scholarly journals Sagittal Alignment in Fixed Bearing Total Ankle Replacements

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Natalie Nielsen ◽  
Austin Sanders ◽  
Joseph Nguyen ◽  
Constantine Demetracopoulos
Keyword(s):  
Sagittal Alignment ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Postoperative Outcome ◽  
Mobile Bearing ◽  
Patient Reported Outcome ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Patient Reported ◽  
Outcome Scores

Category: Ankle Arthritis Introduction/Purpose: Placement of the talar component in total ankle replacement (TAR) is technically challenging and malposition can occur. Implant alignment can affect both contact stresses at the articulation of the prosthesis, as well as forces at the bone implant interface, and survivorship of the implant. In mobile bearing implants, postoperative pain relief and functional outcome correlates with sagittal position of the talar component. The purpose of this study is to evaluate the sagittal alignment of the talar component between two fixed bearing total ankle replacements and determine the effect of alignment on patient outcomes. Methods: We performed a retrospective review of total ankle replacements at a single institution over a seven-year period. Seventy-one patients who underwent a fixed bearing TAR (Salto Talaris, Integra LifeSciences, and INBONE, Wright Medical) with two year minimum followup were included. Preoperative and one year postoperative radiographs were assessed to determine sagittal alignment of the talar component. The preoperative sagittal alignment was measured as the tibial-axis-to-talus ratio (T-T ratio) and the postoperative sagittal alignment was measured as the A-P offset ratio. Postoperative sagittal alignment was categorized as neutral (A-P offset ratio <0.1, N=39) or anterior (A-P offset ratio >0.1, N=32). Functional outcomes were assessed at 2 years utilizing SF12 scores and the FAOS outcome score, which has been previously validated for ankle arthritis. Differences in sagittal alignment between the two implant types and differences in postoperative outcome scores were assessed using T-tests. Interobserver reliability was assessed using intraclass correlation coefficient. Results: Interobserver reliability for the preoperative sagittal alignment using the T-T ratio had very good agreement, while the postoperative A-P offset measurement had only fair/moderate agreement. Preoperatively, there was no difference in the T-T ratio amongst patients receiving a Salto Talaris or INBONE implant. Postoperatively, patients with a Salto Talaris implant have a greater AP offset ratio than patients with an INBONE implant (p <0.01). There was no difference in FAOS or SF12 MCS/PCS scores between postoperative neutral and anterior sagittal alignment groups. Conclusion: Preoperative sagittal alignment can be reliably assessed using the T-T offset ratio. The A-P offset ratio is somewhat less reliable as a measure of postoperative sagittal alignment in fixed bearing implants. Patients with INBONE implants had more neutral sagittal alignment postoperatively. Differences in alignment between the two implants may relate to anterior-posterior coverage of the tibial component and the fixed bearing nature of the prostheses. Patient reported outcome scores did not differ between neutral and anterior sagittal alignment groups.

scholarly journals Hindfoot Alignment after Total Ankle Replacement

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0000
Author(s):  
Christopher E. Gross ◽  
Federico Guiseppe Usuelli ◽  
Christian Indino
Keyword(s):  
Sagittal Alignment ◽  
Mobile Bearing ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Hindfoot Alignment ◽  
Time Points ◽  
Ankle Replacement ◽  
Temporal Course ◽  
Over Time

Category: Ankle Arthritis; Ankle Introduction/Purpose: End-stage ankle arthritis can involve misalignment of the ankle in both the coronal and sagittal planes as up to reported 33% to 44% of patients who present for total ankle replacement have greater than 10° of coronal plane deformity. Improvements in both the design and surgical technique for total ankle replacements (TAR) have allowed surgeons to tackle the most challenging of multiplanar ankle deformities. Normalization of the sagittal and coronal alignment is key in improving survivorship and functional outcomes in TAR. In the present study, we analyzed how both the ankle and hindfoot alignment for both a fixed-bearing and mobile bearing TAR system changes over time. Specifically, we measured coronal and sagittal alignment of both the ankle and hindfoot complex. We hypothesize that both significant differences would be seen between all time points and pre-operative radiographs, and that these differences would not change over time. Methods: A retrospective study performed by a single orthopaedic surgeon was performed on two independent groups of patients undergoing two different systems for total ankle replacement: Zimmer TAR (lateral-approach, fixed-bearing, n=89) and Hintegra (anterior approach, mobile-bearing, n=81). We noted specific demographic data and radiographic data were measured including: Hindfoot alignment view angle (HAV), Hindfoot alignment distance (HAVD), tibiotalar ratio, α angle and β angle. These were measured pre-operatively, and 6 months, 12 months, and 24 months post-operatively. Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points, e.g. T0vsT6vsT12vsT24) within the Hintegra and Zimmer groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed for SA, SD, TT ratio, α and β angle. Specifically, time*group interaction was tested. Results: At the ankle joint itself, as measured by the α and β angles (p>.05), the position of the components remains relatively similar in both the fixed and mobile bearing TAR over the course of 24 months. The sagittal alignment, as measured by the TT ratio, demonstrated a posterior shifting of the talus in the mobile bearing group (p=.036). Though the fixed and mobile- bearing TAR had both significant hindfoot alignment improvement between the pre-op radiographs and twenty-four months, over time, the fixed-bearing ankle had a significant increase in both the HAV and HAVD (p<.001), suggesting a dynamism of the hindfoot in the fixed-bearing ankle. Conclusion: Correcting coronal and sagittal alignment is important for the long-term survivorship of a TAR. The fixed and mobile-bearing implants had maintained coronal and sagittal alignment in the short term, the temporal course of the fixed-bearing ankle showed an increased in the valgus positioning of the hindfoot.

