scholarly journals Miniopen vs Lateral Approach for Ankle Arthrodesis, Which Approach is Superior in Joint Preparation: A Cadaver Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Karthikeyan Chinnakkannu ◽  
Haley McKissack ◽  
Gean C. Viner ◽  
Jun Kit He ◽  
Leonardo V. M. Moraes ◽  
...  
Keyword(s):  
Surface Area ◽  
Ankle Arthrodesis ◽  
Lateral Approach ◽  
Fixation Method ◽  
Open Approach ◽  
Ankle Arthritis ◽  
Joint Preparation ◽  
Significant Difference ◽  
In Trans ◽  
Mini Open

Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: Ankle arthrodesis is a gold standard for end-stage ankle arthritis after conservative managements fail. It may be done through direct anterior, lateral, arthroscopic or mini open approaches. Joint preparation, apposition of joint surfaces and stable fixation are very important for successful outcomes. Ankle arthrodesis maybe associated with infection, chronic pain and nonunion - of these, nonunion is the most common complication reported. Achieving union is of utmost importance while minimizing complications associated with the procedure. Regardless of approach or fixation method, preparation of articular surface is of paramount importance for successful union and may be limited by the approach used. Our study aims to evaluate the difference between direct lateral and dual mini-open approaches (extended arthroscopic portals) in terms of joint preparation. Methods: We used 10 below knee fresh-frozen cadaver legs for this cadaveric study. Ankle joints of five specimens were prepared through the lateral approach, while the remaining five ankles were prepared using dual mini incisions. After the completion of preparation, all ankles were dissected to open, photographic images of tibial plafond and talar articular were taken. Surface areas of each articular facet and unprepared cartilage of the talus, distal tibia, and distal fibula were measured and analyzed using ImageJ software. Results: Significantly greater amount of total surface area was prepared among specimens using mini-open approach compared to those with trans-fibular approach. The percentage of total articulating surface area prepared (including talus and tibia/fibula), talus, tibia and fibula in trans-fibular approach were 76.9%, 77.7% and 75% respectively. The percentages were 90.9%, 92.9%, and 88.6% in mini-open approach. While the medial gutter was well prepared with mini incision technique (unprepared surface 44 .64% vs 91.08%), lateral gutter was well prepared in trans-fibular technique (88.82vs 82.04 square cm). There is no difference in the amount of unprepared surface of talar dome between the two approaches. When excluding the medial gutter, there was no significant difference between trans-fibular and mini open techniques (83.94 vs 90.85, p=0.1412). Conclusion: Joint preparation using the mini-open approach (extended arthroscopic portal) is equally as efficacious as the transfibular approach for preparation of the tibiotalar joint. When including preparation of the medial gutter, the mini-open approach provides superior joint preparation. This may be advantageous with decreased rate of nonunion and less complications. But many surgeons fuse only tibiotalar surface, considering that, both approaches yield equal amount of joint preparation. But it needs to be confirmed with clinical studies.

scholarly journals Subtalar Joint Preparation Using 2 Portal Posterior Arthroscopic Technique vs Sinus Tarsi Open Approach: A Cadaveric Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Karthikeyan Chinnakannu ◽  
Eildar Abyar ◽  
Haley M. McKissack ◽  
Martim Pinto ◽  
Aaradhana J. Jha ◽  
...  
Keyword(s):  
Subtalar Joint ◽  
Cadaveric Study ◽  
Joint Surface ◽  
Open Approach ◽  
Open Technique ◽  
Arthroscopic Technique ◽  
Joint Preparation ◽  
Sinus Tarsi ◽  
Subtalar Fusion ◽  
Significant Difference

