Simulated operation combined with patient-specific instrumentation technology is superior to conventional technology for supramalleolar osteotomy: A retrospective comparative study

Abstract Background Over the past seven years, our team has designed a simulated operation combined with patient-specific instrumentation (SO-PSI) assisted supramalleolar osteotomy (SMOT) method and applied it in the clinic. This study aimed to evaluate the differences between SO-PSI technology and conventional operation (CO) technology for SMOT in preoperative planning, intraoperative application, and postoperative curative effect. Methods We retrospectively analyzed SMOT data collected from our hospital between October 2014 and December 2018. Patients (n = 28) were enrolled and divided into CO (n = 17) and SO-PSI (n = 11) groups; mean follow-up time was 33.4 (range, 13 to 59) months. We statistically analyzed and compared perioperative data, accuracy of preoperative planning, and intraoperative application; difference between pre- and post-operative radiologic ankle angles; and changes in American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of ankle motion, and Takakura stage after surgery. Results All ankle alignments and positions were recovered for both groups. Compared with the CO group, the SO-PSI group had a shorter mean operating time and postoperative hospital stay, a decreased number of fluoroscopy examinations, lower albumin reduction, longer preoperative planning time and preoperative hospital stay, and increased hospitalization expenses. In the SO-PSI group, comparison of ankle angles at preoperative planning and postoperatively revealed good correlation, while this was not the case in the CO group. Mean tibial ankle center discrepancy for the SO-PSI group was 1.86 ± 1.06 mm. On follow-up, all radiologic parameters for the two groups improved significantly; however, the improvement of the tibial anterior surface angle and tibiotalar tilt angle for the SO-PSI group were more obvious than those for the CO group; AOFAS score, VAS score, ankle range of motion, and Takakura stage improved after surgery in both groups; however, the improvements in the SO-PSI group were greater than those in the CO group overall. Conclusions SO-PSI technology can facilitate accurate and rapid preoperative planning for SMOT. In general, compared with conventional technology, SO-PSI has advantages for preoperative planning, intraoperative application, and postoperative curative effect.

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Simulated operation combines patient-specific guide technology is superior to conventional technology for supramalleolar osteotomy: a retrospective comparative study

10.21203/rs.3.rs-18783/v1 ◽

2020 ◽

Author(s):

Chenggong Wang ◽

Can Xu ◽

Yusheng Li ◽

Mingqing Li ◽

Da Zhong ◽

...

Keyword(s):

Hospital Stay ◽

Range Of Motion ◽

Preoperative Planning ◽

Patient Specific ◽

Aofas Score ◽

Curative Effect ◽

Supramalleolar Osteotomy ◽

Conventional Technology ◽

The Mean

Abstract Background: Over the past seven years, our team has designed a simulated operation combines patient-specific guide (SO-PSI) assisted supramalleolar osteotomy (SMOT) method and applied it to the clinic. This study aimed to determine the difference between SO-PSI technology and conventional operation (CO) technology for SMOT in preoperative planning, intraoperative application and postoperative curative effect. Methods: We retrospectively analyzed the data of SMOT in our hospital between October 2014 and December 2018; 28 patients were enrolled and divided into CO group (n=17) and SO-PSI group (n=11); the mean follow-up time was 33.4 (range, 13 to 59) months. We analyzed and compared perioperative data, accuracy of preoperative planning and intraoperative application, difference between pre- and post-operative of radiologic ankle angles, and change of AOFAS score, VAS, range of motion of ankle and Takakura stage after operation. Then we performed statistical analyses. Results: All ankle alignments and positions of two groups have been recovered. Compared with CO group, SO-PSI group has a shorter operative time and a postoperative hospital stay, a decreased number of fluoroscopies and a reduction of albumin, a longer preoperative planning time and a preoperative hospital stay and an increased hospitalization expenses. In SO-PSI group, the ankle angles between preoperative planning and postoperative shown good correlation, but not in CO group; the mean tibial ankle center discrepancy of SO-PSI group was 1.86±1.06 mm. After follow-up, all radiologic parameters of two groups significantly improved, but the improvement of tibial anterior surface angle and tibiotalar tilt angle of SO-PSI group were more obvious than that of CO group; AOFAS score, VAS, range of motion of ankle and Takakura stage of two groups improved after operation; but overall the improvements of SO-PSI group were better than the CO group. Conclusions: SO-PSI technology can carry out the preoperative plan accurately and quickly in SMOT; In general, compared with the conventional technology, SO-PSI technology has advantages in preoperative planning, intraoperative application and postoperative curative effect. Keywords: Supramalleolar osteotomy; Simulated operation; Patient-specific guide; Accuracy of preoperative planning; Practicability of application

