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1.
Bone Joint J ; 106-B(7): 669-679, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38946307

RESUMO

Aims: In cases of severe periprosthetic joint infection (PJI) of the knee, salvage procedures such as knee arthrodesis (KA) or above-knee amputation (AKA) must be considered. As both treatments result in limitations in quality of life (QoL), we aimed to compare outcomes and factors influencing complication rates, mortality, and mobility. Methods: Patients with PJI of the knee and subsequent KA or AKA between June 2011 and May 2021 were included. Demographic data, comorbidities, and patient history were analyzed. Functional outcomes and QoL were prospectively assessed in both groups with additional treatment-specific scores after AKA. Outcomes, complications, and mortality were evaluated. Results: A total of 98 patients were included, 52 treated with arthrodesis and 47 with AKA. The mean number of revision surgeries between primary arthroplasty and arthrodesis or AKA was 7.85 (SD 5.39). Mean follow-up was 77.7 months (SD 30.9), with a minimum follow-up of two years. Complications requiring further revision surgery occurred in 11.5% of patients after arthrodesis and in 37.0% of AKA patients. Positive intraoperative tissue cultures obtained during AKA was significantly associated with the risk of further surgical revision. Two-year mortality rate of arthrodesis was significantly lower compared to AKA (3.8% vs 28.3%), with age as an independent risk factor in the AKA group. Functional outcomes and QoL were better after arthrodesis compared to AKA. Neuropathic pain was reported by 19 patients after AKA, and only 45.7% of patients were fitted or were intended to be fitted with a prosthesis. One-year infection-free survival after arthrodesis was 88.5%, compared to 78.5% after AKA. Conclusion: Above-knee amputation in PJI results in high complication and mortality rates and poorer functional outcome compared to arthrodesis. Mortality rates after AKA depend on patient age and mobility, with most patients not able to be fitted with a prosthesis. Therefore, arthrodesis should be preferred whenever possible if salvage procedures are indicated.


Assuntos
Amputação Cirúrgica , Artrodese , Infecções Relacionadas à Prótese , Qualidade de Vida , Reoperação , Humanos , Artrodese/métodos , Masculino , Feminino , Idoso , Infecções Relacionadas à Prótese/cirurgia , Reoperação/estatística & dados numéricos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Artroplastia do Joelho/efeitos adversos , Prótese do Joelho/efeitos adversos , Idoso de 80 Anos ou mais , Resultado do Tratamento , Estudos Retrospectivos , Estudos Prospectivos
2.
Medicine (Baltimore) ; 103(27): e38727, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38968510

RESUMO

Ankle pathology, such as severe arthritis, often necessitates surgical intervention to restore mobility and alleviate pain. Two commonly performed procedures for end-stage ankle disease are ankle fusion (AF) and total ankle arthroplasty (TAA). This review aims to compare the impact of AF and TAA on postoperative gait parameters. An extensive search in PubMed, Scopus, and Web of Science electronic databases was conducted with the use of the keywords ("ankle arthrodesis" OR "ankle fusion") AND ("ankle replacement" OR "ankle arthroplasty") AND "gait." Clinical studies in terms of postoperative gait parameters were included in this review. At least one of the following gait parameters, included in gait analysis, should be researched: spatiotemporal variables and joint kinematics and kinetics. An initial search revealed 221 studies. After the removal of duplicates and screening of titles,10 studies (7 prospective and 3 retrospective case series) were included for qualitative analysis. In the majority of studies, there is no significant difference in spatiotemporal parameters, such as walking speed, cadence, stance duration, step length, and stride length among AF and TAA patients. Postoperative sagittal ankle ROM, mainly maximum ankle dorsiflexion angle is significantly higher in TAA patients, while results concerning hip and knee ROM are variable. The comparison of AF and TAA in terms of postoperative gait parameters has shown variable results. In the majority of studies, there is no significant difference in spatiotemporal and kinetic parameters among AF and TAA patients. Further high-quality prospective studies are needed to fully elucidate the comparison of postoperative gait parameters.


