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PubMedDate not supplied

[Indications and technique of partial arthrodesis of the carpus].

Partial arthrodesis of the carpus has again become a topical method. The technique has been improved and the range of indications has been extended. Fusion of certain areas has indeed been propagated as first-line therapy, for example in lunatum necrosis or as an important additional operation in substitution plastic surgery. Partial arthrodesis of the carpus is intended to eliminate mechanisms which has become pathological whilst preserving the best possible mobility. Partial arthrodesis alters the movement pattern of the individual ossae carpi. Moreover, the pressure in the adjacent joints also rises. The risk of a new pathological process is considerable. Recent publications report on a rapid development of impingement and symptoms. The most frequent partial arthrodeses are discussed. The indications and the direct consequences are critically analysed and explained with reference to examples. Technical details and potential dangers are described. An STT-arthrodesis is indicated for osteoarthritis of these bones. The radio-lunar arthrodesis is recommended for ulnar drifting of the carpus in cases of rheumatoid arthritis. Reconstruction of the central axis with arthrodesis of the capitate-lunate is indicated for pseudarthrosis of the scaphoid with carpal collapse. Other combinations are possible, they cause however greater functional deficits. We recommend a critical analysis of the function of the entire carpus before the operation. Caution is called for when an incipient arthrosis is present in the adjacent joint. Partial arthrodesis of the carpus is rather a temporary solution, since it enables time to be gained. Total arthrodesis is the ultimate resort.

Arthrodesis↗
PubMed2005

Knee arthrodesis with simultaneous lengthening using the Ilizarov method.

OBJECTIVE: To determine whether knee arthrodesis with simultaneous lengthening using the Ilizarov method for a nonreconstructable knee joint with bone loss and infection is a successful salvage procedure. DESIGN: Retrospective review of patients. SETTING: University hospital-based orthopaedic practice. PATIENTS: From 1999 to 2001, 4 consecutive patients with a nonreconstructable knee joint, bone loss, and infection after trauma underwent knee arthrodesis with simultaneous lengthening. INTERVENTION: Arthrodesis of the knee with simultaneous limb lengthening through an osteotomy of the tibia and/or femur and the use of an Ilizarov frame. External bone stimulation was used at the knee arthrodesis site and the lengthening sites. Application of this device began during the early distraction phase and continued until frame removal. MAIN OUTCOME MEASURES: Bony union at the arthrodesis and bone lengthening sites, alignment of the lower extremity, limb length discrepancy, infection, pain, and outcome scales (SF-36 scores and American Academy of Orthopaedic Surgeons lower limb modules). RESULTS: Bony union of the knee arthrodesis and lengthening sites and good alignment were achieved in all 4 patients. Mean amount of lengthening was 5.4 cm (range 2.5-11.5 cm). Average time in frame was 11 months (range 6-17 months). Limb length discrepancy after treatment averaged 1.8 cm (range 0.6-3.7 cm). Mean duration of follow-up after frame removal was 35 months (range 28-48 months). At follow-up, infection had not recurred, pain was not present, and assistive devices were not needed for ambulation. Average SF-36 scores improved in all 8 categories, and the average American Academy of Orthopaedic Surgeons lower limb modules improved from a mean of 33 (range 11-37) to a mean of 68 (range 51-76). CONCLUSION: Knee arthrodesis with simultaneous lengthening can be performed successfully using the Ilizarov method. It enables surgeons to optimize limb length during knee arthrodesis. The use of external fixation and the avoidance of internal implants may be advantageous in the presence of or history of infection. The Ilizarov frame provides stability that allows weight bearing during treatment.

Adult↗
PubMed2005

Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial.