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: Subtalar fusion is the treatment of choice for subtalar arthritis when conservative management fails. Subtalar fusion can be done through open approach or arthroscopic technique. Arthroscopic technique is associated with rapid recovery; however, it requires adequate training and skill. Arthroscopic technique can be done through lateral or posterior portals. Sometimes it may be necessary to use accessory portal to open or distract the joint for adequate joint preparation. Use of accessory portal may result in injury to the neurovascular structure. Whatever the technique, one of the most important aspects of fusion is adequate preparation of the joint. Aim of our study is to compare the preparation of subtalar joint using sinus tarsi open approach and posterior subtalar scopy using 2 portal technique in cadaveric specimens. Methods: We used 20 below knee fresh-frozen cadaver legs for this cadaveric study. Subtalar joints of ten specimens were prepared through the lateral approach, while the remaining ten joints were prepared using sinus tarsi incisions. After the completion of preparation, all ankles were dissected open, photographic images of calcaneal and talar articular were taken. (Image)Surface areas of each articular facet and prepared area of the talus, distal tibia, and distal fibula were measured and analyzed. Results: Open technique results in better preparation of joint surface in calcaneus and overall. While open technique results in preparation of 92% joint surface (combined talus and calcaneus), arthroscopic technique results in in 80% of joint surface. Open technique results in better preparation of calcaneus (79vs 94%). The anterolateral corner of calcaneus was difficult to be reached using the scope and unprepared in most cases. There was no significant difference in the preparation of talar articular surface. (Table 1) Conclusion: Open sinus tarsi results in more joint preparation compared to 2 portal posterior arthroscopic technique. The less amount of joint preparation in arthroscopic technique is mostly due to less preparation of AL corner. Of calcaneus. When using posterior arthroscopic technique, it is advisable to use accessory portal to distract the joint to aid in adequate preparation.

scholarly journals Management of elderly traumatic ankle arthritis with Ilizarov External Fixation: A Retrospective Study

2021 ◽  
Author(s):  
Jun Li ◽  
Wenzhao Wang ◽  
Bohua Li ◽  
Mingxin Li ◽  
Lei Liu
Keyword(s):  
External Fixation ◽  
Line Segment ◽  
Ankle Arthrodesis ◽  
Healing Time ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
X Ray ◽  
Significant Difference ◽  
Post Operation

Abstract Objective To evaluate the clinical effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.Methods From June 2015 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution, 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). Conventional double-feet loading positive and lateral X ray films were taken before operation. Angle between the tibia anatomic axis and the line segment of inside and outside of talus vertex was measured to evaluate the degree of talipes varus and valgus. Functional assessments were performed using Foot and Ankle pain score of American Orthopedics Foot and Ankle Society(AOFAS) and Visual Analogue Scale(VAS) .Results All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All ankles achieved bony fusion, the clinical healing time was 12.7 weeks on average(11~18 weeks).The AOFAS score was 45.36±6.43 preoperatively and 80.25±9.16 at 12 months post operation, with a statistically significant difference(P<0.0001). The VAS score was 8.56±1.85 on average preoperatively and 2.72±0.83 at 12 months post operation, with a statistically significant difference ( P<0.0001). The angle of anatomical tibial shaft and the line segment of inside and outside of talus vertex on X-ray image was 101.93°±4.12° preoperatively and 94.45°±2.37° at 12 months post operation, with a statistically significant difference(P<0.0001). The results of functional evaluation indicated that 44 patients(61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.Conclusion Satisfactory curative effect can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis, while large sample randomized controlled trials are still needed.

A comparison of mini-open and open approaches for resection of thoracolumbar intradural spinal tumors

2011 ◽  
Vol 14 (6) ◽  
pp. 758-764 ◽  
Author(s):  
Daniel C. Lu ◽  
Dean Chou ◽  
Praveen V. Mummaneni
Keyword(s):  
Blood Loss ◽  
Scale Score ◽  
Tumor Resection ◽  
Open Group ◽  
Spinal Tumors ◽  
Open Approach ◽  
Score Improvement ◽  
Intradural Tumor ◽  
Significant Difference ◽  
Mini Open

