The minimal important change is not a universal fixed value across diagnoses when using the FAOS and FAAM in patients undergoing elective foot and ankle surgery.

PURPOSE: This study aimed to calculate region and diagnosis-specific minimal important changes (MICs) of the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) in patients requiring foot and ankle surgery and to assess their variability across different foot and ankle diagnoses. METHODS: The study used routinely collected data from patients undergoing elective foot and ankle surgery. Patients had been invited to complete the FAOS and FAAM preoperatively and at 3-6 months after surgery, along with two anchor questions encompassing change in pain and daily function. Patients were categorised according to region of pathology and subsequent diagnoses. MICs were calculated using predictive modelling (MICPRED) and receiver operating characteristic curve (MICROC) method and evaluated according to strict credibility criteria. RESULTS: Substantial variability of the MICs between forefoot and ankle/hindfoot region was observed, as well as among specific foot and ankle diagnoses, with MICPRED and MICROC values ranging from 7.8 to 25.5 points and 9.4 to 27.8, respectively. Despite differences between MICROC and MICPRED estimates, both calculation methods exhibited largely consistent patterns of variation across subgroups, with forefoot conditions systematically showing smaller MICs than ankle/hindfoot conditions. Most MICs demonstrated high credibility; however, the majority of the MICs for the FAOS symptoms subscale and forefoot conditions exhibited insufficient or low credibility. CONCLUSION: The MICs of the FAOS and FAAM vary across foot and ankle diagnoses in patients undergoing elective foot and ankle surgery and should not be used as a universal fixed value, but recognised as contextual parameters. This can help clinicians and researchers in more accurate interpretation of the FAOS and FAAM change scores. LEVEL OF EVIDENCE: Level IV.

Analyzing Learning Curve Effects: Total Ankle Replacement Design Switch and Long-Term Survival.

Different aspects of the learning curve in Total Ankle Replacement (TAR) have been studied in the short to mid-term, with 30 cases often considered critical. However, its impact on long-term (10 and 15-year) survival remains unclear. Therefore, we retrospectively analyzed 77 consecutive TARs performed by one orthopedic surgeon. The main outcome was long-term survival between cases 1-30 and 31-77 using the Kaplan-Meier with Competing Risk Analyses. Secondarily, we used Moving Average Method with LOESS regression to confirm the learning curve based on the perioperative complications. Thirdly, associations between perioperative complications and operation time on long-term survival were assessed using Cox proportional hazard models. The 10-year survival of cases 1-30 was 89.9% (95% CI 70.4-96.5), and of 31-77, 92.4% (95% CI 7745- 97.5) (p = 0.58). The 15-year survival was 81.8% (95% CI 59.5-91.8) and 74.8% (95% CI 52.4-86.6), respectively (p = 0.97). The long-term survival rate for the TAR that endured perioperative complication was 96.70% (95% CI 90.28-103.12), and for the uncomplicated TAR 87.50% (95% CI 77.12-97.88%) (p=0.24). Operating time nor occurrence of perioperative fractures were significantly associated with long-term survival (p= 0.11 and 0.26, respectively). However, moving average method revealed a significant decreasing trend with a cut-off value of 33 procedures regarding the marginal probability of perioperative osseous complications (p<0.01). In conclusion, surgeons should note a learning curve when adapting arthroplasty procedures. After the prosthesis design switch, the learning curve regarding perioperative osseous complications was confirmed at 33 TAR. The switch did not affect long-term survival.

Only Low Patients' Expectations Are Prognostic for Dissatisfaction With Performing Work-Related Knee-Straining Activities After Total Knee Arthroplasty: A Prospective Multicenter Cohort Study.

