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PubMed2005

Long-term results of arthroscopic ankle arthrodesis.

BACKGROUND: More than 40 open procedures have been described for ankle arthrodesis, most with high complication rates. Since its description in 1983, arthroscopic ankle arthrodesis has become a viable option in selected patients. With one of the largest series in the literature, the purpose of the paper was to analyze the results of arthroscopic ankle arthrodesis at our institution. METHODS: Between 1989 and 2002, 35 patients with end-stage ankle arthritis underwent arthroscopic ankle arthrodesis. The average followup was 72 months, with a range of 24 to 167 months. Patients returned for a clinical and radiolographic evaluation using the grading systems of Mazur and Morgan. All patients had preoperative and postoperative radiographic evaluation to assess fusion. Indications for arthroscopic ankle arthrodesis included failure of at least 6 months of conservative treatment, minimal or mild correctable deformity in the coronal plane, and no active infections. RESULTS: The overall fusion rate was 97% (34 of 35 patients). The average time to fusion was 11.8 weeks, with a range of 8 to 18 weeks. There were 74% good to excellent results by the Mazur grading system and 83% by the Morgan system. There were no infections or neurovascular injuries. In the three patients who required bone stimulators for delayed unions, fusion occurred in two, and one had a nonunion. Eleven patients had screws removed because of pain at an average of 11 months after the initial surgery. CONCLUSION: Our study demonstrated a high fusion rate with minimal complications for arthroscopic ankle arthrodesis.

Adult↗
PubMed2005

Tibiotalocalcaneal arthrodesis: a biomechanical assessment of stability.

BACKGROUND: Combined ankle and subtalar (tibiotalocalcaneal) arthrodesis is a procedure that can be used to successfully treat disabling foot and ankle arthropathy and is a reasonable salvage alternative to amputation for the treatment of nonbraceable neuropathic, diabetic, degenerative, or rheumatoid joints. Although many methods of tibiotalocalcaneal (TTC) arthrodesis have been described in the literature, the most popular current methods involve the use of crossed cancellous bone screws, plates, or a locked retrograde intramedullary rod. Fusion in these patients can be difficult, with significant complications including infection, malunion, and nonunion. A persistent nonunion can lead to failure of the hardware and recurrent deformity. METHODS: We biomechanically tested the stability and micromotion in four methods of TTC arthrodesis using liquid metal strain gauges and Instron (Norwood, MA) material testing systems. Anatomically identical synthetic bones with properties very similar to human bone were instrumented and tested. Four instrumentation techniques were tested: 1) three crossed 6.5-mm cancellous screws, 2) two crossed 6.5-mm cancellous screws, 3) locked retrograde intramedullary rod, and 4) locked retrograde intramedullary rod augmented with a single anteromedial bone staple. Six separate specimens for each technique were tested. RESULTS: The three crossed cancellous screw technique provided the greatest stability with respect to micromotion (p < 0.05). The addition of a tibiotalar staple to the locked intramedullary rod conferred stability nearly equal to that of the three crossed cancellous screw fixation (p < 0.05). The locked intramedullary rod group and the two crossed cancellous screw group allowed significant micromotion at the arthrodesis sites, which was a full order of magnitude higher (p < 0.05) than in the three crossed cancellous screw group and the staple augmented intramedullary rod group. CONCLUSIONS: Biomechanically, a staple augmented locked intramedullary rod for TTC arthrodesis confers excellent stability nearly equal to the three crossed cancellous screw technique for TTC arthrodesis.

Ankle Joint↗
PubMed1986

External fixation arthrodesis of the ankle joint following trauma.

