RESUMEN

PURPOSE: We aimed to report the union rate after only utilizing a locally obtained autologous bone graft while correcting the deformity and performing joint arthrodesis in patients with foot and ankle Charcot neuropathy (CN) and to report on the radiographic, functional, complications incidence outcomes at a minimum of two years of follow up. METHODS: We included 24 patients having a mean age of 55.4 ± 10.1 years diagnosed with CN of the foot, ankle, or both. Seven (29.2%) cases were classified as Brodsky type 1, 11 (45.8%) as type 3 A, and six (25%) were type 4. Hindfoot and Midfoot bi-columnar arthrodesis was performed in 70.8% and 29.2% of the patients, respectively. Eight (33.3%) cases had preoperative ulcers. Functional outcomes were evaluated using a modified AOFAS score. Arthrodesis site union was assessed clinically and radiographically. All patients were available for a mean follow up of 35.7 ± 9.5 (24-54) months. RESULTS: Arthrodesis site union was achieved in 23 (95.8%) cases after a mean of 4 ± 1.7 (2-7.5) months. The mean modified AOFAS score was 72.4 ± 10.41 (46-83) points; 79.2% achieved excellent and good scores. Ulcers healed in 87.5% of the patients. Twenty-two (91.7%) patients were satisfied with their functional results. Infection incidence was 12.5%, and no patients required revision or amputation. CONCLUSION: Foot and ankle Charcot neuroarthropathy deformity correction by arthrodesis of the affected joint as a salvage management option resulted in acceptable clinical and radiological outcomes. To enhance the local environment for arthrodesis consolidation, locally obtained autografts led to higher union rates and avoided the drawbacks of using other graft types.

Asunto(s)

Artrodesis , Artropatía Neurógena , Trasplante Óseo , Trasplante Autólogo , Humanos , Artrodesis/métodos , Persona de Mediana Edad , Artropatía Neurógena/cirugía , Femenino , Masculino , Trasplante Óseo/métodos , Anciano , Adulto , Trasplante Autólogo/métodos , Resultado del Tratamiento , Estudios de Seguimiento , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Factores de Tiempo , Articulaciones del Pie/cirugía , Articulaciones del Pie/diagnóstico por imagen , Estudios Retrospectivos , Pueblo Norteafricano

RESUMEN

BACKGROUND: End-stage post-traumatic osteoarthritis of the ankle joint may require arthrodesis if conservative treatment fails and a decision against total ankle replacement is made. We aimed to compare the sex-specific differences in outcomes and objectify them using validated specific scores. METHODS: Between 2010 and 2021, 221 patients underwent ankle arthrodesis at our institution, including 143 men (MAA) and 78 women (FAA). In addition to demographic data, the aetiology of osteoarthritis, the Foot Function Index (FFI-D), the Olerud-Molander Score (OMAS), and the Short Form-12 questionnaire (SF-12) were collected in this monocentric study. The mean follow-up time was 5.8 years. End-stage osteoarthritis was mostly due to ankle fractures as a result of sprains, falls, and road traffic accidents. RESULTS: Post-operatively, the mean FFI-D for pain was 17.3 (MAA: 14.7; FAA 22.2) and 43.9 for function (MAA: 41.1; FAA 49.5); the mean OMAS was 58.2; and the mean SF-12 physical component score was 42.5. Women achieved significantly worse results in all scores; only the mental component summary of the SF-12 did not differ between the sexes (p > 0.05). Approximately 34% of women stated that the result in terms of gait pattern was worse than expected (MAA 16.1%; p < 0.05). Again, significantly more men stated that the result was better than expected (MAA: 48.3%; FAA: 31.5%, p < 0.05). CONCLUSIONS: The fact that the clinical results were significantly worse in women after ankle arthrodesis should be considered when determining the indication. However, the expectations of men and women also need to be individually adjusted.

