Search

As the number of patients receiving total joint replacements continues to rise, considerable attention has been directed towards the early detection and prevention of postoperative complications. While D-dimer has long been studied as a diagnostic tool in venous thromboembolism (VTE), this assay has recently received considerable attention in the diagnosis of periprosthetic joint infection (PJI). D-dimer values are substantially elevated in the acute postoperative period after total joint arthroplasty, with levels often exceeding the standard institutional cutoff for VTE (500 µg/L). The utility of D-dimer in detecting VTE after total joint replacement is currently limited, and more research to assess its value in the setting of contemporary prophylaxis protocols is warranted. Recent literature supports D-dimer as a good to excellent biomarker for the diagnosis of chronic PJI, especially when using serum sample technique. Providers should exercise caution when interpreting D-dimer levels in patients with inflammatory and hypercoagulability disorders, as the diagnostic value is decreased. The updated 2018 Musculoskeletal Infection Society criteria, which includes D-dimer levels > 860 µg/L as a minor criterion, may be the most accurate for diagnosing chronic PJI to date. Larger prospective trials with transparent lab testing protocols are needed to establish best assay practices and optimal cutoff values for D-dimer in the diagnosis of PJI. This review summarizes the most current literature on the value of D-dimer in total joint arthroplasty and elucidates areas for future progress.

PURPOSE OF REVIEW: Advances in technology, implant design, and surgical technique have lowered the dislocation rate in primary total hip arthroplasty (THA). Despite these advances, there remain a large number of instability episodes without a known etiology. Recent research suggests that the pelvic and lumbar spine interrelationship may be the explanation in prosthetic dislocations without a known cause. In this review, we describe the biomechanics, measurements, diagnoses, classification, management, and outcomes of total hip and revision total hip instability as it relates to spinopelvic alignment. RECENT FINDINGS: As a person goes from standing to sitting, lumbar lordosis decreases, and the sacrum and entire pelvis tilts posteriorly with sacrum and coccyx rotating posterior-inferiorly, resulting in increased acetabular cup anteversion to accommodate femoral flexion. A fused spine and associated fixed acetabulum can result in abnormal pelvic femoral motion, impingement, and dislocation. Classifying the spinopelvic mechanics by sacral motion based on sitting and standing lateral radiographs provides an understanding of how the acetabulum behaves in space. This information helps appropriate cup positioning, reducing the risk of femoral side impingement and subsequent dislocation. SUMMARY: Surgical techniques to consider in the spinopelvic at-risk patient are positioning considerations in acetabular cup inclination and anteversion, high offset femoral stems, high offset acetabular liners, dual mobility articulations, and removal of impinging structures. Future research is needed to define the safest order of operation in concomitant hip and spine pathology, the effects on pelvic femoral biomechanics in spine surgery, and whether preoperative and intraoperative management strategies have a long-term beneficial effect on the dislocation rate.

Introduction As the research landscape evolves, we sought to investigate the current most cited Orthopaedic Surgery articles and compare these to previously cited articles. Methods Web of Science database screened orthopaedic journal articles with comparison to previous data using multivariate regression analysis. Results Rate of citations increased 172% within the last decade. Previous rank and citations within the last decade had a greater effect on contemporary rank (p = 0.084, p = 0.002, respectively). Conclusion Trends in investigative research can shift by the next decade. Previous citation rank and citations in last decade contributed most to current rank.

Preoperative planning is a fundamental element in total knee arthroplasty (TKA). A previous surgery that must be recognized and identified preoperatively is the Hauser procedure, a posteromedialization of the tibial tubercle for recurrent patellar instability. Here, we describe 2 case reports in patients with previous Hauser surgeries. The first TKA surgery was complicated from a standard medial peripatellar approach resulting in complete transection of the patellar tendon during standard arthrotomy. The tendon was repaired, and the arthroplasty was aborted. For the second case, correct preoperative identification of the Hauser procedure was performed. The second TKA surgery was performed using a lateral peripatellar arthrotomy with excellent exposure, resulting in a successful operation. Here, we highlight the importance of an accurate history, physical and radiographic examination, and the recommendation of an alternative TKA approach to help avoid the serious intraoperative complication of a patellar tendon laceration. Keywords: Hauser procedure, Patellar tendon disruption, Extensor mechanism disruption, Lateral parapatellar approach, Total knee arthroplasty