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Supramalleolar Osteotomy combined with Intra-articular Osteotomy for the Reconstruction of Malunited Supination-Adduction Ankle Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000130 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0001

Author(s):

Guo Changjun ◽

Xiangyang Xu

Keyword(s):

Ankle Fractures ◽

Ankle Arthritis ◽

Vas Score ◽

Supramalleolar Osteotomy ◽

Significant Difference ◽

Scale Scores ◽

Effective Option ◽

Vertical Impaction ◽

Control Study

Category: Ankle Arthritis, Trauma Introduction/Purpose: The supination-adduction ankle fractures often showed vertical impaction of the tibial medial plafond. The malunion of these fractures cause the varus ankle deformity and secondary ankle arthritis. This retrospective control study looked at the use of supramalleolar osteotomy combined with intra-articular osteotomy in patients with malunited supination- adduction ankle fractures. Methods: Twelve patients were treated with malunited supination-adduction ankle fractures between January 2013 and December 2014. All of these patients had the varus ankle deformity and secondary ankle arthritis. Supramalleolar osteotomy combined with intra-articular osteotomy were underwent for the reconstruction surgery. The visual analog scale (VAS) score for pain during daily activities, Olerud and Molander Scale scores, subjective satisfaction survey rating and the modified Takakura classification stage were obtained. Ten patients were available for follow-up at a mean of 35.4 months (range, 28 to 40 months). Results: Average postoperative Olerud and Molander Scale score 24 months after surgery was 83±10 compared with 60±14 preoperatively. The mean VAS score decreased from 7±2 preoperatively to 2±2 at the latest follow-up. Six patients rated their result as excellent, 3 as good and 1 as fair. No significant difference in the modified Takakura classification stage was observed between the preoperative and the last follow-up. Conclusion: The use of supramalleolar osteotomy combined with intra-articular osteotomy was an effective option for the treatment of malunited supination-adduction ankle fractures.

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Selective Arthrodesis for Treatment of Symptomatic Müller-Weiss Disease

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00033 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0003 ◽

Cited By ~ 1

Author(s):

Le Cao ◽

Xu-dong Miao

Keyword(s):

