ankle osteoarthritis
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2022 ◽  
Author(s):  
Kentaro Amaha ◽  
Satoshi Yamaguchi ◽  
Atsushi Teramoto ◽  
Tetsuro Kokubo ◽  
Hiroyuki Seki ◽  
...  

Abstract Background The purpose of this study was to clarify the clinical outcomes of surgical treatment for end-stage ankle osteoarthritis in patients aged ≥75 years and compare the outcomes with those of patients aged <75 years. Methods A total of 148 patients, including 65 post-total ankle arthroplasty and 83 post-ankle arthrodesis patients, were surveyed retrospectively. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot hindfoot scale and the self-administered foot evaluation questionnaire preoperatively and at the last follow-up. Patient characteristics, including age, sex, body mass index, radiographic severity, and follow-up period, were also assessed. Patients were divided into the older age group (≥75 years) and the younger age group (<75 years). Improvements in outcomes were then compared between the age groups using univariate analysis and analysis of covariance adjusted for patient characteristics. Post-total ankle arthroplasty and post-ankle arthrodesis were analyzed separately. Results All clinical outcome scores improved postoperatively in the older age group for both post-total ankle arthroplasty and post-ankle arthrodesis. For example, scores for pain and pain-related subscale of the self-administered foot evaluation questionnaire improved by 37 points (p < 0.001) for post-total ankle arthroplasty patients and by 35 points for post-ankle arthrodesis (p < 0.001). Furthermore, multivariate analysis showed that the improvements observed in all scores were not different between the older and younger age groups for both post-total ankle arthroplasty and post-ankle arthrodesis patients, except for the Self-Administered Foot Evaluation Questionnaire physical functioning subscale score for post-ankle arthrodesis patients. Conclusions Clinical outcomes improved significantly in post-total ankle arthroplasty and post-ankle arthrodesis patients aged ≥75 years. Moreover, the improvements were similar to those in patients aged <75 years. Therefore, surgical treatment of end-stage ankle osteoarthritis can be a viable treatment option, even in elderly patients.


2021 ◽  
pp. 036354652110622
Author(s):  
Shinji Matsubara ◽  
Tomohiro Onodera ◽  
Koji Iwasaki ◽  
Ryosuke Hishimura ◽  
Masatake Matsuoka ◽  
...  

Background: High tibial osteotomy (HTO) changes the alignment and dynamics of the ankle joint; however, differences in the stress distribution of the ankle joint after opening-wedge HTO (OWHTO) and closing-wedge HTO (CWHTO) are not understood. It is believed that subchondral bone density of the articular surface reflects the pattern of cumulative stress distribution across the joint surface. Purpose: To clarify the effects of OWHTO and CWHTO on the distribution patterns of subchondral bone density across the ankle joint using computed tomography (CT)–osteoabsorptiometry. Study Design: Cohort study; Level of evidence, 4. Methods: Radiographic and CT data of 18 cases who underwent OWHTO (OW group), 12 cases who underwent CWHTO (CW group), and 11 cases with unilateral anterior cruciate ligament injury serving as controls were retrospectively reviewed. The subchondral bone density of the distal tibia was assessed in the 3 groups using CT-osteoabsorptiometry. The distal tibial surface of the ankle joint was divided into 4 parts in the coronal direction, and the percentage of the high-density area (%HDA) to each subregion was compared before and after HTO. Results: Preoperatively, comparing %HDA among the 3 groups, there were no significant differences in any regions. In the OW group, postoperative %HDA in the most medial region was significantly increased compared with preoperative %HDA (49.3% to 53.0%; P = .011), and postoperative %HDA in the most lateral region was significantly decreased (21.4% to 17.2%; P = .003). On the other hand, in the CW group, postoperative %HDA in the most medial region was significantly decreased (55.7% to 35.7%; P = .001), and %HDA in the second lateral region was significantly increased (23.6% to 29.2%; P = .002). Conclusion: The ankle distribution pattern of subchondral bone density shifted significantly medially after OWHTO without fibular osteotomy, whereas the distribution pattern shifted laterally after CWHTO with fibular osteotomy. When the OWHTO is performed for patients with medial ankle osteoarthritis, surgeons should pay attention to potential postoperative progression of ankle osteoarthritis due to medial shift of the stress distribution in the ankle joint.


