Diabetic foot care is a significant burden on the NHS in England. We have conducted a nationwide survey to determine the current participation of orthopaedic surgeons in diabetic foot care in England. A questionnaire was sent to all 136 NHS trusts audited in the 2018 National Diabetic Foot Audit (NDFA). The questionnaire asked about the structure of diabetic foot care services.Aims
Methods
In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method. We conducted a retrospective analysis of prospectively collected data of all patients with infected Charcot foot deformity who underwent two-stage reconstruction with internal fixation between July 2011 and November 2019, with a minimum of 12 months’ follow-up.Aims
Methods
Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function.Aims
Methods
The aim of this study was to present a series of patients with
aseptic failure of a total ankle arthroplasty (TAA) who were treated
with fusion of the hindfoot using a nail. A total of 23 TAAs, in 22 patients, were revised for aseptic
loosening and balloon osteolysis to a hindfoot fusion by a single
surgeon (NH) between January 2012 and August 2014. The procedure
was carried out without bone graft using the Phoenix, Biomet Hindfoot
Arthrodesis Nail. Preoperative investigations included full blood
count, CRP and ESR, and radiological investigations including plain
radiographs and CT scans. Postoperative plain radiographs were assessed
for fusion. When there was any doubt, CT scans were performed.Aims
Patients and Methods
The last decade has seen a considerable increase
in the use of in total ankle arthroplasty (TAA) to treat patients
with end-stage arthritis of the ankle. However, the longevity of
the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment
algorithm for the painful TAA to be used when considering revision
surgery. Cite this article:
Lifestyle risk factors are thought to increase the risk of infection
after acute orthopaedic surgery but the evidence is scarce. We aimed
to investigate whether smoking, obesity and alcohol overuse are
risk factors for the development of infections after surgery for
a fracture of the ankle. We retrospectively reviewed all patients who underwent internal
fixation of a fracture of the ankle between 2008 and 2013. The primary
outcome was the rate of deep infection and the secondary outcome
was any surgical site infection (SSI). Associations with the risk
factors and possible confounding variables were analysed univariably
and multivariably with backwards elimination.Aims
Patients and Methods
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. 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.Aims
Patients and Methods
Limited forefoot amputation in diabetic patients
with osteomyelitis is frequently required. We retrospectively reviewed
diabetic patients with osteomyelitis, an unhealed ulcer and blood
pressure in the toe of >
45 mmHg who underwent limited amputation
of the foot with primary wound closure. Between 2006 and 2012, 74
consecutive patients with a mean age of 67 years (29 to 93), and
a median follow-up of 31 months, were included. All the wounds healed
primarily at a median of 37 days (13 to 210; mean 48). At a median
of 6 months (1.5 to 18; mean 353 days), 23 patients (31%) suffered
a further ulceration. Of these, 12 patients (16% of the total) required
a further amputation. We conclude that primary wound closure following limited amputation
of the foot in patients with diabetes is a safe and effective technique
when associated with appropriate antibiotic treatment. Cite this article:
Most of the literature on surgical site infections
following the surgical treatment of fractures of the ankle is based
on small series of patients, focusing on diabetics or the elderly.
None have described post-operative functional scores in those patients
who develop an infection. We performed an age- and gender-matched
case–control study to identify patient- and surgery-related risk
factors for surgical site infection following open reduction and
internal fixation of a fracture of the ankle. Logistic regression
analysis was used to identify significant risk factors for infection
and to calculate odds ratios (OR). Function was assessed using the
Olerud and Molander Ankle Score. The incidence of infection was
4% (29/717) and 1.1% (8/717) were deep infections. The median ankle
score was significantly lower in the infection group compared with
the control group (60 A low incidence of infection following open reduction and internal
fixation of fractures of the ankle was observed. Both superficial
and deep infections result in lower functional scores. Cite this article:
The treatment of peri-prosthetic joint infection
(PJI) of the ankle is not standardised. It is not clear whether
an algorithm developed for hip and knee PJI can be used in the management
of PJI of the ankle. We evaluated the outcome, at two or more years
post-operatively, in 34 patients with PJI of the ankle, identified
from a cohort of 511 patients who had undergone total ankle replacement.
