scholarly journals Guided growth: preliminary results of a multinational study of 967 physes in 537 patients

2018 ◽  
Vol 12 (1) ◽  
pp. 91-96 ◽  
Author(s):  
B. Danino ◽  
R. Rödl ◽  
J. E. Herzenberg ◽  
L. Shabtai ◽  
F. Grill ◽  
...  
Keyword(s):  
Coronal Plane ◽  
Guided Growth ◽  
Level Of Evidence ◽  
Screw Breakage ◽  
Plane Deformity ◽  
Alignment Analysis ◽  
Success Of Treatment ◽  
Angular Deformities ◽  
Standard Alignment

Background Guided growth by tension band plating is commonly used to correct coronal plane deformity. The purpose of this study was to measure the effect and further define parameters that influence results in coronal plane deformity around the knee. Methods The retrospective multicentre study included data on 967 physes in 537 patients, with an average follow-up of 16 months after plate insertion. Alignment analysis was compared preoperatively and in at least two measurements postoperatively, as well as with parameters that influence the rate and amount of correction. Results Average age at plate implantation was 11.35 years (SD 3.29). Of those with femoral deformities, 85% of the patients finished the treatment and of those, 70% were corrected to standard alignment, while 14% have not yet achieved correction, and are still growing. Of those with tibial deformities, 75% of the patients finished the treatment and of those 80% were corrected to standard alignment, while 25% have not yet achieved correction and are still growing. The calculated rate of correction was 0.77°/month for the femur and 0.79°/month for the tibia. In terms of complications, the overall rate of infection was 1.48%. In three patients (0.55%) screw breakage was recorded. Factors found to significantly influence the amount of correction were age at plate implantation and direction of deformity. Conclusion Temporary hemiepiphysiodesis takes the advantage of physiological physeal growth to effectively treat angular deformities. Success of treatment is influenced by the age of the patient at plate implantation and direction of deformity. Level of Evidence IV

The Impact of Coronal Plane Deformity on Ankle Arthrodesis and Arthroplasty

2021 ◽  
pp. 107110072110151
Author(s):  
Michael D. Johnson ◽  
Jane B. Shofer ◽  
Sigvard T. Hansen ◽  
William R. Ledoux ◽  
Bruce J. Sangeorzan
Keyword(s):  
Coronal Plane ◽  
Implant Design ◽  
Ankle Arthritis ◽  
Level Of Evidence ◽  
Sf 36 ◽  
Patient Reported ◽  
Plane Deformity ◽  
End Stage ◽  
The Impact

Background: Ankle coronal plane deformity represents a complex 3-dimensional problem, and comparative data are lacking to guide treatment recommendations for optimal treatment of end-stage ankle arthritis with concomitant coronal plane deformity. Methods: In total, 224 patients treated for end-stage ankle arthritis were enrolled in an observational trial. Of 112 patients followed more than 2 years, 48 patients (19 arthrodesis, 29 arthroplasty) had coronal plane deformity and were compared to 64 patients without coronal plane deformity (18 arthrodesis, 46 arthroplasty) defined as greater than 10 degrees of varus or valgus. The arthroplasty implants used had different internal constraints to intracomponent coronal plane tilting. Patients completed Musculoskeletal Functional Assessment (MFA) and SF-36 preoperatively and at 3, 6, 12, 24, and 36 months postoperatively. Measures included change in SF-36 and MFA, as well as compared reoperation rates and pain scales. Results: For the groups with coronal plane ankle deformity, the median for the arthrodesis group was 19.0 degrees and the median for the arthroplasty group was 16.9 degrees. In the deformity cohort during the follow-up period, we had 7 major reoperations: 2 in the arthrodesis group and 5 in the arthroplasty group, all with the less constrained implant design. MFA, vitality, and social function of the SF-36 improved for all groups. Patients without preoperative deformities had greater improvement with fusion or replacement at both 2 and 3 years. There was no difference in improvement between those patients with coronal deformity who received arthroplasty vs arthrodesis. Conclusion: Patients with and without coronal plane deformity may benefit from ankle arthroplasty and arthrodesis, although greater improvements may be expected in those without preoperative deformity. In this study, at final follow-up of 3 years, overall we found no meaningful difference in patient-reported outcomes between the patients with preoperative coronal plane deformities whether they had a fusion or a replacement as treatment for end-stage ankle arthritis. Level of Evidence: II, comparative study.

