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Clinical outcome for total ankle replacement in patients younger than 50 years
Abstracts / Foot and Ankle Surgery 23(S1) (2017) 1–28
tured with acoustic sensors, strain gages, force/moment readings, and 3D bony kinematics. Post-test necropsies were performed to determine injury patterns. Results: Complete disruption of the proximal attachment of the superficial deltoid (tibionavicular, tibiospring, tibiocalcaneal ligaments) was observed in 15 of 17 specimens (9/9 neutral, 3/4 DF, 3/4 PF). Deep deltoid injuries were more variable, with complete rupture observed in seven specimens, partial rupture in five and no injury in five. Conclusion: Regardless of sagittal ankle position, complete avulsion of the superficial deltoid ligament from the medial malleolus was a consistent finding in a cadaveric study simulating external rotation injuries of the ankle. http://dx.doi.org/10.1016/j.fas.2017.07.1120 77 IFFAS S14 07 Clinical outcome for total ankle replacement in patients younger than 50 years D. Spuehler ∗ , L. Zwicky, C. Schweizer, B. Hintermann Kantonsspital Baselland, Switzerland Introduction: Total ankle replacement (TAR) has been shown to be an effective treatment in reducing pain and maintaining function in end-stage ankle osteoarthritis. Younger patients have high demands and expectations towards functionality of TAR. The purpose of this study was to compare the clinical outcome between patients aged <50 and those aged ≥50 years. Methods: A consecutive series of 813 primary TARs (3rd generation HINTEGRA, 446 male, 367 female) performed between May 2003 and December 2013 were divided into two groups: patients <50 and ≥50 years at the time of implantation. Clinical outcome (AOFAS hindfoot score, pain on VAS, ROM) was documented before implantation and at the last follow-up. Results: At time of implantation, 129 patients (15.9%) were <50 years and had a lower preoperative AOFAS hindfoot score (39 vs. 44, p = 0.010) and more pain (6.7 vs. 6.1, p = 0.002). At the last followup younger patients had lower AOFAS scores (66 vs. 71, p = 0.003) and more pain (2.6 vs. 1.9, p < 0.001). The ROM increased in the younger group by 3◦ on average (p = 0.034). In total, 79% were satisfied or very satisfied with the result. In the younger group, the rate of dissatisfied patients was higher (14.3% vs 6.5%, p = 0.011). Conclusion: The improvement in the clinical outcome is the same in both groups. It seems to be justified to consider TAR in patients <50 years, especially when considering the potential benefit of preserving overall foot function at long-term, thus preserving physiological load on the peritalar joints. http://dx.doi.org/10.1016/j.fas.2017.07.1121
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78 IFFAS S14 08 Medializing calcaneal osteotomy (MCO) for acquired adult flatfoot E. Samaila ∗ , S. Negri, R. Valentini, B. Magnan University of Verona, Italy Introduction: Adult acquired flatfoot deformity shows typical clinical manifestations such as pain and deformity, depending on the stage of the disease. In adult patients affected of hyperpronated painful feet and insufficiency of tibialis posterior (Johnson and Strom classification-stage 1–2) the treatment is surgical and the gold standard is the medializing calcaneal osteotomy (MCO) with the aim to modify the anatomy and biomechanics of foot and ankle in the early stages 1,2. The postoperative complications are infrequent and less disabling than those that occur in arthrodesis. The purpose of this study was to evaluate the clinical outcomes of MCO stabilized with different hardware in painful adult flatfoot. Purpose of this study was to evaluate the clinical outcomes of MCO stabilized with different hardware in painful adult flatfoot. Methods: Between September 2001 and February 2012, 40 procedures of MCO were performed in 34 patients (6 bilateral). The hardware used for the synthesis were: compression screws in 26 patients, K-wires in 6 patients and plates in 7 patients. AOFAS score for hindfoot and SEFAS were used for the clinical assessment. Results: The mean follow-up was 66.1 months. Comparing before and final follow-up, growth rates of AOFAS and SEFAS scores are 145% and 93%, with an improving of the scores from 34.9 ± 22.7 to 85.8 ± 20.4 and from 21.1 ± 10.6 to 40.8 ± 8.7. Complications observed were sural paresthesia in 3 patient treated by plates and 2 patients by screws, one lymphoedema treated by plate, wound discomfort in one patient treated with K-wire. All patients recovered at follow-up. http://dx.doi.org/10.1016/j.fas.2017.07.1122 79 IFFAS S14 09 Percentage of articular surface debridement is equivalent in arthroscopic and open ankle fusions M. Anderson ∗ , A. MacDonald, A.S. Flemister, S. Soin, J. Ketz University of Rochester, United States Background: Tibiotalar arthrodesis is a reliable option in the treatment of ankle arthritis with open and arthroscopic techniques described. Studies have demonstrated advantages of arthroscopic arthrodesis and achieved equivalent or increased rates of fusion. It is unclear why arthroscopic fusion may be favorable to open surgery, however, it is hypothesized that patient selection and soft tissue trauma may play a role. Aims: To evaluate the amount of articular cartilage denuded via open and arthroscopic arthrodesis techniques with time of procedure evaluated as a secondary measure. Methods: Six sets of fresh frozen cadaver lower extremities were studied. One limb from each set was assigned to open debridement while the other limb was assigned to arthroscopic debridement. Each procedure was timed. Following debridement the ankles were disarticulated and residual cartilage was mapped. Student t-tests were used to compare the results.
