Arthroscopic Ankle Arthrodesis for End-Stage Tuberculosis of the Ankle: A 2-Year Follow-Up

Total ankle replacement has become a viable alternative to ankle arthrodesis in the surgical management of advanced ankle arthritis. Total ankle replacement has generally been reserved for patients who are older and for those who will have a lower demand on the replacement. The purpose of the current study is to review patient outcomes, complications, and implant survival in patients younger than 55 years who underwent total ankle replacement at a single institution. A single-center chart and radiographic review was performed of consecutive patients who underwent total ankle replacement for treatment of end-stage ankle arthritis. All surgeries were performed by 1 of 5 fellowship-trained foot and ankle surgeons at a single institution. A total of 51 patients met inclusion criteria with a mean follow-up of 31.2 months (SD = 16.2). Implant survival was 94%, There were 7 major complications (13%) requiring an unplanned return to the operating room and 8 minor complications (15%) that resolved with conservative care. The results of this study show that total ankle replacement is a viable treatment option for patients younger than 55 years. Levels of Evidence: A retrospective case series

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The Talar Body Prosthesis Treated End Stage Ankle Arthrosis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000189 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Thos Harnroongroj

Keyword(s):

Surgical Technique ◽

Ankle Arthrodesis ◽

Total Ankle Replacement ◽

Walking Ability ◽

Prosthesis Failure ◽

Talocrural Joint ◽

Ankle Replacement ◽

End Stage

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrosis creates patient disability. Ankle arthrodesis is treatment of choice which creates ankle stiffness and arthrosis of neighboring joints. Total ankle replacement can preserve ankle motions but the results at mid and long- term follow up needed further evaluation. Talar body prosthesis (TBP) can provide long-term satisfactory foot-ankle function of the ankle sustaining talar body damages. Due to ankle biomechanics is different to hip and knee joints. So, we inserted TBP for treating end stage ankle arthrosis. The present study evaluated outcomes at 5-10 years of follow up and described surgical technique. Methods: Between 2001 and 2011, the TBPs were inserted in 23 ankle arthrosis patients. The data were reviewed. We included grade 3 Bargon and Henkemeyer radiographic grading of ankle arthrosis and deformed talar body. The patient with neurological, hip, knee, mid-foot problems which impeded walking ability and age more than 70 were excluded. The patient consisted of 13 females and 10 males. Mean age at index operation and the latest follow up were 54.70 (39-70) and 61.17 (47-75) years old. Mean BMI at the latest follow up was 25.56 kg/m2 (21.89-29.76). Surgical technique included TBP insertion with addressing and applying tensor fascia lata at the articular end of distal tibia. Pre- and the latest follow up AOFAS (American Orthopaedic Foot and Ankle Society) ankle-hindfoot score and radiographs were reviewed. Neighboring joint arthrosis was evaluated by Kellgren-Lawrence radiographic system. The data was statistically analyzed. Results: Mean follow up duration was 6.48 years (5-10 years). All 23 TBPs maintained congruent talocrural joint. There was no prosthesis failure in term of subsidence into calcaneus and prosthetic stem perforation into talar head at the last follow up. No neighboring joint arthrosis occurred according to the radiographs. The mean range of motion of last follow up was 22.17° of plantar flexion (median 22°, ranged from 15° to 29°) and 0° to 5° of dorsiflexion. The patients could perform activity daily life. Mean AOFAS ankle-hindfoot score at preoperative period and last follow up were 40 points (Median 36, Ranged from 31 to 58) and 74 points (median 75, ranged from 61 to 83), respectively. The statistical analysis showed significant improvement of the score (p<0.001). Conclusion: TBP can provide satisfactory result of ankle-hindfoot functions at 5-10 years follow up. Advantages of the prosthesis over ankle arthrodesis and total ankle replacement included preservation of the ankle motion without neighboring joint arthrosis and no prosthesis failure.