Long-term outcomes of silicone metacarpophalangeal arthroplasty: a longitudinal analysis of 325 cases

2018 ◽  
Vol 43 (10) ◽  
pp. 1076-1082 ◽  
Author(s):  
Chelsea Boe ◽  
Eric Wagner ◽  
Marco Rizzo
Keyword(s):  
Survival Rates ◽  
Coronal Plane ◽  
Functional Improvement ◽  
Silicone Implants ◽  
Fracture Rate ◽  
High Fracture ◽  
Level Of Evidence ◽  
Time Period ◽  
Plane Deformity

An analysis was conducted of 325 consecutive metacarpophalangeal arthroplasties prospectively collected using a single institution’s total joints registry over a 14-year time period to characterize long-term radiographic and functional outcomes. Patients were followed for a mean of 7.2 years (2–18) or until revision. The 5-, 10- and 15-year survival free from revision were 98%, 95% and 95%, respectively. The 5-, 10- and 15-year survival rates free from radiographic implant fracture were 93%, 58% and 35%, respectively. The 5-, 10- and 15-year survival rates free from coronal plane deformity greater than 10° were 81%, 37% and 17%, respectively. Patients had significant improvements in their postoperative pain levels and metacarpophalangeal arc of motion. Neither implant fracture, nor coronal plane deformity >10° had a significant association with worse function. Overall, pain relief and functional improvement are reliable, though silicone implants do not protect from progression of coronal plane deformity and have a high fracture rate. Level of evidence: IV

Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

2019 ◽  
Vol 13 (5) ◽  
pp. 397-403 ◽  
Author(s):  
Derek Stenquist ◽  
Brian T. Velasco ◽  
Patrick K. Cronin ◽  
Jorge Briceño ◽  
Christopher P. Miller ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Case Series ◽  
Break Point ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Retrospective Case Series ◽  
Screw Breakage ◽  
Tissue Stabilization

Background. Syndesmotic disruption occurs in 20% of ankle fractures and requires anatomical reduction and stabilization to maximize outcomes. Although screw breakage is often asymptomatic, the breakage location can be unpredictable and result in painful bony erosion. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw designed with a controlled break point. Methods. We performed a retrospective review of all patients who underwent syndesmotic fixation utilizing the R3lease Tissue Stabilization System (Paragon 28, Denver, CO) over a 12-month period. Demographic and screw-specific data were obtained. Postoperative radiographs were reviewed, and radiographic parameters were measured. Screw loosening or breakage was documented. Results. 18 patients (24 screws) met inclusion criteria. The mean follow-up was 11.7 months (range = 6.0-14.7 months). 5/24 screws (21%) fractured at the break point. No screw fractured at another location, nor did any fracture prior to resumption of weight bearing; 19 screws did not fracture, with 8/19 intact screws (42.1%) demonstrating loosening. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow-up. No screws required removal during the study period. Conclusion. This study provides the first clinical data on a novel screw introduced specifically for syndesmotic fixation. At short-term follow up, there were no complications and the R3lease screw provided adequate fixation to allow healing and prevent diastasis. Although initial results are favorable, longer-term follow-up with data on cost comparisons and rates of hardware removal are needed to determine cost-effectiveness relative to similar implants. Level of Evidence: Level IV: Retrospective case series

scholarly journals Tension band plates have greater risks of complications in temporary epiphysiodesis

