Objective To evaluate the effectiveness of Ilizarov external fixation and ankle arthrodesis in the treatment of late traumatic ankle arthritis. Methods Between June 2013 and June 2015, 27 patients with late traumatic ankle arthritis were treated with Ilizarov external fixation technique. There were 16 males and 11 females with an age of 27-69 years (mean, 45.7 years). Sixteen cases were on the left side, 11 on the right side. All the patients suffered from traumatic ankle fractures or ligament damages caused by initial traumas. After 6 months of standard conservative treatment, the results was invalid and all patients had ankle joint pain and movement disorders. The disease duration was 3-39 years (mean, 11.5 years). According to Takakura ankle arthritis staging, there were 16 cases in stage 3 and 11 cases in stage 4. The tibial-talar angle before operation was (102.55±4.02) ° measured on conventional double-feet loading anteroposterior and lateral X-ray films. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and foot joint score was 45.72±6.45, and the visual analogue scale (VAS) score was 8.61±1.96. Results All the patients were followed up 15-42 months (mean, 28.1 months). All ankles achieved bony fusion, the clinical healing time was 12.9 weeks on average (range, 11-18 weeks). No persistent bleeding in the incisions and needle tract occurred during the follow-up. There were 4 cases of mild needle infection, 2 cases of anterior dislocation of talus, and 3 cases with different degree of limited activity. No traumatic bone defect, bone disconnection, and false joint formation was observed. At 12 months after operation, the AOFAS ankle and foot joint score, VAS score, and tibial-talar angle were 80.53±9.14, 2.77±0.82, and (94.36±2.48)°, respectively, which were significantly improved when compared with preoperative ones (t=16.17, P=0.00; t=14.28, P=0.00; t=9.01, P=0.00). The effectivenss was excellent in 9 cases, good in 13 cases, and fair in 5 cases, with an excellent and good rate of 81.5%. Conclusion Satisfactory effectiveness can be obtained through Ilizarov external fixation and ankle arthrodesis in the treatment of traumatic ankle arthritis, showing certain application prospect, while long-term effectiveness should be comfirmed by large sample randomized controlled trials.
Objective To establish the finite element model of varus-type ankle arthritis and to implement the finite element mechanical analysis of different correction models for tibial anterior surface angle (TAS) in supramalleolar osteotomy. Methods A female patient with left varus-type ankle arthritis (Takakura stage Ⅱ, TAS 78°) was taken as the study object. Based on the CT data, the three-dimensional model of varus-type ankle arthritis (TAS 78°) and different TAS correction models [normal (TAS 89°), 5° valgus (TAS 94°), and 10° valgus (TAS 99°)] were created by software Mimics 21.0, Geomagic Wrap 2021, Solidworks 2017, and Workbench 17.0. The 290 N vertical downward force was applied to the upper surface of the tibia and 60 N vertical downward force to the upper surface of the fibula. Von Mises stress distribution and stress peak were calculated. Results The finite element model of normal TAS was basically consistent with biomechanics of the foot. According to biomechanical analysis, the maximum stress of the varus model appeared in the medial tibiotalar joint surface and the medial part of the top tibiotalar joint surface. The stress distribution of talofibular joint surface and the lateral part of the top tibiotalar joint surface were uniform. In the normal model, the stress distributions of the talofibular joint surface and the tibiotalar joint surface were uniform, and no obvious stress concentration was observed. The maximum stress in the 5° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress distribution of medial tibiotalar joint surface was uniform. The maximum stress of the 10° valgus model appeared at the posterior part of the talofibular joint surface and the lateral part of the top tibiotalar joint surface. The stress on the medial tibiotalar joint surface increased. Conclusion With the increase of valgus, the stress of ankle joint gradually shift outwards, and the stress concentration tends to appear. There was no obvious obstruction of fibula with 10° TAS correction. However, when TAS correction exceeds 10° and continues to increase, the obstruction effect of fibula becomes increasingly significant.
