Pub Date : 2024-04-01DOI: 10.1177/2473011424s00094
Solangel Rodriguez-Materon, Samantha Trynz, Dev Patel, Joshua L. Morningstar, Christopher E Gross, Daniel J. Scott
Introduction/Purpose: There is a paucity of literature investigating the association of operative time and postoperative outcomes following total ankle arthroplasty (TAA). Thus, this study seeks to evaluate the relationship between total operative time and postoperative outcomes following TAA. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007-2020 to identify 2133 TAA patients. Demographics, medical comorbidities, concomitant procedures, hospital length of stay (LOS), and 30-day complication, readmission, and reoperation rates were compared between groups. Patients were excluded based on an operative time greater than 290 minutes to limit the influence of extreme outliers. The cohort was predominantly male (53.8%) and mean patient age was 64.10 (range 19-87) years with a mean BMI of 31.00 (range 17.14-57.78) m/kg2. The mean operative time of the cohort was 149.56 (standard deviation [SD]=49.60) minutes. Results: Demographic characteristics associated with increased operative time were decreased age (p 1 SD above the mean), independently predicted were readmission (OR=2.817; 95%CI=1.334-5.951; p=0.007), urinary tract infection (OR=6.410; 95%CI=1.384-29.6866; p=0.018), wound dehiscence (OR=5.127; 95%CI=1.282-20.508; p=0.021), and bleeding requiring transfusion (OR=18.364; 95%CI=1.846-182.682; p=0.013). Conclusion: The study found longer operative time during TAA is associated with a statistically significant increase in wound dehiscence, urinary tract infection, readmission, reoperation, and increased length of stay. Therefore, surgeons should prioritize measures to reduce operative time when appropriate while optimizing implant placement, deformity correction, and implant stability in TAA.
{"title":"The Effect of Operative Time on Short-Term Total Ankle Arthroplasty Outcomes","authors":"Solangel Rodriguez-Materon, Samantha Trynz, Dev Patel, Joshua L. Morningstar, Christopher E Gross, Daniel J. Scott","doi":"10.1177/2473011424s00094","DOIUrl":"https://doi.org/10.1177/2473011424s00094","url":null,"abstract":"Introduction/Purpose: There is a paucity of literature investigating the association of operative time and postoperative outcomes following total ankle arthroplasty (TAA). Thus, this study seeks to evaluate the relationship between total operative time and postoperative outcomes following TAA. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007-2020 to identify 2133 TAA patients. Demographics, medical comorbidities, concomitant procedures, hospital length of stay (LOS), and 30-day complication, readmission, and reoperation rates were compared between groups. Patients were excluded based on an operative time greater than 290 minutes to limit the influence of extreme outliers. The cohort was predominantly male (53.8%) and mean patient age was 64.10 (range 19-87) years with a mean BMI of 31.00 (range 17.14-57.78) m/kg2. The mean operative time of the cohort was 149.56 (standard deviation [SD]=49.60) minutes. Results: Demographic characteristics associated with increased operative time were decreased age (p 1 SD above the mean), independently predicted were readmission (OR=2.817; 95%CI=1.334-5.951; p=0.007), urinary tract infection (OR=6.410; 95%CI=1.384-29.6866; p=0.018), wound dehiscence (OR=5.127; 95%CI=1.282-20.508; p=0.021), and bleeding requiring transfusion (OR=18.364; 95%CI=1.846-182.682; p=0.013). Conclusion: The study found longer operative time during TAA is associated with a statistically significant increase in wound dehiscence, urinary tract infection, readmission, reoperation, and increased length of stay. Therefore, surgeons should prioritize measures to reduce operative time when appropriate while optimizing implant placement, deformity correction, and implant stability in TAA.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424s00050
Matthew R. Yuro, Dominic S. Carreira, Jorge I. Acevedo, Thomas G. Harris
Introduction/Purpose: Chondral injuries of the ankle are common, often requiring surgical intervention. The purpose of this multicenter study of ankle osteochondral injuries is to report minimum one year outcomes for patients undergoing arthroscopic surgical treatment. Methods: Thirty-nine patients undergoing arthroscopic surgery to treat chondral ankle injuries between December 2017 and January 2022 were enrolled in the present multicenter study. Intraoperative information including diagnoses and procedures performed were recorded. All patients completed the Visual Analog Scale for Pain (VAS), the Veteran RAND 12-Item Health Survey (VR-12) Physical and Mental component scales, and Foot and Ankle Ability Measure Sports subscale (FAAM-S). These measures were collected at the pre-operative visit within two weeks before surgery and at a minimum of one year post- operatively. Patient demographics and perioperative complications were also recorded. Paired T-test was used to determine statistical significance. Results: Of the thirty-nine patients with a minimum of 1 year follow-up, the average age was 46 years old and 51% were male. Average patient BMI was 29. Laterality was right in 54% of the patients, and 8% of surgeries were revisions. Relative to baseline, there was a significant decrease in VAS at minimum 1-year post-operatively (4.9 to 1.7, p< 0.001). Additionally, the VR-12 Physical was significantly higher at minimum 1-year post-operatively (35.4 to 46.8, p< 0.001). The VR-12 Mental was also significantly higher at minimum 1-year post-operatively (47.6 to 54.6, p=0.005). Finally, there was a significant increase in FAAM Sports (11.3 to 34.0, p< 0.001). There were no recorded complications. Conclusion: For patients undergoing arthroscopic surgery to treat chondral ankle injuries, our study found significant improvements in self-reported pain, overall physical health, overall mental health, and sport activities at minimum one-year follow- ups with no complications.