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Comparison of Total Ankle Arthroplasty and Ankle Arthrodesis in End-Stage Hemophilic Arthropathy

Foot & Ankle International ◽

10.1177/1071100720929002 ◽

2020 ◽

Vol 41 (8) ◽

pp. 937-944

Author(s):

Jungtae Ahn ◽

Myung Chul Yoo ◽

Jeunghwan Seo ◽

Moonsu Park ◽

Bi O Jeong

Keyword(s):

Ankle Arthrodesis ◽

Outcome Evaluation ◽

Total Ankle Arthroplasty ◽

Level Of Evidence ◽

Ankle Arthroplasty ◽

The Mean ◽

Retrospective Comparative Study ◽

End Stage ◽

Clinical And Radiological Results

Background: Total ankle arthroplasty (TAA) can result in excellent outcomes in patients with end-stage arthritis, but most patients with end-stage hemophilic ankle arthropathy (ESHAA) still undergo ankle arthrodesis (AA). The purpose of this study was to analyze clinical and radiological results of TAA and AA for ESHAA. Methods: A total of 29 cases (16 TAAs and 13 AAs) of painful ESHAA were included. For clinical outcome evaluation, visual analog scale (VAS) for pain, Foot Function Index (FFI), and range of motion (ROM) were analyzed. Postoperative clinical and radiological complications were also analyzed. The mean duration of follow-up was 6.8 ± 3.0 years. The mean age was 44.1 ± 9.9 years. Results: The VAS for pain was significantly improved from 5.5 ± 2.3 to 0.9 ± 1.2 ( P < .001). The FFI scale was significantly improved from 61.6% ± 15.5% to 16.6% ± 15.4% ( P < .001). In FFI disability and activity subscales, the TAA group exhibited meaningful outcomes relative to those of the AA group ( P = .012 and .036, respectively). The total ROM in the TAA group changed from 30.8 ± 12.6 degrees to 37.3 ± 12.8 degrees at final follow-up ( P = .090). Three cases of osteolysis and 1 case of heterotopic ossification were noted in the TAA group. No cases of nonunion were noted in the AA group. Progressive arthrosis of adjacent joints after AA was observed in 1 case. Conclusion: Both TAA and AA in ESHAA exhibited significant improvement in pain based on VAS and FFI scales. Compared to AA, TAA resulted in superior outcomes in FFI disability and activity subscales, suggesting that TAA may be considered as a surgical option alongside AA for ESHAA. Level of Evidence: Level III, retrospective comparative study.

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Ankle arthrodesis using computer assisted external fixator in patients with end-stage ankle arthrosis

Journal of Clinical and Investigative Surgery ◽

10.25083/2559.5555/6.2.5 ◽

2021 ◽

Vol 6 (2) ◽

pp. 116-120

Author(s):

Bulent Karslioglu ◽

◽

Ali Cagri Tekin ◽

Esra Tekin ◽

Ersin Tasatan

Keyword(s):

External Fixator ◽

Inflammatory Diseases ◽

Ankle Arthrodesis ◽

Deep Infection ◽

Bony Union ◽

Computer Assisted ◽

Aofas Score ◽

The Mean ◽

End Stage

Objective. Ankle arthrosis is an end stage disease for the ankle that happens because of posttraumatic arthropathies or inflammatory diseases. Ankle arthrodesis is the gold standard for ankle arthritis. We present the functional outcome for a mid-term follow up study of the patients who underwent trans fibular ankle arthrodesis fixated with hexapod type external fixator through a distal fibular grafting technique. Materials and Methods. A number of 18 patients with trans fibular ankle arthrodesis were included in this study, out of which 6 were female and 12 were male. The mean age at surgery was 57.6 (ranging from 45 to 73). All the patients underwent follow up for a mean follow up period of 27.5 months (ranging from 24 to 35 months). One of the patients had undergone ankle-related surgery for 9 times. The others had undergone 4 or more ankle-related surgeries. Results. Ankle fusions resulted in bony union within postoperative 4.1 months (ranging from 3 to 6 months). None of our patients had superficial or deep infection, soft tissue problems or problems about the external fixator. The mean preoperative AOFAS score was 52.4, and the postoperative AOFAS score was 78.2. We had 7 excellent (38.8%), and 11 (61.1%) good results. We had two cm shortening in 2 patients, 1.5 cm shortening in 1 patient and 1 cm in 5 patients. Conclusions. We have found this method to be useful to be applied to patients, especially to those who undergo lots of surgeries and for whom amputation is a last option.

