The purpose of this study was to assess the success rate and functional outcomes of bone grafting for periprosthetic bone cysts following total ankle arthroplasty (TAA). Additionally, we evaluated the rate of graft incorporation and identified associated predisposing factors using CT scan. We reviewed a total of 37 ankles (34 patients) that had undergone bone grafting for periprosthetic bone cysts. A CT scan was performed one year after bone grafting to check the status of graft incorporation. For accurate analysis of cyst volumes and their postoperative changes, 3D-reconstructed CT scan processed with 3D software was used. For functional outcomes, variables such as the Ankle Osteoarthritis Scale score and the visual analogue scale for pain were measured.Aims
Methods
This study evaluated the effect of treating clinician speciality on management of zone 2 fifth metatarsal fractures. This was a retrospective cohort study of patients with acute zone 2 fifth metatarsal fractures who presented to a single large, urban, academic medical centre between December 2012 and April 2022. Zone 2 was the region of the fifth metatarsal base bordered by the fourth and fifth metatarsal articulation on the oblique radiograph. The proportion of patients allowed to bear weight as tolerated immediately after injury was compared between patients treated by orthopaedic surgeons and podiatrists. The effects of unrestricted weightbearing and foot and/or ankle immobilization on clinical healing were assessed. A total of 487 patients with zone 2 fractures were included (mean age 53.5 years (SD 16.9), mean BMI 27.2 kg/m2 (SD 6.0)) with a mean follow-up duration of 2.57 years (SD 2.64).Aims
Methods
The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures. Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L). Radiological pre- and postoperative data included Kellgren-Lawrence score and implant position measurement. This was supplemented by data from the National Joint Registry through record linkage to determine: American Society of Anesthesiologists (ASA) grade at index procedure; indication for surgery, index ankle previous fracture; tibial hind foot alignment; additional surgery at the time of TAA; and implant type. Multivariate regression models assessed outcomes, and the relationship between MOXFQ and EQ-5D-5L outcomes, with patient characteristics.Aims
Methods
This study reports updates the previously published two-year clinical, functional, and radiological results of a group of patients who underwent transfibular total ankle arthroplasty (TAA), with follow-up extended to a minimum of five years. We prospectively evaluated 89 patients who underwent transfibular TAA for end-stage osteoarthritis. Patients’ clinical and radiological examinations were collected pre- and postoperatively at six months and then annually for up to five years of follow-up. Three patients were lost at the final follow-up with a total of 86 patients at the final follow-up.Aims
Methods
The purpose of this study was to determine the functional outcome and implant survivorship of mobile-bearing total ankle arthroplasty (TAA) performed by a single surgeon. We reviewed 205 consecutive patients (210 ankles) who had undergone mobile-bearing TAA (205 patients) for osteoarthritis of the ankle between January 2005 and December 2015. Their mean follow-up was 6.4 years (2.0 to 13.4). Functional outcome was assessed using the Ankle Osteoarthritis Scale, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, 36-Item Short-Form Health Survey (SF-36) score, visual analogue scale, and range of movement. Implant survivorship and complications were also evaluated.Aims
Patients and Methods
Various radiological parameters are used to evaluate a flatfoot
deformity and their measurements may differ. The aims of this study
were to answer the following questions: 1) Which of the 11 parameters
have the best inter- and intraobserver reliability in a standardized
radiological setting? 2) Are pre- and postoperative assessments
equally reliable? 3) What are the identifiable sources of variation? Measurements of the 11 parameters were recorded on anteroposterior
and lateral weight-bearing radiographs of 38 feet before and after
surgery for flatfoot, by three observers with different experience
in foot surgery (A, ten years; B, three years; C, third-year orthopaedic
resident). The inter- and intraobserver reliability was calculated.Aims
Patients and Methods
The purpose of this study was to compare the clinical and radiographic
outcomes of total ankle arthroplasty (TAA) in patients with pre-operatively
moderate and severe arthritic varus ankles to those achieved for
patients with neutral ankles. A total of 105 patients (105 ankles), matched for age, gender,
body mass index, and follow-up duration, were divided into three
groups by pre-operative coronal plane tibiotalar angle; neutral
(<
5°), moderate (5° to 15°) and severe (>
15°) varus deformity.
American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot
score, a visual analogue scale (VAS), and Short Form (SF)-36 score
were used to compare the clinical outcomes after a mean follow-up period
of 51 months (24 to 147).Aims
Patients and Methods
The aim of this prospective study was to evaluate the intermediate-term
outcomes after revision anatomical ankle ligament reconstruction
augmented with suture tape for a failed modified Broström procedure. A total of 30 patients with persistent instability of the ankle
after a Broström procedure underwent revision augmented with suture
tape. Of these, 24 patients who were followed up for more than two
years were included in the study. There were 13 men and 11 women.