Assuntos
Articulação do Tornozelo , Artrodese , Artroplastia de Substituição do Tornozelo , Marcha , Humanos , Artroplastia de Substituição do Tornozelo/métodos , Artrodese/métodos , Marcha/fisiologia , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/fisiopatologia , Amplitude de Movimento Articular , Fenômenos Biomecânicos , Período Pós-Operatório
3.
J Orthop Surg Res ; 19(1): 332, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38831325

RESUMO

INTRODUCTION: Charcot arthropathy is a progressive disorder of the ankle and foot joints that can lead to foot deformity and instability. Surgical intervention is often necessary for deformity and ulcer management during the chronic phase. The device used for arthrodesis remains a challenge. METHODS: This clinical trial study included diabetic patients aged 40 years or older with Charcot foot. Lateral approach with lateral malleolar osteotomy was used to access the ankle joints and remove the cartilage. A small incision was made on the plantar aspect of the foot to pass an appropriately sized intramedullary nail. Demographic information, medical history, surgical details and Clinical data were collected at 2-week and 1-year follow-ups using the Ankle-Hindfoot Scale (AOFAS) score and the EuroQol 5-Dimensional 5-Level (EQ-5D-5L) health utility score. RESULTS: Twenty-six patients with a mean age of 63 ± 0.23 years were included in the study. The findings showed significant improvements in AOFAS questionnaire items related to pain score, length of the walk, walking surfaces, walking disorders, sagittal alignment, back leg alignment, sustainability, alignment and the total score (P value < 0.001). The EQ-5D-5L questionnaire also showed a significant improvement in the total score (P value = 0.002). CONCLUSION: This study provides evidence supporting the effectiveness of tibiotalocalcaneal arthrodesis by hindfoot nailing in diabetic patients with Charcot foot joints and demonstrated comparable and superior outcomes in terms of patient satisfaction and complication rate when compared to previous studies.


Assuntos
Articulação do Tornozelo , Artrodese , Artropatia Neurogênica , Pinos Ortopédicos , Qualidade de Vida , Humanos , Pessoa de Meia-Idade , Artrodese/métodos , Artrodese/instrumentação , Feminino , Masculino , Artropatia Neurogênica/cirurgia , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Idoso , Resultado do Tratamento , Seguimentos , Tíbia/cirurgia , Adulto
4.
BMC Musculoskelet Disord ; 25(1): 453, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38849773

RESUMO

BACKGROUND: Posttraumatic wrist osteoarthritis is an irreversible and often progressive condition. Many surgical treatments, used in (daily) practice, aim to relieve symptoms like pain and restore function. The aim of this systematic review is to assess the patient reported and functional outcomes of the most common surgical interventions in patients with posttraumatic wrist osteoarthritis. This overview can help clinicians select the best treatment and manage patient's expectations. METHODS: A literature search was performed in Pubmed, Embase and Cochrane for articles published between 1990 and November 2022 according to the PRISMA guidelines. The study protocol has been registered in the PROSPERO database (CRD42017080427). Studies that describe patient reported outcomes (pain and Disability of Arm, Shoulder and Hand (DASH) -score) and functional outcomes (range of motion (ROM) and grip strength) after surgical intervention with a minimal follow-up of 1 year were included. The identified surgical procedures included denervation, proximal row carpectomy, interpositional- and total arthroplasty, and midcarpal-, radiocarpal- and total arthrodesis. The pre-and postoperative outcomes were pooled and presented per salvage procedure. RESULTS: Data from 50 studies was included. Pain score improved after all surgeries except denervation. Flexion/extension decreased after radiocarpal arthrodesis, did not show significant changes after proximal row carpectomy, and improved for all other surgeries. DASH score improved after arthroplasty, proximal row carpectomy and midcarpal arthrodesis. Grip strength improved after interposition arthroplasty and partial arthrodesis. CONCLUSION: Evidence from this review did not support the indication for denervation in this particular patient population. In patients with SLAC/SNAC II, proximal row carpectomy might be favourable to a midcarpal arthrodesis solely based on better FE ROM of the radiocarpal joint after proximal row carpectomy. In terms of radiocarpal mobility, total wrist arthroplasty might be preferred to radiocarpal arthrodesis in patients with osteoarthritis after a distal radius fracture. More uniform measurements of outcomes would improve the understanding of the effect of surgical treatments of the posttraumatic osteoarthritic wrist.