Asunto(s)

Articulación del Tobillo , Artrodesis , Osteoartritis , Humanos , Artrodesis/métodos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Articulación del Tobillo/cirugía , Osteoartritis/cirugía , Resultado del Tratamiento , Adulto , Anciano , Factores Sexuales , Estudios de Seguimiento

RESUMEN

The aim of this study was to develop a novel surgical technique for stifle arthrodesis in dogs using a semicircular saw for tibial and femoral ostectomies through a medial approach. Ten pelvic limbs from five canine cadavers underwent stifle arthrodesis. Prior to the surgical procedure, the limbs were radiographed to rule out musculoskeletal abnormalities. Additionally, the radiographs were used for surgical planning. For the tibial ostectomy, the center of the intercondylar eminences, the cranial limit of the tibial plateau, and the caudal cortex of the tibia were used as landmarks. In the femur, the groove of the insertion of the long digital extensor tendon and the caudal portion of the femoral cortex served as references. The most significant iatrogenic injury during the surgical procedures was the complete rupture of the long digital extensor tendon during the tibial cut in one of the stifles. Dome ostectomies facilitated interfragmentary contact, allowing for adjustment of the angulation between the fragments without the need for additional ostectomies or osteotomies. The medial approach provided a clear view of intra-articular structures without causing extensive damage to surrounding tissues. After the procedures, the limbs were radiographed to calculate angular measurements, and the final angulation (mean) of the knee joints was 134.7 ± 11°.

Asunto(s)

Artrodesis , Cadáver , Rodilla de Cuadrúpedos , Animales , Perros/cirugía , Artrodesis/veterinaria , Artrodesis/métodos , Rodilla de Cuadrúpedos/cirugía , Rodilla de Cuadrúpedos/diagnóstico por imagen , Tibia/cirugía , Osteotomía/veterinaria , Osteotomía/métodos , Fémur/cirugía

RESUMEN

PURPOSE: The treatments for hallux rigidus (HR) encompass a wide spectrum, including conservative methods and surgical approaches such as arthroplasty and arthrodesis. This study aims to evaluate the outcomes of revision with arthrodesis following the failure of the first metatarsophalangeal joint total arthroplasty (MTPJ1TA). MATERIALS AND METHODS: Patients who had surgery at two advanced orthopedic centers between January 1, 2020, and January 1, 2024, were reviewed. Those with at least 6 months of postoperative follow-up were assessed for demographics (gender, age, side), reoperation rates, complications, Visual Analogue Scale (VAS) scores, Foot and Ankle Disability Index (FADI) scores, and American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal and Interphalangeal Scale (AOFAS-HMI) scores. Radiological evaluations included hallux valgus angle (HVA), intermetatarsal angle (IMA), dorsiflexion angle (DFA), and first ray length (FRL) in anteroposterior and lateral views. RESULTS: Of 27 patients, 4 were male (15%) and 23 female (85%), with an average age of 56.18 ± 7.49 years (range 41-72). Arthrodesis was performed in 26 patients, with one requiring reoperation due to implant failure. Average VAS scores were 7.14 preoperatively and 3.55 postoperatively (p < 0.05). Average FADI scores were 50.51 preoperatively and 71.51 postoperatively (p < 0.05). Average AOFAS-HMI scores were 51.22 preoperatively and 70.59 postoperatively (p < 0.05). Average HVA was 19.7° preoperatively and 6.29° postoperatively (p < 0.05). Average IMA was 10.66° preoperatively and 11.37° postoperatively (p = 0.406). Average DFA was 34.14° preoperatively and 22.33° postoperatively (p < 0.05). Average anteroposterior FRL was 10.17 cm preoperatively and 10.77 cm postoperatively (p < 0.05). Average lateral FRL was 10.12 cm preoperatively and 10.42 cm postoperatively (p < 0.05). None of the patients in the study exhibited postoperative donor site complications or transfer metatarsalgia, while a 100% rate of bone union was observed. CONCLUSION: We think that revision of MTPJ1TA with arthrodesis is a safe treatment option. Additionally, the use of an iliac crest autograft can be a viable option to restore bone stock and create a biological environment conducive to fusion. This study evaluates revision surgery with arthrodesis in the largest patient group with failed MTPJ1TA, highlighting its significance in the field. However, further studies are needed to determine the ideal surgical procedure.