BACKGROUND: Arthrodesis is the current treatment for end-stage hallux rigidus, although there are many reports advocating total joint replacement arthroplasty. The aim of this randomized controlled trial was to evaluate clinical outcomes after first metatarsophalangeal joint (MTPJ) arthrodesis and replacement arthroplasty. METHODS: Between November, 1998, and January 2001, 63 patients between the ages of 34 and 77 years, with unilateral or bilateral MTPJ arthritis were recruited and randomly selected to have either MTPJ arthrodesis or arthroplasty. Twenty-two patients (38 toes) had arthrodesis and 27 patients (39 toes) had arthroplasty. A single surgeon performed all surgery. The primary outcome measure determining successful surgery was a decrease in pain as measured on a Visual Analogue Scale (VAS). Functional outcome was assessed at 6 months and 1 and 2 years. Cost data were simultaneously collected. RESULTS: At 24 months, pain improved in both groups (p < 0.001), but there were significantly greater improvements after arthrodesis (p = 0.01). All 38 arthrodeses united at a mean dorsiflexion angle of 26 degrees, with few complications. In contrast, in the arthroplasty group, six of the 39 inserted implants had to be removed because of phalangeal component loosening. In the remainder the range of motion gained was poor, and the patients tended to bear weight on the outer border of their foot. The cost ratio was 2:1 in favor of arthrodesis. CONCLUSIONS: Outcomes after arthrodesis were better than those after arthroplasty. The results were partially attributable to an unacceptably high incidence of loosening of the phalangeal components, which resulted in removal of the implants. However, even when data from the failures were excluded, arthrodesis was clearly preferred by most patients.

Adult↗
PubMed1999

Forefoot reconstruction in rheumatoid arthritis patients: Keller-Lelièvre-Hoffmann versus arthrodesis MTP1-Hoffmann.

The aim of this study was to compare the subjective, clinical and pedodynographic results of two large groups of patients operated on in our department. From January 1987 to December 1992, 38 rheumatoid patients (59 feet) underwent a Keller-Lelièvre arthroplasty of the first metatarsophalangeal (MTP1) joint and a Hoffmann resection of the lesser metatarsal heads. The mean follow-up was 35 months. From June 1992 to August 1997 48 patients (62 feet) with rheumatoid arthritis underwent an arthrodesis of the MTP1 joint and Hoffmann resection of the lesser metatarsal heads. The mean follow-up was 25 months. In 10 feet the arthrodesis was performed as a revision procedure of a failed Keller-Lelièvre arthroplasty. The patients of both series were assessed in the same way: personal interview, clinical examination, radiographs, bilateral footprints, and pedodynographic measurements. Static and dynamic pedodynographic measurements were taken with a 64-sensor matrix insole in a standard shoe. Six of our patients had an arthrodesis-Hoffmann procedure performed on one foot and a Keller-Lelièvre-Hoffmann procedure on the contralateral side. Although there is better loadbearing of the first ray with relative unloading of the central metatarsal heads in the arthrodesis MTP1-Hoffmann group, subjective evaluation of the procedure was slightly better in the Keller-Lelièvre-Hoffmann group. Ninety-three percent of the patients in the Keller group were satisfied or satisfied with minor reservations versus 87 percent in the arthrodesis group. This difference is not statistically significant. Recurrent deformity was not more prominent in the Keller-Lelièvre-Hoffmann group; however, it may be that with a longer follow-up, the feet in the arthrodesis-Hoffmann group hold up better over time. The arthrodesis MTP1-Hoffmann procedure can be used as a revision procedure for a failed Keller- Hoffmann operation, although these procedures were more difficult and needed a longer recovery time than the primary MTP1 arthrodesis.

Arthritis, Rheumatoid↗
PubMed1993

Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle.

