Post-traumatic Arthropathy Research Articles

Anchor, Implant, and Post-Traumatic Arthropathy After Instability Repair: How to Diagnose and Manage

Anchor, Implant, and Post-Traumatic Arthropathy After Instability Repair: How to Diagnose and Manage

Tibio-Talo-Calcaneal Arthrodesis: Evaluation of the Effectiveness of a Specific Surgical Technique in 17 Cases.

Ankle arthrodesis is a crucial surgical intervention for advanced hindfoot conditions, aiming to restore plantigrade walking and alleviate pain. This study evaluates the effectiveness of a specific surgical approach for tibiotalocalcaneal arthrodesis (TTCA), focusing on rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, and assesses the outcomes of this approach in terms of bone fusion and reduction of postoperative complications. This retrospective analysis includes 17 patients who underwent TTCA in a trauma-orthopedic department over seven years. Data were collected from medical records, the HOSIX software, and patient consultations. Preoperative assessments, surgical techniques, postoperative care, and follow-up evaluations were documented. The mean age of patients was 42.4 years, with a male predominance. Surgical indications included post-traumatic arthropathy (53%), inflammatory arthropathy, ankle infectious pathologies, and Charcot footand ankle prosthesis failures. All patients underwent standard preoperative evaluations and received corticocancellous grafts. An angled retrograde femoral nail in the sagittal plane was used for internal fixation. Postoperative immobilization lasted 6 to 8 weeks, with subsequent rehabilitation. The bone fusion rate was 100%, with a low complication rate (23.5%). Our study showed a younger patient population with a male predominance, different from some previous studies. Surgical techniques, including the anterior approach combined with a lateral subtalar approach, were consistent with some studies but differed from others. Corticocancellous grafts and the angled retrograde femoral nail in the sagittal plane demonstrated favorable outcomes in terms of fusion. Complication rates were lower compared to some previous reports, highlighting potential improvements in postoperative management. The surgical approach described for TTCA, emphasizing rigorous risk factor control, corticocancellous grafting, and internal fixation using an angled retrograde femoral nail in the sagittal plane, led to satisfactory bone fusion and reduced postoperative complications. These results underscore the importance of this approach in achieving optimal functional outcomes in ankle arthrodesis.

Clinical results of total elbow arthroplasty after treatment failure for Monteggia-like injuries

Monteggia-like fractures (MLF) are complex injuries with high complication rates and frequently unsatisfying clinical results. Total elbow arthroplasty (TEA) represents the only option to salvage the functional requirements in some patients with pronounced posttraumatic arthropathy. This case series provides clinical results of TEA following failed treatment of MLF. All patients who underwent TEA from 2017 to 2022 for failed treatment of MLF were retrospectively included in this study. Complications and revisions before and after TEA and functional results, measured by the Broberg/Morrey score, were evaluated. In this study 9 patients with amean age of 68 (±7; 54-79) years were included. The mean follow-up was 12 (±9; 2-27) months. The main reasons leading to posttraumatic arthropathy were chronic infections (44.4%), bony instability due to coronoid deficiency (33.3%) or acombined coronoid and radial head deficiency (22.2%) and non-union of the proximal ulna with radial head necrosis (11.1%). The mean number of surgical revisions between primary fixation and TEA was 2.7 (±1.8; 0-6). The revision rate following TEA was 44%. The mean Broberg/Morrey score at the time of the latest follow-up was 83 (±10; 71-97) points. Chronic infection and coronoid deficiency are the main reasons for posttraumatic arthropathy after MLF leading to TEA. While the overall clinical results are satisfying, the indications should be reserved for selected cases due to high revision rates.

Assessing the hospital volume-outcome relationship in total elbow arthroplasty.

