Evaluation of Clinical and Radiographic Outcomes of Complete Subtalar Release in Clubfoot Treatment

Background: We evaluated patients with unilateral clubfoot deformity who were treated by complete subtalar release according to Simons’ criteria and assessed the correlation between clinical and radiographic results. Methods: Eleven patients underwent a complete subtalar release through a Cincinnati incision. Evaluation included a questionnaire and clinical and radiographic examination. Results: Mean follow-up was 12 years 8 months. The radiographic measurement differences in the diagnostic angles between normal feet and clubfeet were not significant. Shortening of the talus and the navicular bone was significant. The talar dome was flattened in seven patients and was flattened, sclerotic, and irregular in one. Flattening of the talar head was detected in eight patients, irregularity in one, and deformity and sclerosis in one. Six patients had deformity in the talonavicular joint. The navicular bone was wedge shaped in nine patients and subluxated dorsally in seven. The talar head was congruent with the navicular bone semilunar in normal feet; this relation was not detected in patients treated for clubfoot. Conclusion: Radiographic changes, such as flattening of the talar, a wedge-shaped navicular bone, dorsal navicular migration, irregularity, and lack of congruence of the talonavicular joint, can be encountered postoperatively in clinically and cosmetically healthy patients. These changes may be caused by the nature of the disease, correcting manipulations or casting, or surgical techniques. Although complete subtalar release is an effective procedure for satisfactory clinical results, maintenance of anatomical configuration, but not normal anatomical development of tarsal bones, can be achieved with this method. (J Am Podiatr Med Assoc 98(6): 451–456, 2008)

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Preliminary Experience Using Bioactive Glass Wedges for Cotton Osteotomy

Foot & Ankle Orthopaedics ◽

10.1177/2473011418796861 ◽

2018 ◽

Vol 3 (4) ◽

pp. 247301141879686

Author(s):

Tood Borenstein ◽

Tyler Gonzalez ◽

Janet Krevolin ◽

Bryan Den Hartog ◽

David Thordarson

Keyword(s):

Bioactive Glass ◽

Case Series ◽

Clinical Results ◽

Delayed Union ◽

Complication Rates ◽

Level Of Evidence ◽

Opening Wedge ◽

Radiographic Outcomes ◽

Initial Correction

Background: Medial cuneiform dorsal opening wedge (Cotton) osteotomy is often used for treating forefoot varus in patients undergoing surgery for stage II posterior tibialis tendon dysfunction. The goal of this study was to examine the radiographic outcomes of Cotton osteotomy with bioactive glass wedge to assess for both maintenance of correction and clinical results and complications. We hypothesized that bioactive glass wedges would maintain correction of the osteotomy with low complication rates. Methods: Between December 2015 and June 2016, the charts of 17 patients (10 female and 7 male) who underwent Cotton osteotomy using bioactive glass wedges were retrospectively reviewed. Patient age averaged 56.8 years (range, 16-84). The average follow-up was 6.5 months. Radiographs were reviewed to assess for initial correction and maintenance of correction of medial column sag as well as for union. Charts were reviewed for complications. Results: The medial column sag correction averaged 15.6% on the final postoperative lateral radiograph. Meary angle averaged 19 degrees (3.14-42.8 degrees) preoperatively and 5.5 degrees (0.4-20.7 degrees) at final follow-up. All patients achieved clinical and radiographic union. One patient developed neuropathic midfoot pain and was managed with sympathetic blocks. One patient had a delayed union that healed at 6 months without surgical intervention. No patients required the use of custom orthotics or subsequent surgical procedures. Conclusion: Cotton osteotomy with bioactive glass wedges produced consistent correction of the medial column with low risk. Level of Evidence: Level IV, case series.

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The Infinity Total Ankle System: Early Clinical Results With 2- to 4-Year Follow-up

Foot & Ankle Specialist ◽

10.1177/1938640018777601 ◽

2018 ◽

Vol 12 (2) ◽

pp. 159-166 ◽

Cited By ~ 11

Author(s):

Murray Penner ◽

W. Hodges Davis ◽

Kevin Wing ◽

Thomas Bemenderfer ◽

Feras Waly ◽

...