Ct Scan ◽

Stage Iv ◽

Subjective Ratings ◽

Aofas Score ◽

Triple Arthrodesis ◽

Vas Score ◽

American Orthopaedic ◽

Hindfoot Arthrodesis ◽

Old Females

Category: Midfoot/Forefoot Introduction/Purpose: Müller-Weiss Disease (MWD) is also known as Müller-Weiss Syndrome, which is reported an uncommon adult navicular osteonecrosis, frequently occurring in middle-aged and old females and characterized by compression and fragmentation of the lateral aspect of the navicular bone and progressive malformation. In this study, we report the results of selective midfoot and hindfoot arthrodesis for treating symptomatic MWD. Methods: From January 2006 to December 2011, 28 patients (31 feet) with MWD were treated with selective arthrodesis with tricortical autologous iliac crest block fixated by screws and plate and retrospectively reviewed. These included 24 females and 4 males, with an average age of 53.1 years (31-65 years), and an average symptoms duration of 8.6 years (1.5-13 years). The disease was staged according to Maceira, which included 3 feet in stage II, 15 feet in stage III, 7 feet in stage IV, and 6 feet in stage V. Pre- and postoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS), radiologic examination, and patients’ satisfaction rate of the surgery were evaluated at an average of 6.6 years (4-12 years) following surgery. Results: Selective arthrodesis according to various symptoms and CT-scan findings related to MWD, 12 feet had talonavicular arthrodesis, 16 feet had talonavicular-cuneiform arthrodesis, and 3 feet had triple arthrodesis. The follow-up visit showed satisfactory outcomes, solid union was achieved in all cases, with average fusion time was 15.2 weeks (12-26 weeks). VAS score reducing from the preoperative 7.8 (7-9) to postoperative 2.3(0-4), whereas the AOFAS score improved from the preoperative 25.4 (19-42) to the postoperative 80.3 (73-88). The patient’s subjective ratings showed excellent results in 8 feet, good results in 18 feet, and fair outcomes in 5 feet. Conclusion: Selective arthrodesis according to various symptoms and CT-scan findings related to MWD, 12 feet had talonavicular arthrodesis, 16 feet had talonavicular-cuneiform arthrodesis, and 3 feet had triple arthrodesis. The follow-up visit showed satisfactory outcomes, solid union was achieved in all cases, with average fusion time was 15.2 weeks (12-26 weeks). VAS score reducing from the preoperative 7.8 (7-9) to postoperative 2.3(0-4), whereas the AOFAS score improved from the preoperative 25.4 (19-42) to the postoperative 80.3 (73-88). The patient’s subjective ratings showed excellent results in 8 feet, good results in 18 feet, and fair outcomes in 5 feet.

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Arthroscopic-Assisted Versus All-Arthroscopic Ankle Stabilization Technique

Foot & Ankle International ◽

10.1177/1071100720938672 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1360-1367 ◽

Cited By ~ 3

Author(s):

Matteo Guelfi ◽

Gustavo Araujo Nunes ◽

Francesc Malagelada ◽

Guillaume Cordier ◽

Miki Dalmau-Pastor ◽

...

Keyword(s):

Ankle Instability ◽

Clinical Results ◽

Pain Scale ◽

Chronic Ankle Instability ◽

Percutaneous Technique ◽

Aofas Score ◽

Level Of Evidence ◽

Vas Score ◽

The Mean

Background: Both the percutaneous technique with arthroscopic assistance, also known as arthroscopic Broström (AB), and the arthroscopic all-inside ligament repair (AI) are widely used to treat chronic lateral ankle instability. The aim of this study was to compare the clinical outcomes of these 2 arthroscopic stabilizing techniques. Methods: Thirty-nine consecutive patients were arthroscopically treated for chronic ankle instability by 2 different surgeons. The AB group comprised 20 patients with a mean age of 30.2 (range, 18-42) years and a mean follow-up of 19.6 (range, 12-28) months. The AI group comprised 19 patients with a mean age of 30.9 (range, 18-46) years and mean follow-up of 20.7 (range, 13-32) months. Functional outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score and visual analog pain scale (VAS) were assessed pre- and postoperatively. Range of motion (ROM) and complications were recorded. Results: In both groups the AOFAS and VAS scores significantly improved compared with preoperative values ( P < .001) with no difference ( P > .1) between groups. In the AB group the mean AOFAS score improved from 67 (range, 44-87) to 92 (range, 76-100) and the mean VAS score from 6.4 (range, 3-10) to 1.2 (range, 0-3). In the AI group the mean AOFAS score changed from 60 (range, 32-87) to 93 (range, 76-100) and the mean VAS score from 6.1 (range, 4-10) to 0.8 (range, 0-3). At the final follow-up 8 complications (40%) were recorded in the AB group. In the AI group 1 complication (5.3%) was observed ( P < .05). Conclusion: Both the AB and AI techniques are suitable surgical options to treat chronic ankle instability providing excellent clinical results. However, the AB had a higher overall complication rate than the AI group, particularly involving a painful restriction of ankle plantarflexion and neuritis of the superficial peroneal nerve. Level of Evidence: Level III, retrospective comparative study.

