Category: Midfoot/Forefoot; Other Introduction/Purpose: Hallux Rigidus (HR) can cause pain with motion, enlarged joint, decreased joint space, subchondral sclerosis, osteophyte formation and restricted joint mobility, limiting patient physical activity. A modern technique for the treatment of HR is 1st MTP hemiarthroplasty with the use of a Cartiva synthetic cartilage implant. The Cartiva implant is designed to imitate natural cartilage; this allows patients to maintain motion in the 1st MTP joint. Current scientific literature reporting early outcomes of the procedure is sparse and mixed. This discrepancy and the overall scarcity of data indicates the need for further analysis. The purpose of this study is to compare improvement in VAS with 1st MTP hemiarthroplasty with the Cartiva implant, allograft interposition arthroplasty and fusion in patients who failed conservative management or cheilectomy. Methods: This study evaluated subjects who underwent interpositional arthroplasty, arthrodesis, or hemiarthroplasty with the Cartiva implant from January 2008 to April 2020, with a minimum of one year documented follow-up. All subjects were 18 years of age and older, diagnosed Hallux rigidus with pain, had a decrease in 1st MTP motion, and had X-ray findings consistent with decreased joint space. Patient data collected includes age, gender, ethnicity, occupation, height, weight, BMI, diabetes status, rheumatoid arthritis status, smoking, co-morbid conditions, medication, activity of choice, duration of symptoms, and operative data. Pre-operative and post- operative Visual Analog Scale (VAS) pain scores were compared between groups. Pain, function, and alignment between groups were also evaluated, pre-operatively and post- operatively, using the AOFAS Midfoot Scale. Secondary objectives evaluated include surgical complications, surgical revision, and X-rays. Results: One hundred patients with 12 months of post-operative follow-up were included in this study: 52 hemiarthroplasty with Cartiva implant patients (Group A), 24 arthrodesis patients (Group B), and 24 interpositional arthroplasty patients (Group C). The mean age of patients was 57.12 years (range 35-95). Average VAS pain scores for Group A was 3.78 (0-9), for Group B was 2.71 (0-10), and Group C was 3.67 (0-8). The average AOFAS score for Group A was 63.36 (30-95), for Group B was 60.98 (32- 83), and Group C was 60.13 (31-83). Pre-operative average VAS pain scores were 4.86 (Group A), 2.32 (Group B), and 5.58 (Group C). Post-operative average VAS pain scores were 2.69 (Group A), 0.91 (Group B), and 1.75 (Group C). Pre-operative average AOFAS scores were 59.52 (Group A), 48 (Group B), and 47.25 (Group C). Post-operative average AOFAS scores were 67.20 (Group A), 73.96 (Group B), and 73 (Group C). Conclusion: Preliminary data shows the greatest reduction in VAS pain scores in the interpositional arthroplasty group. The greatest improvement in derived AOFAS score was seen in the arthrodesis and interpositional arthroplasty groups, indicating a better overall combination of post-operative pain, function, and alignment when compared to patients who underwent hemiarthroplasty with Cartiva implant. While this study is not yet complete, it appears that hemiarthroplasty with Cartiva implant may allow patients to maintain motion in the 1st MTP joint, but at the cost of increased post-operative pain.
Background: Computerized clinical decision support systems (CDSS) offer predictive statistical measurements of patient outcomes to clinicians using amalgamated data. Methods: The focus of this study was to investigate the usability and reliability of an established CDSS at a pilot site in the management of surgical patients with lumbar degenerative spondylolisthesis, and to assemble recommendations in order to implement a CDSS at other organizations. Results: Physicians reported that in 100% of patients, the clinical decision support tool algorithm (CDSTA) could help discuss surgical options. In 78% of patients, physicians agreed that it could help make the decision to recommend surgery. Physicians agreed with the CDSTA outcome predictions in 96% of patients. Conclusions: Various challenges were identified concerning CDSTA usability, and the main stumbling point was communication between the clinical and information technology staff who developed the CDSTA, demonstrated through technical language barriers, CDSTA backend updating delays, and reluctance of clinicians and staff to adapt to the CDSTA in addition to the typical daily workflow. The most significant lesson was maintaining open lines of dialogue between the developer and pilot site to allow for seamless CDSS integration into a practice and minimal technical downtime.
Category: Ankle; Ankle Arthritis; Hindfoot Introduction/Purpose: The effect of tibial torsion on lower extremity mechanical alignment has been well studied in the literature, including its effect on lower extremity osteoarthritis. It has been suggested that external tibial torsion is associated with cavus hindfoot deformity and may lead to varus osteoarthritis of the ankle. To our knowledge, there are no studies investigating this relationship. The purpose of this study is to characterize the relationship of tibial torsion with ankle coronal plane deformity in patients with ankle arthritis. Methods: The study is a retrospective, cohort of 223 patients who have undergone total ankle arthroplasty at a single institution. Preoperative computerized tomography was used to measure tibial torsion and coronal deformity. Descriptive statistics and regression analysis were used to analyze the data. Results: Descriptive analysis of all 223 patients demonstrated a maximum of 23.9 degrees varus and 20.5 degrees valgus among all patients. The mean for varus deformity was 6.86 degrees with a standard deviation of +- 6.39. Tibial rotation was calculated at an average of 20.8 degrees external rotation, with a maximum of 15.2 degrees internal rotation and 59.5 degrees external rotation in all patients. Plotting overall coronal ankle tilt versus tibial torsion revealed overall varus deformity with R2 of 0.016. Regression analysis of all varus deformities against external tibial torsion revealed a R2 of 0.02. Varus deformity 1 standard deviation above the mean against external tibial torsion demonstrated a R2 of 0.072. Valgus deformity against external tibial torsion revealed a R2 of 6.75 x10-5. Conclusion: An association between external tibial torsion and varus ankle arthritis has been proposed in the literature. The results of our study did not show an association between tibial torsion and coronal deformity in ankle arthritis in all patients undergoing total ankle arthroplasty at our institution. A difference may exist in certain subgroups, such as patients with neuromuscular disorders, but further investigation will be necessary to determine this relationship.
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