Preference-based quality of life of end-stage ankle arthritis treated with arthroplasty or arthrodesis.

BACKGROUND: Health state values, or "utilities,'' are an important preference-based measure of quality of life used by health economists. This study describes the utilities reported by a multicenter cohort of subjects with end-stage ankle arthritis treated with ankle arthrodesis or total ankle arthroplasty. MATERIALS AND METHODS: Subjects with end-stage ankle arthritis were enrolled in a multicenter prospective cohort study. All subjects received either ankle arthrodesis or total ankle arthroplasty. Participants completed baseline SF-36 outcome evaluations preoperatively and at 1-year followup. Preference-based quality of life was assessed using health state values (HSVs) derived from the SF-36 (SF-6D transformation). RESULTS: 107 subjects were included. The mean baseline SF-6D health state value for the TAA group was 0.67 (95% CI 0.64 to 0.69) and 0.66 (95% CI 0.63 to 0.68) for the arthrodesis group. At 1-year followup, the mean reported health state value was 0.73 (95% CI 0.71 to 0.76) for the total ankle arthroplasty group and 0.73 (95% CI 0.70 to 0.76) for the ankle arthrodesis group. The 1-year followup results approach age- and gender-matched US population norms. Health state values poorly correlated with age, however, significant differences between genders were detected. CONCLUSION: These data demonstrate an improvement in preference-based quality of life following ankle arthroplasty or arthrodesis. The results also provide necessary data that can be used in future cost-effectiveness analyses.

Etiology and biomechanics of ankle arthritis.

Of all joints in the body, the ankle joint is subjected to the highest forces per square centimeter and is injured more commonly. Yet, the incidence of symptomatic ankle arthritis is much lower than that of the knee and hip. Various mechanical, biochemical and anatomic peculiarities of the ankle account for its apparent resilience to the process of aging and trauma. The goal of this article is to help the reader better understand the functional paradoxes that make the ankle joint a unique and fascinating articulation.

Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis.

BACKGROUND: The functional outcomes following ankle arthrodesis are not known. The purpose of the present study was to compare the intermediate-term clinical results for a group of patients in whom an ankle arthrodesis had been performed with use of modern surgical techniques with the findings for a group of healthy gender and age-matched controls on the basis of validated outcome measures and gait analysis. METHODS: Twenty-six patients who had undergone ankle arthrodesis for the treatment of isolated unilateral ankle arthritis were identified and retrospectively assessed clinically and radiographically. The mean age at the time of surgery was fifty-four years, and the mean interval between surgery and assessment was forty-four months. A gender and age-matched control group of twenty-seven individuals was recruited for comparison. All subjects were evaluated with gait analysis, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, the Musculoskeletal Outcomes Data Evaluation and Management Systems (MODEMS) questionnaire, and the Ankle Osteoarthritis Scale (AOS). RESULTS: On preliminary review, twenty of the twenty-six patients were completely satisfied or satisfied with their surgical outcome. All patients but one stated that they would undergo the surgery again. Five patients stated that they did not notice a gait abnormality. Twelve patients wore orthotics, and all believed that the use of the orthotics improved their gait. When the functional outcome scores in the arthrodesis group were compared with those in the control group, specific scores assessing hindfoot pain and satisfaction were similar. However, scores focusing on ankle-hindfoot function and disability revealed significant differences. Gait analysis also identified significant differences between the two groups with regard to cadence and stride length. In addition, there was significantly decreased sagittal, coronal, and transverse range of motion of the hindfoot and midfoot during the stance and swing phases of gait in the arthrodesis group. Radiographic review demonstrated that four of the twenty-six patients had development of moderate to severe arthritis of the subtalar joint. CONCLUSIONS: In the intermediate term following an arthrodesis for the treatment of end-stage ankle arthritis, pain is reliably relieved and there is good patient satisfaction. However, there are substantial differences between patients and the normal population with regard to hindfoot function and gait. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function; however, it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of ipsilateral hindfoot arthritis.

