Short-term results of total ankle arthroplasty for end-stage ankle arthritis with severe varus deformity.

BACKGROUND: Many authors have reported that an ankle varus deformity more than 10 to 15 degrees may be the cause of failures in total ankle arthroplasty. Our study aim was to analyze short-term outcomes of total ankle arthroplasty with additional procedures accompanied by more than 20 degrees of varus deformity. METHODS: Among the patients who received total ankle arthroplasty for end-stage osteoarthritis between June 2006 and May 2012, 103 cases that were followed for more than 6 months were reviewed. Depending on the degree of varus deformity, 24 cases with more than 20 degrees of coronal deformity were allocated into group A, and 79 cases with less than 20 degrees were allocated into group B. Soft tissue balancing, bony realignment osteotomy, and subtalar arthrodesis were also performed intraoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, visual analogue scale (VAS) for pain, and ankle range of motion (ROM) were analyzed preoperatively and postoperatively. Subjective satisfaction of the patients (excellent, good, fair, or poor) and complications (major or minor) were identified. RESULTS: The average AOFAS and VAS scores significantly improved in both groups (P < .001), but there was no significant difference between the groups. Patients' subjective satisfaction levels also improved in both groups. CONCLUSION: Short-term follow-up of total ankle arthroplasty, according to the degree of varus deformity, revealed clinically satisfactory progress in both groups without significant differences. There were no significant differences between the 2 groups in postoperative complications and early implant failures. LEVEL OF EVIDENCE: Level III, comparative series.

The effect of ossicle resection in the lateral ligament repair for treatment of chronic lateral ankle instability.

BACKGROUND: The management of an ossicle or avulsion fragment of the fibular tip in chronic lateral ankle instability is an open question. Some authors maintain the necessity of osteosynthesis for reconstruction of the lateral ligamentous structure if the fragment is large. We hypothesized that the modified Broström procedure with resection of the ossicle would result in good outcomes compared to that of the same procedure for chronic lateral instability patients without ossicle. METHODS: Between December 2004 and December 2010, 102 patients underwent the modified Broström procedure for chronic lateral instability. Of these, 82 patients (86 ankles) were available for this study. Forty ankles had ossicles at the fibular tip (group O), 46 had no ossicle (group N). The average follow-up period was 33 months in group O and 37 months in group N. Irrespective of size, if there were ossicles we resected all fragments and performed the modified Broström procedure. To analyze the surgical outcome, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot pain and function scales and Karlsson scores were compared between the 2 groups preoperatively and postoperatively. RESULTS: Preoperative scores in the 2 groups showed no significant difference, except for AOFAS pain score. There was no significant difference in postoperative AOFAS pain and function score between the groups. Postoperative Karlsson score was significantly higher in group O than in group N (P = .001). Group O was divided into 2 subgroups by the largest diameter of the ossicle (< 10 mm and ≥ 10 mm); there was no significant difference in surgical outcomes. CONCLUSIONS: In the treatment of chronic lateral instability of ankle, if there are ossicles on the fibular tip, osteosynthesis of the ossicles may not be necessary, even if the size is considerable. Modified Broström procedure after resection of the ossicle was successful. LEVEL OF EVIDENCE: Level III, retrospective case series.

The difference of surgical site infection according to the methods of lumbar fusion surgery.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To compare the rates and types of a surgical site infection according to the surgical options in spine surgeries. SUMMARY OF BACKGROUND DATA: Scant literatures exist on the difference of surgical site infection according to the surgical methods. We presumed that the incidence of infection after posterior lumbar interbody fusion (PLIF) was higher than posterior or posterolateral fusion (PF, PLF) due to several reasons. METHODS: A retrospective analysis was made on the patients who received instrumented spinal fusion surgeries from 2000 to 2009. The differences of surgical site infection rates and characteristics were compared between the patients who received PF or PLF (group I) and PLIF (group II). In addition, the infection rate according to the graft options and number of cages was compared in group II. RESULTS: A significant difference (P = 0.003) of infection rate between group I (0.3%, 3 cases out of 974) and group II (1.37%, 29 cases out of 2110) was observed. In group I, 67% of infections were wound infections and 33% were osteomyelitis. In group II, 23% were wound infections, 73% were osteomyelitis, and 4% were osteomyelitis combined with wound infection. Significant increase of infection rate was observed in the single cage group (P = 0.001) and mainly local bone grafted group (P = 0.030). CONCLUSIONS: The infection rate of PLIF was higher than that of PF or PLF. Considering the increased infection rate in local bone grafted group and 52% of the infection cases after interbody fusion was osteomyelitis around interbody space, contaminated local bones and interbody space were suspected as major routes of contamination. The higher infection rate in single cage group than that of double cage group was attributed to vulnerability of remained avascular disk materials to infection.

The analysis of risk factors in no thumb test in total knee arthroplasty.

BACKGROUND: We would like to analyze the risk factors of no thumb test among knee alignment tests during total knee arthroplasty surgery. METHODS: The 156 cases of total knee arthroplasty by an operator from October 2009 to April 2010 were analyzed according to preoperative indicators including body weight, height, degree of varus deformity, and patella subluxation and surgical indicators such as pre-osteotomy patella thickness, degree of patella degeneration, no thumb test which was evaluated after medial prepatella incision and before bone resection (1st test), no thumb test which was evaluated with corrective valgus stress (2nd test, J test), and the kind of prosthesis. We comparatively analyzed indicators affecting no thumb test (3rd test). RESULTS: There was no relation between age, sex, and body weight and no thumb test (3rd test). Patellar sulcus angle (p = 0.795), patellar congruence angle (p = 0.276) and preoperative mechanical axis showed no relationship. The 1st no thumb test (p = 0.007) and 2nd test (p = 0.002) showed significant relation with the 3rd no thumb test. Among surgical indicators, pre-osteotomy patella thickness (p = 0.275) and degeneration of patella (p = 0.320) were not relevant but post-osteotomy patellar thickness (p = 0.002) was relevant to no thumb test (3rd test). According to prosthesis, there was no significance with Nexgen (p = 0.575). However, there was significant correlation between Scorpio (p = 0.011), Vanguard (p = 0.049) and no thumb test (3rd test). Especially, Scorpio had a tendency to dislocate the patella, but Vanguard to stabilize the patella. CONCLUSIONS: No thumb test (3rd test) is correlated positively with 1st test, 2nd test, and post-osteotomy patella thickness. Therefore, the more patella osteotomy and the prosthesis with high affinity to patellofemoral alignment would be required for correct patella alignment.