Perioperative Complications of Total Ankle Arthroplasty

2003 ◽  
Vol 24 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Kenneth Mroczek
Keyword(s):  
Soft Tissue ◽  
Tibial Component ◽  
Peroneal Nerve ◽  
Perioperative Complications ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
Soft Tissue Coverage ◽  
Ankle Arthroplasty ◽  
Group A ◽  
Group B

A retrospective radiographic and chart review was performed for the initial 50 patients who underwent Agility (DePuy, Warsaw IN) total ankle arthroplasty by the senior author (M.S.M.). The review focused on the perioperative complications of nerve or tendon lacerations, intraoperative fractures, acute deep infections, wound complications and component positioning. Major wound complications were defined as those requiring a soft-tissue coverage procedure. Minor wound complications did not require soft tissue coverage and included wound breakdowns, wound edge necrosis, and superficial infections. The immediate mortise and lateral postoperative radiographs were reviewed to measure component positioning. The patients were divided into two groups to compare the initial 25 patients (Group A) with the subsequent 25 patients (Group B). There were no major wound complications in either group. Minor wound complications decreased from six in Group A to two in Group B. There were four lacerations (flexor hallucis longus, posterior tibial tendon, deep peroneal nerve, and superficial peroneal nerve), all occurring in Group A. Five patients sustained intraoperative fractures in Group A, as compared with two fractures in Group B. The number of components varying greater than 4° from neutral as measured by the lateral talar, lateral tibial and mortise tibial component angles decreased by 9% from Group A to Group B. The only tibial component to be placed in more than 4° of valgus occurred in Group A. It seems that a notable learning curve exists in the performance of total ankle arthroplasty as demonstrated by a comparison of the initial 25 patients with the subsequent 25 patients performed by one orthopaedic surgeon. This improvement most likely resulted from the use of enhanced techniques and further training with the prosthesis. This information can be used as a teaching tool to decrease the incidence of complications for surgeons performing their initial arthroplasties with this potentially technically demanding procedure.

Perioperative Complications of HINTEGRA Total Ankle Replacement: Our Initial 50 Cases

2008 ◽  
Vol 29 (10) ◽  
pp. 978-984 ◽  
Author(s):  
Keun-Bae Lee ◽  
Sang-Gwon Cho ◽  
Chang-Ich Hur ◽  
Taek-Rim Yoon
Keyword(s):  
Tibial Component ◽  
Perioperative Complications ◽  
Skin Grafting ◽  
Total Ankle Replacement ◽  
Wound Complications ◽  
Soft Tissue Coverage ◽  
Level Of Evidence ◽  
Ankle Replacement ◽  
Group A ◽  
Group B

Background: The purpose of the present study was to report the perioperative complications that occurred among our initial 50 consecutive cases of HINTEGRA total ankle replacement. Materials and Methods: This was a retrospective study of 50 cases composed of 30 men and 18 women of average age 57 years. Perioperative complications were used to compare the first 25 cases (Group A) with the subsequent 25 (Group B). Results: Perioperative complications occurred in 15 cases (60%) in Group A but in only five (20%) in Group B. No major wound complications requiring a soft-tissue coverage procedure were encountered. Minor wound complications occurred in three cases in each group which resolved with skin grafting or topical dressing changes. One deep infection occurred in Group A, which required implant removal and antibiotic impregnated spacer prior to revision TAR. Four patients sustained intraoperative malleolus fractures in Group A, but only one in Group B. Coronal malposition of the tibial component occurred in three cases in Group A and in two in Group B. Increased sagittal slope of the tibial component occurred in two cases in Group B and sagittal malposition of the talar component occurred in two cases in Group A. There were seven instances of anterior translation of the talar component with respect to the tibial component; four in Group A and three in Group B. Conclusion: These results suggest that TAR has a steep learning curve. Moreover, knowledge of the perioperative complications of TAR may reduce the incidence of complications. Level of Evidence: III, Therapeutic Study

scholarly journals Wound Complications Due to Obesity in the Patients Undergoing Abdominal Surgery

