High Energy Transsyndesmotic Ankle Fracture Dislocation - Does Deltoid Ligament Repair Influence the Progression of Posttraumatic Arthritis in Logsplitter Injuries?

OBJECTIVE: To determine the effect of deltoid ligament repair on the development of posttraumatic arthritis in logsplitter ankle injuries. METHODS: Design: Retrospective cohort. SETTING: Academic, Level I trauma center. PATIENT SELECTION CRITERIA: Patients ≥18 years of age with logsplitter injuries (OTA/AO 44B, 44C) treated with open reduction internal fixation with or without deltoid ligament repair from January 2008 to October 2021. OUTCOME MEASURES AND COMPARISON: The rate of posttraumatic arthritis (PTOA) development at final follow-up (minimum 6 months) after open reduction internal fixation was evaluated using the Kellgren-Lawrence scale. The achievement of acceptable reduction indicated by articular reduction <2mm, and a medial clear space ≤4mm was assessed at 6 weeks postoperatively with weightbearing radiographs. The effect of deltoid ligament repair on the development of PTOA was investigated. RESULTS: Fifty-nine patients aged 49.1 ± 17.2 years met inclusion criteria with a mean follow up of 16.6 months (range = 6 to 96). Twenty-six of 59 patients (44%) had developed PTOA at final follow-up. Acceptable reduction was achieved in 83.1% (49/59) of fractures. The acceptable reduction rate in fractures undergoing deltoid ligament repair was 100% versus 78% in those without deltoid ligament repair (13/13 vs. 36/46, p=0.017). The rate of PTOA development was significantly lower in patients who underwent deltoid ligament repair (15%) compared to those who did not (52%), p=0.026. Patients who underwent deltoid ligament repair had a significantly reduced rate of PTOA development leading to arthrodesis compared to those who did not (0% vs. 17%, p=0.013). CONCLUSIONS: Logsplitter injuries resulted in a high rate of development of posttraumatic arthritis. An acceptable reduction is required to minimize risk of development of PTOA and progression to arthrodesis. Deltoid ligament repair during open reduction internal fixation may facilitate acceptable reduction, decrease the rate of PTOA and progression to arthrodesis in these injuries. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Fasciotomy and rate of amputation after tibial fracture in adults: a population-based cohort study.

Objectives: Limb amputation is a possible outcome of acute compartment syndrome. We undertook this study to investigate the occurrence of fasciotomy and amputation in patients with tibial fractures in the Ontario adult population, aiming to evaluate variables that may be associated with each of these outcomes. Design: Retrospective, population-based cohort study (April 1, 2003-March 31, 2016). Setting: Canadian province of Ontario. Participants: Patients with tibial fracture, aged 14 years and older. Interventions: Fasciotomy after tibial fracture. Main Outcomes and Measures: The primary outcomes were fasciotomy and amputation within 1 year of fasciotomy. Secondary outcomes included repeat surgery, new-onset renal failure, and mortality, all within 30 days of fasciotomy. Results: We identified 76,299 patients with tibial fracture; the mean (SD) age was 47 (21) years. Fasciotomy was performed in 1303 patients (1.7%); of these, 76% were male and 24% female. Patients who were younger, male, or experienced polytrauma were significantly more likely to undergo fasciotomy. Limb amputation occurred in 4.3% of patients undergoing fasciotomy, as compared with 0.5% in those without fasciotomy; older age, male sex, presence of polytrauma, and fasciotomy were associated with an increased risk of amputation (age odds ratio [OR] of 1.03 [95% CI, 1.02-1.03], P < 0.0001; sex OR of 2.04 [95% CI, 1.63-2.55], P < 0.0001; polytrauma OR of 9.37 [95% CI, 7.64-11.50], P < 0.0001; fasciotomy OR of 4.35 [95% CI, 3.21-5.90], P < 0.0001), as well as repeat surgery within 30 days (sex OR of 1.54 [95% CI, 1.14-2.07], P = 0.0053; polytrauma OR of 4.24 [95% CI, 3.33-5.38], P < 0.0001). Conclusions: Among tibial fracture patients, those who were male and who experienced polytrauma were at significantly higher risk of undergoing fasciotomy and subsequent amputation. Fasciotomy was also significantly associated with risk of amputation, a finding that is likely reflective of the severity of the initial injury.