Their mean age was 31.8 years (23 to 44). The mean follow-up was 38.5
months (24 to 56) The clinical outcome was assessed using the Foot
and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure
(FAAM) score. The stability of the ankle was assessed using stress
radiographs.Aims
Patients and Methods
To examine the mid-term outcome and cost utility of the BioPro
metallic hemiarthroplasty for the treatment of hallux rigidius. We reviewed 97 consecutive BioPro metallic hemiarthroplasties
performed in 80 patients for end-stage hallux rigidus, with a minimum
follow-up of five years. There were 19 men and 61 women; their mean
age was 55 years (22 to 74). No patient was lost to follow-up.Aims
Patients and Methods
Moderate to severe hallux valgus is conventionally
treated by proximal metatarsal osteotomy. Several recent studies
have shown that the indications for distal metatarsal osteotomy
with a distal soft-tissue procedure could be extended to include
moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was
to compare the outcome of proximal and distal Chevron osteotomy
in patients undergoing simultaneous bilateral correction of moderate
to severe hallux valgus. The original study cohort consisted of 50 female patients (100
feet). Of these, four (8 feet) were excluded for lack of adequate
follow-up, leaving 46 female patients (92 feet) in the study. The
mean age of the patients was 53.8 years (30.1 to 62.1) and the mean
duration of follow-up 40.2 months (24.1 to 80.5). After randomisation,
patients underwent a proximal Chevron osteotomy on one foot and
a distal Chevron osteotomy on the other. At follow-up, the American Orthopedic Foot and Ankle Society
(AOFAS) hallux metatarsophalangeal interphalangeal (MTP-IP) score,
patient satisfaction, post-operative complications, hallux valgus
angle, first-second intermetatarsal angle, and tibial sesamoid position
were similar in each group. Both procedures gave similar good clinical
and radiological outcomes. This study suggests that distal Chevron osteotomy with a distal
soft-tissue procedure is as effective and reliable a means of correcting
moderate to severe hallux valgus as proximal Chevron osteotomy with
a distal soft-tissue procedure. Cite this article:
As it remains unproven that hypermobility of
the first tarsometatarsal joint (TMTJ-1) is a significant factor
in hallux valgus deformity, the necessity for including arthrodesis
of TMTJ-1 as part of a surgical correction of a hallux valgus is
questionable. In order to evaluate the role of this arthrodesis
on the long-term outcome of hallux valgus surgery, a prospective,
blinded, randomised study with long-term follow-up was performed,
comparing the Lapidus procedure (which includes such an arthrodesis)
with a simple Hohmann distal closing wedge metatarsal osteotomy. The
study cohort comprised 101 feet in 87 patients: 50 feet were treated
with a Hohmann procedure and 51 with a Lapidus procedure. Hypermobility
of TMTJ-1 was assessed pre-operatively by clinical examination.
After a mean of 9.25 years (7.25 to 11.42), 91 feet in 77 patients
were available for follow-up. There was no difference in clinical
or radiological outcome between the two procedures. Also, there
was no difference in outcome between the two procedures in the subgroup
clinically assessed as hypermobile. This study does not support
the theory that a hallux valgus deformity in a patient with a clinically
assessed hypermobile TMTJ-1 joint requires fusion of the first tarso-metatarsal
joint. Cite this article:
Severe hallux valgus deformity is conventionally
treated with proximal metatarsal osteotomy. Distal metatarsal osteotomy
with an associated soft-tissue procedure can also be used in moderate
to severe deformity. We compared the clinical and radiological outcomes
of proximal and distal chevron osteotomy in severe hallux valgus deformity
with a soft-tissue release in both. A total of 110 consecutive female
patients (110 feet) were included in a prospective randomised controlled
study. A total of 56 patients underwent a proximal procedure and
54 a distal operation. The mean follow-up was 39 months (24 to 54)
in the proximal group and 38 months (24 to 52) in the distal group.
At follow-up the hallux valgus angle, intermetatarsal angle, distal
metatarsal articular angle, tibial sesamoid position, American Orthopaedic
Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal
score, patient satisfaction level, and complications were similar
in each group. Both methods showed significant post-operative improvement
and high levels of patient satisfaction. Our results suggest that
the distal chevron osteotomy with an associated distal soft-tissue
procedure provides a satisfactory method for correcting severe hallux
valgus deformity. Cite this article:
Supination-external rotation (SER) fractures of the ankle may present with a medial ligamentous injury that is not apparent on the initial radiographs. A cadaver gravity-stress view has been described, but the manual-stress view is considered to be the examination of choice for the diagnosis of medial injuries. We prospectively compared the efficacy of these two examinations. We undertook both examinations in 29 patients with SER fractures. Of these, 16 (55%) were stress-positive, i.e. and had widening of the medial clear space of >
4 mm with a mean medial clear space of 6.09 mm (4.4 to 8.1) on gravity-stress and 5.81 mm (4.0 to 8.2) on manual-stress examination, and 13 patients (45%) were stress-negative with a mean medial clear space of 3.91 mm (3.3 to 5.1) and 3.61 mm (2.6 to 4.5) on examination of gravity- and manual-stress respectively. The mean absolute visual analgoue scale score for discomfort in the examination of gravity stress was 3.45 (1 to 6) and in the manual-stress procedure 6.14 (3 to 10). We have shown that examination of gravity-stress is as reliable and perceived as more comfortable than that of manual stress. We recommend using it as the initial diagnostic screening examination for the detection of occult medial ligamentous injuries in SER fractures of the ankle.