Keyword(s):

Prospective Observational Study ◽

Mobile Bearing ◽

Clinical Results ◽

Outcome Data ◽

Ankle Osteoarthritis ◽

Radiographic Outcomes ◽

Scale Scores ◽

Foot Function ◽

Component Revision

Aims. This study presents the first report of clinical and radiographic outcomes of the Infinity Total Ankle System (Wright Medical, Memphis, TN) with minimum 2-year follow-up. Patients and Methods. The first 67 consecutive patients who underwent primary total ankle arthroplasty (TAA) with the Infinity system at 2 North American sites between August 2013 and May 2015 were reviewed in a prospective, observational study. Demographic, radiographic, and functional outcome data were collected preoperatively, at 6 to 12 months postoperatively, and annually thereafter. Results. The overall implant survival rate was 97% (65 of 67 implants) at a mean follow-up of 35.4 months (27 to 47 months). Two cases underwent talar component revision for aseptic loosening. Six of the 67 cases (9%) required a nonrevision reoperation. Mean Foot Function Index and Ankle Osteoarthritis Scale scores at latest follow-up improved from preoperative by 21.6 ( P < .0001) and 34.0 ( P < .0001), respectively. No radiographic loosening of any talar or tibial components was identified in the 65 nonrevised cases. Conclusion. Early clinical and radiographic outcomes with the Infinity TAA are promising and compare favorably to those reported for both fixed- and mobile-bearing third-generation TAA designs, even when used in cases with deformity and increased case complexity. Levels of Evidence: Level IV

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The Infinity Total Ankle System

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00382 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0038

Author(s):

Murray Penner ◽

W. Hodges Davis ◽

Thomas Bemenderfer ◽

Feras Waly ◽

Robert Anderson

Keyword(s):

Mobile Bearing ◽

Clinical Results ◽

Outcome Data ◽

Total Ankle Arthroplasty ◽

Ankle Arthroplasty ◽

Radiographic Outcomes ◽

Wright Medical Technology ◽

The Usa ◽

Component Revision

Category: Ankle Arthritis Introduction/Purpose: Background: Increasing interest in 2-component total ankle arthroplasty (TAA) designs and the increased use of TAA overall has led to the development of a new generation of 2-component TAA implants. The first of these to become available was the Infinity Total Ankle System (Wright Medical Technology, Memphis, TN), introduced in 2014. Despite it currently being the most commonly used TAA implant in the UK and among the most commonly used in the USA, published clinical results are lacking. Purpose: This study presents the first report of the clinical and radiographic outcomes of the Infinity Total Ankle System with minimum 2 year follow-up Methods: The first 67 consecutive patients who underwent primary Infinity total ankle arthroplasty (TAA) at 2 North American sites between 2013 and 2015 were reviewed in a prospective observational study. Demographic, radiographic, and functional outcome data was collected preoperatively, at 6-12 months postoperatively, and annually thereafter. Results: The overall implant survival rate was 97% (65 of 67 implants) at mean follow up of 3 years (range 27-47 months). Two cases underwent talar component revision for aseptic loosening. Six of the 67 cases (9%) required a non-revision reoperation. Mean FFI and AOS scores at latest follow up improved from preoperative by 21.6 (p<0.0001) and 34.0 (p<0.0001), respectively. No radiographic loosening of any talar or tibial components was identified in the 65 non-revised cases. Conclusion: Early clinical and radiographic outcomes with the Infinity TAA are promising and compare favorably to those reported for both fixed- and mobile-bearing third generation TAA designs, even when used in cases with deformity and increased case complexity.

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HemiCAP Knee Implants: Mid- to Long-Term Results

Cartilage ◽

10.1177/1947603519894732 ◽

2019 ◽

pp. 194760351989473

Author(s):

Jens Ole Laursen ◽

Christian Backer Mogensen ◽

Helene Skjøt-Arkil

Keyword(s):