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Early experience and patient-reported outcomes of 503 INFINITY total ankle arthroplasties

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2058.r2 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1270-1276

Author(s):

David N. Townshend ◽

Andrew J. F. Bing ◽

Timothy M. Clough ◽

Ian T. Sharpe ◽

Andy Goldberg ◽

...

Keyword(s):

Functional Outcome ◽

Early Experience ◽

Outcome Data ◽

Patient Specific ◽

Patient Specific Instrumentation ◽

Significant Difference ◽

Patient Reported ◽

The Mean ◽

One Year

Aims This is a multicentre, non-inventor, prospective observational study of 503 INFINITY fixed bearing total ankle arthroplasties (TAAs). We report our early experience, complications, and radiological and functional outcomes. Methods Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiological, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire, and EuroQol five-dimension five-level score) were collected preoperatively, at six months, one year, and two years. The Canadian Orthopaedic Foot and Ankle Society (COFAS) grading system was used to stratify deformity. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts, and/or subsidence. Results In all, 500 patients reached six-month follow-up, 420 reached one-year follow-up, and 188 reached two-year follow-up. The mean age was 67.8 years (23.9 to 88.5). A total of 38 patients (7.5%) presented with inflammatory arthritis. A total of 101 (20.0%) of implantations used patient-specific instrumentation; 167 patients (33.1%) underwent an additional procedure at the time of surgery. A total of seven patients died of unrelated causes, two withdrew, and one was lost to follow-up. The mean follow-up was 16.2 months (6 to 36). There was a significant improvement from baseline across all functional outcome scores at six months, one, and two years. There was no significant difference in outcomes with the use of patient-specific instrumentation, type of arthritis, or COFAS type. Five (1.0%) implants were revised. The overall complication rate was 8.8%. The non-revision reoperation rate was 1.4%. The 30-day readmission rate was 1.2% and the one-year mortality 0.74%. Conclusion The early experience and complications reported in this study support the current use of the INFINITY TAA as a safe and effective implant in the treatment of end-stage ankle arthritis. Cite this article: Bone Joint J 2021;103-B(7):1270–1276.

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Allograft Versus Autograft Osteochondral Transplant for Chondral Defects of the Talus: Systematic Review and Meta-analysis

The American Journal of Sports Medicine ◽

10.1177/03635465211037349 ◽

2021 ◽

pp. 036354652110373

Author(s):

Filippo Migliorini ◽

Nicola Maffulli ◽

Alice Baroncini ◽

Jörg Eschweiler ◽

Matthias Knobe ◽

...

Keyword(s):

Systematic Review ◽

Revision Surgery ◽

Binary Data ◽

Mri Findings ◽

Aofas Score ◽

Level Of Evidence ◽

Female Ratio ◽

Vas Score ◽

Patient Reported

Background: It is unclear whether the results of osteochondral transplant using autografts or allografts for talar osteochondral defect are equivalent. Purpose: A systematic review of the literature was conducted to compare allografts and autografts in terms of patient-reported outcome measures (PROMs), MRI findings, and complications. Study Design: Systematic review; Level of evidence, 4. Methods: This study was conducted according to the PRISMA guidelines. The literature search was conducted in February 2021. All studies investigating the outcomes of allograft and/or autograft osteochondral transplant as management for osteochondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Data concerning the rates of failure and revision surgery were also collected. Continuous data were analyzed using the mean difference (MD), whereas binary data were evaluated with the odds ratio (OR) effect measure. Results: Data from 40 studies (1174 procedures) with a mean follow-up of 46.5 ± 25 months were retrieved. There was comparability concerning the length of follow-up, male to female ratio, mean age, body mass index, defect size, VAS score, and AOFAS score ( P > .1) between the groups at baseline. At the last follow-up, the MOCART (MD, 10.5; P = .04) and AOFAS (MD, 4.8; P = .04) scores were better in the autograft group. The VAS score was similar between the 2 groups ( P = .4). At the last follow-up, autografts demonstrated lower rate of revision surgery (OR, 7.2; P < .0001) and failure (OR, 5.1; P < .0001). Conclusion: Based on the main findings of the present systematic review, talar osteochondral transplant using allografts was associated with higher rates of failure and revision compared with autografts at midterm follow-up.

