Current Trends in the Treatment of Ankle Arthritis: Analysis of the Korean Foot and Ankle Society (KFAS) Member Survey

Byung-Ki Cho; Jaeho Cho; Heui-Chul Gwak; Hak Jun Kim; Su-Young Bae;

doi:10.14193/jkfas.2021.25.3.111

Degenerative Pathology of the Ankle, Hindfoot, and Midfoot is as Limiting to Patient Mobility as Congestive Heart Failure

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00169 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0016

Author(s):

Amalie Erwood ◽

Gregory Kurkis ◽

Samuel David Maidman ◽

Robert Cole ◽

Shay Ariel Tenenbaum ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Nyha Class ◽

Class Ii ◽

Study Patient ◽

Foot And Ankle ◽

Ankle Arthritis ◽

Patient Mobility ◽

Patient Demographics ◽

Significant Difference

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Degenerative conditions of the ankle, hindfoot, and midfoot can markedly limit mobility. The Life-Space Assessment (LSA) is a questionnaire quantifying how patients mobilize after a medical event as they return to their previous daily settings. Current outcome measures do not accurately assess mobility in the geriatric foot and ankle population. In contrast, the effect of congestive heart failure (CHF) on patient mobility is routinely assessed via the New York Heart Association (NYHA) functional classification. The NYHA classification is stratified by limitation of physical activity: I (no limitation), II (some limitation), III (marked limitation), and IV (unable to carry out without discomfort). We hypothesized that degenerative conditions of the foot and ankle would be as mobility limiting as CHF. Methods: Patients over the age of 50 were included in this study. LSA data was prospectively collected from patients with degenerative ankle, hindfoot, and midfoot diagnoses at their preoperative visit and NYHA-classified CHF patients at a cardiology clinic. The degenerative foot and ankle cohort included Achilles tendonitis, ankle joint cartilage defects, ankle arthritis, subtalar arthritis, and midfoot arthritis. Patient demographics and comorbidities were recorded from the electronic medical record. Mean LSA data was analyzed and compared using a Student’s t-test. Results: 28 degenerative foot and ankle patients and 44 CHF patients met inclusion criteria for the study. Patient demographics, including age, gender, and BMI, were not significantly different between the two groups. The foot and ankle cohort had a mean LSA score of 68. Mobility of the foot and ankle group was significantly less compared to NYHA class I patients, who had a LSA score of 103 (p=0.008). There was no significant difference in mobility compared to class II or III congestive heart failure patients, who recorded a mean LSA score of 62 (p=0.60). There was insufficient data available on NYHA class IV patients to make comparisons to this group. Conclusion: Degenerative ankle, hindfoot, and midfoot pathology is associated with similar mobility limitation to that of NYHA class II and III congestive heart failure.

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The Role of Arthroplasty in Combined Hind Foot and Ankle Arthritis

Seminars in Arthroplasty ◽

10.1053/j.sart.2010.09.012 ◽

2010 ◽

Vol 21 (4) ◽

pp. 303-309

Author(s):

Randall C. Marx ◽

William C. McGarvey

Keyword(s):

Foot And Ankle ◽

Ankle Arthritis ◽

Hind Foot

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Patient reported disability of ankle, hindfoot, midfoot and hallux metatarsophalangeal arthritis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000141 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Matthew Christian ◽

Clifford Jeng ◽

Rebecca Cerrato ◽

John T. Campbell ◽

Scott Koenig ◽

...

