Does the IOFix implant improve union rates?

Abstract Background First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. Methods We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. Results Thirty patients were included in the study. The mean age was 60.36 ± 9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2 ± 12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5 ± 10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%. Conclusions This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices. Level of evidence 4

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Does the IOFix implant Improve Union Rates?

10.21203/rs.3.rs-22714/v2 ◽

2020 ◽

Author(s):

david segal ◽

Nissim Ohana ◽

Meir Nyska ◽

Ezequiel Palmanovich

Keyword(s):

Demographic Data ◽

Retrospective Chart Review ◽

Fusion Rate ◽

Hallux Rigidus ◽

Hardware Removal ◽

Functional Score ◽

Level Of Evidence ◽

Operation Rate ◽

The Mean

Abstract BACKGROUND First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODS We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36±9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2±12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5±10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%.CONCLUSIONS This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.LEVEL OF EVIDENCE: 4

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Does the Expensive IOFix implant Improve Union Rates?

10.21203/rs.3.rs-22714/v1 ◽

2020 ◽

Author(s):

David Segal ◽

Nissim Ohana ◽

Meir Nyska ◽

Ezequiel Palmanovich

Keyword(s):

Demographic Data ◽

Retrospective Chart Review ◽

Fusion Rate ◽

Hallux Rigidus ◽

Hardware Removal ◽

Functional Score ◽

Fixation Devices ◽

Operation Rate ◽

The Mean

Abstract BACKGROUND First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODS We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and X-ray radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36 ± 9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2 ± 12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5 ± 10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%. CONCLUSIONS This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.

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Does the IOFix implant Improve Union Rates?

10.21203/rs.3.rs-22714/v3 ◽

2020 ◽

Author(s):

david segal ◽

Nissim Ohana ◽

Meir Nyska ◽

Ezequiel Palmanovich

Keyword(s):

Demographic Data ◽

Retrospective Chart Review ◽

Fusion Rate ◽

Hallux Rigidus ◽

Hardware Removal ◽

Functional Score ◽

Fixation Devices ◽

Operation Rate ◽

The Mean

Abstract BACKGROUNDFirst metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODSWe have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36±9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2±12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5±10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%.CONCLUSIONSThis is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.

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Early Outcomes and Complications of Synthetic Cartilage Implant for Treatment of Hallux Rigidus in the United States

Foot & Ankle International ◽

10.1177/1071100719855049 ◽

2019 ◽

Vol 40 (10) ◽

pp. 1140-1148 ◽

Cited By ~ 14

Author(s):

Spenser J. Cassinelli ◽

Stephanie Chen ◽

Timothy P. Charlton ◽

David B. Thordarson

Keyword(s):

Patient Satisfaction ◽

Case Series ◽

Retrospective Chart Review ◽

The United States ◽

Reoperation Rate ◽

Hallux Rigidus ◽

Level Of Evidence ◽

Physical Dysfunction ◽

Magnetic Resonance Imaging Mri

Background: The aim of this study was to determine the early outcomes and complications following the implantation of a hydrogel synthetic cartilage implant (SCI, Cartiva) for the treatment of hallux rigidus by a single surgeon. Methods: A retrospective chart review was performed of consecutive patients who underwent treatment for hallux rigidus with an SCI between August 2016 and April 2018 by a single surgeon. Demographic information, radiographic assessment, and concomitant operative procedures performed were evaluated for all patients. Postoperatively, PROMIS physical function (PF) and pain interference (PI) scores, patient satisfaction, reoperation, conversion to arthrodesis, and need for further clinical treatment were collected. Sixty-four SCIs were implanted in 60 patients. Follow-up averaged 18.5 months (range 12-30 months). Results: 14% (9/64) of patients were very satisfied, 28% (18/64) satisfied, 20% (13/64) neutral, 11% (7/64) unsatisfied, and 27% (17/64) very unsatisfied with their outcome. In addition, 45% of patients underwent additional procedures at the time of SCI, and 23% had a history of surgery on the hallux before implantation. PROMIS PF scores averaged 42 and PROMIS PI scores averaged 60. Overall, 63% completed PROMIS PI, 66% completed PROMIS PF, and 100% completed a satisfaction survey. In addition, 30% (19/64) underwent magnetic resonance imaging (MRI) postoperatively due to pain. There was a 20% reoperation rate, which included an 8% rate of conversion to arthrodesis. Conclusion: Synthetic cartilage implantation yielded neutral patient satisfaction, mild pain, and physical dysfunction at early follow-up. We believe patient selection and counseling regarding early postoperative limitations are important before proceeding with SCI. Level of Evidence: Level IV, case series.