Periprosthetic joint infections (PJIs) are fraught with multiple complications including poor patient-reported outcomes, disability, reinfection, disarticulation, and even death. We sought to perform a systematic review asking the question: (1) What is the mortality rate of a PJI of the knee undergoing 2-stage revision for infection? (2) Has this rate improved over time? (3) How does this compare to a normal cohort of individuals?We performed a database search in MEDLINE/EMBASE, PubMed, and all relevant reference studies using the following keywords: "periprosthetic joint infection," "mortality rates," "total knee arthroplasty," and "outcomes after two stage revision." Two hundred forty-two relevant studies and citations were identified, and 14 studies were extracted and included in the review.A total of 20,719 patients underwent 2-stage revision for total knee PJI. Average age was 66 years. Mean mortality percentage reported was 14.4% (1.7%-34.0%) with average follow-up 3.8 years (0.25-9 years). One-year mortality rate was 4.33% (3.14%-5.51%) after total knee PJI with an increase of 3.13% per year mortality thereafter (r = 0.76 [0.49, 0.90], P.001). Five-year mortality was 21.64%. When comparing the national age-adjusted mortality (Actuarial Life Table) and the reported 1-year mortality risk in this meta-analysis, the risk of death after total knee PJI is significantly increased, with an odds ratio of 3.05 (95% confidence interval, 2.69-3.44; P.001).The mortality rate after 2-stage total knee revision for infection is very high. When counseling a patient regarding complications of this disease, death should be discussed.

Purpose Determine whether patient pain and function are similar following hip abductor repair in patients without and with total hip arthroplasty (THA). Methods Patients who underwent hip abductor repair were categorized as to whether they had a THA or not. Pre- and postoperative pain and Harris Hip Score (HHS) were recorded and compared between groups. Results There were no differences in improvement in pain level, improvement in HHS, satisfaction with surgery. Conclusions Hip abductor repair leads to similar pain, function, and satisfaction in patients without and with THA.

Enoxaparin is a widely used low-molecular-weight heparin for perioperative thromboembolic prophylaxis. Enoxaparin-induced skin necrosis in the setting of arthroplasty has been rarely reported in the literature with varying outcomes and management decisions. Our patient developed skin necrosis at his injection site and thrombocytopenia 10 days following left total knee arthroplasty surgery and after receiving subcutaneous Lovenox injections postoperatively. The patient was started on an alternative anticoagulation based on a high suspicion for heparin-induced thrombocytopenia and the wound was monitored without surgical debridement. Our case highlights the key clinical management decisions when facing this potentially life-threatening adverse reaction. Keywords: Lovenox, Enoxaparin, Skin necrosis, Adverse reaction, Arthroplasty

The increasing demand for total hip arthroplasty (THA) in relatively young, high-demand patients has led to the use of hard-on-hard bearing surfaces. Adverse local tissue reaction/pseudotumor and elevated serum metal ion levels are commonly reported complications encountered in metal-on-metal THA, while audible articulation and rim fracture are reported in ceramic-on-ceramic THA. For this reason, ceramic-on-metal THA was implemented as an ideal hard-on-hard bearing combination. In this report, we describe a case of bilateral simultaneous ceramic-on-metal THA in a 69-year-old woman who presented 7 years postoperatively with unilateral hip pain associated with underlying pseudotumor and elevated serum cobalt and chromium ion levels. Pre-revision workup, intraoperative findings, and postoperative evaluation are included and suggest acetabular malposition as a potential source for complication. Keywords: Total hip arthroplasty, Adverse local tissue reaction, Pseudotumor, Hard-on-hard, Ceramic-on-metal

Total knee arthroplasty (TKA) may decrease coronary heart disease (CHD) risk in patients with advanced osteoarthritis by reducing pain and allowing for a more active lifestyle. We examined cardiovascular fitness, CHD risk factors, and quality of life in patients for 1 year after TKA compared with matched controls who did not undergo surgery. A total of 14 patients, 7 surgery patients and 7 matched controls, were tested for measurements of body composition, knee range of motion, resting blood pressure, strength testing, a maximal exercise test, quality-of-life questionnaires (Medical Outcomes Study Short Form-36 and Knee Osteoarthritis Outcome Score [KOOS]), and activity monitoring, fasting blood glucose, and lipids at 0, 3, 6, and 12 months after surgery or baseline testing. Comparison between the two groups was analyzed. Twelve months after surgery, patients with TKA had significantly (p