Asunto(s)

Artrodesis , Autoinjertos , Hallux Rigidus , Ilion , Articulación Metatarsofalángica , Reoperación , Humanos , Femenino , Masculino , Hallux Rigidus/cirugía , Hallux Rigidus/diagnóstico por imagen , Estudios Retrospectivos , Artrodesis/métodos , Persona de Mediana Edad , Reoperación/métodos , Articulación Metatarsofalángica/cirugía , Articulación Metatarsofalángica/diagnóstico por imagen , Anciano , Ilion/trasplante , Artroplastia de Reemplazo/métodos , Adulto , Resultado del Tratamiento , Estudios de Seguimiento , Trasplante Óseo/métodos

RESUMEN

We used finite element analysis to study the mechanical stress distribution of a new intramedullary implant used for proximal interphalangeal joint (PIPJ) arthrodesis (PIPJA) to surgically correct the claw-hammer toe deformity that affects 20% of the population. After geometric reconstruction of the foot skeleton from claw toe images of a 36-year-old male patient, two implants were positioned, in the virtual model, one neutral implant (NI) and another one 10° angled (10°AI) within the PIPJ of the second through fourth HT during the toe-off phase of gait and results were compared to those derived for the non-surgical foot (NSF). A PIPJA was performed on the second toe using a NI reduced tensile stress at the proximal phalanx (PP) (45.83 MPa) compared to the NSF (59.44 MPa; p < 0.001). When using the 10°AI, the tensile stress was much higher at PP and middle phalanges (MP) of the same toe, measuring 147.58 and 160.58 MPa, respectively, versus 59.44 and 74.95 MPa at corresponding joints in the NSF (all p < 0.001). Similar results were found for compressive stresses. The NI reduced compressive stress at the second PP (-65.12 MPa) compared to the NSF (-113.23 MPa) and the 10°AI (-142 MPa) (all p < 0.001). The von Mises stresses within the implant were also significantly lower when using NI versus 10°AI (p < 0.001). Therefore, we do not recommend performing a PIPJA using the 10°AI due to the increase in stress concentration primarily at the second PP and MP, which could promote implant breakage.

Asunto(s)

Artrodesis , Análisis de Elementos Finitos , Síndrome del Dedo del Pie en Martillo , Articulación del Dedo del Pie , Humanos , Masculino , Artrodesis/métodos , Adulto , Articulación del Dedo del Pie/cirugía , Articulación del Dedo del Pie/fisiopatología , Síndrome del Dedo del Pie en Martillo/cirugía , Síndrome del Dedo del Pie en Martillo/fisiopatología , Fenómenos Biomecánicos

RESUMEN

The implantation of unicortical cortex screws in the proximal hole of locking compression plates (LCP) has been recommended for proximal interphalangeal (PIP) arthrodesis in horses to prevent fractures resulting from stress risers in the proximal phalanx (P1). However, this cortex screw fixation technique may limit efficient dorsal compression of the PIP joint by the plate, potentially affecting the stability of the construct. In this study, we aimed to measure stress and strain in P1 and the plate using an ex vivo model of PIP arthrodesis in horses. We employed various implantation methods and proximal screw types in conjunction with two 5.5 mm transarticular cortex screws. Ten pairs of equine forelimbs were divided into four groups based on proximal screw placement: GUC (unicortically placed cortex screw), GBC (bicortically placed cortex screw), GUL (unicortically placed locking screw), and GBL (bicortically placed locking screw). We calculated the magnitude and direction of strain, strain ratio, and stress using strain gauges during an axial compression mechanical testing. The palmar surface of P1 exhibited higher stress and strains than the dorsal surface, with the plate part located at the articular level suffered more stress than the proximal part. Both the implantation method and proximal screw type significantly influenced the analyzed parameters. The GUC promoted greater changes in strain direction in the proximal portion of the P1. Bicortical placement of a cortex screw appears to be the most suitable option for filling the proximal hole of the LCP, because it allows effective dynamic compression via the plate and prevents abrupt shifts in the direction of the forces acting on the proximal part of P1 during loading.

