Aims . This is the first prospective study to report the pre- and post-operative
patient reported outcomes and
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. Methods. This single-centre retrospective cohort study included 116 patients (117 ankles) who underwent revision TAA for failed primary TAA between July 2000 and March 2010. Survival analysis and risk factor assessment were performed, and clinical performance and patient
Aims. We report the medium-term outcomes of a consecutive series of 118 Zenith total ankle arthroplasties (TAAs) from a single, non-designer centre. Methods. Between December 2010 and May 2016, 118 consecutive Zenith prostheses were implanted in 114 patients. Demographic, clinical, and patient-reported outcome measures (PROMs) data were collected. The endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan-Meier survival curves were generated with 95% confidence intervals (CIs) and the rate of failure calculated for each year. Results. Eight patients (ten ankles) died during follow-up, but none required revision. Of the surviving 106 patients (108 ankles: rheumatoid arthritis (RA), n = 15; osteoarthritis (OA), n = 93), 38 were women and 68 were men, with a mean age of 68.2 years (48 to 86) at the time of surgery. Mean follow-up was 5.1 years (2.1 to 9.0). A total of ten implants failed (8.5%), thus requiring revision. The implant survival at seven years, using revision as an endpoint, was 88.2% (95% CI 100% to 72.9%). There was a mean improvement in Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ) from 85.0 to 32.8 and visual analogue scale (VAS) scores from 7.0 to 3.2, and overall
Aims. The aim was to compare long-term patient-reported outcome measures (PROMs) after operative and nonoperative treatment of acute Achilles tendon rupture in the context of a randomized controlled trial. Methods. PROMs including the Short Musculoskeletal Function Assessment (SMFA), Achilles Tendon Total Rupture Score (ATRS), EuroQol five-dimension (EQ-5D),
Aims. Arthroplasty for end-stage hallux rigidus (HR) is controversial. Arthrodesis remains the gold standard for surgical treatment, although is not without its complications, with rates of up to 10% for nonunion, 14% for reoperation and 10% for metatarsalgia. The aim of this study was to analyze the outcome of a double-stemmed silastic implant (Wright-Medical, Memphis, Tennessee, USA) for patients with end-stage HR. Methods. We conducted a retrospective review of 108 consecutive implants in 76 patients, between January 2005 and December 2016, with a minimum follow-up of two years. The mean age of the patients at the time of surgery was 61.6 years (42 to 84). There were 104 females and four males. Clinical, radiological, patient reported outcome measures (PROMS) data, a visual analogue score (VAS) for pain, and
To describe outcome reporting variation and trends in non-pharmacological randomized clinical trials (RCTs) of distal tibia and/or ankle fractures. Five electronic databases and three clinical trial registries were searched (January 2000 to February 2022). Trials including patients with distal tibia and/or ankle fractures without concomitant injuries were included. One reviewer conducted all searches, screened titles and abstracts, assessed eligibility, and completed data extraction; a random 10% subset were independently assessed and extracted by a second reviewer at each stage. All extracted outcomes were mapped to a modified version of the International Classification of Functioning, Disability and Health framework. The quality of outcome reporting (reproducibility) was assessed.Aims
Methods
The primary aim of this study was to present the mid-term follow-up of a multicentre randomized controlled trial (RCT) which compared the functional outcome following routine removal (RR) to the outcome following on-demand removal (ODR) of the syndesmotic screw (SS). All patients included in the ‘ROutine vs on DEmand removal Of the syndesmotic screw’ (RODEO) trial received the Olerud-Molander Ankle Score (OMAS), American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS), Foot and Ankle Outcome Score (FAOS), and EuroQol five-dimension questionnaire (EQ-5D). Out of the 152 patients, 109 (71.7%) completed the mid-term follow-up questionnaire and were included in this study (53 treated with RR and 56 with ODR). Median follow-up was 50 months (interquartile range 43.0 to 56.0) since the initial surgical treatment of the acute syndesmotic injury. The primary outcome of this study consisted of the OMAS scores of the two groups.Aims
Methods
This scoping review aims to identify patient-related factors associated with a poorer outcome following total ankle arthroplasty (TAA). A scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer-based literature search was performed in PubMed, Embase, Cochrane trials, and Web of Science. Two reviewers independently performed title/abstract and full-text screening according to predetermined selection criteria. English-language original research studies reporting patient-related factors associated with a poorer outcome following TAA were included. Outcomes were defined as patient-reported outcome measures (PROMs), perioperative complications, and failure.Aims
Methods
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. Patients and Methods. A total of seven consecutive patients (four women and three men,
mean age 39 years (19 to 61)) underwent attempted surgical treatment
of a closed Hawkins type II talar neck fracture using arthroscopically
assisted reduction and percutaneous screw fixation. Functional and
radiological outcome were assessed using plain radiographs, as well
as weight-bearing and non-weight-bearing CT scans as tolerated.
