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Total ankle arthroplasty (TAA) improves gait symmetry in patients with unilateral end‐stage ankle arthritis but has not been studied in patients undergoing bilateral TAA (B‐TAA), and few studies compare TAA patients to control subjects. The purpose of this study was to compare gait symmetry in U‐TAA and B‐TAA patients and healthy controls. Using prospective databases, 19 unilateral and 19 bilateral ankle arthritis patients undergoing TAA were matched to 19 control subjects by age, sex, and BMI. The Normalized Symmetry Index (NSI) was determined for joint mechanics and ground reaction forces (GRF) during walking trials at a single visit for controls and preoperatively and 1 to 2 years postoperatively for TAA patients. Data was analyzed using linear mixed‐effects models to determine differences among time points and cohorts at a significance of α = 0.05. Following surgery, B‐TAA and U‐TAA experienced improved peak plantarflexion moment symmetry (p = 0.017) but remained less symmetric than controls. B‐TAA patients had more symmetry than U‐TAA patients during peak weight acceptance GRF (p = 0.002), while U‐TAA patients had greater peak dorsiflexion symmetry than B‐TAA patients. TAA patients demonstrated more asymmetry compared to control subjects for all outcome measures. There was no significant impact of TAA on gait symmetry for GRF or peak ankle angles, and neither U‐TAA nor B‐TAA was consistently associated with higher gait symmetry. These results indicate that TAA improves symmetry during peak plantarflexion moment, and that significant gait asymmetry persists for B‐TAA and U‐TAA patients compared to healthy participants. [ABSTRACT FROM AUTHOR]

背景：假体松动和磨损是导致全踝关节置换失败的主要原因, 其与骨-植入物界面的微运动、关节面的接触应力和关节运动密切相关。包 括衬垫和胫/距柄假体在内的人工关节部件的设计构造是影响踝关节受力、运动、接触界面微运动的关键因素, 开发新型衬垫对提高人工 踝关节生存率具有重要意义。 目的：构建全踝关节置换有限元模型用以检测多孔结构优化型衬垫的生物力学特性, 分析多孔结构优化型衬垫在减少假体微动和改善关节 面接触行为方面的作用。 方法：以一名健康成年人右踝关节CT扫描数据和INBONE Ⅱ系统产品手册为基础, 建立包括骨骼和人工关节系统的三维模型, 在经过截骨 和假体安装后获得全踝关节置换模型(模型A), 再通过对原始衬垫进行多孔结构改造获得G50型、G60型、D50型、D60型4种新型衬垫, 将 不同衬垫替换原始衬垫以建立与之相对应的优化型全踝关节置换模型(模型B-E), 在5个模型上施加步态载荷模拟步态工况。比较5种模型 植入物-骨界面微动和关节面接触行为的差异。 结果与结论：①在步态周期下4个优化型全踝关节置换模型的假体微动小于原始模型, 与模型A相比, 模型B-E假体微动数值上分别下降 5.4%, 10.1%, 8.1%及20.9%, 再者优化型模型在胫骨骨槽穹顶部的高微动区域较原始模型明显缩小；②4个优化型模型获得了更大的关节 面接触面积, 与模型A相比, 模型B-E衬垫接触面积均值分别增加了11.8%, 14.7%, 8.1%及32.6%；③与接触面积增大的效果类似, 相较于 原始模型, 优化型模型的关节面接触应力不同程度下降, 其中模型E的数值下降最为显著(P < 0.05), 归功于构成D60型衬垫Diamond晶格良 好的力学属性和较大的孔隙率；④结果表明全踝关节置换使用多孔结构改良衬垫可以提高衬垫的弹性, 增加其吸收关节冲击力的能力, 为 降低植入物-骨界面微动和改善关节接触行为创造有利条件。 [ABSTRACT FROM AUTHOR]

End‐stage ankle arthritis is often treated surgically by total ankle arthroplasty (TAA) due to its potential to improve gait through increased joint range of motion and reduce pain. However, TAA's effect on gait stability is not well understood. This study explores the impact of TAA on gait stability, measured by Margin of Stability (MoS), in 148 patients with end‐stage ankle arthritis. Kinematic data were collected pre‐operatively, at 1‐year post‐op, and at 2‐years post‐op and the MoS was determined at heel strike and midstance for the anteroposterior (MoSAP) and mediolateral (MoSML) directions. A linear mixed effects model including gait speed as a factor was used to assess the effects of limb, session, and their interaction on outcome measures. A significant interaction (p < 0.002) between limb (surgical, nonsurgical) and session (pre‐op, 1‐year post‐op, 2‐years post‐op) was identified for each MoS variable of interest. Cumulatively, our results suggest that the nonsurgical limb, MoSAP at heel strike and MoSML at midstance improved (increased) as time from surgery increased. These results suggest patients developed a compensatory movement pattern to navigate surgical limb single support. TAA reduces this compensation improving side‐to‐side symmetry, while not fully restoring symmetry by 2‐years post‐op. These results indicate that TAA could improve gait stability in patients with end‐stage ankle arthritis, but further work is needed to understand the impact of TAA on altering fall risk. [ABSTRACT FROM AUTHOR]

In the past decade, the transfibular approach to Total Ankle Replacement (TAR) has emerged as an alternative to anterior approach with reduced bone resection. The purpose of this systematic review is to report survival, complications, and reoperation rates of transfibular TAR. We conducted a systematic search of studies that evaluated complications, reoperations, and survival of transfibular TAR following PRISMA guidelines across PubMed, Scopus and Web of Science. Our review included data from 12 cohorts, comprising 919 patients across 7 countries, with an average age of 62 years (59% posttraumatic). Over an average follow-up period of 3 years, adverse events occurred in 23% of cases, with 18% requiring surgical reintervention, mostly due to hardware removal. The survival rate of the transfibular TAR metal components was 97% at the final follow-up. Transfibular TAR demonstrates a 97% survival rate at a 3-year follow-up. Level II [ABSTRACT FROM AUTHOR]

Background: The treatment of failed ankle replacements is debated, and little is published about the medium- and long-term results of revision implants. We wanted to examine prosthesis survival and physical function at least 5 years after insertion of the Salto XT revision prosthesis. Methods: All consecutive patients operated with a Salto XT revision prosthesis underwent clinical and radiologic examinations preoperatively and after 3, 12, 24, and 60 months. Complications and reoperations are described, and changes in patient-reported outcome measures and clinical scores are reported. Results: Thirty patients were operated with a Salto XT revision prosthesis between March 2014 and March 2017. Three of these were revised (1 to a fusion and 2 to a new prosthesis), and 3 patients were reoperated with screw removal. A concurrent subtalar fusion was performed on 13 patients, and there was 1 case of likely nonunion after these procedures, but no reoperations. The mean AOFAS score increased from 39.2 (95% CI 30.8-47.5) preoperatively to 75.1 (95% CI 67.3-82.9) after 5 years, and the mean improvement was 34.2 points (95% CI 23.8-44.6). Mean EQ-5D increased from 0.36 (95% CI 0.30-0.42) preoperatively to 0.74 (95% CI 0.64-0.85) after 5 years, an improvement of 0.34 (95% CI 0.19-0.49). Radiolucent lines were present in all but 3 patients. Five-year prosthesis survival was 93% (83.6-100). Conclusion: This is the first study to present medium-term results of this implant. We found good improvement in outcome scores and good implant survival, but also a high prevalence of radiolucent lines. [ABSTRACT FROM AUTHOR]

Talar avascular necrosis (AVN) is a devastating condition that frequently follows type III and IV talar neck fractures. As 60% of the talus is covered by hyaline cartilage, its vascular supply is limited and prone to trauma, which may eventually lead to AVN development. Early detection of AVN (Hawkins sign, MRI) is crucial, as it may prevent the development of the irreversible stages III and IV of AVN. Alertness is advised regarding non-obvious conditions that may cause this complication (sub chondroplasty, systemic lupus erythematosus, diabetes mellitus). Although, in stages I–II, AVN may be treated with non-surgical procedures (ESWT therapy, non-weight bearing) or joint-sparing techniques (core drilling, bone marrow aspirate injections), stages III–IV require more advanced procedures, such as joint-sacrificing procedures (hindfoot arthrodesis/ankle arthrodesis), or replacement surgery, including total talar replacement (TTR) or combined total ankle replacement (TAR). The advancement of 3D-printing technology and increased access to implant manufacturing are contributing to a rise in the production rates of third-generation total talar prostheses. As a result, there is a growing frequency of alloplasty procedures and combined total ankle replacement (TAR) surgeries. By performing TTR as opposed to deses, the operator avoids (i) delayed union, (ii) a shortening of the limb, (iii) a lack of mobility, and (iv) the stiffening of adjacent joints, which are the main disadvantages of joint-sacrificing procedures. Simultaneously, TTR and combined TAR offer (i) a brief period of weight-bearing restriction, (ii) quick pain relief, and (iii) preservation of the length of the limb. Here, we summarize the most up-to-date knowledge regarding AVN diagnosis and treatment, with a special focus on the role of TTR. [ABSTRACT FROM AUTHOR]

