- Email: [email protected]
Crystal-induced (Gout) arthritis after total ankle arthroplasty – A case report
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
299 Effect of blood flow to metatarsal head in patients with hallux valgus after minimally invasive distal linear metatarsal osteotomy (DLMO) Minokawa ∗ ,
S. I. Yoshimura, K. Kanazawa, T. Hagio, T. Yamamoto Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Japan Background: Distal first metatarsal osteotomy is recommended for surgical treatment of mild to severe hallux valgus (HV) deformities. Minimally invasive distal linear metatarsal osteotomy (DLMO) provides good outcomes without avascular necrosis of the metatarsal head. However, blood flow measurements of the preand post-DLMO metatarsal head in vivo have not been reported. The purpose of this study was to evaluate the in vivo blood flow of the pre- and post-DLMO metatarsal head in patients with HV using laser Doppler flowmetry (LDF). Methods: From April 2015 to October 2016, DLMO was performed on 15 feet with HV in 12 consecutive patients. The patients comprised three men and nine women with a mean age at surgery of 39.3 (range, 21–62) years. Blood flow measurements of the preand post-DLMO first metatarsal head cortical bone in all feet were performed by LDF. Results: The mean pre- and post-DLMO blood flow rate was 1.55 ± 0.64 and 1.52 ± 0.56 ml/min/100 g, respectively (p = 0.97). The mean pre- and post-DLMO systolic blood pressure at the time of the measurements was 90.6 ± 8.41 and 90.7 ± 7.42 mmHg, respectively (p = 0.85). Conclusion: We found that blood flow in the pre- and postDLMO metatarsal head was present in all patients examined, with no significant difference in the blood flow rate before and after DLMO. Based on the present results, it is possible to avoid major complications, especially avascular necrosis of the metatarsal head, because DLMO is minimally invasive and involves less release of the soft tissue.
99
continues to experience effective symptom relief 3 months after surgery. http://dx.doi.org/10.1016/j.fas.2017.07.389
301 Is retrograde drilling really useful for osteochondral lesion of talus with subchondral cyst? K.B. Lee ∗ , D.G. Shim, J.K. Kim Department of Orthopedic Surgery, Chonbuk National University Medical School, Japan
http://dx.doi.org/10.1016/j.fas.2017.07.388
Rationale: Retrograde drilling is a well accepted procedure for osteochondral lesion of the talus and subchondral cyst with intact overlying cartilage. It has good results in most reports. Compared to anterograde drilling, retrograde drilling can protect the integrity of the articular cartilage. The purpose of this study was to evaluate the suitability of using retrograde drilling for osteochondral lesion with subchondral cyst and discuss the mechanism involved in the development of subchondral cyst. Patient concerns: We report a 53-year-old man who had complained left ankle pain that lasted over 6 months which was exacerbated by walking. Diagnoses: We diagnosed it as osteochondral lesion of the talus with subchondral cyst. Interventions: Plain X-ray, computed tomography, and magnetic resonance imaging (MRI) of the ankle. Outcomes: He undertook retrograde drilling without debridement of cartilage. After the surgery, the pain had been subsided for 1-year, although arthritic change had progressed. However, after 5 years of retrograde drilling, he revisited our hospital due to severe ankle pain. Plain X-ray and MRI showed arthritic change of the ankle and multiple cystic formation of talus. Lessons: Retrograde drilling has some problem because this procedure is not theoretically correct when the development of a subchondral cyst in osteochondral lesion of the talus is considered. In addition, retrograde drilling may impair uninjured bone marrow of the talus, resulting in the development of multiple cystic formations.
300
http://dx.doi.org/10.1016/j.fas.2017.07.390
Arthroscopic microfracture for traumatic arthritis of lateral tarsometatarsal joints – A case report
302
K.B.
