Arthroscopic Subtalar Arthrodesis as a treatment strategy for Subtalar Arthritis – A Systematic Review

Background: Subtalar arthrodesis is a common salvage operation for posttraumatic subtalar arthritis. This study aimed to identify factors associated with functional outcomes and quality of life after subtalar fusion for posttraumatic subtalar arthritis after calcaneal fracture. Methods: This is a retrospective study with follow-up by questionnaire in two level 1 trauma centers. Patients who underwent subtalar arthrodesis for posttraumatic arthritis after a calcaneal fracture between 2001 and 2016 were identified and contacted for completion of a survey consisting of the Foot and Ankle Ability Measure (FAAM), Maryland Foot Score (MFS), Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire, EuroQol 5-dimensional (EQ-5D) questionnaire, and EuroQol visual analog scale (EQ-VAS). Exclusion criteria were initial subtalar arthrodesis at an outside facility, primary arthrodesis for fracture, initial arthrodesis earlier than 2001, amputation of the fused foot or leg, younger than 18 years at time of fusion, and inability to communicate in English. A total of 159 patients met our inclusion criteria. Eighty-four patients completed the questionnaires, resulting in a response rate of 59%. Results: Median FAAM score was 79 (interquartile range [IQR], 48-90), median MFS was 74 (IQR, 56-86), and median PROMIS PF was 45 (IQR, 38-51). Quality of life was significantly lower when compared to a reference population ( P = .001). Smoking was independently associated with worse outcomes. Complications after fusion (such as nonunion, implant failure, and infectious complications), high-energy trauma, and ipsilateral injury were also predictors for poorer outcomes. Conclusion: Acceptable functional outcomes and quality of life were observed after subtalar fusion. Smoking, complications after subtalar fusion, high-energy trauma, and presence of ipsilateral injuries were independently associated with worse functionality and quality of life. Level of Evidence: Prognostic level III, comparative series.

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Mini Bone Block Distraction Subtalar Arthrodesis (SAMBB) in the Management of Acquired Adult Flatfoot with Subtalar Arthritis: A Modification to the Grice–Green Procedure

Joints ◽

10.1055/s-0039-3400452 ◽

2019 ◽

Vol 07 (02) ◽

pp. 064-070 ◽

Cited By ~ 1

Author(s):

Massimiliano Mosca ◽

Silvio Caravelli ◽

Francesca Vannini ◽

Camilla Pungetti ◽

Giuseppe Catanese ◽

...

Keyword(s):

Proximal Tibia ◽

Kirschner Wire ◽

Lateral Approach ◽

Bone Block ◽

Subtalar Arthrodesis ◽

Sinus Tarsi ◽

Wide Range ◽

Subtalar Arthritis ◽

Ankle Complex ◽

Green Procedure

AbstractAdult acquired flatfoot encompasses a wide range of deformities. The goal of surgical treatment of adult acquired flatfoot is to achieve proper alignment of the hindfoot and maintain as much flexibility as possible in the foot and ankle complex; nevertheless, if subtalar arthritis is present, subtalar arthrodesis is usually mandatory. A lateral approach over the sinus tarsi is performed and subtalar joint is prepared removing remaining cartilage, reduced up to 5 degrees of heel valgus, and stabilized with a Kirschner wire. The site of insertion of the corticocancellous bone graft, harvested from the ipsilateral proximal tibia, is prepared carving a vertical groove into the talar and calcaneal edges. Additional autologous cancellous chips, harvested from the proximal tibia, can be positioned and pressed with a beater into the sinus tarsi to enhance fusion. The technique described is a modification of the extra-articular arthrodesis originally proposed by Grice. mini bone block distraction subtalar arthrodesis is a simple and effective technique which permits a subtalar fusion with a restored orientation of the hindfoot and ankle alignment in acquired flatfoot with subtalar arthritis.

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Diagnosis and Treatment of Femoral Head Osteonecrosis: A Protocol for Development of Evidence Based Clinical Practice Guidelines

10.21203/rs.3.rs-77450/v1 ◽

2020 ◽

Author(s):

Edward Cheng ◽

Michael A. Mont ◽

Stuart B. Goodman ◽

Rafael J Sierra ◽

Quanjun Cui ◽

...