Twenty-nine patients who had diabetic neuropathic arthropathy of the foot and ankle were managed with open reduction and arthrodesis of various joints. Rigid internal fixation was used in all but four patients, who had external fixation. All patients had severe instability or a fixed deformity that precluded successful treatment with bracing. The sites of the fracture-dislocations or the neuropathic dislocations were the ankle in twenty-one patients, the subtalar joint in six, and the transverse tarsal joint in two. The ankle-brachial Doppler indices of these patients averaged 0.86 (range, 0.55 to 1.14). The involved extremities were graded at the initial evaluations according to the Wagner classification system for neuropathic ulceration. The grade was 0 in fourteen patients, I in seven, II in two, and III in six. A tibiocalcaneal arthrodesis was performed after a talectomy in eleven patients; a tibiotalar arthrodesis, in eight; a triple arthrodesis, in six; a pantalar arthrodesis, in two; and a tibiotalocalcaneal arthrodesis, in two. Postoperatively, all patients remained non-weight-bearing and wore a below-the-knee plaster cast for two months. Weight-bearing was then begun with the leg in a total-contact plaster cast, and use of the cast was continued for a mean of five months (range, four to fourteen months). Thereafter, a polypropylene ankle-foot orthosis was used permanently. The most recent evaluation of the patients was performed at an average of forty-two months (range, fourteen to sixty-eight months) after the arthrodesis. There were twenty complications in nineteen of the twenty-nine patients, and there were nine pseudarthroses (six tibiocalcaneal, one tibiotalar, and two talonavicular). However, seven of the pseudarthroses were clinically stable. In these patients, the arthrodesis was performed as an alternative to amputation, and salvage was successful in twenty-seven (93 per cent) of the twenty-nine patients.

Adult↗
PubMed1998

Arthrodesis with a short Huckstep nail as a salvage procedure for failed total knee arthroplasty.

Arthrodesis of the knee with use of a short Huckstep nail was performed in thirty-three patients (thirty-three knees) after failure of a non-constrained total knee arthroplasty. The indication for the arthrodesis was an infection in thirty-one knees and a Charcot joint in two. Three knees had had a failed attempt at arthrodesis with use of external fixation. The Huckstep nail was inserted through the knee, retrograde into the femur, and then antegrade into the tibia. The duration of the operation averaged 104 minutes (range, sixty-five to 155 minutes). Local bone graft was used in all knees. At the time of follow-up, at an average of forty-seven months (range, eighteen to ninety-four months), thirty knees (91 per cent) had radiographic evidence of union. The average time to union was 5.2 months (range, two to ten months) after the arthrodesis. Eight knees that had a grossly purulent infection were treated with debridement, which was followed by the arthrodesis as a second-stage procedure; the other knees had a one-stage arthrodesis. Only one of the thirty-one knees that had had an infection before the arthrodesis had a recurrence after it. Arthrodesis with a short Huckstep nail provides immediate axial and rotational stability and allows weight-bearing without use of external support as well as placement of the knee in a slightly flexed and valgus position. In addition, the nail does not migrate and it may be used even when there is a standard-size prosthesis in the ipsilateral hip.

Aged↗
PubMed2006

Treatment of primarily ligamentous Lisfranc joint injuries: primary arthrodesis compared with open reduction and internal fixation. A prospective, randomized study.

BACKGROUND: Open reduction and internal fixation is currently the accepted treatment for displaced Lisfranc joint injuries. However, even with anatomic reduction and stable internal fixation, treatment of these injuries does not have uniformly excellent outcomes. The objective of this study was to compare primary arthrodesis with open reduction and internal fixation for the treatment of primarily ligamentous Lisfranc joint injuries. METHODS: Forty-one patients with an isolated acute or subacute primarily ligamentous Lisfranc joint injury were enrolled in a prospective, randomized clinical trial comparing primary arthrodesis with traditional open reduction and internal fixation. The patients were followed for an average of 42.5 months. Evaluation was performed with clinical examination, radiography, the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, a visual analog pain scale, and a clinical questionnaire. RESULTS: Twenty patients were treated with open reduction and screw fixation, and twenty-one patients were treated with primary arthrodesis of the medial two or three rays. Anatomic initial reduction was obtained in eighteen of the twenty patients in the open-reduction group and twenty of the twenty-one in the arthrodesis group. At two years postoperatively, the mean AOFAS Midfoot score was 68.6 points in the open-reduction group and 88 points in the arthrodesis group (p < 0.005). Five patients in the open-reduction group had persistent pain with the development of deformity or osteoarthrosis, and they were eventually treated with arthrodesis. The patients who had been treated with a primary arthrodesis estimated that their postoperative level of activities was 92% of their preinjury level, whereas the open-reduction group estimated that their postoperative level was only 65% of their preoperative level (p < 0.005). CONCLUSIONS: A primary stable arthrodesis of the medial two or three rays appears to have a better short and medium-term outcome than open reduction and internal fixation of ligamentous Lisfranc joint injuries.

