scholarly journals Journal of Foot and Ankle Research, one year on

2009 ◽  
Vol 2 (1) ◽  
Author(s):  
Mike J Potter ◽  
Hylton B Menz ◽  
Alan M Borthwick ◽  
Karl B Landorf
Keyword(s):  
Foot And Ankle ◽  
Ankle Research ◽  
One Year

scholarly journals Increased Early Revision Rate with the INFINITY Total Ankle Prosthesis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0003
Author(s):  
Elizabeth Cody ◽  
Michel Taylor ◽  
James Nunley ◽  
Selene Parekh ◽  
James DeOrio
Keyword(s):  
United States ◽  
Tibial Component ◽  
Revision Rate ◽  
The United States ◽  
Additional Patient ◽  
Foot And Ankle ◽  
Early Revision ◽  
One Year ◽  
Component Loosening

Category: Ankle Arthritis Introduction/Purpose: Modern total ankle arthroplasties (TAAs) have demonstrated improved survival rates at early- and mid-term follow-up, with revision rates ranging from 4 to 8% at five years. The INFINITY total ankle system (Wright Medical Technology, Arlington, TN) was first used in the United States in 2014. Its advantages include the ability to use patient-specific instrumentation and the option to choose between talar dome resurfacing and flat-cut talar components. While this implant is currently popular in the United States, clinical outcomes have not yet been reported. Our aim was to identify the rate of early revision among patients receiving the INFINITY prosthesis. Methods: Patients from two prospectively-collected databases at the authors’ institution were screened for inclusion in the present study. All patients who underwent a primary TAA with the INFINITY prosthesis and who were at least one year postoperative were included. All surgeries were performed by one of two orthopaedic foot and ankle surgeons with extensive experience in total ankle arthroplasty. The primary outcome was the need for revision surgery, which was defined as removal of one or both metal components. Peri-implant lucency at most recent follow-up was a secondary outcome. Anteroposterior and lateral radiographs at most recent follow-up were graded for lucency independently by two reviewers, both orthopaedic foot and ankle fellows, for individual peri-implant zones (Figure). Each zone was only considered “lucent” if recorded as such by both reviewers. Results: 160 patients underwent TAA with the INFINITY prosthesis between August 2014 and November 2016 with a mean 20 months of follow-up (range, 12-37). Six patients were lost to follow-up. Sixteen patients (10%) underwent revision a mean 1.2 years postoperatively. Revision was performed most commonly for tibial component loosening (seven patients, 4.4%) and deep infection (five patients, 3.1%). Of cases with tibial loosening, progressive lucency and/or subsidence was obvious radiographically in four patients; one patient had equivocal radiographs but loosening was suggested on single-photon emission computed tomography; and two patients revised for persistent pain had loosening confirmed intraoperatively. Of the 108 patients with retained components and at least one year of radiographic follow-up, eight (7.4%) had global lucency around the tibial component at most recent follow-up. Conclusion: Our initial review of patients undergoing TAA with the INFINITY prosthesis demonstrates an elevated early revision rate due to tibial component loosening. The reasons for this finding remain unclear, but could possibly include inadequate bony purchase of the implant’s three prongs, particularly in patients with large preoperative deformities or with imperfect component alignment. We plan to further investigate the possible reasons for this finding in the future by assessing additional patient factors, including age, sex, arthritis type, tobacco use, pre- and postoperative coronal and sagittal alignment, and presence of ipsilateral hindfoot fusion.

scholarly journals Lateral versus Anterior TAR: A Prospective Cohort Pilot Study of PROs and Re-Operation Rates

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0002
Author(s):  
Oliver Gagné ◽  
Andrea Veljkovic ◽  
Kevin Wing ◽  
Murray J. Penner ◽  
S.E. Younger Alastair
Keyword(s):  
Pilot Study ◽  
Wound Complication ◽  
Deep Infection ◽  
Foot And Ankle ◽  
Early Results ◽  
Lateral Group ◽  
Sf 36 ◽  
One Year ◽  
The One ◽  
Anterior Group