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Femoral Head ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Treatment Strategy ◽

Large Scale ◽

Patient Specific ◽

Evidence Based ◽

Femoral Head Osteonecrosis

Abstract Background: There are many treatment options for patients who have osteonecrosis of the femoral head (ONFH) and management strategies vary widely both among and within individual countries. Although many researchers have attempted to elucidate the optimal strategies for managing this disease, the lack of large-scale randomized control trials and the lack of agreement on disease staging have curtailed the development of clear-cut guidelines.Methods: The Association Research Circulation Osseous (ARCO) group sought to address three questions for the management of patients who have ONFH: (1) What imaging studies are most sensitive and specific for the diagnostic evaluation of patients who have ONFH?; (2)What is the best treatment strategy for preventing disease progression in patients who have pre-collapse lesions?; and (3) What is the best treatment strategy for patients who have post-collapse disease? The PICO (Patient, Intervention, Comparison, and Outcome) format was used to formulate the search strategy for each research question. A systematic review will be performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ARCO participants have been allocated to three groups, each representing one of the PICO questions. After qualitative and quantitative analysis of the data extracted from studies pertaining to each of the three research questions, a set of evidence-based clinical practice guidelines will be proposed for the management of patients who have ONFH. Discussion: It is not always clear which treatment method is optimal for the management of ONFH. Thus, many surgeons have developed and performed various procedures based on various patient-specific factors. As there is no consensus on the optimal treatment for various stages of disease, it was clear that developing evidence-based clinical practice guidelines would provide more structure and uniformity to management of these patients. Therefore, the results of this systematic review will lead to the development guidelines that may improve patient-care strategies and result in better outcomes for patients who have ONFH.Systematic Review Registration: Registration with PROSPERO has been submitted and is pending.

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2020 IFFAS Award for Excellence Winner: Outcomes and Complications of Open versus Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00077 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0007

Author(s):

Chamnanni Rungprai ◽

Aekachai Jaroenarpornwatana ◽

Yantarat Sripanich ◽

Nusorn Chaiprom

Keyword(s):

Functional Outcomes ◽

Subtalar Joint ◽

T Test ◽

Return To Sports ◽

Subtalar Arthrodesis ◽

Sf 36 ◽

Significant Difference ◽

Subtalar Arthritis ◽

Joint Arthritis

Category: Hindfoot Introduction/Purpose: Open subtalar arthrodesis is a standard treatment for subtalar joint arthritis. Recently, posterior arthroscopic subtalar arthrodesis (PASTA) has been introduced and gained increasing popularity due to fasten recovery time and better cosmesis. However, there is limited current studies to report outcomes and complications between the two techniques. The purpose of this study is to compare outcomes and complications between open and PASTA techniques. Methods: A prospective, randomized collected data of 56 consecutive patients who were diagnosed with isolated subtalar arthritis and underwent either open (28 patients) or PASTA (28 patients) between 2016 and 2019 were enrolled in this study. The minimum follow-up time to be included in this study was 12 months. The primary outcome was union rate which was confirmed by post-operative CT scan. The secondary outcomes were union time, VAS, SF-36, FAAM, tourniquet times, and complications. A paired sample t-test was used to assess statistical differences between pre- and post-operative functional outcomes (VAS, SF-36, and FAAM) in the same group of both open and PASTA techniques while an independent t-test was used to compare functional outcomes (VAS, SF-36, and FAAM) between the two techniques. Results were significance at p < 0.05. Descriptive statistics were used for the demographic variables. Results: There were 56 patients (44 male and 12 female) with mean follow-up time was 17.7 months and 17.5 months for open and PASTA. The union time was significantly shorter in PASTA (9.4 vs 12.8 weeks, p<0.05). PASTA demonstrated significantly fasten recovery times (p<0.05 all) including time to return to ADL (8.4 vs 10.8 weeks), work (9.4 vs 12.8 weeks), and sports (9.4 vs 12.8 weeks). Both Open and PASTA techniques demonstrated significant improvement of all functional outcomes (FAAM, SF- 36, and VAS (p<0.01 all)); however, there was no significant difference between the two techniques. Other outcomes were not significant difference including tourniquet times (55.8 vs 67.2 minutes) and union rates (96.3 vs 100%) and complications. Conclusion: Both open and PASTA techniques demonstrated significant improvement of pain and function for treatment of patients with isolated subtalar joint arthritis. Although there was no significant difference of short-term of functional outcomes and complications, PASTA technique was better in term of shorten time to union and fasten time to return to sports.