OBJECTIVE: To investigate whether preoperative expectations regarding performing work-related knee-straining activities were associated with being dissatisfied 6 months after total knee arthroplasty (TKA) among working patients, and, to identify prognostic factors for being dissatisfied with performing these work-related knee-straining activities. DESIGN: Multicenter prospective cohort study. SETTING: Orthopedic surgery departments of 7 hospitals in the Netherlands. PARTICIPANTS: A consecutive sample of 175 working patients who were on the waiting list for TKA (median age 59 years, 53% women) and intended to return to work (N=175). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Dissatisfaction with performing work-related knee-straining activities 6 months postoperative was measured using the Work Osteoarthritis or joint-Replacement Questionnaire (score range 0-100). The clinically relevant cut-off points for being satisfied and dissatisfied were ≥71 and ≤50, respectively. RESULTS: Thirty-three patients (19%) were dissatisfied with performing work-related knee-straining activities 6 months after TKA. Patients who expected to be dissatisfied preoperative had a 5.1 times higher odds (95% CI 1.7-15.5) of being dissatisfied 6 months postoperatively compared with patients who expected to be satisfied preoperative. Regression analyses revealed that only patients' expectations were prognostic for being dissatisfied 6 months postoperatively rather than age, pain level, or having a knee-straining job. CONCLUSIONS: Two in 10 working patients are dissatisfied with performing work-related knee-straining activities 6 months after TKA. Only preoperative patients' expectations appeared prognostic. Therefore, we should better prepare working patients with low expectations by managing their preoperative expectations and improving their performance of work-related knee-straining activities in rehabilitation.

Lower revision rates for cemented fixation in a long-term survival analysis of three different LCS designs.

BACKGROUND: In primary Total Knee Arthroplasty (TKA), it is still not clear if cemented or uncemented fixation has the best long-term survival. The Low Contact Stress (LCS) mobile-bearing (MB) knee system was introduced in 1977. The aim of this study is to investigate the long-term survival of this design with a minimum of 15-year follow-up. METHODS: A retrospective analysis was performed, with the primary endpoint for survival defined as revision. Cox regression analysis was performed to assess the association between type of fixation and the risk of revision, while correcting for potential confounders (diagnosis, design, age and sex). RESULTS: 1271 cases were included with inflammatory joint disease (IJD) (657 cases) and non-IJD (614 cases). TKAs were performed cemented in 522 cases and uncemented in 749 cases. A bicruciate retaining design was used in 180 cases, a rotating platform design in 174 cases and an anterior posterior glide posterior cruciate-retaining (PCR) design in 916 cases. Cumulative incidence of component revision at 15 years was 2.7% (95% CI 1.6; 4.5) for cemented and 10% (95% CI 8.1; 12.4) for uncemented TKA, respectively. The 20-year cumulative incidence was 2.9% (95% CI 1.7; 4.7) for cemented and 10.9% (95% CI 8.8; 13.4) for uncemented TKA, respectively. Age, non-IJD and PCR design were associated with a significantly higher risk of revision, regardless of the type of fixation. CONCLUSION: Long-term survival for patients undergoing cemented or uncemented TKA using the LCS MB system revealed lower revision rates for cemented fixation. Revision risk was higher in younger, non-IJD patients who had the PCR design, regardless of the type of fixation. For the LCS MB TKA design, it is recommended to use cemented fixation.

Ten-year revision rates of contemporary total ankle arthroplasties equal 22%. A meta-analysis.

BACKGROUND: The National Institute for Health and Care Excellence criterion for hip replacements is a (projected) revision rate of less than 5% after 10 years. No such criterion is available for ankle prostheses. The objective of the current study is to compare survival rates of contemporary primary ankle prostheses to the hip-benchmark. METHODS: The PRISMA methodology was used. Eligible for inclusion were clinical studies reporting revision rates of currently available primary total ankle prostheses. Data was extracted using preconstructed forms. The total and prosthesis-specific annual revision rate was calculated. RESULTS: Fifty-seven articles of eight different ankle prostheses were included (n = 5371), totaling 513 revisions at an average 4.6 years of follow-up. An annual revision rate of 2.2 was found (i.e. an expected revision rate of 22% at 10 years). CONCLUSIONS: The expected 10-year revision rate of contemporary ankle prostheses is lower than the current benchmark for hip prostheses.

The influence of pain catastrophizing and central sensitization on the reported pain after hip arthroscopy.