{"title":"Arthroscopic Chondral Ankle Treatment: A Multicenter Outcome Study","authors":"Matthew R. Yuro, Dominic S. Carreira, Jorge I. Acevedo, Thomas G. Harris","doi":"10.1177/2473011424s00050","DOIUrl":"https://doi.org/10.1177/2473011424s00050","url":null,"abstract":"Introduction/Purpose: Chondral injuries of the ankle are common, often requiring surgical intervention. The purpose of this multicenter study of ankle osteochondral injuries is to report minimum one year outcomes for patients undergoing arthroscopic surgical treatment. Methods: Thirty-nine patients undergoing arthroscopic surgery to treat chondral ankle injuries between December 2017 and January 2022 were enrolled in the present multicenter study. Intraoperative information including diagnoses and procedures performed were recorded. All patients completed the Visual Analog Scale for Pain (VAS), the Veteran RAND 12-Item Health Survey (VR-12) Physical and Mental component scales, and Foot and Ankle Ability Measure Sports subscale (FAAM-S). These measures were collected at the pre-operative visit within two weeks before surgery and at a minimum of one year post- operatively. Patient demographics and perioperative complications were also recorded. Paired T-test was used to determine statistical significance. Results: Of the thirty-nine patients with a minimum of 1 year follow-up, the average age was 46 years old and 51% were male. Average patient BMI was 29. Laterality was right in 54% of the patients, and 8% of surgeries were revisions. Relative to baseline, there was a significant decrease in VAS at minimum 1-year post-operatively (4.9 to 1.7, p< 0.001). Additionally, the VR-12 Physical was significantly higher at minimum 1-year post-operatively (35.4 to 46.8, p< 0.001). The VR-12 Mental was also significantly higher at minimum 1-year post-operatively (47.6 to 54.6, p=0.005). Finally, there was a significant increase in FAAM Sports (11.3 to 34.0, p< 0.001). There were no recorded complications. Conclusion: For patients undergoing arthroscopic surgery to treat chondral ankle injuries, our study found significant improvements in self-reported pain, overall physical health, overall mental health, and sport activities at minimum one-year follow- ups with no complications.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"609 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140791138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424S00074
J. Cutrone, Michael Otten, Seth J. Tysor, Joshua L. Morningstar, Daniel J. Scott, Christopher E. Gross
Introduction/Purpose: Charcot arthropathy is a debilitating and challenging clinical problem for patients and providers. Patient reported outcome measures (PROMs) are an effective tool for gauging a patient’s quality of life and daily functioning, but they have not been reported in the setting of Charcot arthropathy. Our goal is to assess PROMs severity in midfoot Charcot arthropathy (Brodsky Type 1), alongside linked demographics and comorbidities. We will compare these values with PROMs from conditions like ESRD, knee and hip arthritis, highlighting Charcot arthropathy's comparable debilitation. Methods: A retrospective chart review identified 67 patients with Brodsky Type 1 Charcot arthropathy by one of two fellowship- trained foot and ankle surgeons at a single academic medical center between years 2015 and 2023. ICD-10 CM codes E11.610, M14.671, and M14.672 were used to identify diagnosis of Charcot arthropathy and radiological interpretation determined Brodsky type. Data collected from patient charts included demographics, medical history, presence of ulcers, and preoperative Visual Analog Scale (VAS), 12-Item Short Form Health Survey (SF-12), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), SSS- 8, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores and postoperative FAOS and FAAM scores. A One-Way ANOVA was performed to evaluate statistical significance. Averages of preoperative PROM scores were compared to literature values for other diseases. Results: Our cohort was mostly male (58.2%), with mean age 61.73 years, BMI 32.9, and A1C 6.9. Initial presentation revealed 50.7% had ulcers. Brodsky type 1 (midfoot) had notably the lowest pre-op PROM scores when compared to other Brodsky types: PDI Recreation (p=.033), FAOS Symptoms and Stiffness (p=.044), and FAOS Recreation (p=.027). Ulcer presence yielded significantly lower FAAM-ADL scores (p=.038), while other PROMs showed no statistical difference. Our mean VAS score was 53.34 which was higher than hip arthritis VAS (43.0) but lower than ESRD VAS (60.0) and knee arthritis VAS (64.2). Our SF-12 PCS scores (29.4) exceeded prior reports (hip 28.5, knee 28.6), while SF-12 MCS scores were higher in earlier studies (hip 49.6, knee 51.5) than our 43.8. Conclusion: Patients with Charcot arthropathy struggle in daily tasks, reflected in lowered FAOS ADL scores. Brodsky type 1 patients also face challenges in higher-level activities, evident in reduced PDI recreation and FAOS recreation scores. Those with ulcers similarly encounter issues in daily tasks, seen in lower FAAM ADL scores. Brodsky type 1 patients also experience debilitating pain as noted by higher VAS scores when compared to known debilitating conditions such as hip and knee arthritis. Comparatively minor differences in knee and hip arthritis SF-12 PCS scores indicate significant physical limitations for these patients.
