Weight-Bearing Computed Tomography of the Foot and Ankle-What to Measure?

Weight-bearing computed tomography (WBCT) was introduced in 2012 for foot and ankle applications as a breakthrough technology that enables full weight-bearing, three-dimensional imaging unaffected by x-ray beam projections or foot orientation. The literature describing the use of WBCT in the treatment of foot and ankle disorders is growing, and this article provides an overview of what can be measured with WBCT.

A combined program of education plus exercise versus general advice for ankle osteoarthritis: A feasibility randomised controlled trial.

BACKGROUND: Unlike hip and knee OA, there is little evidence to guide the management of ankle osteoarthritis (OA) and there are no clinical guidelines for ankle OA. Regardless of the body region, guidelines for treating OA typically include education, weight loss and exercise as the key components of management. Such an intervention has not been investigated in people with ankle OA. OBJECTIVES: To determine the feasibility of conducting a randomised controlled trial (RCT) that compares physiotherapist-delivered education plus exercise to physiotherapist-delivered general advice for people with ankle OA. Secondarily, to inform planning for future RCTs. DESIGN: A randomised parallel-group feasibility trial. METHOD: Study participants were recruited, assessed for eligibility, and randomised using 1:1 concealed allocation to receive either physiotherapist-delivered education plus exercise, or physiotherapist-delivered general advice. Primary feasibility outcomes were evaluated based on predetermined feasibility criteria. Secondary participant-reported and physical outcomes were collected to inform the design of future RCTs. RESULTS: Thirty participants (67% (n = 20) women, mean (standard deviation) age: 66.1 (11.5) years) were randomised. Data for key feasibility outcomes met a priori feasibility criteria: consent rate (97%), participant adherence with their allocated intervention arm (71%), fidelity of the intervention (94%) and rate of completion of outcome measures at 3 months (87%). CONCLUSIONS: This study demonstrates that it is feasible to run an adequately powered RCT comparing physiotherapist-delivered education plus exercise versus physiotherapist-delivered general advice for people with ankle OA. Study data will inform the planning of a full-scale RCT.

Efficacy of Maitland Mobilization and Myofascial Release as Preoperative Care in Ankle Arthritis With Severe Equinus Deformity: A Rare Case Report.

Advanced post-traumatic ankle osteoarthritis (PTAO) is a severe condition that affects less than one percent of the population, with rare incidence. It accounts for less than 5% of all osteoarthritis (OA) cases. Physiotherapy enhances functionality by strengthening the dynamic stabilizers of the ankle, such as the calf, soleus, tibialis anterior, and peroneal muscles, and by improving proprioception, which aids in balance and coordination. As OA progresses, individuals may experience early losses in their ability to perform everyday activities and job tasks. Occupational therapy and cardiovascular exercises are crucial for conserving energy while walking and improving posture at work. This case report involves a 39-year-old male who presented to the hospital with pain, swelling, difficulty walking, and an equinus deformity. After diagnosing him with ankle arthritis, the orthopedic specialist recommended an X-ray. Medication and physical therapy were administered to educate and rehabilitate the patient, aiming to improve pain, range of motion (ROM), strength, and walking capacity. A four-week treatment plan, along with medication, resulted in significant improvements in pain reduction, ROM, strength, and walking ability. This case report also underscores the importance of focusing on preoperative care to ensure that post-surgery, the hip and knee ranges are normal, and the patient experiences less difficulty walking. Future studies are needed to explore this condition further and to evaluate the effectiveness of ultrasound therapy in such cases, as it was not effective in reducing pain in this instance.

Outcomes of Total Ankle Replacement.

Total ankle replacement (TAR) is an effective operative treatment of end-stage ankle osteoarthritis (OA) in the appropriate patient, conferring improved kinematic function, decreased stress across adjacent joints, and offering equivalent pain relief in comparison to ankle arthrodesis (AA). It is important to consider patient age, weight, coronal tibiotalar deformity, joint line height, and adjacent joint OA to maximize clinical and patient outcomes. Both mobile-bearing and fixed-bearing implants have demonstrated favorable clinical outcomes, marked improvement in patient-reported outcomes, and good survivorship; however, implant survivorship decreases with longer term follow-up, necessitating constant improvement of primary and revision TAR options.