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Adjacent Joint Arthrodesis Risk After First Metatarsophalangeal Joint Arthrodesis: A 10 Year FollowUp Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00416 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0041

Author(s):

Kar Teoh ◽

Gianluca Gonzi

Keyword(s):

Telephone Survey ◽

Metatarsophalangeal Joint ◽

Ankle Arthrodesis ◽

Demographic Information ◽

First Metatarsophalangeal Joint ◽

Secondary Osteoarthritis ◽

Clinical Workstation ◽

End Stage ◽

Time Of Operation

Category: Midfoot/Forefoot Introduction/Purpose: Arthrodesis remains the gold standard for end stage symptomatic first metatarsophalangeal (MTP) joint osteoarthritis. Based on several ankle arthrodesis studies, it is well known that adjacent joints are put under more stress leading to secondary osteoarthritis. However, the direct association between first MTPJ arthrodesis and the progression of adjacent joint arthrosis remains unclear. The purpose of this study was to determine the progression of interphalangeal (IPJ) and 1st tarsometarsal joint (1st TMT) degeneration following first MTP joint arthrodesis. Methods: All patients treated with first MTP joint arthrodesis from 2003 to 2008 were identified from our regional centre. Data was obtained from our institution’s electronic clinical workstation which included demographic information, radiographs and clinical letters. A telephone survey with a predetermined written script was carried out in patients as we were not able to obtain ethics to perform repeat radiographs. Results: A total of 166 first MTPJ arthrodesis were included with at least 10 year follow-up. We excluded patients who have moved out of region. There was a 3:1 female to male ratio, with an average age at time of operation being 63 (27- 83). 25% of the patients reported adjacent joint pain (15% at IPJ, 10% at 1st TMTJ) at final follow up. 3 (1.8%) patients required arthrodesis of adjacent joints (1 at IPJ, 2 at 1st TMTJ). Conclusion: This study improves the understanding of biomechanical impact on the foot following 1st MTPJ fusion and is helpful in the consenting process.

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Knee Kinetics and Kinematics in Patients With Ankle Arthroplasty and Ankle Arthrodesis

HSS Journal ® ◽

10.1177/15563316211007839 ◽

2021 ◽

pp. 155633162110078

Author(s):

Andrew R. Roney ◽

Andrew P. Kraszewski ◽

Constantine A. Demetracopoulos ◽

Howard J. Hillstrom ◽

Jonathan T. Deland ◽

...

Keyword(s):

Mechanical Load ◽

Ankle Arthrodesis ◽

Knee Adduction Moment ◽

Ankle Arthroplasty ◽

Walking Gait ◽

3 Dimensional ◽

Knee Kinetics ◽

End Stage ◽

Walking Speeds

Background: Previous literature suggests that patients treated with total ankle arthroplasty (TAA) versus ankle arthrodesis (AA) may have better function and lower risk for adjacent joint arthritis in the foot. Little is known on how these interventions affect proximal joints such as the knee. Questions: We sought to assess whether patients with TAA and AA exhibited altered biomechanics linked to the onset and progression of knee osteoarthritis (KOA). We used the knee adduction moment (KAM), a surrogate measure for the mechanical load experienced at the medial tibiofemoral compartment, because it is linked with the onset and progression of KOA. Methods: At a minimum of 2 years postoperatively, instrumented 3-dimensional walking gait was recorded in 10 TAA and 10 AA patients at self-selected walking speeds. TAA patients had either a Salto Talaris or INBONE prosthesis. Average first and second peak KAMs (Nm/kg), KAM impulse (Nm-s/kg), and range-of-motion (ROM, °) were calculated on both the affected and unaffected limbs for each patient. Results: There were no significant differences in the KAM’s first and second peaks, impulse, or knee ROM in any plane between the unaffected and affected limbs, or between TAA and AA. Conclusion: TAA and AA may not meaningfully affect ipsilateral knee kinetics and KAMs in short-term follow-up. This study highlights the importance of continuing to study these parameters in larger cohorts of patients with longer follow-up to determine how our treatment of end-stage ankle arthritis may affect the incidence or progression of ipsilateral KOA.

