Introduction

When ankle arthroplasty fails the options are revision to arthrodesis or revision to arthroplasty. We report early outcomes of revision procedures for failed total replacement.

Introduction

We report the functional outcome and survivorship of the Hintegra Total Ankle Replacement (TAR), in consecutive cases by multiple surgeons in a single UK institution. Between 2010–2014 the Hintegra TAR held 7.1% UK market share and surgeons should be aware of failure mechanisms.

Lateral approach open calcaneal osteotomy is the described gold standard procedure in the management of hindfoot deformity. With development of minimally invasive surgery, a MIS approach has been described, citing fewer wound complications and lower risk of sural nerve injury. This audit compares MIS to the traditional procedure. A retrospective review of all patients undergoing calcaneal osteotomy in Northumbria Trust in the past 5 years was performed. A total of 105 osteotomies were performed in 97 patients; 28 (13M:15F) in MIS group and 77 (40M:37F) had an open approach. The average age was 52.1 (range 16–83) for MIS and 51.5 (range 18–83) in the open group. All patients were followed up for development of wound complication, nerve injury and fusion rate. Wound complications were similar (10.7% in MIS group vs 10.3% in Open group) with no significant difference (p=0.48). Patients were treated for infection in 3(3.8%) cases in the open group and 2(7.1%) in the MIS group. This difference was not significant (p=0.43). 4 (14.3%) patients in the MIS group had evidence of sural nerve dysfunction post-operatively (managed expectantly), compared to 12(15.5%) patients in the open group (p=0.44). Of these, 2 went on to undergo neuroma exploration. There was no difference in nerve dysfunction in varus or valgus correction. Mean translation in the open group was measured as 7.3mm(SD=1.91;3 to 13mm) and 7.5mm(SD=1.25;5 to 10mm) in the MIS group. Translation was similar in varus or valgus correction. Non-union occurred in 2 patients in the MIS group and none in the open group (p= 0.06). MIS calcaneal osteotomy is a safe technique, that works as effectively as osteotomy performed through an open approach. There were lower rates of nerve injury, wound complication and infection, but this was not significantly different comparing groups. There was a higher risk of non-union in MIS technique.

Background

Traditionally, the extended lateral approach (ELA) was the favoured approch for calcaneal fractures, but has been reported to have high incidence of wound complications. There has been a move amongst surgeons in the United Kingdom towards the sinus tarsi approach (STA) due to its minimally invasive nature, attempting to reduce such complications.

Introduction:

Symptomatic treatment of ankle osteoarthritis (OA) with corticosteroid injections is well established. Hyaluronic acid is also reported as an effective symptomatic treatment for ankle OA but these two treatments have not been compared directly.

Aim

To review the results of patients who underwent fixation of complex proximal femur fractures using the Proximal Femur Locking Plates (PFP) and analyse causes of failure of PFP.

Introduction

The goal of arthrodesis around the ankle or of triple (hind foot) arthrodesis is a painless, plantigrade, and stable foot. Stress fracture is a differential diagnosis for pain following an ankle/subtalar arthrodesis. Management of stress fractures following sound ankle/subtalar fusion is extremely difficult as the entire movement tends to occur at the fracture site, hence hampering healing.

Background: Resurfacing hip replacement is becoming increasingly used surgical option for young active patients with disabling hip arthritis.However there is a paucity of published literature describing complications and their avoidance.

Objective The objective of this study was to analyse 6 cases of postoperative subcapital fracture following hip resurfacing with a cohort of 54 cases that did not have a fracture and to identify factors associated with fractures risk.

Materials and Methods Between January 1999 and October 2003, 60 hips in 54 patients were treated with metal on metal resurfacing hip replacement (MMT Birmingham, UK).6 of these sustained a fracture just below the femoral component.The notes and radiographs were reviewed.Demographics data was recorded along with height, weight,smoking habits and medication usage including NSAIDS and antiepileptic use.The radiographs were studied for notching of the neck,offset difference as compared to normal and the stem shaft angle. The results were statistically analysed to determine any significant associations.