Arthrodesis is currently the treatment of choice for symptomatic degenerative arthropathy of the ankle. Thirty-seven patients underwent arthrodesis for post-traumatic disorders using either a Hoffmann external fixator or a Calandruccio frame. There was degenerative joint disease in 19 (51%), septic arthritis in 11 (30%), severe comminution in five (14%), and uncontrollable equinus in two (5%). The patients were divided into two groups. Twenty-six (70%) were considered to have sustained high energy open or comminuted injuries and 11 (30%), low energy injuries. Twenty-nine (78%) achieved a radiologic fusion following one operation. Four eventually united with further surgery for a final arthrodesis rate of 89%. In the high energy group 18 of 26 (69%) achieved primary fusion. Four united with additional surgery for a final arthrodesis rate of 85%. Two of these required subsequent amputations and two others, a triple arthrodesis which also failed to control chronic pain. Thus, a total of 18 of the 26 patients (69%) achieved a successful result. Also included in the high energy group were three patients with uncontrolled sepsis who underwent amputation before union occurred and one with a painful non-union. All 11 of the patients (100%) who originally sustained low energy injuries achieved a successful arthrodesis. The most common complication was in pin tract infection requiring incision, drainage, and oral antibiotics in 16 patients (43%). None of these progressed to chronic osteomyelitis.

Adolescent↗
PubMed1995

Deltoid ligament forces after tibialis posterior tendon rupture: effects of triple arthrodesis and calcaneal displacement osteotomies.

Deltoid ligament forces were studied after observing deltoid ligament insufficiency in several post-triple arthrodesis patients. Six fresh-frozen, below-knee amputation specimens were axially loaded. The results demonstrate that a properly positioned triple arthrodesis produced deltoid ligament forces that were similar to those seen with an intact tibialis posterior tendon. A triple arthrodesis in combination with a lateral displacement calcaneal osteotomy produced deltoid ligament forces that were 76% greater than those seen with the intact tibialis posterior tendon (P < .05). A triple arthrodesis in combination with a medial displacement calcaneal osteotomy produced deltoid ligament forces that were 56% less than those seen with the lateral displacement calcaneal osteotomy (P < .01). Patients with longstanding ruptures of the tibialis posterior tendon and associated peritalar subluxation/dislocation may have less than optimal clinical results after triple arthrodesis, unless the hindfoot can be properly reduced, due to persistent elevated forces in the deltoid ligament and resulting ligament laxity. This study suggests that a medial displacement calcaneal osteotomy in combination with a triple arthrodesis may be a viable treatment when the hindfoot cannot be positioned properly.

Ankle Joint↗
PubMed1996

Primary subtaler arthrodesis for the treatment of comminuted calcaneal fractures.

We retrospectively evaluated the results of primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures. Of 108 patients with 112 calcaneal fractures treated at our institution between 1989 and 1992, 16 (15%) underwent primary subtalar arthrodesis through an extensile lateral approach. The calcaneal height and width were restored with standard fixation techniques and then arthrodesis was performed with bone graft and fixation by 7.0-mm cannulated cancellous screws. Fourteen patients (12 males and 2 females; mean age, 40 years) were available for examination at a mean time of 26 months (range, 12-54 months) after surgery. Arthrodesis, evidenced by radiographic bony bridging across the arthrodesis site, was present in all patients between 8 and 12 weeks. Minor wound complications occurred in three patients. Of the 12 patients employed before the injury, 11 returned to their original occupations at a mean time of 8.8 months after injury (range, 1 month to 3 years). The mean AOFAS 100-point clinical rating scale score, evaluating pain, function, and alignment, was 72.4 points (range, 48-88 points). We conclude that primary subtalar arthrodesis is indicated as part of the management of comminuted displaced articular calcaneal fractures, yielding results that allowed 11 of 12 formerly employed patients to return to work.

Adult↗
PubMed1997

Clinical and radiographic outcome of revision surgery for failed triple arthrodesis.