Object Standard approaches to thoracic intradural tumors often involve a large incision and significant tissue destruction. Minimally invasive techniques have been applied successfully for a variety of surgical decompression procedures but have been rarely used for the removal of intradural thoracolumbar tumors. In this paper, the authors compare the clinical outcome of mini-open resection of intradural thoracolumbar tumors with a standard open technique. Methods The authors retrospectively reviewed their series of 18 consecutive mini-open thoracolumbar, intradural, tumor resection cases and compared the outcomes with a profile-matched cohort of 9 cases of open intradural tumor resection. Operative statistics, functional outcome, and complications were compared. Results Tumors were removed successfully using both approaches, except for 1 case in the mini-open cohort in which only biopsy was performed for a diffusely infiltrating tumor (glioblastoma). There was no statistically significant difference in operative duration, American Spinal Injury Association scale score improvement, or back pain visual analog scale score improvement between groups. However, the mini-open group demonstrated a significantly lower estimated blood loss (153 vs 372 ml, respectively) and a significantly shorter length of hospitalization (4.9 vs 8.2 days, respectively). There was 1 complication of pseudomeningocele formation in the mini-open cohort and 1 complication of cerebral infarction in the open cohort. Mean follow-up length was 16 months in the mini-open group compared with 20 months in the open group. Conclusions The mini-open approach allows for adequate treatment of intradural thoracolumbar tumors with comparable outcomes to standard, open approaches. The mini-open approach is associated with less blood loss and a shorter length of stay compared with standard open surgery.

scholarly journals Management of elderly traumatic ankle arthritis with Ilizarov External Fixation: A Retrospective Study

2021 ◽  
Author(s):  
Jun Li ◽  
Wenzhao Wang ◽  
Hai Yang ◽  
Bohua li ◽  
Mingxin Li ◽  
...  
Keyword(s):  
External Fixation ◽  
Line Segment ◽  
Ankle Arthrodesis ◽  
Healing Time ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
X Ray ◽  
Significant Difference ◽  
Post Operation

Abstract Objective To evaluate the clinical effect of Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.Methods From June 2015 to August 2019, 72 patients with elderly traumatic ankle arthritis were treated with arthrodesis through Ilizarov external fixation technique in our institution, 38 cases were males and 34 cases were females, with an average of 65.4 years (ranging from 60 to 74). Conventional double-feet loading positive and lateral X ray films were taken before operation. Angle between the tibia anatomic axis and the line segment of inside and outside of talus vertex was measured to evaluate the degree of talipes varus and valgus. Functional assessments were performed using Foot and Ankle pain score of American Orthopedics Foot and Ankle Society(AOFAS) and Visual Analogue Scale(VAS) .Results All of the patients acquired effective postoperative 18-49 months follow-up, with an average of 31.5 months. All ankles achieved bony fusion, the clinical healing time was 12.7 weeks on average(11~18 weeks).The AOFAS score was 45.36±6.43 preoperatively and 80.25±9.16 at 12 months post operation, with a statistically significant difference(P<0.0001). The VAS score was 8.56±1.85 on average preoperatively and 2.72±0.83 at 12 months post operation, with a statistically significant difference ( P<0.0001). The angle of anatomical tibial shaft and the line segment of inside and outside of talus vertex on X-ray image was 101.93°±4.12° preoperatively and 94.45°±2.37° at 12 months post operation, with a statistically significant difference(P<0.0001). The results of functional evaluation indicated that 44 patients(61.1%) had excellent results, 18 (25%) had good results, and 10 (13.9%) had fair results.Conclusion Satisfactory curative effect can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of elderly traumatic ankle arthritis.

scholarly journals Outcome Comparison of Arthroscopic versus Mini-open Technique for Ankle Arthrodesis