Total elbow arthroplasty (TEA) is an effective intervention for multiple elbow disorders including complex fracture in elderly patients, post-traumatic arthropathy, inflammatory arthropathy, and distal humeral nonunion. Given its known therapeutic value and low utilization rate, an investigation into the thresholds for TEA institutional volume-outcome relationships is warranted. The purpose of this study was to identify TEA volume thresholds that serve as predictors of institutional outcomes including complications, readmissions, revisions, cost of care, length of stay (LOS), and non-home discharge. We hypothesized that increased institutional volume would be associated with decreased 90-day adverse outcomes and resource utilization. The Nationwide Readmission Database was queried from 2010 to 2017 to identify all cases of TEA. Hospital volume was calculated using a unique hospital identifier and divided into quartiles. Outcomes such as complications, readmissions, revisions, cost of care, LOS, and non-home discharge were then analyzed by quartile. The same outcomes were assessed via stratum-specific likelihood ratio (SSLR) analysis to define volume strata among institutions. SSLR analysis defined statistically significant hospital volume categories for each 90-day outcome. The volume category with the lowest complication rate was ≥21 TEAs per year (5.6%). The volume categories with the lowest readmission rates were 1-3 TEAs per year (4.7%) and ≥18 TEAs per year (9.2%). Revision rates were lowest in the volume categories of 1-5 TEAs per year (0.1%) and ≥18 TEAs per year (0.1%). Hospitals with ≥21 TEAs per year had the lowest cost of care and the highest rate of extended LOS (>2 days). SSLR analysis showed that non-home discharges decreased in a stepwise manner as volume increased. The lowest non-home discharge rate was associated with the volume category of ≥22 TEAs per year (20.3%). This study defines TEA volume strata for institutional outcomes. The highest TEA volume strata were associated with the lowest rates of 90-day complications, revisions, and non-home discharges and the lowest cost of care. This trend is likely attributable to the benefits of high-volume institutional experience and standardized patient-care processes.

Anatomic Total Shoulder Arthroplasty With a Stemless Humeral Component

Background: This technique video reviews anatomic total shoulder arthroplasty (TSA) with a stemless humeral component using a representative case example. Indications: Stemless TSA is indicated for patients with symptomatic glenohumeral arthritis typically younger than 65 years of age. Stemless TSA may be used for other glenohumeral degenerative conditions such as avascular necrosis or posttraumatic arthropathy, provided acceptable humeral bone quality is confirmed intraoperatively using a thumb-press test. Poor bone quality is the primary contraindication. Technique Description: Preoperatively, computed tomography is typically used for planning, and intraoperative navigation through magnetic resonance imaging is also useful. The procedure’s critical elements include beach chair positioning, standard deltopectoral approach with lesser tuberosity osteotomy (LTO), freehand proximal humeral osteotomy, perpendicular proximal humeral exposure and subsequent preparation over a central guidewire, stemless implant and humeral head sizing, perpendicular glenoid exposure and implant placement, and final humeral implantation with LTO repair/fixation. A phased rehabilitation protocol includes 6-week sling immobilization to protect the subscapularis/LTO repair and return to normal activities between 3 and 6 months postoperatively. Discussion/Conclusion: Stemless TSA shows promising early and mid-term outcomes with complication rates, including humeral loosening rates, similar to standard stemmed components. Potential complications include neurovascular injury, infection, glenoid or humeral component loosening, and rotator cuff failure.

Recent National Trends and Outcomes in Total Ankle Arthroplasty in the United States

Total ankle arthroplasty (TAA) is an evolving option for treating ankle arthritis. We assessed the national trends in usage and perioperative outcomes of TAA in the United States. International Classification of Diseases, 9th revision (ICD-9), codes were used to search the National Hospital Discharge Survey database for TAA from 1997 to 2010. Patient demographics, comorbidities, hospitalization length, discharge disposition, blood transfusion, lower extremity deep vein thrombosis, pulmonary embolism, and mortality data were gathered. Trends were evaluated using linear regression with Pearson's correlation coefficient, and statistical comparisons were performed using Student's t test and z-test for proportions with significance at p = .05. We identified 120 patients with TAA. TAA demonstrated a positive correlation with time (r = 0.57), significantly increasing from 2.4 cases per 100,000 admissions from 1997 to 2003 to 3.5 cases per 100,000 from 2004 to 2010 (p = .04). The mean age was 57.8 (range 19 to 83) years. The mean number of comorbidities was 4.5 (range 1 to ≥7). Although patient age remained stable (p = .21), the mean number of comorbidities significantly increased from 4.0 from 1997 to 2003 to 4.8 from 2004 to 2010 (p = .02); 8 patients (6.7%) had diabetes, 71 (59.2%) had primary osteoarthritis, and 35 (29.2%) had posttraumatic arthropathy. The mean length of stay significantly decreased from 3.1 to 2.3 days (p = .03). Three patients (2.5%) required a blood transfusion. No deep vein thrombosis or PE was diagnosed. No patients died during the operative admission; 95 patients (87%) were discharged home and 14 (13%) required a skilled rehabilitation facility. Discharge patterns showed no significant change with time (p = .59). Usage of TAA in the United States has increased nearly 50% over the past 14 years. TAA was associated with shorter hospitalization, infrequent rehabilitation facility requirements, and few perioperative complications.