Background Previous studies have noted the progression of arthritis due to increased forces in articular structures adjacent to a fused joint. It is unknown whether spinal fusion generates increased forces at the hip joint causing progression to arthritis leading to total hip arthroplasty (THA). We sought to determine (1) is there a relationship between spinal fusion and THA, (2) what are risk factors for subsequent THA, and (3) is there a time interval from spinal fusion to THA? Methods A large patient discharge dataset was utilized to evaluate all patients who underwent spinal fusion and subsequent THA in California from 2004 through 2013. Patients were categorized by age, sex, hospital type, hospital volume, and number of spinal levels fused. Multivariate analysis was performed to investigate the relationship between spinal fusion and THA. Hazard ratios were calculated for risk factors for THA after spinal fusion. Patients were excluded for previous spinal fusion or hip arthroplasty, inflammatory arthropathy, cancer, and an age of ≤40 years, a surrogate for adolescent and neuromuscular scoliosis. Results A total of 101,206 patients underwent spinal fusion; 2,803 (2.77%) subsequently underwent THA. In a bivariate analysis comparing 1 to 2 levels versus >2 levels fused, males had a 17% increased relative risk of undergoing subsequent THA (relative risk [RR] = 1.17; 95% confidence interval [CI] = 1.16 to 1.17) and female patients had a 35% increased relative risk (RR = 1.35; 95% CI = 1.34 to 1.35) when the fusion involved >2 levels. For females, the relative risk increased by 119% when >7 levels were fused compared with 1 to 7 levels (RR = 2.19; 95% CI = 2.16 to 2.21). Using multivariate random-effects analysis, significant risk factors for THA after spinal fusion included female sex (hazard ratio [HR] = 1.21; 95% CI = 1.13 to 1.31; p 7 levels (HR = 1.52; 95% CI = 1.03 to 2.24; p = 0.035). Conclusions Patients with longer spinal fusion constructs, especially female patients, had a significantly increased risk of undergoing subsequent THA. Patients should be educated regarding the potential for the progression to hip arthritis after spinal fusion and the possibility of future THA. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background Prosthetic joint infections remain a significant cause of morbidity and are frustrating for patients and physicians alike. Unusual causes of infection may be seen in selected circumstances and a high index of suspicion and a careful history are required to ensure an accurate and timely diagnosis can be made. Case presentation We present a case of Mycobacterium bovis prosthetic joint infection secondary to intravesicular Bacillus Calmette-Guérin (BCG) treatment for prior bladder cancer definitively identified by spoligotyping. A favorable clinical outcome was observed following surgical intervention and a 12-month course of anti-mycobacterial therapy. Conclusions BCG therapy, a live attenuated strain of M. bovis, has become the mainstay of adjunctive therapy for bladder cancer and infectious complications, including those affecting the musculoskeletal system, may be seen years after initial therapy. An awareness of this complication and appropriate discussions with the institution’s microbiology laboratory may allow for an accurate and timely identification.

IntroductionSince the advent of antifibrinolytics, blood transfusions and their associated complications in total joint arthroplasty have decreased. Few studies have compared different antifibrinolytic types with respect to blood loss and transfusion rates. We sought to compare the blood loss and transfusion rates between epsilon-aminocaproic acid (EACA), tranexamic acid (TXA), and control.MethodsA total of 564 patients underwent primary total hip or total knee arthroplasty at our institution. Patients were divided into 3 groups: 183 EACA, 204 TXA, and 177 control. Patient demographics, hemoglobin, transfusion rates, and blood loss were collected.ResultsPatient preoperative variables were similar. The control group had a mean estimated blood loss (EBL) of 1.48 L, with 51 units of packed red blood cells (pRBCs) given and 14.7% of patients receiving a blood transfusion. The EACA group had an EBL of 1.33 L, with 20 pRBCs given and 10.9% of patients receiving a transfusion. The TXA group had an EBL of 1.05 L, with 3 pRBCs transfused in 0.98% of patients. Compared with the control group, blood loss (P = 0.0014; P < 0.0001), number of pRBCs given (P = 0.007; P < 0.0001), and number of patients transfused (P = 0.012; P < 0.0001) were significantly lower in the EACA and TXA groups, respectively. TXA had significantly lower blood loss (P < 0.0001), lower number of tranfusions (P = 0.005), and less patients transfused (P = 0.003) compared with EACA.ConclusionOur study reports lower blood loss, transfusion rates, and number of patients needing transfusion with both EACA and TXA in the setting of total joint arthroplasty. When comparing between EACA and TXA, TXA had lower blood loss, transfusion rates, and number of patients requiring transfusion.