Supramalleolar tibial osteotomy secured with the Puddu plate.

Clinical indications for distal tibial osteotomies are rare and information on fixation techniques is limited. This article reviews a retrospective study of 4 patients who underwent 5 distal tibial open-wedge osteotomies stabilized with a Puddu plate. All osteotomies healed within 3 months with no incidence of malunion, nonunion, or fixation failure and all deformities were adequately corrected. The Puddu plate (Arthrex Inc, Naples, Fla) provides secure fixation for open-wedge distal tibial osteotomies with accurate and reproducible results.

Ankle arthroplasty and ankle arthrodesis: gait analysis compared with normal controls.

BACKGROUND: This study compared patients with isolated end-stage ankle osteoarthritis, after undergoing either total ankle arthroplasty or arthrodesis, using gait analysis and patient-reported outcome measures to elucidate differences between the two treatment options, as compared with a healthy control group. METHODS: Gait analyses were performed on patients with isolated ankle arthritis more than one year after undergoing either total ankle arthroplasty or arthrodesis during a ten-year period. Validated outcome questionnaire data were obtained. Seventeen patients undergoing total ankle arthroplasty, seventeen patients undergoing arthrodesis, and ten matched control subjects were included for comparison. RESULTS: Patients who had undergone arthroplasty, when compared with patients who had undergone arthrodesis, demonstrated greater postoperative total sagittal plane motion (18.1° versus 13.7°; p < 0.05), dorsiflexion (11.9° versus 6.8°; p < 0.05), and range of tibial tilt (23.1° versus 19.1°; p < 0.05). Plantar flexion motion was not equivalent to normal in either group. Ankle moments and power in both treatment groups remained significantly lower compared with the control group (p < 0.05 between each treatment group and the control group for both variables). Gait patterns in both treatment groups were not completely normalized. Improvements in patient-reported Ankle Osteoarthritis Scale and Short Form-36 scores were similar for both treatment groups. CONCLUSIONS: The gait patterns of patients following three-component, mobile-bearing total ankle arthroplasty more closely resembled normal gait when compared with the gait patterns of patients following arthrodesis. Dorsal motion in the sagittal plane was primarily responsible for the differences. Improvement in self-reported clinical outcome scores was similar for both groups. Further investigation is needed to determine why patients who have undergone total ankle arthroplasty do not use the plantar flexion motion in the terminal-stance phase and to explain the limited increase in power generation at toe-off after arthroplasty. Results obtained from this study may be used for future modifications of ankle prostheses and may add to clinicians' ability to inform patients of predicted functional outcomes prior to the treatment of end-stage ankle osteoarthritis.

Comparison of a novel distillation method versus a traditional distillation method in a model gin system using liquid/liquid extraction.

This research studied a novel form of distillation (high vacuum distillation) as a method for preserving volatile aroma chemicals important to the organoleptic attributes of a four botanical model gin as well as the degradation products generated during the heating required in traditional methods of gin distillation. A 2 (5) factorial experiment was conducted in a partially confounded incomplete block design and analyzed using the PROC MIXED procedure from SAS. A model gin was made of dried juniper berries (Juniperus communis), coriander seed (Coriandrum sativum), angelica root (Angelica archangelica), and dry lemon peel (Citrus limonum). This was distilled on a traditional still utilizing atmospheric pressure and a heating mantel to initiate phase separation as well as a novel still (high vacuum) utilizing high vacuum pressures below 0.1 mmHg and temperatures below -15 degrees C to initiate phase separation. The degradation products (alpha-pinene, alpha-phellandrene, E-caryophyllene, and beta-myrcene) were present at greater levels (approximately 10 times) in the traditional still-made gin as compared to the novel gin.

Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis.