{"title":"Impact of Midfoot Charcot Arthropathy (Brodsky Type 1) on Patient Reported Outcome Scores","authors":"J. Cutrone, Michael Otten, Seth J. Tysor, Joshua L. Morningstar, Daniel J. Scott, Christopher E. Gross","doi":"10.1177/2473011424S00074","DOIUrl":"https://doi.org/10.1177/2473011424S00074","url":null,"abstract":"Introduction/Purpose: Charcot arthropathy is a debilitating and challenging clinical problem for patients and providers. Patient reported outcome measures (PROMs) are an effective tool for gauging a patient’s quality of life and daily functioning, but they have not been reported in the setting of Charcot arthropathy. Our goal is to assess PROMs severity in midfoot Charcot arthropathy (Brodsky Type 1), alongside linked demographics and comorbidities. We will compare these values with PROMs from conditions like ESRD, knee and hip arthritis, highlighting Charcot arthropathy's comparable debilitation. Methods: A retrospective chart review identified 67 patients with Brodsky Type 1 Charcot arthropathy by one of two fellowship- trained foot and ankle surgeons at a single academic medical center between years 2015 and 2023. ICD-10 CM codes E11.610, M14.671, and M14.672 were used to identify diagnosis of Charcot arthropathy and radiological interpretation determined Brodsky type. Data collected from patient charts included demographics, medical history, presence of ulcers, and preoperative Visual Analog Scale (VAS), 12-Item Short Form Health Survey (SF-12), Pain Catastrophizing Scale (PCS), Pain Disability Index (PDI), SSS- 8, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores and postoperative FAOS and FAAM scores. A One-Way ANOVA was performed to evaluate statistical significance. Averages of preoperative PROM scores were compared to literature values for other diseases. Results: Our cohort was mostly male (58.2%), with mean age 61.73 years, BMI 32.9, and A1C 6.9. Initial presentation revealed 50.7% had ulcers. Brodsky type 1 (midfoot) had notably the lowest pre-op PROM scores when compared to other Brodsky types: PDI Recreation (p=.033), FAOS Symptoms and Stiffness (p=.044), and FAOS Recreation (p=.027). Ulcer presence yielded significantly lower FAAM-ADL scores (p=.038), while other PROMs showed no statistical difference. Our mean VAS score was 53.34 which was higher than hip arthritis VAS (43.0) but lower than ESRD VAS (60.0) and knee arthritis VAS (64.2). Our SF-12 PCS scores (29.4) exceeded prior reports (hip 28.5, knee 28.6), while SF-12 MCS scores were higher in earlier studies (hip 49.6, knee 51.5) than our 43.8. Conclusion: Patients with Charcot arthropathy struggle in daily tasks, reflected in lowered FAOS ADL scores. Brodsky type 1 patients also face challenges in higher-level activities, evident in reduced PDI recreation and FAOS recreation scores. Those with ulcers similarly encounter issues in daily tasks, seen in lower FAAM ADL scores. Brodsky type 1 patients also experience debilitating pain as noted by higher VAS scores when compared to known debilitating conditions such as hip and knee arthritis. Comparatively minor differences in knee and hip arthritis SF-12 PCS scores indicate significant physical limitations for these patients.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140796364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424s00088
Aly M. Fayed, K. Carvalho, Matthew Jones, Eli L Schmidt, Antoine Acker, Emily Joan Luo, Grayson M. Talaski, Albert O. Anastasio, N. Mansur, C. de César Netto
Introduction/Purpose: Interpositional arthroplasty (IPA) is a motion-preserving surgery in patients with advanced hallux rigidus. Literature displays several complications after the procedure including transfer metatarsalgia, cock-updeformity and infection. In a finite element model, shortening of the first metatarsal was associated with increased plantar pressure on lateral rays during gait. Additionally, there are reports of a positive correlation between first metatarsal shortening after hallux valgus surgery and transfer metatarsalgia of the second,third and fourth metatarsophalangeal joints. The goals of this study were to report the outcomes and complications of IPA using acellular dermal allograft (IPA-ADA) as well as study the changes in the length of the proximal phalanx of the hallux (P1) and the first metatarsal (M1) following the procedure. Methods: In this IRB-approved retrospective study, we assessed patients who underwent IPA-ADA in a single academic institute from 2019-2022. All patients’ demographic data, surgical details, complications, and patient-reported outcomes (PROs) were extracted. On standing conventional anteroposterior (AP) foot views, we measured the lengths of the first metatarsal (M1), the second metatarsal (M2), the proximal phalanx of the big toe (P1), and the entire length of the hallux (HX). The ratio of M1/M2 and P1/HX were calculated. The first metatarsophalangeal joint space was measured at the medial and lateral aspects of the joint on the APview. All measurements were recorded pre-operatively, at six weeks follow-up, and at the final follow-up. Descriptive statistics were performed, and comparison between groups was performed using analysis of variance(ANOVA) or Kruskal Wallis test according to data normality. The Dunn-Bonferroni test was then performed for pairwise group comparisons. A p-value < 0.05 was considered significant. Results: Eleven patients were included, 9 being females (81.81%). Six were hallux rigidus Coughlin grade III (54.55%), and 5 were grade IV (45.45%). The average age was 59 years (SD±6.78), and the body mass index (BMI) was 26 (SD±4.79). At the final follow- up, there was significant shortening of the first ray in comparison to the pre-operative length evidenced by lower M1/M2 (82.63 SD±2.29 versus 75.42 SD±5.1; p=0.001) and P1/HX ratio53.38 ± 2.29 versus 48.98 SD ± 7.92; p=0.001). Although there was no significant difference between M1/M2 at 6 weeks and at the final follow-up (p=0.716), there was a significant negative correlation between follow-up length and M1/M2 (r= -0.76, p=0.003). Follow-up was (19.95 months; range 3-39). Complications and PROs are listed in Figure 1. Conclusion: Interposition arthroplasty using dermal allograft for HR is associated with progressive shortening of the first ray at the level of the first metatarsal as well as the proximal phalanx. Although the study did show shortening of the first ray, the small sample size didn't allow for a correlation between