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Long-Term Follow-up of Arthroscopic Treatment of Lateral Epicondylitis

The American Journal of Sports Medicine ◽

10.1177/0363546507311599 ◽

2008 ◽

Vol 36 (2) ◽

pp. 254-260 ◽

Cited By ~ 106

Author(s):

Champ L. Baker ◽

Champ L. Baker

Keyword(s):

Case Series ◽

Lateral Epicondylitis ◽

Operative Management ◽

High Rate ◽

Functional Score ◽

Level Of Evidence ◽

Long Term Follow Up ◽

The Mean

Background In a previously published report of the authors’ arthroscopic technique of operative management of recalcitrant lateral epicondylitis, they demonstrated short-term success with the procedure in their patients. Hypothesis Arthroscopic management of patients with lateral epicondylitis can produce clinical improvement and have successful long-term outcomes. Study Design Case series; Level of evidence, 4. Methods Forty patients (42 elbows) with lateral epicondylitis who had not responded to nonoperative management were treated with arthroscopic resection of pathologic tissue. Thirty of these patients (30 elbows) were located for extended follow-up. At a mean follow-up of 130 months (range, 106–173 months), patients were asked to use a numeric scale to rate their elbow pain from 0 (no pain) to 10 (severe pain). Patients were also asked to rate their elbows according to the functional portion of the Mayo Clinic Elbow Performance Index. Results The mean pain score at rest was 0; with activities of daily living, 1.0; and with work or sports, 1.9. The mean functional score was 11.7 out of a possible 12 points. No patient required further surgery or repeat injections after surgery. One patient continued to wear a counterforce brace with heavy activities. Twenty-three patients (77%) stated they were “much better,” 6 patients (20%) stated they were “better,” and 1 patient (3%) stated he was the same. Twenty-six patients (87%) were satisfied, and 28 patients (93%) stated they would have the surgery again if needed. Conclusion Arthroscopic removal of pathologic tendinosis tissue is a reliable treatment for recalcitrant lateral epicondylitis. The early high rate of success in patients was maintained at long-term follow-up.

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Relationship of Postoperative Achilles Tendon Elongation With Plantarflexion Strength Following Surgical Repair

Foot & Ankle International ◽

10.1177/1071100719879659 ◽

2019 ◽

Vol 41 (2) ◽

pp. 140-146 ◽

Cited By ~ 2

Author(s):

Önder Murat Hürmeydan ◽

Mehmet Demirel ◽

Natig Valiyev ◽

Turker Sahinkaya ◽

Önder İsmet Kılıçoğlu

Keyword(s):

Achilles Tendon ◽

Chart Review ◽

Case Series ◽

Retrospective Chart Review ◽

Isokinetic Dynamometer ◽

Level Of Evidence ◽

Tendon Elongation ◽

The Mean ◽

Relationship Of

Background: Little data exist regarding the adverse effects of Achilles tendon (AT) elongation after rupture repair on plantarflexion strength. This study aimed to investigate the effect of AT elongation measured using AT resting angle (ATRA) on the plantarflexion strength in patients with surgically treated acute AT rupture. Methods: A retrospective chart review was performed on 40 patients (15 female and 25 female) who underwent open operative repair due to an acute AT rupture. At the final follow-up, AT elongation was assessed using ATRA. Plantarflexion strength (peak torques and angle-specific torques) was measured using an isokinetic dynamometer. All variables were obtained from the operated and unoperated contralateral ankles of the patients. Results: The mean ATRA was greater in the operated ankles (mean, 57 degrees; range, 39-71 degrees) compared with the unoperated ones (mean, 52 degrees; range, 36-66 degrees; P = .009). Except the plantarflexion torque at 20 degrees of plantarflexion ( P = .246), all the other angle-specific torques were lower in the operated ankles ( P < .05). Peak flexion torque at 30 degrees/s was lower in the operated ankle ( P = .002). A negative correlation was found between operated/unoperated (O/N) ATRA and O/N plantarflexion torque ratios at 0 degrees ( r = −0.404; P = .01), 10 degrees ( r = −0.399; P= .011), and 20 degrees ( r = −0.387; P = .014). Conclusion: Postoperative AT elongation measured using ATRA may have a deleterious effect on the plantarflexion strength in patients with surgically treated acute AT rupture. Level of Evidence: Level IV, case series.

