Outcomes and Complications of Open vs Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study

2021 ◽  
pp. 107110072110472
Author(s):  
Chamnanni Rungprai ◽  
Aekachai Jaroenarpornwatana ◽  
Nusorn Chaiprom ◽  
Phinit Phisitkul ◽  
Yantarat Sripanich
Keyword(s):  
Functional Outcomes ◽  
Recovery Time ◽  
Subtalar Joint ◽  
Complication Rates ◽  
Union Rate ◽  
Tourniquet Time ◽  
Randomized Controlled ◽  
Subtalar Arthrodesis ◽  
Sf 36 ◽  
Joint Arthritis

Background: Open subtalar arthrodesis is the standard treatment for subtalar arthritis. Posterior arthroscopic subtalar arthrodesis (PASTA) has recently gained increasing popularity due to a shorter recovery time and better cosmesis. However, studies comparing outcomes and complications between these 2 techniques are limited. Methods: In total, 56 patients with subtalar joint arthritis were prospectively randomized to 2 parallel groups to receive either PASTA (n = 28 patients) or open subtalar arthrodesis (n = 28 patients). The minimum follow-up period was 12 months. Primary outcome was union rate confirmed on postoperative computed tomography (CT) scan. Secondary outcomes were union time; visual analog scale (VAS), Short Form–36 (SF-36), and Foot and Ankle Ability Measure (FAAM) scores; tourniquet time; and complications. Results: Union time (9.4 vs 12.8 weeks) and recovery time (time to return to activities of daily living [8.4 vs 10.8 weeks], work [10.6 vs 12.9 weeks], and sports [24.9 vs 32.7 weeks]) were significantly shorter with PASTA than with the open technique ( P < .05 all). Both techniques led to significant improvements in all functional outcomes (FAAM, SF-36, and VAS scores; P < .01 all); however, there was no significant difference between the techniques in these outcomes ( P > .05 all). Other outcomes, including tourniquet time (55.8 vs 67.2 min), union rate (96.3% vs 100%), and complication rate, were not significantly different between the techniques. Conclusion: Both open and PASTA techniques led to significant improvements in pain and function in patients with isolated subtalar joint arthritis. Although short-term functional outcomes and complication rates were not significantly different between the techniques, the PASTA technique was better at shortening the union and recovery times. Level of Evidence: Level I, prospective multicenter randomized controlled trial.

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

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.

scholarly journals Outcomes and Complications of Open Versus Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Multicenter Study

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0001
Author(s):  
Chamnanni Rungprai ◽  
Yantarat Sripanich ◽  
Aekachai Jaroenarpornwatana
Keyword(s):  
Functional Outcomes ◽  
Daily Living ◽  
Subtalar Joint ◽  
Activity Of Daily Living ◽  
Union Rate ◽  
Sf 36 ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
Joint Arthritis ◽  
Return To Activity

Category: Hindfoot; Other Introduction/Purpose: There remains a controversy for treatment of subtalar joint arthritis. Both open and arthroscopic techniques have been reported for successful treatment of subtalar arthritis; however, there is a little evidence to report prospective comparative outcomes between the two techniques. The purpose of this study was to compare clinical and functional outcomes including complications between the two techniques. Methods: A prospective, randomized collected data of 54 consecutive patients who were diagnosed with isolated subtalar joint arthritis and underwent either open (27 patients) or posterior arthroscopic (27 patients) subtalar arthrodesis between 2015 and 2019 in 2 institutions. A minimum follow-up to be included in the study was 12 months (mean, 24.2 months; range, 12 to 41 months). The primary outcome was union time. The secondary outcomes included visual analogue scale (VAS), Short Form-36 (SF-36), and FAAM, union rate, time to return to activity of daily living, sports, work, and complications. Pre- and post-operative SF-36, FAAM, and pain (Visual Analog Scale) were obtained and compared between the two groups using independent t-test and the same group with paired t-test. Results: There were 54 patients (42 male and 12 female) with mean age of 43.7 years (range, 21-68 years) and mean BMI of 25.7 kg/m2 (range, 18.3-33.6 kg/m2). Both techniques demonstrated significant improvement of post-operative functional outcomes (VAS, SF-36, and VAS (<em>p</em> < 0.001 all)) compared to pre-operative period; however, there was no significant difference between the two groups. The secondary outcomes between open and arthroscopic groups were time to return to activity of daily living (8.4 vs 10.8 weeks), works (10.6 vs 12.9 weeks), sports (24.9 vs 32.7 weeks), time to union using CT scan (9.4 vs 12.8 weeks), union rate (100% versus 96.3%), and complications included painful hardware (18.5% vs 22.2%), paresthesia (0 vs 7.4%), and no infection in both groups. Conclusion: Both open and arthroscopic techniques were demonstrated significant improvement in terms of functional outcomes as measured with the FAAM, SF-36, and VAS in patients with subtalar joint arthritis. Although there was no significant difference of short-term of functional outcomes measurement and complications, arthroscopic technique was better in term of fasten recovery time and time to union.