{"title":"Progressive First Metatarsal Shortening Is Observed Following Allograft Interpositional Arthroplasty in Hallux Rigidus","authors":"Aly M. Fayed, K. Carvalho, Matthew Jones, Eli L Schmidt, Antoine Acker, Emily Joan Luo, Grayson M. Talaski, Albert O. Anastasio, N. Mansur, C. de César Netto","doi":"10.1177/2473011424s00088","DOIUrl":"https://doi.org/10.1177/2473011424s00088","url":null,"abstract":"Introduction/Purpose: Interpositional arthroplasty (IPA) is a motion-preserving surgery in patients with advanced hallux rigidus. Literature displays several complications after the procedure including transfer metatarsalgia, cock-updeformity and infection. In a finite element model, shortening of the first metatarsal was associated with increased plantar pressure on lateral rays during gait. Additionally, there are reports of a positive correlation between first metatarsal shortening after hallux valgus surgery and transfer metatarsalgia of the second,third and fourth metatarsophalangeal joints. The goals of this study were to report the outcomes and complications of IPA using acellular dermal allograft (IPA-ADA) as well as study the changes in the length of the proximal phalanx of the hallux (P1) and the first metatarsal (M1) following the procedure. Methods: In this IRB-approved retrospective study, we assessed patients who underwent IPA-ADA in a single academic institute from 2019-2022. All patients’ demographic data, surgical details, complications, and patient-reported outcomes (PROs) were extracted. On standing conventional anteroposterior (AP) foot views, we measured the lengths of the first metatarsal (M1), the second metatarsal (M2), the proximal phalanx of the big toe (P1), and the entire length of the hallux (HX). The ratio of M1/M2 and P1/HX were calculated. The first metatarsophalangeal joint space was measured at the medial and lateral aspects of the joint on the APview. All measurements were recorded pre-operatively, at six weeks follow-up, and at the final follow-up. Descriptive statistics were performed, and comparison between groups was performed using analysis of variance(ANOVA) or Kruskal Wallis test according to data normality. The Dunn-Bonferroni test was then performed for pairwise group comparisons. A p-value < 0.05 was considered significant. Results: Eleven patients were included, 9 being females (81.81%). Six were hallux rigidus Coughlin grade III (54.55%), and 5 were grade IV (45.45%). The average age was 59 years (SD±6.78), and the body mass index (BMI) was 26 (SD±4.79). At the final follow- up, there was significant shortening of the first ray in comparison to the pre-operative length evidenced by lower M1/M2 (82.63 SD±2.29 versus 75.42 SD±5.1; p=0.001) and P1/HX ratio53.38 ± 2.29 versus 48.98 SD ± 7.92; p=0.001). Although there was no significant difference between M1/M2 at 6 weeks and at the final follow-up (p=0.716), there was a significant negative correlation between follow-up length and M1/M2 (r= -0.76, p=0.003). Follow-up was (19.95 months; range 3-39). Complications and PROs are listed in Figure 1. Conclusion: Interposition arthroplasty using dermal allograft for HR is associated with progressive shortening of the first ray at the level of the first metatarsal as well as the proximal phalanx. Although the study did show shortening of the first ray, the small sample size didn't allow for a correlation between","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"90 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424s00092
Joseph A S McCahon, T. Moncman, Tyler M. Radack, Mark Miller, Selene G. Parekh, D. Pedowitz, Joseph N Daniel
Introduction/Purpose: Patients undergoing foot and ankle surgery may find themselves facing unexpected medical bills. This is known as surprise billing and has caused financial hardship for many patients, prompting policymakers to pass the “No Surprise Act”. The purpose of this study was to determine the incidence of surprise bills in patient undergoing foot and ankle surgery and the effect of surprise billing on patient satisfaction. Methods: This was a retrospective study of patients who underwent a foot and ankle surgery from May 2021 to November 2022 at a large multi-state institution. Patients completed a questionnaire regarding the incidence of surprise bills following their surgery, the details regarding those bills, and how those bills affected the surgical satisfaction. Results: Of the 771 responses, 23% of participants received at least one surprise bill following their foot and ankle procedure, with 39% of these bills being greater than $1000. The most common surprise bill came from the surgical facility (46%) followed by anesthesia (42%). Furthermore, the incidence of surprise billing before and after the implementation of the “No Surprise Act” on January 1st, 2022 was not found be significantly different (p=0.134). Patients who received surprise bills reported being significantly less satisfied with their surgery (p < 0.001) and felt their billing experience affected their surgical satisfaction. Conclusion: Despite recent legislative efforts, surprise billing in foot and ankle surgery is common and can negatively affect patient surgical satisfaction. Although surgeons may be unable to limit the amount of bills patients receive postoperatively, increased communication and education regarding the perioperative billing process may prove to be beneficial for both patient satisfaction and the doctor-patient relationship.
{"title":"Surprise Billing in Foot and Ankle Surgery and Its Effect on Patient Satisfaction","authors":"Joseph A S McCahon, T. Moncman, Tyler M. Radack, Mark Miller, Selene G. Parekh, D. Pedowitz, Joseph N Daniel","doi":"10.1177/2473011424s00092","DOIUrl":"https://doi.org/10.1177/2473011424s00092","url":null,"abstract":"Introduction/Purpose: Patients undergoing foot and ankle surgery may find themselves facing unexpected medical bills. This is known as surprise billing and has caused financial hardship for many patients, prompting policymakers to pass the “No Surprise Act”. The purpose of this study was to determine the incidence of surprise bills in patient undergoing foot and ankle surgery and the effect of surprise billing on patient satisfaction. Methods: This was a retrospective study of patients who underwent a foot and ankle surgery from May 2021 to November 2022 at a large multi-state institution. Patients completed a questionnaire regarding the incidence of surprise bills following their surgery, the details regarding those bills, and how those bills affected the surgical satisfaction. Results: Of the 771 responses, 23% of participants received at least one surprise bill following their foot and ankle procedure, with 39% of these bills being greater than $1000. The most common surprise bill came from the surgical facility (46%) followed by anesthesia (42%). Furthermore, the incidence of surprise billing before and after the implementation of the “No Surprise Act” on January 1st, 2022 was not found be significantly different (p=0.134). Patients who received surprise bills reported being significantly less satisfied with their surgery (p < 0.001) and felt their billing experience affected their surgical satisfaction. Conclusion: Despite recent legislative efforts, surprise billing in foot and ankle surgery is common and can negatively affect patient surgical satisfaction. Although surgeons may be unable to limit the amount of bills patients receive postoperatively, increased communication and education regarding the perioperative billing process may prove to be beneficial for both patient satisfaction and the doctor-patient relationship.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"212 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140761498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424s00069
Marguerite Anne Mullen, Emmanuel Budis, Arianna Gianakos, S. A. Esfahani, C. DiGiovanni, D. Guss