Total ankle arthroplasty (TAA) is a motion-preserving treatment for end-stage ankle arthritis. An effective tool for analyzing these implants' mechanical performance and longevity in silico is finite element analysis (FEA). An FEA in ABAQUS was used to statically analyze the mechanical behavior of the ultra-high-molecular-weight polyethylene (UHMWPE) bearing component at varying dorsiflexion/plantarflexion ankle angles and axial loading conditions during the stance phase of the gait cycle for a single cycle. The von Mises stress and contact pressure were examined on the articulating surface of the bearing component in two newly installed fixed-bearing TAA implants (Wright Medical INBONE II and Exactech Vantage). Six different FEA models of variable ankle compressive load levels and ankle angle positions, for the varying subphases of the stance phase of the gait cycle, were created. The components in these models were constrained to be conducive to the bone–implant interface, where implant loosening occurs. Our results showed that the von Mises stress and contact pressure distributions increased as the compressive load increased. The highest stress was noted at dorsiflexion angles > 15°, in areas where the UHMWPE liner was thinnest, at the edges of the talar and UHMWPE components, and during the terminal stance phase of the gait cycle. This static structural analysis highlighted these failure regions are susceptible to yielding and wear and indicated stress magnitudes that are in agreement (within 25%) with those in previous static structural TAA FEAs. The mechanical wear of the UHMWPE bearing component in TAA can lead to aseptic loosening and peri-implant cyst formation over time, requiring surgical revision. This study provides ankle replacement manufacturers and orthopedic surgeons with a better understanding of the stress response and contact pressure sustained by TAA implants, which is critical to optimizing implant longevity and improving patient care. [ABSTRACT FROM AUTHOR]

Individuals with myelomeningocele (MMC) present with neurological and orthopaedic deficiencies, requiring orthoses during walking. Orthoses for counteracting dorsiflexion may restrict activities such as rising from a chair. How are sit-to-stand (STS) movements performed with ankle joint-restricted ankle-foot orthoses (AFO) and knee-ankle-foot orthoses with a free-articulated knee joint (KAFO-F)? Twenty-eight adults with MMC, mean age 25.5 years (standard deviation: 3.5 years), were divided into an AnkleFree group (no orthosis or a foot orthosis) and an AnkleRestrict group (AFOs or KAFO-Fs). Study participants performed the five times STS test (5STS) while their movements were simultaneously captured with a three-dimensional motion system. Centre of mass (CoM) trajectories and joint kinematics were analysed using statistical parametric mapping. The AnkleRestrict group performed the STS slower than the AnkleFree group, median 8.8 s (min, max: 6.9, 14.61 s) vs 15.0 s (min, max: 7.5, 32.2 s) (p = 0.002), displayed reduced ankle dorsiflexion (mean difference: 6°, p = 0.044) (74–81 % of the STS cycle), reduced knee extension (mean difference: 14°, p = 0.002) (17–41 % of the STS cycle), larger anterior pelvic tilt angle (average difference: 11°, p = 0.024) (12–24 % of the STS cycle), and larger trunk flexion angle (on average 4°, p = 0.029) (6–15 % of the STS cycle). The differences between the AnkleFree and AnkleRestrict groups in performing the STS seem consistent with the participants functional ambulation: community ambulation in the AnkleFree group, and household and nonfunctional ambulation with less hip muscle strength in the majority of the AnkleRestrict group. No differences in the 5STS CoM trajectories or the kinematics were found with respect to the AFO and KAFO-Fs groups. Because orthoses are constructed to enable walking, the environment needs to be adjusted for activities in daily living such as the STS movement. • Orthoses for walking require restricted ankle dorsiflexion in individuals with MMC. • A blocked ankle hampers forward movement altering sit-to-stand (STS) movements. • The effort required to perform STS in everyday activities should be acknowledged. • The findings highlight the importance of adjusting the environment with external support. [ABSTRACT FROM AUTHOR]

Total ankle arthroplasty (TAA) is used to treat symptomatic end-stage ankle arthritis (AA). However, little is known about TAA's effects on gait symmetry. Determine if symmetry changes from before surgery through two years following TAA utilizing the normalized symmetry index (NSI) and statistical parametric mapping (SPM). 141 patients with end-stage unilateral AA were evaluated from a previously collected prospective database, where each participant was tested within two weeks of surgery (Pre-Op), one year and two years following TAA. Walking speed, hip extension angle and moment, hip flexion angle, ankle plantarflexion angle and moment, ankle dorsiflexion angle, weight acceptance (GRF1), and propulsive (GRF2) vertical ground reaction forces were calculated for each limb. Gait symmetry was assessed using the NSI. A linear mixed effects model with a single response for each gait symmetry variable was used to examine the fixed effect of follow-up time (Pre-Op, Post-1 yr, Post-2 yr) and the random effect of participant with gait speed as a covariate in the model. A one-dimensional repeated measures analysis of variance (ANOVA) statistical parameter mapping (SPM) was completed to examine differences in the time-series NSI to determine regions of significant differences between follow-up times. Relative to Pre-Op values, GRF1, and GRF2 showed increased symmetry for discrete metrics and the time-series NSI across sessions. Hip extension moment had the largest symmetry improvement. Ankle plantarflexion angle was different between Pre-Op and Post-2 yr (p=0.010); and plantarflexion moment was different between Pre- Op and each post-operative session (p<0.001). The time-series Ankle Angle NSI was greater during the early stance phase in the Pre-Op session compared to Post-2 yr. Symmetry across most of the stance phase improved following TAA indicating that TAA successfully improves gait symmetry and future work should determine if these improvements restore symmetry to levels equivalent with health age-match controls. • At Post-1 yr and −2 yr, TAA patients have improved gait symmetry and gait speed. • Peak vertical GRF and Ankle plantarflexion moment symmetry improve following TAA. • Gait symmetry improves throughout most of the stance phase of gait after TAA. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to reveal the morphometry of the distal tibia and posterior malleolus and to generate morphometric reference data for the tibial component of total ankle prosthesis. Methods: This study was performed on 121 human dry tibiae (47 right, 74 left). The morphometric measurements of distal tibial structures, tibial length and the distance between the medial and posterior malleolus were measured in this study. Measurements on 44 tibiae were repeated three times and averaged for minimizing intra-observer error. Results: The tibial length was found 34.19 ± 2.31 cm. Mean values of width of fibular notch at tibial plafond and 10 mm proximal to the tibial plafond were 25.71 ± 2.44 mm and 17.81 ± 2.46 mm, respectively. Mean depth of fibular notch at tibial plafond and 10 mm proximal to the tibial plafond were 3.60 ± 1.04 mm and 3.37 ± 1.24 mm, respectively. Mean height of fibular notch was found 48.21 ± 10.51 mm. Mean width and height of medial malleolus were 25.08 ± 2.13 mm and 14.73 ± 1.85 mm, respectively. Mean width and length of tibial plafond were 27.71 ± 2.74 mm and 26.96 ± 2.62 mm, respectively. Mean values of width and height of posterior malleolus were measured 21.41 ± 3.26 mm and 6.74 ± 1.56 mm, respectively. Mean distance between medial and posterior malleolus was found 37.17 ± 3.53 mm. Mean width and depth of malleolar groove were 10.26 ± 1.84 mm and 1.73 ± 0.75 mm, respectively. The mean intra-class correlation values were found between the 0.959 and 0.999. Conclusions: Knowing the distal tibial morphometry is crucial for designing convenient ankle replacement implants for Turkish population. To our knowledge, this study is the first in the literature that identifies posterior malleolar morphometry on dry tibiae. We believe that this study will make a significant contribution to the literature about distal tibial morphometry and especially the posterior malleolus and the data of our study can be used for designing total ankle prosthesis in Turkish population. [ABSTRACT FROM AUTHOR]

