scholarly journals Outcome Comparison of Arthroscopic versus Mini-open Technique for Ankle Arthrodesis

2020 ◽  
Author(s):  
Junliang Wang ◽  
WENPING GE ◽  
WENSHAN HU ◽  
FENG LIN ◽  
YUJIE LIU
Keyword(s):  
Length Of Hospital Stay ◽  
Operation Time ◽  
Fusion Rate ◽  
Ankle Arthrodesis ◽  
Open Group ◽  
Tourniquet Time ◽  
Vas Score ◽  
Significant Difference ◽  
End Stage ◽  
Mini Open

Abstract Background Ankle arthrodesis is considered to be the gold standard for the treatment of end-stage ankle diseases. At present, the commonly used methods of ankle arthrodesis include open ankle arthrodesis, arthroscopic ankle arthrodesis and mini-open ankle arthrodesis. The authors analyze and compare the clinical efficacy and related complications of arthroscopic ankle arthrodesis and mini-open ankle arthrodesis in the treatment of end-stage ankle disease. Methods From January 2007 to June 2018, 56 patents with end-stage ankle joint pathology were treated with arthroscopic ankle arthrodesis and mini-open ankle arthrodesis. There were 30 cases in arthroscopy group, including 19 males and 11 females with an average age of 49.6 years old (ranged, 32 to 71); while 26 cases in mini-open group, including 18 males and 8 females with an average age of 48.3 years old (ranged, 43 to 65). The operative time was calculated with use of computerized operative and anesthetic records. The pain visual analogue score (VAS), American Orthopedic Foot ༆ Ankle Society ankle and hind foot score (AOFAS), fusion rate, complications rate, length of hospital stay, operation time, and tourniquet time were compared between the two groups of patients. Results 51 patients were followed up for 15–35 months (mean, 22.5 ± 1.5) months. The bony fusion was achieved in all patients. The average time to fusion was 12.4 weeks (range, 10–16 weeks). The VAS score 3 days post-operation was (6.37 ± 0.69) points in the arthroscopy group and (7.61 ± 1.05) points in the mini-open group, there was significant difference between the two groups (P < 0.05). The VAS score and AOFAS score between the two groups pre- and post-operation have statistically significant differences (P < 0.05). At the last follow-up, VAS score was (1.55 ± 0.57) in the arthroscopy group and (1.43 ± 0.73) in the mini-open group, and there was no significant difference between the two groups (P > 0.05). The AOFAS score was (85.32 ± 2.96) points in the arthroscopy group and (86.72 ± 3.05) points in the mini-open group, and there was no significant difference between the two groups (P > 0.05). Arthroscopic ankle fusion was associated with a shorter tourniquet time and shorter length of hospital stay compared to mini-open ankle fusion (P < 0.05); however, there was no significant difference between two groups in terms of operation time (P > 0.05). Wounds healing was satisfying during the follow-up in the arthroscopy group. But the wounds healing was delayed in two patients of the small incision group. All patients were satisfied with the surgery. Conclusion Arthroscopic ankle arthrodesis and mini-open ankle arthrodesis have satisfactory curative effect and fusion rate. Arthroscopic assisted ankle arthrodesis has more advantages, including small incision, less injury, and low morbidity.

scholarly journals Transforaminal and Posterior Lumbar Interbody Fusion for Llumbar Degenerative Diseases, which one is better: A meta-analysis Through a Ggrade Analysis of Evidence

2021 ◽  
Author(s):  
aixian tian ◽  
xinlong ma ◽  
jianxiong Ma
Keyword(s):  
Blood Loss ◽  
Interbody Fusion ◽  
Meta Analysis ◽  
Posterior Lumbar Interbody Fusion ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Significant Difference