Introduction/Purpose: Today women are over 50% of medical school matriculants but remain underrepresented in orthopaedic surgery (~15% of residents and < 6% of practicing surgeons). Moreover, despite different and sometimes controversial reports, the rate of female society memberships and national and international meeting speakers as well as their contribution to leadership positions including moderating sessions, podiums, and symposiums are believed to be low. The objective of this study was to assess whether there is a gap in female representation among invited speakers at American Orthopaedic Foot & Ankle Society (AOFAS) national meetings relative to research productivity as reflected by article authorship in Foot & Ankle International journal (FAI). Methods: Programs for AOFAS specialty days and annual meetings and FAI articles from January 2012 to December 2022 were obtained. Industry-hosted programs were excluded. Gender was identified through personal acquaintance or online search on the biographies of the authors. Presentations and articles were categorized as “technical” or “non-technical”, where technical was defined as relating to basic science or the clinical practice of orthopaedics. Comparisons were done using the Chi-Square Test (significance level= p< 0.05). Results: 1,020 AOFAS presentations and 2,230 FAI articles were analyzed. Gender was unavailable for 0.19% of AOFAS speakers, 4.48% of FAI first authors and 4.13% of FAI senior authors. 11.08% of AOFAS invited national meeting speakers, 15.18% of FAI first authors and 7.40% of FAI senior authors were female. Overall, the proportion of female speakers was significantly lower than female first authors (p= 0.0036), and significantly higher than female senior authors (p < 0.001). In 2018 and 2019, women were more likely to have given “non-technical” AOFAS presentations. There was no significant difference in other years or among FAI articles. The average annual change was +2.00% female AOFAS presenters, +0.31% FAI female first authors and -0.37% FAI female senior authors per year. Conclusion: Women represented 15.16% of first authors in FAI between 2012 and 2022 but 11.08% of invited speakers at AOFAS meetings. Meanwhile, the percentage of female AOFAS membership in the organization as a whole increased from 7.5% to 13%. Thus, despite historically low rates of representation, female Foot & Ankle surgeons were proportionally represented in 2021 and 2022 among invited national conference presentations and research compared to female society membership and female research publications in FAI. There is still room to increase representation of deserving historically under-represented groups, however the increase in female AOFAS presenters demonstrates a positive trend. Figure 1. Percentage of AOFAS Female Podium Speakers and FAI Female 1st Authors, 2012 - 2022
{"title":"Gender Representation Among Foot & Ankle Conference Presenters and Research Authors: A 10-Year Analysis (2012-2022)","authors":"Marguerite Anne Mullen, Emmanuel Budis, Arianna Gianakos, S. A. Esfahani, C. DiGiovanni, D. Guss","doi":"10.1177/2473011424s00069","DOIUrl":"https://doi.org/10.1177/2473011424s00069","url":null,"abstract":"Introduction/Purpose: Today women are over 50% of medical school matriculants but remain underrepresented in orthopaedic surgery (~15% of residents and < 6% of practicing surgeons). Moreover, despite different and sometimes controversial reports, the rate of female society memberships and national and international meeting speakers as well as their contribution to leadership positions including moderating sessions, podiums, and symposiums are believed to be low. The objective of this study was to assess whether there is a gap in female representation among invited speakers at American Orthopaedic Foot & Ankle Society (AOFAS) national meetings relative to research productivity as reflected by article authorship in Foot & Ankle International journal (FAI). Methods: Programs for AOFAS specialty days and annual meetings and FAI articles from January 2012 to December 2022 were obtained. Industry-hosted programs were excluded. Gender was identified through personal acquaintance or online search on the biographies of the authors. Presentations and articles were categorized as “technical” or “non-technical”, where technical was defined as relating to basic science or the clinical practice of orthopaedics. Comparisons were done using the Chi-Square Test (significance level= p< 0.05). Results: 1,020 AOFAS presentations and 2,230 FAI articles were analyzed. Gender was unavailable for 0.19% of AOFAS speakers, 4.48% of FAI first authors and 4.13% of FAI senior authors. 11.08% of AOFAS invited national meeting speakers, 15.18% of FAI first authors and 7.40% of FAI senior authors were female. Overall, the proportion of female speakers was significantly lower than female first authors (p= 0.0036), and significantly higher than female senior authors (p < 0.001). In 2018 and 2019, women were more likely to have given “non-technical” AOFAS presentations. There was no significant difference in other years or among FAI articles. The average annual change was +2.00% female AOFAS presenters, +0.31% FAI female first authors and -0.37% FAI female senior authors per year. Conclusion: Women represented 15.16% of first authors in FAI between 2012 and 2022 but 11.08% of invited speakers at AOFAS meetings. Meanwhile, the percentage of female AOFAS membership in the organization as a whole increased from 7.5% to 13%. Thus, despite historically low rates of representation, female Foot & Ankle surgeons were proportionally represented in 2021 and 2022 among invited national conference presentations and research compared to female society membership and female research publications in FAI. There is still room to increase representation of deserving historically under-represented groups, however the increase in female AOFAS presenters demonstrates a positive trend. Figure 1. Percentage of AOFAS Female Podium Speakers and FAI Female 1st Authors, 2012 - 2022","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"494 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140781893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424s00091
Jesse F. Doty, Jordan Dunson, Joseph Duff
Introduction/Purpose: As the fourth generation of total ankle arthroplasty (TAA) implants evolve, treatment solutions for end- stage ankle arthritis continue to improve. Technological advancements in CT guided planning and 3-D printing offers surgeons the ability to perform TAA with patient specific instrumentation and implants. 3-D printed components are designed to act as scaffold in hopes to facilitate early in-growth, to increase implant stability, to support long-term survivorship, and ultimately to improve the quality of life our patients. We present our early experience at a single academic center with a minimum of 2-year follow up data on the first 3-D printed, fixed bearing, TAA in the United States. We hypothesize that 3-D printed technology will demonstrate improved long-term survival and increased bony in-growth on the implant-bone interface. Methods: A retrospective review was performed on patients who underwent TAA with a minimum of 2-year clinical and radiographic data in which this 3-D printed TAA was utilized at our single academic center. Patient demographic, radiographic, and functional outcome scores were collected preoperatively, at 6 months, 1 year, and 2 years. The severity of ankle arthritis and associated deformities in patients were stratified using the COFAS classification. The primary outcomes of this study were implant survivorship, comparative analysis of preoperative and postoperative Patient Reported Outcomes Measurement Information