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Supramalleolar osteotomy – A joint-preserving option for advanced osteoarthritis of ankle
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Abstract 9: Ankle Arthritis / Foot and Ankle Surgery 22S (2016) 38–40
80 FI2016_AnkleArthritis_06 The QUOTE foot osteoarthritis to assess surgical treatment M. Stegeman 1,*, B. van Ginneken 2, R. Castelein 3, J.W. Louwerens 2 1
Sint Maartenskliniek Woerden, The Netherlands Sint Maartenskliniek Nijmegen, The Netherlands 3 University of Utrecht, The Netherlands *Corresponding author. 2
Background/aims: Incorporating the patient’s view of treatment and outcome is crucial for improving quality of care. A quality of care through the patient’s eyes (QUOTE) instrument for patients with foot osteoarthritis (OA) was developed to obtain information on expectations and experiences concerning quality of care. Methods: First, a questionnaire containing 33 items about general and disease-specific care was developed after focus group discussions involving five surgical patients treated for OA of the foot. The resulting two-part questionnaire measures expectations (part A) and experiences (part B) of patients before and after surgery, respectively. Next, the questionnaire was given to 111 OA surgical patients between October 2010 and February 2014. A factor analysis of the structure of the questionnaire was performed and internal consistency (Cronbach’s a) was examined. Feasibility was evaluated by calculating impact scores (Q scores), and items of improvement of care were indicated. Results: Principal factor analysis indicated a two-factor solution. The assumed taxonomy was not confirmed; however, the internal consistency of the four categories was moderate to good, with Cronbach’s a ranging from 0.69 (outpatient clinic) to 0.82 (Rehabilitation). Cronbach’s a of the total questionnaire was 0.88, confirming good internal consistency. The highest Q scores (items to be improved) were pain reduction, foot function and waiting time for surgery. Summary/conclusion: The QUOTE foot osteoarthritis has good reliability and is useful for evaluating and improving the quality of care. Patient focus groups will analyse the questionnaire regularly to ensure its continuous improvement. http://dx.doi.org/10.1016/j.fas.2016.05.089
81 FI2016_AnkleArthritis_07 Analysis of mechanical strength in talus using CT-osteoabsorptiometry: In vivo study Y. Hara 1,*, K. Ikoma 1, M. Kido 1, K. Imai 1, N. Inoue 2, D. Tokunaga 1, T. Kubo 1 1 Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan 2 Department of Orthopedic Surgery, Rush University, United States *Corresponding author.
Introduction: Osteoarthritis was diagnosed based on the loss of joint space in radiograph. The measurement of subchondral bone mineralization is importance in assessing the functional adaptation of bony tissue. Mu¨ller-Gerbl developed CT-osteoabsorptiometry (CT-OAM) for assessing the distribution of subchondral mineralization. Relationships between strength and subchondral bone density (SBD) are known. The purpose of this study was to figure out the relationship between joint space distance and SBD.
