One assumed function of Total Ankle Replacement (TAR) is that by maintaining ankle joint motion we can protect the other hind foot joints from further degredation. 1. However, there is no work to our knowledge that compares hindfoot outcomes between TAR and arthrodesis. Sokolowski et al. found that 68% of TAR patients had no radiological progression of subtalar arthritis after TAR, and 4% went on to fusion. 2. However, no evaluation of the other hindfoot joints was made and no comparison made to other treatment. We performed a retrospective review of all patients at our centre who had had a TAR or ankle arthrodesis since 2002. Case notes and imaging were reviewed and all instances of hindfoot treatment (injections or surgical procedures) noted. Patients were excluded who had no documentation, were followed up at other hospitals, had prior hindfoot fusion, or were having staged surgeries at the time of index treatment. Chi squared analysis was used to compare the cohorts. 214 arthrodesis cases and 302 TAR were eligible. The average age was 57. Average time to follow up was 13 years (4–21). At the time of abstract submission 107 sets of notes had been reviewed fully. Full analysis will be performed by conference. 14% of TAR patients went on to have further procedures to the hindfoot joints while 35% of arthrodesis patients had further procedures (p=0.014). There was also a significant difference in the number of patients progressing to fusion of a further hindfoot joint between groups (TAR- 4%, arthrodesis- 20%, p=0.01). These data suggest that TAR are protective of symptomatic change of hindfoot joints. Patients with TAR had fewer hindfoot fusions than those with arthrodesis and also fewer procedures of any form, including injections

Osteoarthritis (OA) is a disease of the joints stemming from a variety of factors, including joint injuries and abnormally high mechanical loading. Although the traditional treatment alternatives for end-stage OA are arthroplasty in the case of the hip and knee, and arthroplasty or arthrodesis in the case of the ankle, these options are not ideal for younger, more active patients. For these patients, joint prostheses would be expected to fail relatively quickly, and ankle fusion is not amenable to maintaining their active lifestyles. In these cases, joint distraction has attracted investigative attention as a conservative OA treatment for younger patients. 9-14. . Based on the principle that decreasing the mechanical load on cartilage stimulates its regeneration. 15. , distraction treatment calls for reduced loading of the joint during a period of typically 3 months, during which time the load customarily passing through the joint is taken up by an external fixator spanning the joint . By mounting the fixator components to the bone on each side of the joint, and then lengthening the rods connecting the proximal and distal portions of the fixator, the joint is distracted. Assuming the fixation is appropriately stiff, any load passes through the fixator instead of the joint, and the two articular surfaces will not be allowed to contact each other under physiologic loading. The exact mechanisms leading to cartilage regeneration during distraction are not yet understood. A possible negative consequence of joint fixation is cartilage degeneration due to immobilization during the treatment. It has been shown by Haapala et al. and others that long-term immobilization can be detrimental to articular cartilage. 16-18. . Conversely, joint motion during fixation (even passive motion) is thought to stimulate or encourage cartilage regeneration. 19-22. Toward this end, considerable effort has been invested in the application of hinges to external fixation for joints Joint motion has also been suggested as a potentially beneficial factor in distraction treatment, as well. 10. This is borne out by data from an RCT comparing the use of a rigid vs motion external fixator. Change in joint biology due to resorption of cysts may be responsible for reversal of symptoms

Introduction. Various rehabilitation shoes are prescribed to protect the forefoot following surgery. Patients often complain of discomfort in other areas as a result of the postoperative shoe, including the knee, hip and lower back. This has never been quantified. This study aims to establish the effect on other joints using gait analysis. Methods: 11 healthy volunteers were investigated using various common types of postoperative shoe. They were studied with gait analysis equipment and the joint motion assessed with commercial software. The effect of commercial devices designed to minimise gait changes by lifting the contralateral foot were also evaluated. Results. There was a reduction in knee flexion and extension compared to the contralateral leg in all phases of the gait cycle. This was the case with both heel wedge shoes and inflatable air boots. There was also an increase in pelvic tilt during gait with both shoes, which was more pronounced with the air boot. The foot raise device for the contralateral foot which is designed to decrease these changes was effective in decreasing gait changes. Discussion. The use of rehabilitation shoes after forefoot surgery is almost universal. Patients are rarely counselled of the risk of joint pain or back pain as a result of the postoperative shoe. Patients with pre-existing back pain or hip pain may have fewer symptoms if they are supplied with an equalising device to raise the other foot. Conclusions. Patients are at risk of initiation or exacerbation of low back pain or lower limb joint pain from the use of postoperative shoes. Patients with a history of back or limb symptoms should be provided with an equalising device for the contralateral limb to minimise their discomfort. Patients should be warned of this risk when giving consent

Introduction. The literature remains controversial on treatment of advanced stages of first metatarsophalangeal (MTP) arthritis and frequently favors arthrodesis. However, complications and suboptimal outcomes in active patients still remain with fusion of the first MTP joint. This study reports results of patients who underwent metallic resurfacing of the metatarsal side of the MTP joint. Materials and Methods. Twenty seven patients (31 implants) with stage II or III hallux rigidus underwent resurfacing with a fourth generation (screw fixation) contoured MTP implant and were willing to participate in a follow up study comparing pre- and postoperative radiographs, range of motion, AOFAS and SF-36 scores. The average age of these patients was 51 years (range 35-74) and the average follow up was 54 months (range 45-66). Results. The postoperative assessment demonstrated statistically significant improvements in range of motion, AOFAS, and SF-36 scores (P<0.05) when compared to baseline. The mean preoperative AOFAS scores improved from 51.5(range 35-74) to 94.1 (range 82-100). The mean preoperative active range of motion improved from 19.7 degrees (range 5-50) to 47.9 degrees (range 25-75). The mean preoperative passive range of motion improved from 28.0 degrees (range 10-60) to 66.3 degrees (range 40-90). The mean SF-36 score improved from 71.2 (range 60.6-80.0) to 88.2 (range 69.6-99.1), physical health sub scores improved from 66.8 (range 40-87) to 90.1 (range 70-98). The average time for return to work was 7 days (range 3-20). There was one implant revision due to phalangeal disease progression. All other patients were satisfied and willing to have the procedure performed again. Conclusion. Current 4 and 5 year results are very promising. Preservation of joint motion, alleviation of pain and functional improvement data are very encouraging. Because minimal joint resection is performed, conversion to arthrodesis or other salvage procedures is relatively simple if further intervention is necessary

Aims

The purpose of this study was to analyse the biomechanics of walking, through the ground reaction forces (GRF) measured, after first metatarsal osteotomy or metatarsophalangeal joint (MTP) arthrodesis.