PURPOSE: This study was conducted to investigate whether the pain catastrophizing scale (PCS) and the central sensitization inventory (CSI) are predictive factors for the reported pain after hip arthroscopy. METHODS: A total of 37 patients undergoing hip arthroscopy for femoroacetabular impingement syndrome and labral tears were prospectively enrolled. All patients completed the PCS and CSI before hip arthroscopy. Postoperative pain was measured with the numeric rating scale (NRS) weekly the first 12 weeks after surgery by electronic diary. RESULTS: At baseline, univariate analyses showed that both the CSI and PCS were significantly associated with the NRS outcome (p < 0.01). During 12 weeks follow-up, a significant decrease on the NRS was observed (p < 0.01). Univariate analyses showed that both the CSI and PCS were significantly associated with the NRS during follow-up. Multivariate mixed model analysis showed that only the PCS remained significantly associated with the NRS outcome with a ß of 0.07 (95% CI 0.03-0.11, p < 0.01). CONCLUSION: Results indicate that both the PCS and CSI are associated with the reported postoperative pain after hip arthroscopy. The PCS and CSI may be useful in daily practice to identify patients that possibly benefit from pain catastrophizing reduction therapy (e.g. counseling) prior to surgery. LEVEL OF EVIDENCE: IV.

Dynamic trial fitting of the cup in press-fit total hip arthroplasty, a feasibility study.

Trial fitting of the cup during total hip arthroplasty (THA) is done by trial cups, which do not resemble the real press-fit obtained by the definitive implant. Our goal is to judge feasibility of the X-pander® in clinical practice ; a device developed to mimic the real press-fit obtained by the definitive cup, to ensure satisfactory press-fit. In this feasibility study 45 experienced orthopaedic surgeons from 7 European countries filled in a structured survey after 78 primary THA and 31 revision surgeries, using the X-pander instead of traditional trial cups. Primary outcomes were decision change concerning cup size or further reaming and increased confidence regarding cup insertion and size. Additionally, potential association between the primary outcomes and procedure (primary or revi- sion), bone quality and experience of the surgeon were evaluated. In 33.3% of the primary and 32.2% of the revision cases the X-pander measurement changed the deci- sion and further reaming or change of cup size was decided. In 61.5% and 58.1% of respectively the primary and revision THAs the X-pander was judged to give fairly to much more reliable information than traditional trial cups. The X-pander could lead to less additional screw fixation, as stated in 37.2% of the primary and 25.8% of the revision cases and to better cup insertion in respectively 50.0% and 51.6%. This study validates that the X-pander may be a suitable option for accurate sizing and assessment of the reamed acetabulum and could replace traditional trial cups in THA.

Three Out of Ten Working Patients Expect No Clinical Improvement of Their Ability to Perform Work-Related Knee-Demanding Activities After Total Knee Arthroplasty: A Multicenter Study.

Purpose Three out of ten patients do not return to work after total knee arthroplasty (TKA). Patient expectations are suggested to play a key role. What are patients' expectations regarding the ability to perform work-related knee-demanding activities 6 months after TKA compared to their preoperative status? Methods A multi-center cross-sectional study was performed among 292 working patients listed for TKA. The Work Osteoarthritis or joint-Replacement Questionnaire (WORQ, range 0-100, minimal important difference 13) was used to assess the preoperatively experienced and expected ability to perform work-related knee-demanding activities 6 months postoperatively. Differences between the preoperative and expected WORQ scores were tested and the most difficult knee-demanding work-related activities were described. Results Two hundred thirty-six working patients (81%) completed the questionnaire. Patients' expected WORQ score (Median = 75, IQR 60-86) was significantly (p < 0.01) higher than their preoperative WORQ score (Median = 44, IQR 35-56). A clinical improvement in ability to perform work-related knee-demanding activities was expected by 72% of the patients, while 28% of the patients expected no clinical improvement or even worse ability to perform work-related knee-demanding activities 6 months after TKA. Of the patients, 34% expected severe difficulty in kneeling, 30% in crouching and 17% in clambering 6 months after TKA. Conclusions Most patients have high expectations, especially regarding activities involving deep knee flexion. Remarkably, three out of ten patients expect no clinical improvement or even a worse ability to perform work-related knee-demanding activities 6 months postoperatively compared to their preoperative status. Therefore, addressing patients expectations seems useful in order to assure realistic expectations regarding work activities.

Feedback to Patients About Patient-reported Outcomes Does Not Improve Empowerment or Satisfaction.