Patient
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
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
Aims. A failed total ankle arthroplasty (TAA) is often associated with
much bone loss. As an alternative to arthrodesis, the surgeon may
consider a custom-made talar component to compensate for the bone
loss. Our aim in this study was to assess the functional and radiological
outcome after the use of such a component at mid- to long-term follow-up. Patients and Methods. A total of 12 patients (five women and seven men, mean age 53
years; 36 to77) with a failed TAA and a large talar defect underwent
a revision procedure using a custom-made talar component. The design
of the custom-made components was based on CT scans and standard
radiographs, when compared with the contralateral ankle. After the
anterior talocalcaneal joint was fused, the talar component was
introduced and fixed to the body of the calcaneum. Results. At a mean follow-up of 6.9 years (1 to 13), 11 ankles were stable
with no radiological evidence of loosening. Only one was lost to
follow-up. The mean arc of movement was 21. °. (10. °. to
35. °. ). A total of nine patients (75%) were satisfied or
very satisfied with the outcome, two (17%) were satisfied but with
reservations and one (8%) was not satisfied. All but one patient
had an improvement in the American Orthopaedic Foot and Ankle Society
hindfoot score (p = 0.01). Just one patient developed deep infection,
leading to arthrodesis. Conclusion. A custom-made talar component yielded satisfactory results with
regard to function, stability and
We present the outcomes in 38 consecutive patients who had total ankle replacement using the Ankle Evolution System with a minimum follow-up of four years. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and regular standardised anteroposterior and lateral weight-bearing radiographs were obtained. Patient
Aims. The objective of this double-blind randomised controlled trial
was to assess whether ultrasound guidance improved the efficacy
of corticosteroid injections for Morton’s neuroma (MN). . Patients and Methods. In all, 50 feet (40 patients) were recruited for this study but
five feet were excluded due to the patients declining further participation.
The mean age of the remaining 36 patients (45 feet) was 57.8 years
(standard deviation (. sd. ) 12.9) with a female preponderance
(33F:12M). All patients were followed-up for 12 months. Treatment
was randomised to an ultrasound guided (Group A) or non-ultrasound
guided (Group B) injection of 40 mg triamcinolone acetonide and
2 ml 1% lignocaine, following ultrasound confirmation of the diagnosis. . Results. The mean visual analogue score for pain improved significantly
in both groups (Group A – from 64 mm, . sd. 25 mm to 29 mm, . sd. 27;
Group B – from 69 mm, . sd. 23 mm to 37 mm, . sd. 25)
with no statistical difference between them at all time-points.
The failure rate within 12 months of treatment was 11/23 (48%) and
12/22 (55%) in Groups A and B, respectively (p = 0.458). The improvement
in Manchester Oxford Foot Questionnaire Index and patient
Aims. The aim of this study was to evaluate antegrade autologous bone
grafting with the preservation of articular cartilage in the treatment
of symptomatic osteochondral lesions of the talus with subchondral
cysts. Patients and Methods. The study involved seven men and five women; their mean age was
35.9 years (14 to 70). All lesions included full-thickness articular
cartilage extending through subchondral bone and were associated
with subchondral cysts. Medial lesions were exposed through an oblique
medial malleolar osteotomy, and one lateral lesion was exposed by
expanding an anterolateral arthroscopic portal. After refreshing
the subchondral cyst, it was grafted with autologous cancellous
bone from the distal tibial metaphysis. The fragments of cartilage
were fixed with 5-0 nylon sutures to the surrounding cartilage.