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Minimally invasive subtalar arthrodesis for traumatic subtalar arthritis

Journal of International Medical Research ◽

10.1177/0300060519847814 ◽

2019 ◽

Vol 47 (12) ◽

pp. 6129-6138 ◽

Cited By ~ 1

Author(s):

Lei Sun ◽

Zhigang Kong ◽

Ming Xu

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Bone Graft ◽

Iliac Crest ◽

Operation Time ◽

Iliac Crest Bone Graft ◽

Intraoperative Blood Loss ◽

Subtalar Arthrodesis ◽

Subtalar Arthritis ◽

The Mean

Objective This study was performed to introduce a new method of minimally invasive subtalar arthrodesis (MISA) and assess its clinical effects on traumatic subtalar arthritis (TSA). Methods Fifteen patients (8 male and 7 female; age range, 36–56 years; mean age, 48.67 years) with TSA who underwent MISA were included. All patients were treated using a series instrument. The intraoperative and postoperative indexes were recorded. Results Among all patients, the mean operation time was 59.67 ± 16.31 minutes and the mean intraoperative blood loss was 43.33 ± 52.87 mL. Four patients underwent iliac crest bone graft surgery, and one patient developed a complication involving fat liquefaction of the iliac crest wound. The mean bony fusion time among all patients was 3.5 months. According to the American Orthopaedic Foot and Ankle Society standard, an excellent outcome was obtained in eight patients and a good outcome was obtained in seven patients. The operation time and intraoperative blood loss were significantly different between patients who did and did not undergo iliac crest bone graft surgery. Conclusion MISA is a simple and effective method for the treatment of TSA.

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1283 The Management of Multiple Morton’s Neuromas in the Same Foot: A Systematic Review

British Journal of Surgery ◽

10.1093/bjs/znab259.1041 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

Z Arshad ◽

A Alshawani ◽

M Bhatia

Keyword(s):

Systematic Review ◽

Treatment Strategy ◽

A Priori ◽

Treatment Strategies ◽

Current Treatment ◽

Future Research ◽

High Quality Research ◽

Computer Based ◽

Full Text Screening ◽

Optimal Treatment Strategy

Abstract Aim The optimal treatment strategy for the presentation of multiple Morton’s neuromas in adjacent intermetatarsal spaces of the same foot is yet to be determined. This systematic review aims to summarise and assess the efficacy of current treatment strategies. Method A systematic review was performed using the PRISMA guidelines. The review is registered in the international prospective register of systematic reviews (CRD42020213631). A computer-based search was completed in PubMed, Embase, Cinahl, Web of Science, Scopus and Emcare, for articles reporting the treatment of multiple neuromas in the same foot. Two authors independently performed title/abstract and full text screening according to a-priori selection criteria. Considering the four studies reporting treatment of a cohort containing both patients with a single neuroma and those with multiple neuromas, the proportion of cases in the latter group was 51/354 (14.41%). Results A total of 253 articles were identified, with 7 articles, involving 383 patients being included in the review. The most common treatment strategy reported was simultaneous neuroma excision using a single incision, whilst two studies each describe simultaneous excision with two separate incisions and delayed excision, respectively. The proportion of patients Discussion There is no strong evidence favouring use of delayed excision or multiple incisions. However, there is currently a lack of evidence focusing on this presentation of neuroma specifically. A number of studies fail to separate results of single and multiple neuroma excision. Further high-quality research is therefore required to make more definitive conclusions and future research should investigate other strategies such as non-operative treatment.

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Impact and efficacy of mobile health intervention in the management of diabetes and hypertension: a systematic review and meta-analysis

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001225 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001225

Author(s):

Yaqian Mao ◽

Wei Lin ◽

Junping Wen ◽

Gang Chen

Keyword(s):

Systematic Review ◽

Economic Development ◽

Clinical Outcomes ◽

Mobile Health ◽

Treatment Strategy ◽

Meta Analysis ◽

Developed Countries ◽

Mhealth Intervention ◽

The Impact ◽

Different Levels

With the continuous development of science and technology, mobile health (mHealth) intervention has been proposed as a treatment strategy for managing chronic diseases. In some developed countries, mHealth intervention has been proven to remarkably improve both the quality of care for patients with chronic illnesses and the clinical outcomes of these patients. However, the effectiveness of mHealth in developing countries remains unclear. Based on this fact, we conducted this systematic review and meta-analysis to evaluate the impact of mHealth on countries with different levels of economic development. To this end, we searched Pubmed, ResearchGate, Embase and Cochrane databases for articles published from January 2008 to June 2019. All of the studies included were randomized controlled trials. A meta-analysis was performed using the Stata software. A total of 51 articles (including 13 054 participants) were eligible for our systematic review and meta-analysis. We discovered that mHealth intervention did not only play a major role in improving clinical outcomes compared with conventional care, but also had a positive impact on countries with different levels of economic development. More importantly, our study also found that clinical outcomes could be ameliorated even further by combining mHealth with human intelligence rather than using mHealth intervention exclusively. According to our analytical results, mHealth intervention could be used as a treatment strategy to optimize the management of diabetes and hypertension in countries with different levels of economic development.

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