2017 ◽  
Vol 23 (1) ◽  
Author(s):  
Ammar Rasool ◽  
Yar Muhammad ◽  
Khalid Masood Gondal ◽  
Umair Ahmed Khan
Keyword(s):  
Body Mass Index ◽  
Abdominal Surgery ◽  
Wound Infection ◽  
Body Mass ◽  
Perioperative Complications ◽  
Wound Complications ◽  
Coagulation Disorder ◽  
Obese Patients ◽  
Group A ◽  
Group B

<p>Various factors may affect the outcome of patients in perioperative period. Obesity is considered as one of these factors which increases the risk of perioperative complications. The wound complications in obese and non-obese are different.</p><p><strong>Objective:</strong><strong>  </strong>The objective of the study was to compare wound complications in obese and non-obese patients undergoing abdominal surgery.<strong></strong></p><p><strong>Methods:</strong>  This comparative study was conducted from 01- 05-2012 to 30-04-2015 on 140 patients in the department of surgery, Mayo Hospital Lahore. All these patients were divided into two groups of 70 patients each. Group A (obese) and B (nonobese) on the basis of body mass index. The patients of age less than 12 years, peritonitis, diabetes mellitus, jaundice, renal failure, coagulation disorder were excluded in both groups. All the patients had open and laparoscopic surgery by the consultant on elective list. The operative and postoperative findings and outcome in term of wound complications like wound infection, dehiscence, seroma, hernia, were noted.</p><p><strong>Results:</strong>  All the140 patients were divided into group A (obese) and B (non obese) of 70 patients each. The age ranged from 17 to 58 years and males were common (50.8%) than females (49.2%). In group A, body mass index varied from 31.9kg m<sup>-2</sup> to 39.08kg m<sup>-2</sup> and in group B from 19.3kg m<sup>-2</sup> to 23.2kg m<sup>-2</sup>. The complications in group A were wound infection in 18, dehiscence in 5, seroma in 13, and hernia 4 patients. While in group B, the complications were wound infection in 3, seroma in 5, no dehiscence and incisional hernia in one patient. The results showed that early and late wound complications are more in obese patients.</p><p><strong>Conclusion:</strong><strong>  </strong>The wound complications are significantly associated with obesity in patients undergoing abdominal surgery and are more in obese than in non obese patients.</p>

Soft-Tissue Reconstruction of Complicated Total Ankle Arthroplasty

2020 ◽  
pp. 193864002096959
Author(s):  
Sammy Othman ◽  
David L. Colen ◽  
Saïd C. Azoury ◽  
William Piwnica-Worms ◽  
John P. Fischer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Intervention ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
Soft Tissue Reconstruction ◽  
Skin Grafts ◽  
Ankle Arthroplasty ◽  
Soft Tissue Envelope ◽  
Tissue Reconstruction ◽  
Reconstructive Techniques

Background Total ankle arthroplasty (TAA) is a popular modality to treat end-stage arthritis or internal ankle derangement. Unfortunately, failure rates remain undesirably high, with severe complications, including prosthesis failure, ankle fusion, and amputation. The importance of a stable soft-tissue envelope for coverage of implant compromise has been previously described, but the predictive factors for successful salvage of complicated TAA remain poorly understood. Methods A retrospective review was conducted of patients requiring soft-tissue reconstruction following TAA wound complications. Patient demographics, history, microbiological data, reconstructive approach, and outcomes data were collected. Statistical analysis was used to abstract factors associated with unsuccessful prosthetic salvage. Results In all, 13 patients met inclusion criteria: 8 (61.5%) achieved prosthetic salvage, and 5 (38.5%) failed. The majority (90.9%) of patients presented with infected joints. Reconstructive techniques included skin grafts, dermal substitutes, locoregional flaps, and free tissue transfer. Successful prosthetic salvage was associated with shorter time intervals between wound diagnosis and index reconstructive surgical intervention (median: 20 days for salvage vs 804 days for failure; P = .014). Additionally, salvage was associated with reduced time from the index orthopaedic/podiatric surgical intervention to the index reconstructive surgery procedure (12 vs 727 days; P = .027). Conclusion The prognosis of complicated TAA requiring soft-tissue reconstruction remains poor, especially in patients who present with infected joints. Several reconstructive techniques, ranging from simple skin grafts to complex free tissue transfers, can be used successfully. Early intervention to achieve soft-tissue coverage is crucial in maximizing salvage rates in the setting of complicated and infected TAA. Level of Evidence Level IV