Kinesiophobia contributes to worse functional and patient-reported outcome measures in Achilles tendinopathy: a systematic review.

PURPOSE: To assess the effect of kinesiophobia or fear of reinjury on patient-reported outcome measures and physical performance measures in patients with chronic Achilles tendinopathy (AT). METHODS: Three databases were systematically screened for studies from inception to May 22nd, 2023 for literature investigating the impact of kinesiophobia on PROMs or physical performance metrics in AT. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, pain, level of activity, self-reported injury severity, quality of life, single-leg hop performance, and heel-raise performance were recorded. Data was presented primarily in a narrative summary fashion. The MINORS score was used for all studies to perform a quality assessment of included studies. RESULTS: Six studies comprising 705 patients were included in this review. Variations of the Tampa Scale of Kinesiophobia (TSK-11 or TSK-17) were used in all studies. TSK scores were strongly correlated with the Pain Catastrophizing Score (PCS) and Visual Analogue Scale (VAS) scores and were correlated with decreased Victorian Institute of Sports Assessment Achilles (VISA-A) and Foot and Ankle Outcome Scores Quality of Life (FAOS-QoL) subscale scores. Kinesiophobia was associated with heel raise completion with conflicting evidence on correlations with hop test performance. CONCLUSION: Increased kinesiophobia scores (> 35 points), measured by TSK are associated with worse PROMs, including increased pain, decreased quality of life, increased self-reported severity, and is also associated with poorer physical performance measures in patients with AT. LEVEL OF EVIDENCE: IV.

Transportal Tibiotalocalcaneal Nail Ankle Arthrodesis: A Systematic Review of Initial Series.

Background: There is currently a scarcity of information and consensus for transportal (arthroscopic or fluoroscopic) joint preparation during tibiotalocalcaneal (TTC) fusion, and therefore this review aims to summarize the available techniques and to evaluate the outcomes after this procedure. Methods: A systematic electronic search of MEDLINE, EMBASE, and Web of Science was performed for all English-language studies published from their inception to April 4, 2022. All articles addressing arthroscopy in TTC nailing were eligible for inclusion. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics are presented. Result: A total of 5 studies with 65 patients were included for analysis. All studies used arthroscopic portals for tibiotalar and subtalar joint preparation (in 4 studies) prior to TTC nailing, with 4 studies using an arthroscope and 1 study using fluoroscopy. The overall major complication rate was 13.8%; however, there was only 1 instance of deep wound infection (1.5%) and 4 instances of surgical site infections (6.2%). Full fusion was achieved in 86% of patients with an average time to fusion of 12.9 weeks. The mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score preoperatively was 34.0 and postoperatively was 70.5. Conclusion: Although limited by the number of studies, transportal joint preparation during TTC nail ankle fusion is associated with good rates of complications and successful fusion. Level of Evidence: Level III, systematic review of Level III-IV studies.

Factors Predictive of Early Complications Following Total Ankle Arthroplasty.

Background: The safety of outpatient total ankle arthroplasty (TAA), and factors predictive of early complications are poorly understood. The objective of this study was to determine the frequency of early complications in patients undergoing outpatient TAA compared to a matched inpatient TAA cohort. Factors predictive of early complications following TAA are elucidated. Methods: A retrospective review of prospectively collected data from the 2011-2018 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was performed. An unadjusted analysis comparing complication rates in outpatient, and inpatient TAA was performed followed by a propensity score-matched cohort analysis. A multivariate logistic regression model was then used to identify significant independent predictors for complications, reoperation, and readmission following TAA. Results: A total of 1487 patients (198 outpatient, 1289 inpatient) undergoing TAA were included in the study. Inpatient TAA was associated with increased 30-day readmission compared with outpatient TAA (3.54% vs 0.51%, P = .032) in a matched cohort analysis. Thirty-eight (2.6%) patients had a minor complication, with 16 (1.1%) patients having a major complication after TAR. Nineteen (1.3%) patients underwent reoperation, and 42 (2.8%) patients were readmitted within 30 days of the index TAR. Multivariate analysis identified factors predictive of early complications to include length of stay (LOS) >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus. Conclusion: From this relatively limited data set, outpatient TAA appears to be safe for management of end-stage ankle arthritis in select patients. Inpatient status was associated with an increased rate of 30-day readmission following TAA. Postoperative length of stay >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus were identified to be associated with early postoperative complications following TAA in this cohort. Level of Evidence: Level III, retrospective cohort study.