Category: Ankle, Ankle Arthritis Introduction/Purpose: Recent advances in arthroplasty for the hip and the knee have motivated modern foot and ankle research to perfect the implant and technique for the optimal total ankle replacement. Unlike in the hip where different approaches can be done with the same implants, the approach of a total ankle is intimately associated to the prosthetic design. The anterior and lateral approaches have pros and cons regarding their respective soft tissue complications, osteotomy necessity, orientation of the bone cut and gutter visualization. While both have been studied independently, very few reports have compared both in the same setting. We set out to quantify the PROs and re-operations of both groups. Methods: A prospective study was conducted from a single center between 2014 and 2018 including a total of 64 total ankles performed by one of four fellowship-trained foot and ankle surgeon. A baseline dataset of their demographic as well as baseline scores (AOS, AAS & SF-36) was documented as well as at the 6 months and yearly mark post-operatively. Re-operations were also reported and coded in the local database. The approach was determined by the surgeon’s practice preference and patients were referred to surgeons as part of a central intake. Patients were included when they had a primary TAR in the timeframe noted and had a complete dataset up to at least the one year outcome. This cohort comprised 27 anterior and 37 lateral with balanced demographic for age (95%CI 63-67 yo) and gender (47% F). The lateral group had higher COFAS type arthritis, longer intraoperative time and adjunct procedures. Results: Comparing the two groups, it was noted that the anterior group had superior SF-36 scores at the one-year post- operative mark on both the physical and mental components. The difference was statistically significant and greater than the MCID. Otherwise, the two groups had similar AOS and AAS post-operative scores that were not statistically different. A total of 8 patients had a reoperation, 7 were from the lateral cohort and 1 from the anterior approach group. The lateral group had 3 surgical debridement for deep infection/wound complication, 2 ankle gutter/HO debridement and 2 lateral hardware removal. The anterior group had one ankle gutter/ HO debridement. Two of the above patients had two re-operations and one had three. Conclusion: This prospective pilot study outlines the early results of lateral versus anterior total ankle replacements. The risk of deep infection requiring reoperation was higher in the lateral group and the SF-36 scores one year after surgery were inferior to the anterior group. The lateral cohort had however significantly more pre-operative peritalar disease which was not balanced and likely affected those results. Patient experience based on PROs (AAS, AOS) otherwise is comparable. Future studies with longer prospective data need to be considered to have the power to draw significant conclusions.

scholarly journals Trends of Foot and Ankle Publishing in JBJS[A] over a 15 Year Period From 2004-2018

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0010
Author(s):  
Bradley Alexander ◽  
James Hicks ◽  
Abhinav Agarwal ◽  
Aaradhana J. Jha ◽  
Spaulding F. Solar ◽  
...  
Keyword(s):  
Geographic Origin ◽  
Median Number ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Quality Research ◽  
Level Ii ◽  
Ankle Surgery ◽  
Ankle Research ◽  
Quality Of Research

Category: Other Introduction/Purpose: As the field of foot and ankle surgery grows and new innovations continue to be made it is important that the quality of research improves. This will help to lay a strong foundation for current and future surgeons in the field. Leading journals need to set the tone for all orthopedic journals by publishing quality literature. This current study will look at all foot and ankle articles published by JBJS[A] over a 15-year period and analyze authorship, article type, geographic origin of articles, and level of evidence trends. This study will give a representative view of where foot and ankle research is currently and where it can go as we enter the new decade. Methods: A foot and ankle research fellow reviewed all of the articles published in JBJS[A] from January 2004 to December of 2018. Articles that related to foot and ankle topics were then selected to analyzed. Editorials, letters to the editor, announcements, technical notes, retraction notes, events, errata, retracted manuscripts, historical papers and pediatric foot and ankle articles were excluded. After exclusions were applied 321 and information pertaining to each article was analyzed. Additionally, a Google Scholar search was conducted for each article to determine the number of times an article had been cited. For calculations relating to median number of citations for each article we excluded articles that were published less than three years ago (2017 and 2018). For level of evidence a kappa value (0.82) was calculated to measure interobserver reliability between two reviewers. Results: We found the following results to be significant. Clinical therapeutic studies were the predominant study design over 15 years. The amount of literature over ankle arthroplasty has increased more than any other article topic. The amount of level IV and V evidence has decreased and the amount of level II and III evidence has increased. The median number of authors has been increasing. This includes female authorship. There has been in an increase in MD, PhDs as last authors. There is more foot and ankle research being produced by Asian countries. A majority of high level of evidence articles (level I and II) comes from North America and Europe. Level of evidence doesn’t correlate with the amount of times an article is cited. Conclusion: As the field of foot and ankle surgery continues to grow it is important that there is a high quality of research being conducted and published to guide surgical and clinical decisions. Our study shows that research is being produced more globally and the number of individuals involved in the research process is increasing and diversifying. This has led to higher quality research being produced (more level II and III) and a decrease in lower quality research (IV and V). Overall, the standard of research has increased in JBJS[A] which benefits the foot and ankle surgery community. [Table: see text]