Abstract BackgroundTo explore the efficacy and safety between posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases.MethodsWe searched the literature in Pubmed, Embase, Cochrane Library and Web of Science. The index words were posterior lumbar interbody fusion, PLIF, transforaminal lumbar interbody fusion, TLIF, lumbar interbody fusion, spinal fusion, degenerative disc disease and lumbar degenerative diseases. Primary outcomes were fusion rate and complications. Secondary outcomes were visual analog scale (ΔVAS), Oswestry Disability Index (ΔODI), total blood loss, operation time and length of hospital stay. Review Manager 5.3 and Stata13.1 was used for the analysis of forest plots, heterogeneity, sensitivity and publication bias.Results17 studies were included (N=1562; PLIF, n=835; TLIF, n=727). The pooled data showed PLIF had a higher complications (P= 0.000), especially in nerve injury (p = 0.003) and dural tear (p = 0.005). PLIF required longer operation time (p = 0.004), more blood loss (p = 0.000) and hospital stays (p = 0.006). Surprisingly subgroup analysis showed there was significant difference in complications in patients under 55 (p = 0.000) and Asian countries (p = 0.000). No statistical difference was found between the two groups with regard to fusion rate (p = 0.593),ΔVAS (p = 0.364) andΔODI (p = 0.237).ConclusionsThis meta-analysis showed there were no significant difference in fusion rate, ΔVAS and ΔODI. However TLIF could reduce complications, especially nerve injury and dural tear. Besides, TLIF was associated with statistically significant less blood loss, shorter operation time and shorter length of hospital stay.

scholarly journals Comparative study between Blair’s procedure of ankle fusion and arthroscopic ankle arthrodesis

2021 ◽  
Vol 7 (4) ◽  
pp. 811
Author(s):  
Daya Krishna ◽  
Gunjan Upadhyay ◽  
Alok Kumar ◽  
Chandra Mohan Singh Rawat
Keyword(s):  
Comparative Study ◽  
Functional Outcome ◽  
Infection Rate ◽  
Complication Rate ◽  
Operation Time ◽  
Ankle Arthrodesis ◽  
X Rays ◽  
Tourniquet Time ◽  
Ankle Fusion ◽  
Significant Difference

<p><strong>Background:</strong> Our objective was to perform a comparative study in terms of functional outcome of Blair’s procedure of ankle fusion versus arthroscopic methods of ankle fusion.</p><p><strong>Methods</strong>: 25 patients that underwent arthroscopic ankle arthrodesis versus Blair’s procedure of ankle fusion were taken for study at government medical college, Srinagar (VCSGGIMS and R) from the duration 2015-2021. Clinical assessment was done foot and ankle disability index and visual analog scale score for pain. Radiological assessment was done by serial X-rays. Regular follow-ups were taken till one year.</p><p><strong>Results</strong>: Both modalities proved to be equally effective in terms of patient’s functional outcome. Our analysis showed that Blair’s procedure ankle fusion was associated with a lower fusion rate (OR 0.26, 95% CI 0.13-0.52, p=0.0002), longer tourniquet time (MD 16.49, 95% CI 9.46-23.41, p&lt;0.00001), and longer length of stay (MD 1.60,95% CI 1.10-2.10, p&lt;0.00001) compared to arthroscopic ankle fusion; however, there was no significant difference between two groups in terms of infection rate (OR 2.41, 95% CI 0.76-7.64, p=0.14), overall complication rate (OR: 1.54, 95% CI 0.80-2.96, p=0.20), and operation time (MD 4.09, 95% CI 2.4910.66, p=0.22).</p><p><strong>Conclusions</strong>: We found no significant difference between two groups in terms of infection rate, overall complication rate, and operation time. Further high quality randomized controlled trials that are adequately powered are required.</p>

scholarly journals Risk Factors for Nonunion in Arthroscopic and Open Ankle Arthrodesis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0018
Author(s):  
William T. Davis ◽  
Bradley Alexander ◽  
Benjamin B. Cage ◽  
Elise M. Greco ◽  
Charles R. Sutherland ◽  
...  
Keyword(s):  
Risk Factors ◽  
External Fixation ◽  
Significant Risk ◽  
The United States ◽  
Ankle Arthrodesis ◽  
Open Group ◽  
Ankle Arthritis ◽  
Patient Factors ◽  
Tourniquet Time ◽  
Radiographic Union