Between 1987 and 1994, we treated 33 patients with surgical revision for failed triple arthrodesis, 28 (29 feet) of whom returned for final examination (mean, 4.4 years; range, 2-7 years). The average age of these 16 women and 12 men was 46 years (range, 14-69 years). Before the revision procedure, patients had undergone nonoperative therapies for an average of 3.7 years (range, 0.5-12 years) and an average of three foot operations (range, 1-6 operations) after the primary triple arthrodesis. All patients were managed with rigid internal fixation via cannulated screws and power staples. Calcaneal osteotomy and/or revision of the transverse tarsal arthrodesis via appropriate saw cuts and bone wedges were used. Iliac crest bone graft was added, when a bone block arthrodesis was required, for those patients with nonunion or ankle impingement. Arthrodesis was achieved in all 29 feet, although 4 patients (4 feet) (14%) required additional procedures for malunion (2 patients), deformity recurrence (1 patient), deep infection (1 patient), and skin graft (1 patient). Comparison of the average pre- (retrospective) and postoperative American Orthopaedic Foot and Ankle Society 94-point hindfoot and ankle scores showed a significant improvement: 31 points (range, 13-61 points) versus 59 points (range, 24-91 points), respectively (P < 0.05). On a scale of 0 to 10 points, average patient satisfaction was 7.8 points (range, 2-10 points). This study demonstrated a satisfactory improvement in patient outcome after surgical correction of failed triple arthrodesis. We conclude that such a revision, although complex, may be attempted to establish a plantigrade foot free of infection and able to wear shoes without and orthosis or brace.

Adolescent↗
PubMed1997

Salvage of pseudoarthrosis after tibiotalar arthrodesis.

We retrospectively reviewed the treatment of a selected group of 23 patients with pseudoarthrosis after ankle arthrodesis who underwent revision arthrodesis at an average of 1.7 years (range, 0.3-17.0 years) after the initial, unsuccessful procedure. Fourteen patients underwent isolated revision tibiotalar arthrodesis, and 9 had an additional hindfoot arthrodesis (7 tibiotalocalcaneal, 2 pantalar) performed at the time of the procedure. Rigid internal fixation with screws was performed when possible, and, in patients with poor bone quality, an external fixator was used. Autogenous bone grafting was used in 14 patients where bone loss was present. Twenty-one of 23 patients had successful union (average, 14 weeks; range, 6-48 weeks). Two patients underwent successful arthrodesis but had persistent pain from reflex sympathetic dystrophy. Overall, 19 of 23 patients were satisfied with the surgery. We conclude that revision arthrodesis for tibiotalar pseudoarthrosis is a worthwhile procedure.

Adult↗
PubMed2006

Ankle arthrodesis for failed total ankle replacement.

Between 1999 and 2005, 23 failed total ankle replacements were converted to arthrodeses. Three surgical techniques were used: tibiotalar arthrodesis with screw fixation, tibiotalocalcaneal arthrodesis with screw fixation, and tibiotalocalcaneal arthrodesis with an intramedullary nail. As experience was gained, the benefits and problems became apparent. Successful bony union was seen in 17 of the 23 ankles. The complication rate was higher in ankles where the loosening had caused extensive destruction of the body of the talus, usually in rheumatoid arthritis. In this situation we recommend tibiotalocalcaneal arthrodesis with an intramedullary nail. This technique can also be used when there is severe arthritic change in the subtalar joint. Arthrodesis of the tibiotalar joint alone using compression screws was generally possible in osteoarthritis because the destruction of the body of the talus was less extensive. Tibiotalocalcaneal arthrodesis fusion with compression screws has not been successful in our experience.

Adult↗
PubMed1996

Results of arthrodesis of the tarsometatarsal joints after traumatic injury.

We retrospectively reviewed the records of thirty-two patients who had had an arthrodesis of the tarsometatarsal joints for intractable pain after a traumatic injury of the midfoot. The arthrodesis was performed at a mean of thirty-five months (range, six to 108 months) after the injury. All of the procedures were performed with use of rigid internal fixation, and twenty-four patients, in whom a defect had been created by debridement of the joints, were managed with an autogenous bone graft. Nine patients had at least one concomitant procedure, including a claw-toe procedure (eight patients), a reconstruction of the posterior tibial tendon (three patients), an excision of an interdigital neuroma (three patients), an arthrodesis of the calcaneocuboid joint (one patient), and an arthrodesis of the ankle (one patient). Complications included neuritis in three patients; metatarsalgia in two; malunion in two; and asymptomatic non-union, wound slough, superficial infection, and reflex sympathetic dystrophy in one each. The patients were evaluated at a mean of fifty months (range, twenty-four to 105 months) after the arthrodesis. The evaluation included a physical examination, radiographs, and use of the rating scale of the American Orthopaedic Foot and Ankle Society for the evaluation of the midfoot. The mean postoperative score of 78 (of a possible 100) points was significantly better than the mean preoperative score of 44 points (p = 0.02). With the numbers available, we could not show that the extent of the arthrodesis, the involvement of other joints in the hindfoot or the forefoot, the mechanism of injury, or whether the injury was work-related significantly affected the functional outcome.