Function was assessed at a mean follow-up of 25.3 months (15 to
50), using the American Orthopaedic Foot and Ankle Society (AOFAS)
ankle-hindfoot outcome score. The radiological outcome was assessed
using MRI and CT scans. Results. The mean AOFAS score improved from 65.7 (47 to 81) preoperatively
to 92 (90 to 100) at final follow-up, with 100% patient
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
This study sought to determine the medium-term
patient-reported and radiographic outcomes in patients undergoing
surgery for hallux valgus. A total of 118 patients (162 feet) underwent
surgery for hallux valgus between January 2008 and June 2009. The
Manchester-Oxford Foot Questionnaire (MOXFQ), a validated tool for
the assessment of outcome after surgery for hallux valgus, was used
and patient
A consecutive series of 23 patients (25 ankles) with osteoarthritis of the ankle and severe varus or valgus deformity were treated by open arthrodesis using compression screws. Primary union was achieved in 24 ankles one required further surgery to obtain a solid fusion. The high level of
We undertook a retrospective review of 24 arthroscopic procedures in patients with symptomatic ossicles around the malleoli of the ankle. Most of the patients had a history of injury and localised tenderness in the area coinciding with the radiological findings. Contrast-enhanced three-dimensional fast-spoiled gradient-echo MRI was performed and the results compared with the arthroscopic findings. An enhanced signal surrounding soft tissue corresponding to synovial inflammation and impingement was found in 20 patients (83%). The arthroscopic findings correlated well with those of our MRI technique and the sensitivity was estimated to be 91%. At a mean follow-up of 30.5 months (20 to 86) the mean American Orthopaedic Foot and Ankle Society score improved from 74.5 to 93 points (p <
0.001). Overall, the rate of patient
We present a series of 16 patients treated between 1993 and 2006 who had a failed total ankle replacement converted to an arthrodesis using bone grafting with internal fixation. We used tricortical autograft from the iliac crest to preserve the height of the ankle, the malleoli and the subtalar joint. A successful arthrodesis was achieved at a mean of three months (1.5 to 4.5) in all patients except one, with rheumatoid arthritis and severe bone loss, who developed a nonunion and required further fixation with an intramedullary nail at one year after surgery, before obtaining satisfactory fusion. The post-operative American Orthopaedic Foot and Ankle Society score improved to a mean of 70 (41 to 87) with good patient
Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens. MEDLINE, Web of Science, Embase, and Scopus databases were searched for studies reporting outcomes following ankle arthrodesis, in which standardized postoperative rehabilitation regimens were employed. Eligible studies were grouped according to duration of postoperative nonweightbearing: zero to one weeks (group A), two to three weeks (group B), four to five weeks (group C), or six weeks or more (group D). Outcome data were pooled and compared between groups. Outcomes analyzed included union rates, time to union, clinical scores, and complication rates.Aims
Patients and Methods
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. A total of 39 patients (12 women, 27 men; mean age 47 years (28 to 72)) with a distal tibial recurvatum deformity were treated with a flexion osteotomy, between 2010 and 2015. Nine patients (23%) subsequently required conversion to either a total ankle arthroplasty (seven) or an arthrodesis (two) after a mean of 21 months (9 to 36). A total of 30 patients (77%), with a mean follow-up of 30 months (24 to 76), remained for further evaluation. Functional outcome, sagittal ankle joint OA using a modified Kellgren and Lawrence Score, tibial lateral surface (TLS) angle, and talar offset ratio (TOR) were evaluated on pre- and postoperative weight-bearing radiographs.Aims
Patients and Methods
The aim of this study was to evaluate the functional outcome in patients undergoing implant removal (IR) after fracture fixation below the level of the knee. All adult patients (18 to 75 years) undergoing IR after fracture fixation below the level of the knee between November 2014 and September 2016 were included as part of the WIFI (Wound Infections Following Implant Removal Below the Knee) trial, performed in 17 teaching hospitals and two university hospitals in The Netherlands. In this multicentre prospective cohort, the primary outcome was the difference in functional status before and after IR, measured by the Lower Extremity Functional Scale (LEFS), with a minimal clinically important difference of nine points.Aims
Patients and 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
We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44).Aims
Patients and Methods