scholarly journals Authorship and Citations in Foot and Ankle International from 1980-2017

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0015
Author(s):  
Daniel Bohl ◽  
Connor Wakefield ◽  
Emily He ◽  
Kamran Movassaghi ◽  
George Holmes ◽  
...  
Keyword(s):  
Case Reports ◽  
Country Of Origin ◽  
The United States ◽  
Foot And Ankle ◽  
Research Journal ◽  
Ankle Research ◽  
The Mean ◽  
American Orthopaedic ◽  
Over Time ◽  
Number Of Authors

Category: Other Introduction/Purpose: Orthopaedic foot and ankle surgery is a young and rapidly evolving orthopaedic subspecialty. Little is known regarding the authors contributing to the field. The purpose of this study is to characterize the demographics of the authors publishing foot and ankle research since the inception of the research journal of the American Orthopaedic Foot and Ankle Society. Methods: All publications in the journal Foot and Ankle International between 1980 and 2017 were reviewed. Papers were characterized in terms of number of authors, number of institutions, and number of references. The first and corresponding authors were also characterized in terms of country of origin, gender, and degree qualification. Each of these characteristics was tested for trends over time. Results: In total, 5,323 publications were reviewed, including 4,297 research articles, 367 case reports, 262 editorials, 159 letters, and 121 technique tips. The mean number of authors per paper increased from 2.3 during the 1980s to 4.3 during the 2010s (p<0.001). The percent of publications with female first authors increased from 4.9% during the 1980s to 13.2% during the 2010s (p<0.001). The country of origin shifted markedly away from the United States during the 1980s towards Europe and other countries during the 2010s (Figure 1). Podiatrists consisted of 1.3% of first authors and 1.4% of corresponding authors—these proportions did not meaningfully change over time (p>0.05). The mean number of references to other work increased from 13.8 during the 1980s to 24.4 during the 2010s (p<0.001). Conclusion: The authors of the foot and ankle literature have changed markedly over the past 4 decades. Most notably, there have been shifts towards female and international authorship. The number of authors per paper has also nearly doubled over time. Such trends are likely to continue as the field of foot and ankle grows.

Quality of Research and Level of Evidence in Foot and Ankle Publications

2012 ◽  
Vol 33 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Heather L. Barske ◽  
Judith Baumhauer
Keyword(s):  
Clinical Research ◽  
Medical Profession ◽  
Research Articles ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
Ankle Research ◽  
Level I ◽  
Quality Of Research

Background: The quality of research and evidence to support medical treatments is under scrutiny from the medical profession and the public. This study examined the current quality of research and level of evidence (LOE) of foot and ankle surgery papers published in orthopedic and podiatric medical journals. Methods: Two independent evaluators performed a blinded assessment of all foot and ankle clinical research articles (January 2010 to June 2010) from seven North American orthopedic and podiatric journals. JBJS-A grading system was used for LOE. Articles were assessed for indicators of study quality. The data was stratified by journal and medical credentials. Results: A total of 245 articles were published, 128 were excluded based on study design, leaving 117 clinical research articles. Seven (6%) were Level I, 14 (12%) Level II, 18 (15%) Level III, and 78 (67%) Level IV. The orthopedic journals published 78 studies on foot and ankle topics. Of the podiatric journals, the Journal of the American Podiatric Medical Association (JAPMA) published 12 clinical studies and the Journal of Foot and Ankle Surgery (JFAS) published 27, 21 (78%) of which were Level IV studies. When the quality of research was examined, few therapeutic studies used validated outcome measures and only 38 of 96 (40%) gathered data prospectively. Thirty (31%) studies used a comparison group. Eighty-seven articles (74%) were authored by a MD and 22 (19%) by a DPM. Conclusion: Foot & Ankle International (FAI) published higher quality studies with a higher LOE as compared to podiatry journals. Regardless of the journal, MDs produced the majority of published clinical foot and ankle research. Although improvements have been made in the quality of some clinical research, this study highlights the need for continued improvement in methodology within foot and ankle literature.