Asunto(s)

Artrodesis , Placas Óseas , Tornillos Óseos , Estrés Mecánico , Animales , Caballos , Artrodesis/veterinaria , Artrodesis/instrumentación , Artrodesis/métodos , Placas Óseas/veterinaria , Fenómenos Biomecánicos , Miembro Anterior/cirugía , Cadáver

RESUMEN

INTRODUCTION: Arthrodesis of a (diseased) ankle joint is usually performed to achieve pain relief and stability. One basic principle of arthrodesis techniques includes rigid fixation of the surfaces until union. It seems plausible that stable anchoring and homogeneous pressure distribution should be advantageous, however, it has not been investigated yet. The aim is to achieve uniform compression, as this is expected to produce favorable results for the bony fusion of the intended arthrodesis. Numerous implants with different biomechanical concepts can be used for ankle fusion. In this study, headless compression screws (HCS, DePuy Synthes, Zuchwil, Switzerland) were compared biomechanically to an alternative fixation System, the IOFix device (Extremity Medical, Parsippany, NJ, USA) in regard to the distribution of the compression force (area of contact) and peak compression in a sawbone arthrodesis-model (Sawbones® Pacific Research Laboratories, Vashon, WA, USA). This study aims to quantify the area of contact between the bone interface that can be obtained using headless compression screws compared to the IOFix. In current literature, it is assumed, that a large contact surface with sufficient pressure between the bones brings good clinical results. However, there are no clinical or biomechanical studies, that describe the optimal compression pressure for an arthrodesis. MATERIAL AND METHODS: Two standardized sawbone blocks were placed above each other in a custom-made jig. IOFix and headless compression screws were inserted pairwise parallel to each other using a template for a uniform drilling pattern. All screws were inserted with a predefined torque of 0.5 Nm. Pressure transducers positioned between the two sawbone blocks were compressed for the measurement of peak compression force, compression distribution, and area of contact. RESULTS: With the IOFix, the compression force was distributed over significantly larger areas compared to the contact area of the HCS screws, resulting in a more homogenous contact area over the entire arthrodesis surface. Maximum compression force showed no significant difference. CONCLUSION: The IOFix system distributes the compression pressure over a much larger area, resulting in more evenly spread compression at the surface. Clinical studies must show whether this leads to a lower pseudarthrosis rate.

Asunto(s)

Articulación del Tobillo , Artrodesis , Tornillos Óseos , Artrodesis/métodos , Artrodesis/instrumentación , Fenómenos Biomecánicos , Humanos , Articulación del Tobillo/cirugía , Fuerza Compresiva

RESUMEN

Metacarpophalangeal joint arthritis of the index finger is a debilitating disease often caused by osteoarthritis or inflammatory arthritides such as rheumatoid arthritis. Treatment options include nonsurgical management with nonsteroidal anti-inflammatory drugs, splinting, occupational therapy, corticosteroid injections, and disease-modifying antirheumatic drugs. Operative management options include arthrodesis and arthroplasty, which can be further broken down into silicone implants and 2 component resurfacing implants. The article summarizes the current literature for each of the treatment options for metacarpophalangeal joint arthritis of the index finger.

Asunto(s)

Articulación Metacarpofalángica , Humanos , Articulación Metacarpofalángica/cirugía , Férulas (Fijadores) , Artrodesis/métodos , Antirreumáticos/uso terapéutico , Osteoartritis/terapia , Osteoartritis/cirugía , Antiinflamatorios no Esteroideos/uso terapéutico , Artritis/terapia , Artritis/etiología , Terapia Ocupacional/métodos

