BackgroundAnkle osteoarthritis commonly involves sagittal malalignment with anterior translation of the talus relative to the tibia. Total ankle arthroplasty has become an increasingly popular treatment for patients with symptomatic ankle osteoarthritis. However, no comprehensive study has been conducted on the outcomes of total ankle arthroplasty for osteoarthritis with preoperative sagittal malalignment. The purpose of this study was to evaluate the effect of anterior translation of the talus on outcomes of three-component total ankle arthroplasty.MethodsOne hundred and four osteoarthritic ankles in 104 patients who underwent three-component total ankle arthroplasty were included in this study. The 104 ankles were divided into 2 groups: ankles with anteriorly translated talus (50 ankles), and ankles with non-translated talus (54 ankles). Clinical and radiographic outcomes were assessed in both groups. The mean follow-up duration was 42.8 ± 17.9 months (range, 24 to 95 months).ResultsForty-six (92%) of 50 ankles with anterior translation of the talus showed relocation of the talus within the mortise at 6 months, and 48 (96%) ankles were relocated at 12 months after total ankle arthroplasty. But, 2 (4%) ankles were not relocated until the final follow-up. The AOFAS scores, ankle range of motion, and radiographic outcomes showed no significant difference between the two groups at the final follow-up (p > 0.05 for each).ConclusionsIn majority of cases, the anteriorly translated talus in osteoarthritic ankles was restored to an anatomical position within 6 months after successful three-component total ankle arthroplasty. The clinical and radiographic outcomes in the osteoarthritic ankles with anteriorly translated talus group were comparable with those in non-translated talus group.

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This study was to report the comparison of outcomes between Ilizarov ring fixator (IRF) and Taylor Spatial Frame® (Smith & Nephew, Memphis, Tenn.; TSF) in terms of the effectiveness of ankle-foot deformities correction, follow-up results, and complications. Fourteen patients with ankle-foot deformities were corrected using circular external fixation (IRF group = 7 patients; TSF group = 7 patients) and related procedures. Baseline data and treatment variables were recorded. The patients’ mean age was 42.9 years. Mean follow-up time was 6.5 months. Most common cause of deformity/traumatic condition was posttraumatic equinus. There were successful results in 8 patients (57.1%), partial successful results in 5 patients (35.7%), and revision-needed in 1 patient (7.1%). TSF group demonstrated significantly higher rate of successful results than IRF group (P=0.033). A trend of lower complication rate was found in TSF group (P=0.286). Deformity corrections using TSF provided significantly better clinical scores and higher rate of successful outcome than conventional IRF.

Background. Increased plantar pressure when walking is among the pathogenesis of diabetic foot ulceration. Contractured Achilles tendon will biomechanically results in increased plantar pressure. In this study, we summarize the correlation between increased transforming growth factor β1 (TGF-β1) expression and the development of Achilles tendon contracture in diabetic foot patients. Methods. Thirty diabetic foot patients with indication for surgery were enrolled to this study and divided to two groups. Case group consisted of patients presenting Achilles tendon contracture, in contrary with control group. During surgery, the specimens of Achilles tendon were taken and analysed semi-quantitatively by immunohistochemical (IHC) examination. Achilles contracture as a dependent variable was concluded from physical examination, and later by histological findings. Results. IHC revealed that the positive TGF-β1 expressions were found in all case and control group cases, respectively. There were different results between both groups regarding the expression strength, specifically 2/15 vs 8/15 for + 3 result, 10/15 vs 6/15 for + 2 result, and 3/15 vs 1/15 for + 1 result. Linear regression analysis showed significant result (p < 0.05) of age and TGF-β1 expressions as the determinants of Achilles tendon contracture, while the results for sex, body mass index (BMI), and HbA1c were insignificant. Conclusions. Chronic hyperglycemia was thought to be one of the etiology of Achilles tendon contracture through the cascade involving the advanced glycation end products (AGEs) accumulation. However, these results suggested that the HbA1c level is not a sole determinant, and TGF-β1 should be considered as a contributing factor for Achilles tendon contracture during the development of diabetic foot ulcerations.