The use of antibiotic-loaded bone cement (ALBC) as a mean for preventing deep surgical site infections (SSI) after total joint replacement is controversial. Therefore, we have conducted a meta-analysis to evaluate the prophylactic effect of ALBC for SSI prevention in patients undergoing arthroplasty. This study was conducted to revise treatment guidelines for MRSA infections in Japan. PubMed (Medline), Scopus, Embase, Web of Science and Cochrane library were searched for relevant articles comparing preventive effect of ALBC for patients undergoing primary total joint arthroplasty by August 2022. Primary outcome was the incidence of deep SSI. Subgroup analyses by type of surgery (total hip (THA) or knee (TKA) arthroplasty) and by causative pathogen (methicillin-resistant Staphylococcus aureus (MRSA)) were performed. Of the 3379 studies identified for screening, six studies involving 5745 patients were included. The use of ALBC significantly reduced the incidence of deep SSI in overall patients (risk ratio [RR] 0.60, 95% confidential interval [CI] 0.39–0.92), but the evidence level was very low. There was no significant preventive effect for ALBC compared with non-ALBC in both THA and TKA (THA, RR 0.52, 95% CI 0.23–1.16; TKA, RR 0.64, 95% CI 0.38–1.06), and for preventing MRSA-SSI (RR 0.27, 95% CI 0.03–2.41). Although the overall preventive effect of ALBC was significant, the evidence level was very low. Thus, the routine use of ALBC as a mean to prevent SSI in arthroplasty may not be suggested. [ABSTRACT FROM AUTHOR]

Background: There are limited data regarding risk factors associated with periprosthetic medial malleolar fractures in total ankle arthroplasty (TAA). This case-control study aimed to identify the risk factors and analyze the effect of prophylactic screw fixation in preventing a medial malleolar fracture after TAA. Methods: A case-control study was conducted on 149 patients who underwent primary TAA. Twenty patients with postoperative medial malleolar fractures >4 weeks postoperatively (cases) were identified. An additional 129 patients (controls) were randomly selected from the TAA database. Radiographic evaluation included tibial component coronal alignment and postoperative medial malleolar width. Demographics and radiographic variables were compared between cohorts. Logistic regression was used to investigate the association between medial malleolar fracture and postoperative coronal alignment, medial malleolar width, and prophylactic fixation of the medial malleolus. Results: Mean (SD) medial malleolar width was significantly smaller in the fracture cohort (8.52 mm [1.6]) than in the control group (11.78 mm [1.74]) (P <.001). Mean (SD) tibial component coronal alignment was 92.17 degrees (2.77) in the fracture cohort and 90.21 degrees (1.66) in the control group (P =.002). Regression analysis identified a significant negative association between postoperative medial malleolar width and the probability of fracture (OR = 0.06, 95% CI 0.01, 0.26, P <.001). Varus malalignment of the tibial component was positively associated with the probability of fracture (OR = 1.90, 95% CI 1.27, 2.86, P =.002). Prophylactic screw fixation resulted in more than 90% reduction in the odds of a fracture (OR = 0.04, 95% CI 0.01, 0.45, P =.01). ROC curve analysis determined a medial malleolar width of 10.3 mm as a potential threshold for predicting fracture. Conclusion: Decreased medial malleolar width and postoperative varus malalignment were associated with an increased risk of postoperative medial malleolar fracture. Therefore, surgeons should consider prophylactic screw fixation in patients with a medial malleolar width <10.3 mm or at risk of postoperative varus deformity. [ABSTRACT FROM AUTHOR]

Background: The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants, which offer an alternative salvage option for failed total ankle replacements. Methods: A prospective observational study was performed of 6 cases of failed total ankle replacements that were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification, and a treatment algorithm were developed based on our initial experience. Results: Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow-up was available for all cases. The mean follow-up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 (P <.05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 (P <.05) and the EQ-VAS also improved from 53.0 to 63.3 (P =.36). The mean VAS-Pain score at final follow-up was 27.5. There were no cases of nonunion. None of the patients were smokers. The overall complication rate was 50%. Two patients returned to surgery: one for wound washout following TAR explantation and a second for removal of metalwork 2 years following surgery for a prosthetic joint infection secondary to hematogenous spread. No patients underwent revision fixation or amputation. Conclusion: Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable treatment option for failed total ankle replacements. [ABSTRACT FROM AUTHOR]

Background: The literature on survivorship and outcomes after revision total ankle replacement (TAR) in the modern era is limited. This study aimed to describe the timing to revision and survivorship after revision TAR. We hypothesized that tibial-sided failures would occur earlier after the primary TAR, and secondary revisions after failure of revision TAR would occur more due to talar-sided failures than tibial-sided failures. Methods: This is a single-institution retrospective study of TAR patients with minimum 2-year follow-up. Revision TARs (defined as exchange of tibial and/or talar components) for aseptic causes with any implant were included. Etiology of failure necessitating revision and ultimate outcomes after revision (survival of TAR revision, additional revision, conversion to fusion, and below-knee amputation [BKA]) were recorded. Results: There were 46 revision TARs, with mean age of 60.6 (range: 31-77) years and mean 3.5 years' follow-up postrevision. Revisions for tibial failure occurred significantly earlier (n = 22, 1.3 ± 0.5 years after index procedure) than those for talar failure (n = 19, 2.3 ± 1.7 years after index procedure) or combined tibial-talar failure (n = 5, 3.4 ± 3.4 years after index procedure) (P =.015). Revisions for tibial-only failure had better survival (95.5%) than revisions for talar or combined tibial-talar failures: 26% of talar failures and 20% of combined tibial-talar failures underwent ≥1 revisions. Of the 6 additional revisions after failure of the talar component, 1 ultimately underwent BKA, 2 were converted to total talus replacement, 2 were revised to modular augmented talar components, and 1 was treated with explant and cement spacer for PJI after the revision. Conclusion: TAR tibial failures occurred earlier than talar failures or combined tibial-talar failures. Revisions for talar failures and combined tibial-talar failures were more likely to require additional revision or ultimately fail revision treatment. This is important given the consequences of talar implant subsidence, bone necrosis, loss of bone stock, and limited salvage options. [ABSTRACT FROM AUTHOR]

Metals, ceramics, and polymers are commonly used as orthopedic implant materials. Conventionally, Cobalt Chromium (CoCr) alloys, Titanium (Ti) alloys, Alumina (Al2O3) ceramic, Hydroxyapatite (HA), and Polyetheretherketone (PEEK) are used. Bone resorption owing to stress shielding is one of the reasons for the failure of total ankle replacement (TAR). The stiffness mismatch between the tibia bone and the implant is responsible for stress shielding. It is hypothesized that stress shielding can be reduced by tailoring the implant material similar to the tibia bone by using functionally graded materials (FGMs). The aim of the study is to understand the effect of FGMs on the stress shielding of the tibia bone for TAR. Finite element (FE) models were prepared for, the natural bone, and the implanted bone with the tibial component made from CoCr alloy, Ti alloy, Al2O3 ceramic, FGM of Al2O3 ceramic at the bottom and PEEK at the top, and FGM of Ti at the bottom and HA at the top. Material properties for FGMs were assigned using Ansys APDL code. The results indicated that the highest stress shielding was present in the Al2O3 ceramic model. Whereas, the least stress shielding was in the Ti + HA FGM model. This implies that the stress shielding and subsequently the bone resorption can be reduced by using the FGMs. Thus, FGMs are advantageous when compared to conventional implant materials in order to reduce stress shielding. [ABSTRACT FROM AUTHOR]

Abstract Background In symptomatic end-stage osteoarthritis of the ankle joint, total ankle replacement and ankle arthrodesis are the two primary surgical options for patients for whom conservative treatment fails. Published revision rates are often biased and difficult to compare. In this study, unplanned reoperation rates and revision rates were determined for both surgical interventions based on a large dataset, and risk factors for unplanned reoperations were identified. Methods German-wide health data of the largest German health-care insurance carrier between 2001 and 2012 were retrospectively analyzed, and unplanned reoperation rates within 10 years were determined for index surgeries conducted in 2001 and 2002. Unplanned reoperation rates within 5 years for index surgeries conducted in 2001/2002 were compared to index surgeries conducted in 2006/2007. Multivariate logistic regression was used to identify risk factors for unplanned reoperations. Results After ankle arthrodesis, 19% (95% confidence interval [CI], 16–22%) of 741 patients needed to undergo an unplanned reoperation within ten years. After total ankle replacement, the unplanned reoperation rate was 38% [95% CI, 29–48%] among 172 patients. For initial surgeries conducted at a later date, unplanned reoperation rates within five years were 21% [95% CI, 19–24%] for 1,168 ankle arthrodesis patients and 23% [95% CI, 19–28%] for 561 total ankle replacement patients. Significant risk factors for unplanned reoperations after ankle arthrodesis in the initial cohort were age

