Meta-analysis of clinical efficacy of ankle arthrodesis and total ankle arthroplasty in the treatment of end-stage ankle arthritis / 中国骨伤

OBJECTIVE@#To systematically review the clinical efficacy of total ankle arthroplasty (TAA) and ankle arthrodesis (AA) in the treatment of end-stage ankle arthritis.@*METHODS@#The PubMed, EMBASE and Cochrane Library databases were searched for articles published in the treatment of end-stage ankle arthritis with AA or TAA from the establishment of the database to June 2021. Bias risk tool was used to evaluate the quality of the literature. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS), visual analog scale (VAS), ankle osteoarthritis scale(AOS), gait analysis (pace, frequency, stride), range of motion (ROM), satisfaction, complications and reoperation rate were analyzed by meta-analysis between AA and TAA groups by RevMan 5.3 software.@*RESULTS@#A total of 12 articles were included, including 1 050 patients in the AA group and 3 760 patients in the TAA group, totaling 4 810 patients. Meta-analysis showed that the total score of AOFAS[MD=-3.12, 95%CI(-9.02, 2.96), P=0.31], pain score [MD=1.60, 95%CI(-1.35, 4.54), P=0.29], alignmentl score[MD=-0.04, 95%CI(-0.52, 0.44), P=0.88], VAS[MD=0.10, 95%CI(-0.49, 0.68), P=0.74], and AOS total score [MD=-4.01, 95%CI(-8.28, 0.25), P=0.06], the difference was not statistically significant (P>0.05). The score of AOFAS functional in TAA group was significantly higher than that in TAA group[MD=44.22, 95%CI(-8.01, -0.43), P=0.03]. There was no significant difference in gait analysis between the two groups (P>0.05). Postoperative ROM [MD=-4.93, 95%CI(-6.35, -3.52), P<0.000 01] and change in ROM from preoperative to follow-up[MD=-5.74, 95%CI(-8.88, -2.61), P=0.0003] between two groups, the difference was statistically significant. There was no significant difference in satisfaction between the two groups [OR=1.011, 95%CI(0.46, 2.23), P=0.98]. Complications [OR=1.61, 95%CI(1.26, 2.06), P=0.0002] and non-revision reoperation [OR=1.61, 95%CI(1.17, 2.21), P=0.003] were significantly lower in the TAA group than in the AA group. There was no significant difference in the rate of revision and reoperation(P>0.05) between the two groups [OR=1.02, 95%CI(0.37, 2.78), P=0.97].@*CONCLUSION@#The clinical efficacy of AA is similar to that of TAA, but the non revision reoperation rate and main surgical complications of TAA are significantly reduced. Therefore, further high-quality methodological research and long-term follow-up are needed to confirm this conclusion.

Evaluation of the efficacy and safety of cellular bone allograft for ankle arthrodesis / 临床外科杂志

Objective To evaluate the efficacy and safety of cellular bone allograft(CBA)in ankle arthrodesis.Methods The clinical data of 56 patients with traumatic ankle joint injury and ankle joint injury treated in our hospital from April 2013 to April 2016 were retrospectively analyzed.Imaging was performed at 3 months after surgery,and the visual analogue(VAS)score of the patients,the ankle and foot surgery score(AOFAS),and the SF-36 health status questionnaire score were recorded.The group included 33 patients who were treated with CBA,and patients with simple fusion in the treatment group(n=23).Results 2 months after operation,the fusion rate of CBA group was 87.9% and the fusion rate of without CBA group was 52.2%.3 months after operation,the fusion rate of CBA group was not higher than that of group CBA,and the fusion rate was in group.The data showed a significant improvement in pain,function,and quality of life.No adverse events caused by CBA were observed during the study.Conclusion The rate of fusion was higher in patients treated with bone allograft(CBA)than in patients with autologous bone graft,and the fusion rate was not affected by high risk factors.CBA is a safe and effective graft material for the bone healing of damaged joints,which can provide an effective bone graft substitute for ankle arthrodesis.

Ankle Arthrodesis with using Variable Pitch Tapered Screws (Acutrak(R) Screw) Fixation / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical and radiologic results of open arthrodesis with using variable pitch tapered screws (Acutrak(R) screw) for treating ankle arthritis. MATERIALS AND METHODS: The subjects were 14 patients with 16 cases of performing ankle arthrodesis with using variable pitch tapered screws. Clinical evaluation was performed with using the American Orthopaedic Foot and Ankle Society ankle-hindfoot functional scale and the visual analogue scale pain score, and we assessed the postoperative complications and the patient's satisfaction. Radiological evaluation was performed by the assessing the time to union, the position of union, and the degenerative changes of the adjacent joints of the foot. RESULTS: The average follow-up period was 15 months. The ankle-hindfoot functional scale was improved from an average of 38.9 points (range: 27-57 points) preoperatively to an average of 77.3 points (range: 66-89 points) at the last follow up. The visual analogue scale pain score was decreased from an average of 7.9 (range: 3-10) to 2.9 (range: 0-5), and 13 cases (81%) were satisfied with the outcome of surgery. For all the cases, radiological union was obtained at an average of 11.2 weeks (range: 6-16 weeks). CONCLUSION: We performed arthrodesis with using variable pitch tapered screws for treating ankle arthritis, and satisfactory short term results were obtained both clinically and radiologically.

The Comparison of the Ankle Arthrodesis According to Surgical Procedures / 대한정형외과학회잡지

The aim in arthrodesis of ankle is to gain a painless, normal walking gait of destroyed ankle joint caused by various origins. Despite more than 30 different fusion techniques have been described in the literature, but the results were not always satisfactory. Blair introduced tibial sliding graft, rectangular hone block donated at distal tibia, to the neck of talus. His method has advantages of a normal apperance of the foot, no shortening, and the weight bearing thrust on normal tissue. The purpose of this study was to compare the ankle arthrodesis according to surgical procedures & introduce the method which could produce excellent results for ankle arthrodesis. We reviewed 23 patients(24 cases) undergone ankle arthrodesis from Jan. 1989 to Dec. 1996 in Kyung Hee Medical Center. Male were twelve(13 cases) and female were eleven. Mean age was 42.6(l8-75)years. The Blair fusion method was used in ten cases. Iliac bone graft followed by internal fixation using Steinmann pin in 4 cases, using cancellous screw in I case, and using both Steinmann pin and staple in 1 case, while tibiotalar coaptation without bone graft followed by internal fixation using Steinmann pin in 3 cases, using staple in 1 case, and using cancellous screw in 1 case. In 3 cases, arthroscopic abrasion and cancellous screw was used. The mean duration of follow-up was 46(6-99) inonths. Time to union was average l4.6(8-23) weeks in Blair fusion and 17.5(8-40) weeks in other methods. Delayed union was observed in three cases, but no case was found in Blair fusion. Pain was ohserved in 5 cases, 3 in Blair fusion and 2 in other methods. Nonunion or pseudoarthrosis was not ohserved. On the clinical criteria for Boston Childrens Hospital ankle-scoring system, we ohserved nineteen excellent and five good cases. The difference in results according to fusion method was not ohserved. The results in tibiopedal motion using cineroentgenography were seven good and three fair cases in Blair, while two good, ten fair and two poor in other methods. By using Blair fusion, we expect early bony union and better clinical results.