Results 57 hips in 51 patients were analysed for comparison. The mean age of the patients was 50 yrs (Range 34–67).In the fracture cases there were three men and three women with a mean age of 48 yrs.Five of six ( 83%) in the fracture cases had notching of the femoral necks compared to 9 (17%) out of 51 of the non fractured patients. The offset was significantly greater in the fractured group(52 ± 7mm) compared to the non fractured group (49 ± 7 mm).The increase in offset appeared to occur as a result of incomplete seating of tight fitting cemented femoral component. The head size appeared smaller in the fractured group but the difference was insignificant. There was no significant trauma in any of the cases. None of the patients who underwent resurfacing for AVN and cyst had a fracture. There were no other significant correlations

Conclusions Increased offset and notching are factors which predispose to fractures following resurfacing hip replacements. AVN and cysts were not associated with fractures in our series. We have changed the cementing technique using smaller volumes of freshly mixed simplex cement and now encourage protected weight bearing if intraoperative notching is noted or if osteoporosis is identified pre or peri operatively. We have had no fractures in the last 18 months.

Aim: This investigation compares the tibial tunnel appearances at 1 year and again at 8 years post-operatively in 49 patients and reports on the clinical significance of these appearances. Materials and Methods:49 consecutive patients who underwent isolated central anterior cruciate ligament reconstruction using a four stranded hamstring tendon technique comprised the study group. The patients were reviewed clinically and with weight bearing AP and Lateral radiographs at one year and eight years (range 5–9years) from reconstruction. Two blinded observers measured the tunnel diameters using a digital caliper on the 1year and 8 year radiographs. Tunnel enlargement was calculated from the known drill size with correction for magnification. The findings were correlated with clinical outcome and various associations were studied. Results: At one year postoperatively tunnels had increased in diameter by a mean of 26% at the proximal end, and by 19% at the distal end. By 8 years both measurements had reduced to 20% and to 13% respectively and this decrease in tunnel enlargement was significant (p< 0.05). Tunnel enlargement was significantly greater in those knees with persistent effusion at one year. (P< 0.05). 10 patients (26%) had distal tibial tunnel diameters which were less than the original drill size and of these ten patients only one had a positive Lachman (side to side difference> 3mm) compared to 9 in the rest. (P< 0.05). Conclusion: Tunnel enlargement that occurs at 1yr reduces by 8 years from reconstruction. Decrease in tunnel enlargement at the distal end is associated with an improved and lasting stability.

Aims: To compare the results of Kellerñs excision arthroplasty with those of distal osteotomy for hallux valgus in patients less than 55 years of age. Patients and Methods: 20 consecutive patients less than 55 years of age with hallux valgus who had undergone unilateral Kellerñs excision arthroplasty were individually matched for age and sex with 20 patients who had undergone distal metatarsal osteotomy. The patients were reviewed for the purpose of this study. The review process included self assessment using foot function index, Hallux metatarsal function index and general health assessment using SF36, patients subjective rating of the result, dynamic foot pressure measurements using F-scan. Standing AP radiographs of both feet were also taken at the review. The results were compared within the two groups and the results statistically analysed. Results: The mean age of the patients in osteotomy group was 44 yrs and that in Kellers group was 44.5 yrs. The sex ratio was 16:4 (M:F) in both groups. The average follow up was 30 months in osteotomy group compared with 38 months in Kellerñs group. The mean Foot function index score was 3 ± 4 in osteotomy group. The hallux metatarsal score was 93 ± 13. In the Kellers group the scores were 24±33 and 80 ±22 respectively. The difference was statistically signiþcant. (Paired T test two tailed p< .05). The scar problems too were higher in Kellerñs group (9 compared to 4). Subjectively the osteotomy group rated the result more satisfactory. Conclusion: In patients with hallux valgus distal metatarsal osteotomy produces better results in comparison to Kellerñs arthroplasty in patients less than 55 yrs at a mean follow up of 33 months.