Perioperative blood loss after total knee arthroplasty (TKA) affects postoperative recovery. Tranexamic acid is safe and efficient in reducing blood loss without increasing thromboembolic events. Epsilon-aminocaproic acid (ε-ACA) is less expensive than and as safe as tranexamic acid. Its efficiency when locally applied in TKA is unknown. The authors retrospectively followed 240 consecutive patients treated by 1 surgeon with TKA from January 2012 to August 2016. From January 2013 to May 2015, the authors topically applied 5 g of ε-ACA to the open wound after tourniquet release and before closure (ε-ACA-after-tourniquet-release group). From August 2015 to August 2016, the authors topically applied 5 g of ε-ACA intraoperatively to the open wound 3 minutes before tourniquet release (ε-ACA-before-tourniquet-release group). The last 80 patients not receiving ε-ACA (control group), the 80 patients in the ε-ACA-after-tourniquet-release group, and the 80 patients in the ε-ACA-before-tourniquet-release group were compared regarding blood loss, treatment costs, and thromboembolic complications. The mean±SD calculated blood loss was 1478.8±367.1 mL for the control group, 1424.0±249.3 mL for the ε-ACA-after-tourniquet-release group, and 1052.3±419.1 mL for the ε-ACA-before-tourniquet-release group ( P P Orthopedics. 2017; 40(6):e1044–e1049.]

A major risk factor for the development of surgical site infections is Staphylococcus aureus carriage. Compared with non-carriers, S. aureus carriers have up to a 14-fold greater risk for post-surgical infections. Pre-operative screening for S. aureus carriage is controversial. Yet, targeted screening in high-risk patients or from clinically relevant sites may be beneficial. We aimed to determine whether S. aureus detection in high-risk surgical patients would be increased by culturing surgical sites, in addition to the nares, vs. nares-only culturing.Adults undergoing pre-operative evaluations in orthopedic and neurosurgical clinics were eligible for participation. For each subject, specimens were collected from the anterior nares and from the proposed surgical site. Samples were inoculated onto methicillin-resistant S. aureus-selective chromogenic agar plates and blood agar plates.Of 150 subjects, 80 (53.3%) were women and 70 (46.7%) men. The mean age was 61 years and 77/150 (51.3%) had a BMI≥30. Culture results were available for 147/150 subjects. Of the 147 surgical site cultures, 54 (36.7%), 51 (34.7%), and 28 (19.0%) were collected from knee, hip, and lumbar sites, respectively; the remaining 14 (9.5%) were from cervical, thoracic, or infra-clavicular sites. Overall, 35/147 (23.8%) nasal cultures grew S. aureus; 29/147 (19.7%) grew methicillin-susceptible S. aureus (MSSA), and 6/147 (4.1%) grew methicillin-resistant S. aureus (MRSA). Only 2/147 (1.4%) surgical site cultures grew S. aureus; both grew MSSA and MSSA was cultured also from the nasal swabs of these subjects. Using nasal culture+surgical site culture as "true positive," the percentage of additional S. aureus carriers detected by the addition of surgical site screening was zero as compared to nasal screening alone.The detection of S. aureus carriage in high-risk surgical patients is not improved by swabbing surgical sites in addition to the nares.

Background Neuromuscular alterations have been reported for patients with osteoarthritis of the hip joint; however, the underlying cause associated with altered gluteus medius muscle function has not been examined. This study assessed electromyographic amplitudes of the gluteus medius muscles during function in patients with unilateral end-stage osteoarthritis of the hip joint compared to controls. Methods Patients with unilateral end-stage hip joint osteoarthritis (n = 13) and asymptomatic control participants (n = 17) participated. Average root-mean squared muscle amplitudes represented as a percent of maximum voluntary isometric contraction for both the involved and uninvolved limb gluteus medius muscles were analyzed during step up, step down, and gait. The association between muscle activation and impact forces during stepping tasks was assessed. Findings Patients with hip osteoarthritis exhibited increased gluteus medius muscle electromyographic amplitudes bilaterally during stair ascent, stair descent, and gait compared to controls, regardless of which limb they led. Involved limb muscle activity was inversely related to impact force during step down onto the ipsilateral limb. Interpretation Patients with hip osteoarthritis demonstrated increased gluteus medius muscle activation levels during stepping tasks and gait when compared to controls. The increased activation is most likely a compensatory response to muscle weakness. Therefore, application of strengthening exercises which target the gluteal muscles should assist in neuromuscular control and result in improved strength for patients with hip joint osteoarthritis.