Objective Methods Results Conclusion Currently, the traditional treatment of moderate‐to‐severe ankle arthritis is joint fusion or joint replacement. The aim of this article is to explore the clinical efficacy of distraction arthroplasty in the treatment of moderate‐to‐severe ankle arthritis.A retrospective analysis was conducted with a total of 34 cases who were diagnosed with moderate‐to‐severe ankle arthritis and treated by distraction arthroplasty from January 2007 to November 2021. The average age was 42.3 years. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle–hindfoot score and pain visual analog scale (VAS) were used to evaluate ankle pain and functional improvement before surgery and at the last follow‐up. Based on age, the patients were divided into the ≤45‐year‐old group [young group, 15 cases, age (36.37 ± 4.31) years old] and the >45‐year‐old group [middle‐aged and elderly group, 19 cases, age (53.74 ± 3.17) years old]. The analysis included comparing preoperative and postoperative AOFAS ankle–hindfoot and VAS scores and the influence of age on distraction arthroplasty.All 34 patients were followed up, and the follow‐up time ranged from 13 to 143 months, with an average of 45.3 months. The follow‐up times for the young and middle‐to‐elderly groups were (33.19 ± 21.37) months and (55.63 ± 29.69) months, respectively. At the last follow‐up, the AOFAS ankle–hindfoot and VAS scores were significantly improved compared with the preoperative assessment (p < 0.05). According to the etiological analysis, except for Pilon fracture, which showed no differences pre‐ and postoperation in the AOFAS ankle–hindfoot score and VAS score (p > 0.05), all other patients showed significant differences in these two scores (p < 0.05). The difference in preoperative AOFAS ankle–hindfoot scores between the young and middle‐to‐elderly groups was statistically significant (t = 3.422, p = 0.021). The preoperative and postoperative comparison of preoperative VAS scores, AOFAS ankle–hindfoot scores, and VAS scores before and after surgery showed no differences (p > 0.05). The joint space width (JSW) of 10 patients who were followed up for more than 5 years was (2.9 ± 0.5) mm. Two patients who were followed up for more than 10 years showed 3.3 and 3.0 mm, respectively, JSW.Distraction arthroplasty with the Ilizarov external fixator can achieve satisfactory results in the treatment of moderate‐to‐severe ankle arthritis (except arthritis caused by Pilon fracture surgery). Age has no statistical impact on the efficacy of distraction arthroplasty. [ABSTRACT FROM AUTHOR]

This study aimed to develop and evaluate a deep learning-based system for the automatic measurement of angles (specifically, Meary's angle and calcaneal pitch) in weight-bearing lateral radiographs of the foot for flatfoot diagnosis. We utilized 3960 lateral radiographs, either from the left or right foot, sourced from a pool of 4000 patients to construct and evaluate a deep learning-based model. These radiographs were captured between June and November 2021, and patients who had undergone total ankle replacement surgery or ankle arthrodesis surgery were excluded. Various methods, including correlation analysis, Bland–Altman plots, and paired T-tests, were employed to assess the concordance between the angles automatically measured using the system and those assessed by clinical experts. The evaluation dataset comprised 150 weight-bearing radiographs from 150 patients. In all test cases, the angles automatically computed using the deep learning-based system were in good agreement with the reference standards (Meary's angle: Pearson correlation coefficient (PCC) = 0.964, intraclass correlation coefficient (ICC) = 0.963, concordance correlation coefficient (CCC) = 0.963, p-value = 0.632, mean absolute error (MAE) = 1.59°; calcaneal pitch: PCC = 0.988, ICC = 0.987, CCC = 0.987, p-value = 0.055, MAE = 0.63°). The average time required for angle measurement using only the CPU to execute the deep learning-based system was 11 ± 1 s. The deep learning-based automatic angle measurement system, a tool for diagnosing flatfoot, demonstrated comparable accuracy and reliability with the results obtained by medical professionals for patients without internal fixation devices. [ABSTRACT FROM AUTHOR]

Background: Although patient-reported outcomes (PROs), such as the Patient-Reported Outcomes Measurement Information System (PROMIS), are a key element of evaluating success after total ankle replacement (TAR), many do not explicitly state a key factor of postoperative success: is the patient satisfied with their outcome after TAR? The patient acceptable symptom state (PASS) represents the symptom threshold beyond which patients consider themselves well. This study aimed to establish the PROMIS thresholds for the PASS in a primary cohort of TAR patients. Methods: This single-institution study included 127 primary TAR patients with preoperative and 2-year postoperative PROMIS scores. At 2 years postoperatively, patients answered 2 PASS anchor questions (Satisfaction, Delighted-Terrible scale) with Likert-scale responses. PASS thresholds with 95% confidence intervals (CIs) were calculated from PROMIS scores using an anchor-based method. Using a bootstrapping technique with 1,000 iterations, the Youden index was calculated to determine the best specificity and sensitivity coordinates to maximize their combination. Finally, preoperative variables associated with the likelihood of achieving the PASS were assessed. Results: There was a strong association between PASS thresholds and PROMIS domains, especially Pain Interference (PASS threshold of <56.0, area under the receiver operating characteristic curve [AUC] = 0.940), Pain Intensity (<48.4, AUC = 0.936), and Physical Function (>44.7, AUC = 0.883). The likelihood of achieving the PASS was not affected by age, race, gender, American Society of Anesthesiologists (ASA) class, body mass index, or severity of ankle deformity. Patients with worse preoperative Physical Function and Global Mental Health scores were less likely to meet the PASS threshold for Physical Function postoperatively (p = 0.028 and 0.041). Conclusions: The ability to reach the PASS after TAR was most strongly associated with postoperative PROMIS pain scores. However, PASS thresholds were generally poorer than population means. This demonstrates that patients do not need to reach normal pain or physical function levels to have an acceptable symptom state after TAR. [ABSTRACT FROM AUTHOR]

Introduction: Noise-Induced Hearing Loss (NIHL) is a condition caused by repeated exposure to loud noise, with operating theatre personnel potentially at risk. The aims of this study were to establish the typical noise levels in orthopaedic theatres and to compare these to The Control of Noise at Work Regulations 2005. Materials and methods: We measured the average noise levels in 40 trauma and orthopaedic surgeries in a single centre. We used the Decibel X app to take measurements, then performed corrections to ascertain noise levels at the surgeon's ear (Leq). The daily noise exposure level for theatre staff for each procedure (LEP, d) and the LEP, d over an average 8-hour working day when performing different groups of procedures were calculated. Data were analysed using descriptive statistics, ANOVA, t-test and the Pearson coefficient of correlation. Results: The LEP, d lower action value (80 dBA) as set by the Health and Safety Executive (HSE) was met by performing a single revision total knee replacement or a right open ankle debridement. Assuming three procedures are conducted per list, lists consisting of joint replacements (82 dBA) or medium elective procedures (81 dBA) exceed this lower limit. Additionally, lists comprising large and medium bone fractures would be within 1 dB of the limit (79 dBA and 79 dBA, respectively). Soft tissue (74 dBA), arthroscopic (73 dBA), and small bone fracture (71 dBA) procedures had the lowest LEP, d. The greatest contributors to noise levels were surgical instruments. The number of people in the room made a significant difference to noise levels (p = 0.032). Conclusions: We have established the baseline noise levels in various orthopaedic procedures. Measures should be taken to meet UK regulations. Further research should determine suitable measures for protection from hearing damage for theatre staff and evaluate the risks high noise levels pose to patients. [ABSTRACT FROM AUTHOR]

Background: Although Total Ankle Arthroplasty (TAA) is primarily performed for post-traumatic ankle arthritis with joint disruption, anatomical landmarks for Joint Line (JL) level are typically preserved. However, severe Post-Traumatic Bone Loss (PTBL) or TAA revision may render some landmarks unidentifiable, challenging JL restoration. Methods: Patients undergoing customized TAA for severe PTBL or revision were enrolled. Custom-made implants, based on 3D CT scans, were designed to address bone defects and provide adequate bone support. Evaluated parameters, measured on bilateral ankle weight-bearing radiographs taken preoperatively and 6–8 months postoperatively, included JL Height Ratio (JLHR) and the distances from JL to the Lateral Malleolus apex (LM-JL), the posterior colliculus of the Medial Malleolus (MM-JL), and the Gissane Calcaneal Sulcus (CS-JL). Reproducibility and variability were assessed, and comparisons were made between radiological parameters measured at TAA and those at the contralateral ankle. Results: Thirteen patients were included. Intra- and interobserver reliability demonstrated excellent values. The least variability was observed in the LM-JL distance. Statistically significant correlations were found between CS-JL and MM-JL distances in the operated limb and between the CS-JL of the operated limb and the contralateral ankle. While TAA parameters did not show statistically significant differences compared with the contralateral ankle, a trend toward proximalization of the JL was noted. Conclusions: This study demonstrated good reproducibility of the analyzed parameters for evaluating JL in TAA among patients with severe PTBL or undergoing revision surgery. However, these parameters cannot be deemed fully reliable. Given their potential weaknesses, it is crucial to identify more reproducible values, preferably ratios. [ABSTRACT FROM AUTHOR]

