Porous Tantalum as a Structural Graft in Foot and Ankle Surgery

2012 ◽  
Vol 33 (3) ◽  
pp. 179-189 ◽  
Author(s):  
Bernard H. Sagherian ◽  
Richard J. Claridge
Keyword(s):  
Bone Graft ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Porous Tantalum ◽  
Native Bone ◽  
Structural Support ◽  
Ankle Surgery ◽  
Structural Graft

Background: Structural bone grafts are often used in foot and ankle surgery to fill gaps, maintain height, length or correction. Bone graft, whether autograft or allograft, has limitations and disadvantages. With porosity and mechanical properties similar to native bone, porous tantalum has been used successfully in hip and knee applications. This study investigates the potential advantages of porous tantalum as a substitute for conventional bone graft in foot and ankle surgery. Methods: A retrospective review of 27 arthrodesis procedures was performed of foot and ankle procedures using Trabecular Metal™ porous tantalum over a period of 5 years. Twenty-five patients were involved. Mean age at the time of surgery was 63 (range, 41 to 80) years. All the patients had pathologies in the foot and ankle that required arthrodesis with structural graft. Average followup was 27 (range, 12 to 72) months. Results: At final followup the mean American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot / Midfoot score improved from 40.6 (range, 16 to 64) preoperatively to 86.3 (range, 57 to 100) postoperatively ( p < 0.001). When the pain component of the AOFAS was examined, the score improved from a mean of 8.2 (range, 0 to 20) to 35.2 (range, 20 to 40), ( p < 0.001). At the time of last followup, 56% of patients reported no pain, 40% reported mild occasional pain, and 4% reported moderate pain. Conclusion: Porous tantalum therefore, was found to be a viable alternative to conventional bone graft when structural support was required. Level of Evidence: IV; Retrospective Case Series

scholarly journals Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

2018 ◽  
Vol 40 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Johanna Marie Richey ◽  
Miranda Lucia Ritterman Weintraub ◽  
John M. Schuberth
Keyword(s):  
Risk Factors ◽  
Hormone Replacement ◽  
Case Series ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
History Of ◽  
Low Incidence ◽  
Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

Safety Profile Associated With Calcaneal Autograft Harvesting Using a Reaming Graft Harvester

2020 ◽  
Vol 41 (12) ◽  
pp. 1487-1492
Author(s):  
Rona W. Law ◽  
Travis M. Langan ◽  
Devon W. Consul ◽  
James Steriovski ◽  
Mark A. Prissel ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Healing ◽  
Complication Rate ◽  
Safety Profile ◽  
Case Series ◽  
Autogenous Bone Graft ◽  
Autogenous Bone ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Ankle Surgery

Background: Foot and ankle surgery often requires bone healing, whether in elective arthrodesis or trauma. While primary bone healing is possible, the rate of nonunion in foot and ankle surgery remains variable. The addition of autogenous bone graft can allow for higher union rates by adding to the biology at the site of bone healing. Harvesting autogenous bone graft from the calcaneus for foot and ankle surgery can be done quickly and efficiently and allow for an adequate amount of graft. Methods: A retrospective chart and radiographic review was performed for 1438 patients at a single center between August 1, 2015, and December 15, 2018, who underwent calcaneal autograft harvesting using a power-driven reaming graft harvester. Results: In total, 966 patients were included and evaluated for the safety and complication rate associated with the procedure. Only 1 patient (0.1%) had a major complication, and there were 14 minor complications (1.4%). Conclusion: The safety profile and low complication rate of this case series demonstrate that this simple and efficient calcaneal autograft harvest technique can be considered when a small to moderate amount of autogenous bone graft is required to augment bone healing. Level of Evidence: Therapeutic level IV, case series.

Triple Nerve Block at the Knee for Foot and Ankle Surgery Performed by the Surgeon: Difficulties and Efficiency

2009 ◽  
Vol 30 (9) ◽  
pp. 854-859 ◽  
Author(s):  
Sokratis E. Varitimidis ◽  
Aaron I. Venouziou ◽  
Zoe H. Dailiana ◽  
Dimitrios Christou ◽  
Apostolos Dimitroulias ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Nerve Block ◽  
Case Series ◽  
Orthopaedic Surgeon ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Nerve Blocks ◽  
Simple Method ◽  
Ankle Surgery

