both surgically and conservatively for ankle fractures of all AO subtypes. Results. 29 patients met our inclusion criteria, 16 females: 13 males with a mean age of 36 (range 16-64). Twelve patients required surgery with seventeen treated conservatively. The majority of patients (11) were classified as 44B1 fractures with the 44C1 and 44B2 the next most common. We did not detect any OCL in any patient but 65% of patients had both a tibiotalar effusion and associated bone bruising. Conclusion. Contrary to the current literature, we did not associate ankle fractures of any subtype with the development of OCL. Future evaluation of this same cohort will be necessary to evaluate the incidence of post traumatic
The autologous osteochondral grafting represents a treatment option for osteochondral lesions of the weight bearing articular surfaces of femoral condyles and talus. The aim of our study was to evaluate the MRI findings and to determine the correlation between the radiological and the functional outcome in the early follow up. We performed a retrospective study and followed up 33 patients 1 to 4 years after osteochondral auto-grafting. The grafts were harvested from the anterolateral region on the lateral femoral condyle of the ipsilateral knee using an insider rinsing diamond bone-cutting instrument (DBCS). The grafts were implanted using press fit technique and mosaic plasty. Sixteen (48%) women and 17 men were included in our follow up with an average age of 38.4 years (age range-16 to 58 yrs). The Lysholm and Foot and
Purpose. Weight loss is often advised to our patients and considered to make a substantial difference in most musculoskeletal symptoms. Patients with end stage ankle arthrosis have severe pain, diminished health related quality of life, and limited physical function. They frequently refer to increased weight as a simple indicator of decline in their quality loose weight. Patients assume that weight loss will follow after surgery secondary to increased activity with reduced pain and disability. Method. Changes in the body mass index, mental and physical component of SF36 and Ankle Scale Osteoarthritis of 145 overweight and obese patients after ankle surgery were assessed up to five year after surgery with a mean of 37.1 month follow up from 2002 to 2009. Results. The
Aim. 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. Methods. Between 1998 and 2005, 111 STAR were implanted into 98 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, AOFAS Hindfoot score, Foot Function Index (FFI),
Objectives. A defect following resection of Giant Cell Tumour of the distal radius (GCT-DR) is reconstructed by either vascularised free fibular transfer (VFF) or non-vascularised structural iliac crest transfer (NIC). The purpose of this study was to compare these procedures. Methods. Twenty-seven patients at two centres were identified, 14 underwent VFF and 13 NIC. The two groups were comparable for age, sex, and tumour grade. Functional outcomes were assessed with TESS, MSTS, and DASH. In the VFF group, ankle joint morbidity was assessed with the
Purpose. Coronal plane malalignment at the level of the tibiotalar joint is not uncommon in advanced ankle joint arthritis. It has been stated that preoperative varus or valgus deformity beyond 15 degrees is a relative contraindication and deformity beyond 20 degrees is an absolute contraindication to ankle joint replacement. There is limited evidence in the current literature to support these figures. The current study is a prospective clinical and radiographic comparative study between patients who underwent total ankle arthroplasty with coronal plane varus tibiotalar deformities greater than 10 degrees and patients with neutral alignment, less than 10 degrees of deformity. Method. Thirty-six ankles with greater than 10 degrees of varus alignment were compared to thirty-six ankles which were matched for implant type, age, gender, and year of surgery. Patients completed preoperative and yearly postoperative functional outcome scores including the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores, the
Purpose. To investigate the effect of obesity on functional outcome following total ankle arthroplasty. Method. We identified 43 obese patients (46 ankles) (BMI > 30kg/m2), using a prospectively collected database of total ankle arthroplasties. Inclusion criteria included: (a) Post-traumatic or inflammatory arthritis; (b) Minimum two-year follow-up, (c) Coronal plane deformity less than 10 degrees. Exclusion criteria: (a) Co-morbidity affecting physical function; (b) Recent total joint arthroplasty. American Orthopaedic Foot and Ankle Society (AOFAS),