Treatment Option For Ankle Arthritis Research Articles

BMI influence on total ankle arthroplasty outcomes: A systematic review

Total ankle arthroplasty has become an increasingly popular surgical treatment option for ankle arthritis. Patient selection for this procedure is a debated topic. Traditionally, total ankle arthroplasty is chosen for patients who perform only low-demand activities, those who are elderly, and those who are not overweight. More recently, foot and ankle surgeons have been expanding this selection criteria. The goal of the present study is to perform a systematic review on the impact of body mass index on total ankle survivorship and complications. 18 articles were included in the present systematic review. Five studies were analyzed for complications and indicated a potential increase in the odds of complications in patients with higher body mass index values, but this did not reach statistical significance (p > 0.05). There was not sufficient information to estimate a pooled effect of body mass index on total ankle arthroplasty survivorship. Due to the limited number of studies that met the review's inclusion and exclusion criteria, a statistical analysis was only performed on complication rates. In addition to a slight increase in complication risk for individuals with higher body mass index values, the results of this review also highlight the need for further studies that investigate the impact of body mass index on total ankle arthroplasty outcomes.

Development and Validation of a Patient Decision Aid for the Treatment of Ankle Arthritis

Category: Ankle Arthritis; Ankle Introduction/Purpose: Choosing a treatment course can be challenging for patients with ankle osteoarthritis given the multiple operative and nonoperative options. We developed and validated the Ankle Arthritis Patient Decision Aid as a tool to improve shared decision-making for such patients. Methods: Eighty patients of 2 surgeons at a US academic foot and ankle practice were recruited from October 2020 to June 2021 using an electronic medical record messaging system. Participants reviewed the tool and answered survey questions evaluating its quality and factors affecting treatment choice in a hypothetical patient scenario. We evaluated the tool using decisional conflict scores (maximum, 40 points, with higher scores indicating greater uncertainty), pre- and post-knowledge test scores (maximum, 8 points), and helpfulness scores (maximum, 7 points). We compared pre- and post-test knowledge scores using paired Student t- tests. Alpha=.05. Results: Mean (+- standard deviation) knowledge scores improved from 4.8 +- 1.2 (pre-test) to 6.7 +- 1.3 (post-test), for a mean improvement of 1.9 +- 1.4 (p<.001). The mean decisional conflict score was 4.1 +- 5.7, reflecting minimal uncertainty. Factors greatly affecting participants' treatment choices were desire to maintain a high level of physical activity (n=58), risk of complications (n=35), recovery time (n=33), and risk of increased rate of arthritis in adjacent joints (n=32). The mean reported helpfulness score was 5.9 +- 1.2, reflecting substantial benefit. Conclusion: The Ankle Arthritis Patient Decision Aid is a comprehensible tool that significantly improves patient knowledge regarding treatment options for ankle arthritis.

Management of Ankle Arthritis After Severe Ankle Trauma.

There are still unanswered questions about the best treatment options for ankle arthritis after severe lower leg trauma. This study compared results in outcomes and complications for 3 groups. Retrospective cohort study case-control study. Single institution. Three groups of 100 surgeries. Patients underwent an ankle fusion using anterior plate, total ankle arthroplasty (TAA) for primary osteoarthritis (OA), or a TAA for post-traumatic arthritis (PTA). Veterans Rand 12-Item Health Survey (VR-12), Ankle Osteoarthritis Scale, Visual Analog Pain Scale, and the American Orthopaedic Foot and Ankle Society Hindfoot score were collected preoperatively and at subsequent postoperative appointments. A patient satisfaction survey was also distributed to each patient postoperatively. Although all scores improved from preoperative to latest postoperative, the total ankle for PTA consistently resulted in the best postoperative outcomes. Patient satisfaction survey indicated 26% of fusion, 55% of TAA-OA, and 63% of TAA-PTA experienced very good to excellent pain relief. The overall satisfaction was found to be 92.5% for the TAA-PTA patients, 90.5% for the TAA-OA patients, and 84% for the fusion patients. Revision surgeries included 2 from the TAA-OA group, 2 from the TAA-PTA group, and 1 fusion patient. Results of comparing 3 groups who underwent an ankle fusion or a TAA demonstrate improvement in pain (P < 0.001), physical quality of life (P < 0.001), and activity (P < 0.001) and resulted in a high level of patient satisfaction. Level III. See Instructions for Authors for a complete description of levels of evidence.

Kinematics of a Pyrocarbon Ankle Spacer for the Treatment of Arthritic Disease

Category:Ankle, Ankle ArthritisIntroduction/Purpose:Treatment options for ankle arthritis in younger patients are currently limited. Since the longevity of modern total ankle replacements is not sufficient for this patient population, ankle arthrodesis is typically utilized when joint preserving treatment is not a viable option. A new procedure using a pyrocarbon ankle spacer has been developed as a potential alternative, allowing for talar articular resurfacing for pain relief with minimal bone resection. The objective of this study was to assess whether this pyrocarbon ankle spacer could provide normal ankle kinematics as the native ankle joint using cadaveric gait simulation.Methods:Five mid-tibia cadaveric specimens without deformity and no history of lower limb injury or surgery were utilized. The stance phase of gait was simulated for each specimen using a six degree-of-freedom robotic device. A force plate was moved relative to stationary specimen through an inverse tibial kinematic path calculated from in vivo data while extrinsic tendons were actuated using physiologic loads (Figure 1A). Magnitudes of load were scaled to that of 25% bodyweight. Ankle kinematics were measured from reflective markers attached to the tibia and talus via surgical pins. The pyrocarbon ankle spacer (Exactech, Gainesville, FL, USA) was implanted in a nest formed 3-4 mm in depth on the talar articular surface using a custom burring technique (Figure 1B). Ankle spacer kinematics were compared to 95% confidence intervals of native, intact ankle joint kinematics to assess agreement.Results:Outcomes revealed no significant difference in ankle joint kinematics between the native, intact condition and post- pyrocarbon spacer implantation (Figure 1C). This result was consistent for the sagittal, coronal and axial planes of motion.Conclusion:The results of this study demonstrate that a pyrocarbon spacer permits normal ankle kinematics. Further, the device was observed to be stable in the joint throughout simulations. While the testing was performed at 25% bodyweight for analyses on all specimens, load magnitudes were also increased up to 75% on a subset of specimens and the structural integrity of the device remained pristine. With these findings, we concluded that the pyrocarbon spacer device offers promising potential as a treatment option for ankle arthritis.