Femoral Condyle ◽

Survival Rates ◽

Long Term Results ◽

Radiographic Examination ◽

Vas Score ◽

Radiographic Outcomes ◽

Potential Risk Factors ◽

And Function

Purpose The aim of the study was to investigate the long-term outcomes of the Focal Femoral Condyle Resurfacing Prosthesis (HemiCAP) using clinical and radiographic assessments, and to evaluate the revision and survival rates. Methods Clinical evaluation was performed in those not revised and was able to participate. This was a prospective single-center cohort study of HemiCAP patients with 7 to 10 years of clinical and radiographic follow-up. The clinical examination included the Knee Society Score (KSS) and visual analogue scale (VAS) score. The radiographic examination included the Kellgren-Lawrence (KL) grade. Survival was estimated by Kaplan-Meier survival analysis, and potential risk factors for revision was evaluated by a regression analysis. Results Of the 62 patients with 64 HemiCAP prostheses, 37 were HemiCAP condyle, 11 HemiCAP PF, and 16 HemiCAP Wave; 27 (42%) were revised—HemiCAP condyle 17 (42%), HemiCAP PF 4 (36%), HemiCAP Wave 6 (37%), and 1 died. Examinations were performed on 31 patients (86%). When compared with the preoperative data, there were significant increases in the KSS objective (mean = 51.5, standard deviation [SD] = 5.9 vs. mean =94.2, SD = 5.0) and function (mean = 51.0, SD = 6.2 vs. mean = 93.7, SD = 4.8) scores, a decrease in the VAS score (mean = 7.1, SD = 0.7 vs. mean = 2.7, SD = 1.7) and a decrease in the KL lateral score (mean = 1.1, SD = 0.3 vs. mean = 0.6, SD = 0.6). The mean follow-up was 7.3 years (SD 1.4) with minimum 4.2 years and maximum 10.2 years. No failures occurred in the series beyond 5 years. Conclusions As hypothesized, we found good clinical and radiographic outcomes, and for those patients who did not require revisions, there were long-term improvements in disability and function. This suggests that patient selection is a key element to successfully applying these devices in clinical practice.

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Open or arthroscopic Latarjet? Prospective analysis of the clinical results

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00004 ◽

2021 ◽

Vol 9 (2_suppl) ◽

pp. 2325967121S0000

Author(s):

Mathieu Girard ◽

Yoann Dalmas ◽

Vadim Azoulay ◽

Marie Martel ◽

Simon Rattier ◽

...

Keyword(s):

Surgical Techniques ◽

Clinical Results ◽

Bone Block ◽

Return To Sports ◽

Short Term ◽

Significant Difference ◽

Bone Block Procedure ◽

Group A ◽

Net Promoter

Objectives: The arthroscopic bone block procedure in the treatment of anterior shoulder instabilities is now a validated technique. Nevertheless, few studies have compared the clinical results of this technique to the conventional Latarjet procedure. Therefore the objective of this study was to compare the short-term clinical results of the 2 surgical techniques. Methods: We conducted a monocentric prospective comparative study, including patients who had undergone a bone block procedure for anterior instability with a minimum follow-up of 12 months. Patients with a surgical history concerning the affected shoulder were excluded. Evaluation was based on the measurement of mobility, the Walch-Duplay score, the Rowe score, the Subjective Shoulder Value (SSV), return to sports, the Net Promoter satisfaction Score, and recurrence (subluxation/luxation). Scarring was assessed by the POSAS score. Results: It was possible to follow 45 patients: arthroscopy (A) n=22, open (O) n=25. With an average follow-up of 20 months (12-30), no recurrence of instability was recorded. No significant difference was noted between groups A and O in terms of the Walch-Duplay score (85±19 vs 91±11 points; p=0.3), the Rowe score (93±14 vs 95±9 points; p=0.9), the SSV (72% vs 88%; p=0.2) and the Net Promoter Score (9.3 vs 9.7; p=0.5). At 3 months, return to sports was 11% for group A vs 48% for group O (p=0.01). This difference was no longer significant at 6 months. Loss of external rotation in group A was significantly greater at 1.5 months -58°±18° vs -41°±17° (p=0.01) and 3 months -35°±20° vs -19°±18° (p=0.01). There was no difference in the POSAS score between the 2 groups. (p= 0.9). Conclusion: With a longer recovery time for joint amplitudes and a delayed return to sports, the arthroscopic double-button fixation procedure does not seem to provide any short-term clinical benefit. Longer follow-up is required to confirm these results.

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A fibular notch approach for the treatment of ankle fractures involving the distal tibial plafond

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02270-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tong Liu ◽

Yiheng Cheng ◽

Wenqing Qu

Keyword(s):

Articular Surface ◽

Clinical Results ◽

Ankle Fractures ◽

Aofas Score ◽

Radiographic Outcomes ◽

Tibial Plafond ◽

Operative Notes ◽

Tibial Plafond Fractures

Abstract Background Although efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures. Ankle fractures involving the distal tibial plafond frequently present a surgical challenge in choosing which incisions will be best for surgical treatment. Here, we present an innovative fibular notch approach for the treatment of some specific ankle fractures and present a series of patients with either functional or radiographic outcomes. Methods Twenty-two patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach in this retrospective study. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment. Results All surgeries were successfully performed via the fibular notch approach as the primary approach with excellent intraoperative visualization. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis. All fractures healed with an average time of 17.3 ± 3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. The average AOFAS score was 88.8 at the last follow-up. Conclusions The fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.