Lee ∗ ,
D.G. Shim, J.K. Kim
Crystal-induced (Gout) arthritis after total ankle arthroplasty – A case report D.G. Shim ∗ , K.B. Lee, J.K. Kim
Department of Orthopedic Surgery, Chonbuk National University Medical School, Republic of Korea
Department of Orthopedic Surgery, Chonbuk National University Medical School, Japan
Conservative treatment is generally successful in treating early tarsometatarsal (TMT) arthritis. However, if such treatment fails, invasive arthrodesis or arthroplasty may be needed. Arthroscopy is a less invasive alternative and can provide a precise diagnosis of early osteoarthritis or cartilage injury. Furthermore, arthroscopic treatments such as microfracture, chondroplasty, or loose-body removal are expected to delay progression of the osteoarthritis. We describe a fifty-two year old male with early TMT arthritis after calcaneal fracture healing, who underwent a successful arthroscopic microfracture for cartilage defects. Arthroscopic findings show cartilage defects on the 4th and 5th TMT joint. The patient underwent shaving and microfracture. The patient
A 43-year-old man presented with pain in the left ankle. He underwent total ankle arthroplasty 5 years ago. The patient continuously complained about ankle pain for last 2 years but it have gotten worse within last 2 weeks. Physical examination revealed a mild swelling and a range of motion of 0◦ –40◦ , but there are no signs of inflammation such as erythema or local heating sensation. Plain radiographs showed no signs of loosening, but signs of polyethylene wear such as narrowing of medial space was observed. Because we thought that the pain is caused by polyethylene wear and synovitis by wear particle, we performed ankle arthroscopy to evaluate the degree of polyethylene wear and synovitis. However, we found a white-yellowish crystalline deposit within the synovial tissue under arthroscopy. And, there was no sign of polyethylene
100
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
wear. We collected the deposition using an arthroscopic shaver and performed histological analysis during synovectomy. Histological examination showed the reactive bone formation with eosinophilic amorphous materials. Blood investigation showed a within normal limit white cell count of 8.2 × 103 l, an erythrocyte sedimentation rate of 1 mm/h (reference range, 0–9), a C-reactive protein of 0.20 mg/l (reference range, 0–5), and uric acid of 6.4 mg/dl (reference range, 3.0–8.3). The patient felt more comfortable to move 2 weeks after the surgery. To the best of our knowledge it is the first report of crystal-induced arthritis after total ankle arthroplasty. http://dx.doi.org/10.1016/j.fas.2017.07.391
303 Anatomical positions facilitating of anterocentral portal for ankle arthroscopy on ultrasonography S. Chida 1,∗ , H. Kura 2 , T. Kashiwakura 3 , K. Nozaka 4 , Y. Shimada 4 1
Hiraka General Hospital, Japan Hitsujigaoka Hospital, Japan 3 Akita City Hospital, Japan 4 Akita University Graduate School of Medicine, Japan 2
An anterocentral portal for ankle arthroscopy provides a wide and favorable visual field through a single portal, but it may damage nerves and blood vessels, therefor an index to safely prepare a portal is necessary. The relationship between the extensor hallucis longus muscle and dorsalis pedis artery, which are important for portal preparation, was investigated using ultrasound. In 46 feet of healthy adults (male: female = 24:22), the distances between the lateral margins of the extensor hallucis longus muscle tendon and dorsalis pedis artery (A) and between the epidermis and dorsalis pedis artery (B) were measured. Athletic experience and a past medical history of ankle joint trauma were investigated. (A) was 2.2 mm, (B) was 6.0 mm, and no significant difference was noted between the sexes or between the feet with and without ankle joint trauma. The dorsalis pedis artery was unlikely to be damaged when the portal was prepared at a maximum of 5 mm lateral to the lateral margin of the extensor hallucis longus muscle tendon. Since the minimum depth of the dorsalis pedis artery from the epidermis was 4.9 mm, the portal can be safely prepared by incision of only the epidermis and subcutaneous exposure by blunt dissection in portal preparation followed by the atraumatic insertion of an arthroscope. An anterocentral portal may be a useful viewing portal. http://dx.doi.org/10.1016/j.fas.2017.07.392