RESUMEN

BACKGROUND: Scaphoid nonunion advanced collapse (SNAC) injuries are frequently associated with irreversible degenerative wrist arthritic changes that necessitate surgical intervention. Midcarpal fusion remains the mainstay of the management of SNAC II and III injuries. A successful four-corner fusion (4CF) relies on a stable lunate-capitate fusion (LCF). There have been reports of management relying solely on LCF. The outcomes of LC- and 4 C-fusions in SNAC injuries were not widely documented. The objective of this research is to provide valuable insights into the effectiveness of both fusion procedures in the management of SNAC II and III wrist injuries, with a focus on reporting associated complications, functional and radiological outcomes. PATIENTS AND METHODS: This retrospective study encompassed 65 patients diagnosed with SNAC II and III wrist injuries who underwent limited wrist fusion procedures between 2015 and 2024, with a minimum of 2 years of postoperative follow-up. Exclusion criteria encompassed patients with carpal instability, prior wrist surgical interventions, and scapholunate advanced collapse. Following the fusion procedure performed, patients were stratified into two groups: the LCF group consisting of 31 patients, and the 4CF group comprising 34 patients. Preoperative and intraoperative data were retrieved from the patient's medical records. At their final follow-up appointments, patients underwent comprehensive radiographic and clinical evaluations. Clinical outcomes including hand grip strength, range of motion, the Disabilities of the Arm, Shoulder, and Hand Score, and the Mayo Modified Wrist Score, were compared between groups. Any associated complications were reported. RESULTS: The average healing time was 74.7 ± 15.6 and 72.2 ± 13.2 days for the LCF and 4CF groups, respectively. At the final visit, all patients showed functional improvement relative to their preoperative status, with comparable wrist range of motions observed in both groups. The functional wrist scores were slightly better in the LCF patients (P > 0.05). The average grip strength was significantly greater in the LCF group (P = 0.04), with mean strength values of 86.8% and 82.1% of the contralateral side, for the LCF and 4CF groups, respectively. CONCLUSION: The LCF is not less efficient than the 4CF in the treatment of SNAC II and III wrist injuries. Through a less time-consuming procedure, LCF can efficiently provide comparable results to 4CF. LEVEL OF EVIDENCE: level IV evidence.

Asunto(s)

Artrodesis , Hueso Grande del Carpo , Fracturas no Consolidadas , Hueso Semilunar , Hueso Escafoides , Humanos , Hueso Escafoides/cirugía , Hueso Escafoides/lesiones , Hueso Escafoides/diagnóstico por imagen , Masculino , Artrodesis/métodos , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Hueso Semilunar/cirugía , Hueso Semilunar/lesiones , Hueso Semilunar/diagnóstico por imagen , Hueso Grande del Carpo/cirugía , Hueso Grande del Carpo/lesiones , Hueso Grande del Carpo/diagnóstico por imagen , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Resultado del Tratamiento , Traumatismos de la Muñeca/cirugía , Traumatismos de la Muñeca/diagnóstico por imagen , Rango del Movimiento Articular , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/fisiopatología , Adulto Joven , Estudios de Seguimiento , Fuerza de la Mano

RESUMEN

Background: Ankle fusion is considered a treatment of choice for end-stage ankle arthritis when a total ankle replacement procedure is not indicated. However, the potential risk of secondary arthritis in the adjacent joint after ankle fusion raises arguments on whether preserving the adjacent joint during an isolated tibiotalar (TT) fusion brings about any future benefits with regard to pain and gait discomfort. In this study, we intended to present midterm results following TT or tibiotalocalcaneal (TTC) fusion using an Ilizarov external fixator and to investigate whether spontaneous fusion occurred in the subtalar or midtarsal joint. Methods: This is a retrospective observational study. Medical records of patients who underwent TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint between 1994 and 2018 were manually searched. Forty-one patients were included and the status of the joints adjacent to the fusion site was evaluated in radiographic examinations. Results: Of the 34 patients who underwent TT fusion, 30 patients (88.3%) had a spontaneous fusion in the adjacent joints. Specifically, 11 patients (29.4%) had subtalar joint fusion and 19 patients (55.9%) had both midtarsal joint and subtalar joint fusion. In TTC fusion, the midtarsal joint was spontaneously fused in all 7 patients. Conclusions: In this study, we observed spontaneous adjacent joint fusion following TT or TTC fusion using an Ilizarov external fixator for substantial bone defects around the ankle joint. Although a careful approach should be made since patients treated in this study may not represent typical candidates that need primary joint-sacrificing procedures, we believe that this study may draw attention from surgeons concerned about the fate of the adjacent joint status after TT or TTC fusion.