BACKGROUND: Although patient-reported outcome measures (PROMs) are helpful to define whether an intervention has improved a patient's status in ways the patient feels are important, they may also serve an empowering educational role; specifically, sharing a patient's scores might help the patient understand his or her progress during treatment. However, whether sharing PROM scores in this way improves the sense of empowerment or satisfaction with the process of care has not been well explored. Also, less is known whether specific demographic factors or coping strategies are associated with empowerment. QUESTIONS/PURPOSES: We asked the following: (1) Does giving patients feedback on their PROM scores improve a patient's sense of empowerment or satisfaction? (2) Do demographic factors, duration of disability, or self-efficacy correlate with patient empowerment? METHODS: In this prospective cohort study, we assigned patients with osteoarthritis of the knee or hip sequentially such that the first 70 patients did not receive the intervention and the next 72 did. Patients enrolled in the control cohort were managed according to standard care, whereas patients enrolled in the intervention cohort completed web-based questionnaires measuring their physical function and pain. After filling out the questionnaires, a printout with the scores was given to the patients providing feedback about their physical function and pain. The primary outcome measure was patient empowerment, as measured by the Patient Activation Measure. Secondary outcomes were patient satisfaction, as measured by an 11-point Likert scale and Patient Doctor Relation Questionnaire. Independent variables were demographic factors and coping, measured by the Pain Self-efficacy Questionnaire. Bivariate and multivariable analyses were performed to determine the influence of the feedback. Although no minimum clinically important differences have been defined for the patient empowerment or satisfaction scales, we believe that differences smaller than 10% are unlikely to be clinically important, even if they are statistically significant. RESULTS: Although the group that received PROM feedback had higher scores for empowerment than the group that did not, the effect size was small and likely not to have been clinically important (2.8 ± 0.85 versus 3.1 ± 0.811; mean difference -0.31; 95% confidence interval, 2.8-3.1; p = 0.037). With the numbers available, there were no differences between the group given PROM feedback and the group that did not receive such feedback in terms of satisfaction scores (8.6 ± 1.4 versus 8.8 ± 1.2; mean difference -0.19; p = 0.39). After controlling for demographic factors such as level of education and duration of complaint, we found that the group that received PROM feedback and who had a higher level of self-efficacy had higher scores for empowerment than the group that did not, although the effect size was small. CONCLUSIONS: PROM feedback did not have a clinically important impact on empowerment or satisfaction. This might indicate that counseling based on PROMs during a single visit may be ineffective. The most important positive finding is that more effective coping strategies are associated with greater patient empowerment. LEVEL OF EVIDENCE: Level II, therapeutic study.

A risk assessment model for chronic ankle instability: indications for early surgical treatment? An observational prospective cohort - study protocol.

BACKGROUND: Chronic ankle instability (CAI) is a common result of an ankle sprain. Even though early surgical treatment yields the best results, overall only professional athletes are eligible for acute surgical stabilization. Treating all patients with early surgical stabilization leads to a high amount of unnecessary invasive interventions, as not all patients progress to CAI. If patients at risk of developing CAI can be identified, treatment policies may be applied more effectively and efficiently. The purpose of this study is to develop a risk assessment model to identify patients at risk for CAI that should receive early surgical treatment. METHODS: In this observational prospective cohort, all patients aged sixteen years and older, reporting at the emergency department of one of the participating hospitals after sustaining a lateral ankle sprain, and filled out 1 out of 3 follow-up questionnaires and the 1 year follow-up are included. A lateral and anteroposterior radiograph is made. Patients are excluded if a fracture or other pathology is present. The included patients receive four questionnaires, including questions focusing on the sprain, treatment and complaints, the Foot and Ankle Outcome Score and the Cumberland Ankle Instability Tool. A total of eleven radiographic variables are assessed for inter- and intra-observer reliability. Additionally, four factors extracted from the questionnaires, will be evaluated for correlation with CAI. Significantly correlating factors (e.a. risk factors) will be implemented in a risk assessment model. For the final model, based on sixteen variables with a minimum of 20 events per variable and a prevalence of 30-40% after an initial sprain, a sample size of 2370 patients is needed to perform both internal and external model validation. DISCUSSION: This study will develop the first large scale model for the risk at CAI after an ankle sprain combining radiographic and patient characteristics. With this risk assessment model, patients at risk for CAI may be identified and properly informed on the treatment options. Patients identified as being at risk, may receive more adequate follow-up and become eligible for early surgical stabilization. This prevents patients from experiencing unnecessary long-lasting complaints, increasing the success rate of conservative and surgical treatment. TRIAL REGISTRATION: Retrospectively registered: NCT02955485 [Registration date: 3-11-2016]. NTR6139 [Registration date: 3-1-2017].