Adult↗
PubMed1997

Treatment of complications of shoulder arthrodesis.

A reconstructive osteotomy was performed to correct symptomatic malposition after arthrodesis of the shoulder in nine of fourteen patients who had complications related to the arthrodesis. The clinical position of the arm in relation to the trunk was determined with the method described by Rowe. Malposition was primarily the result of fusion in more than 15 degrees of either flexion or abduction, or both, coupled with improper rotation, defined as rotation of less than 40 degrees or more than 60 degrees. Reconstructive osteotomy eliminated pain and improved the ability of the patient to perform six activities of daily living. The complications necessitating operative treatment after the arthrodesis in the remaining five patients included failure of the arthrodesis site to unite (three patients), a wound hematoma at the iliac-crest donor site (one patient), and a superficial wound infection (one patient). Two additional complications - a fracture through a screw-hole in the humerus and a fracture distal to the internal fixation device - occurred after the reconstructive osteotomies for malposition. All of the complications resolved with treatment. Arthrodesis of the shoulder is a technically demanding procedure that can lead to serious complications that necessitate operative intervention. Careful attention to operative technique and to the position of the arthrodesis are essential.

Activities of Daily Living↗
PubMed2004

Triple arthrodesis in adults with non-paralytic disease. A minimum ten-year follow-up study.

BACKGROUND: The triple arthrodesis was developed to treat sequelae of neurologic disorders affecting the hindfoot. Today, the typical adult patient undergoing this procedure has degenerative disease, usually not related to a neurologic disorder. The purpose of this study was to investigate the long-term outcome of triple arthrodesis in this patient population. METHODS: Twenty-seven adult patients (thirty-one feet) who had undergone triple arthrodesis for the treatment of chronic hindfoot pain and had been followed for a minimum of ten years completed an outcomes questionnaire, and twenty-two patients (twenty-six feet) were available for physical examination, radiographs, and functional testing. The mean age of the patients who were examined was forty-five years at the time of the surgery, and the mean duration of follow-up of those patients was fourteen years (range, eleven to eighteen years). RESULTS: Twenty-five (93%) of the patients were satisfied with the result of the treatment. However, only eleven (41%) reported that they could perform moderate activity with mild or no pain in the foot and ankle. Twenty patients (74%) reported moderate-to-severe difficulty with, or an inability to negotiate, uneven surfaces. The mean Short Form-36 (SF-36) physical component outcomes score was 35.2 points, well below the mean of 50 points for the United States population. The SF-36 score was significantly lower for patients with systemic inflammatory disease (primarily rheumatoid arthritis). There was an average 12 degrees (27%) loss of plantar flexion but no significant loss of dorsiflexion compared with the untreated foot. Severe arthrosis developed in seven of the twenty-six ankles, in seven naviculocuneiform joints, and in six tarsometatarsal joints. Some patients had severe arthrosis at more than one level, and three patients later required an ankle arthrodesis. There were no nonunions or revisions of the triple arthrodeses. The average patient performances on the six-minute walk and the 3-m up-and-go functional tests were well below the age-controlled means. CONCLUSIONS: Triple arthrodesis may provide patients with substantial long-term relief of preoperative symptoms. However, there may also be adverse consequences, particularly degenerative changes in adjacent joints, that may be reasons for orthopaedic surgeons to consider alternatives to triple arthrodesis when feasible. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMed2006

Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis.