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Early Term Radiographic Follow-Up of the Trident Tritanium Acetabular Component

Reconstructive Review ◽

10.15438/rr.11.1.273 ◽

2021 ◽

Vol 11 ◽

Author(s):

David DeBoer ◽

Jeffrey Hodrick ◽

Matthew Christie

Keyword(s):

Acetabular Component ◽

Radiolucent Line ◽

Clinical Results ◽

Acetabular Cup ◽

Single Institution ◽

Radiolucent Lines ◽

Radiographic Outcomes ◽

Therapeutic Study ◽

Primary Total Hip Arthroplasty

INTRODUCTION: The purpose of this study was to evaluate the two year clinical and radiographic outcomes of patients undergoing a primary total hip arthroplasty (THA) using the Trident Tritanium primary Cup. METHODS: 197 patients who underwent a direct anterior THA using a Tritanium acetabular component between 2011 and 2015 were retrospectively reviewed by two surgeons from a single institution. The investigators, along with an independent physician, separately reviewed radiographs blinded to clinical data looking for radiolucent lines adjacent to the acetabular cup using the Charnley-DeLee zones. Clinical results were measured using acetabular revision surgery as an end point for failure. According to the American Academy of Orthopaedic Surgeons Levels of Evidence, this study was consistent with a Level III Therapeutic study. RESULTS: 101 (48.73%) subjects did not exhibit any radiolucent lines around the acetabular component. 53 (26.90%) subjects displayed radiolucency in only one zone. 27 (13.71%) subjects displayed radiolucency in two zones, and 16 (8.12%) displayed radiolucency in all three zones. Radiolucency was most prevalent in zone 1 at 2 years with 83 (42.13%) subjects displaying radiolucency. There were five (2.54%) acetabular failures within two years of the index surgery. Of those 5 subjects, 3 displayed radiolucency in 1 zone, 2 displayed radiolucency in >1 zone, and 2 displayed radiolucencies >1 mm. CONCLUSION: In our study, the Tritanium Cup demonstrated a 2.54% failure rate for aseptic loosening at 2 year follow-up. In addition, 48.73% of patients displayed a radiolucent line in at least one Charnley-DeLee zone. We also observed a progression of radiolucencies between the 6 month radiographs and the 2 year radiographs.

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Three-Year Clinical Results of a Cruciate-Retaining Type of the Knee Prosthesis with Anatomical Geometry Developed in Japan

10.21203/rs.3.rs-107082/v1 ◽

2020 ◽

Author(s):

Arata Nakajima ◽

Manabu Yamada ◽

Masato Sonobe ◽

Yorikazu Akatsu ◽

Masahiko Saito ◽

...

Keyword(s):

Knee Prosthesis ◽

Clinical Results ◽

Implant Design ◽

Cruciate Retaining ◽

Radiolucent Lines ◽

Radiographic Outcomes ◽

Patient Reported ◽

Total Knee ◽

Anatomical Geometry

Abstract Background: The FINE total knee was developed in Japan and clinical use began in 2001. It has unique design features, including an oblique 3o femorotibial joint line that reproduces anatomical geometry. Although 20 years have passed since the FINE knee was clinically used for the first time in Japan, a formal clinical evaluation including patient-reported and radiographic outcomes has not been undertaken.Methods: A total of 175 consecutive primary cruciate-retaining (CR)-FINE total knee arthroplasties (TKAs) at our hospital between February 2015 and March 2017 were included in this study. Three years postoperatively, range of motion (ROM), Knee Society Score (KSS), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score (FJS) were recorded and compared with preoperative scores. Radiographic analyses including mechanical alignment, component alignment, and incidence of radiolucent lines also were undertaken based on the radiographs three years postoperatively.Results: One-hundred twenty-two knees (70%) were available for 3-year follow-up data using KOOS, except for the sports subscale. Postoperative KOOS-symptom, -pain and -ADL were > 85 points, but KOOS-sports, -QOL and FJS were less satisfactory. ROM, KSS and all the subscales of KOOS were significantly improved compared with preoperative scores. Postoperative mean FJS was 66 and was significantly correlated with all the subscales of KOOS, but not with postoperative ROM. Radiolucent lines ≧1 mm wide were detected in five knees (4.1%). There were no major complications needing revision surgeries.Conclusions: Patient-reported outcomes (PROs) for symptoms, pain and ADL after the CR-FINE TKA were generally improved, but those for sports, QOL and FJS were improved less. The incidence of radiolucent lines was rare but detected around the femoral components. Improvements of surgical technique or innovation of the implant design with mid- to long-term follow-up will be necessary to achieve better PROs from patients receiving the FINE knee.

