The influence of foot and ankle injury patterns and treatment delays on outcomes in a tertiary hospital; a one-year prospective observation

Category: Ankle Arthritis Introduction/Purpose: Modern total ankle arthroplasties (TAAs) have demonstrated improved survival rates at early- and mid-term follow-up, with revision rates ranging from 4 to 8% at five years. The INFINITY total ankle system (Wright Medical Technology, Arlington, TN) was first used in the United States in 2014. Its advantages include the ability to use patient-specific instrumentation and the option to choose between talar dome resurfacing and flat-cut talar components. While this implant is currently popular in the United States, clinical outcomes have not yet been reported. Our aim was to identify the rate of early revision among patients receiving the INFINITY prosthesis. Methods: Patients from two prospectively-collected databases at the authors’ institution were screened for inclusion in the present study. All patients who underwent a primary TAA with the INFINITY prosthesis and who were at least one year postoperative were included. All surgeries were performed by one of two orthopaedic foot and ankle surgeons with extensive experience in total ankle arthroplasty. The primary outcome was the need for revision surgery, which was defined as removal of one or both metal components. Peri-implant lucency at most recent follow-up was a secondary outcome. Anteroposterior and lateral radiographs at most recent follow-up were graded for lucency independently by two reviewers, both orthopaedic foot and ankle fellows, for individual peri-implant zones (Figure). Each zone was only considered “lucent” if recorded as such by both reviewers. Results: 160 patients underwent TAA with the INFINITY prosthesis between August 2014 and November 2016 with a mean 20 months of follow-up (range, 12-37). Six patients were lost to follow-up. Sixteen patients (10%) underwent revision a mean 1.2 years postoperatively. Revision was performed most commonly for tibial component loosening (seven patients, 4.4%) and deep infection (five patients, 3.1%). Of cases with tibial loosening, progressive lucency and/or subsidence was obvious radiographically in four patients; one patient had equivocal radiographs but loosening was suggested on single-photon emission computed tomography; and two patients revised for persistent pain had loosening confirmed intraoperatively. Of the 108 patients with retained components and at least one year of radiographic follow-up, eight (7.4%) had global lucency around the tibial component at most recent follow-up. Conclusion: Our initial review of patients undergoing TAA with the INFINITY prosthesis demonstrates an elevated early revision rate due to tibial component loosening. The reasons for this finding remain unclear, but could possibly include inadequate bony purchase of the implant’s three prongs, particularly in patients with large preoperative deformities or with imperfect component alignment. We plan to further investigate the possible reasons for this finding in the future by assessing additional patient factors, including age, sex, arthritis type, tobacco use, pre- and postoperative coronal and sagittal alignment, and presence of ipsilateral hindfoot fusion.

Download Full-text

Occurrence and Risk Factors of Renal Artery Stenosis in Patients Undergoing Abdominal Computed Tomography Angiography, a One-Year Study in a Tertiary Hospital in Manila

Journal of Medicine, University of Santo Tomas ◽

10.35460/2546-1621.2019-0002 ◽

2020 ◽

Vol 4 (1) ◽

pp. 448-454

Author(s):

Francis Angelo D Basilio

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Renal Artery ◽

Renal Artery Stenosis ◽

Computed Tomography Angiography ◽

Tertiary Hospital ◽

Artery Stenosis ◽

Abdominal Computed Tomography ◽

One Year

Download Full-text

Journal of Foot and Ankle Research, one year on

Journal of Foot and Ankle Research ◽

10.1186/1757-1146-2-31 ◽

2009 ◽

Vol 2 (1) ◽

Author(s):

Mike J Potter ◽

Hylton B Menz ◽

Alan M Borthwick ◽

Karl B Landorf

Keyword(s):

Foot And Ankle ◽

Ankle Research ◽

One Year

Download Full-text

Acute Kidney Injury Patterns Following Transplantation of Steatotic Liver Allografts

Journal of Clinical Medicine ◽

10.3390/jcm9040954 ◽

2020 ◽

Vol 9 (4) ◽

pp. 954 ◽

Cited By ~ 2

Author(s):

Caroline Jadlowiec ◽

Maxwell Smith ◽

Matthew Neville ◽

Shennen Mao ◽

Dina Abdelwahab ◽

...