BACKGROUND: The functional outcomes following ankle arthrodesis are not known. The purpose of the present study was to compare the intermediate-term clinical results for a group of patients in whom an ankle arthrodesis had been performed with use of modern surgical techniques with the findings for a group of healthy gender and age-matched controls on the basis of validated outcome measures and gait analysis. METHODS: Twenty-six patients who had undergone ankle arthrodesis for the treatment of isolated unilateral ankle arthritis were identified and retrospectively assessed clinically and radiographically. The mean age at the time of surgery was fifty-four years, and the mean interval between surgery and assessment was forty-four months. A gender and age-matched control group of twenty-seven individuals was recruited for comparison. All subjects were evaluated with gait analysis, the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale, the Musculoskeletal Outcomes Data Evaluation and Management Systems (MODEMS) questionnaire, and the Ankle Osteoarthritis Scale (AOS). RESULTS: On preliminary review, twenty of the twenty-six patients were completely satisfied or satisfied with their surgical outcome. All patients but one stated that they would undergo the surgery again. Five patients stated that they did not notice a gait abnormality. Twelve patients wore orthotics, and all believed that the use of the orthotics improved their gait. When the functional outcome scores in the arthrodesis group were compared with those in the control group, specific scores assessing hindfoot pain and satisfaction were similar. However, scores focusing on ankle-hindfoot function and disability revealed significant differences. Gait analysis also identified significant differences between the two groups with regard to cadence and stride length. In addition, there was significantly decreased sagittal, coronal, and transverse range of motion of the hindfoot and midfoot during the stance and swing phases of gait in the arthrodesis group. Radiographic review demonstrated that four of the twenty-six patients had development of moderate to severe arthritis of the subtalar joint. CONCLUSIONS: In the intermediate term following an arthrodesis for the treatment of end-stage ankle arthritis, pain is reliably relieved and there is good patient satisfaction. However, there are substantial differences between patients and the normal population with regard to hindfoot function and gait. On the basis of these results, patients should be counseled that an ankle fusion will help to relieve pain and to improve overall function; however, it is a salvage procedure that will cause persistent alterations in gait with a potential for deterioration due to the development of ipsilateral hindfoot arthritis.

Adolescent↗
PubMed1996

Intraarticular foot and ankle injections to identify source of pain before arthrodesis.

OBJECTIVE: The purpose of our study was to evaluate the usefulness of diagnostic joint injections in patients with foot and ankle pain when the radiologist attempts to identify the source of pain. This study also correlated the results of injection with outcome after arthrodesis. MATERIAL AND METHODS: We retrospectively reviewed the records of 22 patients who had a foot or ankle joint injected to identify a source of pain and who later underwent arthrodesis of the painful joint. All patients had long-term foot and ankle symptoms of variable causes. Twenty-four joints were assessed: 13 subtalar, five talonavicular, four ankle, one calcaneocuboid, and one metatarsocuneiform. All patients had plain radiographs, 11 had CT studies, and five had bone scans. Contrast material was used to assess adequate positioning of the needle inside the joint before injection. All joints were injected under fluoroscopic control. Steroid was added in eight joints. After injection, patients were assessed for relief of symptoms. Patients subsequently underwent arthrodesis on the basis of the results of the injection. RESULTS: In 20 patients (22 joints), long-term follow-up showed that injections allowed us to correctly identify the source of pain and successfully guide arthrodesis. Of these 20 patients, 17 had significant pain relief after injection and fusion, whereas three patients had mild or no response. With one of these patients, we injected other joints and changed surgical plans. One of the two remaining patients had more pain relief after injection than after arthrodesis. The other patient had no relief after injection, but subsequent fusion because of persistent pain was successful. We found imaging studies to be less useful than diagnostic injections when we were attempting to identify the source of pain. CONCLUSION: Intraarticular injection of anesthetic in painful foot and ankle joints helped us confirm the source of pain in 20 of 22 patients, which in turn led to successful arthrodesis and good outcomes for these patients.

Adult↗
PubMed2001

[Recurrent hallux valgus treated with metatarsophalangeal arthrodesis. A series of 32 patients].