Indication, Technique and Long-term Results after Shoulder Arthrodesis Performed with Plate Fixation.

Arthrodesis of the shoulder joint is a radical event, so it is difficult to explain its significance to patients. It has been the last resort in hopeless cases. Knowledge of long-term results and evaluation of advantages and disadvantages seems to be helpful in this regard. Eleven patients with mean age of 45 (31 - 58) years were operated between 2000 and 2013. All patients could be included in the investigation (FU mean 8.5 [3 - 16] years; 8 male and 3 female; right 9, left 2). Patients had the following indications: persistent instability 5 (2 with epilepsy), rotator cuff rupture 2 (1× after combined latissimus dorsi and teres major transfer), brachial plexus injury/defect 2, locked dislocation 1 and posttraumatic arthropathy 1. Fixation with DC plate (pre-bent to 110°) was used in all cases; with special focus on placing at least one screw in the scapular neck. The targeted arthrodesis position was abduction 30°, forward flexion 30°, and internal rotation 30°. Active abduction improved from 12 to 63°, forward flexion from 21 to 79° and internal rotation from 10 to 47° (mean values). In the resting position with hanging arm aside, mean abduction was 3° and forward flexion 8°. Nine of 11 patients had considerable relief of pain, from 8.3 to 2.4 points VAS. Five patients rated the outcome as excellent, 3 as good and 1 as satisfactory. Nine patients would repeat the procedure. In summary, an Oxford Shoulder Score of 31.6 points was achieved, and SSV of 58%. Bony fusion was achieved in all cases, 3 - 4 months p. o. in mean. There were no important neurological or angiological complications. Plate arthrodesis in the technique used achieves high fusion and a low complication rate. Relief of pain and functional improvement are astonishing. Analysis of our results indicates that correction of the positions mentioned above is necessary: i. o. arthrodesis position for abduction 25° (by means of pre-bending plate of 105°), forward flexion 20° and internal rotation 30° are suggested.

Pantalar Arthrodesis for Post-Traumatic Arthritis and Diabetic Neuroarthropathy of the Ankle and Hindfoot

Pantalar arthrodesis is an important salvage option for stabilizing the hindfoot and salvaging the limb following trauma or collapse. This report evaluates the healing rates and complications which occur in diabetics and post-traumatic patients. Twenty patients presenting with post-traumatic arthritis of the ankle-hindfoot (twelve) or with Type II or Type IIIA Charcot arthropathy (eight) were managed with a pantalar fusion. Followup averaged 46 months. Patients were evaluated using the Short Form-36 (SF-36), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, the Short Musculoskeletal Function Assessment (SMFA) and the Visual Analog Pain Scale (VAS). There were no amputations in either group. Casting averaged 14.9 weeks, full weightbearing was achieved at 25.1 weeks and time to union averaged 44.1 weeks. Average age was 56.3 yrs. and BMI averaged 34.2. Fourteen patients (70%) had their surgery performed in multiple stages. Acceptable outcomes were noted for all patients for the SF-36, AOFAS and SMFA scores. VAS scores averaged 2.2. There were ten complications (50%); four patients (two in each group) required additional surgery. Pantalar arthrodesis is a reasonable salvage option for patients with severe post traumatic arthropathy and neuropathic arthropathy. Patients should be informed of the increased risks as well as the long periods of postoperative immobilization and nonweightbearing. We believe a pantalar arthrodesis can produce acceptable outcomes regardless of the cause of disability, with a staged or single approach, and whether the surgery is performed with plates and screws or an intramedullary device.