Neurovascular and Clinical Outcomes of the Percutaneous Endoscopically Assisted Calcaneal Osteotomy (PECO) Technique to Correct Hindfoot Malalignment

2018 ◽  
Vol 40 (2) ◽  
pp. 178-184 ◽  
Author(s):  
Andrea Veljkovic ◽  
Michael Symes ◽  
Alastair Younger ◽  
Chamnanni Rungprai ◽  
Kaniza Zahra Abbas ◽  
...  
Keyword(s):  
Wound Infection ◽  
Functional Outcomes ◽  
Sural Nerve ◽  
Short Form ◽  
Wound Complications ◽  
Foot Deformities ◽  
Complication Rates ◽  
Calcaneal Osteotomy ◽  
Sf 36 ◽  
Preoperative Status

Background: Standard open calcaneal osteotomies to correct hindfoot malalignment have been associated with high complication rates, including nerve damage and wound infection. This has resulted in the development of minimally invasive techniques such as the percutaneous endoscopically assisted calcaneal osteotomy (PECO), which in cadaver studies has been shown to be potentially safer than open surgeries. The aim of this study was to demonstrate the safety and effectiveness of PECO in a clinical setting, with regard to neurovascular injury rates, infection, and short-term radiographic and functional outcomes. Methods: Forty-one (41) patients with planovalgus or cavovarus foot deformities underwent treatment using PECO. Outcomes were analyzed at 6 months and primarily included neurovascular outcomes and wound infection rates. Secondarily, radiographic and functional (visual analog scale for pain [VAS], 36-Item Short Form Medical Outcomes Survey [SF-36], and Foot Function Index [FFI] scores) outcomes were also assessed. Results: There were no reported cases of superficial wound infections, lateral calcaneal or sural nerve dysesthesia. Minor complications occurred in 6/41 feet. The mean postoperative hindfoot correction was 8.3 ± 2.2 mm (range: 6-15mm) compared to preoperative status. Compared to preoperative status, significant improvements ( P = .001 for all) were seen in the VAS, SF-36, and FFI at 6 months postoperatively. Conclusions: PECO resulted in minimal complications with no lateral calcaneal or sural nerve dysesthesias and no wound complications. It also resulted in significant improvements in postoperative radiographic and functional outcomes from baseline to 6-months postoperatively, demonstrating its use as a safe and effective means of treating hindfoot malalignment. Level of Evidence: Level IV, retrospective case series.

Outcomes of Posterior Arthroscopic Subtalar Arthrodesis for Medial Facet Talocalcaneal Coalition

2021 ◽  
pp. 107110072110272
Author(s):  
Daniel Saraiva ◽  
Markus Knupp ◽  
André Sá Rodrigues ◽  
Tiago Mota Gomes ◽  
Xavier Martin Oliva
Keyword(s):  
Subtalar Joint ◽  
Adult Patients ◽  
Painful Condition ◽  
Hindfoot Alignment ◽  
Subtalar Arthrodesis ◽  
Radiographic Outcomes ◽  
Talocalcaneal Coalition ◽  
Sf 36 ◽  
Screw Breakage