PURPOSE OF THE STUDY: We reviewed a series of 32 cases of recurrent hallux valgus treated by great toe metatarsophalangeal arthrodesis with a minimal 5-year follow-up. MATERIAL AND METHOD: Mean delay from the first surgical procedure and revision surgery was 11 years. All patients complained of forefoot pain. The average angle of the phalangeal valgus was 39 degrees. Sixteen patients had metatarsalgia. The first toe metatarsophalangeal joint was evaluated according to Regnauld's classification: two grade 1, eight grade 2a, six grade 2b, sixteen grade 3. Arthrodesis was fixed with an axial screw and associated with adductor hallux plasty. Outcome was assessed at a minimum 5-year follow-up according to Kitaoka's criteria. RESULTS: Seventy-eight percent of the patients were pain free at last follow-up. Valgus deviation of the great toe was corrected with an average angle of 19 degrees. The arthodesis healed in 90.6% of the cases. Statistical analysis showed the importance of great toe valgus pre- and postoperatively and at last assessment. Final outcome was poor in the oldest patients. The overall outcome was rated good in 84% of the cases, average in 6% and poor in 10%. DISCUSSION: Arthrodesis of the great toe is not a disabling surgery. Interphalangeal osteoarthritis may occur due to joint overuse (12 cases). Kitaoka's series compared outcome after arthrodesis with that after conservative surgery and reported better results with arthrodesis. Revision surgery for hallux valgus using great toe metatarsophalangeal arthrodesis remains an acceptable alternative.

Adult↗
PubMed2001

Conversion of hip arthrodesis to total hip arthroplasty.

With the predictably good outcome now found with THA, hip arthrodesis has limited indications today. The procedure still has a role in the case of the young, heavy demand male with an isolated arthritic hip condition, and developments such as the Cobra head plate have considerably improved success rates. However, a long-term hip arthrodesis can have profound effects on a patient's daily function and activities of daily living. In addition, gait pattern is considerably affected as well as other joints such as the lower back, ipsilateral knee, and contralateral hip. Many patients with a hip arthrodesis will eventually require a takedown of the fused hip and conversion to a THA. The primary indications include fusion in malposition, pseudarthrosis, or severe pain in other joints. The surgeon undertaking such a task must be familiar with the arthrodesis techniques that have been used in the past as well as the equipment that may be required to extract the fixation hardware. Clinical assessment with particular attention to leg-length discrepancy, position of the arthrodesis, and function of the abductors is of paramount importance. The surgeon must carefully review preoperative radiographs to plan the procedure. The surgeon must also be aware of the presence of pathology in other joints. After takedown of a hip arthrodesis and conversion to a THA, patients cannot expect the result to equal the success rates of primary THA. Patients generally can expect an improvement in function and mobility. Back pain and ipsilateral knee pain are usually improved postoperatively, but the effect on contralateral hip pain is less predictable. Many patients will continue to show a positive Trendelenburg sign, but further improvement in strength of the hip abductors can be expected with time. Leg-length discrepancy is generally improved substantially after THA. However, a substantial number of patients will require a walking aid postoperatively. Overall, the risk of complications and the rates of revision after converting an arthrodesed hip to a THA are quite high. The procedure can be complex. Consideration should be given to referring these patients to a specialized center under the care of an experienced arthroplasty surgeon if preoperative planning suggests that the conversion will not be straightforward.

Adult↗
PubMed2001

[Tridimensional gait analysis after unilateral subtalar arthrodesis].