scholarly journals Evans Osteotomy with Locked Plate with Wedge Block for Stage IIB Flat Foot

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Maria Gala Santini Araujo ◽  
Nelly Carrasco ◽  
Pablo Sotelano ◽  
Ana Cecilia Parise ◽  
Leonardo Conti ◽  
...  
Keyword(s):  
Late Complication ◽  
Wound Dehiscence ◽  
Primary Objective ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Flat Foot ◽  
Lateral Column ◽  
Significant Difference ◽  
One Year ◽  
Clinical Records

Category: Hindfoot Introduction/Purpose: Elongation of the lateral column is indicated only in patients who have a flexible deformity Stage 2B of flat foot. The Evans osteotomy is performed 1.5 or 2 cm from the cuboideal calcaneal joint, and in many publications is maintained by different kind of devices. Our hypothesis is that Evans osteotomy, with blocked plates with a wedge block, without the use of bone graft, maintain the correction obtained at one year after surgery. The primary objective was to evaluate the radiological results at the postoperative year of the osteotomy Secondary objectives were to evaluate the persistence of the correction obtained between the 3 months and the year of the postoperative period and to evaluate the functional outcomes with AOFAS score. Methods: We studied a total of 12 patients, 14 feet. with stage 2 B flat foot, in all cases surgery was performed by the same specialist between March of 2011 and March of 2014 in the Service of foot and ankle of our institution. Inclusion criteria were: patients with type 2B flat foot, submitted to external column elongation, with plates blocked with a 6 to 10 mm wedge block, without the use of bone grafting, minimum follow-up of 1 year. Exclusion criteria: revision of previous surgery, another type of material used for elongation of the external column, neurological sequelae. The study was performed retrospectively through clinical records database, data collection and measurements were performed by 2 second-year Foot and ankle fellow trained in the same institution. Statistical analysis was performed with the T-student test. Results: A total of 12 patients / 14 feet were evaluated during the study period, with a diagnosis of flatfoot type 2B. The average age was 57 years (32-65 years), 11 (78.5%) were female. No statistically significant difference was observed in any of the radiographic variables measured, at 3 months and at 12 months postoperatively. The preoperative AOFAS score, was 54 points. At the first year was 93 points. Consolidation was achieved at 3 months in all cases. The complications found were 2 superficial infections and 1 wound dehiscence. As a late complication, there was only 1 case of cuboidal calcaneal osteoarthritis that did not require surgical resolution. Conclusion: Evans osteotomy for elongation of the external column provides a reproducible and reliable method to restore the normal functional stability of the midfoot and hindfoot. According to the results obtained in our work, we can conclude that the blocked plates with a wedge lock manage to preserve the corrections obtained with the Evans osteotomy in patients with type IIB flat foot. There is no need of autograft with the consequent risk of comorbidities produced by a second approach to the grafting as well as the complications that could happen with the use of allografts.

scholarly journals Joint Preservation of the 1st MTP

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Bryan Van Dyke ◽  
Gregory Berlet ◽  
Justin Daigre ◽  
Christopher Hyer ◽  
Terrence Philbin
Keyword(s):  
Articular Cartilage ◽  
Early Detection ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Pain Level ◽  
Foot And Ankle ◽  
Inclusion Criteria ◽  
First Metatarsal ◽  
The Mean ◽  
One Year