Assuntos
Osteoartrite , Medidas de Resultados Relatados pelo Paciente , Amplitude de Movimento Articular , Terapia de Salvação , Articulação do Punho , Humanos , Osteoartrite/cirurgia , Articulação do Punho/cirurgia , Articulação do Punho/fisiopatologia , Terapia de Salvação/métodos , Artrodese/métodos , Força da Mão , Resultado do Tratamento , Traumatismos do Punho/cirurgia , Traumatismos do Punho/fisiopatologia , Recuperação de Função Fisiológica , Denervação/métodos
5.
Medicina (Kaunas) ; 60(6)2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38929461

RESUMO

Background and Objectives: Despite the established role of subtalar joint arthrodesis (SJA) for treatment of subtalar osteoarthritis, achieving bone union remains challenging, with up to 46% non-union rates. Adequate compression and stable fixation are crucial for successful outcomes, with internal screw fixation being the gold standard for SJA. The delta configuration, featuring highly divergent screws, offers stability, however, it can result in hardware irritation in 20-30% of patients. Solutions to solve this complication include cannulated compression screw (CCS) countersinking or cannulated compression headless screw (CCHS) application. The aim of this biomechanical study was to investigate the stability of a delta configuration for SJA utilizing either a combination of a posterior CCHS and an anterior CCS or a standard two-CCS combination. Materials and Methods: Twelve paired human cadaveric lower legs were assigned pairwise to two groups for SJA using either two CCSs (Group 1) or one posterior CCHS and one anterior CCS (Group 2). All specimens were tested under progressively increasing cyclic loading to failure, with monitoring of the talocalcaneal movements via motion tracking. Results: Initial stiffness did not differ significantly between the groups, p = 0.949. Talocalcaneal movements in terms of varus-valgus deformation and internal-external rotation were significantly bigger in Group 1 versus Group 2, p ≤ 0.026. Number of cycles until reaching 5° varus-valgus deformation was significantly higher in Group 2 versus Group 1, p = 0.029. Conclusions: A delta-configuration SJA utilizing a posterior CCHS and an anterior CCS is biomechanically superior versus a standard configuration with two CCSs. Clinically, the use of a posterior CCHS could prevent protrusion of the hardware in the heel, while an anterior CCS could facilitate less surgical time and thus less complication rates.


Assuntos
Artrodese , Parafusos Ósseos , Cadáver , Articulação Talocalcânea , Humanos , Artrodese/métodos , Artrodese/instrumentação , Articulação Talocalcânea/cirurgia , Fenômenos Biomecânicos , Masculino , Feminino , Idoso , Osteoartrite/cirurgia , Pessoa de Meia-Idade
6.
JBJS Case Connect ; 14(2)2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38913810

RESUMO

CASE: A 64-year-old man presented with a 3-year history of right wrist pain and swelling 33 years after a silicone scaphoid arthroplasty for chronic scaphoid nonunion. Radiographs demonstrated a deformed scaphoid implant, carpal and distal radius cysts, and mild carpal collapse. He elected to undergo a wrist arthrodesis with a dorsal fusion plate after failing conservative management. CONCLUSION: Although carpal bone silicone implant arthroplasties of the wrist have long been abandoned, our patient was pain free and fully functional for 3 decades. He was pleased to undergo serial examinations with radiographs for 30 years without any therapeutic intervention.


Assuntos
Osso Escafoide , Silicones , Humanos , Masculino , Pessoa de Meia-Idade , Osso Escafoide/cirurgia , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/lesões , Silicones/efeitos adversos , Artroplastia de Substituição/efeitos adversos , Articulação do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Prótese Articular/efeitos adversos , Artrodese/métodos , Seguimentos
7.
Med Sci Monit ; 30: e944452, 2024 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-38918940