Category: Ankle; Ankle Arthritis; Arthroscopy Introduction/Purpose: Ankle arthrodesis remains the most popular surgical treatment option for end-stage ankle arthritis (ESAA) among surgeons in the United States. The primary objective endpoint for judging failure versus success of any arthrodesis is radiographic union versus nonunion. Overall, reported union rates in the last two decades have been excellent; however, there does remain significant variation in results with conflicting evidence regarding both treatment and patient factors that are associated with nonunion. We present a relatively large case series of ankle arthrodeses from a single institution with a high-risk patient population with the goal of further clarifying the patient and treatment factors that lead to nonunion. Methods: We conducted a retrospective chart review of 118 patients who underwent primary open or arthroscopic ankle arthrodesis at our institution between November 2014 and April 2019. Revision arthrodesis and patients with a history of complex open fracture were excluded. A minimum 6-month postoperative followup was required. The patients were divided into arthroscopic and open arthrodesis cohorts. The primary outcome measure was radiographic union at 6 months. Patient factors including demographics, BMI, medical comorbidities, and smoking status were analyzed as predictors of nonunion. Likewise, treatment factors such as surgical approach, method of fixation, and tourniquet time were analyzed as predictors of nonunion. Results: Of the 43 individuals that underwent arthroscopic ankle arthrodesis seven progressed to nonunion (16.27%). Among those undergoing open ankle arthrodesis 6 patients out of 46 progressed to nonunion (13.04%). In the arthroscopic cohort, individuals with preoperative lower extremity infection had a significantly higher rate of nonunion compared to those without infection (50.00%, p=0.0447). The open group had two significant predictors of nonunion: use of external fixation and low tourniquet time. Individuals who underwent arthrodesis with the use of an external fixator had a 100% nonunion rate compared to 11.11% for those treated with screws and 0% for those treated with plate fixation (p=0.020). Individuals that had a total tourniquet time under 90 minutes had a non-union rate of 66.67% (p=0.0082). Conclusion: While it was unsurprising that preoperative infection was a significant risk factor for nonunion, it is interesting that this effect was only shown in the arthroscopic group and not the open group. This could have practice implications and warrants further study. Our findings also add to the body of evidence that external fixation is inferior to modern internal fixation techniques for achieving bony fusion. This result may also reflect the poor preoperative prognosis of those requiring external fixation. There remains little evidence that diabetes, smoking, or BMI are significant risk factors for nonunion in primary ankle arthrodesis. [Table: see text]

scholarly journals Nighttime Appendectomy is Safe and has Similar Outcomes as Daytime Appendectomy: A Study of 1198 Appendectomies

2020 ◽  
pp. 145749692093860
Author(s):  
T. Mönttinen ◽  
H. Kangaspunta ◽  
J. Laukkarinen ◽  
M. Ukkonen
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Time Of Day ◽  
University Hospital ◽  
Patient Comfort ◽  
Intraoperative Bleeding ◽  
Significant Difference ◽  
Clinically Significant

Introduction: Although it is controversial whether appendectomy can be safely delayed, it is often unnecessary to postpone operation as a shorter delay may increase patient comfort, enables quicker recovery, and decreases costs. In this study, we sought to study whether the time of day influences the outcomes among patients operated on for acute appendicitis. Materials and Methods: Consecutive patients undergoing appendectomy at Tampere University Hospital between 1 September 2014 and 30 April 2017 for acute appendicitis were included. Primary outcome measures were postoperative morbidity, mortality, length of hospital stay, and amount of intraoperative bleeding. Appendectomies were divided into daytime and nighttime operations. Results: A total of 1198 patients underwent appendectomy, of which 65% were operated during daytime and 35% during nighttime. Patient and disease-related characteristics were similar in both groups. The overall morbidity and mortality rates were 4.8% and 0.2%, respectively. No time categories were associated with risk of complications or complication severity. Neither was there difference in operation time and clinically significant difference in intraoperative bleeding. Patients undergoing surgery during night hours had a shorter hospital stay. In multivariate analysis, only complicated appendicitis was associated with worse outcomes. Discussion: We have shown that nighttime appendectomy is associated with similar outcomes than daytime appendectomy. Subsequently, appendectomy should be planned for the next available slot, minimizing delay whenever possible.