Cost and safety of inpatient versus outpatient open reduction internal fixation of isolated ankle fractures.

BACKGROUND: As health care shifts to value-based models, one strategy within orthopedics has been to transition appropriate cases to outpatient or ambulatory settings to reduce costs; however, there are limited data on the efficacy and safety of this practice for isolated ankle fractures. The purpose of this study was to compare the cost and safety associated with inpatient versus outpatient ankle open reduction internal fixation (ORIF). METHODS: All patients who underwent ORIF of isolated closed ankle fractures at 2 affiliated hospitals between April 2016 and March 2017 were identified retrospectively. Demographic characteristics, including age, gender, comorbidities and injuryspecific variables, were collected. We grouped patients based on whether they underwent ankle ORIF as an inpatient or outpatient. We determined case costing for all patients and analyzed it using multivariate regression analysis. RESULTS: A total of 196 patients (125 inpatient, 71 outpatient) were included for analysis. Inpatients had a significantly longer mean length of stay than outpatients (54.3 h [standard deviation (SD) 36.3 h] v. 7.5 h [SD 1.7 h], p < 0.001). The average cost was significantly higher for the inpatient cohort than the outpatient cohort ($4137 [SD $2285] v. $1834 [SD $421], p < 0.001). There were more unimalleolar ankle fractures in the outpatient group than in the inpatient group (42 [59.2%] v. 41 [32.8%], p < 0.001). Outpatients waited longer for surgery than inpatients (9.6 d [SD 5.6 d] v. 2.0 d [SD 3.3 d], p < 0.001). Fourteen patients (11.2%) in the inpatient group presented to the emergency department or were readmitted to hospital within 30 days of discharge, compared to 5 (7.0%) in the outpatient group (p = 0.3). CONCLUSION: In the treatment of isolated closed ankle fractures, outpatient surgery was associated with a significant reduction in length of hospital stay and overall case cost compared to inpatient surgery, with no significant difference in readmission or reoperation rates. In medically appropriate patients, isolated ankle ORIF can be performed safely in an ambulatory setting and is associated with significant cost savings.

A Two-Stage Diabetic Foot Salvage Using Synthetic Bone Void Filler and Lesser Toe Fillet Flap: A Case Report.

CASE: A 54-year-old type 2 diabetic man with a diabetic forefoot ulcer and osteomyelitis successfully underwent a staged reconstruction to salvage his foot. An antibiotic-carrying bone void filler was used to decrease the infection burden after initial debridement. The fifth toe fillet flap was performed to cover the large soft-tissue defect. The patient returned to baseline ambulation at the 1-year follow-up with a well-incorporated flap. CONCLUSION: This case highlights the utility of combining an antibiotic-carrying bone void filler and a toe fillet flap in a two-stage approach to salvage complex diabetic foot ulcers.

Preoperative photography improves patient satisfaction following hallux valgus surgery.

BACKGROUND: Patient satisfaction is variable following hallux valgus (HV) surgery. This prospective, blinded, randomized trial endeavored to determine whether showing patients a preoperative photograph would improve satisfaction following HV corrective surgery. METHODS: Adult patients undergoing HV surgery were randomized to a picture group (P) or a no picture group (NP). P-group patients were shown their preoperative photograph for 5 min at each postoperative visit. Outcome measures included the Foot Function Index (FFI), the Foot Ankle Outcome Score (FAOS), and a patient satisfaction questionnaire. RESULTS: Twenty-nine patients were enrolled in the study (15P, 14 NP). At 3, and 6 months postoperatively, patients in the P-group were more likely to be completely satisfied with the appearance of their foot. There were no differences between groups with respect to postoperative HVA, IMA, or FFI, and FAOS scores. CONCLUSION: Patient satisfaction is increased following hallux valgus corrective surgery by reminding patients of the preoperative appearance of their foot through the use of photographs. LEVEL OF EVIDENCE: Level I, randomized control trial.