304 Failure to restore sagittal tibiotalar alignment in total ankle arthroplasty J. Cho 1,∗ , W.C. Lee 2 , Y. Yi 2 , H.J. Choi 3 , C.H. Park 4 , D.I. Chun 5 , T.K. Ahn 6 , J.Y. Kim 7 1
Chuncheon Sacred Heart Hospital, Hallym University, South Korea 2 Seoul Foot and Ankle Center, Dubalo Orthopaedic Institute, Brazil 3 Haeundae Paik Hospital, South Korea 4 Yeung-Nam University Hospital, South Korea 5 Soonchunhyang University Medical Center, South Korea 6 Bundang CHA Hospital, South Korea 7 Armed Forces Daejeon Hospital, South Korea The purpose of this study was to evaluate the change in sagittal tibiotalar alignment aftertotal ankle arthroplasty (TAA) for osteoarthritis and to investigate factors affecting the restoration of alignment. This retrospective study included 119 patients (120 ankles) who underwent three component TAA using the Hintegra prosthesis. A total of 63 ankles had anterior displacement of the talus before surgery (group A), 49 had alignment in the normal range(group B), and eight had posterior displacement of the talus (group C). Ankles in group A were further sub-divided into those in whom normal alignment was restored following TAA(41 ankles) and those with persistent displacement (22 ankles). Radiographic and clinical results were assessed. Pre-operatively, the alignment in group A was significantly more varus than that in group B, and the posterior slope of the tibial plafond was greater (p < 0.01 in both cases). The posterior slope of the tibial component was strongly associated with restoration of alignment: ankles in which the alignment was restored had significantly less posterior slope (p < 0.001). An anteriorly translated talus was restored to a normal position after TAA in most patients. We suggest that surgeons performing TAA using the Hintegra prosthesis should aim to insert the tibial component at close to 90◦ relative to the axis of the tibia, hence reducing posterior soft-tissue tension and allowing restoration of normal tibiotalar alignment following surgery. http://dx.doi.org/10.1016/j.fas.2017.07.393
299 Effect of blood flow to metatarsal head in patients with hallux valgus after minimally invasive distal linear metatarsal osteotomy (DLMO) Minokawa ∗ ,
S. I. Yoshimura, K. Kanazawa, T. Hagio, T. Yamamoto Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Japan Background: Distal first metatarsal osteotomy is recommended for surgical treatment of mild to severe hallux valgus (HV) deformities. Minimally invasive distal linear metatarsal osteotomy (DLMO) provides good outcomes without avascular necrosis of the metatarsal head. However, blood flow measurements of the preand post-DLMO metatarsal head in vivo have not been reported. The purpose of this study was to evaluate the in vivo blood flow of the pre- and post-DLMO metatarsal head in patients with HV using laser Doppler flowmetry (LDF). Methods: From April 2015 to October 2016, DLMO was performed on 15 feet with HV in 12 consecutive patients. The patients comprised three men and nine women with a mean age at surgery of 39.3 (range, 21–62) years. Blood flow measurements of the preand post-DLMO first metatarsal head cortical bone in all feet were performed by LDF. Results: The mean pre- and post-DLMO blood flow rate was 1.55 ± 0.64 and 1.52 ± 0.56 ml/min/100 g, respectively (p = 0.97). The mean pre- and post-DLMO systolic blood pressure at the time of the measurements was 90.6 ± 8.41 and 90.7 ± 7.42 mmHg, respectively (p = 0.85). Conclusion: We found that blood flow in the pre- and postDLMO metatarsal head was present in all patients examined, with no significant difference in the blood flow rate before and after DLMO. Based on the present results, it is possible to avoid major complications, especially avascular necrosis of the metatarsal head, because DLMO is minimally invasive and involves less release of the soft tissue.