RESUMO

BACKGROUND This retrospective study included 31 patients from 2 centers in Türkiye with posttraumatic ankle osteoarthritis treated with anterior tibiotalar arthrodesis using an anterior plate and cannulated screw fixation, with 6 months of follow-up. MATERIAL AND METHODS In this bi-center study, conducted between January 2018 and July 2022, we retrospectively reviewed the digital records of 31 patients with end-stage posttraumatic ankle osteoarthritis who were treated with anterior tibiotalar arthrodesis surgery using 2 or 3 cannulated screws and the anterior plating technique. Data on age, gender, comorbidities, and smoking were recorded, as were operative technique and graft use. Union characteristics, complications, visual analog scale (VAS) results, and Maryland functional scoring were assessed preoperatively and at the 6-month follow-up visit. RESULTS The mean age of the 31 (n=13 male, n=18 female) patients was 55.5 (19-82) years. The union findings were good in 26 (83.9%) of the patients and late in 3 (9.7%) of them. Nonunion was seen in 2 (6.5%) patients. Complications were observed in 7 (22.6%) patients. Union formation was statistically significantly prolonged among the cases with complications (P=0.002). The smoking rate was significantly higher in patients encountering complications (P=0.001). Among cases with complications, the VAS and Maryland scores recorded in the postoperative sixth month were significantly higher (P=0.027, P=0.018, respectively). The mean union time was 13.5±6.5 weeks among all of the patients. CONCLUSIONS Our study showed that cannulated screw fixation, strengthened with the common and easy-to-supply anterior reconstruction plating technique, had high fixation power and good functional results in patients with end-stage posttraumatic ankle osteoarthritis.


Assuntos
Articulação do Tornozelo , Artrodese , Placas Ósseas , Parafusos Ósseos , Osteoartrite , Humanos , Masculino , Artrodese/métodos , Artrodese/efeitos adversos , Feminino , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Adulto , Idoso , Estudos Retrospectivos , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Idoso de 80 Anos ou mais , Resultado do Tratamento , Adulto Jovem
8.
BMC Musculoskelet Disord ; 25(1): 492, 2024 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-38918769

RESUMO

BACKGROUND: In symptomatic end-stage osteoarthritis of the ankle joint, total ankle replacement and ankle arthrodesis are the two primary surgical options for patients for whom conservative treatment fails. Published revision rates are often biased and difficult to compare. In this study, unplanned reoperation rates and revision rates were determined for both surgical interventions based on a large dataset, and risk factors for unplanned reoperations were identified. METHODS: German-wide health data of the largest German health-care insurance carrier between 2001 and 2012 were retrospectively analyzed, and unplanned reoperation rates within 10 years were determined for index surgeries conducted in 2001 and 2002. Unplanned reoperation rates within 5 years for index surgeries conducted in 2001/2002 were compared to index surgeries conducted in 2006/2007. Multivariate logistic regression was used to identify risk factors for unplanned reoperations. RESULTS: After ankle arthrodesis, 19% (95% confidence interval [CI], 16-22%) of 741 patients needed to undergo an unplanned reoperation within ten years. After total ankle replacement, the unplanned reoperation rate was 38% [95% CI, 29-48%] among 172 patients. For initial surgeries conducted at a later date, unplanned reoperation rates within five years were 21% [95% CI, 19-24%] for 1,168 ankle arthrodesis patients and 23% [95% CI, 19-28%] for 561 total ankle replacement patients. Significant risk factors for unplanned reoperations after ankle arthrodesis in the initial cohort were age < 50 years (odds ratio [OR] = 4.65 [95% CI 1.10;19.56]) and osteoporosis (OR = 3.72 [95% CI, 1.06;13.11]); after total ankle replacement, they were osteoporosis (OR = 2.96 [95% CI, 1.65;5.31]), Patient Clinical Complexity Level (PCCL) grade 3 (OR = 2.19 [95% CI, 1.19;4.03]), PCCL grade 4 (OR = 2.51 [95% CI, 1.22;5.17]) and diabetes mellitus (OR = 2.48 [95% CI, 1.33;4.66]). Kaplan-Meier analyses including 1,525 ankle arthrodesis patients and 644 total ankle replacement patients revealed an average unplanned reoperation-free time of approximately 17 years for both procedures. CONCLUSIONS: Similar revision rates and unplanned reoperation rates for both procedures in the later-date cohort can likely be attributed to a learning curve for surgeons as well as advances in implant design. This analysis of billing health insurance data supports an increase in total ankle replacement surgeries.