Early radiographic outcomes following deltoid ligament repair in bimalleolar equivalent ankle fractures.

BACKGROUND: Indications for deltoid ligament repair in bimalleolar equivalent ankle fractures are unclear. This study compared radiographic outcomes in bimalleolar equivalent ankle fractures undergoing open reduction internal fixation (ORIF) +/- deltoid ligament repair. METHODS: A retrospective review of 1024 ankle fractures was performed. Bimalleolar equivalent injuries treated with ORIF +/- deltoid ligament repair were included. Radiographic assessment was performed preoperatively, and at three months postoperatively. RESULTS: One hundred and forty-seven ankle fractures met inclusion criteria with 46 undergoing deltoid ligament repairs. There was a significant decrease in medial clear space (1.93 ± 0.65 mm vs. 2.26 ± 0.64 mm, p = 0.01), and tibiofibular clear space (3.89 ± 1.20 mm vs. 4.87 ± 1.37 mm, p = 0.0001) at 3 months postoperative in the deltoid repair group compared to the no repair group. When syndesmotic fixation was performed, there were no differences between groups. CONCLUSION: Deltoid ligament repair in bimalleolar equivalent ankle fractures resulted in reduced medial clear space, and tibiofibular clear space in the early postoperative period. These differences were small and remained within established normal limits. LEVEL OF CLINICAL EVIDENCE: Level III, retrospective cohort study.

High-Energy Transsyndesmotic Ankle Fracture Dislocation-Injury Characteristics, Radiographic Outcomes, and Factors Affecting the Rate of Posttraumatic Arthritis in Logsplitter Injuries.

OBJECTIVES: To investigate patient demographics, injury characteristics, radiographic outcomes, and identify risk factors for developing posttraumatic arthritis in high-energy transsyndesmotic ankle fracture dislocations or "logsplitter" injuries. DESIGN: Retrospective cohort study. SETTING: Academic level one trauma center. PATIENTS/PARTICIPANTS: Twenty-seven adult patients with logsplitter injuries. INTERVENTION: All patients were treated with open reduction internal fixation, with possible addition of syndesmosis screw(s) and deltoid repair. MAIN OUTCOME MEASUREMENTS: The rate of posttraumatic arthritis at one year along with rate and reasons for reoperation. RESULTS: Twenty-seven patients were included with a mean follow-up of 14.5 ± 12.5 months. At one-year postoperative, 14 of the 20 patients (70%) demonstrated posttraumatic arthritis. Two patients (7.4%) went onto fusion. The reoperation rate was 51.9%. There was no significant difference in the arthritis rate with the number of syndesmosis screws used, quality of reduction, or addition of deltoid repair. CONCLUSIONS: The logsplitter injury is one with devastating outcomes and high rates of arthritis; it should be considered separately from conventional ankle fractures. The role of deltoid repair remains unclear. Further study of this injury pattern is required. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Rigid intramedullary nail fixation of traumatic femoral fractures in the skeletally immature.

OBJECTIVE: To determine the rate of femoral head osteonecrosis, and other complications following rigid intramedullary (IM) nail fixation of traumatic diaphyseal femur fractures through the greater trochanter in the skeletally immature. DESIGN: Retrospective review, case series. SETTING: Level I academic trauma center. PATIENTS/PARTICIPANTS: One hundred forty-eight traumatic pediatric diaphyseal femur fractures in 145 patients treated with rigid IM nail fixation from November 1, 2004 to December 31, 2018. INTERVENTION: Rigid intramedullary nail fixation of traumatic diaphyseal femur fractures through a trochanteric start point in the skeletally immature. MAIN OUTCOME MEASUREMENT: Rate of osteonecrosis of the femoral head. RESULTS: Sixty-five fractures in 64 skeletally immature patients met inclusion criteria. Motor vehicle collisions were implicated in 32 fractures. Of the 65 fractures, 5 were open. All rigid IM nails were anterograde with a trochanteric start point. Mean radiographic follow-up was 27.4 ±â€Š8.1 months. Twenty-two patients experienced postoperative pain and/or hardware irritation, with 24 patients (36.9%) undergoing reoperation for hardware removal. No occurrences of infection, malunion, nonunion, refracture, venous thromboembolism, fat embolism, significant leg length discrepancy, or femoral head osteonecrosis were documented. Two cases of heterotopic ossification were observed, 1 requiring surgical excision, yielding a complication rate of 3.1%. CONCLUSIONS: No cases of femoral head osteonecrosis were observed following treatment of 65 traumatic diaphyseal femur fractures with rigid IM nailing through the greater trochanter with a mean radiographic follow-up of 27 months. Rigid IM nail fixation with a trochanteric start point is both safe and efficacious for management of diaphyseal femur fractures in the skeletally immature.