Background: Medial facet talocalcaneal coalition can be a painful condition. This study aimed to determine clinical and radiographic outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, with a minimal follow-up of 18 months. Methods: Between June 2017 and July 2019, this procedure was performed on 8 feet (8 patients; mean age, 55 [42-70] years; mean BMI, 29.8 [24.4-45.0] kg/m2). Clinical assessment was performed using Visual Analog Scale for Pain (VAS-P), Foot and Ankle Outcome Score (FAOS) and the 36-Item Short-Form Health Survey (SF-36). Patient satisfaction was assessed at the last available follow-up as “very satisfied”, “satisfied” or “unsatisfied”. Radiographic analysis was performed using plain radiography, computed tomography (CT) scan and magnetic resonance imaging (MRI). The primary outcome was to determine both clinical and radiographic outcomes. Results: The mean follow-up was 25.1 (18.2-34.2) months. The authors found statistically significant improvement on all clinical scores (VASP-P, FAOS and SF-36). They registered 6 “very satisfied” patients, 2 “satisfied” patients and no “unsatisfied” patient. Fusion of the subtalar joint was observed in all patients by 12 weeks and in 5 of them as soon as 8 weeks postoperatively (mean, 9.5 [8-12] weeks). There were no cases of delayed fusion or nonunion of the subtalar joint, superficial or deep infection, neurovascular damage, thromboembolic event, screw breakage, need for hardware removal or revision surgery. Conclusion: This study found that PASTA is a safe and reliable technique for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, demonstrating and maintaining clinical improvement at an average follow-up of 2 years. Level of Evidence: Level IV, case series.

scholarly journals TL 18097 - Role of bone graft and bone graft substitutes in isolated subtalar joint arthrodesis

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 80S
Author(s):  
Alexandre Leme Godoy-Santos ◽  
Ibukunoluwa Araoye ◽  
Osama Elattar ◽  
Sameer Naranje ◽  
Cesar de Cesar Netto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bone Graft ◽  
Subtalar Joint ◽  
Bone Grafts ◽  
Union Rate ◽  
Subtalar Arthrodesis ◽  
Significant Difference ◽  
Subtalar Arthritis ◽  
Bone Graft Substitutes

Introduction: Subtalar joint (STJ) arthrodesis is a well-established operative procedure in the treatment of subtalar arthritis and hindfoot deformities. Nonunion remains an important complication, with an incidence and role of risk factors varying in the literature. Recent reports have highlighted a decrease in overall union rates between 96% and 100% to 84%, further strengthening the need for an understanding of risk factors that may be implicated in nonunion rates. Some possible factors have been identified, including smoking, revision surgery, the presence and extent of devascularized bone, and previous ankle joint fusion. Current practice suggests that using bone grafts or bone graft substitutes decreases the risk of its occurrence. Objective: To compare union rates of isolated subtalar arthrodesis with and without the use of bone grafts or bone graft substitutes. Methods: We retrospectively reviewed 135 subtalar fusions with a mean follow-up of 18 ± 14 months. The standard approach was used for all operations. Graft materials included β-tricalcium phosphate, demineralized bone matrix, iliac crest autograft and allograft and allograft cancellous chips. Successful subtalar fusion was determined clinically and radiographically. Results: There was an 88% (37/42) union rate without graft and an 83% (78/93) union rate with bone graft use. The odds ratio of union for graft versus no graft was 0.703 (95% CI, 0.237-2.08). The average time to union in the graft group was 3 ± 0.73 months and 3 ± 0.86 in the nongraft group, with no statistically significant difference detected (p = 0.56). Conclusion: Graft use did not improve union rates for subtalar arthrodesis.

scholarly journals Does Patient Positioning and Portal Placement for Arthroscopic Subtalar Arthrodesis Matter?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0043
Author(s):  
Alan Shamrock ◽  
Natalie Glass ◽  
Keith Shamrock ◽  
Chris Cychosz ◽  
Kyle Duchman
Keyword(s):  
Prone Position ◽  
Subtalar Joint ◽  
Patient Positioning ◽  
Comfort Level ◽  
Complication Rates ◽  
Arthroscopic Procedure ◽  
Subtalar Arthrodesis ◽  
Lateral Group ◽  
Surgeon Experience ◽  
Portal Placement