Keyword(s):

Acute Kidney Injury ◽

Patient Survival ◽

Kidney Injury ◽

Allograft Survival ◽

Injury Patterns ◽

Initiation Of Dialysis ◽

One Year ◽

End Stage ◽

The Impact ◽

Macrovesicular Steatosis

Background: Steatotic grafts are increasingly being used for liver transplant (LT); however, the impact of graft steatosis on renal function has not been well described. Methods: A total of 511 allografts from Mayo Clinic Arizona and Minnesota were assessed. We evaluated post-LT acute kidney injury (AKI) patterns, perioperative variables and one-year outcomes for patients receiving moderately steatotic allografts (>30% macrovesicular steatosis, n = 40) and compared them to non-steatotic graft recipients. Results: Post-LT AKI occurred in 52.5% of steatotic graft recipients versus 16.7% in non-steatotic recipients (p < 0.001). Ten percent of steatotic graft recipients required new dialysis post-LT (p = 0.003). At five years, there were no differences for AKI vs. no AKI patient survival (HR 0.95, 95% CI 0.08–10.6, p = 0.95) or allograft survival (HR 1.73, 95% CI 0.23–13.23, p = 0.59) for those using steatotic grafts. Lipopeliosis on biopsy was common in those who developed AKI (61.0% vs. 31.6%, p = 0.04), particularly when the Model for End-Stage Liver Disease (MELD) was ≥20 (88.9%; p = 0.04). Lipopeliosis was a predictor of post-LT AKI (OR 6.0, 95% CI 1.1–34.6, p = 0.04). Conclusion: One-year outcomes for moderately steatotic grafts are satisfactory; however, a higher percentage of post-LT AKI and initiation of dialysis can be expected. Presence of lipopeliosis on biopsy appears to be predictive of post-LT AKI.

Download Full-text

Prevalence of Cytomegalovirus Infection in Hospitalized Infants

Folia Medica ◽

10.2478/v10153-012-0005-5 ◽

2012 ◽

Vol 54 (4) ◽

pp. 45-52 ◽

Cited By ~ 2

Author(s):

Ivan S. Ivanov ◽

Nikolay I. Popov ◽

Rumyana I. Moshe ◽

Dora D. Terzieva ◽

Rumen S. Stefanov ◽

...

Keyword(s):

Cytomegalovirus Infection ◽

Clinical Manifestations ◽

Tertiary Hospital ◽

High Rate ◽

Cmv Infection ◽

Predictive Capacity ◽

Entire Study ◽

One Year ◽

Duration Of Breastfeeding ◽

First Year Of Life

Abstract Data on cytomegalovirus infection (CMV) prevalence and course in hospitalized infants are rather scarce, obsolete and considerably inconsistent. AIM: to determine the prevalence, rate of clinical manifestations, risk factors and predictive capacity of clinical manifestations of CMV infection in hospitalized infants during their first year of life. PATIENTS AND METHODS: All 163 infants hospitalized in the Pediatric Ward for Nonrespiratory Pathology in a tertiary hospital were serologically screened for cytomegalovirus infection for 10 months. In infants up to 6 months old that were CMV IgG (+) and CMV IgM (-) we followed up the CMV IgG concentration or compared it with that of their mothers. RESULTS: The CMV prevalence for the entire study sample was 33.1 ± 3.7% (54 seropositive out of 163 examined infants); in newborns it was 19.4 ± 6.7% (7 of 36), in infants aged 1-3 months - 23.8 ± 5.4% (15 of 63), in 4-6-month olds - 28.1 ± 8.1% (9 of 32), and in 7-12-month old - 71.9 ± 8.1% (23 of 32). The rates of clinically apparent infections in the respective groups was 33.3 ± 6.5%, 57.01 ± 20.2%, 53.3 ± 13.3%, 33.3 ± 16.6%, and 13.0 ± 7.17%. The overall rate of clinically apparent CMV infection in all 163 children was between 11.0 ± 2.5% and 17.2 ± 2.9%. The probability of CMV infection increased with age and duration of breastfeeding. Hepatitis, cerebral vasculopathy and pneumonia (alone or combined) turned out to be predictors of CMV infection, but none of these symptoms had a frequency greater than 22%. CONCLUSIONS: We found a high rate of cytomegalovirus infections in hospitalized infants less than one year of age. This infection is the reason why at least 10% of the newborns and 12% of the children aged 1 to 3 months were hospitalised. The course was clinically apparent in over half of the infected children of up to 3 months of age.

Download Full-text

Lateral versus Anterior TAR: A Prospective Cohort Pilot Study of PROs and Re-Operation Rates

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00024 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0002

Author(s):

Oliver Gagné ◽

Andrea Veljkovic ◽

Kevin Wing ◽

Murray J. Penner ◽

S.E. Younger Alastair

Keyword(s):