Anatomic Repair vs Closed Reduction of the Syndesmosis.

BACKGROUND: The goal of the study was to compare radiographic and functional outcomes between conventional closed syndesmotic reduction and screw fixation with open reduction, direct repair of the anterior inferior tibiofibular ligament (AiTFL) and screw fixation. We hypothesized that open reduction with restoration of the AiTFL would provide an improved reduction with better radiographic and functional outcomes. METHODS: Fifty consecutive patients with OTA 44-C ankle fractures were enrolled. Treatment was nonrandomized and based on surgeon preference. Patients were treated with either open reduction, suture-anchor AiTFL repair, and screw fixation (ART group), or conventional closed reduction of the syndesmosis followed by screw fixation (CR group). The primary outcome measure was anteroposterior (AP) displacement of the fibula on CT scan at 3 months postoperatively. Secondary outcome measures included the Maryland Foot Score, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score, and the Foot and Ankle Outcome Score (FAOS). RESULTS: Mean AP difference between injured and noninjured ankles was decreased in the ART group compared with the CR group (0.7 ± 0.3 mm vs 1.5 ± 0.3 mm, P = .008). No differences were observed between groups in overall scores for secondary outcome measures. The ART group displayed a significant difference in Maryland Foot Shoe subscore at 12 months (ART = 9.5 vs CR = 8.3, P = .03) and FAOS Quality of Life subscore at 12 months (64.1 compared to 38.3, P = .04). CONCLUSION: Open anatomic syndesmotic repair resulted in improved radiographic outcomes compared with closed reduction. Cosmesis was worse at 6 weeks compared to the CR group; however, quality of life and shoewear were improved in the ART group at 1 year postoperatively. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Impaction fractures of the anterior tibial plafond: Outcomes after fractures around the ankle: Is the anterior impaction plafond fracture a problem?

OBJECTIVES: To determine whether patients with AO/OTA 43-B anterior impaction tibial plafond fractures have worse clinical outcomes, and an increased risk of progression to ankle arthrodesis. DESIGN: Retrospective cohort study. SETTING: Level 1 academic trauma center. PATIENTS: One hundred sixty-eight patients were included in the study, all of whom had tibial plafond fractures. INTERVENTION: Study patients underwent external fixation and/or open reduction internal fixation (ORIF) as indicated by fracture/injury pattern. MAIN OUTCOME MEASUREMENTS: Arthrodesis rate. RESULTS: AO 43-B Anterior impaction tibial plafond fractures have an increased risk of progression to arthrodesis when compared to AO 43-B nonanterior impaction type fractures (19.4% vs 8%). CONCLUSIONS: AO 43-B anterior impaction tibial plafond fractures have a worse clinical outcome compared to AO 43-B nonanterior impaction fractures. These fractures also confer increased risk of progression to arthrodesis. CONFLICTS OF INTEREST: The authors have no conflict of interests to declare.

Biomechanical Consequences of Nail Insertion Point and Anterior Cortical Perforation for Antegrade Femoral Nailing.

