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Musculoskeletal Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The most common long-term sequela following limb trauma is joint arthrosis. Osteoarthritis of the hip, knee and ankle is likely to follow intra-articular fractures of these joints, although the incidence of osteoarthritis is reduced if near-anatomical reduction of the fracture is achieved and maintained. Good results of hip replacement are now universally expected, with knee replacement being slightly less predictable. Ankle replacement is still largely experimental, and ankle osteoarthritis, if severe, may require fusion. In the upper limb, shoulder and elbow replacement generally provides better pain relief than function.
Foot and ankle
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The definitive operative treatment for arthritis of the ankle will usually be in the form of total ankle replacement (TAR) or more commonly arthrodesis (fusion); the latter is often carried out via an open approach but arthroscopic techniques have better outcomes, more rapid recovery and fewer complications. Such techniques are mandatory in the presence of poor soft-tissue envelope or in the presence of a clotting diathesis. A UK National trial is currently underway to evaluate the relative outcomes of TAR versus arthrodesis (the TARVA trial), which are as yet undefined.
Foot and ankle disorders
Published in Maneesh Bhatia, Tim Jennings, An Orthopaedics Guide for Today's GP, 2017
Ankle replacement also known as ankle arthroplasty (Figure 8.9): Ankle arthroplasty has become popular in the last few years.3 It helps in preserving movements of the ankle thereby relieving pressure on neighbouring joints as compared to ankle arthrodesis. The modern arthroplasty implants have resulted in improved longitivity and better results. The survivorship of one make of ankle replacements (Hintegra) has been reported to be 84% at 10 years for a group of 684 patients.4 An ideal candidate for ankle replacement is a patient with low functional demand usually greater than 65 years. It can be considered for younger patients with rheumatoid arthritis. The presence of a significant deformity is a contraindication for ankle replacement.
The availability of new drugs for hemophilia treatment
Published in Expert Review of Clinical Pharmacology, 2020
Massimo Morfini, Emanuela Marchesini
Then, patient 1 underwent a total right hip replacement, and patient 2 right knee prosthesis followed by concomitant bilateral ankle replacement after 4 months. To our knowledge, this is the first report of a simultaneous bilateral total ankle replacement in a patient with severe hemophilia A and a high-responding inhibitor. Emicizumab prophylaxis was continued throughout the peri- and postoperative period (dose administered in the morning of surgery that was planned in the function of the prophylaxis schedule Then, patient 1 underwent a total right hip replacement, and patient 2 right knee prosthesis followed by concomitant bilateral ankle replacement after 4 months. To our knowledge, this is the first report of a simultaneous bilateral total ankle replacement in a patient with severe hemophilia A and a high-responding inhibitor. Emicizumab prophylaxis was continued throughout the peri- and postoperative period (dose administered in the morning of surgery that was planned in the function of the prophylaxis schedule Then, patient 1 underwent a total right hip replacement, and patient 2 right knee prosthesis followed by concomitant bilateral ankle replacement after 4 months. To our knowledge, this is the first report of a simultaneous bilateral total ankle replacement in a patient with severe hemophilia A and a high-responding inhibitor. Emicizumab prophylaxis was continued throughout the peri- and postoperative period (dose administered in the morning of surgery that was planned in the function of the prophylaxis schedule
Partial talar replacement with a novel 3D printed prosthesis
Published in Computer Assisted Surgery, 2023
Yidong Cui, Bin Chen, Gang Wang, Juntao Wang, Ben Liu, Lei Zhu, Qingjia Xu
Treatment for talar AVN begins with conservative measures, including bracing, protected weightbearing, or shock wave therapy [4]. Despite conservative treatment, many patients continue to complain of pain and require surgical intervention. Patients with talar AVN without dome collapse are recommended joint-preserving surgery methods, such as core decompression or bone grafting [5]. Bone marrow stimulation may best be reserved for osteochondral lesions of the talus sizes less than107.4 mm2 in area and/or 10.2 mm in diameter [6,7]. While osteochondral autograft is mainly required for the ipsilateral knee to repair talar defects with native hyaline cartilage, osteochondral allograft transplantation is suitable for large cystic lesions accompanied by a lack of subchondral bone integrity [8]. Fresh frozen allogenic osteochondral transplantation has been applied for talar osteochondral injuries greater than 20 mm [9]. Allografts are more expensive than autografts, and they carry a small risk of disease transmission [10]. Further, fresh frozen allogenic osteochondral transplantation is not allowed in our country. Tibiotalocalcaneal (TTC) is usually performed as a salvage treatment toward setting the talar dome collapse [11]. Although TTC arthrodesis has been reported to have an excellent prognosis in some studies, the incidence of complications including nonunion and infection continue to occur [12]. Restriction of joint mobility can greatly interfere with the quality of life and performance of routine functions. Although total ankle replacement can reserve the function of ankle, but it is more appropriate for the end-stage arthritis [13].
Bone remodelling around the tibia due to total ankle replacement: effects of implant material and implant–bone interfacial conditions
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Scandinavian Total Ankle Replacement (S.T.A.R@TM) prosthesis was used in this study. Prosthetic components were positioned (optimal position) according to surgical guidelines (Small Bone Innovations, Inc.). Tibial, meniscal bearing and talar components were generated using Solidworks software (DS Solidworks Corp., Concord, MA) conferring to information provided by the Small Bone Innovations, Inc. All three components were chosen according to patients (tibial component 32 × 30mm; mobile-bearing thickness of 10 mm; talar component 34 × 35mm). The virtual positioning of implant and operation was done using Rhinoceros software (Robert McNeel& Associates, Seattle, WA). In the case of the optimally positioned implant component, the tibial implant was set to perpendicular to the anatomic axis of the tibia. The anterior direction was set by the bisection of the medial and lateral gutters. Medial/lateral implant placement matches the medial gutter corner, and the anterior/posterior implant placement matches at the anterior edge of the tibia for optimal positioning. Using these bony landmarks and references, the authors positioned the tibial component and other implant components in Rhinoceros software, accordingly. Finally, all bones and implant components were imported in ANSYS FE software v 17 for further processes as similar to the intact model. In order to understand the influence of different material on bone remodelling, three prosthetic FE models namely, model 1 (tibial and talar components were assigned with Cobalt–Chromium–Molybdenum, and meniscal bearing was UHMWPE), model 2 (tibial and talar components were assigned with ceramic, and meniscal bearing was UHMWPE) and model 3 (tibial and talar components were assigned with ceramic and meniscal bearing was CFR-PEEK) were developed. In the case of the intact model, a constant thickness of cartilage was developed between all bones (Mondal and Ghosh 2017). Total 16 numbers of ligaments were modelled around the ankle joint by following the same procedure as similar to the earlier study by the corresponding author (Mondal and Ghosh 2017).