The long term results of Total Ankle Arthroplasty still remain largely unsatisfactory and Ankle Arthrodesis remains the gold standard treatment for severe degenerative ankle joint disease resulting from trauma and other causes. We describe the method and results of ankle fusion performed with a single anterior midline incision using the standard AO T-Plate. 18 patients underwent fusion of the tibio-talar joint with this technique over the past 5 years with a follow up range of 10 months to 5 years (mean-19 months). Though the commonest indication was post-traumatic degenerative joint disease (this included 6 patients who had previous internal fixation), other causes included primary osteoarthritis, rheumatoid arthritis, neuro-pathic joint (Charcot’s) and failed arthrodesis with other
There was radiological union in all 18 patients. Excellent clinical results were finally achieved in 16 (89%). Complications included persistent pain(1), delayed union(2), infection(2, including one deep) and 2 under-went removal of plate with good final result. This technique is a modification of that described previously by Rowan and Davey. In our practice the plate is contoured to the surface of talus and the distal screws are directed more vertically towards the sustenaculum talus. We found it helpful to obtain more compression of adjacent surfaces. With the use of an anterior T-plate not only a better stability in biomechanical terms is achieved, less dissection and better soft tissue cover of the metalwork help in overall patient satisfaction. Though we have performed ankle arthrodesis with different
Patellofemoral problems represent a significant source of morbidity following total knee arthroplasty (TKA). Patellofemoral biomechanics and contact stress following TKA depends (among other factors) upon the position of the patella relative to the tibiofemoral joint. Patellar height may be altered either by changes in the tibio-femoral joint level (pseudo patella baja/alta) or by a change in patella tendon length (true patella baja/alta). The purpose of this study is to examine the latter. Two previous studies have described patella tendon shortening following TKA but both have significant limitations and produced differing results. The aim of this study was to identify the incidence of true patella tendon shortening following TKA for the treatment of osteoarthritis (OA). All patients undergoing primary TKA for OA in 2001 and 2002 were identified. Cases were excluded if they had rheumatoid arthritis, had undergone previous open knee surgery, suffered a significant post-op complication, or had less than 1 year radiological follow up. Case notes and radiographs of 50 knees in 34 patients were reviewed. The Insall-Salvati ratio was measured on immediate pre-op, initial post-op, and final follow-up lateral knee radiographs. Differences between mean pre and post-op ratios were compared using a paired t-test. There were 19 women and 15 men aged 47 to 84 (mean 70.4) years. The mean pre-op Insall-Salvati ratio was 0.99. The initial post-op ratio was unchanged (p=0.06). After a minimum of 1 year the mean ratio remained 1.0 (p=0.09). In no knee was there a significant change in patella tendon length. In this study we found no evidence of patella tendon shortening. Two other studies have identified shortening in one third to two thirds of knees. The methodology of these studies is however open to criticism. The patients in neither study are representative of general orthopaedic practice; the surgical technique in one was unorthodox and the radiological measurement method in the other not validated. This work therefore represents the first study of patella tendon length following TKA using a validated radiological index in a representative osteoarthritic population. In conclusion, TKA in this group of patients with osteoarthritis, employing a standard surgical technique was not associated with postoperative patella tendon shortening or true patella baja.
To compare the results of anterior cruciate ligament reconstructive surgery with or without fluoroscopic control. We retrospectively compared 2 groups of 15 patients who had ACL reconstruction between 1997–2001. Our primary concern was to see if a perioperative lateral x-ray significantly improved the position of the graft when compared with a similar group having no such x-ray. All patients were reconstructed using an open bone-patella-bone technique. Data was collected on patient demographics, previous surgery, time to reconstruction, operative time, and complications. The post–operative lateral x-ray was assessed and the relative position of the centre of the graft determined using a percentage for the tibial and femoral tunnels. The graft divergence angle and distance between the posterior femoral cortex and the centre of the graft was calculated. All patients were male with equal mean age at reconstruction (29 yrs). The 2 groups were also similar in terms of previous surgery and time to reconstruction. In the group without x-ray control there were 2 graft failures due to anterior placement of the graft whereas in the x-ray control group there were no failures. The operative time was slightly longer in the x-ray group. There was no significant difference between the 2 groups when comparing tibial tunnel placement and graft divergence. However the position of the femoral tunnel was significantly improved in the x-ray group when compared with the control group as measured by the distance between posterior femoral cortex and centre of graft (7mm vs 9mm) and also the relative position along Blumenstaat’s line (90% vs 75%). The authors conclude that in our institution the use of Fluoroscopic control during ACL reconstructive surgery improved femoral tunnel placement.