Assuntos
Articulação do Tornozelo , Artrodese , Artroplastia de Substituição do Tornozelo , Osteoartrite , Reoperação , Humanos , Artrodese/estatística & dados numéricos , Artroplastia de Substituição do Tornozelo/estatística & dados numéricos , Osteoartrite/cirurgia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Articulação do Tornozelo/cirurgia , Reoperação/estatística & dados numéricos , Idoso , Alemanha/epidemiologia , Resultado do Tratamento , Fatores de Risco , Adulto
9.
Clin Orthop Surg ; 16(3): 448-454, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38827751

RESUMO

Background: Altering wrist biomechanics, Kienbock's disease leads to progressive carpal collapse that results in early arthritis and degenerative changes. By shifting the loading axis toward the radioscaphoid joint, scaphocapitate arthrodesis (SCA) has been reported as a salvage procedure effective in treating symptomatic patients with advanced Kienbock's disease. In this study, we aimed to evaluate the clinical and radiological outcomes of arthroscopic SCA in symptomatic patients with advanced stages of Kienbock's disease. Methods: Between March 2010 and February 2021, we included 15 patients with symptomatic stage IIIA (n=2) and stage IIIB (n=13) Kienbock's disease who were followed up for a minimum of 24 months after arthroscopic SCA with or without lunate excision. The lunate was excised in 6 patients and retained in 9. Visual analog scale (VAS) pain score, grip strength, range of motion (ROM), active flexion-extension arc, and modified Mayo wrist score (MMWS) were measured preoperatively and at each follow-up examination after surgery. Operation-related complications and radiographic changes were also assessed. Results: There were 13 women and 2 men, with a mean age of 57.6 years (range, 21-74 years) at the time of undergoing arthroscopic SCA. Follow-up ranged from 24 to 116 months, with an average of 56.9 ± 32.3 months. Bony union was achieved in all patients. At preoperative examination, wrist ROM (67%) and grip strength (48%) significantly decreased, compared to the contralateral wrist. At the final follow-up, there were significant improvements in VAS, grip strength, and MMWS, whereas the active wrist ROM showed no significant change. Radioscaphoid angle recovered after surgery, while radiographic carpal collapse and ulnar translation of the carpus occurred. In subgroup analysis according to excision of the lunate, there were no significant differences in VAS, MMWS, grip strength, or total ROM. However, increased ulnar translation and decreased radial deviation were noted in the lunate excision group. Conclusions: Arthroscopic SCA achieved significant improvements in pain and wrist function in patients with advanced Kienbock's disease without any complications. Excision of the lunate when performing arthroscopic SCA seemed to induce progressive carpal ulnar translation, with no apparent clinical benefits over retaining it.


Assuntos
Artrodese , Artroscopia , Osteonecrose , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Artrodese/métodos , Adulto , Artroscopia/métodos , Osteonecrose/cirurgia , Osteonecrose/diagnóstico por imagem , Idoso , Adulto Jovem , Força da Mão , Amplitude de Movimento Articular , Osso Escafoide/cirurgia , Osso Escafoide/diagnóstico por imagem , Medição da Dor , Radiografia , Capitato/cirurgia , Capitato/diagnóstico por imagem , Estudos Retrospectivos , Articulação do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia
10.
Clin Orthop Surg ; 16(3): 477-484, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38827769

RESUMO

Background: To compare radiographic union and clinical outcomes between parallel and angulated screw configurations (SCs) for patients undergoing subtalar arthrodesis due to posttraumatic subtalar arthritis (PSA) after displaced intra-articular calcaneal fractures. Methods: This study retrospectively reviewed 140 consecutive PSA cases from March 2011 to November 2021 (parallel SC: group 1, n = 80; angulated SC: group 2, n = 60). Radiographic union, Foot and Ankle Outcome Score (FAOS), and visual analog scale (VAS) scores were among the outcome assessments. Six months after surgery, nonunion was confirmed based on plain radiographs, clinical evaluation, and computed tomography. Results: Groups 1 and 2 included 14 (17.5%) and 3 (5.0%) nonunion cases, respectively (p = 0.035). There was no significant difference in preoperative FAOS and VAS scores between the groups. However, group 2 had significantly better clinical outcomes in 2 of the 5 FAOS domains (sports and quality of life), as well as VAS scores at 3 and 6 months postoperatively and at the final follow-up (p < 0.05). Conclusions: Using the angulated SC for PSA had a lower nonunion rate and superior clinical outcomes than the parallel SC. Obtaining better radiological and clinical outcomes when using the angulated SC, rather than the parallel SC, would be advantageous.