2020 ◽  
Author(s):  
Junliang Wang ◽  
WENPING GE ◽  
WENSHAN HU ◽  
FENG LIN ◽  
YUJIE LIU
Keyword(s):  
Length Of Hospital Stay ◽  
Operation Time ◽  
Fusion Rate ◽  
Ankle Arthrodesis ◽  
Open Group ◽  
Tourniquet Time ◽  
Vas Score ◽  
Significant Difference ◽  
End Stage ◽  
Mini Open

Abstract Background Ankle arthrodesis is considered to be the gold standard for the treatment of end-stage ankle diseases. At present, the commonly used methods of ankle arthrodesis include open ankle arthrodesis, arthroscopic ankle arthrodesis and mini-open ankle arthrodesis. The authors analyze and compare the clinical efficacy and related complications of arthroscopic ankle arthrodesis and mini-open ankle arthrodesis in the treatment of end-stage ankle disease. Methods From January 2007 to June 2018, 56 patents with end-stage ankle joint pathology were treated with arthroscopic ankle arthrodesis and mini-open ankle arthrodesis. There were 30 cases in arthroscopy group, including 19 males and 11 females with an average age of 49.6 years old (ranged, 32 to 71); while 26 cases in mini-open group, including 18 males and 8 females with an average age of 48.3 years old (ranged, 43 to 65). The operative time was calculated with use of computerized operative and anesthetic records. The pain visual analogue score (VAS), American Orthopedic Foot ༆ Ankle Society ankle and hind foot score (AOFAS), fusion rate, complications rate, length of hospital stay, operation time, and tourniquet time were compared between the two groups of patients. Results 51 patients were followed up for 15–35 months (mean, 22.5 ± 1.5) months. The bony fusion was achieved in all patients. The average time to fusion was 12.4 weeks (range, 10–16 weeks). The VAS score 3 days post-operation was (6.37 ± 0.69) points in the arthroscopy group and (7.61 ± 1.05) points in the mini-open group, there was significant difference between the two groups (P < 0.05). The VAS score and AOFAS score between the two groups pre- and post-operation have statistically significant differences (P < 0.05). At the last follow-up, VAS score was (1.55 ± 0.57) in the arthroscopy group and (1.43 ± 0.73) in the mini-open group, and there was no significant difference between the two groups (P > 0.05). The AOFAS score was (85.32 ± 2.96) points in the arthroscopy group and (86.72 ± 3.05) points in the mini-open group, and there was no significant difference between the two groups (P > 0.05). Arthroscopic ankle fusion was associated with a shorter tourniquet time and shorter length of hospital stay compared to mini-open ankle fusion (P < 0.05); however, there was no significant difference between two groups in terms of operation time (P > 0.05). Wounds healing was satisfying during the follow-up in the arthroscopy group. But the wounds healing was delayed in two patients of the small incision group. All patients were satisfied with the surgery. Conclusion Arthroscopic ankle arthrodesis and mini-open ankle arthrodesis have satisfactory curative effect and fusion rate. Arthroscopic assisted ankle arthrodesis has more advantages, including small incision, less injury, and low morbidity.

scholarly journals Total Ankle Arthroplasty vs Ankle Arthrodesis

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0001
Author(s):  
Thomas Clanton ◽  
Lauren Matheny ◽  
Angela Chang
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Proportional Hazard ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Cox Proportional Hazard ◽  
Age At Surgery ◽  
Significant Difference ◽  
Surgical Failure

