Impact of Subtalar Distraction Arthrodesis on Ankle Joint: Radiological Insights from Modified Grice-Green Procedure.

Subtalar distraction arthrodesis (SDA) is a surgical procedure designed to treat hindfoot deformities associated with isolated subtalar joint arthritis. In 1996, Fitzgibbons was the first to observe that, in some cases, hindfoot fusion appeared to be associated with the development of tibiotalar valgus tilt. Since then, few studies have addressed this issue. Given that hindfoot fusion can be performed using various techniques, this study investigated the potential tibiotalar joint frontal or sagittal modifications resulting from the modified Grice-Green technique. All the consecutive patients who underwent the modified Grice-Green procedure were included. The patient records were reviewed to extract demographic data. Weight-bearing foot and ankle radiographs were assessed to measure the talar tilt angle and the tibiotalar ratio on the same picture archiving and communication system by three independent observers. A total of 69 patients met the criteria for inclusion. The mean talar tilt showed no substantial changes, since the increase from 1.46 ± 1.62 preoperatively to 1.93 ± 2.19 at a minimum of 8 months postoperatively was not statistically significant (p = 0.47). The average preoperative tibiotalar ratio significantly increased from 33.4 ± 4.4% to 35 ± 4% postoperatively (p = 0.007), although remaining within the normal range, indicating a possible realignment of the posterior facet of the subtalar joint. In conclusion, this study highlights the effectiveness of the modified Grice-Green procedure in achieving a favorable realignment without impacting the ankle joint, particularly regarding tibiotalar valgus tilt.

Combined Distal Metatarsal and Akin Osteotomies for Concomitant Metatarsophalangeal and Interphalangeal Hallux Valgus: Clinical and Radiological Outcomes.

Combined metatarsal and Akin-type proximal phalanx osteotomies represent a surgical solution for concomitant metatarso-phalangeal and inter-phalangeal hallux valgus. This retrospective observational study aimed to evaluate clinical and radiographic outcomes following combined distal linear metatarsal and Akin osteotomies. The study included 42 feet from 37 patients, with a mean follow-up of 27.1 (range 24-37) months. Mean surgical time was 16.54 ± 4.17 minutes. Pre- and postoperative clinical scores and radiological parameters were collected. Positive outcomes with a low recurrence and complications rates were reported. A statistically significant improvement in the Manchester-Oxford foot questionnaire, the EuroQol 5D-5L dimensions instrument, the visual analogue scale, the intermetatarsal angle, the hallux valgus angle, the distal metatarsal articular angle, and the interphalangeal angle correction was observed. Despite the results reported, further prospective studies are needed to identify the most suitable patients for this combined osteotomy approach.

Staged vs concurrent hardware removal in total ankle arthroplasty.

INTRODUCTION: Ankle osteoarthritis is more commonly posttraumatic. Consequently, dealing with hardware removal is quite frequent when performing a total ankle arthroplasty (TAA). The purpose of this study is to compare outcomes regarding either a staged or concurrent hardware removal when performing TAA. MATERIALS AND METHODS: 275 consecutive patients with TAA previously treated with internal fixation were retrospectively reviewed. Finally, 57 patients were enrolled based on exclusion criteria, and were differentiated into two groups considering the timing of hardware removal (staged-group A vs concurrent-group B) to compare: neurovascular and wound complications, time to recover full weight bearing, scar-tissue esthetic, and surgical time. Moreover, a subgroup comparison considering the surgical approach (single approach, minor additional approach, major additional approach) was performed between the group A and group B. RESULTS: No statistically significant difference other that longer surgical time (p < 0.05) was observed between group A and group B. When considering surgical approach subgroups, statistically significant higher surgical wound complications and revision rate were reported in group B (concurrent) major additional approach subgroup, and a statistically significant shorter time to full weight bearing was reported in group A (staged) major additional approach subgroup. CONCLUSIONS: When performing TAA requiring hardware removal, no clear superiority of staged over concurrent hardware removal was observed. However, when considering a subgroup of patients requiring a separate major incision, a staged approach has shown reduced surgical time, less risk of wound complications, and shorter recovery to full weight bearing. LEVEL OF EVIDENCE: III.

Return to sports after total ankle arthroplasty: A systematic review and meta-analysis.