Category: Midfoot/Forefoot Introduction/Purpose: Focal damage to articular cartilage and the supporting subchondral plate, commonly referred to as an osteochondral defect (OCD), can be a cause of joint pain and subsequent decreased range of motion. There are few studies specifically describing these lesions in the first metatarsophalangeal (MTP) joint, where they are traditionally grouped into hallux rigidus. There exists an opportunity for early detection and intervention with the intent to prevent deterioration and improve patient outcomes. One contemporary treatment concept is to implant particulated juvenile cartilage allograft to restore articular cartilage. The aim of our study was to review the clinical results of patients that had undergone this procedure for first metatarsal head OCDs. Methods: After IRB approval, a retrospective review of a consecutive case series was studied utilizing the records of three foot and ankle surgeons. Inclusion criteria included all adult patients who were a minimum of one year post surgery and consented to participate. Patient demographics and preoperative visual analog scale (VAS) pain level were recorded from a standardized intake sheet. From the operative note, the OCD size and location was recorded, as well as any concomitant procedures. At a minimum follow up of one year, we obtained objective measurements of arthritis grade and subjective considerations of pain and function, including VAS pain level, Foot Function Index (FFI) questionnaire, the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal scale, and an overall patient satisfaction score. Results: Nine patients met inclusion criteria, 4 males and 5 females. The average age was 41 years old (±11.77, range 21-65). The mean preoperative VAS pain score was 57.50 (±18.32, range 30-80). Four OCDs were located centrally on the first metatarsal head. The average OCD size intraoperatively was 30 mm2 (range 16-49). The average time since surgery was 3.26 years (±1.21, range 1.41-5.62). Average first MTP dorsiflexion was 41.78 degrees (±20.70, range 6-70). The average postoperative hallux rigidus classification was grade 2 (range 1-3). The mean VAS pain score improved to 5.22 (±8.44, range 0-20). The average AOFAS score was 88 (±15.91, range 52-100). The average FFI score was 8.04 (±12.60, range 0-30.6). All but one patient were satisfied or very satisfied with their results. Conclusion: At an average of 3.26 years postoperatively, patients had improved pain, did not show significant progression of their first MTP joint degeneration, and were satisfied with their results. Patients reported very little, if any, limitations in their activity level. We believe that articular damage of the first MTP should be viewed in the same way as OCD lesions in larger joints with emphasis on early detection and treatment to avoid the progression to arthritis. Particulated juvenile cartilage allograft is a valuable tool for surgeons to use in treating focal articular defects of the first metatarsal head.

scholarly journals Pain course after foot and ankle surgery

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Christian Plaass ◽  
Sarah Ettinger ◽  
Leif Claassen ◽  
Christina Stukenborg-Colsman ◽  
Kiriakos Daniilidis ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Characteristic Curve ◽  
Tertiary Care ◽  
Pain Level ◽  
Foot And Ankle ◽  
Primary Surgery ◽  
Ankle Surgery ◽  
The Mean ◽  
One Year ◽  
A Prospective Study

Category: Pain managment Introduction/Purpose: Most surgeons believe, that the postoperative pain course after foot and ankle surgery differs from other joints due to the initial protection and immobilization. The knowledge of the normal pain course after foot and ankle surgery is important to know for the surgeon and correctly inform patients preoperative and may help to identify abnormal postoperative healing courses. Methods: 180 patients were enclosed in a prospective study. 66,7% were female and 33.3% were male. All patients had primary surgery for foot and ankle diseases at a tertiary care foot and ankle center. The pain course was measured using a VAS over a one year period. The mean age was 53,2 (±13.6) years. Results: The mean pain level was 4.56 (± 2.0) preoperative. In the first postoperative week it was 3.5 (± 2.18) and declined until the 6th postoperative week to 1.57 (± 1.52) it increased again after the sixth week up to 1.95 (± 1.63) and decreased then again to 1.09 (± 1.51) one year postoperative. The pain level in patient with tendon surgeries tended to be higher in the first 12 weeks postoperative than that of patients with bony procedures. Conclusion: The pain course after Foot and ankle surgery shows a characteristic curve with a significant increase of the pain level after 6 weeks. A comprehensive patient information can increase satisfaction rates of the patient. Any abnormal postoperative pain course should arise suspection of a complicated healing period.

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