Patient-Reported Outcomes in Total Ankle Arthroplasty: Patient Specific Versus Standard Instrumentation.

BACKGROUND: Total ankle arthroplasty (TAA) can now be performed using patient-specific instrumentation (PSI). Advantages include the ability to preoperatively plan and reduce the number of intraoperative surgical steps. The aim of this study was to compare PSI with standard instrumentation (SI) in a nonrandomized retrospective cohort study with respect to patient-reported outcome measures (PROMs). Secondary aims were to compare complications, reoperations, tourniquet time, fluoroscopy time, and postoperative alignment. METHODS: In all, 159 patients (111 men, 48 women) undergoing a total of 168 Infinity TAA (Stryker, Memphis, TN) using PSI (Prophecy, Stryker, Memphis, TN) or SI between 2014 and 2021 were included with a minimum follow-up of 12 months. The PROMs were obtained preoperatively and at 1 year, and included the Manchester-Oxford Foot Questionnaire (MOXFQ), Ankle Osteoarthritis Scale (AOS), and European Quality of Life 5 Dimension 3 Level (EQ-5D-3L). Coronal plane deformity correction was assessed using the midline tibiotalar angle (MTTA). Demographics, tourniquet time, and intraoperative fluoroscopy times were obtained from the hospital records. RESULTS: There were 61 TAAs in the PSI group and 107 TAAs in the SI group. There was no significant difference in total MOXFQ, AOS, or EQ-5D. There was a significantly reduced tourniquet time (PSI mean: 95.39 minutes, SI mean: 116.87 minutes, P < .001) and radiation exposure (PSI mean: 31 seconds, SI mean: 53 seconds, P < .001). Angular correction was more accurate in the PSI group (PSI mean: 1.29°, SI mean: 2.26°, P = .005). CONCLUSION: This study supports the use of PSI to decrease operative time, reduce intraoperative fluoroscopy, improve accuracy of implantation, and improve postoperative alignment in TAA. There was a significant difference (P = .032) in favor of PSI in the walking/standing domain of the MOXFQ at 12 months but no significant difference in overall PROMs. LEVELS OF EVIDENCE: Level III, Retrospective.

A prediction model for treatment decisions in distal radial physeal injuries: A multicenter retrospective study.

Background: There are no clearly defined guidelines for the management of distal radial physeal injuries. We aimed to identify the risk factors for patients with distal radial physeal trauma for the risk of deformity, physeal closure, and revision procedure and develop a predictive model. Methods: The retrospective study included patients less than 16 years old with displaced distal radial physeal injuries treated between 2011 and 2018 across five centers in the United Kingdom. Deformity was defined as a volar angulation of >11°, dorsal angulation of >15°, a radial inclination of <15° or >23°, or positive ulnar variance. Presence of a bony bar spanning the physis was considered physeal closure. Results: This study comprised of 479 patients. In that, 32 (6.6%) patients had a second procedure. Also, 49 (10.2%) patients had closure of physis, and 28 (6%) patients had deformity at the end of follow-up. The occurrence of deformity had a strong correlation with age (p = 0.04) and immobilization duration (p = 0.003). Receiver operating characteristic analysis showed that age >12.5 years (p = 0.006) and sagittal angulation of >21.7° (p = 0.002) had a higher odd of deformity. Immobilization for <4.5 weeks (p = 0.01) had a higher revision rate. The nomograms showed good calibration, with a sensitivity of 70% and specificity of 75%. Interpretation: The nomograms provide accurate, pragmatic multivariate predictive models. Anatomical reduction is recommended in patients >12.5 years of age with >22° of dorsal angulation with cast immobilization for no less than 4.5 weeks. Any revision procedure should be performed within 11 days from the date of injury to reduce the risk of physeal damage.

Novel bone grafting technique in stand-alone ALIF procedure combining allograft and autograft ('Northumbria Technique')-Fusion rate and functional outcomes in 100 consecutive patients.

INTRODUCTION: Successful ALIF surgery depends upon achieving solid fusion, whilst avoiding significant complications. Herein, we present the 'Northumbria Technique' of combining allograft with autograft in order to achieve solid interbody fusion. MATERIALS AND METHODS: A single-surgeon series of 100 consecutive patients undergoing stand-alone ALIF from 2016 to 2019 was studied. All had percutaneously harvested iliac crest bone graft (ICBG) dowels inserted into blocks of fresh frozen femoral head (FFFH) allograft, which were then inserted into the ALIF cages. Patients had dynamic radiographs at 4 months, CT at 6 months, and patient reported outcome measure scores (PROMS) throughout. RESULTS: One hundred patients (average age 44.8 years) were followed-up for an average of 29.1 months. Ninety-four (94%) patients were assessed as having fused on both CT and radiographs by an independent Radiologist. Three (3%) patients had abolition of movement on radiographs, but either lacked a CT scan or failed to meet Williams criteria for fusion. Two patients failed to attend for any imaging, so were considered not fused, and one patient had no evidence of fusion in either modality. There was a significant improvement in all PROMS. There were no intra-operative complications, and one patient had transient donor-site pain. CONCLUSIONS: The newly described 'Northumbria Technique' utilises the osteoconductive characteristics of the FFFH allograft, as well as the osteoinductive and osteogenic properties of the ICBG autograft. It gives high fusion rates (94-97%) and statistically significant improvements in PROMS, whilst avoiding the complications of harvesting a large amount of autograft and the huge costs of using synthetic agents.