The Use of Soft Tissue Expanders Prior to Total Ankle Arthroplasty

2017 ◽  
Vol 10 (5) ◽  
pp. 473-479
Author(s):  
Ameya V. Save ◽  
Daniel H. Wiznia ◽  
Mike Wang ◽  
Chang-Yeon Kim ◽  
John S. Reach
Keyword(s):  
Soft Tissue ◽  
Tissue Expander ◽  
Total Ankle Arthroplasty ◽  
Soft Tissue Coverage ◽  
Ankle Arthroplasty ◽  
Tissue Expanders ◽  
Tension Free ◽  
Levels Of Evidence ◽  
Evidence Level ◽  
Free Closure

Soft tissue coverage and tension-free closure can often be challenging in patients with ankle arthropathy being considered for total ankle arthroplasty. We present 2 patients with severe posttraumatic ankle arthropathy who underwent placement of a soft tissue expander to assist with soft tissue coverage prior to total ankle arthroplasty. Levels of Evidence: Level IV

scholarly journals Non-locking buttress plate in distal tibial metaphyseal fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 87-91
Author(s):  
Norman Lamichhane ◽  
Bhogendra Bahadur KC ◽  
Chandra Bahadur Mishra ◽  
Sabita Dhakal
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Delayed Union ◽  
Full Weight Bearing ◽  
Distal Fibula ◽  
Fibula Fracture ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Metaphyseal Fractures

Background: Treatment of distal tibial metaphyseal fractures is often challenging and no single technique has been unanimously advocated. Open reduction and internal fixation with plates and screws allows better restoration of anatomical alignment but with more soft tissue complication. Simultaneous fixation of the fibula is not universally carried out. This study aims at evaluation of the outcome of plating technique and the effect of fixation of fibula fracture in treatment of distal tibial metaphyseal fractures. Material and methods: Thirty-one cases (14 cases in Group A with concomitant distal fibula fracture and 17 cases in Group B without distal fibula fracture) were analyzed retrospectively for the mean duration of full weight bearing, mean union time and complications, and compared. Results: The mean time for full weight bearing and radiological union in our study was 14.2 weeks (15.9 in Group A and 13.1 in Group B) and 23.8 weeks (26.6 in Group A and 21.5 in Group B) respectively. 16.1% of cases had post-operative complications including one case of deep infection and malalignment of 6 degree varus (following delayed union) was seen in one case of Group A. Range of motion (ROM) at ankle was not problem in any of the cases except the one delayed union which had 5 degrees of dorsiflexion and 15 degrees of plantiflexion. Conclusion: Open reduction and internal fixation with plate and screws in distal tibial metaphyseal fracture is more economic means of treatment modality with comparable incidence of post-union malalignment and union time,though more soft tissue complications compared to other modalities. Fixation of fibula fracture aids in reducing the incidence of malalignment.

Possible Implications for Bundled Payment Models of Comorbidities and Complications as Drivers of Cost in Total Ankle Arthroplasty

2018 ◽  
Vol 40 (2) ◽  
pp. 210-217 ◽  
Author(s):  
Daniel Cunningham ◽  
Vasili Karas ◽  
James K. DeOrio ◽  
James A. Nunley ◽  
Mark E. Easley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
Patient Factors ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Bundled Payment ◽  
Significance Threshold ◽  
Ed Visits

Background: The Comprehensive Care for Joint Replacement (CJR) model provides bundled payments for in-hospital and 90-day postdischarge care of patients undergoing total ankle arthroplasty (TAA). Defining patient factors associated with increased costs during TAA could help identify modifiable preoperative patient factors that could be addressed prior to the patient entering the bundle, as well as determine targets for cost reduction in postoperative care. Methods: This study is part of an institutional review board–approved single-center observational study of patients undergoing TAA from January 1, 2012, to December 15, 2016. Patients were included if they met CJR criteria for inclusion into the bundled payment model. All Medicare payments beginning at the index procedure through 90 days postoperatively were identified. Patient, operative, and postoperative characteristics were associated with costs in adjusted, multivariable analyses. One hundred thirty-seven patients met inclusion criteria for the study. Results: Cerebrovascular disease (intracranial hemorrhages, strokes, or transient ischemic attacks) was initially associated with increased costs (mean, $5595.25; 95% CI, $1710.22-$9480.28) in adjusted analyses ( P = .005), though this variable did not meet a significance threshold adjusted for multiple comparisons. Increased length of stay, discharge to a skilled nursing facility (SNF), admissions, emergency department (ED) visits, and wound complications were significant postoperative drivers of payment. Conclusion: Common comorbidities did not reliably predict increased costs. Increased length of stay, discharge to an SNF, readmission, ED visits, and wound complications were postoperative factors that considerably increased costs. Lastly, reducing the rates of SNF placement, readmission, ED visitation, and wound complications are targets for reducing costs for patients undergoing TAA. Level of Evidence: Level II, prognostic prospective cohort study.