Pilot Study ◽

Wound Complication ◽

Deep Infection ◽

Foot And Ankle ◽

Early Results ◽

Lateral Group ◽

Sf 36 ◽

One Year ◽

The One ◽

Anterior Group

Category: Ankle, Ankle Arthritis Introduction/Purpose: Recent advances in arthroplasty for the hip and the knee have motivated modern foot and ankle research to perfect the implant and technique for the optimal total ankle replacement. Unlike in the hip where different approaches can be done with the same implants, the approach of a total ankle is intimately associated to the prosthetic design. The anterior and lateral approaches have pros and cons regarding their respective soft tissue complications, osteotomy necessity, orientation of the bone cut and gutter visualization. While both have been studied independently, very few reports have compared both in the same setting. We set out to quantify the PROs and re-operations of both groups. Methods: A prospective study was conducted from a single center between 2014 and 2018 including a total of 64 total ankles performed by one of four fellowship-trained foot and ankle surgeon. A baseline dataset of their demographic as well as baseline scores (AOS, AAS & SF-36) was documented as well as at the 6 months and yearly mark post-operatively. Re-operations were also reported and coded in the local database. The approach was determined by the surgeon’s practice preference and patients were referred to surgeons as part of a central intake. Patients were included when they had a primary TAR in the timeframe noted and had a complete dataset up to at least the one year outcome. This cohort comprised 27 anterior and 37 lateral with balanced demographic for age (95%CI 63-67 yo) and gender (47% F). The lateral group had higher COFAS type arthritis, longer intraoperative time and adjunct procedures. Results: Comparing the two groups, it was noted that the anterior group had superior SF-36 scores at the one-year post- operative mark on both the physical and mental components. The difference was statistically significant and greater than the MCID. Otherwise, the two groups had similar AOS and AAS post-operative scores that were not statistically different. A total of 8 patients had a reoperation, 7 were from the lateral cohort and 1 from the anterior approach group. The lateral group had 3 surgical debridement for deep infection/wound complication, 2 ankle gutter/HO debridement and 2 lateral hardware removal. The anterior group had one ankle gutter/ HO debridement. Two of the above patients had two re-operations and one had three. Conclusion: This prospective pilot study outlines the early results of lateral versus anterior total ankle replacements. The risk of deep infection requiring reoperation was higher in the lateral group and the SF-36 scores one year after surgery were inferior to the anterior group. The lateral cohort had however significantly more pre-operative peritalar disease which was not balanced and likely affected those results. Patient experience based on PROs (AAS, AOS) otherwise is comparable. Future studies with longer prospective data need to be considered to have the power to draw significant conclusions.

Download Full-text

Evans Osteotomy with Locked Plate with Wedge Block for Stage IIB Flat Foot

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000353 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Maria Gala Santini Araujo ◽

Nelly Carrasco ◽

Pablo Sotelano ◽

Ana Cecilia Parise ◽

Leonardo Conti ◽

...

Keyword(s):

Late Complication ◽

Wound Dehiscence ◽

Primary Objective ◽

Foot And Ankle ◽

Aofas Score ◽

Flat Foot ◽

Lateral Column ◽

Significant Difference ◽

One Year ◽

Clinical Records

Category: Hindfoot Introduction/Purpose: Elongation of the lateral column is indicated only in patients who have a flexible deformity Stage 2B of flat foot. The Evans osteotomy is performed 1.5 or 2 cm from the cuboideal calcaneal joint, and in many publications is maintained by different kind of devices. Our hypothesis is that Evans osteotomy, with blocked plates with a wedge block, without the use of bone graft, maintain the correction obtained at one year after surgery. The primary objective was to evaluate the radiological results at the postoperative year of the osteotomy Secondary objectives were to evaluate the persistence of the correction obtained between the 3 months and the year of the postoperative period and to evaluate the functional outcomes with AOFAS score. Methods: We studied a total of 12 patients, 14 feet. with stage 2 B flat foot, in all cases surgery was performed by the same specialist between March of 2011 and March of 2014 in the Service of foot and ankle of our institution. Inclusion criteria were: patients with type 2B flat foot, submitted to external column elongation, with plates blocked with a 6 to 10 mm wedge block, without the use of bone grafting, minimum follow-up of 1 year. Exclusion criteria: revision of previous surgery, another type of material used for elongation of the external column, neurological sequelae. The study was performed retrospectively through clinical records database, data collection and measurements were performed by 2 second-year Foot and ankle fellow trained in the same institution. Statistical analysis was performed with the T-student test. Results: A total of 12 patients / 14 feet were evaluated during the study period, with a diagnosis of flatfoot type 2B. The average age was 57 years (32-65 years), 11 (78.5%) were female. No statistically significant difference was observed in any of the radiographic variables measured, at 3 months and at 12 months postoperatively. The preoperative AOFAS score, was 54 points. At the first year was 93 points. Consolidation was achieved at 3 months in all cases. The complications found were 2 superficial infections and 1 wound dehiscence. As a late complication, there was only 1 case of cuboidal calcaneal osteoarthritis that did not require surgical resolution. Conclusion: Evans osteotomy for elongation of the external column provides a reproducible and reliable method to restore the normal functional stability of the midfoot and hindfoot. According to the results obtained in our work, we can conclude that the blocked plates with a wedge lock manage to preserve the corrections obtained with the Evans osteotomy in patients with type IIB flat foot. There is no need of autograft with the consequent risk of comorbidities produced by a second approach to the grafting as well as the complications that could happen with the use of allografts.

Download Full-text