PURPOSE OF THE STUDY: Subtalar arthrodesis can be useful in various conditions. Initially used for the treatment of congenital or acquired foot deformities, it was later applied to surgical repair of traumatic injury. The subtalar joint does however play an important role in gait, particularly for transmitting rotational movement of the leg to the foot. The functional outcome after subtalar arthrodesis has been the object of many studies. These studies examined clinical and radiological results and raised the problem of determining the appropriate extent of the fusion. None of these studies has however provided a three-dimensional analysis of gait after subtalar arthrodesis, performed in the present work. MATERIAL AND METHODS: We used the Vicon VX3D system with 2 integrated force platforms. Acquisition was made at 50 Hz. The Vicon recording was coupled with EMG recordings of the gastrocnemius, the rectus, the anterior tibialis, and the glutius medius. Gait was analyzed in 8 patients who had undergone unilateral subtalar arthrodesis at least 18 months earlier. Several recordings were made for each patient but only one complete gait cycle was retained for analysis of kinematic, kinetic and electromyographic curves and ground reaction forces. Wilcoxon's test for paired series was used to compare the operated side to the healthy side (excepting EMG recordings). RESULTS: The operated and healthy side were significantly different. Total amplitude of joint movement was lower for the operated side: 16.5 degrees versus 21.5 degrees for the healthy side. Peak power generated at the ankle for plantar flexion was lower at the end of the stance phase. Electromyography recordings showed a shift in muscle activity between the healthy and fused foot. DISCUSSION: Few statistical differences were found between the tested values. It can thus be concluded that gait pattern is globally symmetrical after subtalar arthrodesis and that this fusion has little functional impact on the knee or the hip. The difference in amplitude between the healthy and operated side showed a wider variability than observed by Winter in the healthy subject that was also greater than the measurement error reported by Laasel. We did not perform a statistical analysis of the EMG data since the values recorded were arbitrary and the observed shift in activities had no general impact. CONCLUSION: Despite the reduction in flexion-extension amplitude of the ankle, subtalar arthrodesis allows a globally symmetrical gait in the experimental conditions described.

Adult↗
PubMed2003

[Indications for arthrodesis of the knee joint in modern orthopedics].

INTRODUCTION: Indication for arthrodesis of the knee joint is nowadays most frequently failure of a total endoprosthesis, usually septic. A less frequent indication is purulent gonitis, frequently after corticoid administration, the condition after a complicated intraarticular fracture with subsequent arthritis or oncological disease of the bones in the area of the knee joint. MATERIAL AND METHODS: In the course of 2000 to 2002 at the authors' department 15 arthrodeses were implanted. In three cases the indication for arthrodesis was purulent gonitis, in three cases the condition after an open articular injury associated with infectious complications and in the remaining nine cases failure of an endoprosthesis of the knee, incl. seven caused by infection. The patients were three men and 12 women, mean age 64 years (30-75 years). For stabilization of the arthrodesis 9x external fixation was used, 5x plates and 1x intramedullary osteosynthesis. RESULTS: In all cases consolidation of the arthrodesis was achieved. In one case the external fixation had to be replaced by a system of two fixation devices and in one case correction of the axial position of the extremity was made. The presence of external fixation was perceived negatively in particular by female patients. DISCUSSION: Plate osteosynthesis and the use of external fixation devices are relatively quick, cheap and considerate methods of arthrodesis. External fixation must be used in acute virulent infections while plate osteosynthesis can be indicated in its absence. The characteristic of intramedullary fixation is similar, however special nails used for arthrodesis of the knee are several times more expensive than the previous types of stabilization. The advantage is the possibility to use a massive bone graft to fill the defect.

Adult↗
PubMedDate not supplied

[Arthrodesis of the ankle. A study of the complications and long term results (author's transl)].

The authors have studied the complications and long term results of 91 cases of tibio-talar arthrodesis and 43 cases of tibio-talar arthrodesis associated with subtalar arthrodesis. Minor complications such as limited skin necrosis were noted in 13 p. 100 of the cases, and no-fusion occurred in 7 p. 100. The results were satisfactory in 75 p. 100 of the cases, fair in 13 p. 100, poor in 12 p. 100. Most of the poor results were related to painfull subtalar joints after isolated tibio-talar arthrodesis. This happened often following conditions : excessive equinus, protrusion of screws in the subtalar joint, preoperative lesions of the subtalar joint. In cases of associated tibio-tarsal and subtalar arthrodesis, the long term study revealed moderate and painless secondary arthrosis of the mid-tarsal joint. It is concluded that associated fusion of the subtalar joint should always be considered when tibio-talar arthrodesis is indicated.

Adolescent↗