Total ankle replacement is an established treatment for end-stage arthritis. However, there is little data examining outcomes in sequential bilateral replacements. This study aimed to compare outcomes between first and second ankles in sequential replacement. Patients were retrospectively contacted to complete a follow-up questionnaire including the Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D-3 L, and a question assessing satisfaction. Electronic records identified demographics, procedural details, and complications. Twenty patients underwent sequential bilateral ankle replacement over the study period. At a mean follow-up of four years, 18 patients completed the follow-up questionnaire. There was no statistically significant difference between first and second ankles in terms of MOXFQ score, EQ-5D-3 L or satisfaction. Eleven complications were noted. We report excellent outcomes after sequential bilateral ankle replacement with no difference in outcomes between first and second ankles. These results can be used to counsel patients in the future and manage expectations. IV. [ABSTRACT FROM AUTHOR]

This study seeks to evaluate the relationship between American Society of Anesthesiologist (ASA) score and postoperative outcomes following TAA. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2020 to identify 2210 TAA patients. Patients were stratified into low (n = 1328; healthy/mild systemic disease) or high (n = 881; severe/life-threatening systemic disease) ASA score cohorts. There was no statistically significant difference in complications, readmission, or reoperation rate based on ASA score. Increased ASA score was significantly associated with longer length of stay (low = 1.69 days, high = 1.98 days; p <.001) and higher rate of adverse discharge (low = 95.3 %, high = 87.4 %; p <.001). Higher ASA scores (3 and 4) were statically significantly associated with increased length of stay and non-home discharge disposition. These findings are valuable for physicians and patients to consider prior to TAA given the increased utilization of resources and cost associated with higher ASA scores. Level III, Retrospective cohort study [ABSTRACT FROM AUTHOR]

Revision of failed total ankle replacement (TAR) is challenging and associated with increased morbidity. Given the increased popularity of TAR in treating end-stage ankle arthritis (ESAA), viable revision options are needed. The objective of this case series is to present a minimum 2-year clinical and radiographic outcomes of patient-specific custom 3D-printed total ankle total talus (TATR) prostheses in this unique subset of patients. 19 participants with ESAA and failed primary TAR who underwent TATR by a single surgeon at our institution from 2019 to 2021 were retrospectively identified. All participants were indicated for revision of primary STAR implant (Stryker, Kalamazoo, MI) and underwent replacement with 3D-printed titanium implants based on preoperative CT analysis (Additive Orthopaedics, Little Silver, NJ). Custom components included a mobile-bearing total talus and stemmed tibial system, performed through an anterior approach. Pre- and postoperative patient-reported outcomes were assessed using the Patient Reported Outcomes Measurement Information System (PROMIS). Pre- and postoperative implant alignment was assessed using medial distal tibial angle (MDTA) and tibiotalar angle (TTA) on anteroposterior, and sagittal tibial angle (STA) on lateral weight-bearing plain films. The average patient age was 60.6 (range, 39–77) years, with an average follow-up of 37.9 (range, 25.3–57.5) months. There was statistically significant improvement in all PROMIS domains. Short-term survivorship was 100%, with two participants (11.0%) requiring reoperation for postoperative complications: one underwent open reduction internal fixation of the tibia for a periprosthetic fracture, and another underwent medial gutter debridement and tarsal tunnel release for recurrent pain. There were no significant differences in pre- versus postoperative radiographic alignment measured by MDTA (89.9 vs 86.4), TTA (89.7 vs 88.1), or STA (85.2 vs 85.3). Custom 3D-printed TATR is a promising option for revision TAR. There was significant short-term improvement in pain and physical function, with excellent short-term survivorship and an acceptable postoperative complication rate. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence The aim of this study is to investigate the cost‐effectiveness of revision total knee arthroplasty compared to primary total knee arthroplasty in terms of cost‐per‐quality‐adjusted life year (QALY).Data were retrieved for all primary and revision total knee replacement (TKA) procedures performed at a tertiary Swiss hospital between 2006 and 2019. A Markov model was created to evaluate revision risk and we calculated lifetime QALY gain and lifetime procedure costs through individual EuroQol 5 dimension (EQ‐5D) scores, hospital costs, national life expectancy tables and standard discounting processes. Cost‐per‐QALY gain was calculated for primary and revision procedures.EQ‐5D data were available for 1343 primary and 103 revision procedures. Significant QALY gains were seen following surgery in all cases. Similar, but significantly more QALYs were gained following primary TKA (PTKA) (5.67 ± 3.98) than following revision TKA (RTKA) (4.67 ± 4.20). Cost‐per‐QALY was €4686 for PTKA and €10,364 for RTKA. The highest average cost‐per‐QALY was seen in two‐stage RTKA (€12,292), followed by one‐stage RTKA (€8982).RTKA results in a similar QALY gain as PTKA. The costs of achieving health gain are two to three times higher in RTKA, but both procedures are highly cost‐effective.Economic level II. [ABSTRACT FROM AUTHOR]

This article explores the use of reverse V-shaped osteotomy as a treatment for ankylosing rocker-bottom foot deformity in patients with rheumatoid arthritis (RA). The study examined three cases where patients with RA and foot deformities underwent the procedure, which successfully corrected the deformities and improved their clinical scores. The authors suggest that reverse V-shaped osteotomy could be a valuable and definitive procedure for this type of foot deformity in RA patients. The study acknowledges the need for additional research and highlights some limitations. [Extracted from the article]

Purpose: This retrospective study aims to compare surgical outcomes between two cohorts of patients who underwent total ankle arthroplasty (TAA) using either standard technique or patient-specific instrumentation (PSI). Methods: A consecutive series of patients who affected of end-staged ankle osteoarthritis were retrospectively assessed and divided into two groups based on TAA techniques: a TAA standard technique group and a TAA-using PSI group. The two groups were compared in terms of operative time, additional procedures, complications (neurovascular and wound problems, infection, loosening and osteolysis, revision and explantation rates, and perioperative fracture), clinical scores, and range of motion (ROM). Result: Fifty-one patients underwent standard TAA, while 13 patients underwent TAA with PSI. At 1-year follow-up, there were no significant differences in complication rates between the two groups (p > 0.05). AOFAS scores were similar, with the standard TAA group scoring 83.33 ± 7.55 and the PSI group scoring 82.92 ± 9.7 (p = 0.870). Likewise, the postoperative ROM did not differ significantly, with 15.12 ± 7.6 degrees for the standard TAA group and 16.05 ± 6.7 degrees for the PSI group (p = 0.689). However, the standard TAA group experienced significantly longer operative time (107.1 ± 22.1 min) compared to the PSI group (91.92 ± 22.9 min, p = 0.032). Additionally, the standard TAA group required more adjunctive procedures (29.7%) compared to the PSI group (7.7%, p = 0.04). Residual pain was also more frequently reported in the standard TAA group (62.7%) than in the PSI group (30.7%, p = 0.038). Conclusion: While both techniques resulted in comparable complication rates, clinical scores and ROM, the PSI group reported significantly shorter operative time and less residual pain, thus requiring fewer postoperative procedures. [ABSTRACT FROM AUTHOR]

The success of uncemented total ankle replacement (TAR) is linked to initial stability because bony ingrowth depends upon limited early micromotion. Tibial implant design fixation features resist micromotion aided by bony sidewall retention and interference fit. Our goal was to investigate factors influencing implant‐bone micromotion in TAR. Two TAR tibial components were virtually inserted into CT‐derived computer models of two distal tibias from patients with end‐stage ankle arthritis. Density‐based inhomogeneous material assignment was used to model bone compaction during press‐fit. Finite element analysis (FEA) was used to simulate three fixation cases: (1) no sidewalls + line‐to‐line fit, (2) sidewalls + line‐to‐line fit, and (3) sidewalls + 50, 100, or 200 µm interference fit. Kinetic profiles from the stance phase of gait were simulated and micromotions computed from FEA output. Without sidewalls or interference fit, micromotions were largest in early and late stance, with largest micromotions (averaging ~150–250 µm) observed near heel strike. Micromotions decreased 39%–62% when sidewalls were retained. When interference fit was also modeled, micromotions decreased another 37%–61% to ~10 µm. Micromotion differences between patients persisted with sidewall retention but largely disappeared with interference fit. This study presents new insights into the effects of TAR fixation features on implant‐bone micromotion. Stability appeared to be influenced by surrounding bone quality, but this influence was greatly diminished when interference fit was introduced. More complete understanding of TAR implant features and performance is needed, but our results show the importance of bone quality and interference fit in the stability of uncemented TAR. [ABSTRACT FROM AUTHOR]