Their median age was 62.1 years (53.3 to 68.2), and 20 patients
were women. Infection was exogenous in 28 (82.4%) and haematogenous
in six (17.6%); 19 (55.9%) were acute infections and 15 (44.1%)
chronic. Staphylococci were the cause of 24 infections (70.6%).
Surgery with retention of one or both components was undertaken
in 21 patients (61.8%), both components were replaced in ten (29.4%),
and arthrodesis was undertaken in three (8.8%). An infection-free
outcome with satisfactory function of the ankle was obtained in
23 patients (67.6%). The best rate of cure followed the exchange
of both components (9/10, 90%). In the 21 patients in whom one or
both components were retained, four had a relapse of the same infecting organism
and three had an infection with another organism. Hence the rate
of cure was 66.7% (14 of 21). In these 21 patients, we compared
the treatment given to an algorithm developed for the treatment
of PJI of the knee and hip. In 17 (80.9%) patients, treatment was
not according to the algorithm. Most (11 of 17) had only one criterion against
retention of one or both components. In all, ten of 11 patients
with severe soft-tissue compromise as a single criterion had a relapse-free
survival. We propose that the treatment concept for PJI of the ankle
requires adaptation of the grading of quality of the soft tissues. Cite this article
The rate of surgical site infection after elective
foot and ankle surgery is higher than that after other elective orthopaedic
procedures. Since December 2005, we have prospectively collected data on
the rate of post-operative infection for 1737 patients who have
undergone elective foot and ankle surgery. In March 2008, additional
infection control policies, focused on surgical and environmental
risk factors, were introduced in our department. We saw a 50% reduction in the rate of surgical site infection
after the introduction of these measures. We are, however, aware
that the observed decrease may not be entirely attributable to these
measures alone given the number of factors that predispose to post-operative
wound infection. Cite this article:
We report the outcomes of 20 patients (12 men,
8 women, 21 feet) with Charcot neuro-arthropathy who underwent correction
of deformities of the ankle and hindfoot using retrograde intramedullary
nail arthrodesis. The mean age of the patients was 62.6 years (46
to 83); their mean BMI was 32.7 (15 to 47) and their median American
Society of Anaesthetists score was 3 (2 to 4). All presented with
severe deformities and 15 had chronic ulceration. All were treated
with reconstructive surgery and seven underwent simultaneous midfoot
fusion using a bolt, locking plate or a combination of both. At
a mean follow-up of 26 months (8 to 54), limb salvage was achieved
in all patients and 12 patients (80%) with ulceration achieved healing
and all but one patient regained independent mobilisation. There was
failure of fixation with a broken nail requiring revision surgery
in one patient. Migration of distal locking screws occurred only
when standard screws had been used but not with hydroxyapatite-coated
screws. The mean American Academy of Orthopaedic Surgeons Foot and
Ankle (AAOS-FAO) score improved from 50.7 (17 to 88) to 65.2 (22
to 88), (p = 0.015). The mean Short Form (SF)-36 Health Survey Physical
Component Score improved from 25.2 (16.4 to 42.8) to 29.8 (17.7
to 44.2), (p = 0.003) and the mean Euroqol EQ‑5D‑5L score improved
from 0.63 (0.51 to 0.78) to 0.67 (0.57 to 0.84), (p = 0.012). Single-stage correction of deformity using an intramedullary
hindfoot arthrodesis nail is a good form of treatment for patients
with severe Charcot hindfoot deformity, ulceration and instability
provided a multidisciplinary care plan is delivered. Cite this article:
Between 2002 and 2008, 130 consecutive ankles were replaced with an hydroxyapatite (HA) and titanium-HA-coated Ankle Evolutive System total ankle prosthesis. Plain radiographs were analysed by two independent observers. Osteolytic lesions were classified by their size and location, with cavities >
10 mm in diameter considered to be ‘marked’. CT scanning was undertaken in all patients with marked osteolysis seen on the plain radiographs. Osteolytic lesions were seen on the plain films in 48 (37%) and marked lesions in 27 (21%) ankles. The risk for osteolysis was found to be 3.1 (95% confidence interval 1.6 to 5.9) times higher with implants with Ti-HA porous coating. Care should be taken with ankle arthroplasty until more is known about the reasons for these severe osteolyses.