Gout arthritis of the ankle successfully treated with arthroscopic debridement: A case report.

INTRODUCTION: Gout is an inflammatory arthritis that causes acute pain due to the accumulation of uric acid crystals. Hyperuricemia primarily causes it, resulting in the deposition of monosodium urate crystals in and around joints. Gout can affect joints such as the metatarsophalangeal joint and the foot's talus bone. Treatment involves addressing hyperuricemia and managing symptoms with medications like febuxostat. Surgical treatment is crucial, especially in cases of chronic tophaceous gout or severe joint damage, including arthroscopic debridement, ankle arthrodesis, or total ankle arthroplasty. CASE PRESENTATION: A 32-year-old male with a history of hyperuricemia experienced pain in his left ankle for a year. The ankle was swollen and prone to pain when he walked. Magnetic resonance imaging (MRI) tests revealed the thickening and irregular shape of the anterior talofibular ligament (ATFL), suggesting a rupture. The arthroscopic operation revealed a crystal deposit, leading to the diagnosis of gout arthritis and subsequent debridement for the patient. Following the surgery, the patient experienced minimal pain, an improved range of motion, and a significant improvement in swelling within a week. The patient was able to walk with minimal assistance and without aid. DISCUSSION: Gout arthritis and ATFL injuries share common clinical features, including joint swelling, limited motion, and joint deformity. The presence of monosodium urate (MSU) crystals and inflammation in both conditions complicates diagnosis. Performing arthroscopic debridement surgery in gout arthritis presents challenges due to tophi and inflammation, as well as the risk of articular cartilage damage. Expertise is crucial for successful arthroscopic debridement, with patient selection, preoperative planning, and thorough removal of MSU crystals being key factors. CONCLUSION: Thorough evaluation, patient selection, preoperative planning, joint identification, removal of MSU crystals, and comprehensive postoperative care are crucial for successful arthroscopic debridement for gout arthritis of the ankle.

What is the Total Ankle Arthroplasty Experience of Podiatric Foot and Ankle Surgery Fellows? A National Survey.

In 2011, the Council of Podiatric Medical Education, the accrediting body of the American Podiatric Medical Association, approved the conversion of all Podiatric Residencies to 3-year surgical programs. In 2012, there were 12 podiatric fellowships recognized by the American College of Foot and Ankle Surgeons. To date, there are 53 programs listed under the college's website. As podiatric fellowships expand, further research is needed to identify advantages and pitfalls of fellowship training. Our primary aim was to obtain current fellow survey data to enhance our understanding of podiatric reconstructive foot and ankle surgery fellowship training programs. In doing so, we decided to use one of the most salient topics in fellowship training- Total Ankle Replacement. Invitation was administered by email and 73.6% of active reconstructive 2023-24 American College of Foot and Ankle Surgeons postgraduate fellows responded. Fellowship total ankle replacement case volume was significantly greater than residency (p = 0.037). Completion of 0-5 total ankle replacement(s) was 30.8%, and greater than 30 in 17.9% of fellows. Fifty nine percent reported feeling "comfortable" or "very comfortable" with total ankle arthroplasty. Patient specific instrumentation was used in a majority of cases (66.7%). Over three fourths (79.8%) of fellows stated they planned on performing TAR as an attending surgeon after their fellowship. Despite its limitations, we hope our survey data can aid graduating and previous fellows and add to the body of knowledge for future TAR educational programs and industry involvement. As podiatric fellowships continue to transform, so too must our research efforts to track progress.

Effect of Preoperative Coronal Plane Alignment on Actual Versus Predicted Alignment Using Patient Specific Instrumentation in Total Ankle Replacement.

