Is obesity a risk factor in percutaneous hallux valgus surgery?

BACKGROUND: Obesity and its relationship with higher rate of complications in orthopedic surgeries have been reported. There is no evidence of the relation between obesity and percutaneous foot surgery. Our objective was to evaluate obesity as a risk factor for complications and reoperations in percutaneous surgery of the hallux valgus. METHODS: A total 532 feet were retrospectively reviewed in which a percutaneous hallux valgus correction was performed. Complications and surgical reoperations were recorded. Patients were divided into 2 groups: BMI less and greater than 30kg/m2. RESULTS: There were no differences in the rate of complications or reoperations. The total complication rate was 8%. Obesity as an isolated risk factor, presented aOR=1.14 (95%CI 0.54-2.4, p=.714). The overall rate of reoperations was 9%. Obesity presented an aOR=0.64 (95%CI 0.27-1.49, p=.31). CONCLUSION: Obesity has not been associated with a higher rate of complications and reoperations in percutaneous hallux valgus surgery. It is a safe procedure and BMI should not influence in the prognosis. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Comparación de los resultados de la artroplastia total de tobillo en pacientes menor o igual a 55 y mayor a 55 años / Comparison of total ankle arthroplasty outcomes between patients younger and older than 55 years

Objetivo: Comparar los resultados posoperatorios clínicos y radiográficos en dos grupos de pacientes: menor o igual a 55 años y mayor a 55 años, sometidos a una artroplastia total de tobillo de tercera generación. Materiales y Métodos: Se evaluó, en forma retrospectiva, a dos grupos de pacientes: menor o igual a 55 años (n = 13) y mayor a 55 años (n = 18), que fueron sometidos a una artroplastia total de tobillo de tercera generación. La edad promedio del grupo de menor o igual a 55 años era 42.8 (DE 6.4) y la del grupo mayor a 55 años, 65.7 (DE 8.8). Resultados: El seguimiento promedio fue de 36 meses (RIC 25-60). La etiología era principalmente postraumática en ambos grupos. El puntaje promedio de la escala AOFAS al año de la cirugía fue 76,69 (RIC 58-89) en el grupo menor o igual a 55 años y 85,22 (RIC 67-100) en el grupo mayor a 55 años. No hubo diferencias estadísticamente significativas entre ambos grupos en los ángulos alfa, beta y gamma; medidos en las radiografías con apoyo a los 2 meses y a los 2 años de la cirugía. Conclusiones: Nuestro estudio demostró que los resultados clínicos y radiográficos en pacientes más jóvenes serían comparables con los de pacientes más grandes en el seguimiento temprano. Se necesita un seguimiento a más largo plazo para determinar si el riesgo de revisión es más alto en los pacientes jóvenes, debido a la falla relacionada con el desgaste de la prótesis

Objective: To compare the clinical and radiographic postoperative outcomes in two groups of patients: younger 55 and older than 55-year patients undergoing a third-generation total ankle arthroplasty (TAA). Materials and Methods: Two groups of patients were retrospectively studied: younger 55 (n=13) and older 55-year patients (n=19) undergoing a third-generation TAA. Group younger 55 average age was 42.8 (SD, 6.4) and Group older 55 average age was 65.7 (SD, 8.8). Results: The average follow-up was 36 months (IQR, 25-60). The main etiology was post-traumatic conditions in both groups. The mean score of the AOFAS scale one year after surgery was 76.69 (IQR, 58-89) in the group younger 55 and 85.22 (IQR, 67-100) in the group older 55. There were no statistically significant differences between the two groups in the alpha, beta and gamma angles measured on weight-bearing radiographs at 2-month and 2-year postoperative controls. Conclusions: Our study shows clinical and radiographic short-term outcomes in younger patients are similar to those in older patients. Longer-term follow-up is warranted to determine if the revision risk is greater in young patients, due to failures related to prosthesis wear

Minimally-invasive hallux arthrodesis with endomedullary and a crossed screw fixation.

BACKGROUND: Minimally invasive surgery has several advantages: minor pain, smaller incisions and less tissue damage than traditional open surgery. Hallux arthrodesis with an endomedullary screw fixation provides compression and axial stability. The aim of this study was to describe the procedure and evaluate our first results of the minimally invasive first metatarsophalangeal arthrodesis with an endomedullary screw combined with a crossed screw fixation. METHODS: We retrospectively studied 15feet, with a minimum 1year follow-up. Patients were evaluated with full-load radiographs and AOFAS score preoperatively and at last follow-up. RESULTS: Consolidation rate was 93.3%, radiological consolidation time was 18 weeks (14-60). Radiographic alignment was achieved with satisfactory results. The preoperative AOFAS score improved from a mean 49 to 90 (p=0.001). There was one postoperative superficial site infection, which healed and a patient developed a pseudarthrosis but it was asymptomatic. CONCLUSIONS: The minimally invasive metatarsophalangeal arthrodesis with an intramedullary screw is a secure procedure with comparable results to open techniques. LEVEL OF CLINICAL EVIDENCE: 4.

Long-term Outcome of Unconstrained Primary Total Hip Arthroplasty in Ipsilateral Residual Poliomyelitis.

Incapacitating articular sequelae in the hip joint have been described for patients with late effects of poliomyelitis. In these patients, total hip arthroplasty (THA) has been associated with a substantial rate of dislocation. This study was conducted to evaluate the long-term clinical and radiologic outcomes of unconstrained THA in this specific group of patients. The study included 6 patients with ipsilateral polio who underwent primary THA between 1985 and 2006. Patients with polio who underwent THA on the nonparalytic limb were excluded. Mean follow-up was 119.5 months (minimum, 84 months). Clinical outcomes were evaluated with the modified Harris Hip Score (mHHS) and the visual analog scale (VAS) pain score. Radiographs were examined to identify the cause of complications and determine the need for revision surgery. All patients showed significantly better functional results when preoperative and postoperative mHHS (67.58 vs 87.33, respectively; P=.002) and VAS pain score (7.66 vs 2, respectively; P=.0003) were compared. Although 2 cases of instability were diagnosed, only 1 patient needed acetabular revision as a result of component malpositioning. None of the patients had component loosening, osteolysis, or infection. Unconstrained THA in the affected limb of patients with poliomyelitis showed favorable long-term clinical results, with improved function and pain relief. Nevertheless, instability may be a more frequent complication in this group of patients compared with the general population. [Orthopedics. 2017; 40(2):e255-e261.].