To evaluate the peri-operative blood loss with the use of epsilon-aminocaproic acid (e-ACA) in total hip arthroplasty (THA). One hundred sixty patients treated with THA were followed; 5 g e-ACA diluted in 100 ml normal saline was applied intra-operatively. Eighty patients not receiving e-ACA (non e-ACA group) and eighty patients receiving e-ACA (e-ACA group) were compared regarding blood loss, need of transfusion, and thrombo-embolic complications. Blood loss (mean ± SD) for the non e-ACA group was 1678 ± 515 ml and for the e-ACA group 1403 ± 417 ml (p

The increasing use of digital technologies and e-learning in nursing education and the health professions was also reflected in the time to many studies and reviews. The aim of this overview was to analyze education through e-learning technologies for nursing and health professional students.A comprehensive search of literature was conducted using database PubMed/MEDLINE, Ebsco/CINAHL, 2003-2013.The search strategy resulted in the inclusion, in first instance, of 9732 items. After the reduction of duplicates, applying limits and other parameters of inclusion/exclusion and, at the end, evaluation of quality through AMSTARD check list, we included in this overview, 22 reviews. The analized reviews were allowed to spread in different topic areas: study population (students and faculty), e-learning methods (blended learning Game/3D/situated learning) and evaluation (information technology, learning satisfaction comparison of e-learning with the traditional teaching methods)This overview demonstrates that e-learning in nursing academic education is a valid alternative to traditional learning. If e-learning activities are well structured and modulated, some advantages and economies are clear possible. Regard effects of e-learning on the improvement of ability, data are at the momenti limited when compared to traditional learning. Often e-learning appear as an adjunct respect traditional learning, but is necessary consider e-learning and digital tecnology as priority for the future of education of nursing students.L’obiettivo di questa overview delle revisioni è quella di fornire un quadro dei vantaggi e degli svantaggi sull’utilizzo dell’e-learning in ambito accademico per la professione infermieristica. Per e-learning (letteralmente “apprendimento elettronico”) si intende l’insieme di tutte quelle metodologie e strategie didattiche finalizzate alla distribuzione di attività formative, informative e di aggiornamento tramite l'uso delle tecnologie multimediali e della rete internet.E’ stata effettuata una ricerca bibliografica delle revisioni sistematiche e integrative sulle banche dati PubMed/MEDLINE, Ebsco-CINAHL nel periodo 2003-2013 relativa all’e-learning per la formazione accademica nel settore infermieristico RISULTATI: L’interrogazione delle banche dati selezionate per le revisioni pubblicate nel periodo 2003-2013 ha riportato 9732 articoli. Dopo la riduzione dei duplicati, applicando limiti temporali e parametri di inclusione/esclusione e a seguito della valutazione delle revisioni attraverso la check-list AMSTAR, sono stati incluse 22 revisioni. I lavori esaminati hanno consentito di ripartire in diverse aree le tematiche trattate: la popolazione di studio (studenti e docenti) le metodologie (blended learning, Game/3D/situated learning) e le valutazioni (tecnologie informatiche, apprendimento/gradimento, confronto dell’e-learning con il metodo tradizionale) CONCLUSIONI: Questa overview dimostra che l’e-learning per la formazione accademica nel settore infermieristico rappresenta un’alternativa valida se ben strutturata e modulata, per parte delle attività didattiche in presenza, con conseguenti economie di scala. E’ richiesta tuttavia una concordanza tra metodo e percorso formativo ed è necessario un adeguato training per i formatori.

With the introduction of improved bearing surfaces for total hip arthroplasty (THA) has come a reintroduction of larger femoral heads with the promise of reducing the rate of hip instability and increasing hip range of motion (ROM). The size of femoral heads used for THA ranges from 22 to 40 mm, and even larger heads are used for hip resurfacing. With accurately positioned components, larger heads reduce the hip instability rate and theoretically increase hip ROM. However, for any given bearing surface, the volumetric wear rate is higher for larger heads than for smaller heads, which potentially jeopardizes the long-term survival of these reconstructions. In this article, we review the evidence for use of larger femoral heads with respect to stability, ROM, impingement, wear rate, bearing surfaces, and future directions.