Assuntos
Artrite , Artrodese , Parafusos Ósseos , Articulação Talocalcânea , Humanos , Artrodese/métodos , Artrodese/instrumentação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Feminino , Articulação Talocalcânea/cirurgia , Adulto , Artrite/cirurgia , Artrite/etiologia , Idoso , Calcâneo/cirurgia , Calcâneo/lesões
11.
J Orthop Surg (Hong Kong) ; 32(2): 10225536241264623, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38881517

RESUMO

PURPOSE: End-stage ankle arthrosis causes severe pain and limited movement. Tibiotalocalcaneal arthrodesis with arthroscopy-assisted hindfoot nailing can be used to achieve a high union rate and low complication rate. We aimed to examine the early- and mid-term results of patients treated with this technique from various perspectives and to evaluate them by comparing them with the current literature. METHODS: Data were collected from 25 patients who met the established criteria and underwent TTCA with arthroscopic-assisted hindfoot nailing. In addition to the demographic data of the patients, their clinical and pain scores were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS). Additionally, the union time and complication data during the follow-up period were examined. RESULTS: When the AOFAS and VAS scores of the 25 patients were examined, a significant improvement was observed in the preoperative period and early postoperative period comparisons (p < .001). No significant change was observed between the comparison of the postoperative 12th month and last postoperative control clinical scores. While the union rate of the patients was observed to be 92%, the average union time was 13.1 ± 3.5 weeks. During follow-up, peri-implant fracture, deep infection, and non-union were observed in one patient each (12%). CONCLUSION: The early- and mid-term postoperative results of patients treated with TTCA surgery with posterior approach arthroscopic-assisted hindfoot nailing show that this technique may be an option with low complication and high union rates for the appropriate group of patients planned for ankle arthrodesis.


Assuntos
Articulação do Tornozelo , Artrodese , Artroscopia , Pinos Ortopédicos , Humanos , Artrodese/métodos , Artrodese/instrumentação , Masculino , Feminino , Pessoa de Meia-Idade , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Artroscopia/métodos , Idoso , Adulto , Estudos Retrospectivos , Osteoartrite/cirurgia
13.
Hand Surg Rehabil ; 43(3): 101713, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38701948

RESUMO

A case of a rapidly progressing giant cell tumor of the middle phalanx is presented. The patient underwent en bloc resection with iliac crest grafting and distal interphalangeal fusion. Surgical technique and patient's functional outcomes are described.


Assuntos
Neoplasias Ósseas , Transplante Ósseo , Falanges dos Dedos da Mão , Tumor de Células Gigantes do Osso , Ílio , Humanos , Ílio/transplante , Tumor de Células Gigantes do Osso/cirurgia , Neoplasias Ósseas/cirurgia , Falanges dos Dedos da Mão/cirurgia , Transplante Ósseo/métodos , Masculino , Artrodese , Adulto , Feminino
15.
Foot Ankle Int ; 45(6): 567-573, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38712752

RESUMO

BACKGROUND: Prior literature has demonstrated that ipsilateral hindfoot arthrodesis may increase the risk for reoperation after total ankle arthroplasty (TAA) and that simultaneous hindfoot arthrodesis with TAA could result in short-term clinical and radiologic improvements. The purpose of this study is to compare the reoperation rates after TAA with prior hindfoot arthrodesis vs simultaneous arthrodesis and TAA. METHODS: Patients who underwent primary TAA were identified in the PearlDiver database. Patients were sorted into 2 study cohorts: hindfoot arthrodesis prior to TAA and simultaneous arthrodesis and TAA. Propensity matched control cohorts were identified for each study group. Multivariate analysis was conducted to account for any confounding variables and covariates when identifying differences in complications between cohorts. RESULTS: 297 patients underwent TAA with prior hindfoot arthrodesis and 174 underwent TAA and hindfoot arthrodesis concurrently. The incidence of reoperation (13.8% vs 5.2%, P < .001) and infection (12.6% vs 5.9%, P = .011) for the simultaneous cohort was higher when compared to the matched control cohort. In contrast, there was no statistically significant difference when comparing the prior arthrodesis cohort to the matched control cohort in reoperation rates (5.1% vs 4.7%, P = .787) or infection rates (4.4% vs 4.8%, P = .734). Those undergoing simultaneous procedures had increased incidences of reoperation, wound complications, infection, and emergency department visits (P < .0167) when compared to the TAA with prior arthrodesis cohort. CONCLUSION: Patients undergoing TAA and hindfoot arthrodesis concurrently were found to have higher rates of reoperation and infection when compared to the matched control cohort . In contrast, there was no difference in these rates in patients undergoing TAA with prior hindfoot arthrodesis compared with their matched control cohort. Patients undergoing simultaneous procedures had increased rates of reoperations, wound complications, infection, and emergency department visits compared to the TAA with prior arthrodesis cohort.