Keyword(s):

Rating Scales ◽

Short Form ◽

High Volume ◽

Data Sets ◽

Foot And Ankle ◽

Operative Techniques ◽

Ankle Arthritis ◽

Patient Reported ◽

Study Population ◽

Component Scores

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: There has been in increased interest in foot and ankle arthritis in the literature in recent years. A significant focus of the literature has been which operative techniques are best for managing these problems. Some work has been done analogizing disability due to ankle arthritis to more familiar joints such as the hip. There is little data explaining how much patient reported disability is associated with each type of isolated foot and ankle arthritis. Various clinical rating scales have proven how debilitating foot and ankle arthritides can be to patients. The purpose of our study was to use Functional Foot Index (FFI) and Short Form-12 (SF-12) rating scales to compare the patient reported disability associated with ankle, hindfoot, midfoot, and hallux metatarsalphalangeal (MTP) arthritides. Methods: We retrospectively reviewed the FFI and SF-12 (both Physical Component Scores (PCS) and Mental Component Scores (MCS)) of patients who presented to a high volume orthopaedic foot and ankle practice between 2010 and 2016 with either ankle, hindfoot, midfoot or hallux MTP arthritis. We included patients between 18-65 years of age who underwent a surgical procedure for arthritis within 6 months of their initial presentation. We excluded patients with any medical or surgical co-morbidities known to affect disability scores. A total of 214 FFI and 195 SF-12 data sets were included. Results: Study population SF-12 PCS scores for all patients with ankle or foot arthritis were significantly lower than US age-based norms. Patients with ankle arthritis had the highest disability (FFI score 46.5, SF-12 PCS 32.3). Patients with midfoot and hindfoot arthritis had intermediate disability (Midfoot FFI score 34.9, SF-12 PCS 34.5; Hindfoot FFI score 44.3, SF-12 PCS 34.5). Patients with hallux MTP arthritis had the lowest disability (FFI score 32.9, SF-12 PCS 40.7). All FFI and SF-12 PCS scores were statistically significant. SF 12 MCS were not statistically significant. Conclusion: All patients with foot and ankle arthritis had increased disability compared to US age-based norms. Patients with ankle arthritis experience the most self-reported disability and patients with hallux MTP arthritis experience the least self- reported disability of the isolated types of arthritis in orthopaedic foot and ankle.

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Is the Canadian Orthopaedic Foot and Ankle Society Ankle Arthritis Score (COFAS AAS) Associated with the Need for Revision Surgery?

Foot & Ankle Orthopaedics ◽

10.1177/2473011416s00035 ◽

2016 ◽

Vol 1 (1) ◽

pp. 2473011416S0003

Author(s):

Kevin Wing ◽

Stephen Croft ◽

Timothy R. Daniels ◽

Mark A. Glazebrook ◽

Peter Dryden ◽

...

Keyword(s):

Revision Surgery ◽

Arthritis Score ◽

Foot And Ankle ◽

Ankle Arthritis

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Current Trends in Thromboprophylaxis in Surgery of the Foot and Ankle

Foot & Ankle International ◽

10.3113/fai.2007.1069 ◽

2007 ◽

Vol 28 (10) ◽

pp. 1069-1073 ◽

Cited By ~ 25

Author(s):

Aniruth Gadgil ◽

Rhys H. Thomas

Keyword(s):

Best Practice ◽

Significant Proportion ◽

Foot And Ankle ◽

Thromboembolic Prophylaxis ◽

Current Trends ◽

Published Evidence ◽

Ankle Surgery ◽

Hip And Knee Arthroplasty ◽

Wide Variability ◽

Common Situation

Background: Few studies exist to guide the best practice in thromboprophylaxis after foot and ankle surgery. A survey of foot and ankle surgeons was performed to assess current trends in thromboprophylaxis. Methods: An email-based survey of American and British foot and ankle surgeons was conducted. Surgeons were questioned as to their use and type(s) of thromboprophylaxis as well as reasons for not using prophylaxis. Surgeons also were asked about their use of thromboprophylaxis in hip and knee arthroplasty, if they did these surgeries. Results: Nearly one-fifth (19%, 27) of surgeons routinely used thromboprophylaxis in both elective and trauma foot and ankle surgery. The most common situation for use was in a postoperative patient who was immobilized and nonweightbearing. A lack of published evidence and a low rate of thromboembolism were the most commonly cited reasons for not using thromboprophylaxis. Conclusions: This survey showed a wide variability in thromboembolic prophylaxis. It suggests that despite the literature indicating to the contrary, a significant proportion of foot and ankle surgeons routinely use thromboprophylaxis. Confusion remains regarding the appropriateness of thromboprophylaxis and what type(s)(if any) should be used. This study has identified a need for more in-depth evaluation of the importance of, and possible prophylaxis against, thromboembolic problems after foot and ankle surgery.