Quantitative determination of the diagnostic accuracy of the synovitis score and its components

To assess the diagnostic accuracy of a three-component synovitis score and to determine the relative contribution of each of its components to its overall discriminatory power. The synovitis score was determined in 666 synovial specimens: normal synovium, n = 33; post-traumatic arthropathy (PtA), n = 29; osteoarthritis (OA), n = 221; psoriatic arthritis (PsA), n = 42; and rheumatoid arthritis (RA), n = 341. The discriminatory abilities of the score and its components were quantified with binary and multicategory receiver operating characteristic (ROC) analysis. The score differentiated all arthropathies accurately from normal tissue (area under the ROC curve, AUC: 0.87-0.98) and RA from OA or PtA (AUC: 0.85 for both), but could not distinguish well within pairs of inflammatory or degenerative arthropathies. AUCs of the intimal hyperplasia and stromal cellularity components correlated with the AUCs of the complete score markedly more strongly (r = 0.94 and 0.91, respectively) than the inflammatory infiltration component (r = 0.60). Multicategory ROC analysis ranked the score several-fold higher than any of its components, and the components in the order stromal cellularity>intimal hyperplasia>infiltration. Combining three distinct histological parameters into a three-component score produces greatly increased overall diagnostic power. The discriminatory ability of the score stems more from measuring proliferative than infiltrative aspects of synovitis.

Technical Considerations in Tarsometatarsal Joint Arthrodesis

Tarsometatarsal arthrodesis is indicated for degenerative joint disease after trauma. Deformity is often associated with post-traumatic arthropathy. Outcomes after surgical management are directly related to realignment. This article reviews the indications, preoperative evaluation, technical execution, and postoperative management of tarsometatarsal arthrodesis. Special emphasis is placed on realignment and restoration of normal foot architecture.

Surface arthroplasty in shoulder arthritis

Use of a resurfacing arthroplasty in shoulder arthritis has the advantage of bone preservation. It diminishes the risk of periprosthetic fractures of the humeral shaft by avoiding the stress concentration effect associated with stemmed implants. Revision or, when rarely needed, arthrodesis may be undertaken more easily since the bone stock has been maintained. The largest studies to date have concluded that the indications for this surface replacement are the same as those for the conventional stemmed prostheses, namely osteoarthritis, rheumatoid arthritis, avascular necrosis, instability arthropathy, posttraumatic arthropathy, and cuff arthropathy. The best results have been achieved in primary osteoarthritis. Results for other indications are comparable with those for stemmed prostheses with a similar follow-up and case mix. Use in cuff tear arthropathy has yielded successful outcomes consistent with the limited goals in these patients, similar to those with use of available stemmed implants but with technical advantages. The implant is not suitable where the humeral head is insufficient or in four-part fractures. In such cases, a stemmed implant should be used. Access to the glenoid is more difficult with this technique because of humeral head retention resulting in a greater propensity to perform hemiarthroplasty.

Decision making in glenohumeral arthroplasty

Prosthetic replacement arthroplasty for glenohumeral arthritis is a well-developed and well-described technique with good and excellent results. The surgeon is faced with many decisions to make, however, regarding choice of implant, implant fixation, soft tissue management, and options for glenoid resurfacing. In general, when the precise cause of the arthritic condition is identified, the choices become more straightforward. For advanced osteoarthritis of the shoulder joint in an older patient with asymmetric posterior erosion of the glenoid, a total shoulder arthroplasty renders the best relief of pain and improvement in motion. Similarly, for advanced rheumatoid arthritis in patients with an intact rotator cuff, a total shoulder arthroplasty results in the best pain relief. If the rotator cuff is deficient and irreparable, an anatomically sized humeral head replacement is appropriate, taking care to preserve the coracoacromial arch. Acute, nonreducible fractures of the proximal humerus are treated best with a humeral head replacement. Post-traumatic arthropathy of the shoulder joint is treated with arthroplasty, and the decision to resurface the glenoid should take into account the age of the patient and the wear and concentricity of the glenoid. Many options exist for the choice of an implant; biomechanical and anatomic studies suggest that a better technical result can be achieved with a third-generation implant design that has the ability to recreate accurately the proximal anatomy of the humerus. Copyright 2003, Elsevier Science (USA). All rights reserved.

Cementless surface replacement arthroplasty of the shoulder. 5- to 10-year results with the Copeland mark-2 prosthesis.