Adult↗
PubMed2006

Arthrodesis of the knee with a long intramedullary nail following the failure of a total knee arthroplasty as the result of infection.

BACKGROUND: Knee arthrodesis can be an effective treatment option for relieving pain and restoring some function after the failure of a total knee arthroplasty as the result of infection. The purpose of the present study was to review the outcome of a staged approach for arthrodesis of the knee with a long intramedullary nail after the failure of a total knee arthroplasty as the result of infection. METHODS: We reviewed the results for twelve patients who underwent knee arthrodesis after the removal of a prosthesis because of infection. The study group included seven women and five men who had an average age of sixty-eight years at the time of the arthrodesis. All patients were managed with a staged protocol. Implant removal, débridement, and insertion of antibiotic cement spacers was followed by the administration of systemic antibiotics. Provided that clinical and laboratory data suggested eradication of the infection, arthrodesis of the affected knee with use of a long intramedullary nail was carried out. Clinical and laboratory evaluation and radiographic analysis were performed after an average duration of follow-up of 4.1 years. RESULTS: Solid union was achieved in ten of the twelve knees. The average time to union was 5.5 months. One patient had an above-the-knee amputation because of recurrence of infection. In another patient, nail breakage occurred three years following implantation. The average limb-length discrepancy was 5.5 cm. The mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score improved from 41 to 64 points. None of the seven patients who underwent arthrodesis with a technique involving convex-to-concave reamers had a complication, and the average time to union for these seven patients was shorter than that for the remaining five patients (4.3 compared with 7.4 months). CONCLUSIONS: We believe that obtaining large surfaces of bleeding contact bone during arthrodesis following staged treatment of an infection at the site of a failed total knee arthroplasty contributes to stability and enhances bone-healing. Staged arthrodesis with use of a long intramedullary nail and convex-to-concave preparation of bone ends provided a painless functional gait with low complication and reoperation rates in this challenging group of patients.

Aged↗
PubMed2005

Comparison of intra-articular drilling and diode laser treatment for arthrodesis of the distal tarsal joints in normal horses.

REASONS FOR PERFORMING STUDY: Anecdotal reports suggest that laser-facilitated arthrodesis of the distal tarsal joints improves the prognosis compared with intra-articular drilling but no objective comparisons have been performed. OBJECTIVES: To evaluate intra-articular drilling and laser-facilitated arthrodesis using in situ and in vivo techniques. METHODS: Fourteen cadaver limbs were evaluated in situ for chondrocyte viability after both surgical techniques. In vivo, one randomly selected limb was subjected to laser-facilitated arthrodesis and the other underwent intra-articular drilling in 6 normal horses. Clinical examinations were performed at 1, 3 and 5 months. Two horses were subjected to euthanasia at 1, 3 and 5 months. RESULTS: Significantly more chondrocyte death was observed with laser-facilitated arthrodesis compared to drilling, but the overall degree suggested only a focal effect. In vivo, both groups demonstrated minimal post operative morbidity. There was more evidence of arthrodesis seen at all time points with intra-articular drilling. CONCLUSIONS: This study demonstrated that changes associated with ultimate arthrodesis occur earlier after intra-articular drilling of the distal tarsal joints than laser-facilitated arthrodesis, although clinically affected horses may respond differently. POTENTIAL RELEVANCE: Intra-articular drilling may provide earlier arthrodesis of the distal tarsal joints, but not necessarily a better long-term result.

Animals↗
PubMed2001

Factors influencing the outcome of arthrodesis for congenital kyphosis and kyphoscoliosis.