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Decompression Surgery With Antibiotic-impregnated Calcium Sulfate Can Achieve More Satisfactory Results Than Decompression Alone in Pediatric Hematogenous Osteomyelitis

10.21203/rs.3.rs-289026/v1 ◽

2021 ◽

Author(s):

Cheng-he Qin ◽

Rui Tao ◽

Yu-han Chee ◽

Ji-wei Luo ◽

Lei Xu ◽

...

Keyword(s):

Wound Healing ◽

Hospital Stay ◽

Calcium Sulfate ◽

Pathological Fracture ◽

Control Group ◽

Curative Effect ◽

Inflammatory Index ◽

Hematogenous Osteomyelitis ◽

Infection Recurrence

Abstract BackgroundThe curative effect of antibiotic-impregnated Calcium Sulfate in pediatric ostemyelitis is unknown. The purpose of this study was to compare the outcomes of two treatment methods, decompression combined with antibiotic-impregnated calcium sulfate and decompression alone, for the treatment of pediatric Hemotogenous Osteomyelitis.MethodsBetween 2013 to 2016, forty-one patients with Hematogenous Osteomyelitis met the criteria were included for assessment. Twenty-one patients were included in the calcium sulfate group (the CS group) in which vancomycin and/or gentamicin impregnated calcium sulfate was used as an adjuvant after bone decompression while 20 patients as the control group were undergone bone decompression alone. The infection recurrence rate, hospital stay, wound healing duration, serum inflammatory index, pathological fracture, leakage of the incision ,follow-up time were compared between the two groups.ResultsInfection recurrence was 0% (0/21) in CS group and 15%(3/20) in control group within 12 months(P=0.107). Infection recurrence was 0%(21/21) in CS group and 20% (16/20) of patients at a minimum of 24(range 24 to 67) months follow-up(P=0.048). Mean hospital stay were 8.19(range 3 to 21) days in CS group and 15.95(range 5 to 47) days in control group(P=0.02). Mean wound healing duration were 16.1(range 10 to 29) days in CS group and 15.5(range 10 to 25) days in control group(P=0.65). Serum inflammatory index for WBC(White Blood Cells), ESR( Sedimentation Rate), CRP(C-Reactive Protein) was respectively 8.76(6.03-12.07)*10^9/L, 44.14(26-70)mm/L, 12.35(1.03-35.04) mg/Lin CS group and 8.90(5.68-13.56)*10^9/L, 39.25(19-57)mm/L, 15.65(1.02-45.69) mg/L in control group(P=0.82, P=0.31, P=0.51). Pathological fracture was 0% (0/21) in CS group and 10%(2/20) in control group(P=0.23). Leakage of the incision was 4.76% (0/21) in CS group and 10%(2/20) in control group(P=0.61). ConclusionsAntibiotic-impregnated Calcium Sulfate can reduce infection recurrence and shorten the mean hospital stay in pediatric Hemotogenous Osteomyelitis. The curative effect of antibiotic-impregnated Calcium Sulfate in pediatric ostemyelitis is satisfactory. Trial registrationRetrospectively registered.