We report the long-term clinical and radiological outcomes of a consecutive series of 200 total ankle arthroplasties (TAAs, 184 patients) at a single centre using the Scandinavian Total Ankle Replacement (STAR) implants. Between November 1993 and February 2000, 200 consecutive STAR prostheses were implanted in 184 patients by a single surgeon. Demographic and clinical data were collected prospectively and the last available status was recorded for further survival analysis. All surviving patients underwent regular clinical and radiological review. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scoring system. The principal endpoint of the study was failure of the implant requiring revision of one or all of the components. Kaplan–Meier survival curves were generated with 95% confidence intervals and the rate of failure calculated for each year.Aims
Patients and Methods
We studied prospectively 30 patients who had a Mitchell’s osteotomy secured by either a suture followed by immobilisation in a plaster boot for six weeks, or by a cortical screw with early mobilisation. The mean time for return to social activities after fixation by a screw was 2.9 weeks and to work 4.9 weeks, which was significantly earlier than those who had stabilisation by a suture (5.7 and 8.7 weeks, respectively; p <
0.001). Use of a screw also produced a higher degree of patient
We carried out a cross-sectional study in 51 patients (81 feet) with a clawed hallux in association with a cavus foot after a modified Robert Jones tendon transfer. The mean follow-up was 42 months (9 to 88). In all feet, concomitant procedures had been undertaken, such as extension osteotomy of the first metatarsal and transfer of the tendon of the peroneus longus to peroneus brevis, to correct the underlying foot deformity. All patients were evaluated clinically and radiologically. The overall rate of patient
The incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits. A PubMed search about the management of acute Achilles tendon rupture was performed. The search was open for original manuscripts and review papers limited to publication from January 2006 to July 2017. A total of 489 papers were identified initially and finally 323 articles were suitable for this review.Objectives
Methods
The traditional transosseus flexor hallucis longus (FHL) tendon
transfer for patients with Achilles tendinopathy requires two incisions
to harvest a long tendon graft. The use of a bio-tenodesis screw
enables a short graft to be used and is less invasive, but lacks
supporting evidence about its biomechanical behaviour. We aimed,
in this study, to compare the strength of the traditional transosseus
tendon-to-tendon fixation with tendon-to-bone fixation using a tenodesis
screw, in cyclical loading and ultimate load testing. Tendon grafts were undertaken in 24 paired lower-leg specimens
and randomly assigned in two groups using fixation with a transosseus
suture (suture group) or a tenodesis screw (screw group). The biomechanical
behaviour was evaluated using cyclical and ultimate loading tests.
The Student’s Aims
Materials and Methods
The aim of this retrospective study was to compare the functional
and radiological outcomes of bridge plating, screw fixation, and
a combination of both methods for the treatment of Lisfranc fracture
dislocations. A total of 108 patients were treated for a Lisfranc fracture
dislocation over a period of nine years. Of these, 38 underwent
transarticular screw fixation, 45 dorsal bridge plating, and 25
a combination technique. Injuries were assessed preoperatively according
to the Myerson classification system. The outcome measures included
the American Orthopaedic Foot and Ankle Society (AOFAS) score, the
validated Manchester Oxford Foot Questionnaire (MOXFQ) functional
tool, and the radiological Wilppula classification of anatomical
reduction.Aims
Patients and Methods
The aim of this study was to describe the technique of distraction
osteogenesis followed by arthrodesis using internal fixation to
manage complex conditions of the ankle, and to present the results
of this technique. Between 2008 and 2014, distraction osteogenesis followed by arthrodesis
using internal fixation was performed in 12 patients with complex
conditions of the ankle due to trauma or infection. There were eight
men and four women: their mean age was 35 years (23 to 51) at the
time of surgery. Bone healing and functional recovery were evaluated
according to the criteria described by Paley. Function was assessed
using the ankle-hindfoot scale of the American Orthopedic Foot and
Ankle Society (AOFAS).Aims
Patients and Methods
Flexor hallucis longus (FHL) tendon transfer is a well-recognized
technique in the treatment of the neglected tendo Achillis (TA)
rupture. We report a retrospective review of 20/32 patients who had undergone
transtendinous FHL transfer between 2003 and 2011 for chronic TA
rupture. Their mean age at the time of surgery was 53 years (22
to 83). The mean time from rupture to surgery was seven months (1
to 36). The mean postoperative follow-up was 73 months (29 to 120).