Sixty-five patients with congenital kyphosis and kyphoscoliosis who underwent spinal arthrodesis are reviewed to determine the factors that influenced the outcome of arthrodesis. Mean follow up after surgery was 6 years and 6 months with all patients having a minimum of 2 years follow up. A satisfactory outcome, or a stable arthrodesis was defined as a loss of correction of less than 10 degrees from the time of surgery till review. An unsatisfactory outcome, or unstable arthrodesis was considered when there was more than 10 degree loss. Type of vertebral anomaly and type of arthrodesis procedure were significantly influenced stability of arthrodesis, whereas age when arthrodesis was performed and size of curve at surgery were not significantly related to stability of arthrodesis.

Adolescent↗
PubMed2005

Resection arthrodesis of the knee for osteosarcoma: an alternative when mobile joint reconstruction is not feasible.

BACKGROUND: Wide resection and mobile joint reconstruction are preferable for treating an osteosarcoma around the knee. In certain situations, resection arthrodesis or an amputation is suggested. METHODS: During the past decade, 86 patients with an osteosarcoma around the knee were treated surgically in our institution. Wide resection and endoprosthetic reconstruction were performed in 35 patients, resection arthrodesis was performed in 36 patients, and an amputation was performed in 15 patients. The oncological and functional results were compared. Special attention was paid to the indications, techniques, and complications of patients receiving resection arthrodesis. RESULTS: Extensive tumor involvement was the main reason, followed by inappropriate previous treatment, for precluding mobile joint reconstruction. The local recurrence rates were similar among the 3 groups (11.4% for the endoprosthetic group, 11.1% for the arthrodesis group, and 6.7% for the amputation group). The 5-year survival rate was 39% for the arthrodesis group, which was significantly lower than that of the endoprosthetic group (60%, p = 0.040), although it was higher than that of the amputation group (13%, p = 0.056). Major complications were found in 7 patients receiving resection arthrodesis (7/24, 29%), and these included nonunion, infection, and allograft fracture. Functional results for the arthrodesis patients were inferior to those of the endoprosthetic patients, but most patients were grateful for preservation of the limb despite certain handicaps. CONCLUSIONS: The importance of early and proper planning of treatment cannot be over-stressed when treating osteosarcomas. Resection arthrodesis offers a durable reconstruction alternative to amputation in a special group of patients when extensive resection precludes mobile joint reconstruction.

Adolescent↗
PubMed1983

The use of pulsing electromagnetic fields to achieve arthrodesis of the knee following failed total knee arthroplasty. A preliminary report.

Treatment with pulsing electromagnetic fields was used as an adjunct in twenty patients who had had a knee arthrodesis after failure of a total joint arthroplasty. Eighteen had had an infected arthroplasty; one, mechanical loosening; and one, recurrent dislocation. Arthrodesis had been attempted twenty-five times in these twenty patients prior to application of the coils. These procedures included the use of twenty-two external fixation frames, one compression plate, one intramedullary rod, and one cylinder cast. Two groups of patients were identified: those with non-union and those with delayed union. Fourteen patients began treatment six months or more after arthrodesis and were considered to have a non-union. The other six patients started treatment less than six months after attempted arthrodesis because there was no evidence of progression toward union. They were considered to have delayed union. In seventeen (85 per cent) of the twenty patients a clinically solid arthrodesis with roentgenographic evidence of bone-bridging was achieved. The average time to union after coil therapy was started was 5.8 months, with a range of three to twelve months. The patients who started coil treatment earlier after arthrodesis showed a tendency to heal faster. The three patients who had failures were the only ones who did not adhere to the protocol, and all three were in the non-union group. All patients with a solid arthrodesis were free of pain and able to walk at the time of follow-up, nine to thirty-one months after the completion of treatment. The use of pulsing electromagnetic fields appears to be a valuable non-invasive adjunct when performing arthrodesis of the knee after failed total joint arthroplasty.

Adult↗
PubMed1993

Ankle arthrodesis.