Correction to: The ESSKA-AFAS international consensus statement on peroneal tendon pathologies.

Unfortunately, the spelling of the names Daniel Haverkamp and Ákos Kynsburg were incorrect in the original online publication of the article.

Validity and reliability of a Dutch version of the Foot and Ankle Ability Measure.

PURPOSE: The aim of the study was to develop a Dutch language version of the Foot and Ankle Ability Measure (FAAM) and evaluate its measurement properties according to the consensus-based standards for the selection of health measurement instruments (COSMIN) definitions. METHODS: A forward-backward translation procedure was performed and subsequently the Dutch version of the FAAM was evaluated for its reliability and validity in 369 patients with a variety of foot and ankle complaints. The reliability was assessed by calculating the intraclass correlation coefficients (ICC, test-retest reliability), Cronbach's alpha (internal consistency), the standard error of measurement and the minimal detectable change (MDC). Additionally, this was done for athletes. The construct validity was assessed by the use of Spearman's correlation coefficient between FAAM domains and similar and contradictory domains of the Foot and Ankle Outcome Score, Short Form 36 and the Numeric Rating Scale for pain. RESULTS: The ICC of the subscales ranged from 0.62 to 0.86. Cronbach's alpha's minimum was 0.97. At individual level, the MDC ranged from 23.9 to 44.7 and at group level from 2.77 to 4.32. In the subgroup of athletes, the reliability was higher. The hypothesized correlations of the construct validity were supported by an 80% confirmation rate. CONCLUSION: The Dutch version of the FAAM met adequate measurement properties, although the reliability is not optimal. The FAAM-Sport subscale is more useful in athletes and the FAAM-Sport % seems not to contribute. In athletes with various foot and ankle symptoms, the FAAM can be used for functional assessment and follow-up at group level. For the general population, the FAAM is less appropriate. LEVEL OF EVIDENCE: Diagnostic study, Level I.

Posterior Ankle Impingement in Two Athletic Twin Brothers, Could Genetics Play a Role?

Pain posteriorly in the ankle can be caused by bony impingement of the posterolateral process of the talus. This process impinges between the tibia and calcaneus during deep forced plantar flexion. If this occurs it is called posterior ankle impingement syndrome. We report the case of 2 athletic monozygotic twin brothers with bony impingement posteriorly in the left ankle. Treatment consisted of ankle arthroscopy in both patients during which the symptomatic process was easily removed. At 3 months after surgery, both patients were completely free of pain, and 1 of the brothers had already returned to sports. The posterior ankle impingement syndrome is not a rare syndrome, but it has not been described in siblings thus far. That these 2 patients are monozygotic twin brothers suggests that genetics could play a role in the development of skeletal deformities that can result in posterior ankle impingement syndrome.

Total ankle replacement for posttraumatic arthritis. Similar outcome in postfracture and instability arthritis: a comparison of 90 ankles.

BACKGROUND AND PURPOSE: Most studies on total ankle replacement (TAR) have used a case mix of patients. We evaluated the outcome of TAR performed for end-stage arthritis either because of fracture or ligamentous injury. PATIENTS AND METHODS: We prospectively followed 88 consecutive patients (50 postfracture ankles and 40 ankles with instability arthritis (2 bilateral)) who underwent TAR between 2001 and 2009. Mean follow-up for both groups was 5 years. RESULTS: Preoperative varus deformity of 10° or more was present in 23 ankles in the instability group. At 6 years, survival with revision or salvage fusion as an endpoint was 87% (95% CI: 74-99) in the postfracture group and 79% (95% CI: 63-94) in the instability group. Progressive periprosthetic osteolysis was seen in 23 ankles, and required salvage fusion in 6. The number of reoperations was similar in both groups. Clinical outcome, as assessed with 2 ankle scores and 2 questionnaires, showed good results and was similar at the latest follow-up. INTERPRETATION: The outcome was similar in the postfracture and instability groups and also similar to that reported in series including a case mix of patients. In contrast to earlier reports, preoperative frontal plane deformity in this series was not identified as a risk factor for failure.