Asunto(s)

Articulación del Tobillo , Técnica de Ilizarov , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Articulación del Tobillo/cirugía , Técnica de Ilizarov/instrumentación , Anciano , Artrodesis/métodos , Artrodesis/instrumentación , Fijadores Externos , Adulto , Articulación Talocalcánea/cirugía , Calcáneo/cirugía

RESUMEN

BACKGROUND: Talar neck non-unions result in significant hindfoot deformity and morbidity and are infrequently reported in the literature. The optimal surgical management for this condition is evolving, with various authors reporting the results of open reduction and internal fixation (ORIF) with bone grafting (BG), ankle fusion and modified Blair fusion. We performed this study to report the clinical and radiological outcomes of a cohort of talar neck non-unions managed by ankle joint preserving reconstruction. METHODS: This was an ambispective study which included 8 patients (7 male and 1 female) with talar neck non-unions. All patients underwent ORIF+BG through dual approaches. Additional medial malleolar osteotomy was done in 2 cases, and calcaneofibular split approach to the subtalar joint in 3. Adjunct subtalar fusion was done in 5 cases. Clinical and radiological evaluation was performed pre- and post-operatively. Functional outcomes were assessed by the Manchester Oxford Foot Questionnaire (MOxFQ). RESULTS: The mean age of patients 32.3 ± 13.1 years. The mean surgical delay was 4.1 ± 1.7 months. As per Zwipp and Rammelt classification of post-traumatic talar deformities, 5 cases were classified as Type 3, 2 were Type 4, and 1 was Type 1. Union was achieved in 7 cases at a mean of 3.4 ± 1.3 months. One case had progressive collapse, which was managed by pantalar arthrodesis. All 3 cases where subtalar fusion was not performed primarily demonstrated subtalar arthrosis, but none required a secondary subtalar fusion. The MOxFQ score from 61.1 ± 10.1 to 41 ± 14.1 postoperatively (P = 0.005). The mean follow-up was 14.6 ± 6.8 months. CONCLUSION: ORIF+BG of the talar neck, with or without subtalar fusion has the potential to achieve solid union, correct the hindfoot deformity and improve functional outcomes. However, larger studies with longer follow-up are needed to evaluate the long-term efficacy of this procedure.

Asunto(s)

Articulación del Tobillo , Trasplante Óseo , Fijación Interna de Fracturas , Fracturas no Consolidadas , Radiografía , Astrágalo , Humanos , Masculino , Femenino , Adulto , Resultado del Tratamiento , Fijación Interna de Fracturas/métodos , Articulación del Tobillo/cirugía , Articulación del Tobillo/diagnóstico por imagen , Articulación del Tobillo/fisiopatología , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Astrágalo/cirugía , Astrágalo/diagnóstico por imagen , Trasplante Óseo/métodos , Artrodesis/métodos , Osteotomía/métodos , Persona de Mediana Edad , Adulto Joven , Curación de Fractura/fisiología , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Rango del Movimiento Articular , Fracturas de Tobillo/cirugía , Fracturas de Tobillo/diagnóstico por imagen

Asunto(s)

Artrodesis , Estudios de Factibilidad , Bloqueo Nervioso , Escápula , Nervios Torácicos , Humanos , Bloqueo Nervioso/métodos , Escápula/inervación , Escápula/cirugía , Artrodesis/métodos , Masculino , Femenino , Persona de Mediana Edad , Anciano

RESUMEN

Aims: In cases of severe periprosthetic joint infection (PJI) of the knee, salvage procedures such as knee arthrodesis (KA) or above-knee amputation (AKA) must be considered. As both treatments result in limitations in quality of life (QoL), we aimed to compare outcomes and factors influencing complication rates, mortality, and mobility. Methods: Patients with PJI of the knee and subsequent KA or AKA between June 2011 and May 2021 were included. Demographic data, comorbidities, and patient history were analyzed. Functional outcomes and QoL were prospectively assessed in both groups with additional treatment-specific scores after AKA. Outcomes, complications, and mortality were evaluated. Results: A total of 98 patients were included, 52 treated with arthrodesis and 47 with AKA. The mean number of revision surgeries between primary arthroplasty and arthrodesis or AKA was 7.85 (SD 5.39). Mean follow-up was 77.7 months (SD 30.9), with a minimum follow-up of two years. Complications requiring further revision surgery occurred in 11.5% of patients after arthrodesis and in 37.0% of AKA patients. Positive intraoperative tissue cultures obtained during AKA was significantly associated with the risk of further surgical revision. Two-year mortality rate of arthrodesis was significantly lower compared to AKA (3.8% vs 28.3%), with age as an independent risk factor in the AKA group. Functional outcomes and QoL were better after arthrodesis compared to AKA. Neuropathic pain was reported by 19 patients after AKA, and only 45.7% of patients were fitted or were intended to be fitted with a prosthesis. One-year infection-free survival after arthrodesis was 88.5%, compared to 78.5% after AKA. Conclusion: Above-knee amputation in PJI results in high complication and mortality rates and poorer functional outcome compared to arthrodesis. Mortality rates after AKA depend on patient age and mobility, with most patients not able to be fitted with a prosthesis. Therefore, arthrodesis should be preferred whenever possible if salvage procedures are indicated.

