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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 44 - 44
1 Sep 2012
SPECT-CT TO EVALUATE PAINFUL TOTAL ANKLE REPLACEMENT
Townshend D Ng P Wing K Penner M Younger A
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Introduction

Single photon emission computed tomography (SPECT) can be used to create a three dimensional image of a radiopharmaceutical bone scan. This combined with high resolution CT scan (SPECT-CT) with bone windows allows the linking of the information obtained in both investigations. The multiplanar anatomical information provided by CT is therefore linked with the functional, biological information of bone scintigraphy. The painful total ankle replacement has a number of potential causes of discomfort including impingement and loose components. Correct identification of the source of pain will assist surgeons in treating the source of the pain while avoiding unnecessary surgery. We present our experience of the use of SPECT-CT to investigate patients with ongoing pain following Total Ankle Replacement (TAR).

Materials and Methods

A retrospective analysis of all patients having SPECT-CT for continuing pain following TAR. Scans were requested in addition to plain radiographs, joint aspiration and blood testing. Results: A total of 12 patients were identified. The scan proved helpful in all cases. 5 patients showed increased uptake around one or both prostheses signifying loosening which was not apparent on plain films. Gutter impingement was identified in 4 patients. One patient had a talo-navicular non-union, one patient demonstrated sub-talar joint arthrosis and one patient showed no bony abnormality but soft tissue impingement at arthroscopy.

Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 16 - 16
1 Sep 2012
PREDICTORS OF PROLONGED LENGTH OF STAY AFTER MAJOR FOOT AND ANKLE SURGERY
Pakzad H Thevendran G Younger A Qian H Penner M
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Introduction

Greater length of stay (LOS) after elective surgery results in increased use of health care resources and higher costs. Within the realm of foot and ankle surgery, improved perioperative care has enabled a vast majority of procedures to be performed as a day surgery. The objective of this study was to determine the perioperative factors that predict a prolonged LOS after elective ankle replacement or fusion.

Methods

Data was prospectively collected on patients undergoing either an ankle fusion or ankle replacement for end-stage ankle arthritis at our institution (2003–2010). In the analysis, LOS was the outcome and age, sex, physical and mental functional scores, comorbid factors, ASA grades, type and length of operation and body mass index (BMI) were potential perioperative risk factors. Univariate and multivariate generalized linear regression models with gamma distribution and log link function were conducted.

Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XLIII | Pages 43 - 43
1 Sep 2012
ARTHROSCOPIC VERSUS OPEN ANKLE ARTHRODESIS: A MULTICENTRE PROSPECTIVE CLINICAL OUTCOME STUDY
Townshend D Penner M Younger A Glazebrook M Wing K
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Background

Ankle arthrodesis results in significantly improved pain and function for patients with end-stage ankle arthritis. Arthroscopic ankle arthrodesis has gained increasing popularity with reports of shorter hospital stays, time to union and equivalent union rates to open arthrodesis. However, there remains a lack of good quality prospective data.

Methods

We report a prospective comparative clinical study comparing open and arthroscopic ankle arthrodesis at two institutions with two-year follow-up. The primary outcome was the Ankle Osteoarthritis Scale and secondary outcomes included the SF-36, hospital stay and radiographic alignment. A power calculation was performed. There were 30 patients in each group.