Alignment in total ankle replacement is important for success and implant survival. Recently there has been the introduction and adoption of patient specific instrumentation for implantation in total ankle replacement. Current literature does not evaluate the effect of preoperative deformity on accuracy of patient specific instrumentation. A retrospective radiographic analysis was performed on 97 consecutive patients receiving total ankle replacement with patient specific instrumentation to assess the accuracy and reproducibility of the instrumentation. Subgroup analysis evaluated the effect of preoperative deformity. All surgeries were performed by fellowship trained foot and ankle surgeons without industry ties to the implants used. Preoperative and postoperative films were compared to plans based on computerized tomography scans to assess how closely the plan would be implemented in patients. Overall postoperative coronal plane alignment was within 2° of predicted in 87.6% (85 patients). Similarly, overall postoperative sagittal plane alignment was within 2° of predicted in 88.7% (86 patients). Tibial implant size was accurately predicted in 81.4% (79 patients), and talus implant size was correct in 75.3% (73 patients). Patients with preoperative varus deformity had a higher difference between predicted and actual postoperative alignment compared to valgus deformity (1.1° compared to 0.3°, p = .02). A higher average procedure time was found in varus patients, and more adjunctive procedures were needed in patients with varus or valgus deformity, but these were not significant, p > .5. Surgeons can expect a high degree of accuracy when using patient specific instrumentation overall, but less accurate in varus deformity.

Age Influence on Total Ankle Arthroplasty Outcomes: A Systematic Review.

Total ankle arthroplasty has gained popularity as advancing technology has resulted in higher survivorship and lower complication rates. In the past, total ankle replacement candidates have been reserved for patients greater than 50 years old with low physical demands and minimal deformity. However, with newer designs, surgeons have begun to expand their patient inclusion criteria. The purpose of this study was to analyze current literature comparing patient outcomes among total ankle replacement patients over and under age 50. A systematic review of the literature was performed comparing the impact of age to total ankle replacement outcomes. 159 articles were reviewed. Seven studies met our inclusion criteria and therefore were included in the synthesis. No statistically significant difference in outcomes was determined for the younger and older age groups in regard to reoperation, complications, and implant survivorship (p = .412, .955, .155, respectively). However, the statistical model is underpowered given the limited number of studies. While the findings of this study infer that total ankle replacement outcomes are not significantly different among older and younger age groups, further research in this area is needed.

Weight-Bearing CT for Diseases around the Ankle Joint.

Weight-bearing computed tomography (WBCT) enables acquisition of three-dimensional bony structure images in a physiological weight-bearing position, which is fundamental in understanding the pathologic lesions and deformities of the ankle joint. Over the past decade, researchers have focused on validating and developing WBCT measurements, which has significantly enhanced our knowledge of common foot and ankle diseases. Consequently, understanding the application of WBCT in clinical practice is becoming more important to produce improved outcomes in the treatment of disease around the ankle joint. This review will describe an overview of what is currently being evaluated in foot and ankle surgery using WBCT and where the course of research will be heading in the future.

An evaluation of the total ankle replacement in the modern era: a narrative review.

Background and Objective: Total ankle replacement has become an increasingly popular surgical procedure for treatment of end-stage ankle arthritis. Though ankle arthrodesis has historically been considered the gold standard treatment, advancements in implant design, functional outcomes, and survivorship have made total ankle replacement a compelling alternative. Particularly, in the past 20 years, total ankle replacement has undergone tremendous innovation, and the field of research in this procedure continues to grow. In this review, we aim to summarize the history, evolution, advancements, and future directions of total ankle replacement as described through implant design, indications, surgical procedures, complications, and outcomes. Methods: Literature searches were conducted in PubMed to identify relevant articles published prior to March 2023 using the following keywords: "total ankle replacement", "total ankle arthroplasty", and "total ankle". Key Content and Findings: Total ankle replacement has demonstrated significant improvements in surgical technique, implant design, survivorship, and clinical and functional outcomes in the modern era. The procedure reports high patient satisfaction, low complication rates, and improved functional abilities that challenge the current gold standard treatment for ankle arthritis. Conclusions: Though there are areas of improvement for total ankle replacement, the procedure demonstrates promising outcomes for patients with end-stage ankle arthritis to improve pain and functional abilities. Research studies continue to explore various the facets of total ankle replacement, including outcomes, risk factors, novel techniques and modalities, and complications, to direct future innovation and to optimize patient results.

Effect of Distraction Arthroplasty in the Treatment of Moderate-to-Severe Ankle Arthritis.