Asunto(s)

Amputación Quirúrgica , Artrodesis , Infecciones Relacionadas con Prótesis , Calidad de Vida , Reoperación , Humanos , Artrodesis/métodos , Masculino , Femenino , Anciano , Infecciones Relacionadas con Prótesis/cirugía , Reoperación/estadística & datos numéricos , Persona de Mediana Edad , Complicaciones Posoperatorias , Artroplastia de Reemplazo de Rodilla/efectos adversos , Prótesis de la Rodilla/efectos adversos , Anciano de 80 o más Años , Resultado del Tratamiento , Estudios Retrospectivos , Estudios Prospectivos

RESUMEN

Hallux rigidus can present a difficult problem to both competitive and elite athletic populations. Once an appropriate diagnostic workup has been performed, nonoperative management strategies, including anti-inflammatory medications, injection therapies, shoewear modifications, and orthotic devices, represent the mainstay conservative management options. Surgical management can be considered where an athlete's athletic performance is limited. A joint-sparing cheilectomy can provide a predictable return to sport at the most elite levels. The addition of a proximal phalangeal osteotomy can be considered when necessary. Arthroplasty or arthrodesis techniques can be used for persistent symptoms or progressive disease, but with less predictable outcomes.

Asunto(s)

Atletas , Hallux Rigidus , Humanos , Hallux Rigidus/cirugía , Artrodesis/métodos , Osteotomía/métodos , Tratamiento Conservador/métodos

RESUMEN

First metatarsophalangeal (MTP) joint fusion, or arthrodesis, has been a cornerstone treatment for advanced joint degeneration since the 1950s, benefiting not only older patients but also younger individuals. The procedure boasts favorable long-term outcomes and a low rate of revision when fusion is successful. However, complications such as interphalangeal arthritis may occur, and nonunion or malunion can necessitate revision. While the first MTP fusion provides significant relief, its applicability varies, underscoring the need for careful patient selection.

Asunto(s)

Artrodesis , Hallux Rigidus , Articulación Metatarsofalángica , Humanos , Artrodesis/métodos , Hallux Rigidus/cirugía , Hallux Rigidus/diagnóstico por imagen , Articulación Metatarsofalángica/cirugía , Resultado del Tratamiento

RESUMEN

Noninferiority studies in surgery are, by their very nature, reductionist. They use multiple variables to generate a yes or no answer about the new device being tested. A binary outcome is appropriate for a regulatory agency such as the Food and Drug Administration, but the clinical situation is more nuanced. It is critical to understand the underlying philosophies and choices that go into trial design when a surgeon is recommending a new device. In the case of Cartiva, any of 3 reasonable alternative means of defining surgical success would have altered the final outcome of the MOTION trial. Additionally, using a more rigorous noninferiority margin rather than adding an additional cushion based upon the argument that motion alone had extra inherent value would have also led to failure of the trial to demonstrate noninferiority.

Asunto(s)

Artrodesis , Humanos , Artrodesis/métodos , Estudios de Equivalencia como Asunto

RESUMEN

Cheilectomy, a joint-conserving procedure, is often a first-line choice for treating early stages of hallux rigidus. Recent evidence has revealed its efficacy in treating more advanced stages. However, when degeneration is profound, first metatarsophalangeal (MTP) fusion remains the most appropriate strategy. Nevertheless, it is common for surgeons to proceed initially with cheilectomy, reserving joint fusion for subsequent considerations if cheilectomy fails. This article will explore the relationship between the 2 procedures and evaluate the research surrounding the effect of prior cheilectomy on first MTP joint arthrodesis.

