Aims

Implant failure has become more common as the number of primary total ankle arthroplasties (TAAs) performed has increased. Although revision arthroplasty has gained attention for functional preservation, the long-term results remain unclear. This study aimed to assess the long-term outcomes of revision TAA using a mobile-bearing prosthesis in a considerably large cohort; the risk factors for failure were also determined.

Aims

To assess the effect of age on clinical outcome and revision rates in patients who underwent total ankle arthroplasty (TAA) for end-stage ankle osteoarthritis (OA).

Aims

There is little information about how to manage patients with a recurvatum deformity of the distal tibia and osteoarthritis (OA) of the ankle. The aim of this study was to evaluate the functional and radiological outcome of addressing this deformity using a flexion osteotomy and to assess the progression of OA after this procedure.

Aims

Arthroscopically controlled fracture reduction in combination with percutaneous screw fixation may be an alternative approach to open surgery to treat talar neck fractures. The purpose of this study was thus to present preliminary results on arthroscopically reduced talar neck fractures.

Talonavicular and subtalar joint fusion through a medial incision (modified triple arthrodesis) has become an increasingly popular technique for treating symptomatic flatfoot deformity caused by posterior tibial tendon dysfunction.

The purpose of this study was to look at its clinical and radiological mid- to long-term outcomes, including the rates of recurrent flatfoot deformity, nonunion and avascular necrosis of the dome of the talus.

A total of 84 patients (96 feet) with a symptomatic rigid flatfoot deformity caused by posterior tibial tendon dysfunction were treated using a modified triple arthrodesis. The mean age of the patients was 66 years (35 to 85) and the mean follow-up was 4.7 years (1 to 8.3). Both clinical and radiological outcomes were analysed retrospectively.

In 86 of the 95 feet (90.5%) for which radiographs were available, there was no loss of correction at final follow-up. In all, 14 feet (14.7%) needed secondary surgery, six for nonunion, two for avascular necrosis, five for progression of the flatfoot deformity and tibiotalar arthritis and one because of symptomatic overcorrection. The mean American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score) at final follow-up was 67 (between 16 and 100) and the mean visual analogue score for pain 2.4 points (between 0 and 10).

In conclusion, modified triple arthrodesis provides reliable correction of deformity and a good clinical outcome at mid- to long-term follow-up, with nonunion as the most frequent complication. Avascular necrosis of the talus is a rare but serious complication of this technique.

Cite this article: Bone Joint J 2015; 97-B:668–74.

QCT permits a direct measure of bone and muscle size and assessment of bone/muscle relationship. We have studied cross-sectional QCT variables in mid-thigh as predictors of incidental limb fractures in the AGES-Reykjavik Study, a cohort of 66–96-year-old men (n=2160) and women (n=2385) drawn from an established population based cohort and not taking medications affecting bone metabolism. We used 4-detector Siemens CT system, a single axial section through the right mid-thigh (10 mm slice thickness). The variables included in the Cox’s proportional hazard model were; total cross-sectional cortical area (CSA), derived cortical thickness, shaft BMD, shaft bending strength index (BSI), medullary area and buckling ratio, total cross-sectional muscle and quadriceps area and bone/muscle area ratio. All low trauma limb fractures (including proximal end of femur but excluding toes, foot, hand and finger fractures) during mean 3.5 years of follow-up were validated by medical and radiological records, altogether 170 in women and 61 in men, including 87 hip fractures.

Results: with sex as a confounding variable the most significant risk factor was the buckling ratio (ratio of bone radius to cortical thickness) with more than twofold greater risk in the top compared to the lowest tertile. This variable was mostly independent of muscle area which was however a significant protective factor independent of bone variables. Bone/muscle area ratio and BSI were not significant in multivariate analysis. The area under the ROC curve, using these QCT predictors and age, was 0.70 (CI 0.66–0.73).

We conclude that cortical instability associated with decreasing cortical thickness due to medullary expansion is a significant risk factor for limb fractures including hip fractures in old age. Further knowledge on factors affecting buckling ratio might be of importance in the prevention of these fractures in the elderly.