Cementless surface replacement arthroplasty of the shoulder is designed to replace the damaged joint surfaces and restore normal anatomy with minimal resection of bone. We have used the Copeland shoulder arthroplasty for 14 years. Between 1986 and 2000, 285 surface replacement arthroplasties were implanted in our unit. The prosthesis has evolved during this time, but the principle of minimal bone resection has remained the same. Between 1990 and 1994, 103 Mark-2 prostheses were inserted into 94 patients (9 bilateral). The operations were carried out for the treatment of osteoarthritis, rheumatoid arthritis, avascular necrosis, instability arthropathy, post-traumatic arthropathy and cuff arthropathy. The mean follow-up was for 6.8 years (5 to 10). The best results were achieved in primary osteoarthritis, with Constant scores of 93.7% for total shoulder replacement and 73.5% for hemiarthroplasty. The poorest results were seen in patients with cuff arthropathy and post-traumatic arthropathy with adjusted Constant scores of 61.3% and 62.7%, respectively. Most patients (93.9%) considered their shoulder to be much better or better than before the operation. Of the 88 humeral implants available for radiological review, 61 (69.3%) showed no evidence of radiolucency, nor did 21 (35.6%) of the 59 glenoid prostheses. Three were definitely loose, and eight shoulders required revision (7.7%), two (1.9%) for primary loosening. The results of this series are comparable with those for stemmed prostheses with a similar follow-up and case mix. The cementless surface replacement arthroplasty diminishes the risk of complications involving the humeral shaft and periprosthetic fractures. Revision or arthrodesis can be undertaken easily since the bone stock has been maintained with no loss of length.

Cementless surface replacement arthroplasty of the shoulder

Cementless surface replacement arthroplasty of the shoulder is designed to replace the damaged joint surfaces and restore normal anatomy with minimal resection of bone. We have used the Copeland shoulder arthroplasty for 14 years. Between 1986 and 2000, 285 surface replacement arthroplasties were implanted in our unit. The prosthesis has evolved during this time, but the principle of minimal bone resection has remained the same. Between 1990 and 1994, 103 Mark-2 prostheses were inserted into 94 patients (9 bilateral). The operations were carried out for the treatment of osteoarthritis, rheumatoid arthritis, avascular necrosis, instability arthropathy, post-traumatic arthropathy and cuff arthropathy. The mean follow-up was for 6.8 years (5 to 10). The best results were achieved in primary osteoarthritis, with Constant scores of 93.7% for total shoulder replacement and 73.5% for hemiarthroplasty. The poorest results were seen in patients with cuff arthropathy and post-traumatic arthropathy with adjusted Constant scores of 61.3% and 62.7%, respectively. Most patients (93.9%) considered their shoulder to be much better or better than before the operation. Of the 88 humeral implants available for radiological review, 61 (69.3%) showed no evidence of radiolucency, nor did 21 (35.6%) of the 59 glenoid prostheses. Three were definitely loose, and eight shoulders required revision (7.7%), two (1.9%) for primary loosening. The results of this series are comparable with those for stemmed prostheses with a similar follow-up and case mix. The cementless surface replacement arthroplasty diminishes the risk of complications involving the humeral shaft and periprosthetic fractures. Revision or arthrodesis can be undertaken easily since the bone stock has been maintained with no loss of length.

Diagnosis of infection in ununited fractures. Combined imaging with indium-111-labeled leukocytes and technetium-99m methylene diphosphonate.

The results of combined scintigraphy in which indium-111-labeled leukocytes and technetium-99m methylene diphosphonate were used were compared with the results of cultures of open bone at 102 sites of delayed union or non-union, to determine the effectiveness of this combination as a preoperative indicator of osteomyelitis. There were twenty-five true-positive, fifty-nine true-negative, eleven false-positive, four false-negative, and three indeterminate interpretations, yielding, for the diagnosis of osteomyelitis, a sensitivity of 86 per cent, a specificity of 84 per cent, an accuracy of 82 per cent, a positive predictive value of 69 per cent, and a negative predictive value of 94 per cent. There were few false-negative scans; false-positive results were most likely at a metaphyseal site adjacent to a joint in which there was post-traumatic arthropathy, at the site of a failed arthrodesis, and at the site of an unstable delayed union or non-union.