Etiopathogenesis of osteolytic cysts associated with total ankle arthroplasty, a histological study.

BACKGROUND: Osteolytic cyst formation after total ankle arthroplasty has been identified in recent years and is probably an important problem with longer follow-up. The aim of this study is to describe the outcome of a histological analysis of samples from periprosthetic intra-osseous cysts and joint capsules, retrieved during revision surgery after primary total ankle arthroplasty. METHODS: All samples (n=22) were analyzed and scored using a semi-quantitative grading system. The main items of interest were polyethylene (PE) particles, metal particles, histiocytes, and giant cells. RESULTS: All cyst samples contained PE particles. A similar number of PE particles were found in talar and tibial cysts. No significant correlation between the number of PE particles and time to reoperation was found. Metal particles were found in 16 cysts. CONCLUSIONS: We suggest that PE particles are not the primary cause of osteolytic cyst formation but a secondary contributing factor probably accelerating the process of osteolysis. It is likely that implant design, biomechanical factors and local anatomic-physiological factors play an important role.

No difference in anterior knee pain between a fixed and a mobile posterior stabilized total knee arthroplasty after 7.9 years.

PURPOSE: The presence of anterior knee pain remains one of the major complaints following total knee arthroplasty (TKA). Since the introduction of the mobile TKA, many studies have been performed and only a few show a slight advantage for the mobile. In our short-term follow-up study, we found less anterior knee pain in the posterior stabilized mobile knees compared to the posterior stabilized knees. The concept of self-alignment and the results from our short-term study led us to form the hypothesis that the posterior stabilized mobile knee leads to a lower incidence of anterior knee pain compared to the posterior stabilized fixed knee. This study was designed to see whether this difference remains after 7.9 years in the follow-up. A secondary line of enquiry was to see whether one was superior to the other regarding pain, function, quality of life and survival. METHODS: This current report is a 6-10-year (median 7.9 years) follow-up study of the remaining 69 patients with a cemented three-component TKA for osteoarthritis in a prospective, randomized, double-blinded clinical trial. RESULTS: In the posterior stabilized group, five of the 40 knees (13%) versus five of the 29 posterior stabilized mobile group (17%) experienced anterior knee pain. No differences were observed with regard to ROM, VAS, Oxford 12-item knee questionnaire, SF-36, HSS patella, Kujala or the AKSS score. Patients with anterior knee pain reported more pain, lower levels of the AKSS, HSS patella and the Kujala scores than the patients without anterior knee pain. CONCLUSION: In the current clinical practice, the appearance of anterior knee pain persists as a problem; simply changing to a mobile bearing does not seem to be the solution. The posterior stabilized mobile total knee did not sustain the advantage of less anterior knee pain, compared with the posterior stabilized fixed total knee arthroplasty. LEVEL OF EVIDENCE: Therapeutic study, Level II.

Revision rate after short-stem total hip arthroplasty: a systematic review of 49 studies.

BACKGROUND AND PURPOSE: The aim of short-stem total hip arthroplasty is to preserve proximal bone stock for future revisions, to improve biomechanical reconstruction, and to make minimally invasive approaches easier. It is therefore being increasingly considered to be a sound alternative to conventional total hip arthroplasty, especially for young and active patients. However, it is still unknown whether survival rates of short-stem hips match current standards. We made a systematic summary of reported overall survival after short-stem total hip arthroplasty. MATERIALS AND METHODS: We conducted a systematic review of English, French, German, and Dutch literature. 2 assessors independently identified clinical studies on short-stem hip arthroplasty. After recalculating reported revision rates, we determined whether each implant had a projected revision rate of 10% or less at 10 years of follow-up or a revision rate per 100 observed component years of 1 or less. Stems were classified as "collum", "partial collum", or "trochanter-sparing". RESULTS AND INTERPRETATION: We found 49 studies, or 51 cohorts, involving 19 different stems. There was a large increase in recent publications. The majority of studies included had a follow-up of less than 5 years. We found a large number of observational studies on "partial collum" and "trochanter-sparing" stems, demonstrating adequate survival rates at medium-term follow-up. Clinical evidence from "collum stem" studies was limited to a small number of studies with a medium-term follow-up period. These studies did not show a satisfactory overall survival rate.