scholarly journals Effect of Ultrasound Therapy with Cryokinetics versus Ultrasound Therapy with Soft Tissue Massage (Deep Friction Massage) in Acute Supraspinatus Tendinitis - A Comparative Study

2021 ◽  
Vol 11 (7) ◽  
pp. 249-256
Author(s):  
Pradeep Krishna Reddy ◽  
Jayashree Dey ◽  
Yashodhara S Joshi
Keyword(s):  
Soft Tissue ◽  
Analogue Scale ◽  
Ultrasound Therapy ◽  
Exclusion Criteria ◽  
Functional Scale ◽  
Analysis Group ◽  
Total Treatment ◽  
Group A ◽  
Group B ◽  
Supraspinatus Tendinitis

Background and Objective: In supraspinatus tendinitis there is inflammatory and or degenerative changes of tendon. This study was done to assess the effectiveness of ultrasound and cryokinetics versus ultrasound and soft tissue massage (deep friction massage) in patients with acute supraspinatus tendinitis. Method: All subjects were clinically diagnosed by orthopaedician and were screened as per the inclusion and exclusion criteria. 60 patients were randomly divided into 2 groups with n= 30 each group, Group A- received ultrasound therapy and cryokinetics, whereas Group B- received ultrasound therapy and soft tissue massage. The treatment was given 1 session/day, 6 days/week. The total treatment duration was for 2 weeks. Outcome Measures: Patients were evaluated on day 1, day 7 and day 14. All the patients were assessed for pain and shoulder functional scale by taking VAS and SPADI. Results: Both the groups showed statistically significant changes in pre and post values. However, Group B showed greater improvement from baseline to week 1 on VAS and SPADI. After analysis group B showed significance with P<0.001*. Conclusion: Ultrasound therapy with cryokinetics, and ultrasound therapy with soft tissue massage both were effective in reducing pain intensity and increasing the shoulder functional scale but ultrasound therapy with soft tissue massage showed superior hand over ultrasound therapy with cryokinetics. Key words: Acute Supraspinatus Tendinitis, Ultrasound Therapy, Cryokinetics, Soft Tissue Massage, Visual Analogue Scale, Shoulder Pain And Disability Index.

the value of patient hydration prior to bone scintigraphy

2003 ◽  
Vol 5 (1) ◽  
pp. 13-18
Author(s):  
s. m. stace ◽  
s. m. huggett ◽  
b. k. denton ◽  
a. m. harries
Keyword(s):  
Soft Tissue ◽  
Bone Scintigraphy ◽  
Statistical Difference ◽  
Mean Value ◽  
Regions Of Interest ◽  
Femoral Diaphysis ◽  
Post Injection ◽  
Group A ◽  
The Mean ◽  
Group B

the aim of this study was to establish whether hydration prior to radiopharmaceutical injection, in addition to post injection hydration, contributed any value to image quality during bone scintigraphy. two hundred patients referred for bone imaging over a four month period were randomised into two groups. group a was issued with instructions to hydrate pre and post injection, and group b was only advised to hydrate between injection and scan. equal regions of interest (roi) were then drawn on each image: firstly over the femoral diaphysis, and secondly over the contra-lateral adductor area. the total number of gamma counts from the bone roi and the soft tissue roi was then expressed as a ratio, and a mean value for each group was established.the mean ratio for group a was found to be 2.25, and for group b 2.30. a t test of variance confirmed that there was no statistical difference between the ratios of the groups (t = 50.272, n = 5100, p = 50.618). it was concluded that hydration levels prior to bone scintigraphy injection, where it is preserved post injection, have no significant effect on the bone-soft tissue (b:st) ratio in the image.

