(i) The principles of foot and ankle arthrodesis

Parker, Lee D.; Singh, Dishan

doi:10.1016/j.mporth.2009.08.006

Cited by 13 publications

(7 citation statements)

References 44 publications

(40 reference statements)

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“…Arthrodesis is defined as the surgical fusion of a diseased joint for the purposes of obtaining pain relief and stability. 13 The aim of first MTPJ arthrodesis is to achieve an immobile, pain-free joint that contributes to forefoot stability, improved gait and, ultimately, an improvement in quality of daily living. 6,14 This procedure is frequently performed in the practice of orthopaedic foot and ankle surgery and has a multitude of indications.…”

Section: Discussionmentioning

confidence: 99%

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

Meijer¹,

Grabe²,

Greyling³

2020

SA orthop. j.

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BACKGROUND: Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a common and frequently performed procedure in the practice of orthopaedic foot and ankle surgery. Fusion techniques and preferred surgical implants have significantly evolved during recent years. It is however still under debate which surgical device provides the best outcome. One of the modern techniques described includes the use of a dorsal anatomical locking plate. These plates are usually used in combination with an additional compression cross screw across the arthrodesis site. The aim of this study was to assess the outcome of arthrodesis of the first MTPJ using a dorsal locking plate without making use of additional compression cross screw fixation. METHODS: We retrospectively assessed data at an orthopaedic practice specialising in foot and ankle surgery. All patients who had a first MTPJ arthrodesis with an anatomical locking plate system between 2010 and 2016 were identified. No additional compression cross screw fixation was done in any of these cases. Standard standing dorsoplantar and lateral X-rays of the foot were taken six weeks after surgery. As a primary objective, these radiographs were assessed to determine the rate of radiological union. As a secondary objective, any other complications that occurred in the post-operative period were recorded. RESULTS: We included 115 patients in the study. Fifteen of these patients underwent bilateral first MTPJ arthrodesis surgery, making the total number of feet included in the study 130. Of these, 86% (n=99) were female and 14% (n=16) were male. The mean age at the time of surgery was 54.7 years (range 37-74). An observed radiological union rate of 97% at three months after surgery was recorded. A total of four cases (3%) presented with symptomatic non-union. Two of these were successfully revised and progressed to union before the nine-month follow-up. One patient had bilateral surgery for severe rheumatoid arthritis with poor bone quality. No union was achieved even after a revision procedure with bone grafting. A Keller-type resection arthroplasty was eventually performed in this patient. Another secondary complication that was recorded is an overall infection rate of 2%. CONCLUSION: The results of this retrospective study suggest that high union rates and a low incidence of complications can be expected when fusing the first MTPJ with the use of a locking plate system without the need for an additional compression cross screw Level of evidence: Level 4 Keywords: first metatarsophalangeal joint, fusion, arthrodesis, locking plate, union

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Section: Discussionmentioning

confidence: 99%

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

Meijer¹,

Grabe²,

Greyling³

2020

SA orthop. j.

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“…Arthrodesis is the surgical fusion of a joint for the purposes of obtaining pain relief, deformity correction, and stability [1,27,28]. Historically, Park is said to have performed one of the first arthrodesis procedures in 1781 of a tuberculous knee joint.…”

Section: Evolution Of Compressive Technologymentioning

confidence: 99%

“…Arthrodesis of the ankle was described by Albert in 1879 for treatment of paralytic equinus [29]. In 1882, Albert introduced the term ''arthrodesis'' after he started performing them to stabilize the feet and ankles of polio sufferers [27,29]. In 1906, Lexer used boiled cadaveric bone as an IM device [2].…”

Section: Evolution Of Compressive Technologymentioning

confidence: 99%

“…Reported clinical outcomes (such as union rates and functional restoration) vary considerably for TTCA patients with IM nail fixation, likely due to the variety of clinical indications, different nail types, evaluation method for union, and heterogeneity among patients [2]. Union rates have varied from 48% to 100%, with lower rates frequently associated with challenging patient and case factors including but not limited to tobacco or drug use, diabetes, neuroarthropathies, bulk bone defects, and revisions [2,27,37,[42][43][44][45][46]. In particular, one study involving TTCA with IM nails and bulk femoral head allografts to treat bulk defects reported a 50% union rate, but that rate dropped to 0% for diabetic patients with bulk grafts [42].…”