Background: Combined nerve blocks at the knee can provide safe anesthesia below the knee avoiding the potential complications of general or spinal anesthesia while reducing the need for opioids in the postoperative period. This study presents the outcomes of a large series of patients that underwent foot and ankle surgery receiving a triple nerve block at the knee. Materials and Methods: Three hundred eighty patients underwent foot and ankle surgery receiving anesthesia with triple nerve block at the knee (tibial, common peroneal and saphenous nerve). Surgery included a variety of bone and soft tissue procedures. The nerve block was performed by an orthopaedic surgeon in the lateral decubitus position. Results: The successful nerve block rate was 91 percent. There was no need to convert to general or spinal anesthesia, although 34 patients (9%) needed additional analgesia intraoperatively. Complete anesthesia required 25 to 30 minutes from the time of performing the block. No complication occurred secondary to the use of the anesthetic agent (ropivacaine 7.5%). Postoperative analgesia lasted from 5 to 12 hours, reducing the need of additional analgesics. Hospitalization averaged 1.4 days (from 0 to 5) with the majority of patients discharged the day after the operation (248/380). A high satisfaction rate was reported by the patients with no adverse effects and complications. Conclusion: We found triple nerve block at the knee to be a safe and reliable method of regional anesthesia providing low morbidity, high success rate, long acting analgesia, and fewer complications than general or spinal anesthesia. It is a simple method that can be performed by the orthopaedic surgeon. Level of Evidence: IV, Retrospective Case Series

scholarly journals Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

2021 ◽  
Author(s):  
Gabriele Colo’ ◽  
Mattia Alessio Mazzola ◽  
Giulio Pilone ◽  
Giacomo Dagnino ◽  
Lamberto Felli
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Deformity Correction ◽  
Tibialis Posterior ◽  
Open Wedge ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

scholarly journals Arthroscopic-assisted arthrodesis in the foot and ankle. Subtalar, tibiotalar, tibiocalcaneal, and metatarsophalangeal: 25 years of experience

2021 ◽  
Vol 0 ◽  
pp. 1-7
Author(s):  
Luis Perez-Carro ◽  
Carlos Rodrigo-Arriaza ◽  
Lorena Trueba-Sanchez ◽  
Gustavo Gutierrez-Castanedo ◽  
Guillermo Menendez-Solana ◽  
...  
Keyword(s):  
Case Series ◽  
Invasive Procedure ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Non Union ◽  
End Stage ◽  
Mean Time ◽  
Radiographic Union

Objectives: Arthritis of the foot and ankle joints provoke pain and restricts function. The arthroscopic assisted arthrodesis (AAA) is a minimally invasive procedure for end stage arthritis to eliminate pain and achieve painless mobilization, with numerous benefits like faster time to union, less blood loss, less morbidity, less infection rate, and less soft tissue complications compared with open surgery. The objective of this paper is to retrospectively evaluate our case series (136 patients) of arthroscopic assisted foot and ankle fusion that includes the subtalar, tibiocalcaneal, tibiotalar and metatarsophalangeal joint in our last 25 years of practice. Level of Evidence: Level IV, retrospective case series. Materials and Methods: Patients who underwent arthroscopic assisted arthrodesis in the foot and ankle were identified by review of a registry. Minimum follow-up was 24 months. Patient demographics characteristics, time to radiographic union, and preoperative and postoperative American Orthopaedic Foot and Ankle Society score (AOFAS) were obtained. Results: Subtalar fusion: 43 patients. Radiographic union was seen in 40 patients at a mean time of 10 weeks (8-14) and non union was seen in three patients, of which 1 required open revision surgery. AOFAS score improved from 43 preoperatively (27-57) to 83 (67-93) postoperatively. Tibiotalar fusion: 55 patients. Radiographic union in a mean time of 12 weeks (7-15) in all 55 cases. AOFAS score improved from 50.5 preoperatively (25-60) to 82 (62-94) postoperatively. Tibiotalocalcaneal fusion: 3 patients. 2 patients with radiographic union at 14 and 16 weeks and 1 showed a fibrotic union of the subtalar joint without pain. AOFAS score improved from 43 preoperatively (34-58) to 78 (67-81) postoperatively. Metatarsophalangeal fusion: 35 patients. Radiographic union in 33 patients at a mean time of 8 weeks (6-11). Two patients presented asymptomatic non union. AOFAS score improved from 38 preoperatively (30-60) to 86 (75-93) postoperatively. Conclusion: Arthroscopic assisted arthrodesis in the foot and ankle is an excellent procedure for end stage degenerated joint.