99
continues to experience effective symptom relief 3 months after surgery. http://dx.doi.org/10.1016/j.fas.2017.07.389
301 Is retrograde drilling really useful for osteochondral lesion of talus with subchondral cyst? K.B. Lee ∗ , D.G. Shim, J.K. Kim Department of Orthopedic Surgery, Chonbuk National University Medical School, Japan
http://dx.doi.org/10.1016/j.fas.2017.07.388
Rationale: Retrograde drilling is a well accepted procedure for osteochondral lesion of the talus and subchondral cyst with intact overlying cartilage. It has good results in most reports. Compared to anterograde drilling, retrograde drilling can protect the integrity of the articular cartilage. The purpose of this study was to evaluate the suitability of using retrograde drilling for osteochondral lesion with subchondral cyst and discuss the mechanism involved in the development of subchondral cyst. Patient concerns: We report a 53-year-old man who had complained left ankle pain that lasted over 6 months which was exacerbated by walking. Diagnoses: We diagnosed it as osteochondral lesion of the talus with subchondral cyst. Interventions: Plain X-ray, computed tomography, and magnetic resonance imaging (MRI) of the ankle. Outcomes: He undertook retrograde drilling without debridement of cartilage. After the surgery, the pain had been subsided for 1-year, although arthritic change had progressed. However, after 5 years of retrograde drilling, he revisited our hospital due to severe ankle pain. Plain X-ray and MRI showed arthritic change of the ankle and multiple cystic formation of talus. Lessons: Retrograde drilling has some problem because this procedure is not theoretically correct when the development of a subchondral cyst in osteochondral lesion of the talus is considered. In addition, retrograde drilling may impair uninjured bone marrow of the talus, resulting in the development of multiple cystic formations.
300
http://dx.doi.org/10.1016/j.fas.2017.07.390
Arthroscopic microfracture for traumatic arthritis of lateral tarsometatarsal joints – A case report
302
K.B.
Lee ∗ ,
D.G. Shim, J.K. Kim
Crystal-induced (Gout) arthritis after total ankle arthroplasty – A case report D.G. Shim ∗ , K.B. Lee, J.K. Kim
Department of Orthopedic Surgery, Chonbuk National University Medical School, Republic of Korea
Department of Orthopedic Surgery, Chonbuk National University Medical School, Japan
Conservative treatment is generally successful in treating early tarsometatarsal (TMT) arthritis. However, if such treatment fails, invasive arthrodesis or arthroplasty may be needed. Arthroscopy is a less invasive alternative and can provide a precise diagnosis of early osteoarthritis or cartilage injury. Furthermore, arthroscopic treatments such as microfracture, chondroplasty, or loose-body removal are expected to delay progression of the osteoarthritis. We describe a fifty-two year old male with early TMT arthritis after calcaneal fracture healing, who underwent a successful arthroscopic microfracture for cartilage defects. Arthroscopic findings show cartilage defects on the 4th and 5th TMT joint. The patient underwent shaving and microfracture. The patient
A 43-year-old man presented with pain in the left ankle. He underwent total ankle arthroplasty 5 years ago. The patient continuously complained about ankle pain for last 2 years but it have gotten worse within last 2 weeks. Physical examination revealed a mild swelling and a range of motion of 0◦ –40◦ , but there are no signs of inflammation such as erythema or local heating sensation. Plain radiographs showed no signs of loosening, but signs of polyethylene wear such as narrowing of medial space was observed. Because we thought that the pain is caused by polyethylene wear and synovitis by wear particle, we performed ankle arthroscopy to evaluate the degree of polyethylene wear and synovitis. However, we found a white-yellowish crystalline deposit within the synovial tissue under arthroscopy. And, there was no sign of polyethylene
100
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