Methods: Eighteen ankles of 10 normal subjects underwent ankle CT scans. The images were taken with using a custom-made loading device of the foot. CT-image data from tibia to talus were converted to point-cloud 3D models and curved 3D ankle joint surface data. SBD at each point of talus was calculated in Hounsfield Units (HU). The mean HU in the talus at each depth was calculated. The joint space distance (JSD) and the distance between tibia and the depth of highest HU value of talus(tibiaMaxHU) was calculated. Talus surface was divided into 9 sections. The shortest JSD, shortest; tibia-MaxHU and highest HU section were selected. Results: Distribution of JSD, tibia-MaxHU, and HU values; were distributed at medial sections. Conclusions: We observed that the area of maximum density of the tibia was located in the medial part in most subjects. Therefore we observed that shortest joint space was located medial sections. We believed our data shows that stress concentration was increased in area of joint space narrowing especially. CT-OAM analysis may elucidate the pathology of foot and ankle disorders. http://dx.doi.org/10.1016/j.fas.2016.05.090
82 FI2016_AnkleArthritis_08 Supramalleolar osteotomy – A joint-preserving option for advanced osteoarthritis of ankle A. Chauhan *, P. Karpe, M.-C. Killen, R. Limaye University Hospital of North Tees, UK *Corresponding author. Background: Arthrodesis and ankle replacement have been the mainstay for advanced ankle osteoarthritis. Supramalleolar osteotomy provides a joint-preserving option for patients with eccentric osteoarthritis of ankle, particularly those with varus or valgus malalignment. Aim: To evaluate radiological and functional outcomes of patients undergoing shortening supramalleolar osteotomy for eccentric (varus or valgus) ostearthritis of ankle. Methods: This prospective study included patients with eccentric osteoarthritis of ankle from 2008 to 2015 who failed initial conservative management for six months. Preoperative standing anteroposterior and Saltzman view radiographs evaluated degree of malalignment. Patients were assessed for range of motion and American Orthopedic Foot and Ankle Society (AOFAS) scores. Radiological and Clinical outcomes were assessed at 3, 6 and 12 months follow-up. Results: Over a period of seven years (2008–2015), 33 patients were followed for an average of 25 months (range 22–30 months). Mean radiological union time was 8.6 weeks (range 8–10 weeks), without any case of non-union. There was a statistically significant (P < 0.001) improvement in functional scoring; mean AOFAS score improved from 34.8 (range 15–40) preoperatively to 79.9 (range 74–90) at 12 months postoperatively. There was no significant change in pre- and post-operative range of motion. Two patients required revision surgery at 12 months; one underwent arthrodesis; other an ankle replacement. Conclusions: Supramalleolar osteotomy is a viable jointpreserving option for patients with eccentric osteoarthritis of the ankle. It preserves motion, redistributes forces away from the affected compartment, corrects malalignment and provides significant symptomatic and functional improvement. http://dx.doi.org/10.1016/j.fas.2016.05.091
Abstract 9: Ankle Arthritis / Foot and Ankle Surgery 22S (2016) 38–40
80 FI2016_AnkleArthritis_06 The QUOTE foot osteoarthritis to assess surgical treatment M. Stegeman 1,*, B. van Ginneken 2, R. Castelein 3, J.W. Louwerens 2 1
Sint Maartenskliniek Woerden, The Netherlands Sint Maartenskliniek Nijmegen, The Netherlands 3 University of Utrecht, The Netherlands *Corresponding author. 2
Background/aims: Incorporating the patient’s view of treatment and outcome is crucial for improving quality of care. A quality of care through the patient’s eyes (QUOTE) instrument for patients with foot osteoarthritis (OA) was developed to obtain information on expectations and experiences concerning quality of care. Methods: First, a questionnaire containing 33 items about general and disease-specific care was developed after focus group discussions involving five surgical patients treated for OA of the foot. The resulting two-part questionnaire measures expectations (part A) and experiences (part B) of patients before and after surgery, respectively. Next, the questionnaire was given to 111 OA surgical patients between October 2010 and February 2014. A factor analysis of the structure of the questionnaire was performed and internal consistency (Cronbach’s a) was examined. Feasibility was evaluated by calculating impact scores (Q scores), and items of improvement of care were indicated. Results: Principal factor analysis indicated a two-factor solution. The assumed taxonomy was not confirmed; however, the internal consistency of the four categories was moderate to good, with Cronbach’s a ranging from 0.69 (outpatient clinic) to 0.82 (Rehabilitation). Cronbach’s a of the total questionnaire was 0.88, confirming good internal consistency. The highest Q scores (items to be improved) were pain reduction, foot function and waiting time for surgery. Summary/conclusion: The QUOTE foot osteoarthritis has good reliability and is useful for evaluating and improving the quality of care. Patient focus groups will analyse the questionnaire regularly to ensure its continuous improvement. http://dx.doi.org/10.1016/j.fas.2016.05.089
81 FI2016_AnkleArthritis_07 Analysis of mechanical strength in talus using CT-osteoabsorptiometry: In vivo study Y. Hara 1,*, K. Ikoma 1, M. Kido 1, K. Imai 1, N. Inoue 2, D. Tokunaga 1, T. Kubo 1 1 Department of Orthopaedics, Kyoto Prefectural University of Medicine, Kyoto, Japan 2 Department of Orthopedic Surgery, Rush University, United States *Corresponding author.