As a fused ankle provides a painless ankle joint with limited functional disability, ankle arthrodesis is still the treatment of choice for most disabling ankle arthritis. From January 1987 to December 1990, 45 cases of ankle arthrodesis were performed, including 27 male and 18 female patients, aged from 18 to 70 years with an average of 41.9 years. The causes leading to arthrodesis included 19 cases of post-traumatic arthritis, 3 rheumatoid arthritis, 7 osteoarthritis, 9 ankle infections (4 pyogenic and 5 tuberculosis), 4 ankle deformities, 2 avascular necrosis of the talus and 1 cases of Charcot joint. The methods included modified Blair's ankle arthrodesis (34 cases), compression arthrodesis (7 cases) either by Hoffman external fixation or triangular compression device, and intra articular arthrodesis by staple fixation (4 cases). The follow up period ranged from 17 Ms to 52 Ms with an average of 28.6 Ms. There were 2 cases who ultimately required amputation due to uncontrollable infection, and 2 cases of nonunion and one of them received refusion. There were 11 cases of delayed union (union time more than 6 Ms). The average union time was 5.6 Ms, ranging from 2 Ms to 10 Ms. Excluding the cases of amputation and nonunion, all patients had improvement in the ankle functional scale evaluation and 85.3% of the patients were satisfied with their present condition. The modified Blair's method of ankle arthrodesis has proven to be an effective method for treating ankle arthritis no matter what the cause. However, for cases of infection, compression arthrodesis with an external fixational device is superior.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

[Long-term influence of associated arthrodesis on adjacent segments in the treatment of lumbar stenosis: a series of 127 cases with 9-year follow-up].

PURPOSE OF THE STUDY: Little is known about the impact of posterolateral arthrodesis on adjacent levels. In order to examine this question, we analyzed the radiological evolution of the lumbar spine in patients treated for lumbar stenosis, comparing cases where posterolateral arthrodesis was used with the other cases. Our aim was to determine whether the long-term radiographical modifications were affected by the arthrodesis. MATERIAL AND METHODS: Among our series of patients presenting with lumbar stenosis between 1984 and 1992, we retained two groups: patients in group 1 (n=46) who underwent single-level decompressions at L4-L5 or L4-L5 and L5-S1 level; and patients in group II (n=81) who underwent decompressions on the same levels associated with posterolateral arthrodesis extending from L4 to the sacrum with or without instrumentation. We compared the course of the two levels above the decompression (L2-L3 and L3-L4) between the two groups. We compared three radiological parameters: disc height, intervertebral slipping, and intersegmental mobility. We also examined the correlations between radiological modifications and functional outcome. Mean follow-up for these 127 patients was 9 years. RESULTS: The two groups were comparable for age, gender, follow-up, and presurgical functional score, disc height and intervertebral slipping at equivalent levels. At last follow-up, disc narrowing was observed at L2-L3 and L3-L4; it was significantly greater in the group with complementary arthrodesis. At L3-L4, intervertebral slipping also worsened more in the arthrodesis patients. Use of osteosynthesis significantly increased the risk of developing such radiological lesions. These lesions were associated, solely in the arthrodesis group, with poorer functional outcome. CONCLUSION: Our findings allow the conclusion that, despite the effect of physiological aging, the observed long-term degenerative lesions in patients undergoing treatment of lumbar stenosis are related to the associated arthrodesis which increases their frequency and severity, deteriorating the functional outcome.

Aged↗
PubMedDate not supplied

Functional and radiographic outcome of sacroiliac arthrodesis for the disorders of the sacroiliac joint.