System (PROMIS) physical function scores, VAS pain scores, radiographic development of linear radiolucency >2 mm, cystic radiolucency > 5mm, subsidence, and adverse events within 2 years of surgery. Results: Thirty patients were included with a median follow-up of 26 months (range, 24-36 months). Implant survival rate was 90%. One patient was revised to a stemmed TAA secondary to tibial subsidence. One patient required a TTC fusion secondary to Charcot collapse. One patient was revised to a staged ankle fusion secondary to periprosthetic joint infection. Two patients (6.7%) experienced linear radiolucency >2mm with tibial subsidence in which one patient required a revision TAA (mentioned above) and another who was asymptomatic. No significant cystic radiolucency >5 mm were identified. Five patients required re-operation from complications unrelated to the implant. VAS scores decreased significantly from 6 (IQR, 4-8) to 1 (IQR, 2-4) (P <.001; r=0.55). PROMIS Physical scores increased significantly from 43.6 (IQR, 33-47.7) to 50.8 (44.8-57.7)(P <.001; r=0.60). Conclusion: The utilization of this new 3-D printed, fixed bearing TAA demonstrated a ninety percent overall implant survival rate in our small cohort of patients. Further data will be required to determine the long term efficacy of this new 3-D printed implant on patient outcomes. Our early experience and complications presented in our study demonstrate that this 3-D printed TAA implant is safe and effective in the treatment of end
{"title":"Single-Center, Early Experience with the First 3D-Printed Surface, Fixed Bearing, Total Ankle Arthroplasty: A Minimum of 2-Year Follow-Up","authors":"Jesse F. Doty, Jordan Dunson, Joseph Duff","doi":"10.1177/2473011424s00091","DOIUrl":"https://doi.org/10.1177/2473011424s00091","url":null,"abstract":"Introduction/Purpose: As the fourth generation of total ankle arthroplasty (TAA) implants evolve, treatment solutions for end- stage ankle arthritis continue to improve. Technological advancements in CT guided planning and 3-D printing offers surgeons the ability to perform TAA with patient specific instrumentation and implants. 3-D printed components are designed to act as scaffold in hopes to facilitate early in-growth, to increase implant stability, to support long-term survivorship, and ultimately to improve the quality of life our patients. We present our early experience at a single academic center with a minimum of 2-year follow up data on the first 3-D printed, fixed bearing, TAA in the United States. We hypothesize that 3-D printed technology will demonstrate improved long-term survival and increased bony in-growth on the implant-bone interface. Methods: A retrospective review was performed on patients who underwent TAA with a minimum of 2-year clinical and radiographic data in which this 3-D printed TAA was utilized at our single academic center. Patient demographic, radiographic, and functional outcome scores were collected preoperatively, at 6 months, 1 year, and 2 years. The severity of ankle arthritis and associated deformities in patients were stratified using the COFAS classification. The primary outcomes of this study were implant survivorship, comparative analysis of preoperative and postoperative Patient Reported Outcomes Measurement Information System (PROMIS) physical function scores, VAS pain scores, radiographic development of linear radiolucency >2 mm, cystic radiolucency > 5mm, subsidence, and adverse events within 2 years of surgery. Results: Thirty patients were included with a median follow-up of 26 months (range, 24-36 months). Implant survival rate was 90%. One patient was revised to a stemmed TAA secondary to tibial subsidence. One patient required a TTC fusion secondary to Charcot collapse. One patient was revised to a staged ankle fusion secondary to periprosthetic joint infection. Two patients (6.7%) experienced linear radiolucency >2mm with tibial subsidence in which one patient required a revision TAA (mentioned above) and another who was asymptomatic. No significant cystic radiolucency >5 mm were identified. Five patients required re-operation from complications unrelated to the implant. VAS scores decreased significantly from 6 (IQR, 4-8) to 1 (IQR, 2-4) (P <.001; r=0.55). PROMIS Physical scores increased significantly from 43.6 (IQR, 33-47.7) to 50.8 (44.8-57.7)(P <.001; r=0.60). Conclusion: The utilization of this new 3-D printed, fixed bearing TAA demonstrated a ninety percent overall implant survival rate in our small cohort of patients. Further data will be required to determine the long term efficacy of this new 3-D printed implant on patient outcomes. Our early experience and complications presented in our study demonstrate that this 3-D printed TAA implant is safe and effective in the treatment of end","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"2 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140786442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424s00093
MD Andres Lopez, MD Edward T. Haupt, BSc BSc Giselle M. Porter, BS Yianni Bakaes, MD Glenn Shi, M. M. J. Benjamin Jackson, PhD Paisley Myers, MD Mba Tyler Gonzalez
Introduction/Purpose: Minimally invasive surgical (MIS) treatment of hallux valgus (HV) deformity is increasing in popularity. A 2mm-diameter burr is used to create a distal first metatarsal osteotomy prior to capital fragment translation and fixation. The metatarsal will shorten by the burr’s diameter (2mm). Plantar or dorsal capital fragment displacement may also cause load transference and possibly transfer metatarsalgia. In this study, we examine the effect of MIS HV on forefoot loading mechanics with respect to metatarsal shortening and sagittal plane displacement. Methods: Four lower-limb cadaveric specimens were studied. A pedobarography pressure-sensing mat was used to record forefoot plantar pressure in a controlled weightbearing stance position.10 Control and post-osteotomy measurements were obtained with the capital fragment fixated in 3 possible positions: 0mm, 5mm dorsal, and 5mm plantar displacement. Pedobarography data yielded pressure data within measurable graphical depictions. Raw mean contact pressure measurements were taken under the first and fifth metatarsal heads to establish medial and lateral forefoot loading pressure ratios. A priori power analysis was performed based on previous peer-reviewed pedobarographic data and our study was adequately powered. Results: 40 measurements were recorded and ratios of medial-to-lateral forefoot loading were constructed. Medial forefoot pressure change control versus 0mm displacement, and control versus dorsal displacement was not found to be statistically significant (p=0.525, p=0.55 respectively). Significant medial pressure increase was identified comparing control versus plantar displacement (p=0.006). Lateral pressure increased significantly with dorsal displacement of the osteotomy (p=0.013). Conclusion: MIS hallux valgus correction does not appear to cause increase in lateral forefoot pressure loading when sagittal plane displacements are controlled. Plantar displacement increases medial loading, and dorsal displacement increases lateral loading. The clinician must consider metatarsal head position post-osteotomy, as decrease in medial loading and subsequent increase in lateral loading may lead to lateral forefoot pain and transfer metatarsalgia.