2021 ◽  
Vol 15 (2) ◽  
pp. 106-113
Author(s):  
You-Hung Cheng ◽  
Wei-Chun Lee ◽  
Yi-Feng Tsai ◽  
Hsuan-Kai Kao ◽  
Wen-E Yang ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Distal Femur ◽  
Mechanical Axis ◽  
Valgus Deformity ◽  
Tension Band ◽  
Leg Length ◽  
Level Of Evidence ◽  
Grade Ii ◽  
Angular Deformities

Purpose This study aimed to compare the efficacy of decreasing leg-length discrepancy (LLD) and postoperative complications between tension band plates (TBP) and percutaneous transphyseal screws (PETS). Methods This retrospective study reviewed LLD patients who underwent temporary epiphysiodesis at the distal femur and/or proximal tibia from 2010 to 2017 (minimum two years follow-up). Efficacy of decreasing LLD was assessed one and two years postoperatively. Complications were classified with the modified Clavien-Dindo-Sink complication classification system. Knee deformities were assessed by percentile and zone of mechanical axis across the tibial plateau. Results In total, 53 patients (25 boys, 28 girls) underwent temporary epiphysiodesis (mean age, 11.4 years). The efficacy of decreasing LLD at two years between the TBP (n = 38) and PETS (n = 15) groups was comparable. Seven grade III complications were recorded in six TBP patients and in one PETS patient who underwent revision surgeries for knee deformities and physis impingement. Four grade I and two grade II complications occurred in the TBP group. The mechanical axis of the leg shifted laterally in the PETS group and medially in the TBP groups (+7.1 percentile versus -4.2 percentile; p < 0.05). Shifting of the mechanical axis by two zones was noted medially in four TBP patients and laterally in two PETS patients. Conclusion More implant-related complications and revision surgeries for angular deformities were associated with TBP. A tendency of varus and valgus deformity after epiphysiodesis using TBP and PETS was observed, respectively. Patients and families should be informed of the risks and regular postoperative follow-up is recommended. Level of evidence Level III

scholarly journals Long-Term Follow up of Correction of Moderate to Severe Deformity with the STAR Ankle Prosthesis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0039
Author(s):  
Sudheer C. Reddy ◽  
Roger A. Mann ◽  
Kyle Zemeir ◽  
Sudheer C. Reddy
Keyword(s):  
Deformity Correction ◽  
Mobile Bearing ◽  
Coronal Plane ◽  
Consecutive Series ◽  
Original Cohort ◽  
Entire Cohort ◽  
Long Term Follow Up ◽  
Plane Deformity

Category: Ankle Arthritis Introduction/Purpose: Addressing coronal plane deformity when performing a total ankle arthroplasty (TAA) remains a topic of controversy. While surgeons have become bolder in correcting deformity, long-term follow-up is sparse regarding maintenance of correction and viability of the prosthesis. The purpose of this study is to assess the long-term follow up of the correction of moderate to severe coronal plane deformity with the use of a mobile bearing prosthesis. Methods: Out of a consecutive series of 130 patients who underwent TAA between 2000 and 2009, 43 patients (44 ankles) had at least 100 of tibiotalar coronal plane deformity, with 25 having between 100 and 200 of deformity and 18 having greater than 200. Average age at time of the index surgery was 66 yrs (range 41-79). Initial deformity was 17.90 (range 10-290) in the entire cohort. All patients underwent intraarticular deformity correction with intraoperative soft-tissue balancing as indicated utilizing the STAR prosthesis. Patients requiring realignment osteotomies were performed in a staged fashion prior to undergoing TAA. Results: Seven patients (16%) were available for long-term follow up (avg 13 yrs; range 9-16 yrs) with retention of the original prosthesis, two of which had greater than 200 of initial deformity. Average final tibiotalar deformity was 4.90, with a mean correction of 130(p=0.0001). No additional procedures related to the prosthesis were performed. Eleven patients (12 ankles) were deceased at the time of the study due to unrelated conditions. Of the original cohort, five were deemed failures (2 converted to arthrodesis; 2 underwent component revision; 1 polyethylene fracture) and excluded from long-term follow up. The remaining 20 patients were lost to follow-up, had declined or were unable to participate due to health status. Conclusion: While the low follow-up rate limits the overall generalizability of the results, enduring correction of moderate and severe coronal plane deformity with a mobile bearing prosthesis can be achieved in a cohort of patients traditionally regarded as high-risk. One must be cautious when discussing with patients the utilization of TAA in the setting of moderate and severe coronal plane deformity given the risk of failure. However, provided a well-balanced ankle can be achieved intraoperatively, long-term mobile bearing prosthesis survivorship is achievable.