BACKGROUND CONTEXT: The sacroiliac joint is known to be a possible cause of chronic low back pain, but the diagnosis and treatment of disorders of the sacroiliac joint have been difficult and controversial. PURPOSE: To describe the outcome of sacroiliac joint arthrodesis for sacroiliac joint disorders, with the hypothesis that sacroiliac arthrodesis leads to improved postoperative function. STUDY DESIGN/SETTING: Consecutive case series performed in an academic medical institution. PATIENT SAMPLE: The patient population consisted of 20 patients undergoing sacroiliac joint arthrodesis between December 1994 and December 2001. Patients undergoing concomitant procedures at the time of sacroiliac joint arthrodesis were excluded. The 3 men and 17 women in the study group had an average age of 45.1 years (range 21.8-66.4 years), a mean duration of symptoms of 2.6 years (range 0.5-8.0 years), and a mean follow-up period of 5.8 years (range 2.0-9.0 years). OUTCOME MEASURES: Outcome measures included general health and function, clinical evaluation, and radiographic assessment. METHODS: For all 20 patients, nonoperative treatment had failed, and for all, the diagnosis was confirmed by pain relief with intraarticular sacroiliac joint injections under fluoroscopic guidance. Sacroiliac joint arthrodesis (via a modified Smith-Petersen technique) was recommended only when a positive response to the injection was noted, and patients had recurrence of symptoms after the initial positive response. Preoperative and postoperative general health and function were assessed via the 36-item Short-Form (SF-36) Health Survey and American Academy of Orthopaedic Surgeons (AAOS) Modems Instrument, which were collected prospectively. Medical records and plain radiographs were reviewed retrospectively to determine the clinical and radiographic outcome. RESULTS: Multiple etiologies of sacroiliac symptoms were observed: sacroiliac joint dysfunction (13 patients), osteoarthritis (5 patients), and spondyloarthropathy and sacroiliac joint instability (1 each). Seventeen patients (85%) had solid fusion. Fifteen patients (75%) completed preoperative and postoperative SF-36 forms. Significant (p< or =.05) improvement occurred in the following categories: physical functioning, role physical, bodily pain, vitality, social functioning, role emotional, and neurogenic and pain indices. Improvement (not statistically significant) was also noted in general and mental health. CONCLUSIONS: For carefully selected patients, sacroiliac arthrodesis appears to be a safe, well-tolerated, and successful procedure, leading to significant improvement in functional outcome and a high fusion rate. To the authors' knowledge, the current report is the largest series to document the functional and radiographic outcome of sacroiliac joint arthrodesis.

Adult↗
PubMed2004

[Ankle arthrodesis after failure of a total ankle prosthesis. Eight cases].

UNLABELLED: We report outcome in eight cases of ankle arthrodesis after failure of a total ankle prosthesis. MATERIAL AND METHODS: This series included eight patients, mean age 57 years (range 36-76) who had initially: post-traumatic talocrural joint degeneration (n=4), rheumatoid polyarthritis (n=3), idiopathic talocrural degeneration (n=1). Three patients had a New Jersey (DePuy) cemented prosthesis, four had a Star (Link) uncemented prosthesis and one, whose implantation was performed in another institution, had a spherical cemented prosthesis. The preoperative Kitaoka score was 19.1 (0-32). Seven patients had subtalar joint degeneration; one patient had a subtalar arthrodesis. The tibial component was cemented alone in two patients, the talar piece in three (two with talar fracture). Failure resulted from loosening, talus fracture or deep infection. Bipolar loosening was observed in two patients. Time to revision was 36 months (range 4-108). Arthrodesis was associated with an iliac graft for seven patients: several tricortical grafts (vertical alignment of the corticals) and cancelous grafts for filling. The height of the graft was adjusted to the substance loss. A bone graft could not be used in one patient who had a deep infection. The arthrodesis was fixed with an anterior plate bridging the talocrural space in six patients, with an external fixator in infected patient, with a conventional centromedullary tibial nail transfixing the talocrural joint and planted in the talus and the calcaneus in one. Outcome was assessed with the Kitaoka score. Mean follow-up was 56 Months (range 10-114). RESULTS: The overall Kitaoka score improved to 54/100 (range 42-70) at last follow-up. The arthrodesis provided improvement in all patients although the final outcome was still considered poor in three patients. Radiographic healing was obtained in seven patients at a mean 3.1 months (range 2.5-6). Wound healing was slow in two patients. One patient developed a deep infection early. DISCUSSION: The rate of fusion was 87%. This is in the general range reported in the literature; use of an iliac graft allows preserving joint height but because of the poor bone quality often encountered, residual bone stock may be insufficient to achieve complete fixation with screwing. Plate fixation appears to be a better way of achieving fixation. This provides a rate of fusion comparable with earlier series where external fixation was generally employed. For us, external fixation should be reserved for infected cases. Use of a conventional anterograde nail can be another solution in the event of poor bone quality. The overall result remains relatively modest although all the patients achieved a functional gain with arthrodesis. The results obtained are less satisfactory than after first-intention ankle arthrodesis.