Six patients experienced postoperative wound complications.Aims
Patients and Methods
The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures. Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared.Objectives
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
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
Macrodactyly of the foot is a rare but disabling
condition. We present the results of surgery on 18 feet of 16 patients, who
underwent ray amputation and were followed-up for more than two
years at a mean of 80 months (25 to 198). We radiologically measured the intermetatarsal width and forefoot
area pre-operatively and at six weeks and two years after surgery.
We also evaluated the clinical results using the Oxford Ankle Foot
Questionnaire for children (OxAFQ-C) and the Questionnaire for Foot
Macrodactyly. The intermetatarsal width and forefoot area ratios were significantly
decreased after surgery. The mean OxAFQ-C score was 42 (16 to 57)
pre-operatively, improving to 47 (5 to 60) at two years post-operatively
(p = 0.021). The mean questionnaire for Foot Macrodactyly score
two years after surgery was 8 (6 to 10). Ray amputation gave a measurable reduction in foot size with
excellent functional results. For patients with metatarsal involvement,
a motionless toe, or involvement of multiple digits, ray amputation
is a clinically effective option which is acceptable to patients. Cite this article:
In recent years, the plantaris tendon has been
implicated in the development of chronic painful mid-portion Achilles tendinopathy.
In some cases, a thickened plantaris tendon is closely associated
with the Achilles tendon, and surgical excision of the plantaris
tendon has been reported to be curative in patients who have not
derived benefit following conservative treatment and surgical interventions. The aim of this review is to outline the basic aspects of, and
the recent research findings, related to the plantaris tendon, covering
anatomical and clinical studies including those dealing with histology,
imaging and treatment. Cite this article
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:
While many forefoot procedures may be performed
as a day case, there are no specific guidelines as to which procedures
are suitable. This study assessed the early post-operative pain
after forefoot surgery performed a day case, compared with conventional
inpatient management. A total of 317 consecutive operations performed by a single surgeon
were included in the study. Those eligible according to the criteria
of the French Society of Anaesthesia (SFAR) were managed as day
cases (127; 40%), while the remainder were managed as inpatients. The groups were comparable in terms of gender, body mass index
and smoking status, although the mean age of the inpatients was
higher (p <
0.001) and they had higher mean American Society
of Anaesthesiologists scores (p = 0.002). The most severe daily
pain was on the first post-operative day, but the levels of pain
were similar in the two groups; (4.2/10, Apart from the most complicated cases, forefoot surgery can safely
be performed as a day case without an increased risk of pain, or
complications compared with management as an inpatient. Cite this article:
The purpose of this study was to compare symptomatic treatment
of a fracture of the base of the fifth metatarsal with immobilisation
in a cast. Our null hypothesis was that immobilisation gave better patient
reported outcome measures (PROMs). The alternative hypothesis was
that symptomatic treatment was not inferior. A total of 60 patients were randomised to receive four weeks
of treatment, 36 in a double elasticated bandage (symptomatic treatment
group) and 24 in a below-knee walking cast (immobilisation group).
The primary outcome measure used was the validated Visual Analogue
Scale Foot and Ankle (VAS-FA) Score. Data were analysed by a clinician,
blinded to the form of treatment, at presentation and at four weeks,
three months and six months after injury. Loss to follow-up was
43% at six months. Multiple imputations missing data analysis was performed.Aims
Patients and Methods
Few reports compare the contribution of the talonavicular articulation
to overall range of movement in the sagittal plane after total ankle
arthroplasty (TAA) and tibiotalar arthrodesis. The purpose of this
study was to assess changes in ROM and functional outcomes following
tibiotalar arthrodesis and TAA. Patients who underwent isolated tibiotalar arthrodesis or TAA
with greater than two-year follow-up were enrolled in the study.
