Survival and complications of transfibular trabecular metal total ankle replacement - A systematic review.

BACKGROUND: In the past decade, the transfibular approach to Total Ankle Replacement (TAR) has emerged as an alternative to anterior approach with reduced bone resection. The purpose of this systematic review is to report survival, complications, and reoperation rates of transfibular TAR. METHODS: We conducted a systematic search of studies that evaluated complications, reoperations, and survival of transfibular TAR following PRISMA guidelines across PubMed, Scopus and Web of Science. RESULTS: Our review included data from 12 cohorts, comprising 919 patients across 7 countries, with an average age of 62 years (59% posttraumatic). Over an average follow-up period of 3 years, adverse events occurred in 23% of cases, with 18% requiring surgical reintervention, mostly due to hardware removal. The survival rate of the transfibular TAR metal components was 97% at the final follow-up. CONCLUSION: Transfibular TAR demonstrates a 97% survival rate at a 3-year follow-up. LEVEL OF EVIDENCE: Level II.

Comparison of postoperative costs of two surgical techniques for hallux valgus (Kramer vs. scarf).

BACKGROUND: Most studies of hallux valgus surgery focus on the radiological findings or on medium-term clinical follow-up. The results obtained using various osteotomy techniques do not differ greatly. However, patient comfort and the need for postoperative care do appear to present differences. In the Kramer technique, the osteotomy is secured with a wire extruding from the skin of the foot. In this situation, patients may well experience problems (or at least discomfort) in the immediate postoperative period. Previous studies of the Kramer technique (also known as SERI, or percutaneous distal metatarsal osteotomy) do not report an increased number of complications. Early complications may not influence the outcome in the medium to long term, and patient discomfort during the postoperative period is rarely reflected in the analysis of one-year results obtained with standard scales such as AOFAS; in our experience, however, patient discomfort, the care burden (i.e., the number of visits and emergency service consultations) and the economic cost of immediate postoperative care are all aspects that should be borne in mind when assessing the merits of different surgical techniques. In this study we compare the care burden and economic cost of two surgical approaches to hallux valgus correction--the Kramer and the scarf techniques--during the first postoperative year. METHODS: Retrospective review of two independent patient cohorts. Sixty-nine feet underwent Kramer osteotomy and 133 the scarf technique. Care burden was assessed by the number of visits each patient required and the complications. The follow-up and costs of each were assessed and compared independently. RESULTS: Both techniques obtain satisfactory clinical results at one year. However, comparison of clinical progression showed AOFAS score increases of 34.7 points for Kramer and 41.1 points for the scarf technique (p-value<0.05). Patients in the Kramer group required a higher number of visits, especially postoperative emergency department visits (p<0.05), and had a significantly higher number of complications (27.5% vs. 6.7%, p<0.05). The mean cost of follow-up was significantly higher in the Kramer group (€ 218.97 vs. € 171.41, p<0.05). CONCLUSIONS: Kramer osteotomy presented significantly higher care burdens, complication rates and associated costs during the first year of follow-up. It is therefore a less cost-effective technique. Thus, even though according to the results of AOFAS we would not have changed our clinical practice, the analysis of these data has made us change our treatment strategy for hallux valgus and practically abandoned the use of the Kramer osteotomies.

Is there a role for subtalar arthroereisis in the management of adult acquired flatfoot?

Subtalar arthroereisis, often combined with Achilles tendon lengthening, is a simple and effective way to treat flexible flatfoot in adults. The most common complication is pain in sinus tarsi, which usually disappears after removal of the implant. Midterm results are good and it does not hinder other treatments in the future.

Subtalar arthroereisis in pediatric flatfoot reconstruction.

Pediatric and juvenile flatfoot is a common problem in childhood, present in one in nine children. The morphologic characteristics of this condition are heel valgus and flattening of the medial longitudinal arch. Other characteristics are usually observed, such as supination and abduction of the forefoot, tightening of the Achilles tendon, and hypertonia of the peroneal muscles. Most children with flatfoot will undergo spontaneous correction or become asymptomatic; those that are symptomatic require treatment. Subtalar arthroereisis, often combined with Achilles tendon lengthening, is a simple and effective way to treat flexible flatfoot in children. Mid- and long-term results are good, and the procedure does not prevent future treatments.

Uremic tumoral calcinosis of the foot mimicking infection.

Uremic tumoral calcinosis is an uncommon, benign condition characterized by slow-growing calcified periarticular soft tissue masses of varying size. We describe two patients with chronic renal failure on hemodialysis presenting uremic tumoral calcinosis, one in the fifth toe of the right foot and the other in the dorsum of the left foot between the first and second metatarsals. Excision of the calcic masses and parathyroidectomy were successfully performed in both patients. These cases are unusual in their rapid onset, mimicking acute infection. Differential diagnosis, radiological features and therapy are discussed.