OBJECTIVE: Currently, the traditional treatment of moderate-to-severe ankle arthritis is joint fusion or joint replacement. The aim of this article is to explore the clinical efficacy of distraction arthroplasty in the treatment of moderate-to-severe ankle arthritis. METHODS: A retrospective analysis was conducted with a total of 34 cases who were diagnosed with moderate-to-severe ankle arthritis and treated by distraction arthroplasty from January 2007 to November 2021. The average age was 42.3 years. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and pain visual analog scale (VAS) were used to evaluate ankle pain and functional improvement before surgery and at the last follow-up. Based on age, the patients were divided into the ≤45-year-old group [young group, 15 cases, age (36.37 ± 4.31) years old] and the >45-year-old group [middle-aged and elderly group, 19 cases, age (53.74 ± 3.17) years old]. The analysis included comparing preoperative and postoperative AOFAS ankle-hindfoot and VAS scores and the influence of age on distraction arthroplasty. RESULTS: All 34 patients were followed up, and the follow-up time ranged from 13 to 143 months, with an average of 45.3 months. The follow-up times for the young and middle-to-elderly groups were (33.19 ± 21.37) months and (55.63 ± 29.69) months, respectively. At the last follow-up, the AOFAS ankle-hindfoot and VAS scores were significantly improved compared with the preoperative assessment (p < 0.05). According to the etiological analysis, except for Pilon fracture, which showed no differences pre- and postoperation in the AOFAS ankle-hindfoot score and VAS score (p > 0.05), all other patients showed significant differences in these two scores (p < 0.05). The difference in preoperative AOFAS ankle-hindfoot scores between the young and middle-to-elderly groups was statistically significant (t = 3.422, p = 0.021). The preoperative and postoperative comparison of preoperative VAS scores, AOFAS ankle-hindfoot scores, and VAS scores before and after surgery showed no differences (p > 0.05). The joint space width (JSW) of 10 patients who were followed up for more than 5 years was (2.9 ± 0.5) mm. Two patients who were followed up for more than 10 years showed 3.3 and 3.0 mm, respectively, JSW. CONCLUSION: Distraction arthroplasty with the Ilizarov external fixator can achieve satisfactory results in the treatment of moderate-to-severe ankle arthritis (except arthritis caused by Pilon fracture surgery). Age has no statistical impact on the efficacy of distraction arthroplasty.

Total ankle arthroplasty improves discrete and continuous stance phase gait symmetry.

BACKGROUND: Total ankle arthroplasty (TAA) is used to treat symptomatic end-stage ankle arthritis (AA). However, little is known about TAA's effects on gait symmetry. RESEARCH QUESTION: Determine if symmetry changes from before surgery through two years following TAA utilizing the normalized symmetry index (NSI) and statistical parametric mapping (SPM). METHODS: 141 patients with end-stage unilateral AA were evaluated from a previously collected prospective database, where each participant was tested within two weeks of surgery (Pre-Op), one year and two years following TAA. Walking speed, hip extension angle and moment, hip flexion angle, ankle plantarflexion angle and moment, ankle dorsiflexion angle, weight acceptance (GRF1), and propulsive (GRF2) vertical ground reaction forces were calculated for each limb. Gait symmetry was assessed using the NSI. A linear mixed effects model with a single response for each gait symmetry variable was used to examine the fixed effect of follow-up time (Pre-Op, Post-1 yr, Post-2 yr) and the random effect of participant with gait speed as a covariate in the model. A one-dimensional repeated measures analysis of variance (ANOVA) statistical parameter mapping (SPM) was completed to examine differences in the time-series NSI to determine regions of significant differences between follow-up times. RESULTS: Relative to Pre-Op values, GRF1, and GRF2 showed increased symmetry for discrete metrics and the time-series NSI across sessions. Hip extension moment had the largest symmetry improvement. Ankle plantarflexion angle was different between Pre-Op and Post-2 yr (p=0.010); and plantarflexion moment was different between Pre- Op and each post-operative session (p<0.001). The time-series Ankle Angle NSI was greater during the early stance phase in the Pre-Op session compared to Post-2 yr. SIGNIFICANCE: Symmetry across most of the stance phase improved following TAA indicating that TAA successfully improves gait symmetry and future work should determine if these improvements restore symmetry to levels equivalent with health age-match controls.

Postoperative Medial Malleolar Fractures in Total Ankle Replacement Are Associated With Decreased Medial Malleolar Width and Varus Malalignment: A Case-Control Study.