Overall arc of movement and talonavicular movement in the sagittal
plane were assessed with weight-bearing lateral maximum dorsiflexion
and plantarflexion radiographs. All patients completed Short Form-12
version 2.0 questionnaires, visual analogue scale for pain (VAS)
scores, and the Foot and Ankle Ability Measure (FAAM).Aims
Patients and Methods
Flexor digitorum longus transfer and medial displacement
calcaneal osteotomy is a well-recognised form of treatment for stage
II posterior tibial tendon dysfunction. Although excellent short-
and medium-term results have been reported, the long-term outcome
is unknown. We reviewed the clinical outcome of 31 patients with
a symptomatic flexible flat-foot deformity who underwent this procedure
between 1994 and 1996. There were 21 women and ten men with a mean
age of 54.3 years (42 to 70). The mean follow-up was 15.2 years
(11.4 to 16.5). All scores improved significantly (p <
0.001).
The mean American Orthopedic Foot and Ankle Society (AOFAS) score improved
from 48.4 pre-operatively to 90.3 (54 to 100) at the final follow-up.
The mean pain component improved from 12.3 to 35.2 (20 to 40). The
mean function score improved from 35.2 to 45.6 (30 to 50). The mean
visual analogue score for pain improved from 7.3 to 1.3 (0 to 6).
The mean Short Form-36 physical component score was 40.6 ( Cite this article:
The aim of this study was to report a single surgeon series of
consecutive patients with moderate hallux valgus managed with a
percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35
women and three men. The mean age of the patients was 48 years (17
to 69). An additional percutaneous Akin osteotomy was performed
in 37 feet and percutaneous lateral capsular release was performed
in 22 feet. Clinical and radiological assessments included the type
of forefoot, range of movement, the American Orthopedic Foot and
Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients
were lost to follow-up.Aims
Patients and Methods
Large osteochondral lesions (OCLs) of the shoulder
of the talus cannot always be treated by traditional osteochondral
autograft techniques because of their size, articular geometry and
loss of an articular buttress. We hypothesised that they could be
treated by transplantation of a vascularised corticoperiosteal graft
from the ipsilateral medial femoral condyle. Between 2004 and 2011, we carried out a prospective study of
a consecutive series of 14 patients (five women, nine men; mean
age 34.8 years, 20 to 54) who were treated for an OCL with a vascularised
bone graft. Clinical outcome was assessed using a visual analogue
scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society
(AOFAS) hindfoot score. Radiological follow-up used plain radiographs
and CT scans to assess graft incorporation and joint deterioration. At a mean follow-up of 4.1 years (2 to 7), the mean VAS for pain
had decreased from 5.8 (5 to 8) to 1.8 (0 to 4) (p = 0.001) and
the mean AOFAS hindfoot score had increased from 65 (41 to 70) to
81 (54 to 92) (p = 0.003). Radiologically, the talar contour had
been successfully reconstructed with stable incorporation of the
vascularised corticoperiosteal graft in all patients. Joint degeneration
was only seen in one ankle. Treatment of a large OCL of the shoulder of the talus with a
vascularised corticoperiosteal graft taken from the medial condyle
of the femur was found to be a safe, reliable method of restoring
the contour of the talus in the early to mid-term. 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:
In a retrospective study we compared 32 HINTEGRA
total ankle replacements (TARs) and 35 Mobility TARs performed between
July 2005 and May 2010, with a minimum follow-up of two years. The
mean follow-up for the HINTEGRA group was 53 months (24 to 76) and
for the Mobility group was 34 months (24 to 45). All procedures
were performed by a single surgeon. There was no significant difference between the two groups with
regard to the mean AOFAS score, visual analogue score for pain or
range of movement of the ankle at the latest follow-up. Most radiological
measurements did not differ significantly between the two groups.