scholarly journals Miniopen vs Lateral Approach for Ankle Arthrodesis, Which Approach is Superior in Joint Preparation: A Cadaver Study

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Karthikeyan Chinnakkannu ◽  
Haley McKissack ◽  
Gean C. Viner ◽  
Jun Kit He ◽  
Leonardo V. M. Moraes ◽  
...  
Keyword(s):  
Surface Area ◽  
Ankle Arthrodesis ◽  
Lateral Approach ◽  
Fixation Method ◽  
Open Approach ◽  
Ankle Arthritis ◽  
Joint Preparation ◽  
Significant Difference ◽  
In Trans ◽  
Mini Open

Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: Ankle arthrodesis is a gold standard for end-stage ankle arthritis after conservative managements fail. It may be done through direct anterior, lateral, arthroscopic or mini open approaches. Joint preparation, apposition of joint surfaces and stable fixation are very important for successful outcomes. Ankle arthrodesis maybe associated with infection, chronic pain and nonunion - of these, nonunion is the most common complication reported. Achieving union is of utmost importance while minimizing complications associated with the procedure. Regardless of approach or fixation method, preparation of articular surface is of paramount importance for successful union and may be limited by the approach used. Our study aims to evaluate the difference between direct lateral and dual mini-open approaches (extended arthroscopic portals) in terms of joint preparation. Methods: We used 10 below knee fresh-frozen cadaver legs for this cadaveric study. Ankle joints of five specimens were prepared through the lateral approach, while the remaining five ankles were prepared using dual mini incisions. After the completion of preparation, all ankles were dissected to open, photographic images of tibial plafond and talar articular were taken. Surface areas of each articular facet and unprepared cartilage of the talus, distal tibia, and distal fibula were measured and analyzed using ImageJ software. Results: Significantly greater amount of total surface area was prepared among specimens using mini-open approach compared to those with trans-fibular approach. The percentage of total articulating surface area prepared (including talus and tibia/fibula), talus, tibia and fibula in trans-fibular approach were 76.9%, 77.7% and 75% respectively. The percentages were 90.9%, 92.9%, and 88.6% in mini-open approach. While the medial gutter was well prepared with mini incision technique (unprepared surface 44 .64% vs 91.08%), lateral gutter was well prepared in trans-fibular technique (88.82vs 82.04 square cm). There is no difference in the amount of unprepared surface of talar dome between the two approaches. When excluding the medial gutter, there was no significant difference between trans-fibular and mini open techniques (83.94 vs 90.85, p=0.1412). Conclusion: Joint preparation using the mini-open approach (extended arthroscopic portal) is equally as efficacious as the transfibular approach for preparation of the tibiotalar joint. When including preparation of the medial gutter, the mini-open approach provides superior joint preparation. This may be advantageous with decreased rate of nonunion and less complications. But many surgeons fuse only tibiotalar surface, considering that, both approaches yield equal amount of joint preparation. But it needs to be confirmed with clinical studies.

Clinical and radiographic comparison of mini–open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up

2008 ◽  
Vol 9 (6) ◽  
pp. 560-565 ◽  
Author(s):  
Sanjay S. Dhall ◽  
Michael Y. Wang ◽  
Praveen V. Mummaneni
Keyword(s):  
Blood Loss ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Open Group ◽  
Lumbar Interbody Fusion ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Mean ◽  
Mini Open