Background: This retrospective cohort study compared short-term complication rates following total ankle arthroplasty (TAA), alone or with concomitant procedures. Secondary independent risk factors were also examined as they related to postoperative outcomes. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using Current Procedural Terminology (CPT) codes to identify patients who underwent TAA (27702) between 2010 to 2021. Patients were divided into cohorts based on the presence or absence of ancillary procedures. Propensity score matching was employed to account for demographic differences, and statistical analyses were performed to compare short-term complication rates between matched cohorts. Results: A total of 2225 patients were identified, with 1432 (64.4%) receiving TAA alone and 793 (35.6%) with ancillary procedure(s). After matching, 793 patients were included in each cohort. The ancillary cohort had longer operative times (P <.001) and length of hospital stay (LOS) (P < 0.001). Rates for extended LOS were significantly higher in the ancillary cohort than in the simple cohort (P =.01). No other complications varied significantly between cohorts, including the incidence of any adverse event (AAE). American Society of Anesthesiologists classification of 4 was found to be an independent risk factor for development of AAE (odds ratio [OR] = 1.091, P =.04). Matched subgroup analysis excluding tendon lengthening as a concomitant procedure found that the ancillary cohort still had longer operative time (P <.001) and LOS (P <.05) than patients undergoing simple TAA. Conclusion: Without significant difference in rates of AAE other than extended LOS, the relative safety of ancillary TAA appears similar to that of TAA alone. Such knowledge can help inform surgical decision-making and assuage safety concerns for patients requiring additional corrective procedures at the time of TAA. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background: Total ankle arthroplasty (TAA) has primarily been performed in the inpatient setting. However, with the advent of fast-tracked joint arthroplasty protocols, TAA has slowly been shifting to the outpatient setting. Therefore, this systematic review aims to evaluate outcomes of outpatient TAA and compare them to inpatient TAA. Methods: A literature search was performed on October 23, 2023, in the PubMed, Embase, and CENTRAL databases using the PRISMA guidelines. Studies were included if they reported on outcomes of outpatient TAA or compared outcomes between outpatient and inpatient TAA. Pooled odds ratios (ORs) and mean differences were calculated using a random effects model. Quality assessment was performed using the MINORS criteria. Results: 12 studies were included, with 4 outpatient-only and 8 outpatient-inpatient comparative studies. Patients in the outpatient group were relatively younger, had a lower body mass index, and had fewer comorbidities relative to the inpatient group. For outpatient vs inpatient TAA, the pooled complication rate was 2.6% vs 3.6%, readmission rate was 2.5% vs 4%, and reoperation rate was 3.6% vs 5.5%. We found significantly lower odds of complications (OR = 0.47, CI: 0.26-0.85; P =.01), readmissions (OR = 0.63, CI: 0.54-0.74; P <.00001), and reoperations (OR = 0.66, CI: 0.46-0.95; P =.03) in the outpatient vs inpatient group. Conclusion: Although this analysis is limited by the dominance of data included from a single study, we found that outpatient TAA was generally performed on lower-risk patients and was associated with lower rates of complications, readmissions, and reoperations compared with inpatient TAA. [ABSTRACT FROM AUTHOR]

Study Design: Systematic Review. Objectives: To systematically review the clinical outcomes, re-operation, and complication rates of lumbar TDR devices at mid-to long-term follow-up studies for the treatment of lumbar degenerative disc disease (DDD). Methods: A systematic search was conducted on PubMed, SCOPUS, and Google Scholar to identify follow-up studies that evaluated clinical outcomes of lumbar TDR in patients with DDD. The included studies met the following criteria: prospective or retrospective studies published from 2012 to 2022; a minimum of 5 years post-operative follow-up; a study sample size >10 patients; patients >18 years of age; containing clinical outcomes with Oswestry Disability Index (ODI), Visual Analog Scale (VAS), complication or reoperation rates. Results: Twenty-two studies were included with data on 2284 patients. The mean follow-up time was 8.30 years, with a mean follow-up rate of 86.91%. The study population was 54.97% female, with a mean age of 42.34 years. The mean VAS and ODI pain score improvements were 50.71 ± 6.91 and 30.39 ± 5.32 respectively. The mean clinical success and patient satisfaction rates were 74.79% ± 7.55% and 86.34% ± 5.64%, respectively. The mean complication and reoperation rates were 18.53% ± 6.33% and 13.6% ± 3.83%, respectively. There was no significant difference when comparing mid-term and long-term follow-up studies for all clinical outcomes. Conclusions: There were significant improvements in pain reduction at last follow-up in patients with TDRs. Mid-term follow-up data on clinical outcomes, complication and reoperation rates of lumbar TDRs were maintained longer term. [ABSTRACT FROM AUTHOR]

Background and Objectives: As a treatment modality for advanced knee osteoarthritis, total knee arthroplasty is well established and has been performed on many patients over time. To improve surgical outcomes, fixed-bearing implant insertion with robotic-assisted TKA has been introduced; however, the insertion of mobile-bearing (MB) implants with the same method is challenging. The aim of this study was to compare the short-term postoperative follow-up outcomes of MB implant insertion using a robotic-assisted TKA system and conventional TKA. Materials and Methods: We investigated functional improvement in the knees of 60 patients who underwent the insertion of MB implants using either robotic-assisted TKA or conventional TKA. Isokinetic muscular function, range of motion, the Western Ontario and McMaster Universities Osteoarthritis Index score, visual analog scale (VAS) score, and Knee Society Score (KSS) were measured 6 months after surgery. The statistical analysis of outcome measurements was performed using the Mann–Whitney U test and the Wilcoxon signed-rank test. Results: Some isokinetic muscular functions, as well as Knee Society Scores (pain and function) and VAS scores, were significantly higher in patients who underwent MB insertion with robotic-assisted TKA than in those who underwent conventional TKA. Conclusions: When an MB implant is inserted using a robotic-assisted TKA system, a better surgical outcome can be expected. [ABSTRACT FROM AUTHOR]

Background: In symptomatic end-stage osteoarthritis of the ankle joint, total ankle replacement and ankle arthrodesis are the two primary surgical options for patients for whom conservative treatment fails. Published revision rates are often biased and difficult to compare. In this study, unplanned reoperation rates and revision rates were determined for both surgical interventions based on a large dataset, and risk factors for unplanned reoperations were identified. Methods: German-wide health data of the largest German health-care insurance carrier between 2001 and 2012 were retrospectively analyzed, and unplanned reoperation rates within 10 years were determined for index surgeries conducted in 2001 and 2002. Unplanned reoperation rates within 5 years for index surgeries conducted in 2001/2002 were compared to index surgeries conducted in 2006/2007. Multivariate logistic regression was used to identify risk factors for unplanned reoperations. Results: After ankle arthrodesis, 19% (95% confidence interval [CI], 16–22%) of 741 patients needed to undergo an unplanned reoperation within ten years. After total ankle replacement, the unplanned reoperation rate was 38% [95% CI, 29–48%] among 172 patients. For initial surgeries conducted at a later date, unplanned reoperation rates within five years were 21% [95% CI, 19–24%] for 1,168 ankle arthrodesis patients and 23% [95% CI, 19–28%] for 561 total ankle replacement patients. Significant risk factors for unplanned reoperations after ankle arthrodesis in the initial cohort were age < 50 years (odds ratio [OR] = 4.65 [95% CI 1.10;19.56]) and osteoporosis (OR = 3.72 [95% CI, 1.06;13.11]); after total ankle replacement, they were osteoporosis (OR = 2.96 [95% CI, 1.65;5.31]), Patient Clinical Complexity Level (PCCL) grade 3 (OR = 2.19 [95% CI, 1.19;4.03]), PCCL grade 4 (OR = 2.51 [95% CI, 1.22;5.17]) and diabetes mellitus (OR = 2.48 [95% CI, 1.33;4.66]). Kaplan-Meier analyses including 1,525 ankle arthrodesis patients and 644 total ankle replacement patients revealed an average unplanned reoperation-free time of approximately 17 years for both procedures. Conclusions: Similar revision rates and unplanned reoperation rates for both procedures in the later-date cohort can likely be attributed to a learning curve for surgeons as well as advances in implant design. This analysis of billing health insurance data supports an increase in total ankle replacement surgeries. [ABSTRACT FROM AUTHOR]