scholarly journals Hindfoot Alignment after Total Ankle Replacement

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0018
Author(s):  
Christopher Gross ◽  
Luigi Manzi ◽  
Cristian Indino ◽  
Fausto Romano ◽  
Camilla Maccario ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Mobile Bearing ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Hindfoot Alignment ◽  
Time Points ◽  
Ankle Replacement ◽  
Temporal Course ◽  
Over Time

Category: Ankle, Ankle Arthritis Introduction/Purpose: End-stage ankle arthritis can involve misalignment of the ankle in both the coronal and sagittal planes as up to reported 33% to 44% of patients who present for total ankle replacement have greater than 10° of coronal plane deformity. Normalization of the sagittal and coronal alignment is key in improving survivorship and functional outcomes in TAR. In the present study, we analyzed how both the ankle and hindfoot alignment for both a fixed-bearing and mobile bearing TAR system changes over time. Specifically, we measured coronal and sagittal alignment of both the ankle and hindfoot complex. We hypothesize that both significant differences would be seen between all time points and pre-operative radiographs, and that these differences would not change over time. Methods: A retrospective study performed by a single orthopaedic surgeon was performed on two independent groups of patients undergoing two different systems for total ankle replacement: Zimmer TAR (lateral-approach, fixed-bearing, n=89) and Hintegra (anterior approach, mobile-bearing, n=81). We noted specific demographic data and radiographic data were measured including: Hindfoot alignment view angle (HAV), Hindfoot alignment distance (HAVD), tibiotalar ratio, a angle and ß angle. These were measured pre-operatively, and 6 months, 12 months, and 24 months post-operatively. Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points, e.g. T0vsT6vsT12vsT24) within the Hintegra and Zimmer groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed for SA, SD, TT ratio, a and ß angle. Specifically, time*group interaction was tested. Results: At the ankle joint itself, as measured by the a and ß angles (p>.05), the position of the components remains relatively similar in both the fixed and mobile bearing TAR over the course of 24 months. The sagittal alignment, as measured by the TT ratio, demonstrated a posterior shifting of the talus in the mobile bearing group (p=.036). Though the fixed and mobile-bearing TARhad both significant hindfoot alignment improvement between the pre-op radiographs and twenty-four months, over time, the fixed-bearing ankle had a significant increase in both the HAV and HAVD (p<.001), suggesting a dynamism of the hindfoot in the fixed-bearing ankle. Conclusion: Correcting coronal and sagittal alignment is important for the long-term survivorship of a TAR. The fixed and mobile-bearing implants had maintained coronal and sagittal alignment in the short term, the temporal course of the fixed-bearing ankle showed an increased in the valgus positioning of the hindfoot. The mobile-bearing implant maintained its hindfoot alignment over the course of the study. More studies are needed to explore the clinical implications of this new data.

scholarly journals Correlation of patient-reported numbness around surgical scars with patient-reported outcome measures and joint awareness after knee replacement: a cohort study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Masafumi Itoh ◽  
Junya Itou ◽  
Umito Kuwashima ◽  
Ken Okazaki
Keyword(s):  
Outcome Measures ◽  
Knee Replacement ◽  
Intraclass Correlation ◽  
Postoperative Outcome ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Knee Replacements ◽  
A Minor ◽  
End Stage