Outcomes of Total Ankle Replacement with Preoperative Varus Deformity.

Historically, coronal plane deformities of greater than 10° to 15° have been deemed contraindications for total ankle replacement (TAR). However, recent studies show satisfactory results in TAR with severe preoperative varus deformity. When correctly applying ancillary procedures, preoperative varus deformity can be structurally corrected, resulting in similar clinical scores to those obtained with "regular TAR." However, complications and revisions appear to increase with increasing deformity. Unfortunately, results of TAR in varus ankles consist of heterogeneous data (eg, with regards to prosthetic brands, bearing-types, duration of follow-up, and ancillary procedures) precluding strict conclusions. This could be solved by an international consensus group.

Mid-term survival of the Optimys short stem: A prospective case series of 500 patients.

BACKGROUND: In recent years, there has been an increase in the number of total hip arthroplasty procedures in the younger patient population. This active group has higher expectations of their prosthesis in comparison to the older population, and there is a greater physical demand for the prosthesis. Short femoral stems were introduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population. Currently, the long-term survival and functional outcomes of various short stems are still being investigated in different clinics. AIM: To determine the 5-year survival of the Optimys hip stem. METHODS: This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands. All patients received the Optimys short stem (Mathys Ltd, Bettlach, Switzerland). The primary outcome measure was survival of the hip stem, with revision as the endpoint. The secondary outcome measurements included patient-reported outcome measures (PROMs). Kaplan-Meier analysis was used to calculate the 5-year survival rate. Log-minus-log transformation was performed to calculate the 95% confidence interval (95%CI). Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery. Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs. RESULTS: The mean age of the total 500 patients was 62.3 years (standard deviation: 10.6) and 202 were male (40%). At a median follow-up of 5.5 years (interquartile range: 4.5-6.7), 7 patients were deceased and 6 revisions were registered, for infection (n = 3), subsidence (n = 2) and malposition (n = 1). This resulted in an overall 5-year survival of 98.8% (95%CI: 97.3-99.5). If infection was left out as reason for revision, a stem survival of 99.4% (95%CI: 98.1-99.8) was seen. Baseline questionnaires were completed by 471 patients (94%), 317 patients (63%) completed the 1-year follow-up questionnaires and 233 patients (47%) completed the 2-year follow-up. Both outcome measures significantly improved across all domains in the 1st year after the operation (P < 0.03 for all domains). In the 2nd year after surgery, no significant changes were observed in any domain in comparison to the 1-year follow-up. CONCLUSION: The Optimys stem has a 5-year survival of 98.8%. Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.

Timing of arthroplasty, what is the influence of nocturnal pain and pain at rest on the outcome?

PURPOSE: The purpose of this study was to investigate whether nocturnal pain and pain at rest preoperatively influence the satisfaction in patients after joint arthroplasty. The second research question is whether subjective outcome (VAS/WOMAC) after hip (THA) or knee arthroplasty (TKA) differs in patients with or without nocturnal pain and pain at rest preoperatively compared to those who do not. METHODS: A consecutive group of 189 TKAs and 189 THAs was evaluated. The influence of pain at rest and nocturnal pain preoperatively on the outcome was evaluated by means of a one-way ANOVA. Outcome measurements used were WOMAC, VAS pain and VAS Satisfaction. RESULTS: The results show that satisfaction at follow up was not influenced by the presence of nocturnal pain or pain at rest preoperatively. The presence of nocturnal pain and pain at rest preoperatively did result in a poorer WOMAC pain score WOMAC physical impairment score and a higher VAS pain at rest and activity after surgery for both THA and TKA. CONCLUSION: The results show that the presence of pain at night and pain at rest in symptomatic osteoarthritic patients results in worse VAS and WOMAC scores, but with similar amounts of satisfaction at follow up.