BACKGROUND: There are limited data regarding risk factors associated with periprosthetic medial malleolar fractures in total ankle arthroplasty (TAA). This case-control study aimed to identify the risk factors and analyze the effect of prophylactic screw fixation in preventing a medial malleolar fracture after TAA. METHODS: A case-control study was conducted on 149 patients who underwent primary TAA. Twenty patients with postoperative medial malleolar fractures >4 weeks postoperatively (cases) were identified. An additional 129 patients (controls) were randomly selected from the TAA database. Radiographic evaluation included tibial component coronal alignment and postoperative medial malleolar width. Demographics and radiographic variables were compared between cohorts. Logistic regression was used to investigate the association between medial malleolar fracture and postoperative coronal alignment, medial malleolar width, and prophylactic fixation of the medial malleolus. RESULTS: Mean (SD) medial malleolar width was significantly smaller in the fracture cohort (8.52 mm [1.6]) than in the control group (11.78 mm [1.74]) (P < .001). Mean (SD) tibial component coronal alignment was 92.17 degrees (2.77) in the fracture cohort and 90.21 degrees (1.66) in the control group (P = .002). Regression analysis identified a significant negative association between postoperative medial malleolar width and the probability of fracture (OR = 0.06, 95% CI 0.01, 0.26, P < .001). Varus malalignment of the tibial component was positively associated with the probability of fracture (OR = 1.90, 95% CI 1.27, 2.86, P = .002). Prophylactic screw fixation resulted in more than 90% reduction in the odds of a fracture (OR = 0.04, 95% CI 0.01, 0.45, P = .01). ROC curve analysis determined a medial malleolar width of 10.3 mm as a potential threshold for predicting fracture. CONCLUSION: Decreased medial malleolar width and postoperative varus malalignment were associated with an increased risk of postoperative medial malleolar fracture. Therefore, surgeons should consider prophylactic screw fixation in patients with a medial malleolar width <10.3 mm or at risk of postoperative varus deformity.

Management of Recurrent Giant Cell Tumor of Distal Tibia With Intramedullary Hindfoot Fusion Nail and Trabecular Metal Implant Construct.

Reconstruction options for giant cell tumors (GCTs) of bone are limited and challenging due to the amount of structural compromise and the high recurrence rates. This is especially true for GCTs of the foot and ankle, as the area is vital for weight bearing and function. The typical treatment for GCTs is currently excision, curettage, and cementation, although that is not always effective. A 36-year-old otherwise healthy female presented with an original diagnosis of a large aneurysmal bone cyst (ABC) of the distal tibia that had recurred despite two previous attempts at treatment with resection and cementation. She was treated with surgical resection of the lesion, reconstruction, and ankle and subtalar joint arthrodesis with a tibiotalocalcaneal intramedullary nail in combination with a trabecular metal cone. The final pathology of the intraoperative samples was consistent with GCT. Postoperatively, she recovered well, and her imaging was consistent with a successful fusion. This case report provides evidence that tibiotalocalcaneal fusion with a unique combination of hindfoot nail and trabecular metal cone construct in a single procedure is a successful option for the treatment of large, recurrent GCT lesions in the distal tibia.

Artificial Intelligence Language Models Are Useful Tools for Patients Undergoing Total Ankle Replacement.

BACKGROUND: Artificial intelligence (AI) large language models (LLMs), such as Chat Generative Pre-trained Transformer (ChatGPT), have gained traction as both augmentative tools in patient care but also as powerful synthesizing machines. The use of ChatGPT in orthopaedic foot and ankle surgery, particularly as an informative resource for patients, has not been described to date. The purpose of this study was to assess the quality of information provided by ChatGPT in response to commonly asked questions about total ankle replacement (TAR). METHODS: ChatGPT was asked 10 frequently asked questions about TAR in a conversational thread. Responses were recorded without follow-up, and subsequently graded A, B, C, or F, corresponding with "excellent response," "adequate response needing mild clarification," "inadequate response needing moderate clarification," and "poor response needing severe clarification." RESULTS: Of the 10 responses, 2 were grade "A," 6 were grade "B," 2 were grade "C," and none were grade "F." Overall, the LLM provided good-quality responses to the posed prompts. Conclusion. Overall, the provided responses were understandable and representative of the current literature surrounding TAR. This study highlights the potential role LLMs in augmenting patient understanding of foot and ankle operative procedures. LEVELS OF EVIDENCE: IV.

