Functional outcomes after ankle arthrodesis in elderly patients.

BACKGROUND: Ankle arthrodesis has been the gold standard operative treatment for ankle arthritis refractory to nonoperative treatment. Although multiple studies have evaluated the outcomes after ankle fusion, none has focused on outcomes in elderly patients. The purpose of this study was to evaluate outcomes of ankle fusion in patients over the age of 70. METHODS: Thirty patients (30 ankles) over the age of 70 who underwent ankle fusion were identified. Average age at the time of surgery was 74.5 years (±3.7). The Foot and Ankle Ability Measure (FAAM) was obtained postoperatively in 22 of the 23 patients still living. Radiographs were followed until union with an average followup of 2.2 years. RESULTS: Union was achieved in 27 of 30 ankles (90%). Postoperative radiographs showed 11 (36.6%) patients had progression of subtalar arthritis. The average postoperative FAAM score was 81.5 (±18.3) with an average followup of 8.5 years (±1.7). Subjectively, when asked to compare present function with their prearthritic state, the average response was 75.1% (±19.6). The average American Orthopaedic Foot and Ankle Society hindfoot score was 73.0 (±11.5). Complications included nonunion, deep infection, and adjacent joint arthritis. CONCLUSIONS: In this clinical cohort, ankle fusion was found to be effective in the treatment of ankle arthritis. Functional outcome was satisfactory and the rate of union was comparable with that previously reported in the literature for younger patients. Although total ankle arthroplasty is becoming increasingly popular, ankle arthrodesis is an effective surgical treatment option in an elderly patient population.

Injury Surveillance and Evaluation of Medical Services Utilized During the 2016 Track and Field Olympic Trials.

BACKGROUND: Injury surveillance systems have been implemented at world championships, yet no previous work has determined the burden of injuries during the United States Track and Field Olympic Trials. Additionally, the type of medical service providers utilized throughout the meet has not been reported, leaving it unclear whether optimal staffing needs are being met. PURPOSE: To describe the incidence of injuries presenting to the medical team at the 2016 US Track and Field Olympic Trials (Eugene, Oregon) by event type and competitor demographics. STUDY DESIGN: Descriptive epidemiology study. METHODS: A retrospective review was performed of all documented injuries and treatments recorded from June 28 through July 10, 2016. Descriptive statistics and the prevalence of newly incurred injuries were calculated for registered athletes and nonathlete (ie, support) staff. The incidence of acute injuries was analyzed for registered athletes, as stratified by athlete sex and event type. RESULTS: A total of 514 individuals were seen during the trials: 89% were athletes and 11% were supporting staff. Physicians treated 71 injuries and 14 illnesses. Of diagnosed injuries, 85% (n = 60) occurred among athletes, with hamstring strains (16.7%, n = 10) being the most prevalent. A mean of 124 medical services (median, 137; interquartile range, 65.5-179.5) were provided each day of the trials. Among medical services, 41.8% were attributed to massage therapists for athletes, while chiropractic services were the most utilized service (47.1%) by the support staff. There was an overall incidence of 59.7 injuries per 1000 registered athletes, with jumpers (109.4 per 1000) and long-distance athletes (90.4 per 1000) being the most commonly seen athletes. CONCLUSION: Throughout the trials, athletes participating in jumping and long-distance events were the most commonly seen by physicians, creating the potential need for an increase in staffing of physicians during meet periods when these events occur. The provided medical services appeared to follow the number of athletes competing during the trials and the need for recovery treatments after competition. Findings from this study should inform future strategy for staffing and policy development at Olympic Trials and other elite-level track and field events in the United States.

Minimal Preoperative Degenerative Arthritis May Not Predict Poor TKA Outcome.

Although most orthopedic surgeons presume that patients with more severe degenerative osteoarthritis are better candidates for total knee arthroplasty (TKA), few data have compared outcomes based on the extent of radiographic osteoarthritis. The authors tested the hypothesis that patients with minimal radiographic osteoarthritis would have worse outcomes compared with a matched cohort with severe osteoarthritis. The authors identified 29 patients (31 knees) with minimal degenerative changes who underwent TKA between 2000 and 2004. The authors identified a matched cohort with severe osteoarthritis. Mean follow-up was 5 years (range, 2-10 years). Preoperative knee scores were 63 and 59 in patients with minimal osteoarthritis and severe osteoarthritis, respectively. Postoperative knee scores were 89 and 93, respectively. Preoperative function scores were 57 and 56 in patients with minimal osteoarthritis and severe osteoarthritis, respectively. Postoperative function scores increased to 79 and 72, respectively. Of 31 patients in the minimal osteoarthritis group, 26 (84%) had mild or no pain at the time of last follow-up, whereas 5 (16%) had moderate or severe pain. In the group with severe osteoarthritis, 25 of 31 patients (81%) had mild or no pain at the time of last follow-up, whereas 6 (19%) had moderate or severe pain. In the group with minimal osteoarthritis, 6 of 31 knees (19%) had a complication. Only 1 of 31 knees (3.1%) in the matched cohort had a complication. Fewer than 1% of patients undergoing TKA at the authors' institution had minimal preoperative radiographic osteoarthritis. These patients had a higher risk of complications, but similar pain relief, function, and overall satisfaction compared with a matched group with severe arthritis.