scholarly journals Axial Rotational Alignment of Mobile-Bearing Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0021
Author(s):  
Beat Hintermann ◽  
Lukas Zwicky ◽  
Christine Schweizer ◽  
Alexej Barg ◽  
Roxa Ruiz
Keyword(s):  
Tibial Component ◽  
Mobile Bearing ◽  
Total Ankle Arthroplasty ◽  
Axial Position ◽  
Anterior Surface ◽  
Ankle Arthroplasty ◽  
Medial Border ◽  
Wide Range ◽  
Angle Of Rotation

Category: Ankle Arthritis Introduction/Purpose: In total ankle arthroplasty (TAA), component malpositioning is a major cause of implant failure, possibly due to the altered force patterns caused by the malpositioning which are then transmitted to the bone-implant interface or neighboring joints during physiological loading. Mobile-bearing TAA with their second interface, may allow the talus to adapt its position based upon the individual anatomy. However, no data exist on the change in component positioning after implantation. It is unclear whether it is the result of initial positioning during implantation or secondary adjustments such as possible soft tissue adaptions. We aimed to determine the relative axial rotation between the talar and tibial components at the end of surgery and after a minimum of 3 years follow-up. Methods: The relative rotation between the tibial and talar components was measured in two groups. First, intraoperatively before wound closure, in a consecutive series of 58 patients (60 ankles; age 61.8 [31 to 86] years; females 25, males, 35) who underwent TAA between February and November 2018. A K-wire inserted along the medial border of the tibial component and a rectangular marker positioned at the anterior surface of PE insert were used to determine the angle of rotation. Second, in 48 patients (48 ankles; age 60.2 [31 - 82] years; females, 24; males, 24) out of 1411 patients who underwent TAA between January 2003 and December 2015, and in whom a weight-bearing CT scan was taken for evaluation at 6.3 (range, 3.0 -16.3) years. The medial border of the tibial component and a perpendicular line to the anterior surface of the PE insert were used to determine the angle of rotation. Results: The angle of rotation, thus the relative position of the talar component compared to the tibial component, did not differ between the two groups (p = 0.2). While the talus was internally rotated by 1.7 (range, -14.0 - 14.0) degrees at the end of surgery, it was internally rotated by 1.5 (range, -13.0 – 19.5) degrees after a minimum follow-up of 3 years (Figure 1). Conclusion: Although there was no significant difference in average axial position measured intraoperatively compared to a 3- years follow-up, there was a wide range of rotational measurements. The possibility of the talar component to find its position as given by individual anatomy may be crucial in TAA to avoid non-physiological joint loads and shear forces which may otherwise result in increased PE wear. Due to the wide range of measurements, our data suggests that axial talar rotation cannot be predicted preoperatively or intraoperatively by surgical techniques that reference the transtibial axis, tibial tuberosity and transmalleolar axis as guidance for tibial component positioning.

scholarly journals The Role of Lateral Soft Tissue Release for the Treatment of Hallux Valgus with Distal Chevron Osteotomy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0051
Author(s):  
Zhijian Wang ◽  
Tao Zhong
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Soft Tissue Release ◽  
Aofas Score ◽  
Chevron Osteotomy ◽  
Valgus Angle ◽  
Group A ◽  
Group B

Category: Bunion Introduction/Purpose: To define the effect of distal chevron osteotomy with and without lateral soft tissue release for the correction of mild and moderate hallux valgus. Methods: 24 consecutive patients were enrolled in this prospective study. In Group A, 12 patients underwent a chevron osteotomy only. In Group B, 12 patients underwent a chevron osteotomy with lateral soft tissue release. The hallux valgus angle (HVA) and intermetatarsalangle (IMA), and AOFAS score were measured preoperatively, and 6-month follow up postoperatively and complications were evaluated. Results and complications were evaluated. Results: The change in HVA, IMA and AOFAS score were insignificant (p > 0.05) between Group A and Group B. Complications of digital neuritis and cosmetically dissatisfied scarring of the dorsal web space were seen only in Group B. No cases had avascular necrosis of the metatarsal head, malunion or nonunion. Conclusion: Lateral soft tissue release may not be needed for mild or moderate hallux valgus deformities which may prevent neuritis of dorsal or plantar lateral digital nerve and cosmetic dissatisfaction of adorsal scar.

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