Category: Ankle, Ankle Arthritis Introduction/Purpose: Ankle arthritis is a debilitating disorder which significantly limits activities of daily living and can lead to reduced quality of life. Total ankle arthroplasty(TAA) and ankle arthrodesis are common treatments for ankle arthritis; however, patient indications may differ based on individual patient needs. Few studies compare proportional hazard modeling, survivorship and patient-centered outcomes following these two procedures, which may be useful in determining the appropriate procedure for end-stage ankle arthritis in different patient populations. The purpose of this study was to determine proportional hazards for the risk of failure in patients who underwent TAA vs. arthrodesis, as well as survivorship and outcomes. Methods: All patients >18 years, between January 2009 and November 2013, who underwent TAA or ankle arthrodesis by a single surgeon for treatment of ankle arthritis were included. Patients completed a subjective questionnaire at minimum 2-years following index surgery. Outcomes measures included Foot and Ankle Ability Measure(FAAM), Foot and Ankle Disability Index(FADI), Lysholm, WOMAC, SF-12 physical component summary(PCS) and mental component summary(MCS), Tegner activity scale and patient satisfaction with outcome. Detailed surgical data/intraoperative findings were documented at time of surgery. All data were collected prospectively. Cox proportional hazard modeling and survivorship analysis were performed to assess differences between the two cohorts. Survivorship utilizing Kaplan-Meier method, using a log-rank test, was used to compare median survivorship. Cox-proportional hazard model was conducted to compare hazard rates of surgical failure for patients in each cohort, while adjusting for age at surgery, body mass index(BMI) and sex. All outcome measures were compared between cohorts. Results: There were 97 patients available for analysis. Eight patients failed surgery(9.2%). Demographic data were documented (Table 1). There was no significant difference in failures (TAA=2 failures (6.5%) vs. arthrodesis=6 failures (11.8%)(p=0.709). There was no significant difference in survivorship of surgery between the arthrodesis cohort and the TAA cohort(p=0.785)(Table 1, Figure 1). There was a decrease in survivorship at 4 years in TAA cohort compared to arthrodesis cohort, which was not significant. The hazard ratio was 0.804 [95%CI: 0.111–5.842], indicating that cohort did not have a significant effect on the hazard of surgical failure(p=0.829). Sex, age and BMI did not have a significant effect on the hazard of surgical failure(p>0.05). There was no significant difference in any outcome measures between cohorts(Table 1). Conclusion: There was no significant difference in survivorship or in the hazard of surgical failure based on cohort (TAA and arthrodesis) while accounting for sex, age at surgery and BMI. There was no significant difference in the hazard of surgical failure for factors including age at surgery, BMI or sex. There was no significant difference in survivorship or outcomes between cohorts. Total ankle arthroplasty seems to provide similar results as arthrodesis; however, there was a decrease in survivorship at 4 years in the TAA cohort. Although not significant, this may indicate that survivorship differs during the longer-term follow-up period.

scholarly journals Consumer Prices for Surgical Management of Ankle Arthritis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0045
Author(s):  
Niall Smyth ◽  
Brody Dawkins ◽  
Joshua Goldstein ◽  
Jonathan Kaplan ◽  
Amiethab Aiyer
Keyword(s):  
Surgical Management ◽  
Operative Management ◽  
The United States ◽  
Ankle Arthrodesis ◽  
Ankle Arthritis ◽  
Consumer Prices ◽  
Wide Range ◽  
Significant Difference ◽  
Private Center ◽  
The Mean

Category: Ankle Arthritis Introduction/Purpose: In the United States alone there are over 50,000 new cases of ankle arthritis every year. The financial healthcare burden for surgical management of ankle arthritis likely continues to rise with the volume of total ankle replacements (TAR) increasing 100-fold over the last 20 years. Healthcare consumers however are generally unaware of the costs of the services they use. Understanding the costs associated with operative management of ankle arthritis is an important facet of patient care although access to this information may not be readily available. The purpose of this study was to determine the access to the surgical cost of TARs and ankle arthrodesis and the variability of the cost between the two procedures. Methods: 50 foot and ankle centers (25 academic, 25 private) that perform TARs and ankle arthrodeses were contacted using a standardized patient script. The described patient was a healthy 63-year-old male who had failed conservative treatment of ankle arthritis. Each institution was contacted up to three times to attempt to obtain a full bundled operative quote for a TAR and an ankle arthrodesis. Results: 21 centers (42%, 14 academic, 7 private) were able to provide a quote for a TAR and ankle arthrodesis. The mean bundled price for a TAR was $50,332 (SD +/- $25,744) with the mean academic and private center quote being $56,529 and $37,937 respectively. The mean bundled price for an ankle arthrodesis was $41,756 (SD +/- $26,033) with the mean academic and private center quote being $48,116 and $29,037 respectively. There was no statistically significant difference between the bundled price for TAR and ankle arthrodesis. Conclusion: There was limited availability of consumer prices for TAR and ankle arthrodesis thus hindering healthcare consumers’ decision making. When comparing different institutions for surgical management of ankle arthritis, there was a wide range of quotes for both TAR and ankle arthrodesis. When comparing the choice of surgical management for ankle arthritis, there was no difference in price between TAR and ankle arthrodesis.