Object As minimally invasive approaches gain popularity in spine surgery, clinical outcomes and effectiveness of mini–open transforaminal lumbar interbody fusion (TLIF) compared with traditional open TLIF have yet to be established. The authors retrospectively compared the outcomes of patients who underwent mini–open TLIF with those who underwent open TLIF. Methods Between 2003 and 2006, 42 patients underwent TLIF for degenerative disc disease or spondylolisthesis; 21 patients underwent mini–open TLIF and 21 patients underwent open TLIF. The mean age in each group was 53 years, and there was no statistically significant difference in age between the groups (p = 0.98). Data were collected perioperatively. In addition, complications, length of stay (LOS), fusion rate, and modified Prolo Scale (mPS) scores were recorded at routine intervals. Results No patient was lost to follow-up. The mean follow-up was 24 months for the mini-open group and 34 months for the open group. The mean estimated blood loss was 194 ml for the mini-open group and 505 ml for the open group (p < 0.01). The mean LOS was 3 days for the mini-open group and 5.5 days for the open group (p < 0.01). The mean mPS score improved from 11 to 19 in the mini-open group and from 10 to 18 in the open group; there was no statistically significant difference in mPS score improvement between the groups (p = 0.19). In the mini-open group there were 2 cases of transient L-5 sensory loss, 1 case of a misplaced screw that required revision, and 1 case of cage migration that required revision. In the open group there was 1 case of radiculitis as well as 1 case of a misplaced screw that required revision. One patient in the mini-open group developed a pseudarthrosis that required reoperation, and all patients in the open group exhibited fusion. Conclusions Mini–open TLIF is a viable alternative to traditional open TLIF with significantly reduced estimated blood loss and LOS. However, the authors found a higher incidence of hardware-associated complications with the mini–open TLIF.

scholarly journals A Comparison of the Bridge-type ROI-C Interbody Fusion Cage System and Titanium Mesh Graft With Titanium Plate Fixation in 2-level Anterior Cervical Discectomy and Fusion With Plating and Cage System: A Retrospective Study

2020 ◽  
Author(s):  
Shuangjun He ◽  
Zhangzhe Zhou ◽  
Xiaofeng Shao ◽  
Changhao Zhang ◽  
Xinfeng Zhou ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Operation Time ◽  
Fusion Rate ◽  
Cage System ◽  
Significant Difference ◽  
Group A ◽  
Bridge Type ◽  
Group B ◽  
Fusion Cage

Abstract Objective To explore the clinical efficacy and radioactive results of the bridge-type ROI-C interbody fusion cage (ROI-C) and anterior cervical discectomy and fusion with plating and cage system (ACDF) for cervical spondylopathy. Methods From January 2014 to January 2018, 45 patients undergoing ACDF were retrospectively analyzed, including 24 cases of ROI-C (group A) and 21 cases of ACDF (group B). The operation time, blood loss, Neck Disability Index (NDI), Japanese Orthopaedic Association score (JOA), postoperative complications, imaging results including cervical Cobb angle and fusion were compared between groups. Results All patients were successfully treated with surgery, and no cerebrospinal fluid leakage, esophageal fistula, or hoarseness occurred after surgery. The operation time and blood loss in group A were lower than those in group B (P < 0.05). During the follow-up period, JOA score increased and NDI score decreased after operation (P < 0.05), but there was no significant difference between the groups (P > 0.05). The incidence of dysphagia in group A was lower than that in group B at 1 month and 3 months after operation (P < 0.05), but the final follow-up results showed that there was no significant difference in the incidence of dysphagia between the two groups (P > 0.05). In group A, the fusion rate was 83.3% 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 12.5%. In group B, the fusion rate was 85.7% 3 months after surgery and 100% at the last follow-up. The rate of adjacent level ossification development was 23.8%. Conclusion Both ROI-C and ACDF can achieve satisfactory results, but ROI-C has shorter operation time, less bleeding and lower incidence of dysphagia in the short term.

scholarly journals Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis

2020 ◽  
Author(s):  
Yingjie Lu ◽  
Yuepeng Fang ◽  
Xu Shen ◽  
Dongdong Lu ◽  
Liyu Zhou ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Meta Analysis ◽  
Operation Time ◽  
Fusion Rate ◽  
Subsidence Rate ◽  
Radiological Data ◽  
Significant Difference ◽  
Score Fusion ◽  
Definition Of