This biomechanical study assessed the influence of changing antegrade cephalomedullary nail insertion point from anterior to neutral to posterior locations relative to the tip of the greater trochanter with or without anterior cortical perforation in the distal femur. Artificial osteoporotic femurs and cephalomedullary nails were used to create 5 test groups each with 8 specimens: intact femur without a nail or perforation, anterior nail insertion point without perforation, neutral nail insertion point without perforation, posterior nail insertion point without perforation, and posterior nail insertion point with perforation. Nondestructive biomechanical tests were done at 250 N in axial, coronal 3-point bending, sagittal 3-point bending, and torsional loading in order to measure overall stiffness and bone stress. The intact femur group vs. all femur/nail groups had lower stiffness in all loading modes (p ≤ 0.018), as well as higher bone stress in the proximal femur (p ≤ 0.027) but not in the distal femur above the perforation (p = 0.096). Compared to each other, femur/nail groups only showed differences in sagittal 3-point bending stiffness for anterior and neutral vs. posterior nail insertion points without (p ≤ 0.025) and with perforation (p ≤ 0.047). Although it did not achieve statistical significance (p ≥ 0.096), moving the nail insertion point from anterior to neutral to posterior to posterior with perforation did gradually increase bone stress by 45% (proximal femur) and 46% (distal femur). No femur or hardware failures occurred. Moving the nail insertion point and the presence of a perforation had little effect on stiffness, but the increased bone stress may be important as a predictor of fracture. Based on current bone stress results, surgeons should use anterior or neutral nail insertion points to reduce the risk of anterior cortical perforation.

Does the Additional Articulation in Retrieved Bipolar Hemiarthroplasty Implants Decrease Trunnionosis Compared to Total Hip Arthroplasty?

BACKGROUND: Trunnionosis at the modular head-neck taper interface in metal-on-polyethylene total hip arthroplasty (MoP THA) has been shown to occur, and represents a potential mode of MoP THA failure. The purpose of the present investigation is to elucidate differences in fretting and corrosion at the head-neck taper interface of prostheses retrieved from bipolar hemiarthroplasty (BH) and MoP THA. METHODS: A retrieval analysis of BH and MoP THA prostheses featuring a single taper design from a single manufacturer and in vivo for a minimum 2 years was performed. Fifteen femoral heads of 28-mm diameter and corresponding femoral stems retrieved from BH were compared with MoP THA implants matched based on time in vivo and head length (28 mm, -3 mm to 28 mm, +8 mm). Fretting and corrosion damage scoring was completed under stereomicroscopic visualization. RESULTS: Femoral head bore tapers retrieved from BH exhibited decreased overall fretting (P = .02), when compared to those retrieved from MoP THA. Total corrosion scores for all retrieved implants were positively correlated with implantation time (ρ = 0.54, P < .02). CONCLUSION: Femoral heads retrieved from BH exhibit decreased fretting damage compared to those retrieved from MoP THA. The added articulation in BH implants may decrease torque produced at the head-neck taper junction, thereby decreasing fretting. Increased fretting damage in implants from MoP THA is not associated with increased corrosion in 28-mm heads of this taper design. The longer a BH or MoP THA prosthesis is implanted, the greater the risk of damage due to corrosion.

Trunnionosis: Does Head Size Affect Fretting and Corrosion in Total Hip Arthroplasty?

BACKGROUND: Wear and tribocorrosion at the modular head-neck taper interface may be a cause of failure in metal-on-polyethylene total hip arthroplasty (THA). The present investigation endeavored to elucidate the effect of femoral head diameter on fretting and corrosion in retrieved head-neck tapers. METHODS: A retrieval analysis of THA prostheses in vivo for a minimum of 1 year was performed. Twenty-three femoral heads of 32-mm diameter were matched with 28-mm heads based on time in vivo and head length (-3 mm to +8 mm). All included implants featured a single taper design from a single manufacturer. Fretting and corrosion damage scoring was performed for each implant under stereomicroscopic visualization. RESULTS: Head diameter was observed to affect fretting (P = .01), with 32-mm femoral heads exhibiting greater total fretting scores than 28-mm heads. Fretting damage was greatest (P = .01) in the central concentric zone of the femoral head bore tapers, regardless of head diameter, length, or stem offset. No significant effect on total corrosion scores was observed for any head or stem variable. Retrieved implant total corrosion scores were positively correlated (ρ = 0.51, P < .001) with implantation time. CONCLUSION: Increased femoral head diameter in THA may produce greater fretting damage owing to and increased head-neck moment arm. There is no associated increase in corrosion with 28-mm and 32-mm heads of this taper design. The longer a THA prosthesis is implanted, the greater the risk of damage due to corrosion.