Activities of Daily Living↗
PubMed2005

[Scapulohumeral arthrodesis for non-neurological shoulder: a study of 8 cases].

PURPOSE OF THE STUDY: Scapulohumeral arthrodesis is mainly used for the treatment of sequelar injury after brachial plexus palsy. Indications are however controversial and limited to patients with non-neurological shoulders. We report a series of eight shoulder arthrodeses performed on non-neurological shoulders in order to determine and detail the current role of this procedure. PATIENTS AND METHODS: The series included eight patients, five men and three women, mean age 47 years (23-87). The dominant side was operated on in two patients and the non-dominant side in six. Seven patients had had at least one shoulder procedure prior to arthrodesis. Arthrodesis was performed for foreign body reaction on a tendon prosthesis in one patients, posttraumatic head necrosis in two, off-centered degenerative joint disease with full thickness rotator cuff tear in three, and multi-directional instability on degenerative joint disease in two. Arthrodesis was performed via a posterior approach in all patients but one using screw fixation associated with external fixation left in place for 2.5 months on average. RESULTS: All patients except one were satisfied with the outcome (basically because of pain relief). Mean active motion was 75 degrees flexion, 65 degrees abduction (arthrodesis at 20 degrees flexion, 25 degrees abduction and 30 degrees internal rotation). Two groups were identified to analyse the absolute Constant score. The score improved 16 points (from 24 to 40) in the group of patients without instability (pain score improved from 3 to 13) and decreased 14 points (from 66 to 52) in the group with instability (due to decreased motion, the mean motion score declining from 38 to 14). Complications included one radial palsy, one nonunion, and one gravity edema of the upper limb. DISCUSSION AND CONCLUSION: Shoulder arthrodesis is more than a salvage method to reduce pain and gain stability. The objective should be to recover useful function (hand-mouth, hand-perineum, brachio-thoracic function). It should be used when prosthetic arthroplasty is not possible (infectious arthritis, advanced degenerative disease in young subjects, loss of glenoid bone stock, failure after treatment of multidirectional instability with degenerative disease). Shoulder arthrodesis still has rare indications because of the predictability of sustained outcome.

Adult↗
PubMed2001

Degenerative arthritis of the wrist: proximal row carpectomy versus scaphoid excision and four-corner arthrodesis.

Two cohort populations of 19 patients from separate institutions performing exclusively either a scaphoid excision and 4-corner arthrodesis (lunate, capitate, hamate, and triquetrum) or proximal row carpectomy (PRC) for scapholunate advanced collapse arthritis were compared. There were no preoperative differences with respect to age, gender, dominance, stage of arthritis, or preoperative measures of pain and function. The length of the follow-up period averaged 28 months for the 4-corner arthrodesis group compared with 19 months for the PRC patients. At the follow-up examination wrist motion revealed no significant differences in the flexion-extension arc, averaging 81 degrees in the PRC patients and 80 degrees following 4-corner arthrodesis, which was 62% and 58%, respectively, of the opposite wrist. The 4-corner arthrodesis patients maintained greater radial deviation and total percent radial-ulnar deviation of the wrist. Grip strength averaged 71% for the PRC group compared with 79% for the 4-corner arthrodesis patients. Pain relief was similar using a variety of measures and patient satisfaction was equivalent. Function was similar except that the 4-corner arthrodesis patients scored significantly higher on the mental health component of the short form-36 health status survey. No differences were seen on the physical health component or an outcome scale specifically designed for the wrist. Both PRC and scaphoid excision and 4-corner arthrodesis are motion-preserving options for the treatment of scapholunate advanced collapse arthritis with minimal subjective or objective differences in short-term follow-up evaluations.

Adult↗