Association of Timing of Hindfoot Arthrodesis and Early Reoperation Rates for Total Ankle Arthroplasty.

BACKGROUND: Prior literature has demonstrated that ipsilateral hindfoot arthrodesis may increase the risk for reoperation after total ankle arthroplasty (TAA) and that simultaneous hindfoot arthrodesis with TAA could result in short-term clinical and radiologic improvements. The purpose of this study is to compare the reoperation rates after TAA with prior hindfoot arthrodesis vs simultaneous arthrodesis and TAA. METHODS: Patients who underwent primary TAA were identified in the PearlDiver database. Patients were sorted into 2 study cohorts: hindfoot arthrodesis prior to TAA and simultaneous arthrodesis and TAA. Propensity matched control cohorts were identified for each study group. Multivariate analysis was conducted to account for any confounding variables and covariates when identifying differences in complications between cohorts. RESULTS: 297 patients underwent TAA with prior hindfoot arthrodesis and 174 underwent TAA and hindfoot arthrodesis concurrently. The incidence of reoperation (13.8% vs 5.2%, P < .001) and infection (12.6% vs 5.9%, P = .011) for the simultaneous cohort was higher when compared to the matched control cohort. In contrast, there was no statistically significant difference when comparing the prior arthrodesis cohort to the matched control cohort in reoperation rates (5.1% vs 4.7%, P = .787) or infection rates (4.4% vs 4.8%, P = .734). Those undergoing simultaneous procedures had increased incidences of reoperation, wound complications, infection, and emergency department visits (P < .0167) when compared to the TAA with prior arthrodesis cohort. CONCLUSION: Patients undergoing TAA and hindfoot arthrodesis concurrently were found to have higher rates of reoperation and infection when compared to the matched control cohort . In contrast, there was no difference in these rates in patients undergoing TAA with prior hindfoot arthrodesis compared with their matched control cohort. Patients undergoing simultaneous procedures had increased rates of reoperations, wound complications, infection, and emergency department visits compared to the TAA with prior arthrodesis cohort.

Sequential bilateral total ankle replacements: No difference in patient-reported outcomes between the first and second ankle.

BACKGROUND: Total ankle replacement is an established treatment for end-stage arthritis. However, there is little data examining outcomes in sequential bilateral replacements. This study aimed to compare outcomes between first and second ankles in sequential replacement. METHODS: Patients were retrospectively contacted to complete a follow-up questionnaire including the Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D-3 L, and a question assessing satisfaction. Electronic records identified demographics, procedural details, and complications. RESULTS: Twenty patients underwent sequential bilateral ankle replacement over the study period. At a mean follow-up of four years, 18 patients completed the follow-up questionnaire. There was no statistically significant difference between first and second ankles in terms of MOXFQ score, EQ-5D-3 L or satisfaction. Eleven complications were noted. CONCLUSIONS: We report excellent outcomes after sequential bilateral ankle replacement with no difference in outcomes between first and second ankles. These results can be used to counsel patients in the future and manage expectations. LEVEL OF EVIDENCE: IV.

Total ankle replacement versus ankle fusion for end-stage ankle arthritis: A meta-analysis.

PURPOSE: This study aims to systematically review the efficacy and safety of total ankle replacement (TAR) and ankle fusion (AF) as treatment options for end-stage ankle arthritis. METHODS: A comprehensive literature search was conducted on data from multiple databases, including PubMed, The Cochrane Library, Construction and Building Materials, Embase, Web of Science, and Scopus for RCTs and prospective cohort studies comparing TAR and AF in patients with end-stage ankle arthritis from inception up to June, 2023. Our primary outcomes of interest included patients' clinical function scores and complications. We employed Review Manager 5.4 and Stata/MP 14.0 software for the meta-analysis. RESULTS: Our analysis incorporated 13 comparative studies, including 11 prospective studies, one pilot RCT, and one RCT. The pooled results revealed no significant difference in postoperative Short Form-36 scores between the TAR and AF groups (MD = -1.19, 95% CI: -3.89 to 1.50, p = .39). However, the postoperative Foot and Ankle Ability Measure scores in the AF group were significantly higher than in the TAR group (MD = 8.30, 95% CI: 1.01-15.60, p = .03). There was no significant difference in postoperative complication rates between the TAR and AF groups (RR = 0.95, 95% CI: 0.59 to 1.54, p = .85). CONCLUSION: Currently available evidence suggests no significant disparity in postoperative outcomes between TAR and AF. In the short term, TAR demonstrates better clinical scores than AF and lower complication rates. Conversely, in the long term, AF exhibits superior clinical scores and lower complication rates, although this difference is not statistically significant.