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Clinical comparison of ankle arthrodesis with distal tibial oblique osteotomy for the patient with stage 3b ankle arthritis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00476 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0047

Author(s):

Akira Taniguchi ◽

Yasuhito Tanaka ◽

Hiroaki Kurokawa ◽

Yoshinori Takakura

Keyword(s):

Social Functioning ◽

Clinical Outcomes ◽

General Health ◽

Well Being ◽

Ankle Arthrodesis ◽

Bony Union ◽

Ankle Arthritis ◽

End Stage ◽

Health And Well Being

Category: Ankle Arthritis Introduction/Purpose: Ankle arthrodesis (AA) has been applied for end-stage ankle arthritis. On the other hand, low tibial osteotomy has been applied for mild to moderate ankle arthritis, however distal tibial oblique osteotomy (DTOO) has come to be applied for end-stage arthritis and clinical results were reported to be favorable. The purpose of this study was to compare clinical outcomes after AA and DTOO. Methods: From 2011 to 2014, 37 patients with stage 3b ankle arthritis were treated surgically. In these patients, 25 whose talar tilting angle (TTW) was over 10 degrees with minimum follow-up of 1 year were investigated in this study. Seventeen patients were treated by AA and 8 were treated by DTOO. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale before surgery and at the latest follow up. The patient-based evaluation was performed at the latest follow up using Self-administered evaluation questionnaire (SAFE-Q). TTW and range of motion (ROM) of the ankle were also evaluated before surgery and at the latest follow up. In addition, rate of bony union and complications were investigated. Results: The average ages at the surgery were 60(41-77) years old in the AA group and 66(49-75) in the DTOO group. The average follow up periods were 32(15-49) months in the AA group and 29(13-52) in the DTOO group. Scores of the JSSF scale significantly improved at the latest follow up in both groups. In comparison between two groups, “Social functioning” and “General Health and Well-being” scores in SAFE-Q were significantly higher in the AA group than in the DTOO group. In contrast, ROM was higher in the DTOO group than in the AA group. There were no significant differences in TTW, bony union rate and complications. Conclusion: Ankle arthrodesis spoils the joint motion, however it restores stability and activity of the daily living, that leads to the higher levels of social functioning, general health and well-being.

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Endovascular mechanical thrombectomy and stenting in a case of central vein thrombosis

BMJ Case Reports ◽

10.1136/bcr-2020-236508 ◽

2021 ◽

Vol 14 (2) ◽

pp. e236508

Author(s):

Rajesh Vijayvergiya ◽

Navjyot Kaur ◽

Saroj K Sahoo ◽

Ashish Sharma

Keyword(s):

Mechanical Thrombectomy ◽

Transluminal Angioplasty ◽

Brachiocephalic Vein ◽

Central Vein ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Stage Renal Disease ◽

End Stage ◽

Vein Stenosis

Central vein stenosis and thrombosis are frequent in patients on haemodialysis for end-stage renal disease. Its management includes anticoagulation, systemic or catheter-directed thrombolysis, mechanical thrombectomy and percutaneous transluminal angioplasty (PTA). Use of mechanical thrombectomy in central vein thrombosis has been scarcely reported. We hereby report a case of right brachiocephalic vein thrombosis with underlying stenosis, which was successfully treated by mechanical thrombectomy followed by PTA and stenting. The patient had a favourable 10 months of follow-up.