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Intra-Articular Opening Osteotomy Combined with Lateral Ligament Reconstruction for Varus Ankle Arthritis

10.21203/rs.3.rs-77020/v1 ◽

2020 ◽

Author(s):

Yang Xu ◽

Xing-chen Li ◽

Chang-jun Guo ◽

Xiang-yang Xu

Keyword(s):

Ligament Reconstruction ◽

Lateral Ligament ◽

Anterior Surface ◽

Ankle Arthritis ◽

Aofas Score ◽

Vas Score ◽

Therapeutic Outcomes ◽

Sf 36 ◽

The Mean

Abstract Background One type of Takakura 3B ankle arthritis is varus talus with medial disital tibial platform erosion. Among these cases, the tibial anterior surface (TAS) angles are usually normal. The purpose of this study was to evaluate the therapeutic outcomes of intra-articular opening osteotomy combined with lateral ligament reconstruction for Takakura 3B ankle arthritis with medial disital tibial platform erosion. Methods From September 2009 to May 2016, 17 patients with Takakura 3B ankle arthritis were reviewed, including 3 male and 14 female patients. All underwent the operation of intra-articular opening osteotomy combined with lateral ligament reconstruction. All patients were available for analysis. The main outcome measurements included TT angle, AOFAS score, VAS score, SF-36 scale and AOS scale. Results All patients were followed for a mean follow-up of 87.2 months (range, 49 to 129 months). The VAS scale improved from 5.5 ± 1.6 to 2.3 ± 1.9. The mean AOFAS score improved from 47.7 ± 15.7 to 75.8 ± 12.0. The SF-36 scale improved from 41.6 ± 14.0 to 67.7 ± 14.6. The AOS improved from 60.9 ± 13.9 to 28.2 ± 17.7. The TT angle improved from 14.3 ± 5.0° to 5.3 ± 4.0°. Conclusion Intra-articular opening osteotomy combined with lateral ligament reconstruction is an effective method to treat varus ankle arthritis with medial disital tibial platform erosion.

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The UK INFINITY Study - Early Experience and Complications of a Multicenter series of 504 Total Ankle Arthroplasties.

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00085 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0008

Author(s):

David N. Townshend ◽

Rajesh Kakwani ◽

Murty N. Aradhyula ◽

John C. Mckinley ◽

Hisham Shalaby ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Early Experience ◽

Outcome Data ◽

Patient Specific ◽

Patient Specific Instrumentation ◽

Early Revision ◽

Significant Difference ◽

The Uk

Category Ankle Arthritis; Ankle Introduction/Purpose: This is the first report from the UK INFINITY study. This is a multicentre, non-inventor, prospective observational study of 504 INFINITY fixed bearing total ankle arthroplasties. We report our early experience, complications, radiographic and functional outcomes of this prosthesis. Methods: Patients were recruited from 11 specialist centres between June 2016 and November 2019. Demographic, radiographic, and functional outcome data (Ankle Osteoarthritis Scale, Manchester Oxford Questionnaire and Euroquol 5D-5L) were collected preoperatively, at 6 months (454 patients), 1 year (328 patients) and 2 years (104 patients). The average age was 67.8 (range 23.9 to 88.5) and average BMI 29.9 (18.9 to 48.0). The COFAS grading system was used to stratify deformity. There were 259 (51.4%) COFAS Type 1, 122 (24.2%) COFAS Type 2, 32 (6.3%) COFAS 3 and 87 (17.3%) COFAS type 4. 38 patients (7.54%) presented with inflammatory arthritis. 101 (20.0%) of implantations utilised patient specific instrumentation (Prophecy). 169 (33.5%) of patients underwent an additional procedure at the time of surgery. Early and late complications and reoperations were recorded as adverse events. Radiographs were assessed for lucencies, cysts and/or subsidence. Results: There was a significant (p<0.01) improvement across all functional outcome scores at 6 months, which was sustained at one and two years. There was no significant difference with the use of patient specific instrumentation. 167 (33.1%) underwent additional procedures at index surgery. At the latest follow up 3 implants (0.6%) have been revised. One patient at 6 weeks for deep infection, one patient at 6 months for subsidence and one patient at 18 months for loosening. There were an additional 13 reoperations (2.6%) at the latest follow up. Conclusion: The UK INFINITY study is the largest reported multicentre study of a Total Ankle Arthroplasty to date. This study has shown a low early revision rate and high functional outcomes of the INFINITY prosthesis.

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