scholarly journals Mini-open vs. Transfibular Approach for Ankle Arthrodesis, Which Approach is Superior in Joint Preparation: A Cadaver Study

2020 ◽  
Author(s):  
Karthikeyan Chinnakkannu ◽  
Haley M. McKissack ◽  
Jun Kit He ◽  
Bradley Alexander ◽  
John Wilson ◽  
...  
Keyword(s):  
Ankle Arthrodesis ◽  
Cadaver Study ◽  
Joint Preparation ◽  
Mini Open

scholarly journals Outcomes After Management of Subspine and Femoroacetabular Impingement Using a Direct Anterior Mini-Open Approach

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110557
Author(s):  
Liu-yang Xu ◽  
Kang-ming Chen ◽  
Jian-ping Peng ◽  
Jun-feng Zhu ◽  
Chao Shen ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Open Group ◽  
Harris Hip Score ◽  
Decompression Surgery ◽  
Open Approach ◽  
Meralgia Paresthetica ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores ◽  
Mini Open

Background: Subspine impingement (SSI) has been commonly managed with arthroscopic decompression. However, arthroscopic decompression is a demanding technique, as under- or over-resection of the anterior inferior iliac spine (AIIS) could lead to inferior outcomes. An anterior mini-open approach has also been used in the management of femoroacetabular impingement (FAI), and it could provide adequate visualization of the anterior hip joint without a long learning curve. Purpose/Hypothesis: The objective of the current study was to compare the outcomes of SSI patients with FAI who underwent arthroscopic subspine decompression and osteoplasty with a group undergoing subspine decompression and osteoplasty using a modified direct anterior mini-open approach. It was hypothesized that there would be no significant difference in outcomes between the groups. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the records of SSI patients who underwent decompression surgery (arthroscopic or mini-open) at our institution from June 1, 2015 to December 31, 2016. Both groups underwent the same postoperative rehabilitation protocol. Preoperative and 2-year postoperative patient-reported outcomes were compared using the modified Harris Hip Score (mHHS), International Hip Outcome Tool–33 (iHOT–33), and Hip Outcome Score—Activities of Daily Living (HOS–ADL). Major and minor complications as well as reoperation rates were recorded. Results: Included were 47 patients (49 hips) who underwent subspine decompression using an anterior mini-open approach and 35 patients (35 hips) who underwent arthroscopic subspine decompression. There were no differences in demographic and radiological parameters between the groups, and patients in both groups showed significant improvement in all outcome scores at follow-up. The pre- to postoperative improvement in outcome scores was also similar between groups (mini-open vs arthroscopy: mHHS, 26.30 vs 27.04 [ P = .783]; iHOT–33, 35.76 vs 31.77 [ P = .064]; HOS–ADL, 26.09 vs 22.77 [ P = .146]). In the mini-open group, 10 of the 47 patients had temporary meralgia paresthetica, and fat liquefaction was found in 1 female patient. There were no reoperations in the mini-open group. Conclusion: Subspine decompression using the anterior mini-open approach had similar outcomes to arthroscopic decompression in the management of SSI. The lateral femoral cutaneous nerve should be protected carefully during use of the anterior mini-open approach.

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