Abstract Background: The zero-profile anchored cage ( ZP ) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate. Methods: We performed a meta-analysis of studies that compared the subsidence rates of ZP and CP. An extensive and systematic search covered the Medline, Embase and Web of Science databases according to the PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analyzed by RevMan 5.3 software. Results: Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in the ZP group was significantly higher than that in the CP group [15.1% (89/588) vs. 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In the subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61-3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than that of the CP group (OR 2.61, 95% CI 1.55-4.40, P = 0.0003) after multilevel (≥2-level) procedures. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate or cervical alignment in the final follow-up between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia than the ZP group at each follow-up time. Conclusion: Based on the limited evidence, we suggest that ZP has a higher risk of postoperative subsidence than CP, although with elevated swallowing discomfort. A high-quality, multi-center randomized controlled trial is required to validate our results in the future.

scholarly journals Enhanced recovery care versus traditional non- ERAS  care following osteotomies in developmental dysplasia of the hip in children : a retrospective case-cohort study

2020 ◽  
Author(s):  
Jin Li ◽  
Saroj Rai ◽  
Renhao Ze ◽  
Xin Tang ◽  
Ruikang Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Developmental Dysplasia ◽  
Control Group ◽  
Postoperative Fever ◽  
Vas Score ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). The VAS score in 3-day was significantly lower in ERAS group (2.9±0.8) than traditional non-ERAS group (4.0±0.8) (P<0.001). However, there was no significant difference in the frequency of breakout pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

scholarly journals Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0036
Author(s):  
Julie Neumann ◽  
Maxwell Weinberg ◽  
Chong Zhang ◽  
Charles Saltzman ◽  
Alexej Barg
Keyword(s):  
Wound Complication ◽  
Ankle Arthrodesis ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Wound Complications ◽  
Complication Rates ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
Tibiotalar Arthrodesis ◽  
End Stage

Category: Ankle Introduction/Purpose: Tibiotalar arthrodesis is generally a successful treatment option for patients with end stage ankle arthritis. However, there is a 9% risk of nonunion in patients undergoing primary tibiotalar arthrodesis. To date, it is unclear whether concurrent distal tibio-fibular joint arthrodesis affects this nonunion rate as there have been no studies directly comparing patients with and without arthrodesis of the distal tibio-fibular joint. The purpose of this clinical study is to compare the rate of nonunion in patients with a distal tibio-fibular fusion to those without a distal tibio-fibular fusion in the setting of a primary, open ankle arthrodesis. The hypothesis of this study was that the addition of a distal tibio-fibular fusion would decrease the nonunion rate in patients undergoing open ankle arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. 366 ankles from 354 unique patients met inclusion criteria. All patients underwent primary, open tibiotalar arthrodesis. 250 patients underwent open tibiotalar arthrodesis with a distal tibio-fibular fusion and 116 patients underwent open tibiotalar arthrodesis without a distal tibio-fibular fusion. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was nonunion rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, and rate of development of post-operative deep vein thrombosis (DVT)/Pulmonary embolism (PE). Results: Average age of the patients was 56.2 +/- 14.2 years. Mean follow-up time was 33.8 months. Unions were assessed on routine post-operative radiographs and by clinical examination. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had the distal tibio-fibular joint included was 19/250 (8%) and nonunion rate of those who did not have the distal tibio-fibular joint fused was 14/116 (12%) (p=0.16). There was no significant difference between those who had the distal tibio-fibular joint included versus who did not in wound complication rate (27% vs 31%, p=0.40), time to union (4.9 weeks versus 5 weeks, p =0.54), and DVT/PE rate (5% vs 3%, p=0.41), respectively [Table 1]. There were no major complications. Conclusion: To our knowledge, this is the first study directly comparing nonunion rates and complication rates in patients who underwent primary, open ankle arthrodesis with and without distal tibio-fibular joint arthrodesis. In this study, inclusion of the distal tibio-fibular joint in tibiotalar arthrodesis does not affect nonunion rate in patients undergoing primary, open ankle arthrodesis. Additionally, inclusion of the distal tibio-fibular joint does not affect rate of wound complication, time to union, and DVT/PE rate.

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