Background: To investigate the outcome and prognosis after Unicondylar knee arthroplasty (UKA) in patients with medial compartment arthritis of the knee combined with anterior cruciate ligament(ACL) dysfunction. Methods: A total of 122 patients diagnosed with knee osteoarthritis and treated with medial mobile platform unicondylar replacement at our center from January 2019 to December 2021 were retrospectively included in the study, and were divided into two groups according to ACL function, namely the normal ACL function group (ACLF) and the poor ACL function (N-ACLF) group. The postoperative results and prognosis of the two groups were evaluated and compared. Results: This study included 122 patients who underwent UKA surgery. There were no statistical differences in preoperative and postoperative posterior tibial tilt angle, knee mobility, KOOS, and prognosis between the two groups (P > 0.05). Conclusion: For medial compartment arthritis of the knee combined with ACL malfunction, surgery resulted in pain relief, improved quality of life and a good prognosis for such patients. It is hoped that clinicians will perform UKA in patients with ACL dysfunction after a comprehensive evaluation to improve their quality of life. [ABSTRACT FROM AUTHOR]

Background: The current high standards in orthognathic surgery demand surgical solutions that are both ⁠ functionally ⁠ effective and aesthetically pleasing. Our approach offers one for enhanced stability, attractiveness, and nerve protection ⁠ with improved accessibility ⁠ in the majority of orthognathic scenarios ⁠ compared to an inverted L osteotomy. Methods: A case series is presented to illustrate the application and outcomes of HSSO, an optimised approach that combines the advantages of a transoral inverted L osteotomy with specific enhancements and increased versatility, ⁠ with accessibility and exposure similar to a BSSO. Results: HSSO as a completely transoral technique, demonstrate the ability to perform significant counterclockwise rotations of the mandible, eliminating the need for trocars or skin incisions. We experinced high postoperative stability when HSSO was performed in conjunction with a three-piece LeFort 1 osteotomy on a dynamic opposing arch. In comparison to an inverted L approach, we postulated that HSSO offers advantages in stability, due to the increased segmental overlap of the proximal and distal segments of the mandible. This approach is designed to enhance the safety of the inferior alveolar nerve compared to traditional sagittal split methods. Furthermore, HSSO represents an alternative to total joint replacement in select cases of idiopathic condylar resorption and is effective for correcting mandibular asymmetries while maintaining jawline aesthetics. This is achieved through the manipulation of the mandibular angle, ramus height, and inferior border without creating a step deformity in the soft tissue. Conclusions: The outcomes of HSSO highlight its capacity to deliver predictable, functional, and aesthetically pleasing results, offering a viable alternative to more traditional orthognathic techniques. [ABSTRACT FROM AUTHOR]

Background: Unstable fractures often necessitate open reduction and internal fixation (ORIF), which generally yield favourable outcomes. However, the impact of surgical trainee autonomy on healthcare quality in these procedures remains uncertain. We hypothesized that surgery performed solely by residents, without supervision or participation of an attending surgeon, can provide similar outcomes to surgery performed by trauma or foot and ankle fellowship-trained orthopaedic surgeons. Methods: A single-center cohort of an academic level-1 trauma center was retrospectively reviewed for all ankle ORIF between 2015 and 2019. Data were compared between surgery performed solely by post-graduate-year 4 to 6 residents, and surgery performed by trauma or foot and ankle fellowship-trained surgeons. Demographics, surgical parameters, preoperative and postoperative radiographs, and primary (mortality, complications, and revision surgery) and secondary outcome variables were collected and analyzed. Univariate analysis was performed to evaluate outcomes. Results: A total of 460 ankle fractures were included in the study. Nonoperative cases and cases operated by senior orthopaedic surgeons who are not trauma or foot and ankle fellowship-trained orthopaedic surgeons were excluded. The average follow-up time was 58.4 months (SD ± 12.5). Univariate analysis of outcomes demonstrated no significant difference between residents and attendings in complications and reoperations rate (p = 0.690, p = 0.388). Sub-analysis by fracture pattern (Lauge-Hansen classification) and the number of malleoli involved and fixated demonstrated similar outcomes. surgery time was significantly longer in the resident group (p < 0.001). Conclusion: The current study demonstrates that ankle fracture surgery can be performed by trained orthopaedic surgery residents, with similar results and complication rates as surgery performed by fellowship-trained attendings. These findings provide valuable insights into surgical autonomy in residency and its role in modern clinical training and surgical education. Level of evidence: Level III – retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background. Knee and hip arthroplasty are two of the most frequently performed procedures in orthopaedic surgery. They are associated with positive patient-reported outcomes and significant improvements in quality of life for patients. Despite this, there may be room for further progress by quantifying functional improvements with gait analysis. Our study therefore aims to characterise the disease-specific gait pattern of participants with knee and hip osteoarthritis undergoing total joint replacement using a single chest-based wearable sensor. Methods. Twenty-nine participants awaiting total hip replacement and 28 participants awaiting total knee replacement underwent three-dimensional motion analysis with inertial wearable sensors. These gait metrics were then compared with 28 healthy controls of similar ages. Differences in gait metrics were evaluated using a T-test. The participants were recruited through a single centre to participate in this cross-sectional observational study. Participants with osteoarthritis severity sufficient to warrant surgical intervention were considered for inclusion in our study. The participants were instructed to walk 15–120 m in a hospital environment while fitted with a chest-based wearable sensor. Results. In total, three domains were evaluated, including spatiotemporal, variability and asymmetry parameters. There were marked variations in the gait asymmetry parameters and step length variation in both the hip and knee osteoarthritis patients compared with the healthy controls. The magnitude of gait deterioration in terms of step length asymmetry was greater on average in the hip osteoarthritis group than the knee group. The hip osteoarthritis (+180%, p < 0.001) and knee osteoarthritis (+129%, p = 0.001) groups demonstrated marked differences in step length asymmetry. Discussion. A single chest-based sensor was found to be capable of detecting pathological gait signatures in osteoarthritis patients when compared with age-matched controls. Future studies should compare pre- and postoperative changes to disease-specific gait impairments to validate the use of wearable sensors as a clinical adjunct. [ABSTRACT FROM AUTHOR]

This study evaluates the clinical outcomes of contemporary total ankle arthroplasty (TAAs) to primarily establish the current benefits and risks to facilitate informed decision making to secondarily establish if improvements are seen between subsequent generations of implants, bearing philosophy, and associated surgical technique. A systematic review and meta-analysis of published data from January 2000 to January 2020 was conducted following PRISMA guidelines. Inclusion criteria: English language papers, adult population, ≥20 ankles with a minimum follow up ≥24 months, pre- and post-operative functional scores available. Ankle implants were characterised by generations, which were determined from the original studies and confirmed based on literature set definitions. A total of 4642 TAAs in 4487 patients from 51 studies were included. The mean age was 61.9-years and follow up 57.8-months. Overall, 10-year survivorship rates were 77.63 %, with mobile bearing designs showing a small but significant advantage. Improved survivorship favoured the most modern implants at both two (p < 0.05), and 10-years (p < 0.01). The relative risk of a complication occurring improved with the evolution of implants e.g., nerve injury, and post-operative complications such as fracture, wound complications (e.g., dehiscence or heamatoma) and radiological abnormalities (e.g., radiolucencies, heterotopic bone formation and aseptic loosening). However, surgical site infection, and intra-operative fracture rates remain implant independent. Modern TAA offers improved survivorship, even with a trend to lower mean implantation age, similar complexity and ever changing indications. It would appear that implant evolution has reduced risks, especially those associated with revision, without affecting functional outcomes. • TAA offers an alternative to fusion for ankle arthritis in carefully selected patients. • TAA's are classified based on generation or type of bearing (fixed/mobile). • We evaluate outcomes – complications & revision rates for informed decision making. [ABSTRACT FROM AUTHOR]

Objectives: In recent years, minimally invasive approaches have been used with increasing frequency, even for more complex aortic procedures. However, evidence on the practicability and safety of expanding minimally invasive techniques from isolated operations of the ascending aorta towards more complex operations such as the hemiarch replacement is still scarce to date. Methods: A total of 86 patients undergoing elective surgical replacement of the ascending aorta with (n = 40) or without (n = 46) concomitant proximal aortic arch replacement between 2009 and 2023 were analyzed in a retrospective single-center analysis. Groups were compared regarding operation times, intra- and postoperative complications and long-term survival. Results: Operation times and ventilation times were significantly longer in the hemiarch replacement group. Despite this, no statistically significant differences between the two groups were observed for the duration of the ICU and hospital stay and postoperative complication rates. At ten-year follow-up, overall survival was 82.6% after isolated ascending aorta replacement and 86.3% after hemiarch replacement (p = 0.441). Conclusions: Expanding the indication for minimally invasive aortic surgery towards the proximal aortic arch resulted in comparable postoperative complication rates, length of hospital stay and overall long-term survival compared to the well-established minimally invasive isolated supracommissural ascending aorta replacement. [ABSTRACT FROM AUTHOR]