scholarly journals Mid-Term (4-10 year) Outcomes of INBONE I Total Ankle Arthroplasty with Deformity Analysis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Andrew Harston ◽  
James Nunley ◽  
Mark Easley ◽  
James DeOrio ◽  
Samuel Adams ◽  
...  
Keyword(s):  
Short Form ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Consecutive Series ◽  
Ankle Arthroplasty ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported ◽  
Plane Deformity

Category: Ankle, Ankle Arthritis Introduction/Purpose: Concerns for limited coronal plane stability prompted the manufacturer and designers of the INBONE total ankle arthroplasty system to replace the original saddle-shaped talar component (INBONE I) with a sulcus-shaped talar component (INBONE II). Prior to the availability of the INBONE II talar component, numerous INBONE I total ankle replacements were performed. To our knowledge mid-term outcomes of INBONE I total ankle arthroplasty have not been reported. This study compares the mid-term outcomes of patients with and without preoperative coronal plane deformity who underwent total ankle replacement with the INBONE I prosthesis. In our opinion, the longer-term outcomes of the INBONE I prosthesis are important for patient and surgeon education. Methods: A consecutive series of patients, from May, 2007 to September, 2011, at a single institution who underwent total ankle arthroplasty with the INBONE I Total Ankle Arthroplasty (Wright Medical) were prospectively enrolled. Pain and patient- reported function were assessed preoperatively and at yearly follow-ups with use of a visual analog scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle- hindfoot score, the Short Musculoskeletal Function Assessment (SMFA), and the Short Form-36 (SF-36) Health Survey. We analyzed the data for complications, reoperations, and failures (defined as undergoing revision for exchange or removal of the metallic components for any reason). Patients were grouped according to coronal plane tibiotalar alignment (preoperative coronal plane malalignment of >10 degrees and <10 degrees deformity) and outcomes compared. Results: One-hundred fifty-five INBONE I prostheses were implanted in 151 patients, with minimum 4 year clinical and radiographic follow-up. Follow-up ranged from 48-113 months with an average of 67 months. There was significant (p<0.05) improvement in the VAS, AOFAS, SMFA, and SF-36 scores at most recent follow-up. Forty-five patients (29%) had 49 additional surgeries for impingement, loosening/subsidence, malalignment, ligament instability, polyethylene exchange, and/or infection. There were 14 implant failures with overall survivorship of 90.3%. There was no statistically significant difference in outcomes between patients with coronal plane deformity >10 degrees (47.7%) and <10 degrees (52.3%). Patients with >10 degrees had fewer reoperations (19 vs. 30) and fewer revisions (5 vs. 9) when compared to patients with <10 degrees deformity. Conclusion: Patients who underwent INBONE I total ankle arthroplasty demonstrated significant improvement in pain and patient-reported outcomes at a mean of 5.7 years post-operatively. The patients with preoperative coronal plane tibiotalar deformity had similar pain relief, function, and need for additional surgeries and revisions. Despite the presumed shortcomings of the INBONE I’s saddle-shaped talar design, this operation shows promising results, with or without deformity, at mid-term follow- up with survivorship of 90.3%.