Tribocorrosion: Ceramic and Oxidized Zirconium vs Cobalt-Chromium Heads in Total Hip Arthroplasty.

BACKGROUND: This matched-cohort study aims to compare tribocorrosion between matched ceramic and cobalt-chromium femoral head trunnions and between matched Oxinium and cobalt-chromium femoral head trunnions. Secondary objectives were to investigate whether taper design, depth of trunnion, implantation time, age, body mass index, and gender have an effect on fretting and corrosion. METHODS: All hip prostheses retrieved between 1999 and 2015 at one center were reviewed, giving a total of 52 ceramic heads. These were matched to a cobalt-chromium cohort according to taper design, head size, neck length, and implantation time. The trunnions were examined by 2 observers using a 4-point scoring technique and scored in 3 zones: apex, middle, and base. The observers were blinded to clinical and manufacturing data where possible. A separate matched-cohort analysis was performed between 8 Oxinium heads and 8 cobalt-chromium heads, which were similarly scored. RESULTS: Ceramic head trunnions demonstrated a lower median fretting and corrosion score at the base zone (P < .001), middle zone (P < .001), and in the combined score (P < .001). Taper design had a significant effect on fretting and corrosion in the apex zone (P = .04) of the ceramic group, as well as the cobalt-chromium group (P = .03). Between Oxinium heads and cobalt-chromium heads, there was no significant difference in the fretting and corrosion score across all 3 zones (base: P = .22; middle: P = .92; and apex: P = .71) and for the combined score (P = .67). CONCLUSION: This study shows that ceramic head confers an advantage in trunnion fretting and corrosion. Taper design and implantation time were also significant factors for fretting and corrosion.

Effect of Taper Design on Trunnionosis in Metal on Polyethylene Total Hip Arthroplasty.

This study examines how taper design affects corrosion and fretting at the head trunnion surface. All hip prostheses retrieved between 1999 and 2013 with 28mm/+0 heads were selected, resulting in 44 cobalt-chrome-on-polyethylene implants, representing six taper designs. Mean implantation time: 8.9±3.7years. The femoral head tapers were scored for fretting and corrosion using the Goldberg scale as both a combined score and by three zones (apex, central and base). There was no difference in age (P=0.34), BMI (P=0.29), or implantation time (P=0.19) between taper groups. The 11/13 taper had the highest combined corrosion and fretting score, but no difference (P=0.22) between groups for combined scores (P=0.22 for corrosion, P=0.19 for fretting). In a zone-specific analysis, the 11/13 taper had highest corrosion score at base zone (P=0.02). Taper design had a significant effect on corrosion at base of trunnion.

Adaptations in the activation of human skeletal muscle induced by short-term isometric resistance training.

This study employed longitudinal measures of evoked spinal reflex responses (Hoffman reflex, V wave) to investigate changes in the activation of muscle and to determine if there are "linked" neural adaptations in the motor pathway following isometric resistance training. Twenty healthy, sedentary males were randomly assigned to either the trained (n = 10) or control group (n = 10). The training protocol consisted of 12 sessions of isometric resistance training of the plantar flexor muscles over a 4-wk period. All subjects were tested prior to and after the 4-wk period. To estimate changes in spinal excitability, soleus Hoffman (H) reflex and M wave recruitment curves were produced at rest and during submaximal contractions. Recruitment curves were analyzed using the slope method (Hslp/Mslp). Modulation of efferent neural drive was assessed through evoked V wave responses (V/Mmax) at 50, 75, and 100% maximal voluntary contraction (MVC). After 4 weeks, MVC torque increased 20.0 +/- 13.9% (mean +/- SD) in the trained group. The increase in MVC was accompanied by significant increases in the rate of torque development (42.5 +/- 13.3%), the soleus surface electromyogram (60.7 +/- 30.8%), voluntary activation (2.8 +/- 0.1%), and the rate of activation (48.7 +/- 24.3%). Hslp/Mslp was not altered by training; however, V/Mmax increased 57.3 +/- 34.2% during MVC. These results suggest that increases in MVC observed in the first few days of isometric resistance training can be accounted for by an increase in the rate of activation at the onset of muscle contraction. Augmentation of muscle activation may be due to increased volitional drive from supraspinal centers.