Objective To evaluate the early effectiveness of a new minimally invasive plate in the treatment of varus-type ankle arthritis. Methods A clinical data of 15 patients with varus-type ankle arthritis who met the selection criteria between March 2021 and October 2021 were retrospectively analyzed. All the patients were treated with medial open-wedge supramalleolar osteotomy and fibular osteotomy. The osteotomies were fixed with the new minimally invasive plate. There were 7 males and 8 females with an average age of 49.8 years (range, 16-71 years). The causes of ankle arthritis included post-fracture deformity in 1 case, sprain in 8 cases, and acquired clubfoot in 1 case; and 5 cases were without obvious factors. The disease duration ranged from 1 to 12 years, with an average of 4.1 years. Comparisons were made between pre-operation and the last follow-up in the Takakura staging, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, foot function index (FFI), visual analogue scale (VAS) score, tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT). Results All incisions healed by first intention. All patients were followed up 7-18 months (mean, 12.8 months). At last follow-up, the AOFAS ankle-hindfoot score, FFI, VAS score, and Takakura staging significantly improved when compared with the preoperative ones (P<0.05). X-ray films showed that the osteotomy healed at 3 months after operation. At last follow-up, TAS significantly increased and TT decreased when compared with the preoperative ones (P<0.05), and the difference in TLS between pre- and post-operation was not significant (P>0.05). Complications included 1 case of intraoperative screw breakage and 2 cases of nerve injury of the affected foot. None of the patients complained of significant discomfort at the plate placement during follow-up, and no loosening of the internal fixator occurred. Eleven patients were very satisfied with the effeectiveness, while 4 were relatively satisfied. Conclusion The new minimally invasive plate for the varus-type ankle arthritis has good early effectiveness in relieving ankle pain, correcting deformity, improving limb alignment and ankle function, and reducing the incidence of postoperative incisional complications.
ObjectiveTo investigate the short-term effectiveness of INBONETM Ⅱ total ankle prosthesis arthroplasty in the treatment of moderate to severe varus-type ankle arthritis. MethodsThe clinical and radiographic data of patients with moderate to severe varus-type ankle arthritis, who were admitted between May 2017 and November 2021 and treated with total ankle arthroplasty (TAA) using INBONETM Ⅱ prosthesis, was retrospectively analyzed. A total of 58 patients (58 ankles) met the selection criteria and were included in the study. Among them, there were 24 males and 34 females, with an average age of 62.6 years (range, 41-85 years). According to the preoperative tibiotalar angle (TTA), the patients were divided into a moderate varus group (group A, TTA 5°-15°, n=34) and a severe varus group (group B, TTA>15°, n=24). There was no significant difference in gender, side, etiology, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle dorsiflexion, plantarflexion, and total range of motion, and tibial lateral surface angle (TLS) between the two groups (P>0.05). Yet the patients in group A were younger than group B, the degrees of oesteoarthritis (Takakura stage) and ankle pain [visual analogue scale (VAS) score] were milder, and the TTA, talar tilt angle (TT), hindfoot alignment angle (HAA) were smaller while the tibial articular surface angle (TAS) was larger, showing significant differences (P<0.05). The pre- and post-operative VAS score, AOFAS score, the occurrence of early and late complications, the radiographic parameters of the ankle (TTA, TAS, TT, HAA, TLS), ankle dorsiflexion, plantarflexion, and total range of motion were recorded and compared. ResultsAll patients were followed up 19-72 months, with an average of 38.9 months. Compared with the preoperative data, the VAS score of all patients significantly decreased (P<0.05); the AOFAS score, ankle dorsiflexion range of motion, and total range of motion significantly increased (P<0.05); and the TTA, TAS, TT, HAA, and TLS significantly improved at last follow-up (P<0.05); but there was no significant difference in plantarflexion range of motion (P>0.05). Early complications occurred in 13 patients, and only 1 patient underwent revision surgery due to a larger size of the talar component. At last follow-up, there was no significant difference in the difference of clinical parameters before and after operation between the two groups (P>0.05); there was a significant difference in the difference of other radiographic parameters (P<0.05) except TLS. No significant difference in the incidence of complications between the two groups was found (P>0.05). ConclusionTAA using the INBONETM Ⅱtotal ankle prosthesis is an effective treatment for moderate or severe varus-type ankle arthritis, and good clinical and radiographic results can be obtained. Correcting bony deformities and balancing soft tissue are the keys to successful surgery.