scholarly journals Should 15° of Valgus Coronal-Plane Deformity Be the Upper Limit for a Total Ankle Replacement?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Mansur Halai ◽  
Matthew Mann ◽  
Ryan Khan ◽  
Ellie Pinsker ◽  
Timothy Daniels
Keyword(s):  
Short Form ◽  
Valgus Deformity ◽  
Total Ankle Replacement ◽  
Coronal Plane ◽  
Control Group ◽  
Ankle Arthritis ◽  
Ankle Replacement ◽  
Sf 36 ◽  
Plane Deformity

Category: Ankle Arthritis Introduction/Purpose: Preoperative talar valgus deformity increases the technical difficulty of total ankle replacement (TAR) and is associated with an increased failure rate. Deformity of ≥15° has been reported to be a contraindication to arthroplasty. The goal of the present study was to determine whether the clinical outcomes of TAR for treatment of end-stage ankle arthritis were comparable for patients with preoperative talar valgus deformity of ≥15° as compared to those with <15°. Methods: Fifty ankles with preoperative coronal-plane tibiotalar valgus deformity of ≥15° (“valgus” group) and 50 ankles with valgus deformity of <15° (“control” group) underwent TAR. The cohorts were similar with respect to demographics and components used. All TARs were performed by a single surgeon. The mean duration of clinical follow-up was 5.5 years (minimum two years). Preoperative and postoperative radiographic measurements of coronal-plane deformity, Ankle Osteoarthritis Scale (AOS) scores and Short Form (SF)-36 scores were prospectively recorded. All ancillary (intraoperative) and secondary procedures, complications and measurements were collected. Results: The AOS pain and disability subscale scores decreased significantly in both groups. The improvement in AOS and SF-36 scores did not differ significantly between the groups at the time of the final follow-up. The valgus group underwent more ancillary procedures during the index surgery (80% vs 26%). Tibio-talar deformity improved significantly toward a normal weight-bearing axis in the valgus group. Secondary postoperative procedures were more common in the valgus group (36%) than the controls (20%). Overall, re-operation was not associated with poorer patient outcome scores. Metal component revision surgery occurred in seven patients (three valgus and four controls). These revisions included two deep infections (2%), one in each group, which were converted to hindfoot fusions. Therefore, 94% of the valgus group retained their original components at final follow-up. Conclusion: Satisfactory midterm results were achieved in patients with valgus mal-alignment of ≥15°. The valgus cohort required more procedures during and after their TAR, as well as receiving more novel techniques to balance their TAR. Whilst longer term studies are needed, valgus coronal-plane alignment of ≥15° should not be considered an absolute contraindication to TAR if the associated deformities are addressed.

scholarly journals The efficacy of guided growth as an initial strategy for Blount disease treatment

2020 ◽  
Vol 14 (4) ◽  
pp. 312-317
Author(s):  
Barry Danino ◽  
Robert Rödl ◽  
John E. Herzenberg ◽  
Lior Shabtai ◽  
Franz Grill ◽  
...  
Keyword(s):  
Proximal Tibia ◽  
Average Rate ◽  
Line Treatment ◽  
First Line ◽  
Guided Growth ◽  
Level Of Evidence ◽  
Post Surgery ◽  
Blount Disease ◽  
First Line Treatment

Purpose The aim of this study was to evaluate the success of guided growth by temporal hemiepiphysiodesis of the lateral proximal tibia as a first line treatment option for Blount disease. Methods This was a retrospective multicentre study conducted in five centres, covering data on 55 limbs in 45 patients, with an average follow-up of 24.5 months following plate insertion. Preoperative alignment analysis was compared with three measurements taken postoperatively. The normalization of the mechanical medial proximal tibia angle (mMPTA) was defined as the primary outcome measure. Results Mean age at surgery was 9.5 years. Average preoperative mMPTA was 77°. On average, at 24.5 months post-surgery, mMPTA was 86.33°, while 43/55 limbs (78.18%) have achieved normalization (mMPTA 85° to 90°). Average rate of correction was 1° per month. When grouping the children as infantile (11 limbs), juvenile (12 limbs) and adolescent (32 limbs), operated on before the age of four years, between four and ten years and after the age of ten years, respectively, 63.63%, 66.67%, 87.5% have completed correction of deformity during the follow-up period. Interestingly, the femoral component of the deformity has achieved correction as well in 33/55 limbs (64%). Conclusion Hemiepiphysiodesis is an effective first line treatment for Blount disease. Overall success rate is good but varies according to child’s age. Adolescent Blount has the best chance of achieving full correction while same treatment is less effective in infantile Blount. Level of evidence: IV