{"title":"The Effect of First Metatarsal Shortening and Sagittal Displacement on Forefoot Pressure in MIS Hallux Valgus Correction","authors":"MD Andres Lopez, MD Edward T. Haupt, BSc BSc Giselle M. Porter, BS Yianni Bakaes, MD Glenn Shi, M. M. J. Benjamin Jackson, PhD Paisley Myers, MD Mba Tyler Gonzalez","doi":"10.1177/2473011424s00093","DOIUrl":"https://doi.org/10.1177/2473011424s00093","url":null,"abstract":"Introduction/Purpose: Minimally invasive surgical (MIS) treatment of hallux valgus (HV) deformity is increasing in popularity. A 2mm-diameter burr is used to create a distal first metatarsal osteotomy prior to capital fragment translation and fixation. The metatarsal will shorten by the burr’s diameter (2mm). Plantar or dorsal capital fragment displacement may also cause load transference and possibly transfer metatarsalgia. In this study, we examine the effect of MIS HV on forefoot loading mechanics with respect to metatarsal shortening and sagittal plane displacement. Methods: Four lower-limb cadaveric specimens were studied. A pedobarography pressure-sensing mat was used to record forefoot plantar pressure in a controlled weightbearing stance position.10 Control and post-osteotomy measurements were obtained with the capital fragment fixated in 3 possible positions: 0mm, 5mm dorsal, and 5mm plantar displacement. Pedobarography data yielded pressure data within measurable graphical depictions. Raw mean contact pressure measurements were taken under the first and fifth metatarsal heads to establish medial and lateral forefoot loading pressure ratios. A priori power analysis was performed based on previous peer-reviewed pedobarographic data and our study was adequately powered. Results: 40 measurements were recorded and ratios of medial-to-lateral forefoot loading were constructed. Medial forefoot pressure change control versus 0mm displacement, and control versus dorsal displacement was not found to be statistically significant (p=0.525, p=0.55 respectively). Significant medial pressure increase was identified comparing control versus plantar displacement (p=0.006). Lateral pressure increased significantly with dorsal displacement of the osteotomy (p=0.013). Conclusion: MIS hallux valgus correction does not appear to cause increase in lateral forefoot pressure loading when sagittal plane displacements are controlled. Plantar displacement increases medial loading, and dorsal displacement increases lateral loading. The clinician must consider metatarsal head position post-osteotomy, as decrease in medial loading and subsequent increase in lateral loading may lead to lateral forefoot pain and transfer metatarsalgia.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"381 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140758195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/24730114241247826
Riley Swenson, T. Paull, Gaonhia Moua, David Weatherby, Khalid Azzam, Robert Wojahn, Sarah Anderson, Peter A Cole, Mai P. Nguyen
Background: Ankle fractures are a common injury treated by orthopaedic surgeons. Unstable, displaced ankle fractures are often fixed with open reduction internal fixation (ORIF) using different implant constructs at various cost. No study to date has looked at transparency in ankle implant costs to surgeon behavior. Our surgeons self-identified that the biggest barrier for lowering implant cost was the lack of cost transparency. This was a surgeon-led-study to evaluate whether increased transparency in implant costs affected surgeon behavior. Methods: Monthly operative logs from December 2021 to September 2022 were reviewed at our level 1 trauma center for operative fixation of ankle fractures. The cost data of each fixation construct was reported to trauma-trained surgeons at the end of each month from March 2022 to June 2022. Average costs of implants were compared before and after education. A linear mixed model was used to explore what factors were associated with changes in costs. Surgeons also participated in a poststudy survey. Results: The implant costs of 110 ankle fracture fixations were reviewed over the period before education (n = 60), during education (n = 30), and after education (n = 20). The mean implant cost difference for unimalleolar fractures was −$204.80 (P = .68), whereas the mean cost difference for bimalleolar fractures was −$9.82 (P = .98). Trimalleolar fractures had a mean cost difference of +$94.47 (P = .84). Linear mixed model demonstrated fracture pattern as the only factor significantly associated with implant costs (P < .01). Post-education surgeon survey revealed that 6 of 7 surgeons felt that monthly updates affected their implant selection. However, only 2 surgeons demonstrated a change in practice with decreased implant costs during the study. Conclusion: The majority of surgeons self-reported being influenced by the implant cost education, but the detected change in implant cost was only observed in less than one-third of surgeons. Our results suggest implant selection and related costs are not influenced by increased cost transparency education alone. Level of Evidence: Level III, case control study.
{"title":"Does Transparency of Ankle Implant Costs Influence Surgeon Behavior?","authors":"Riley Swenson, T. Paull, Gaonhia Moua, David Weatherby, Khalid Azzam, Robert Wojahn, Sarah Anderson, Peter A Cole, Mai P. Nguyen","doi":"10.1177/24730114241247826","DOIUrl":"https://doi.org/10.1177/24730114241247826","url":null,"abstract":"Background: Ankle fractures are a common injury treated by orthopaedic surgeons. Unstable, displaced ankle fractures are often fixed with open reduction internal fixation (ORIF) using different implant constructs at various cost. No study to date has looked at transparency in ankle implant costs to surgeon behavior. Our surgeons self-identified that the biggest barrier for lowering implant cost was the lack of cost transparency. This was a surgeon-led-study to evaluate whether increased transparency in implant costs affected surgeon behavior. Methods: Monthly operative logs from December 2021 to September 2022 were reviewed at our level 1 trauma center for operative fixation of ankle fractures. The cost data of each fixation construct was reported to trauma-trained surgeons at the end of each month from March 2022 to June 2022. Average costs of implants were compared before and after education. A linear mixed model was used to explore what factors were associated with changes in costs. Surgeons also participated in a poststudy survey. Results: The implant costs of 110 ankle fracture fixations were reviewed over the period before education (n = 60), during education (n = 30), and after education (n = 20). The mean implant cost difference for unimalleolar fractures was −$204.80 (P = .68), whereas the mean cost difference for bimalleolar fractures was −$9.82 (P = .98). Trimalleolar fractures had a mean cost difference of +$94.47 (P = .84). Linear mixed model demonstrated fracture pattern as the only factor significantly associated with implant costs (P < .01). Post-education surgeon survey revealed that 6 of 7 surgeons felt that monthly updates affected their implant selection. However, only 2 surgeons demonstrated a change in practice with decreased implant costs during the study. Conclusion: The majority of surgeons self-reported being influenced by the implant cost education, but the detected change in implant cost was only observed in less than one-third of surgeons. Our results suggest implant selection and related costs are not influenced by increased cost transparency education alone. Level of Evidence: Level III, case control study.","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"152 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140794189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1177/2473011424s00080