Purpose: Technological developments and implants newer generation allowed to expand the indications for total ankle arthroplasty (TAA) with aim to maintain active lifestyles. This systematic review and meta-analysis examined chance of return to sport, achievable activity level, the type of patients and the sport type after TAA. Methods: A literature search of PubMed, Scopus, and Cochrane databases was performed. Meta-analysis was performed if the same outcomes scores were reported at least by 4 studies. PRISMA guidelines were used. Risk of bias was assessed through the MINORS criteria. Included studies reported data and outcomes related to sport in patients undergoing TAA. Result: Initial search results yielded 483 articles; 11 articles were included in the review process. The chance to return to sport increases after TAA, achieving a mean sport participation rate of 61.9% postoperatively. Until to 92% of patients was able to return to their preoperative level of activity. Meta-analysis showed a significant postoperative improvement in the most represented outcomes scores. Especially, young, male, with lower BMI, and affected by non-inflammatory osteoarthritis were those who returned to sport reporting significantly better outcomes scores. The most frequent postoperative sports included cycling, swimming, hiking and gymnastic. Only few patients practiced impact sport. Conclusions: Current literature does not allow to advise TAA for young and active patient who want to play sports after surgery. Selected patients undergoing TAA can return to sport after surgery, and the most approachable activities are low demanding sport. However, no strong evidence is available to support these findings. Further prospective randomized studies are necessary to establish more accurate expectations concerning sport activity after TAA implantation. Level of evidence: Level II, systematic review.

Probiotics in Orthopedics: From Preclinical Studies to Current Applications and Future Perspective.

In recent years, probiotics have been emerging as an attractive therapeutic strategy for several diseases. In orthopedics, probiotics seem to be a promising supplementation for treatment of osteoporosis, osteoarthritis, muscle loss-related disease, wound and ulcer issues, and prevention of surgical antibiotic prophylaxis side effects. Although probiotics are still not included in guidelines for these conditions, several studies have reported theoretical benefits of their administration. Further high-level clinical trials are necessary to convert research into solid clinical practice. However, probiotics represent a cost-effective future perspective and may play a role in association with traditional orthopedic therapies.

How to Prevent Wound Complications After Total Ankle Arthroplasty Through Anterior Approach: A Systematic Review on Current Treatment Options.

INTRODUCTION: Total ankle arthroplasty (TAA) through anterior approaches is a common treatment for end-stage tibiotalar arthritis. The occurrence of wound healing problems can lead to severe consequences. The aim of this systematic review is to summarize the available methods to minimize postoperative wound complications after TAA through standard anterior approaches. METHODS: Three databases were searched for original articles concerning methods to reduce anterior wound complications after TAA. Eligible articles were examined to extract studies' characteristics, population data, type of intervention, and related wound complications. Study risk of bias assessment was conducted through the Newcastle-Ottawa Scale. RESULTS: Thirteen articles were included for analysis, investigating 8 types of intervention, which were grouped into 3 classes: biological, mechanical, and pharmacological methods. A significant decrease in wound complications was reported for negative pressure wound therapy (3% vs 24%, P = .014), soft tissue expansion strips (2% vs 12%, P = .04), and tranexamic acid (TXA) administration (9% vs 22%, P = .002). CONCLUSION: Despite the limitations of the included studies, this review showed encouraging results for TXA administration. Good results were found for mechanical methods, despite each intervention being supported by only 1 comparative study. Careful selection of patients is recommended to identify potential benefits or contraindications to such interventions. Further prospective randomized studies would be helpful to confirm these results.Levels of Evidence: 3.

Severe hallux valgus can be treated using a distal metatarsal osteotomy: Results of 144 cases treated with the SERI technique.

PURPOSE: Aim of this study is to analyze the clinical and radiographic results of the simple, effective, rapid and inexpensive (SERI) technique, a linear distal metatarsal osteotomy, for treating severe hallux valgus (HV). METHODS: Clinical outcomes were assessed pre- and postoperatively using the AOFAS, MOxFQ and VAS score. Pre and postoperative HV angle (HVA) and intermetatarsal angle (IMA) were measured. RESULTS: 117 consecutive patients for a total of 144 feet were included. Pre and postoperatively, mean AOFAS changed from 44.8 ± 16.7 to 89 ± 10.3 (p < .001), mean MOxFQ changed from 76.2 ± 15.8 to 23.4 ± 7.9 (p < .001) and mean VAS score improved from 6.7 ± 2.1 to 1.5 ± 1.5 (p < .001). HVA diminished from 40.6° ± 6.9 preoperatively to 16.0° ± 7.3 postoperatively (p < .001). IMA decreased from 15.1° ± 2.8 preoperatively to 6.5° ± 2.4 postoperatively (p < .001). The main complication reported was stiffness (10.4 %). CONCLUSION: SERI technique applied to severe HV showed positive clinical and radiological outcomes. A careful patient selection and a low grade first MTPJ arthritis are essential to obtain favorable results. LEVEL OF EVIDENCE: IV.