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Current Trends in Foot and Ankle Surgery

Foot & Ankle Specialist ◽

10.1177/1938640012472454 ◽

2013 ◽

Vol 6 (1) ◽

pp. 11-11

Author(s):

Anand Vora

Keyword(s):

Foot And Ankle ◽

Current Trends ◽

Ankle Surgery

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

10.21203/rs.3.rs-757620/v1 ◽

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.

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Total Ankle Arthroplasty with Simultaneous Versus Secondary Hindfoot Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00479 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0047

Author(s):

Michel Taylor ◽

Elizabeth Cody ◽

Mark Easley ◽

Selene Parekh ◽

James Nunley ◽

...

Keyword(s):

Short Form ◽

Total Ankle Arthroplasty ◽

Functional Improvement ◽

Foot And Ankle ◽

Ankle Arthritis ◽

Extensive Experience ◽

Ankle Arthroplasty ◽

Sf 36 ◽

Outcome Scores ◽

Hindfoot Arthrodesis

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) for ankle arthritis leads to a more normal gait pattern compared to ankle arthrodesis, prompting many to hypothesize that TAA slows development of adjacent joint arthrosis. However, following TAA, patients may also develop hindfoot pain, deformity and dysfunction, ultimately requiring arthrodesis procedures. Many patients with AA also have subtalar and/or talonavicular arthrosis. In these cases, simultaneous TAA and hindfoot arthrodesis may be performed. Previous studies have found that TAA in conjunction with hindfoot arthrodesis procedures led to inferior outcomes compared to isolated TAA. The purpose of this analysis was to compare the functional outcomes of simultaneous vs. subsequent hindfoot arthrodesis procedures and to describe the change, if any, in outcome scores following a subsequent hindfoot arthrodesis procedure. Methods: After receiving Institutional Review Board approval, the TAA database at our institution was reviewed for all TAA performed between 1998 and 2015. All patients who received a TAA and either a simultaneous or subsequent hindfoot arthrodesis with at least two years of clinical follow up were included in the analysis. All surgeries were performed by one of three fellowship-trained orthopaedic foot and ankle surgeons with extensive experience in TAA and associated hindfoot arthrodesis procedures. Outcome measures included preoperative and 2-year postoperative visual analog scale (VAS) scores, Short Musculoskeletal Function Assessment (SMFA), Short Form (SF)-36 and American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores. Results: 64 patients met the inclusion criteria. 39 patients underwent TAA with simultaneous hindfoot arthrodesis (Sim) and 25 underwent a subsequent arthrodesis procedure (Sub) an average 22.2 months following TAA. 20 patients underwent double arthrodesis (11 Sub) and 44 patients underwent subtalar fusion (14 Sub). There were no differences in preoperative questionnaire scores between the two groups. Both the Sim and Sub groups experienced significant improvement in their postoperative VAS, SMFA, SF-36 and AOFAS scores. Postoperative VAS and SMFA bother scores were significantly lower for the Sim group (p<0.05). In the Sub group, there was no difference in outcome scores before and after the fusion procedure. Demographics and questionnaire scores are shown in the Table. Conclusion: These results support previous findings demonstrating significant functional improvement and decrease in pain scores following TAA and associated fusion procedures. However, these results also suggest that simultaneous fusion procedures may provide better reduction in pain when compared to sequential procedures. In addition, for patients who underwent subsequent fusion, the improvement experienced in terms of pain and function tends to be maintained postoperatively.

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