tured with acoustic sensors, strain gages, force/moment readings, and 3D bony kinematics. Post-test necropsies were performed to determine injury patterns. Results: Complete disruption of the proximal attachment of the superficial deltoid (tibionavicular, tibiospring, tibiocalcaneal ligaments) was observed in 15 of 17 specimens (9/9 neutral, 3/4 DF, 3/4 PF). Deep deltoid injuries were more variable, with complete rupture observed in seven specimens, partial rupture in five and no injury in five. Conclusion: Regardless of sagittal ankle position, complete avulsion of the superficial deltoid ligament from the medial malleolus was a consistent finding in a cadaveric study simulating external rotation injuries of the ankle. http://dx.doi.org/10.1016/j.fas.2017.07.1120 77 IFFAS S14 07 Clinical outcome for total ankle replacement in patients younger than 50 years D. Spuehler ∗ , L. Zwicky, C. Schweizer, B. Hintermann Kantonsspital Baselland, Switzerland Introduction: Total ankle replacement (TAR) has been shown to be an effective treatment in reducing pain and maintaining function in end-stage ankle osteoarthritis. Younger patients have high demands and expectations towards functionality of TAR. The purpose of this study was to compare the clinical outcome between patients aged <50 and those aged ≥50 years. Methods: A consecutive series of 813 primary TARs (3rd generation HINTEGRA, 446 male, 367 female) performed between May 2003 and December 2013 were divided into two groups: patients <50 and ≥50 years at the time of implantation. Clinical outcome (AOFAS hindfoot score, pain on VAS, ROM) was documented before implantation and at the last follow-up. Results: At time of implantation, 129 patients (15.9%) were <50 years and had a lower preoperative AOFAS hindfoot score (39 vs. 44, p = 0.010) and more pain (6.7 vs. 6.1, p = 0.002). At the last followup younger patients had lower AOFAS scores (66 vs. 71, p = 0.003) and more pain (2.6 vs. 1.9, p < 0.001). The ROM increased in the younger group by 3◦ on average (p = 0.034). In total, 79% were satisfied or very satisfied with the result. In the younger group, the rate of dissatisfied patients was higher (14.3% vs 6.5%, p = 0.011). Conclusion: The improvement in the clinical outcome is the same in both groups. It seems to be justified to consider TAR in patients <50 years, especially when considering the potential benefit of preserving overall foot function at long-term, thus preserving physiological load on the peritalar joints. http://dx.doi.org/10.1016/j.fas.2017.07.1121
27
78 IFFAS S14 08 Medializing calcaneal osteotomy (MCO) for acquired adult flatfoot E. Samaila ∗ , S. Negri, R. Valentini, B. Magnan University of Verona, Italy Introduction: Adult acquired flatfoot deformity shows typical clinical manifestations such as pain and deformity, depending on the stage of the disease. In adult patients affected of hyperpronated painful feet and insufficiency of tibialis posterior (Johnson and Strom classification-stage 1–2) the treatment is surgical and the gold standard is the medializing calcaneal osteotomy (MCO) with the aim to modify the anatomy and biomechanics of foot and ankle in the early stages 1,2. The postoperative complications are infrequent and less disabling than those that occur in arthrodesis. The purpose of this study was to evaluate the clinical outcomes of MCO stabilized with different hardware in painful adult flatfoot. Purpose of this study was to evaluate the clinical outcomes of MCO stabilized with different hardware in painful adult flatfoot. Methods: Between September 2001 and February 2012, 40 procedures of MCO were performed in 34 patients (6 bilateral). The hardware used for the synthesis were: compression screws in 26 patients, K-wires in 6 patients and plates in 7 patients. AOFAS score for hindfoot and SEFAS were used for the clinical assessment. Results: The mean follow-up was 66.1 months. Comparing before and final follow-up, growth rates of AOFAS and SEFAS scores are 145% and 93%, with an improving of the scores from 34.9 ± 22.7 to 85.8 ± 20.4 and from 21.1 ± 10.6 to 40.8 ± 8.7. Complications observed were sural paresthesia in 3 patient treated by plates and 2 patients by screws, one lymphoedema treated by plate, wound discomfort in one patient treated with K-wire. All patients recovered at follow-up. http://dx.doi.org/10.1016/j.fas.2017.07.1122 79 IFFAS S14 09 Percentage of articular surface debridement is equivalent in arthroscopic and open ankle fusions M. Anderson ∗ , A. MacDonald, A.S. Flemister, S. Soin, J. Ketz University of Rochester, United States Background: Tibiotalar arthrodesis is a reliable option in the treatment of ankle arthritis with open and arthroscopic techniques described. Studies have demonstrated advantages of arthroscopic arthrodesis and achieved equivalent or increased rates of fusion. It is unclear why arthroscopic fusion may be favorable to open surgery, however, it is hypothesized that patient selection and soft tissue trauma may play a role. Aims: To evaluate the amount of articular cartilage denuded via open and arthroscopic arthrodesis techniques with time of procedure evaluated as a secondary measure. Methods: Six sets of fresh frozen cadaver lower extremities were studied. One limb from each set was assigned to open debridement while the other limb was assigned to arthroscopic debridement. Each procedure was timed. Following debridement the ankles were disarticulated and residual cartilage was mapped. Student t-tests were used to compare the results.