In the present paper the new wind tunnel located in the Fluid-dynamic Laboratory of the Dipartimento di Ingegneria Meccanica e Gestionale (DIMeG) of the Bari Polytechnic will be shortly described and the first experimental measurements on a vertical axis wind turbine (VAWT) will be shown. The DIMeG wind tunnel has been designed by the research group on wind energy of the Department. It is a subsonic, closed loop, wind tunnel with a transparent test part where small scale models can be analyzed. A four bladed axial fan is driven by an asynchronous three phase electric motor, which is connected to an inverter in order to change the wind speed. Angular blades have been inserted at the two curves between the fan and the test section in order to increase the uniformity of the velocity profile after the two curves. An optimization fluid-dynamic study has been carried out in order to find the best blade profile. A honeycomb has been also inserted upstream the test section in order to destroy the still existing small vorticity generated by the fan and the curves. A three-axis traversing, called Cartesian robot, has been designed and built above the test section, in order to move the hot wire probe, for wind speed measurements, by means of four step by step electric motors controlled by a personal computer. A data acquisition system has been set up. All the principal commands and controls can be performed by a dedicated personal computer, which has been programmed using LabVIEW® G-programming language. The first experimental activity has been performed on a VAWT model, of the Giromill type with parallel blades. The turbine has been connected to an AC brushless servo, able to control the braking torque. Experimental results of the flow field in two horizontal planes have been set up using a two component hot wire probe (Dantec 55R51) calibrated with the manual system Dantec 54H10. The measurement grid adopted is formed by 20 nodes in the Y direction (main flow direction) and 10 nodes in the X direction.Copyright © 2010 by ASME

Skin and soft-tissue necrosis is a known, but rare, complication of warfarin administration. The diagnosis is usually guided by clinical suspicion, possible biopsy, and the exclusion of other diagnoses. The treatment is cessation of warfarin, local and/or surgical wound care, and medical therapy. Regardless of the treatment, the disease can lead to substantial morbidity or even death. We report the case of a patient who underwent total knee arthroplasty and developed tissue necrosis localized to the area of surgery. To the best of our knowledge, this complication previously has been reported only twice in the orthopaedic literature1,2. In these cases, the tissue necrosis occurred in multiple locations of the patient’s body. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. An eighty-three-year-old man with multiple medical comorbidities, including atrial fibrillation, underwent a primary right total knee arthroplasty. A tourniquet was used only during the cementing portion. No drain was used. There were no perioperative complications. Preoperatively, the patient had been on chronic warfarin therapy for the atrial fibrillation, but the warfarin had been stopped for six days before the procedure. In the five months prior to stopping the warfarin, the international normalized ratio (INR) ranged from 1.7 to 2.1. After surgery, the patient was treated with enoxaparin while hospitalized, and warfarin therapy was resumed. On postoperative day three, the skin around the incision appeared slightly swollen and ecchymotic but was within normal expectations, and the patient was discharged home. On postoperative day four, the patient presented to the emergency room because of increased pain and inability to mobilize, and he was admitted to the hospital. The knee was swollen and mildly erythematous and had some new hemorrhagic blisters. On postoperative day five, blisters were noted on the …

Five different intertarsal arthrodeses were simulated in 15 fresh cadaver feet/ankles utilizing external fixation. Pin placement was verified radiographically. Range of motion measurements were performed before pin placement, after pin placement, and after simulated arthrodesis. The deficit in foot motion created by selected limited intertarsal fusions was then measured. The prearthrodesis range of motion measurements were found to be dorsiflexion (DF), 27°; plantarflexion (PF), 57°; total inversion (INVT), 29°; eversion total (EVT), 22°; hindfoot varus (VRH), 16°; hindfoot valgus (VLH), 12°. The deficits in motion after arthrodesis were as follows. Ankle (tibiotalar): DF, 50.7%; PF, 70.3%; INVT, 8.7%; EVT, 9.4%; VRH, 34.6%; VLH, 27.8%. Hindfoot arthrodesis (Tibiotalar calcaneal): DF, 53%; PF, 71.3%; INVT, 49.5%; EVT, 47.6%, VRH, 100%; VLH, 100%. Pantalar (Tibotalar calcanea cuboid navicular): DF, 62.8%; PF, 82.2%; INVT, 71.7%; EVT, 67.4%; VRH, 100%; VLH, 100%. Triple (Talocalcaneal cuboid navicular): DF, 12.5%; PF, 15.5%; INVT, 50%; EVT, 51.4%; VRH, 60.5%; VLH, 60.5%. Total tarsal arthrodesis: DF, 78.5%; PF, 90.2%, INVT, 87.5%; EVT, 83.6%; VRH, 100%; VLH, 100%.