Assuntos
Artrodese , Artroplastia de Substituição do Tornozelo , Reoperação , Artrodese/métodos , Reoperação/estatística & dados numéricos , Humanos , Artroplastia de Substituição do Tornozelo/efeitos adversos , Pessoa de Meia-Idade , Masculino , Feminino , Idoso , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo
16.
Clin Podiatr Med Surg ; 41(3): 407-423, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38789161

RESUMO

Lisfranc injuries were thought to primarily occur during high-energy events, leading to a preference for fusion treatment; however, recent data have shifted this perspective by highlighting a greater occurrence of low-energy injuries and reshaping the focus on open reduction internal fixation. This multifaceted process is guided by various factors, including the nature of the injury, specific anatomic considerations, and the involved joints. Our overarching goal remains to achieve anatomic reduction, with flexibility in hardware fixation methods. In cases of comminution, bridge plating may be warranted, potentially followed by arthrodesis in the future.


Assuntos
Traumatismos do Pé , Fixação Interna de Fraturas , Humanos , Masculino , Artrodese/métodos , Placas Ósseas , Traumatismos do Pé/cirurgia , Traumatismos do Pé/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Ossos do Metatarso/lesões , Ossos do Metatarso/cirurgia , Redução Aberta/métodos
17.
Acta Ortop Mex ; 38(2): 123-128, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-38782480

RESUMO

INTRODUCTION: pain in the pubic symphysis, even if studied in athletes, still sets out diagnostic and therapeutic challenges in other patient groups. Within this context, refractory osteorthritis of the pubic symphysis presents itself as an issue lacking clear therapeutic consensus. MATERIAL AND METHODS: two women over 65 years old and presenting osteoarthritis of the pubic symphysis were evaluated. Following unsuccessful conventional therapies, arthrodesis via subpubic plate, wire suture and autologous graft from the iliac crest was performed. RESULTS: after a one-year of following, both patients experienced clinical and radiographic improvement. Bone arthrodesis was achieved without significant complications, proving to be a viable surgical option. CONCLUSION: this study supports the medium and long-term efficacy of arthrodesis of the pubic symphysis in refractory cases of osteoarthrisis. Therefore, the technique can be considered a surgical option in the management of said condition.


INTRODUCCIÓN: el dolor en la sínfisis púbica, aunque estudiado en atletas, plantea desafíos diagnósticos y terapéuticos en otros grupos. En este contexto, la artrosis refractaria de la sínfisis púbica se presenta como un problema sin consenso terapéutico claro. MATERIAL Y MÉTODOS: se evaluaron dos mujeres mayores de 65 años con artrosis de la sínfisis púbica. Tras terapias convencionales infructuosas, se optó por la artrodesis mediante placa suprapúbica, sutura alámbrica e injerto óseo autólogo de la rama íleo-púbica. RESULTADOS: después de un año de seguimiento, ambas pacientes experimentaron mejoría clínica y radiográfica. La artrodesis se consolidó sin complicaciones evidentes, proporcionando una opción quirúrgica viable. CONCLUSIÓN: este estudio respalda la eficacia a medio y largo plazo de la artrodesis de la sínfisis púbica en casos refractarios de artrosis. La técnica utilizada puede considerarse como una opción quirúrgica eficaz en el manejo de esta condición.