Jensen K. Henry, Emily Teehan, Scott Ellis, Jonathan Deland, Constantine Demetracopoulos
Introduction/Purpose: With the last decade’s surge in total ankle replacement (TAR), there is an anticipated commensurate increase in the number of revisions that orthopaedic foot and ankle surgeons will encounter. The salvage and implant options to deal with a failed primary TAR are expanding. However, the literature on survivorship and outcomes after revision TAR in the modern era is relatively limited. What’s more, little is known about the risk factors for further revision or failure of revision TAR. This study aimed to describe the timing to and survivorship after revision TAR. We hypothesized that tibial-sided failures would occur earlier after the index surgery, and secondary revisions after failure of revision TAR would occur more due to talar-sided failures than tibial-sided failures. Methods: This is a single-institution retrospective cohort study of TAR patients (2012-2022) with minimum 2-year follow-up. Revision TARs (defined as exchange of tibial and/or talar components) with any implant (Cadence, Inbone, Invision, Infinity, Salto, STAR, Vantage, Zimmer; or custom total talus replacement [TTR]) were included. Five surgeons contributed patients. Demographics, primary and revision surgical data, and postoperative complications were recorded. Etiology of failure necessitating revision (tibial failure, talus failure, combined failure) and ultimate outcomes after revision (revision TAR survived, additional revisions, conversion to fusion, below-knee-amputation [BKA]) were recorded. Revisions for periprosthetic joint infection (PJI) and conversions to fusion were excluded. There were 59 ankles that underwent revision for any cause. Excluding 9 2-stage revisions for PJI and 3 conversions to ankle or tibiotalocalcaneal fusion, there were 47 ankles that underwent revision TAR that were included for analysis. Chi-square and ANOVA tests were used to compare risk factors and timing for failure. Results: There were 47 revision TARs, with mean age 60.6 (range: 31-77) years, mean BMI 29.5 kg/m2, 19 (40.4%) females, and mean 3.5 years follow-up. Revisions for tibial failure (n=22) occurred significantly earlier (1.3 ± 0.5 years) than those for talus failure (n=19, 2.3 ± 1.7 years) or combined tibial/talus failure (n=6, 2.9 ± 3.3 years) (P=0.048). Revisions for tibial-only failure had significantly better survivorship (95.5%) than revisions for talus or combined tibia/talus failures: 26% of talus failures and 33% of combined tibia/talus failures underwent at least one more revision (P=0.033). Of the 7 failures after revision talus, 2 ultimately underwent BKA, 2 were converted to TTR, 2 were revised to modular stemmed talus implants, and 1 was treated with explant and cement spacer for PJI. Conclusion: This study demonstrates that TAR tibial failures occur earlier than talus failures or combined tibial/talus failures. When patients with isolated tibial failure undergo revision of both tibial and talar components, they usually do well with good survivo
{"title":"Lessons from Revision Total Ankle Replacement: Tibias Fail Early, and Taluses Fail Late (And Fail Again)","authors":"Jensen K. Henry, Emily Teehan, Scott Ellis, Jonathan Deland, Constantine Demetracopoulos","doi":"10.1177/2473011424s00080","DOIUrl":"https://doi.org/10.1177/2473011424s00080","url":null,"abstract":"Introduction/Purpose: With the last decade’s surge in total ankle replacement (TAR), there is an anticipated commensurate increase in the number of revisions that orthopaedic foot and ankle surgeons will encounter. The salvage and implant options to deal with a failed primary TAR are expanding. However, the literature on survivorship and outcomes after revision TAR in the modern era is relatively limited. What’s more, little is known about the risk factors for further revision or failure of revision TAR. This study aimed to describe the timing to and survivorship after revision TAR. We hypothesized that tibial-sided failures would occur earlier after the index surgery, and secondary revisions after failure of revision TAR would occur more due to talar-sided failures than tibial-sided failures. Methods: This is a single-institution retrospective cohort study of TAR patients (2012-2022) with minimum 2-year follow-up. Revision TARs (defined as exchange of tibial and/or talar components) with any implant (Cadence, Inbone, Invision, Infinity, Salto, STAR, Vantage, Zimmer; or custom total talus replacement [TTR]) were included. Five surgeons contributed patients. Demographics, primary and revision surgical data, and postoperative complications were recorded. Etiology of failure necessitating revision (tibial failure, talus failure, combined failure) and ultimate outcomes after revision (revision TAR survived, additional revisions, conversion to fusion, below-knee-amputation [BKA]) were recorded. Revisions for periprosthetic joint infection (PJI) and conversions to fusion were excluded. There were 59 ankles that underwent revision for any cause. Excluding 9 2-stage revisions for PJI and 3 conversions to ankle or tibiotalocalcaneal fusion, there were 47 ankles that underwent revision TAR that were included for analysis. Chi-square and ANOVA tests were used to compare risk factors and timing for failure. Results: There were 47 revision TARs, with mean age 60.6 (range: 31-77) years, mean BMI 29.5 kg/m2, 19 (40.4%) females, and mean 3.5 years follow-up. Revisions for tibial failure (n=22) occurred significantly earlier (1.3 ± 0.5 years) than those for talus failure (n=19, 2.3 ± 1.7 years) or combined tibial/talus failure (n=6, 2.9 ± 3.3 years) (P=0.048). Revisions for tibial-only failure had significantly better survivorship (95.5%) than revisions for talus or combined tibia/talus failures: 26% of talus failures and 33% of combined tibia/talus failures underwent at least one more revision (P=0.033). Of the 7 failures after revision talus, 2 ultimately underwent BKA, 2 were converted to TTR, 2 were revised to modular stemmed talus implants, and 1 was treated with explant and cement spacer for PJI. Conclusion: This study demonstrates that TAR tibial failures occur earlier than talus failures or combined tibial/talus failures. When patients with isolated tibial failure undergo revision of both tibial and talar components, they usually do well with good survivo","PeriodicalId":12429,"journal":{"name":"Foot & Ankle Orthopaedics","volume":"113 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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