However, the most common grade of heterotopic ossification (HO)
was grade 3 in the HINTEGRA group (10 of 13 TARs, 76.9%) and grade
2 in the Mobility group (four of seven TARs, 57.1%) (p = 0.025).
Although HO was more frequent in the HINTEGRA group (40.6%) than
in the Mobility group (20.0%), this was not statistically significant
(p = 0.065).The difference in peri-operative complications between
the two groups was not significant, but intra-operative medial malleolar
fractures occurred in four (11.4%) in the Mobility group; four (12.5%)
in the HINTEGRA group and one TAR (2.9%) in the Mobility group failed
(p = 0.185). Cite this article:
Osteochondral lesions (OCLs) occur in up to 70%
of sprains and fractures involving the ankle. Atraumatic aetiologies have
also been described. Techniques such as microfracture, and replacement
strategies such as autologous osteochondral transplantation, or
autologous chondrocyte implantation are the major forms of surgical
treatment. Current literature suggests that microfracture is indicated
for lesions up to 15 mm in diameter, with replacement strategies
indicated for larger or cystic lesions. Short- and medium-term results
have been reported, where concerns over potential deterioration
of fibrocartilage leads to a need for long-term evaluation. Biological augmentation may also be used in the treatment of
OCLs, as they potentially enhance the biological environment for
a natural healing response. Further research is required to establish
the critical size of defect, beyond which replacement strategies
should be used, as well as the most appropriate use of biological augmentation.
This paper reviews the current evidence for surgical management
and use of biological adjuncts for treatment of osteochondral lesions
of the talus. Cite this article:
We have evaluated the clinical effectiveness
of a metal resurfacing inlay implant for osteochondral defects of
the medial talar dome after failed previous surgical treatment.
We prospectively studied 20 consecutive patients with a mean age
of 38 years (20 to 60), for a mean of three years (2 to 5) post-surgery.
There was statistically significant reduction of pain in each of
four situations (i.e., rest, walking, stair climbing and running;
p ≤ 0.01). The median American Orthopaedic Foot and Ankle Society
ankle-hindfoot score improved from 62 (interquartile range (IQR)
46 to 72) pre-operatively to 87 (IQR 75 to 95) at final follow-up
(p <
0.001). The Foot and Ankle Outcome Score improved on all
subscales (p ≤ 0.03). The mean Short-Form 36 physical component
scale improved from 36 (23 to 50) pre-operatively to 45 (29 to 55)
at final follow-up (p = 0.001); the mental component scale did not
change significantly. On radiographs, progressive degenerative changes
of the opposing tibial plafond were observed in two patients. One
patient required additional surgery for the osteochondral defect.
This study shows that a metal implant is a promising treatment for
osteochondral defects of the medial talar dome after failed previous
surgery. Cite this article:
We report the clinical and radiological outcome of total ankle replacement performed in conjunction with hindfoot fusion or in isolation. Between May 2003 and June 2008, 60 ankles were treated with total ankle replacement with either subtalar or triple fusion, and the results were compared with a control group of 288 ankles treated with total ankle replacement alone. After the mean follow-up of 39.5 months (12 to 73), the ankles with hindfoot fusion showed significant improvement in the mean visual analogue score for pain (p <
0.001), the mean American Orthopaedic Foot and Ankle Society score (p <
0.001), and the mean of a modified version of this score (p <
0.001). The mean visual analogue pain score (p = 0.304) and mean modified American Orthopaedic Foot and Ankle Society score (p = 0.119) were not significantly different between the hindfoot fusion and the control groups. However, the hindfoot fusion group had a significantly lower mean range of movement (p = 0.009) and a higher rate of posterior focal osteolysis (p = 0.04). Both groups showed various complications (p = 0.131) and failure occurring at a similar rate (p = 0.685). Subtalar or triple fusion is feasible and has minimal adverse effects on ankles treated with total ankle replacement up to midterm follow-up. The clinical outcome of total ankle replacement when combined with hindfoot fusion is comparable to that of ankle replacement alone. Thus, hindfoot fusion should be performed in conjunction with total ankle replacement when indicated.