Prevalence and Safety of Left-Footed Driving Following Right Foot Surgery Patients Including a Driving Simulation

2019 ◽  
Vol 40 (7) ◽  
pp. 818-825 ◽  
Author(s):  
Haley M. McKissack ◽  
Yvonne E. Chodaba ◽  
Tyler R. Bell ◽  
Eva J. Lehtonen ◽  
Ibukunoluwa B. Araoye ◽  
...  
Keyword(s):  
Driving Simulator ◽  
Recovery Period ◽  
Significant Proportion ◽  
Case Series ◽  
Postoperative Recovery ◽  
Foot And Ankle ◽  
Foot Surgery ◽  
Level Of Evidence ◽  
Ankle Surgery ◽  
The Right

Background: For many patients, returning to driving after right foot and ankle surgery is a concern, and it is not uncommon for patients to ask if driving may be performed with their left foot. A paucity of literature exists to guide physician recommendations for return to driving. The purpose of this study was to describe the driving habits of patients after right-sided foot surgery and assess the safety of left-footed driving using a driving simulator. Methods: Patients who underwent right foot or ankle operations between January 2015 and December 2015 were retrospectively identified. A survey assessing driving habits prior to surgery and during the recovery period was administered via a REDCap database through email or telephone. Additionally, simulated driving scenarios were conducted using a driving simulator in 20 volunteer subjects to compare characteristics of left- versus right-footed driving. Results: Thirty-six of 96 (37%) patients who responded to the survey reported driving with the left foot postoperatively. No trends were found associating left-footed driving prevalence and socioeconomic status. In driving simulations, patients exceeded the speed limit significantly more ( P < .001) and hit other vehicles more ( P < .026) when driving with the right foot than the left. The time to fully brake and fully release the throttle in response to vehicular hazards was significantly prolonged in left-footed driving compared with right ( P = .019 and P = .034, respectively). Conclusion: A significant proportion of right foot ankle surgery patients engaged in left-footed driving during postoperative recovery. Driving with both the right and left foot presents a risk of compromised safety. This study provides novel objective data regarding the potential risks of unipedal left-footed driving using a standard right-footed console, which indicates that driving with the left foot may prolong brake and throttle release times. Further studies are warranted for physicians to be able to appropriately advise patients about driving after foot and ankle surgery. Level of Evidence: Level IV, case series.

Osteochondral Lesions of the Talus: Predictors of Clinical Outcome

2011 ◽  
Vol 32 (11) ◽  
pp. 1045-1051 ◽  
Author(s):  
Daniel J. Cuttica ◽  
W. Bret Smith ◽  
Christopher F. Hyer ◽  
Terrence M. Philbin ◽  
Gregory C. Berlet
Keyword(s):  
Clinical Outcome ◽  
Treatment Plan ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Nonoperative Treatment ◽  
Treatment Modalities ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence

Background: Osteochondral lesions of the talus (OLT) are a common and challenging condition treated by the orthopedic foot and ankle surgeon. Multiple operative treatment modalities have been recommended, and there are several factors that need to be considered when devising a treatment plan. In this study, we retrospectively reviewed a group of patients treated operatively for osteochondral lesions of the talus to determine factors that may have affected outcome. Methods: A retrospective chart review of clinical, radiographic and operative records was performed for all patients treated for OLTs via marrow stimulation technique. All had a minimum followup of 6 months or until return to full activity, preoperative magnetic resonance imaging (MRI) of the OLT to determine size, and failure of nonoperative treatment. Results: A total of 130 patients were included in the study. This included 64 males and 66 females. The average patient age at the time of surgery was 35.1 ± 13.7 (range, 12 to 73) years. The average followup was 37.2 ± 40.2 (range, 7.43 to 247) weeks. The average size of the lesion was 0.84 ± 0.67 cm2. There were 20 lesions larger than 1.5 cm2 and 110 lesions smaller than 1.5 cm2. There were 113 contained lesions and 17 uncontained lesions. OLTs larger than 1.5 cm2 and uncontained lesions were associated with a poor clinical outcome. Conclusions: The treatment of osteochondral lesions of the talus remains a challenge to the foot and ankle surgeon. Arthroscopic debridement and drilling will often provide satisfactory results. However, larger lesions and uncontained lesions are often associated with inferior functional outcomes and may require a more extensive initial procedure. Level of Evidence: IV, Retrospective Case Series