BACKGROUND: End-stage ankle arthrosis is one of the leading causes of chronic disability in North America. Information on this condition is limited. The amount of pain and the reduction in health-related quality of life and function have not been quantified with use of universal outcome measures. The purpose of the present study was to compare the extent of pain, loss of function, and health-related quality of life in two cohorts of patients waiting for the surgical treatment of end-stage ankle or hip arthrosis. METHODS: One hundred and thirty patients with end-stage ankle arthrosis who were awaiting total ankle arthroplasty or ankle arthrodesis were recruited through a Canadian Orthopaedic Foot and Ankle Society multicenter study. All patients prospectively completed the Short Form-36 (SF-36) generic outcome instrument. This cohort was compared with a similar cohort of 130 patients with end-stage hip arthrosis, randomly selected from an existing prospective joint replacement database, who had completed an SF-36 questionnaire prospectively from 2000 to 2005. RESULTS: In both groups, the scores for all SF-36 subscales were approximately two standard deviations below normal population scores. Patients with ankle arthrosis had significantly worse mental component summary scores (p < 0.05), role-physical scores (p < 0.05), and general health scores (p < 0.05). Patients with hip arthrosis reported significantly lower physical function scores (p < 0.05), although the SF-36 physical component summary score was not significantly different between the two groups. The SF-36 physical component summary, bodily pain, vitality, role-emotional, social functioning, and mental health subscale scores were equally affected in both cohorts. CONCLUSIONS: The mental and physical disability associated with end-stage ankle arthrosis is at least as severe as that associated with end-stage hip arthrosis.

Rheumatoid forefoot deformity: a comparison study of 2 functional methods of reconstruction.

OBJECTIVE: To compare the functional, radiographic, and pedobarographic results of different reconstructive methods for severe rheumatoid forefoot deformities. METHODS: A total of 138 feet in 79 patients with RA forefoot reconstructions between 1978 and 1997 were reviewed through a detailed questionnaire, clinical examination, standardized radiographs, and pedobarographic analysis. Five subgroups based on procedure to the 1st ray were identified, then divided into 2 functional categories: Group 1: stable 1st ray by means of arthrodesis or no surgery; and Group 2: a resection procedure to 1st metatarsophalangeal (MTP) joint. RESULTS: Sixty-one patients (106 feet) attended clinical review; 18 returned the questionnaire. There were 65 women and 14 men, with a mean age of 59 years (range 24-80): with 52 feet in Group 1 and 86 feet in Group 2. Mean age at surgery for both groups was 52 years (range 23-79). Mean age at the time of review was 55 years (Group 1) and 60.5 years (Group 2). Length of followup was significantly different: Group 1 averaged 36 months; Group 2, 102 months (p < 0.001). At review, no significant difference was noted in SF-36, comorbidities, WOMAC, or Foot Function Index. The disability score as defined by the American Rheumatological Society was significantly different: Group 1, 2.1 +/- 0.5; and Group 2, 2.4 +/- 0.6 (p = 0.006). Group 1 did significantly better in terms of walking distance, satisfaction with postoperative appearance of foot, relief of plantar pain, less plantar calluses, and higher AOFAS HMIP and LMIP scores. Postoperative complications occurred in 16 feet (11%); 15 feet required reoperation (10.6%). Major resection of the 1st MTP joint was associated with a significant increase in the 1st and 2nd intermetatarsal angle on radiographic review. The pattern of pressure distribution on the plantar aspect was similar regardless of the surgical procedure. The maximum contact area, maximum peak pressure, and maximum pressure time integral were located under the region of the 1st metatarsal, with a progressive decrease in values under the more lateral rays and under the lesser toes. Significantly higher pressures were seen under the 1st, 2nd, and 3rd metatarsal regions in Group 2 (1st MTP joint resection). Toe function was absent or minimal in the majority of Group 2. CONCLUSION: Forefoot arthroplasty by means of a resection or stabilization provides significant pain relief. Maintenance of a stable 1st MTP joint and resection of the lesser metatarsal heads with K-wire stabilization will result in a more cosmetic forefoot, more even distribution of forefoot pressures, and more satisfied patients.