Assuntos
Artrodese , Osteíte , Sínfise Pubiana , Humanos , Artrodese/métodos , Feminino , Osteíte/cirurgia , Osteíte/etiologia , Sínfise Pubiana/cirurgia , Idoso , Osteoartrite/cirurgia
19.
J Plast Surg Hand Surg ; 59: 77-82, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38769788

RESUMO

BACKGROUND: Four-corner arthrodesis with scaphoid excision (FCA) and proximal row carpal resection (PRC) are frequently performed in wrists with post-traumatic Scaphoid Non- Union Advanced Collapse (SNAC)/Scapho-Lunate Advanced Collapse (SLAC) osteoarthritis. The aim of this study was to compare the clinical outcomes of these two procedures. METHODS: This single-center, retrospective cohort study included all patients who had PRC or FCA between January 1st, 2009 and January 1st, 2019 and who were followed up. Follow-up included: mobility (radial deviation, ulnar deviation, flexion, extension), strength (grip test, pinch test), function (QuickDash, patient-rated wrist evaluation [PRWE]), subjective mobility, and global satisfaction scores. RESULTS: Among 25 patients included, 11 had PRC and 14 had FCA with a mean follow-up of 69.5 months [12-132]. Radial deviation was 18° versus 14° (p = 0.7), ulnar deviation was 21° versus 22° (p = 0.15), flexion was 39° versus 30° (p = 0.32), extension was 32.5° versus 29.5° (p = 0.09), grip test compared to the controlateral side was 72% versus 62% (p = 0.53), Quick Dash score was 12.5 versus 17.6 (p = 0.84), PRWE was 18.7 versus 17.6 (p = 0.38), subjective mobility was 7.8 versus 7.5 (p = 0.23), and satisfaction score was 8.7 versus 9 (p = 0.76), respectively, in the FCA group and the PRC group. Re-operation rates were 14% patients in the FCA group and 0% in the PRC group. CONCLUSION: This study found no significant difference between FCA and PRC on strength, mobility, and function in patients with post-traumatic SLAC or SNAC stage II wrist arthritis. Both FCA and PRC seem to be reliable surgical techniques with good outcomes with more revision in the FCA group.


Assuntos
Artrodese , Ossos do Carpo , Osteoartrite , Osso Escafoide , Humanos , Artrodese/métodos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Ossos do Carpo/cirurgia , Adulto , Osteoartrite/cirurgia , Osso Escafoide/cirurgia , Força da Mão , Articulação do Punho/cirurgia , Amplitude de Movimento Articular , Satisfação do Paciente , Idoso , Estudos de Coortes
20.
PLoS One ; 19(5): e0302898, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38753715

RESUMO

Trapeziometacarpal osteoarthritis (TMC-OA) reduces the range of motion (ROM) of the thumb. However, the kinematic change achieved through surgical treatment remains unclear. Therefore, to quantify the kinematic change following TMC-OA surgery, we performed a three-dimensional motion analysis of the thumb using an optical motion capture system preoperatively and 1 year postoperatively in 23 patients with TMC-OA scheduled for arthrodesis (AD) or trapeziectomy with suspensionplasty (TS). Eighteen hands of nine healthy volunteers were also included as controls. Both procedures improved postoperative pain and Disability of the Arm, Shoulder and Hand scores, and AD increased pinch strength. The ROM of the base of the thumb was preserved in AD, which was thought to be due to the appearance of compensatory movements of adjacent joints even if the ROM of the TMC joint was lost. TS did not improve ROM. Quantifying thumb kinematic changes following TMC-OA surgery can improve our understanding of TMC-OA treatment and help select surgical procedures and postoperative assessment.


Assuntos
Artrodese , Osteoartrite , Amplitude de Movimento Articular , Polegar , Trapézio , Humanos , Osteoartrite/cirurgia , Osteoartrite/fisiopatologia , Feminino , Polegar/cirurgia , Polegar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Artrodese/métodos , Idoso , Trapézio/cirurgia , Trapézio/fisiopatologia , Fenômenos Biomecânicos , Articulações Carpometacarpais/cirurgia , Articulações Carpometacarpais/fisiopatologia , Movimento , Adulto , Período Pós-Operatório
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