2021 ◽  
Vol 10 (24) ◽  
pp. 5848
Author(s):  
Tetyana Gorbachova ◽  
Yulia V. Melenevsky ◽  
L. Daniel Latt ◽  
Jennifer S. Weaver ◽  
Mihra S. Taljanovic

Posttraumatic osteoarthritis of the ankle and hindfoot is a common and frequently debilitating disorder. 70% to 90% of ankle osteoarthritis is related to prior trauma that encompasses a spectrum of disorders including fractures and ligamentous injuries that either disrupt the articular surface or result in instability of the joint. In addition to clinical evaluation, imaging plays a substantial role in the treatment planning of posttraumatic ankle and hindfoot osteoarthritis. Imaging evaluation must be tailored to specific clinical scenarios and includes weight bearing radiography that utilizes standard and specialty views, computed tomography which can be performed with a standard or a weight bearing technique, magnetic resonance imaging, and ultrasound evaluation. This review article aims to familiarize the reader with treatment rationale, to provide a brief review of surgical techniques and to illustrate expected imaging appearances of common operative procedures performed in the setting of posttraumatic ankle and hindfoot osteoarthritis, such as joint-preserving procedures, ankle fusion, subtalar fusion, tibiotalarcalcaneal fusion and ankle arthroplasty. Preoperative findings will be discussed along with the expected postoperative appearance of various procedures in order to improve detection of their complications on imaging and to provide optimal patient care.


EMJ Radiology ◽  
2021 ◽  
Author(s):  
Jenn Shiunn Wong ◽  
PNM Tyrrell ◽  
B Tins ◽  
T Woo ◽  
N Winn ◽  
...  

Objective: Loose bodies resulting from any form of osteochondral insult can migrate out of their intra-articular position to adjacent compartments. This retrospective study aims to illustrate the phenomenon of loose bodies migration from the ankle joint into the flexor hallucis longus (FHL) tendon sheath. Materials and Methods: Cases of loose bodies in the FHL tendon sheath were identified from the authors' radiological database by way of keyword interrogation, covering the modalities of CT, MRI, and ultrasound over a period of 11 years. The imaging features of the loose bodies were recorded, together with the presence of ankle instability and osteoarthritis. Patient demographics and relevant history, including trauma and surgery, were collected. Results: Thirty-four cases including 33 patients, with a total of 125 loose bodies in the FHL tendon sheath, were identified. There were 58 loose bodies (46.4%) in Zone 1 of the FHL tendon sheath, 65 loose bodies (52%) in Zone 2, and 2 loose bodies (1.6%) in Zone 3. All patients had features of ankle osteoarthritis on imaging, 14 of which had imaging features of ankle instability, and 19 patients had previous ankle trauma. Conclusion: Osteochondral loose bodies originating from the ankle joint can migrate into the FHL tendon sheath. It is important to recognise this phenomenon as a distinct entity, different from primary tenosynovial chondromatosis of the FHL tendon sheath, which may have a different surgical management and clinical outcome. Detection of FHL tendon sheath loose bodies should also prompt closer examination for articular disease in the ankle joint.


Author(s):  
Yuya Oishi ◽  
Yuto Ishige ◽  
Hiroshi Takemura ◽  
Hiroaki Kurokawa ◽  
Yasuhito Tanaka ◽  
...  

2021 ◽  
Author(s):  
Ho Won Kang ◽  
Dae-Yoo Kim ◽  
Gil-Young Park ◽  
Jung Min Kim ◽  
Dong-Oh Lee ◽  
...  

Abstract Background The biomechanics of the hindfoot in ankle osteoarthritis (OA) are not yet fully understood. Here we aimed to identify hindfoot motion in a gait analysis using a multi-segment foot model (MFM) according to ankle OA stage or hindfoot alignment by the presence of subtalar compensation. Methods We retrospectively reviewed the medical records, simple radiographs, and gait MFM data of 54 ankles admitted to our hospital for the treatment of advanced ankle OA. Spatiotemporal gait parameters and three-dimensional motions of the hindfoot segment were analyzed according to sex, age, body mass index, Takakura classification, and presence of subtalar compensation. Results No spatiotemporal gait parameters differed significantly according to the presence of subtalar compensation or ankle OA stage. Only normalized step width differed significantly (P = .028). Average hindfoot motion (decompensation versus compensation) did not differ significantly between the sagittal and transverse planes. Graphing of the coronal movement of the hindfoot revealed collapsed curves in both groups that differed significantly. Compared with Takakura stages 3a, 3b, and 4, cases of more advanced stage 3b had a smaller sagittal range of motion than those of stage 3a (P = .028). Coronal movement of the hindfoot in cases of Takakura stage 3a/3b/4 showed a relatively flat pattern. Conclusions The spatiotemporal parameters were not affected by the alignment state of the heel resulting from subtalar compensation. The sagittal range of hindfoot motion decreased in patients with advanced ankle OA. Once disrupted, the coronal movement of the subtalar joint in ankle OA did not change regardless of ankle OA stage or hindfoot compensation state.


JAMA ◽  
2021 ◽  
Vol 326 (16) ◽  
pp. 1595
Author(s):  
Liam D. A. Paget ◽  
Gustaaf Reurink ◽  
Robert-Jan de Vos ◽  
Adam Weir ◽  
Maarten H. Moen ◽  
...  

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