Category: Arthroscopy Introduction/Purpose: Arthroscopic subtalar joint arthrodesis was first described over two decades ago. The procedure was originally performed with the patient in the lateral decubitus or supine position using anterolateral and posterolateral portals based on the fibula. More recently, several authors have advocated for prone positioning utilizing posteromedial and posterolateral portals. Proponents of the prone position cite improved intra-articular visualization with limited need for traction and more thorough preparation of the posterior facet. Multiple studies have compared arthroscopic to open subtalar arthrodesis and demonstrated similar fusion rates, lower morbidity, and a high level of patient satisfaction with the arthroscopic procedure. To our knowledge, this is the first study investigating how patient positioning and portal placement affects outcomes and morbidity for the arthroscopic procedure. Methods: A systematic review was performed according to PRISMA guidelines utilizing PubMed and Embase. All original studies with reported complication rates for arthroscopic subtalar arthrodesis were included. Two independent reviewers collected patient demographic data, operative positioning, complications, and outcomes including time to fusion and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Patients were placed into the prone group if they were positioned prone with posterior portals or the lateral group if they underwent lateral portal placement. The rate of complications related to portal placement, nonunion rate, rate of painful hardware, and rate of revision were also recorded. The proportions of patients with specific complications in each group were determined and transformed using the Freeman-Tukey double-arcsine method to stabilize variances. Heterogeneity across studies was present as determined using the Q and I2 statistics or likelihood ratio test. Inverse-variance weighted random-effects models were used to evaluate the pooled estimates using R software. Results: A total of 484 feet in 468 patients with a mean follow-up of 36.1 months were included for analysis. Thirteen studies examined patients in the prone position (n=302) and seven articles looked at lateral portals (n=182). Mean AOFAS scores improved from 46.3 to 81.6 following surgery. Fusion was seen in 95.8% of feet at a mean of 10.9 weeks. The total complication rate was similar (p=0.620) between the prone (18.2%) and lateral (17.6%) groups. There was no difference observed in the rate of complications secondary to portal placement (p=0.919), rate of painful hardware (p=0.534), and revision rate (p=0.400) between the two groups. The prone group sustained 20 nonunions (6.6%) which was significantly more than the 2 nonunions (1.1%) found in the lateral group (p=0.039). Conclusion: Arthroscopic subtalar arthrodesis is an effective treatment option for subtalar joint pathology. We found a higher rate of nonunion when the patient is positioned prone and the arthroscopic portals are placed posteriorly. There was no difference in the rate of nerve/tendon injury, painful hardware, and revision surgery. AOFAS scores were improved regardless of portal placement. Limitations of our study include the variability in fusion hardware and use of bone graft for fusion augmentation between studies. We also were unable to account for surgeon experience, operative volume, and comfort level with the procedure. Further large scale prospective studies are warranted.

scholarly journals Early results of patellofemoral inlay resurfacing arthroplasty using the HemiCap Wave prosthesis

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901769270 ◽  
Author(s):  
Akash Patel ◽  
Zakir Haider ◽  
Amarjit Anand ◽  
Dominic Spicer
Keyword(s):  
Disease Progression ◽  
Functional Outcomes ◽  
Short Form ◽  
Oxford Knee Score ◽  
Published Data ◽  
Complication Rates ◽  
Patellofemoral Osteoarthritis ◽  
Resurfacing Arthroplasty ◽  
Early Results ◽  
Sf 36

Background: Common surgical treatment options for isolated patellofemoral osteoarthritis include arthroscopic procedures, total knee replacement and patellofemoral replacement. The HemiCap Wave patellofemoral resurfacing prosthesis is a novel inlay design introduced in 2009 with scarce published data on its functional outcomes. We aim to prospectively evaluate early functional outcomes and complications, for patients undergoing a novel inlay resurfacing arthroplasty for isolated patellofemoral arthrosis in an independent centre. Methods: From 2010 to 2013, 16 consecutive patients underwent patellofemoral resurfacing procedures using HemiCap Wave (Arthrosurface Inc., Franklin, Massachusetts, USA) for anterior knee pain with confirmed radiologically and/or arthroscopically isolated severe patellofemoral arthrosis. Standardized surgical technique, as recommended by the implant manufacturer, was followed. Outcome measures included range of movement, functional knee scores (Oxford Knee Score (OKS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Short Form-36 (SF-36)), radiographic disease progression, revision rates and complications. Results: Eight men and eight women underwent patellofemoral HemiCap Wave resurfacing, with an average age of 63 years (range: 46–83). Average follow-up was 24.1 months (6–34). Overall, post-operative scores were excellent. There was a statistically significant improvement in the post-operative OKS, KOOS and SF-36 scores ( p < 0.01). One patient had radiological disease progression. One patient underwent revision for deep infection. Two other minor complications were observed and treated conservatively. Conclusions: The HemiCap Wave patellofemoral resurfacing prosthesis has excellent early results in terms of functional outcomes, radiological outcomes and low complication rates. At the very least, early results show that the HemiCap Wave is comparable to more established onlay prostheses. The HemiCap Wave thus provides a safe and effective surgical option in the treatment of isolated patellofemoral osteoarthritis in selected patients.