Abstract Background Knee replacement is a very effective and indispensable treatment option for end-stage knee arthritis, and the number of cases has been increasing worldwide. A replaced knee joint without patient joint awareness is thought to be the ultimate goal of artificial knees. Joint awareness reportedly correlates with patient satisfaction. Although numbness around a replaced knee is a minor but common problem, its effect on postoperative outcome is controversial. Joint awareness also is sensitive to subtle abnormalities of the joint, so it must be negatively affected by numbness. Although numbness is minor, it cannot be ignored to further improve knee replacement outcomes. This study investigated the relationship between patient-reported numbness and other patient-reported outcome measures (PROMs), including joint awareness, and kneeling. We developed a numbness score based on a 5-point Likert scale on frequency of numbness, with an intraclass correlation coefficient of 0.76 and higher scores indicating less numbness. Methods The numbness score, New Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS), Forgotten Joint Score-12 (FJS-12), and other clinical and radiological data from 311 patients (394 primary knee replacements) were analyzed. Kneeling ability was evaluated by using kneeling-specific items in the KSS (KSS-Kneeling). Results No numbness was found in 170 knees (43.1%), and some degree of numbness was found in the remaining 224 knees (56.9%). The numbness score showed weak-to-moderate correlations with KSS-Symptoms (r = 0.44), KSS-Satisfaction (r = 0.41), KSS-Activities (r = 0.29), and all KOOS subscales (r = 0.23–0.44), and FJS-12 (r = 0.42). Multiple regression analyses suggested that midline incision positively affected the numbness score over the anteromedial incision (p = 0.04) and that a better numbness score (p = 0.001), male sex (p < 0.0001), and better postoperative knee flexion angle (0.04) positively affected kneeling. Conclusions The numbness score positively correlated with PROMs and positively affected kneeling. Knee replacements performed via an anteromedial incision may be at higher risk for numbness.

scholarly journals Enhancing Interpretation of Patient-Reported Outcome Scores Through Intuitive Metrics: An Example from Prostate Cancer

2016 ◽  
Vol 19 (3) ◽  
pp. A160
Author(s):  
S Naidoo ◽  
J Paty ◽  
C Fickley ◽  
C Gwaltney ◽  
E Hawryluk ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Outcome Scores

scholarly journals Early Return To Play After Intramedullary Screw Fixation Of Jones Fractures In Collegiate Athletes: 23 Year Experience

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0012
Author(s):  
Scott Thomas Watson ◽  
Amy Trammell ◽  
Stephanie Tanner ◽  
Rebecca Snider ◽  
Steven Martin ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Collegiate Athletes ◽  
Patient Reported Outcome ◽  
Return To Play ◽  
Early Return ◽  
Hardware Complications ◽  
Patient Reported ◽  
Outcome Scores ◽  
Intramedullary Screw

Objectives: There is a general consensus that Jones fractures should be treated operatively with an intramedullary screw in high-level athletes. However, there is disagreement among team physicians, without conclusive evidence as to when the athlete should be allowed to return to play. The objective of this study is to report our experience of early return to sport in collegiate athletes after intramedullary screw fixation of Jones Fractures. Methods: All skeletally mature collegiate athletes with a true Jones fracture of the base of the fifth metatarsal that was treated by one of two orthopaedic surgeons with operative intramedullary screw fixation over a 23 year period (1994-2016) were identified and records reviewed retrospectively. All return to play and complication data was obtained from the athletic trainer database at the two universities. Fixation consisted of a single intramedullary screw (10 partially threaded cannulated screws, 13 cannulated variable pitch screws, 3 solid screws). The athletes were allowed to weight bear as tolerated in a CAM boot immediately postoperatively, and return to play with a carbon fiber insert as soon as they could tolerate activity. In 2016, patients were contacted to complete patient reported outcome scores that included the Foot and Ankle Ability Measure (FAAM) score and a brief survey specific to our study, as well as follow-up radiographs if possible. Results: 26 Jones Fractures were treated in 25 collegiate athletes. The average age was 20 years (18-23). Overall, athletes returned to play or training at an average of 3.5 weeks (1.5-6). All in-season athletes returned to play within 4.5 weeks (1.5-4.5). Off-season athletes returned to play within 4-6 weeks. There were no cases of nonunion (clinically or radiographically). Three screws were removed due to symptomatic skin irritation. There was one re-fracture following screw removal after documented radiographic and clinical fracture union. This patient was treated with repeat cannulated percutaneous screw fixation. The athlete returned to play in 2 weeks. One screw was noted to be broken on an ankle radiograph 1 year post-op, but the fracture was healed and the athlete was playing division 1 sports without symptoms, and continued professionally without symptoms. 18/25 athletes completed patient reported outcome scores at an average of 7.95 years (range 1.2-17) follow-up. The average estimated percent of normal for activities of daily living was 93.8% (70-100%, and for athletic participation was 90.3% (40-100%). Follow up radiographs were obtained on 13/26 fractures at an average of 6.48 years (range 1.2-16) with no nonunion, malunion, or additional hardware complications identified. Conclusion: Athletes with Jones fractures can safely be allowed to return to play after intramedullary screw fixation as soon as their symptoms allow without significant complications. In our experience, this is usually within 4 weeks from injury.

