Ankle fusion after failed ankle replacement in rheumatic and non-rheumatic patients.

BACKGROUND: With longer follow-up, survival rate of total ankle replacements (TAR) diminishes. It is therefore important to have a reliable fall-back option in case of failed TAR. Revision arthroplasty is often impossible because of loss of bonestock or infection. Conversion to ankle fusion is then indicated. We investigated the clinical, radiographic and patient reported results for fusion after failed TAR in a consecutive group of patients. We concentrated on the influence of inflammatory joint disease (IJD) on union rate. METHODS: Patient files and radiographic images of 46 consecutive patients (47 ankles) were reviewed. There were 22 patients with IJD. Fixation methods included; anterior plating, blade plate fixation, intramedullary nailing, compression screws and external fixation. Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM) were used to determine patient related outcomes. RESULTS: Forty out of 47 ankles (85%) Fused. Union rate in the non-IJD group (96%) was significantly higher compared to the IJD-group (73%, p=0.04). Revisions and complications were more frequent in the IJD group, but numbers were too small to detect a significant difference. Mean PROM scores were: FAOS-symptoms; 68.5, FAOS-pain; 70.3, FAOS-QoL; 43.7, FAOS-ADL; 68.1 and FAAM-ADL; 52.1, with no significant difference between IJD and non-IJD patients. CONCLUSIONS: IJD-patients have a higher nonunion rate after ankle fusion for failed TAR. However, patient reported outcome is not significantly different between the two groups. LEVEL OF EVIDENCE: IV, retrospective cohort.

C-reactive protein kinetics and its predictive value in orthopedic (trauma) surgery: A systematic review.

In Orthopedic Trauma Surgery (OTS), C-reactive- protein (CRP) is a widely used marker for the diagnosis of postoperative wound infections (POWI's) and other complications. The aim of this systematic review was to describe specific CRP kinetics and to evaluate the diagnostic value of CRP for te detection of post-operative complications in OTS. The same pattern is reported consistently, where the highest levels of CRP are found at post-operative-day two or three, returning to normal in three weeks. Amplitude varies per procedure. Persistently high CRP levels or secondary increases may indicate complications. A low CRP may be used to rule out complications.

Protection by dietary proteins against the effects of bile acids on rat jejunum and stomach.

Because bile acids bind to certain proteins we examined whether the effect of dihydroxy bile acids on jejunal water transport and gastric mucosal function could be blocked by the presence of protein. In the rat jejunum 2.5% bovine serum albumin blocked the secretion of water and electrolytes induced by 2 mM deoxycholate, whereas 5% ovalbumin, which does not bind bile acids, had no effect. Bovine serum albumin protected large unilamellar liposomes from damage by taurodeoxycholate and reduced the monomer concentration of taurodeoxycholate, whereas ovalbumin afforded no protection. In equilibrium dialysis studies whey protein and bovine serum albumin reduced the free taurodeoxycholate concentration (150 mM HCl enhanced this effect). In the rat stomach taurodeoxycholate (2.5 or 10 mM) in the presence of 150 mM HCl reduced potential difference and enhanced sodium secretion and hydrogen ion loss. These effects were reduced in the presence of whey protein. We conclude that proteins that bind bile acids have the potential to protect mucosal membranes from the adverse effects of bile acids.