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Coronary sinus catalase and ceruloplasmin levels predict all-cause mortality in patients with end-stage heart failure awaiting heart transplantation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1005 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

W Szczurek ◽

M Gasior ◽

M Skrzypek ◽

G Kubiak ◽

A Kuczaj ◽

...

Keyword(s):

Heart Failure ◽

Heart Transplantation ◽

Coronary Sinus ◽

Public Institution ◽

Funding Source ◽

Organ Shortage ◽

Number Of Patients ◽

End Stage ◽

Medical University

Abstract Background, As a consequence of the worldwide increase in life expectancy and due to significant progress in the pharmacological and interventional treatment of heart failure (HF), the proportion of patients that reach an advanced phase of disease is steadily growing. Hence, more and more numerous group of patients is qualified to the heart transplantation (HT), whereas the number of potential heart donors has remained invariable since years. It contributes to deepening in disproportion between the demand for organs which can possibly be transplanted and number of patients awaiting on the HT list. Therefore, accurate identification of patients who are most likely to benefit from HT is imperative due to an organ shortage and perioperative complications. Purpose The aim of this study was to identify the factors associated with reduced survival during a 1.5-year follow-up in patients with end-stage HF awating HT. Method We propectively analysed 85 adult patients with end-stage HF, who were accepted for HT at our institution between 2015 and 2016. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine the panel of oxidative stress markers. Oxidative-antioxidant balance markers included glutathione reductase (GR), glutathione peroxidase (GPx), glutathione transferase (GST), superoxide dismutase (SOD) and its mitochondrial isoenzyme (MnSOD) and cytoplasmic (Cu/ZnSOD), catalase (CAT), malondialdehyde (MDA), hydroperoxides lipid (LPH), lipofuscin (LPS), sulfhydryl groups (SH-), ceruloplasmin (CR). The study protocol was approved by the ethics committee of the Medical University of Silesia in Katowice. The endpoint of the study was mortality from any cause during a 1.5 years follow-up. Results The median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. All included patients were treated optimally in accordance with the guidelines of the European Society of Cardiology. Mortality rate during the follow-up period was 40%. Multivariate logistic regression analysis showed that ceruloplasmin (odds ratio [OR] = 0.745 [0.565–0.981], p=0.0363), catalase (OR = 0.950 [0.915–0.98], p=0.0076), as well as high creatinine levels (OR = 1.071 [1.002–1.144], p=0.0422) were risk factors for death during 1.5 year follow-up. Conclusions Coronary sinus lower ceruloplasmin and catalase levels, as well as higher creatinine level are independently associated with death during 1.5 year follow-up. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of SIlesia, Katowice, POland

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Fertility and Pregnancy in End Stage Kidney Failure Patients and after Renal Transplantation: An Update

Transplantology ◽

10.3390/transplantology2020010 ◽

2021 ◽

Vol 2 (2) ◽

pp. 92-108

Author(s):

Maurizio Salvadori ◽

Aris Tsalouchos

Keyword(s):

Renal Transplantation ◽

Time Lapse ◽

Sexual Life ◽

End Stage Kidney Disease ◽

Correct Evaluation ◽

Functional Aspects ◽

Long Term Follow Up ◽

End Stage

Sexual life and fertility are compromised in end stage kidney disease both in men and in women. Successful renal transplantation may rapidly recover fertility in the vast majority of patients. Pregnancy modifies anatomical and functional aspects in the kidney and represents a risk of sensitization that may cause acute rejection. Independently from the risks for the graft, pregnancy in kidney transplant may cause preeclampsia, gestational diabetes, preterm delivery, and low birth weight. The nephrologist has a fundamental role in correct counseling, in a correct evaluation of the mother conditions, and in establishing a correct time lapse between transplantation and conception. Additionally, careful attention must be given to the antirejection therapy, avoiding drugs that could be dangerous to the newborn. Due to the possibility of medical complications during pregnancy, a correct follow-up should be exerted. Even if pregnancy in transplant is considered a high risk one, several data and studies document that in the majority of patients, the long-term follow-up and outcomes for the graft may be similar to that of non-pregnant women.

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