scholarly journals Prospective Randomized Trial Comparing Mobile-bearing and Fixed-bearing Total Ankle Replacement

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0009
Author(s):  
James Nunley ◽  
Samuel Adams ◽  
James DeOrio ◽  
Mark Easley
Keyword(s):  
Clinical Outcomes ◽  
Mobile Bearing ◽  
Cyst Formation ◽  
Total Ankle Replacement ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Significant Difference ◽  
End Stage

Category: Ankle Arthritis Introduction/Purpose: Outcomes of total ankle replacement for the treatment of end-stage ankle arthritis continue to improve. Debate continues whether a mobile-bearing total ankle replacement (MB-TAR) or a fixed-bearing total ankle replacement (FB-TAR) is superior, with successful outcomes reported longterm for MB-TAR and at intermediate-to-longterm follow-up for newer generation FB-TAR. Although comparisons between the two total ankle designs have been reported, to our knowledge, no investigation has compared the two designs with a high level of evidence. This prospective, randomized controlled trial conducted at a single institution compares patient satisfaction, functional outcomes and radiographic results of the mobile-bearing STAR and the fixed-bearing Salto-Talaris in the treatment of end-stage ankle arthritis. Methods: This investigation was approved by our institution’s IRB committee. Between November 2011 and November 2014, adult patients with end-stage ankle osteoarthritis failing nonoperative treatment were introduced to the study. With informed consent, 100 patients (31 male and 69 female, average age 65, range 35 to 85) were enrolled; demographic comparison between the two cohorts was similar. Exclusion criteria included inflammatory arthropathy, neuropathy, weight exceeding 250 pounds, radiographic coronal plane deformity greater than 15 degrees or extensive talar dome wear pattern (“flat top talus”). Prospective patient-reported outcomes, physical exam and standardized weightbearing ankle radiographs were obtained preoperatively, at 6 and 12 months postoperatively, and then at yearly intervals. Data collection included visual analog pain score (VAS), short form 36 (SF-36), foot and ankle disability index (FADI), short musculoskeletal functional assessment (SMFA) and AOFAS ankle-hindfoot score. Surgeries were performed by non-design team orthopaedic foot and ankle specialists with total ankle replacement expertise. Statistically analysis was performed by a qualified statistician. Results: At average follow-up of 4.5 years (range 2-6 years) complete clinical data and radiographs were available for 84 patients; 7 had incomplete data, one had died, 4 were withdrawn after enrolling but prior to surgery and 4 were lost to follow-up. In all outcome measures, the entire cohort demonstrated statistically significant improvements from preoperative evaluation to most recent follow-up. There was no statistically significant difference in improvement in clinical outcomes between the two groups. Radiographically, tibial lucency/cyst formation was 26.8% and 20.9% for MB-TAR and FB-TAR, respectively. Tibial settling/subsidence occurred in 7.3% of MB-TAR. Talar lucency/cyst formation occurred in 24.3% and 2.0% of MB-TAR and FB-TAR, respectively. Talar subsidence was observed in 21.9% and 2.0% of MB-TAR and FB-TAR, respectively. Re-operations were performed in 8 MB-TAR and 3 FB-TAR, with the majority of procedures being to relieve impingement or treat cysts and not to revise or remove metal implants. Conclusion: For the first time, with a high level of evidence, our study confirms that patient reported and clinical outcomes are favorable for both designs and that there is no significant difference in clinical improvement between the two implants. The incidence of lucency/cyst formation was similar for MB-TAR and FB-TAR for the tibial component, but the MB-TAR had greater talar lucency/cyst formation and tibial and talar subsidence. As has been suggested in previous studies, clinical outcomes do not correlate with radiographic findings. Re-operations were more common for MB-TAR and in the majority of cases were to relieve impingement or treat cysts rather than revise or remove metal implants.

Tracking Functional Status Across the Spinal Cord Injury Lifespan: Linking Pediatric and Adult Patient-Reported Outcome Scores

2014 ◽  
Vol 95 (11) ◽  
pp. 2078-2085.e15 ◽  
Author(s):  
Feng Tian ◽  
Pengsheng Ni ◽  
M.J. Mulcahey ◽  
Ronald K. Hambleton ◽  
David Tulsky ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Adult Patient ◽  
Functional Status ◽  
Patient Reported Outcome ◽  
Cord Injury ◽  
Patient Reported ◽  
Outcome Scores
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