The use of mechanoregulatory schemes based on finite element (FE) analysis for the evaluation of bone ingrowth around porous surfaces is a viable approach but requires significant computational time and effort. The aim of this study is to develop a combined macro–micro FE and artificial neural network (ANN) framework for rapid and accurate prediction of the site-specific bone ingrowth around the porous beaded-coated tibial implant for total ankle replacement (TAR). A macroscale FE model of the implanted tibia was developed based on CT data. Subsequently, a microscale FE model of the implant-bone interface was created for performing bone ingrowth simulations using mechanoregulatory algorithms. An ANN was trained for rapid and accurate prediction of bone ingrowth. The results predicted by ANN are well comparable to FE-predicted results. Predicted site-specific bone ingrowth using ANN around the implant ranges from 43.04 to 98.24%, with a mean bone ingrowth of around 74.24%. Results suggested that the central region exhibited the highest bone ingrowth, which is also well corroborated with the recent explanted study on BOX®. The proposed methodology has the potential to simulate bone ingrowth rapidly and effectively at any given site over any implant surface. [ABSTRACT FROM AUTHOR]

Main objective of this research is to know if there is a different survival rate between fixed bearing (FB) and mobile bearing (MB) total ankle replacement (TAR). We hypothesized that there are no differences between the survival rates of both implants. A systematic search was performed in PubMed, Cochrane, EMBASE and ClinicalTrials.gov databases‎ to identify published studies from August 2018 to September 2022 including results for FB and MB TAR survivorship. Inclusion criteria included 1) primary TAR in one or both feet in which implant could be identified‎, 2) a minimum of 20 procedures reported, 3) reported implant survivorship or calculable and 4) a minimum of 12 months follow-up for level 1–3 studies or 60 months for level 4 studies. 3902 ankles in 28 studies were included. 719 were FB and 3104 MB with an overall survivorship of 94% (95% CI [0.89; 0.97]) and 89% (95% CI [0.86; 0.92]) respectively. After subgroup analysis, we did not find differences among both groups (p = ‎0.429‎). Meta-regression analysis showed that longer follow-up was associated with lower survival rates in MB group (p = 0.000) while no other relationships were found with other factors (age, level of evidence or conflict of interests). No differences in survival rates between both groups were found. Age and other studied confounders were not found to be related with implant survivorship. However, longer follow-up was found to be related with lower survival rates. Studies with longer follow-up and higher level of evidence are needed to confirm results. IV, systematic review of level I to IV studies. • We have not found clinical differences between mobile-bearing and fixed-bearing total ankle arthroplasties survivorship. • Age does not seem to influence total ankle arthroplasties failure after evaluating all the included studies. • Total ankle arthroplasties revision rates increase when the follow-up is longer. [ABSTRACT FROM AUTHOR]

Purpose: Ankle injuries involving the tibiofibular syndesmosis often necessitate operative fixation to restore stability to the ankle. Recent literature in the adult population has suggested that suture button fixation may be superior to screw fixation. There is little evidence as to which construct is preferable in the pediatric and adolescent population. This study investigates outcomes of suture button and screw fixation in adolescent ankle syndesmotic injuries. Methods: A retrospective matched cohort study over 10 years of pediatric patients who underwent ankle syndesmotic fixation at a large Level 1 Trauma Center was conducted. Both isolated syndesmotic injuries and ankle fractures with syndesmotic disruption were included. Preoperative variables collected include basic patient demographics, body mass index, and fracture type. Suture button and screw cohorts were matched based on age, race, sex, and open fracture utilizing propensity scores. Outcomes assessed include reoperation and implant failure. Results: A total of 44 cases of operative fixation of the ankle syndesmosis were identified with a mean age of 16 years. After matching cohorts based on age, sex, race, and open fracture status, there were 17 patients in the suture button and screw cohorts, respectively. Patients undergoing screw fixation had a six times greater risk of reoperation (p = 0.043) and 13 times greater risk of implant failure (p < 0.001). Out of six cases of reoperation in the screw cohort, five were unplanned. Conclusion: Our findings favor suture button fixation in operative management of adolescent tibiofibular syndesmotic injuries. Compared with screws, suture buttons are associated with lower risk of both reoperation and implant failure. Level of evidence: level III therapeutic. [ABSTRACT FROM AUTHOR]

General principles of cartilage repair therapies have not changed in the last years. Recommendations for cartilage repair include symptomatic ICRS grade 3 and 4 classified cartilage defects. However, what has changed in the last years is a better understanding of underlying or concomitant pathologies. Since a more precise analysis and stringent therapy of concomitant pathologies has been performed, an increase in success rates especially in formerly difficult entities could be observed. The most important concomitant pathologies in cartilage therapies of the hip-, knee- and ankle joint are axis deviations, instabilities, meniscus pathologies or prearthrotic deformities like hip dysplasia and femuroacetabular impingement syndrome. To increase the efficiency of cartilage repair procedures these pathologies should be corrected either prior to, or at latest concomitant to any cartilage repair surgery. Therefore, this article is intended to give an overview of the most important concomitant pathologies in cartilage repair of the lower extremities and their possibilities of correction. [ABSTRACT FROM AUTHOR]

Background: Total knee replacement is a commonly adopted surgical intervention to reduce physical limitations and pain in advanced-stage knee osteoarthritis. However, these patients may experience physical dysfunction to limit their access during conventional rehabilitation after total knee replacement. The use of telemedicine may be the promising solution. This study aims to compare the effectiveness of telerehabilitation with conventional in-person rehabilitation in patients who underwent a total knee replacement. Methods: For this systematic review on randomized controlled trials, PubMed, Medline, EMBASE, Cochrane Library, ScienceDirect and CINAHL databases were searched for eligible articles published between 1 January 2003 and 28 February 2022. The eligibility criteria were patients who underwent total knee replacement, randomized controlled trials and publications in English. The main outcome measures were focused on pain and physical function. Reference lists of relevant studies were also manually checked to find additional studies. Two independent reviewers conducted study selection separately. PEDro scale was used to assess the methodological quality of the included randomized controlled trials. A meta-analysis was performed on the collected data. Review Manager (RevMan, version 5.3) was used for all analyses. Results: A total of 11 studies met the eligibility criteria and included 1825 participants in the systematic review. Overall, the results revealed that the effectiveness of telerehabilitation is comparable to conventional in-person rehabilitation in improving various pain and functional outcomes in patients who underwent a total knee replacement. In the meta-analysis with the fixed-effects model, no significant difference was found in the improvement of pain and physical function in patients with knee osteoarthritis compared with conventional rehabilitation (Standardized Mean Difference (SMD) –0.15, 95% CI −0.47 to 0.16, P = 0.34 and SMD –0.04, 95% CI −0.19 to 0.12, P = 0.62, respectively). In addition, the utilization of hospital resources and costs were significantly lower in telerehabilitation when compared with in-person rehabilitation. Conclusion: Telerehabilitation was comparable to conventional in-person rehabilitation in improving clinical outcomes following total knee replacement. However, it might be a more preferable alternative rehabilitation intervention for patients following total knee replacement given the significantly lower cost of telerehabilitation. [ABSTRACT FROM AUTHOR]

Total Ankle Replacement (TAR) could, in theory, partially restore joint sensation and motion, enhancing motor coordination, functional stability, and proprioception in a joint affected by osteoarthritis. The aim of this study is to evaluate ankle proprioception before and after a Total Ankle Replacement via an instrumental objective assessment. The evaluation of proprioceptive stability was carried out using the dedicated Delos Postural Proprioceptive System (DPPS). The clinical evaluation was performed by administering validated questionnaires, namely the American Orthopaedic Foot and Ankle Society (AOFAS) score and Short Form-36 (SF-36). Twenty patients were selected, undergoing a complete procedure with clinical and instrumental pre-operative and post-operative evaluation at the end of the follow-up. AOFAS ankle–hindfoot and SF-36 both showed a statistically significant improvement between the pre-operative and post-operative state. The postural tests performed using the DPPS showed that the affected limb showed results slightly lower than in pre-operative. In conclusion, according to the current data, the TAR does not show an improvement in proprioceptive joint stability, and although the registered mean values do not present a statistical significance, the stabilometry shows data lower than the healthy limb. In this perspective, further studies are recommended to highlight any rehabilitation scheme or protocols, using wider case series. [ABSTRACT FROM AUTHOR]