scholarly journals 5 Year Follow Up Evaluation of a Third Generation Fixed Bearing Total Ankle Arthroplasty with an Intramedullary Tibial Component and a Central Sulcus Talus

2020 ◽  
Vol 5 (2) ◽  
pp. 2473011420S0000
Author(s):  
Evan M. Loewy ◽  
Robert B. Anderson ◽  
Bruce E. Cohen ◽  
Carroll P. Jones ◽  
W. Hodges Davis
Keyword(s):  
Tibial Component ◽  
Total Ankle Arthroplasty ◽  
Coronal Plane ◽  
Third Generation ◽  
Fixed Bearing ◽  
Ankle Arthritis ◽  
Central Sulcus ◽  
Ankle Arthroplasty ◽  
Plane Deformity

Category: Ankle Arthritis, Ankle Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be a viable option in the treatment of end stage ankle arthritis (ESAA). Early reports demonstrated good results with intramedullary fixation implants. Third generation implants of this kind added a central sulcus to the talar component. This is a report of clinical follow up data from a prospectively collected database at a single US institution using a Third generation fixed bearing total ankle arthroplasty implant with a stemmed tibial component and a talar component with a central sulcus. To our knowledge, this is the first report of 5 year follow up data for this implant. Methods: Patients undergoing primary TAA at a single institution by one of four fellowship trained orthopedic foot and ankle surgeons with a Third generation fixed bearing implant consisting of an intramedullary stemmed tibial component and a sulcus talus that were at least 5 years postoperative were reviewed from a prospectively collected database. These patients were followed at regular intervals with history, physical examination and radiographs. All ankles were classified using the Canadian Orthopedic Foot and Ankle Society (COFAS) End-Stage Ankle Arthritis Classification System. The primary outcome was implant survivability. Secondary outcomes included pre- and postoperative coronal plane radiographic alignment, evaluation for osteolysis, and failure mode when applicable. All reoperation events were recorded using the COFAS Reoperations Coding System (CROCS). Results: 126 TAA with this implant were performed in 124 patients between 2010 and 2013; 74 met inclusion criteria for our study. The mean age at surgery was 61.6 +- 10.0 years (range 38.7-84.3). Four patients died with their initial implants in place. The mean duration of follow up for living patients that retained both initial components at final follow-up was 6.2 +- .9 years (range 4.7-8.1 years). 35% (26 of 74) of ankles had a preoperative coronal plane deformity of at least 10 degrees. 11% (8 of 74) of the ankles had a preoperative coronal plane deformity of at least 20 degrees. There were 6 (8%) implant failures that occurred at a mean 2.0 +- 1.4 years postoperative. Two failures were due to deep infection. One failure was related to talar component subsidence. All failures occurred in patients with =preoperative coronal plane deformity of less than 5 degrees. 81% (60 of 74) of TAA had no reoperation events in the follow up period. Conclusion: This cohort of TAA patients with minimum 5 year follow up using a third generation fixed bearing implant demonstrates acceptable implant survival, improved reoperation rates, and maintenance of coronal plane alignment. These data also suggest tolerance of a larger preoperative deformity with improved implant design. Continued follow up and reporting is needed to ensure that these favorable outcomes are maintained. Additionally, further investigation on acceptable coronal plane alignment correction with TAA is needed to determine the possible limitations of this procedure.

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