Asunto(s)

Artrodesis , Hallux Rigidus , Articulación Metatarsofalángica , Humanos , Articulación Metatarsofalángica/cirugía , Artrodesis/métodos , Hallux Rigidus/cirugía , Hallux Rigidus/diagnóstico por imagen , Resultado del Tratamiento

RESUMEN

This article describes the etiology, clinical presentation, surgical management, and outcomes for treatment of the failed first metatarsophalangeal (MTP) joint arthroplasty. Failure following implant arthroplasty typically creates large osseous deficits and surgical management can be difficult. Salvage arthrodesis provides reliable joint stability while maintaining hallux length. Outcomes following conversion of a failed MTP joint arthroplasty to MTP joint arthrodesis have demonstrated consistent pain relief and high satisfaction: however, high rates of complication and nonunion have been reported. Bone graft may be necessary to fill large voids in the joint. Other revision options for failed arthroplasty have been described, but outcomes remain inconsistent and varied. Ultimately, conversion to MTP joint arthrodesis is the recommended intervention for treatment of the failed MTP arthroplasty implant, providing sufficient stability and pain relief.

Asunto(s)

Artrodesis , Articulación Metatarsofalángica , Reoperación , Humanos , Articulación Metatarsofalángica/cirugía , Artrodesis/métodos , Artrodesis/efectos adversos , Artroplastia de Reemplazo/efectos adversos , Insuficiencia del Tratamiento , Hallux Rigidus/cirugía , Hallux Rigidus/diagnóstico por imagen

RESUMEN

OBJECTIVES: This study aimed to assess clinical, functional and radiological outcomes after three-corner arthrodesis in patients suffering from symptomatic scapholunate or scaphoid non-union advanced collapsed wrists. We hypothesised that three-corner arthrodesis provided satisfactory clinical and radiological results in the long term. MATERIAL AND METHODS: This was a retrospective study of 13 patients (14 wrists) who underwent a three-corner arthrodesis between March 2004 and January 2019 with a mean follow-up of 6,7 years. Clinical assessment consisted of wrist motion, grip strength, pain and functional scores (Quick-DASH, PRWE, MWS). All complications and surgical revisions were investigated. Radiographic assessment searched for union, evaluated carpal height and ulnar translation, lunate tilt and occurrence of radio-lunate arthritis. RESULTS: At the last follow-up Quick-DASH and PRWE scores were 24,87(± 17.2) and 47.4 (± 26.9) respectively and were significantly improved. Wrist motion was 35°, 32°, 10° et 24° of flexion, extension, radial and ulnar deviation respectively. Union was obtained for 13 (92,9%) wrists. The mean radiolunate angle was 11° (-17°-34°). Three patients needed reintervention, which 2 consisted of total wrist arthrodesis due to persisting pain. Mild signs of radio-lunate arthritis were found in three patients. CONCLUSION: Three-corner arthrodesis seemed to provide satisfactory long-term functional outcomes. The union rate was high and even patients with signs of radio-lunate arthritis still had improved outcomes at the last follow-up. It could be a part of surgical options in wrists with radio- and midcarpal arthritis, among other procedures.

Asunto(s)

Artrodesis , Fracturas no Consolidadas , Hueso Semilunar , Radiografía , Rango del Movimiento Articular , Hueso Escafoides , Articulación de la Muñeca , Humanos , Artrodesis/métodos , Masculino , Femenino , Estudios Retrospectivos , Hueso Escafoides/cirugía , Hueso Escafoides/diagnóstico por imagen , Articulación de la Muñeca/cirugía , Articulación de la Muñeca/fisiopatología , Articulación de la Muñeca/diagnóstico por imagen , Persona de Mediana Edad , Estudios de Seguimiento , Resultado del Tratamiento , Adulto , Hueso Semilunar/cirugía , Hueso Semilunar/diagnóstico por imagen , Fracturas no Consolidadas/cirugía , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/fisiopatología , Fuerza de la Mano

RESUMEN

VIDEO AVAILABLE AT: https://ota.org/education/ota-online-resources/video-library-procedures-techniques/knee-arthrodesis-surgical.

Asunto(s)

Artrodesis , Articulación de la Rodilla , Humanos , Artrodesis/métodos , Articulación de la Rodilla/cirugía