scholarly journals Case Series: Allograft Tibiotalocalcaneal Arthrodesis Utilizing Fresh Talus

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141983454
Author(s):  
Joshua Vaughn ◽  
Kenneth W. DeFontes ◽  
Cornelia Keyser ◽  
Eric M. Bluman ◽  
Jeremy T. Smith
Keyword(s):  
Femoral Head ◽  
Functional Outcomes ◽  
Case Series ◽  
High Rate ◽  
Diabetic Patients ◽  
Union Rate ◽  
Level Of Evidence ◽  
Difficult Condition ◽  
Sf 36 ◽  
Rate Of Failure

Background: Talar body osteonecrosis can be a difficult condition to treat. Recent reports highlight a high rate of failure with the use of femoral head allograft. Additionally, higher rates of failure have been reported in diabetics and smokers. Our institution attempted a novel technique utilizing fresh allograft talus in attempt to improve on a reported 50% nonunion rate. Methods: Five patients who underwent tibiotalocalcaneal (TTC) fusion utilizing fresh talar allograft were clinically and radiographically reviewed to evaluate fusion rates and functional outcomes. Results: Our case series of 5 patients had a 100% union rate, including 2 former smokers and 2 diabetic patients. There were no infections or complications. Functional outcomes also improved in our series of patients postoperatively as noted by their FAAM and SF-36 scores. Conclusion: TTC fusion using fresh allograft talus has a higher union rate than reported with femoral head allograft. This case series requires further study to evaluate whether this technique can be used beyond patients with osteonecrosis of the talus. Level of Evidence: Level IV, case series.

scholarly journals Colonic J-pouch versus side-to-end anastomosis for rectal cancer: a systematic review and meta-analysis of randomized controlled trials

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zheng Wang
Keyword(s):  
Rectal Cancer ◽  
Randomized Controlled Trials ◽  
Surgical Outcomes ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Controlled Study ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Sf 36 ◽  
J Pouch

Abstract Background This study aims to compare colonic J-pouch and side-to-end anastomosis for rectal cancer in terms of surgical and bowel functional outcomes and quality of life (QoL). Methods A systematic literature search was performed in PubMed, Embase and Cochrane. The last search was performed on March 28, 2021. All randomized controlled trials comparing colonic J-pouch with side-to-end anastomosis for rectal cancer were enrolled. The main outcomes were bowel functional outcomes and QoL. The secondary outcomes were surgical outcomes including operative time, postoperative hospital stay, complications, and mortality. Results Nine articles incorporating 7 trials with a total of 696 patients (330 by J-pouch and 366 by side-to-end) were enrolled in this meta-analysis. The bowel functional outcomes were comparable between J-pouch and side-to-end groups in terms of stool frequency, urgency, and incomplete defecation at the short term (< 8 months), medium term (8–18 months), and long term (> 18 months) follow up evaluations. No difference was observed between groups with regards to QoL (SF-36: physical function, social function, and general health perception). Besides, surgical outcomes were also similar in two groups. Conclusion The currently limited evidence suggests that colonic J-pouch and side-to-end anastomosis are comparable in terms of bowel functional outcomes, QoL, and surgical outcomes. Surgeons may choose either of the two techniques for anastomosis. A large sample randomized controlled study comparing colonic J-pouch and side-to-end anastomosis for rectal cancer is warranted.

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