Ankle arthrodesis through minimally-invasive transfibular approach: a new surgical technique.

PURPOSE: The purpose of our work was to demonstrate the surgical technique of ankle arthrodesis using the minimally-invasive transfibular (MITF) approach, which minimizes soft tissue damage and is advantageous for high-risk patients. METHODS: In this prospective study, a total of 12 patients with end-stage varus ankle osteoarthritis, including high-risk individuals, underwent ankle arthrodesis using the MITF approach. The technique involves a unique osteotomy at the joint space level, minimizing soft tissue detachment from the fibula. The primary outcomes assessed included bony union, time to weight-bearing, correction of varus deformity, and functional outcomes measured by the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scale. However, the study's limitations encompass a small sample size and the absence of a control group. RESULTS: At 6 months post-operation, all patients achieved bony union, with a mean time to union of 13.7 ± 5.2 weeks. The average time to initiate weight-bearing without additional support was 11.2 ± 3.8 weeks. Preoperative varus deformity (17.08 ± 8.36 degrees) and talar tilt (8.75 ± 4.33 degrees) were successfully corrected, with postoperative alignment within 0-5 degrees of valgus. Functional outcomes showed a significant improvement in AOFAS scores from 37.83 ± 7.79 points preoperatively to 77.42 ± 5.63 points one year after surgery (p = 0.002). Minor complications occurred in two patients, both effectively treated with local therapy and antibiotics. CONCLUSIONS: The MITF approach for ankle arthrodesis demonstrates promising results in addressing end-stage varus ankle osteoarthritis, even in high-risk patients. However, the study's limitations highlight the need for a prospective comparative clinical trial with a larger sample size to ascertain the technique's effectiveness and safety definitively.

Long-Term Outcome Analysis of Surgically Treated Talus Fractures in a Tertiary Care Hospital.

Aim The present study aims to look at the long-term clinical and radiological outcomes of surgically treated talus fractures. We have compared the outcomes and complications between simple and complex talar fracture patterns. Additionally, patients' ability to return to activity following surgical treatment of these fractures was also analysed. Materials and methods Retrospective analysis of surgically treated talus fractures at the PSG Institute of Medical Sciences and Research from 2012 to 2015. The fractures were classified as neck and body fractures. The fractures were classified anatomically (neck and body) based on their severity (simple and complex) fracture patterns. A radiological assessment was done at follow-up to assess for complications of malunion, avascular necrosis (AVN), and arthritis. The outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Maryland foot score (MFS). Results Twenty patients were included in the analysis. There were 12 talar neck and eight body fractures, subclassified into simple (10) and complex fracture patterns (10). The surgical approach involved either a medial malleolus osteotomy/via fractured medial malleolus (55%) or a non-osteotomy-based approach (anteromedial (AM)/anterolateral (AL)/combined AM and AL) (45%). The average AOFAS score was 71.34, while the MFS was 74.35. The outcomes were consistently unfavourable for patients with complex fractures with a higher propensity for complications, but no difference was observed when comparing neck and body fractures. There was a 10% incidence of malreduction in the non-osteotomy-based approach group. AVN was found in 35% of cases, and post-traumatic arthritis occurred in 75% of cases during the five-year follow-up period. Conclusion The findings of the present study consistently reiterate the propensity for complex talus fractures to develop complications like AVN and post-traumatic arthritis in the long term. This study serves to help predict talus fractures based on their severity, with poor outcomes noted with more complex fracture types. We also advocate a more extensile medial malleolus osteotomy-based approach to better visualise complex body fractures of the talus and obtain more anatomical reduction.