Management of Long-Term Sequelae of Compartment Syndrome Involving the Foot and Ankle

2009 ◽  
Vol 30 (9) ◽  
pp. 847-853 ◽  
Author(s):  
Francois Lintz ◽  
Jean A. Colombier ◽  
Joseph Letenneur ◽  
Francois Gouin
Keyword(s):  
Compartment Syndrome ◽  
Case Series ◽  
Personal Data ◽  
Functional Results ◽  
Ankle Arthrodesis ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Muscle Fibrosis

Background: Lower leg compartment syndrome can lead to severe sequelae affecting patient autonomy. Ischemic muscle fibrosis and retraction result in foot and ankle deformities ranging from claw toes to complex multiplanar dislocations with soft tissue impairment requiring amputation. Although these deformities have been reported in relation to compartment syndrome, they have rarely been discussed specifically in the light of a long term follow up. Materials and Methods: Between 1981 and 2006, 151 patients were treated in our hospital for compartment syndrome of the lower limb. Ten of them later required further surgery to treat sequelae on the foot and ankle and were followed up prospectively. Personal data and surgical events were recorded, as well as potential risk factors for sequelae and functional outcome. The data was analyzed and compared to that available in previous literature. We analyzed and describe the different surgical procedures available for the management of this condition including arthroscopic ankle arthrodesis which could be a less invasive and efficient technique in mild equinus deformities. Results: All ten patients were diagnosed late for compartment syndrome. The anterior and lateral compartments were most often involved but rarely accounted for late sequelae. The deep posterior compartment seems to be the key element in generating after effects. Functional results were good in eight patients. Two required amputation after failed secondary surgery. Conclusion: The late, post-compartment syndrome affecting the foot and ankle can be treated efficiently provided surgery is performed acurately, taking into account the multiplanar deformity. However, the best treatment for this condition remains prevention. Level of Evidence: IV, Retrospective Case Series

Opioid Consumption Following Foot and Ankle Surgery

2018 ◽  
Vol 39 (6) ◽  
pp. 649-656 ◽  
Author(s):  
Haley M. Merrill ◽  
Daniel M. Dean ◽  
Jay L. Mottla ◽  
Steven K. Neufeld ◽  
Daniel J. Cuttica ◽  
...  
Keyword(s):  
Pain Control ◽  
Case Series ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Short Acting ◽  
Postoperative Visit ◽  
Ankle Surgery ◽  
Significant Difference ◽  
The Mean ◽  
Long Acting

Background Orthopedic surgeons frequently prescribe pain medications during the postoperative period. The efficacy of these medications at alleviating pain after foot/ankle surgery and the quantity of medication required (and conversely, leftover) are unknown. Methods: Patients undergoing foot/ankle surgery during a 3-month period who met inclusion criteria were surveyed at their first postoperative visit. Information collected included gender, number of prescribed pills remaining, satisfaction with pain control, and willingness to surrender leftover opioids to a Drug Enforcement Administration (DEA) disposal center. Additional data, including utilization of a perioperative nerve block and type (bony versus nonbony) and anatomic region of procedure, were collected through review of the medical record. All data were analyzed in a retrospective fashion. A total of 171 patients with a mean age of 53.1 ± 15.5 years (range, 18-81 years) were included in the study. Results: The mean number of opioids taken was 27.2 ± 17.5 pills (range, 0-70). The mean number of short-acting opioids and long-acting opioids taken was 21.4 ± 14.8 and 9.2 ± 5.0 pills, respectively. Most (73.5%) patients were satisfied with their pain control. Patients who underwent ankle/hindfoot surgery took more long-acting opioids on average than others ( P = .047). There was not a significant difference in opioid usage between bony and nonbony procedures. Of those with leftover opioids, 63% were willing to surrender them to a DEA disposal center. Patients willing to surrender leftover medications had both more short-acting ( P < .001) and long-acting ( P = .015) opioids leftover than those not willing to surrender them. Conclusion: Most patients undergoing foot/ankle surgery had opioids leftover at the first postoperative visit, and most were willing to surrender them. We can adequately treat patients’ pain and decrease the number of opioid pills available in the community by decreasing the number of pills prescribed and encouraging disposal of leftovers. Level of Evidence: Level IV, retrospective case series.

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