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Patient-Reported Outcomes and Early Complications After Synthetic Cartilage Device Implantation

Foot & Ankle Orthopaedics ◽

10.1177/2473011420930691 ◽

2020 ◽

Vol 5 (3) ◽

pp. 247301142093069

Author(s):

William M. Engasser ◽

J. Chris Coetzee ◽

Patrick B. Ebeling ◽

Bryan D. Den Hartog ◽

Jeffrey D. Seybold ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Case Series ◽

Retrospective Chart Review ◽

Hallux Rigidus ◽

Early Complications ◽

Level Of Evidence ◽

Device Implantation ◽

Patient Reported ◽

Level I

Background: Previous Level I studies show promising results for the use of a hydrogel synthetic cartilage implant (SCI) for the treatment of hallux rigidus. A recent independent retrospective review has put those results into question, however. The purpose of this article is to report patient-reported outcomes and early complications using this implant so as to add to the paucity of data in the literature regarding this implant. Methods: This was a retrospective chart review of patients undergoing hydrogel synthetic cartilage implant for the treatment of hallux rigidus from July 2017 to November 2018. Data collected included patient demographics, radiographic grading, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. Fifty-four patients (59 feet) with an average age of 57.6 (range, 39-78) years were analyzed. The average latest follow-up was 18.9 (range, 3-31.3) months. Body mass index was 26.7 (range, 18.7-35.2). None were diabetic and 5 were smokers. Results: The mean outcome improvements were 6.5 points (VR-12 Physical), 17.2 points (FAAM ADL), 27.4 points (FAAM Sport), and 18.4 points (VAS) ( P < .01 for each). Scores were significantly improved from preoperatively to most recent follow-up for FAAM ADL (71.0 vs 88.2 points), FAAM Sports (44.6 vs 72.0 points), and VAS (49.4 vs 31.0) ( P < .01). Overall, 72.5% patients would definitely or probably have the operation again. Ten patients (18.5%) went on to have revision surgery. Of these, 7 patients were revised to an arthrodesis, and 1 metal hemiarthroplasty and 2 implants were removed because of infection. Conclusion: Synthetic cartilage implantation for the treatment of hallux rigidus demonstrated improved pain and outcome scores at short-term follow-up. Reoperation and conversion to fusion rates were comparable to prior studies. Level of Evidence: Level IV, case series.

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Intralesional Tetracycline Injection, Pinch Technique, and Canthopexy for the Treatment of Severe Festoons: Preliminary Results

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojab048 ◽

2021 ◽

Vol 4 ◽

Author(s):

Sergio Lessa ◽

João Pontello ◽

Deilton Duarte ◽

Diogo Lobão

Keyword(s):

Retrospective Chart Review ◽

Lower Eyelid ◽

Time Interval ◽

Level Of Evidence ◽

Preliminary Results ◽

Initial Injection ◽

Intralesional Injections ◽

The Mean ◽

Board Review

Abstract Background Many techniques have been presented for the treatment of lower eyelid festoons, but no singular technique has become dominant. Objectives The authors describe the safety and efficacy of intralesional tetracycline injection, the pinch technique, and canthopexy for the treatment of severe festoons. Methods Institutional board review approval was obtained, and a retrospective chart review was performed on 15 consecutive patients who had received 2% tetracycline injections to treat lower eyelid large festoons between February 2017 and February 2020. Three months after the last injection, a series of patients underwent the surgical procedure: pinch technique and canthopexy bilaterally. Results Clinical and photographic records were reviewed, and 12 patients were included in the analysis. Three patients did not return for follow-up after the injection series. Of the 12 patients, there were 3 male patients and 9 female patients, with an average age of 66.6 years. The mean volume injected in each festoon was 0.43 mL, and the mean follow-up was 313 days. A series of injections with a 3-month time interval were performed for patients with a partial response to the initial injection. There was no evidence of complications at the site of the injection. Three months after the last injection, these 12 patients underwent complementary surgical treatment, which included pinch resection and canthopexy. Conclusions These preliminary results suggest that intralesional injections of tetracycline 2% may offer a safe option to treat lower eyelid festoons. This noninvasive procedure represents adjunct benefits to complementary surgical therapy. Level of Evidence: 4