wear. We collected the deposition using an arthroscopic shaver and performed histological analysis during synovectomy. Histological examination showed the reactive bone formation with eosinophilic amorphous materials. Blood investigation showed a within normal limit white cell count of 8.2 × 103 l, an erythrocyte sedimentation rate of 1 mm/h (reference range, 0–9), a C-reactive protein of 0.20 mg/l (reference range, 0–5), and uric acid of 6.4 mg/dl (reference range, 3.0–8.3). The patient felt more comfortable to move 2 weeks after the surgery. To the best of our knowledge it is the first report of crystal-induced arthritis after total ankle arthroplasty. http://dx.doi.org/10.1016/j.fas.2017.07.391
303 Anatomical positions facilitating of anterocentral portal for ankle arthroscopy on ultrasonography S. Chida 1,∗ , H. Kura 2 , T. Kashiwakura 3 , K. Nozaka 4 , Y. Shimada 4 1
Hiraka General Hospital, Japan Hitsujigaoka Hospital, Japan 3 Akita City Hospital, Japan 4 Akita University Graduate School of Medicine, Japan 2
An anterocentral portal for ankle arthroscopy provides a wide and favorable visual field through a single portal, but it may damage nerves and blood vessels, therefor an index to safely prepare a portal is necessary. The relationship between the extensor hallucis longus muscle and dorsalis pedis artery, which are important for portal preparation, was investigated using ultrasound. In 46 feet of healthy adults (male: female = 24:22), the distances between the lateral margins of the extensor hallucis longus muscle tendon and dorsalis pedis artery (A) and between the epidermis and dorsalis pedis artery (B) were measured. Athletic experience and a past medical history of ankle joint trauma were investigated. (A) was 2.2 mm, (B) was 6.0 mm, and no significant difference was noted between the sexes or between the feet with and without ankle joint trauma. The dorsalis pedis artery was unlikely to be damaged when the portal was prepared at a maximum of 5 mm lateral to the lateral margin of the extensor hallucis longus muscle tendon. Since the minimum depth of the dorsalis pedis artery from the epidermis was 4.9 mm, the portal can be safely prepared by incision of only the epidermis and subcutaneous exposure by blunt dissection in portal preparation followed by the atraumatic insertion of an arthroscope. An anterocentral portal may be a useful viewing portal. http://dx.doi.org/10.1016/j.fas.2017.07.392
304 Failure to restore sagittal tibiotalar alignment in total ankle arthroplasty J. Cho 1,∗ , W.C. Lee 2 , Y. Yi 2 , H.J. Choi 3 , C.H. Park 4 , D.I. Chun 5 , T.K. Ahn 6 , J.Y. Kim 7 1
Chuncheon Sacred Heart Hospital, Hallym University, South Korea 2 Seoul Foot and Ankle Center, Dubalo Orthopaedic Institute, Brazil 3 Haeundae Paik Hospital, South Korea 4 Yeung-Nam University Hospital, South Korea 5 Soonchunhyang University Medical Center, South Korea 6 Bundang CHA Hospital, South Korea 7 Armed Forces Daejeon Hospital, South Korea The purpose of this study was to evaluate the change in sagittal tibiotalar alignment aftertotal ankle arthroplasty (TAA) for osteoarthritis and to investigate factors affecting the restoration of alignment. This retrospective study included 119 patients (120 ankles) who underwent three component TAA using the Hintegra prosthesis. A total of 63 ankles had anterior displacement of the talus before surgery (group A), 49 had alignment in the normal range(group B), and eight had posterior displacement of the talus (group C). Ankles in group A were further sub-divided into those in whom normal alignment was restored following TAA(41 ankles) and those with persistent displacement (22 ankles). Radiographic and clinical results were assessed. Pre-operatively, the alignment in group A was significantly more varus than that in group B, and the posterior slope of the tibial plafond was greater (p < 0.01 in both cases). The posterior slope of the tibial component was strongly associated with restoration of alignment: ankles in which the alignment was restored had significantly less posterior slope (p < 0.001). An anteriorly translated talus was restored to a normal position after TAA in most patients. We suggest that surgeons performing TAA using the Hintegra prosthesis should aim to insert the tibial component at close to 90◦ relative to the axis of the tibia, hence reducing posterior soft-tissue tension and allowing restoration of normal tibiotalar alignment following surgery. http://dx.doi.org/10.1016/j.fas.2017.07.393