Introduction: Osteoarthritis was diagnosed based on the loss of joint space in radiograph. The measurement of subchondral bone mineralization is importance in assessing the functional adaptation of bony tissue. Mu¨ller-Gerbl developed CT-osteoabsorptiometry (CT-OAM) for assessing the distribution of subchondral mineralization. Relationships between strength and subchondral bone density (SBD) are known. The purpose of this study was to figure out the relationship between joint space distance and SBD.
Methods: Eighteen ankles of 10 normal subjects underwent ankle CT scans. The images were taken with using a custom-made loading device of the foot. CT-image data from tibia to talus were converted to point-cloud 3D models and curved 3D ankle joint surface data. SBD at each point of talus was calculated in Hounsfield Units (HU). The mean HU in the talus at each depth was calculated. The joint space distance (JSD) and the distance between tibia and the depth of highest HU value of talus(tibiaMaxHU) was calculated. Talus surface was divided into 9 sections. The shortest JSD, shortest; tibia-MaxHU and highest HU section were selected. Results: Distribution of JSD, tibia-MaxHU, and HU values; were distributed at medial sections. Conclusions: We observed that the area of maximum density of the tibia was located in the medial part in most subjects. Therefore we observed that shortest joint space was located medial sections. We believed our data shows that stress concentration was increased in area of joint space narrowing especially. CT-OAM analysis may elucidate the pathology of foot and ankle disorders. http://dx.doi.org/10.1016/j.fas.2016.05.090
82 FI2016_AnkleArthritis_08 Supramalleolar osteotomy – A joint-preserving option for advanced osteoarthritis of ankle A. Chauhan *, P. Karpe, M.-C. Killen, R. Limaye University Hospital of North Tees, UK *Corresponding author. Background: Arthrodesis and ankle replacement have been the mainstay for advanced ankle osteoarthritis. Supramalleolar osteotomy provides a joint-preserving option for patients with eccentric osteoarthritis of ankle, particularly those with varus or valgus malalignment. Aim: To evaluate radiological and functional outcomes of patients undergoing shortening supramalleolar osteotomy for eccentric (varus or valgus) ostearthritis of ankle. Methods: This prospective study included patients with eccentric osteoarthritis of ankle from 2008 to 2015 who failed initial conservative management for six months. Preoperative standing anteroposterior and Saltzman view radiographs evaluated degree of malalignment. Patients were assessed for range of motion and American Orthopedic Foot and Ankle Society (AOFAS) scores. Radiological and Clinical outcomes were assessed at 3, 6 and 12 months follow-up. Results: Over a period of seven years (2008–2015), 33 patients were followed for an average of 25 months (range 22–30 months). Mean radiological union time was 8.6 weeks (range 8–10 weeks), without any case of non-union. There was a statistically significant (P < 0.001) improvement in functional scoring; mean AOFAS score improved from 34.8 (range 15–40) preoperatively to 79.9 (range 74–90) at 12 months postoperatively. There was no significant change in pre- and post-operative range of motion. Two patients required revision surgery at 12 months; one underwent arthrodesis; other an ankle replacement. Conclusions: Supramalleolar osteotomy is a viable jointpreserving option for patients with eccentric osteoarthritis of the ankle. It preserves motion, redistributes forces away from the affected compartment, corrects malalignment and provides significant symptomatic and functional improvement. http://dx.doi.org/10.1016/j.fas.2016.05.091