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Early outcomes of augmented glenoid components in anatomic total shoulder arthroplasty: a systematic review

Shoulder & Elbow ◽

10.1177/17585732211032922 ◽

2021 ◽

pp. 175857322110329

Author(s):

Ujash Sheth ◽

James YJ Lee ◽

Diane Nam ◽

Patrick Henry

Keyword(s):

Los Angeles ◽

Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Clinical Results ◽

Long Term Outcomes ◽

Simple Shoulder Test ◽

Radiographic Outcomes ◽

Glenoid Retroversion

Background The objective was to evaluate the short-term clinical and radiological outcomes following augmented anatomic total shoulder arthroplasty in patients with posterior glenoid deficiency. Methods An electronic search of EMBASE, MEDLINE, and PubMed identified studies reporting clinical and radiographic outcomes following augmented anatomic total shoulder arthroplasty among patients with posterior glenoid deficiency. Results Nine studies including 312 shoulders underwent anatomic total shoulder arthroplasty using an augmented glenoid implant between 2015 and 2020. A statistically significant improvement in range of motion (ROM), visual analog scale (VAS), American Shoulder & Elbow Surgeons (ASES), Constant, University of California - Los Angeles and Simple Shoulder Test (SST) scores was demonstrated at mean follow-up of 37.1 months. Glenoid retroversion improved from 21.8° to 9.5°. At final follow-up, radiolucency was reported in 35.1% of shoulders. The 16° full-wedge augment led to higher and more severe radiographic lucency, while high peg perforation rates (44%) were observed among 5-mm augment stepped implants. The overall rate of complication was 2.6%. Rate of revision surgery was 1.9%. Conclusions Overall, early- to mid-term outcomes following augmented anatomic total shoulder arthroplasty for posterior glenoid deficiency demonstrate good to excellent overall clinical results. More radiographic and clinical failures were reported in larger full wedge (16°) augments and stepped augments (5 mm). Prospective studies examining mid- and long-term outcomes will help further elucidate safety and efficacy of these relatively new implants.

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Medial Cuneiform Opening Wedge Osteotomy for Correction of Flexible Flatfoot Deformity: Trabecular Titanium vs. Bone Allograft Wedges

BioMed Research International ◽

10.1155/2019/1472471 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Giovanni Romeo ◽

Alberto Bianchi ◽

Vincenzo Cerbone ◽

Matteo Maria Parrini ◽

Francesco Malerba ◽

...

Keyword(s):

Surgical Techniques ◽

Bone Allograft ◽

Wedge Osteotomy ◽

Opening Wedge ◽

Metallic Implant ◽

Radiographic Outcomes ◽

Clinical Scores ◽

Medial Cuneiform ◽

Forefoot Varus

Adult flatfoot is a common pathology characterized by multiplanar deformity involving hindfoot, midfoot, and forefoot. Various surgical techniques have been described for the treatment but may not adequately correct the fixed forefoot varus component. Residual forefoot supination can be addressed by a plantar flexing opening wedge osteotomy of the medial cuneiform, also known as a Cotton osteotomy. Thus, the aims of this study were to compare clinical, radiological, and functional outcome after Cotton osteotomy, in patients treated with bone allograft or metallic implant. Consequently, 36 patients treated with opening wedge osteotomy of the medial cuneiform for forefoot varus were studied retrospectively. Patients were divided into two groups: the bone allograft group (HBG) (n=18) and the metallic implant group with BIOFOAM® Cotton Wedges (TTW) (n=18). Radiographic assessment and clinical scores including American Orthopaedic Foot and Ankle Society score, Foot Function Index, and visual analogue scale for pain were collected before operation and the last follow-up. The difference between baseline and follow-up for both groups was statistically significant for all the clinical scores and radiographic angles (p < 0.05). Most participants (92%) were very satisfied after surgery. Our results showed that Cotton osteotomy with a metallic implant provided both good clinical and radiographic outcomes comparable with bone allograft.

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