Introduction

Degenerative, inflammatory, and posttraumatic arthritis of the ankle are the primary indications for total ankle arthroplasty

Ankle arthrodesis has long been the “gold standard” for the surgical treatment

Total Ankle Arthroplasty. implant survivorship has been reported to range from 70% to 98% at three to six years

The combination of younger age and hindfoot arthrodesis or osteoarthritis may lead to a relative increase in failure rates after TAA

Intraoperative complication include malaligment, fracture and tendon Postoperative complications include syndesmotic nonunion, wound problems, infections and component instability and lysis

After TAA few difficulties mainly due to poor Talar and Tibial bone stock. It is difficult to stabilize the fusion and usually there is shortening after removal of the implant. Also there is a need for massive bone graft-allograft or autograft.

In cases when there is significant bone loss there is a need for stable reconstruction and stabilization of the hindfoot. Bone grafting with structural bone graft may collapse and it has to be stabilized with screws or nail.

Purpose: The elderly population is increasing in the modern world. Societies in general and medical personnel are facing new ethical and medical dilemmas when treating extremely old patients. Elderly patients have osteoporotic bone and hence a high incidence of fractures. Evaluating this unique group of patients who have hip fractures is our goal.

Materials and Methods: A retrospective analysis of all patients who had hip fractures between January 1990 and December 2001 and were beyond 100 years old was handled.

Data was collected from the medical files (hospitalization and out-patient charts) for age, sex, type of fracture, type of treatment, background disease, rehabilitation and time until death. The latter was confirmed by data from ministry of home office.

Results: 23 patients (17 females and 6 males) were found. Ages ranged from 100 and 107 (mean: 101.78). They had 4 subcapital and 19 per-subtrochanteric fractures. The patients had between 1–5 major background diseases. 4 patients were treated conservatively (1 due to major pneumonia and 3 refused the operative procedure). All these patients died at the same month of admission. Among the 19 patients who underwent operation, 12 patients have died and lived between 0–34 months (mean: 7.43) post-operatively, and 7 are still alive for 4–75 months (mean: 34.43) post-operatively. No differences between the operative and conservative groups in terms of major background disease were found.

Conclusions: Most of hip fractures in the extreme old age are per-subtrochanteric. Operative treatment yielded better results and should be the treatment of choice.

Purpose: To describe the first 22 cases of Total Ankle Replacement (TAA) performed by the same team. The learning curve and the complications due to technical problems or medical problems are discussed

Patients : 22 patients underwent TAA during the last two and half years in our department. There were 6 males and 7 females. The average age was 63 ranging from 22 –79 years old. 11 patients developed osteoarthritis after trauma to the ankle, 9 had primary osteoarthritis and 2 patients suffered from rheumatoid arthritis.

Results: The average time of operation was 111 minutes (range 148–90) and 12 patients were operated under general anesthesia and the rest had spinal epidural anesthesia. During the operations the medial malleolus was fractured three times and one patient had fracture of the lateral malleolus fixated with KW. In two patients Achilles lengthening was performed as well. There was fracture of the posterior lip of the tibia during insertion of the tibial component in one patient. All the patients recovered with no primary wound healing problem. There was deep infection after 6 weeks in one patient who was treated by drainage debridment of synovium and recovered uneventfully. One patient had synovitis 6 months after the operation and underwent synovectomy proved to be non infected.

One patient still had pain after a year after the operation and x ray disclosed medial talar osteophyte which had to be resected and one patient progressed to subtalar arthritis and had to be fused. The same patient had superficial nerve neuralgia as well and the nerve was resected at the same procedure.

Altogether there were five fractures during the insertion, 2 late operations and one deep infection. The average follow up was two years (ranging from 7 months to 30 months). The patients had free painless ankle range of motion of 40 degrees and could walk few hundreds meters without pain. All the patients were satisfied from the procedure except for one patient with the medial talar osteophyte.

Clinical relevance: The outcome of TAA is good and leads to high satisfaction from the patients. However it is demanding procedure and has long learning curve with high rate of technical complications which can be overcome leading to complete recovery.

The treatment of OA of the ankle is similar to any other large joint and includes conservative and surgical treatment. The surgical treatment is fusion or replacement but conservative treatment is limited and include mainly ankle supports and physiotherapy. Hyaluronic acid was discovered by Meyer and Palmer in 1934 and recently is widely used in the treatment of knee osteoarthritis. We evaluated the efficacy of intra-articular preparation containing Sodium Hyaluronate, in the treatment of OA of the ankle.

A group of 16 patients suffering from ankle osteoarthritis were selected for the study. The mean age was 43 years (range 31–79 years) and the duration of pain from nine months to 27 years. Twelve patients had ankle fractures and four had no trauma history. The clinical presentation included at least one or more of the following conditions of the ankle joint: pain in motion or at rest, swelling and tenderness for over than nine months. The radiographic severity of the ankle osteoarthritis was grade II, III or IV according to Kellgren and Lawrence. Intra-articular injections of 25 mg Sodium-hyaluronate (Adant) were administered on five consecutive weeks. Follow-up visits were perfumed one, two, three, four and seven months post treatment and included clinical evaluation and score scale.

Global assessment showed, in 13 out of 16 patients, improvement in the range of motion by 20%. Significant reduction of the OA symptoms according to the score: two to three points improvement on each scale. According to the osteoarthrithis ankle score scale: up to 20 points. Improvement continued for seven months follow-up after the treatment; no decrease in the treatment efficacy has been shown. Global assessment of two patients did not show any significant improvement after the treatment. One patient dropped off the study due to other operation.

Symptomatic relief of OA of the ankle can be achieved by injection of intraarticular preparation containing Sodium Hyaluronate.

Background: Osteoarthritis (OA) may affect large and small joints and is common final pathway of large array of conditions. OA of the large joints includes mainly hip, knee, shoulder and ankle. The treatment of OA of the ankle is limited and the surgical treatment is usually salvage procedure as fusion. Therefore there is a need for an efficient conservative treatment of the ankle OA.

Aims: The objective of this clinical trial was to evaluate the symptomatic efficacy of intraarticular preparation containing Sodium Hyaluronate, in the treatment of OA of the ankle.

Methods: The study was conducted on patients who visited our out-patients clinic under the direct supervision of the principle investigator. The male or female patient aged between 30 and 80 suffering from osteoarthritis of the ankle joint of radiographic severity II or III or IV according to Kellgren and Lawrance, suffering from one or more of the following conditions of the ankle joint: swelling, tenderness or pressure, and/or pain on motion or at rest, who have clinical history of ankle pain for over 6 months.

Intraarticular injections of 25 mg Sodium-hyaluronate in 5 following weeks were administrated to 16 patients, 31–79 years old (average 43 years) suffering from pain in the ankle, 9 months to 27 years. 12 patients after operation, 4 with no trauma history.

Follow-up visits were performed 1,2,3,4,7 months post treatment and included clinical evaluation and score scale.

Results: Global assessment showed in 13 out of 16 patients improvement in the motion range (20%) and significantly reduction of the OA symptoms according to the score: 2–3 points improvement on each scale and according to the osteoarthritis ankle hindfoot score scale (100 points total): up to 20 points improvement. Seven months after the treatment, no decrease in the treatment efficacy has been shown.

Global assessment of 2 patients did not show any significant improvement after the treatment. One patient dropped off the study due to other operation.

Conclusions: Symptomatic relief of OA of the ankle can be achieved by admission of intraarticular preparation containing Sodium Hyaluronate.