Section: Potential Drawbacks Include Patient Noncompliance and Limitedmentioning

confidence: 99%

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Untitled

2019

GJOR

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In many cases, tibiotalocalcaneal arthrodesis (TTCA) acts as a salvage procedure and alternative to amputation in nonbraceable neuropathic deformities, failed ankle arthrodesis, failed total ankle arthroplasty, talar osteonecrosis, and severe ankle and subtalar arthritis [1,2]. The goal of this procedure is to fuse the ankle and subtalar joints simultaneously leading to pain relief, stability, and a functional limb [3]. The purpose of this review is to examine the mechanobiological foundations of TTCA and the technological evolution of intramedullary (IM) nails used to provide fixation in TTCA procedures. Discussion Mechanobiological backgroundMechanobiology is the study of how mechanical or physical stimuli regulate biological processes [4]. Julius Wolff was among the first to recognize the influence of mechanical forces on bone morphology and architecture, and in 1866 observed that trabecular trajectories within the proximal femur roughly align with directions of maximum stresses [5,6]. Wolff's Law states that mechanical inputs, creating functional and morphological changes in a bone, are followed by alterations of the bone's architecture and mechanical strength. Animal and cell culture models and their associated techniques (histology, radiography, mechanical testing, etc.) have been used to study the effects of mechanical inputs on biological responses, including bone repair, at multiple biological scales.Mechanobiological principles are relevant to TTCA with IM nails, because knowledge of micromovements and mechanical stresses, and how they stimulate bone cells leading to tissue adaptation, can be incorporated into development of new nail designs, leading to improved joint fixation and superior local healing conditions [7,8].

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“…However, there is little agreement on the period of immobilisation and post-operative weight-bearing. 2 The definition of 'early' rehabilitation/mobilisation is poorly defined in the literature.…”

Section: Introductionmentioning

confidence: 99%

Post-operative rehabilitation in ankle and hindfoot/midfoot fusion and reconstruction surgery - A scoping survey of UK foot and ankle surgeons and allied health professionals

Houchen-Wolloff

Essop-Adam

Calver

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Objective: There has recently been a paradigm shift in the management of Achilles tendon rupture and ankle fracture rehabilitation with emphasis on early mobilisation. There is, however, no consensus on post-operative rehabilitation for hind/mid-foot fusion and reconstructive surgery. The aim was to scope the post-operative rehabilitation practices of UK foot and ankle surgeons and allied health professionals (AHPs). Methods: A 10 question online survey was sent to UK surgeons and AHPs via specialist interest groups in February 2019. Quantitative and qualitative data were analysed. Results: 117 surgeons and 55 AHPs responded. There was good agreement between survey responses in the 2 groups. Fifty percent reported that they followed a local post-operative rehabilitation protocol. More than half of respondents (57%) reported that not all patients were referred for post-operative rehabilitation. There was a wide variation in the time point at which patients were instructed to weight bear (2 weeks to >12-weeks). Non-union was a concern of early mobilisation as highlighted by 62% of respondents. Qualitative themes identified were: treatment tailored to individual patients, lack of knowledge about the patient journey, treatment tailored to surgeon preferences, lack of a pathway, variation in practice. Conclusions: There is a wide variation in the post-op rehabilitation of patients undergoing this surgery in the UK, with a lack of published research in this area. Early rehabilitation could improve patient outcomes, yet the risk of non-union is a major concern. Further research in the form of a multicentre trial is warranted to answer this research question.

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(i) The principles of foot and ankle arthrodesis

Cited by 13 publications

References 44 publications

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

The outcome of first metatarsophalangeal joint arthrodesis using a locking compression plate

Untitled

Post-operative rehabilitation in ankle and hindfoot/midfoot fusion and reconstruction surgery - A scoping survey of UK foot and ankle surgeons and allied health professionals

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