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Metatarsophalangeal arthrodesis of the hallux using a minimally invasive technique

Journal of the Foot & Ankle ◽

10.30795/jfootankle.2021.v15.1565 ◽

2021 ◽

Vol 15 (3) ◽

pp. 208-212

Author(s):

Luiz Carlos Ribeiro Lara ◽

Lúcio Carlos de Azevedo Torres Filho ◽

Gabriel Lopes de Faria Cervone ◽

Juan Antonio Grajales ◽

Glaucia Bordignon ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Analogue Scale ◽

Hallux Rigidus ◽

Invasive Technique ◽

Percutaneous Technique ◽

Union Rate ◽

Level Of Evidence ◽

The Mean ◽

American Orthopaedic

Objective: To evaluate the outcomes of the metatarsophalangeal arthrodesis (MTPA) of the hallux using a percutaneous technique. Methods: The MTPA of the hallux was performed in a total of 27 feet: 20 patients diagnosed with hallux rigidus and 7 with rheumatoid arthritis. The mean postoperative follow-up time was 30.7 months. The results were evaluated using the visual analogue scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, and regards to union rate. Results: All 27 patients were operated percutaneously and noticed relief of the pain, with a mean increase of 50.9 points in AOFAS scores and a mean decrease of 7.4 points in the VAS. The mean union time was 10 weeks. There were no cases of nonunion. Conclusion: Percutaneous first MTP arthrodesis proved effective for treating hallux rigidus and degenerative rheumatic pathologies. Level of Evidence IV; Therapeutic Studies; Cases Series.

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Patellar Tendon Imbrication Is a Safe and Efficacious Technique to Shorten the Patellar Tendon in Patients With Patella Alta

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120959318 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095931

Author(s):

Ronak M. Patel ◽

Michael Gombosh ◽

Joshua Polster ◽

Jack Andrish

Keyword(s):

Patellar Tendon ◽

Patellar Instability ◽

Case Series ◽

Retrospective Chart Review ◽

Patella Alta ◽

Level Of Evidence ◽

Tendon Length ◽

Patellar Tendon Length ◽

The Mean

Background: Patella alta has been noted to be a risk factor for recurrent patellar instability. Purpose: We conducted a radiographic study to determine whether a patellar tendon imbrication technique normalizes patellar height as well as whether the shortened length is maintained at a minimum 2-year follow-up. Study Design: Case series; Level of evidence, 4. Methods: A total of 54 consecutive patients were identified after a retrospective chart review was performed on patients who underwent patellar tendon imbrication between 2008 and 2013. Preoperative, 3 weeks postoperative, and minimum 2 years postoperative lateral radiographs were analyzed using Insall-Salvati (IS), Blackburne-Peel (BP), and Caton-Deschamps (CD) indices to determine the amount of shortening that was achieved after the procedure and to what degree that shortening was maintained at a minimum 2-year follow-up. Results: A total of 27 patients (32 knees) completed a minimum 2-year follow-up. The mean patellar tendon length preoperatively was 6.1 cm (range, 5-8 cm). At 3 weeks and 2 years, the mean tendon lengths were 5.1 and 5.2 cm, respectively. Thus, the mean ± SD change in patellar tendon length from preoperative to 3 weeks postoperative was 0.97 ± 0.67 cm. IS, BP, and CD ratios had minimal change (loss of correction) from 3-week to 2-year follow-up; the delta values were 0.04, –0.03, and 0.09, respectively. There were no complications directly related to the technique. Conclusion: Patellar tendon imbrication is a safe and effective procedure to correct patella alta in the setting of lateral patellar instability. On average, the technique allowed 1 cm of patellar tendon shortening and maintained the correction at a minimum 2-year follow-up. In the skeletally immature patient, this technique allows correction of patella alta by avoidance of a tibial tuberosity osteotomy.

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