Lower risk of revision in fixed-bearing compared to mobile-bearing total ankle arthroplasties: A register based evaluation of 1246 patients in the Netherlands.

Background: Total ankle arthroplasty (TAA) has been developed as treatment for disabling tibiotalar osteoarthritis. TAAs are divided into mobile- and fixed-bearings. The aim was to determine the incidence and trends of fixed- and mobile bearings over time and investigate the association of bearing type and risk of revision after primary TAA in the Netherlands.

Mechanical Ankle Joint Axis Point on a Hip-to-Calcaneus Long Leg View Correlates Significantly With SPECT/CT Activation in Symptomatic Asymmetric Ankle Osteoarthritis.

Background: Asymmetric joint load is the main cause of development of ankle osteoarthritis (OA). Realignment surgery aims to transfer ankle joint load from the degenerative area toward the uninvolved area. Determination of the optimal shift is still challenging.

Is there a time when we should treat a fresh hip fracture in a physiologically elder patient with palliative care?

HISTORY - A 92-year-old female patient presents to the Emergency Room with a displaced intertrochanteric hip fracture after a fall from bed. She lives in a full care nursing home with severe dementia and wears an adult diaper. She does not walk anymore (for 3 months) and the family decision makers (they have power of attorney) have decided that she is not a surgical candidate except under extreme circumstance.

Factors Associated With Nonunion in Arthrodesis of the First Metatarsophalangeal Joint: A Multicenter Retrospective Cohort Study.

Background: Arthrodesis of the first metatarsophalangeal joint is the current treatment of choice for symptomatic advanced hallux rigidus and moderate-to-severe hallux valgus. There are different methods to perform arthrodesis, yet no consensus on the best approach. Therefore, this study aimed to determine the effects of preoperative and postoperative hallux valgus angle (HVA), joint preparation and fixation technique, and postoperative immobilization on the incidence of nonunion.

Is there an optimal degree of correction for ankle varus deformity after supramalleolar osteotomy? A systematic review.

Background: There is no consensus on the angle targeted for in varus ankle deformity after supramalleolar osteotomy (SMOT). The aim of this study was to investigate which obtained correction has the best clinical outcome after valgus SMOT.

Methods: A systematic review according PRISMA guidelines was conducted with studies being eligible for inclusion when published in English, German or Dutch, patients older than 18 years at study entrance, primary or posttraumatic varus ankle osteoarthritis, using any valgus SMOT technique, describing radiological alignment and clinical outcome at baseline and after at least 12 months follow-up.

Two-Step 3D-Guided Supramalleolar Osteotomy to Treat Varus Ankle osteoarthritis.

Background: Success of valgus-type supramalleolar osteotomy (SMOT) depends on adequate correction of malalignment, which can be hard to achieve with current 2-dimensional (2D) planning and operative techniques. A personalized digital 3-dimensional (3D) workflow to virtually plan and perform a 2-step 3D-guided medial opening (MO) SMOT has the potential to improve precision of correction.

Methods: Computed tomography (CT)-based Proplan medical 3D models were made to virtually plan the desired MO SMOT, and exported to 3-Matic medical to develop patient-specific 2-step cutting and wedge guides.

Effect of preoperative duloxetine treatment on postoperative chronic residual pain after total hip or knee arthroplasty: a randomised controlled trial.

Objectives: A key predictor for developing chronic residual pain after total knee or hip arthroplasty (TKA/THA) is sensitisation. Sensitisation can be defined as an 'increased responsiveness of nociceptive neurons in the nervous system'. Aim of this study is to investigate the effects of preoperative treatment with duloxetine in sensitised knee and hip osteoarthritis (OA) patients on postoperative chronic residual pain up to 1 year after arthroplasty.

The recovery after Achilles tendon rupture: a protocol for a multicenter prospective cohort study.

Background: Achilles tendon rupture (ATR) is a common sports injury, with a rising incidence and significant impairments. Due to the lack of treatment guidelines, there is no consensus about diagnostic methods, primary treatment (non-surgical or surgical) and rehabilitation. It is hypothesized that this lack of consensus and guidelines leads to sub-optimal recovery and higher societal costs.

Anaphylactic shock during cement implantation of a total hip arthroplasty in a patient with underlying mastocytosis: case report of a rare intraoperative complication.

Background: Cemented total hip arthroplasty (THA) is a safe and common procedure. In rare cases life threatening bone cement implantation syndrome (BCIS) may occur, which is commonly caused by pulmonary embolism (PE).

Case Presentation: We describe the rare case of a 70-year old patient who underwent an elective total hip replacement.

Technical aspects of revision and functional outcome after revision of the Oxford unicompartmental knee arthroplasty.

Background: This study analysed the technical aspects of revision of the Oxford unicompartmental knee arthroplasty (OUKA) and functional results after revision.

Methods: In a historic cohort study we analysed all revised OUKAs that were primarily implanted at our clinic over a 10-year period (1998-2009). The primary aim was to investigate surgical difficulties encountered during revision surgery of the OUKA.

[A patient with a painful swelling and a foot drop].

A 72-year old patient presented himself at the outpatient clinic with a painful swelling on the dorsum of the left foot and a foot drop. The diagnosis was a complete rupture of the tibialis anterior tendon.

Proximal Tibial Valgus Osteotomy: Lateral Closing Wedge.

Valgus-producing high tibial osteotomy (HTO) is a well-accepted treatment modality in active patients with varus malalignment and symptomatic medial unicompartmental osteoarthritis (OA) of the knee. One of the key factors for long-term success of the osteotomy is the achievement of an even distribution of the mechanical load on the knee joint by obtaining an ideal alignment of the lower-extremity mechanical axis. Proper surgical techniques are very important, and lateral closing wedge proximal tibial valgus osteotomy (CWO) is highly effective in achieving the desired overcorrection of 3° to 7° of valgus.

Braces and orthoses for treating osteoarthritis of the knee.

Background: Individuals with osteoarthritis (OA) of the knee can be treated with a knee brace or a foot/ankle orthosis. The main purpose of these aids is to reduce pain, improve physical function and, possibly, slow disease progression. This is the second update of the original review published in Issue 1, 2005, and first updated in 2007.

Osteotomy for treating knee osteoarthritis.

Background: Patients with unicompartmental osteoarthritis of the knee can be treated with an osteotomy. The goal of an osteotomy is to unload the diseased compartment of the knee. This is the second update of the original review published in The Cochrane Library, Issue 1, 2005.

Patellar resurfacing in posterior cruciate ligament retaining total knee arthroplasty (PATRES): design of a randomized controlled clinical trial.

Background: Anterior knee pain may occur after total knee arthroplasty (TKA). Patellar resurfacing, which is considered to lower the incidence of anterior knee pain after TKA, remains controversial. In the present study clinical and radiological outcomes after TKA performed on patients with clinical and radiological signs of femorotibial and patellofemoral osteoarthritis (OA) with and without patellar resurfacing will be compared.

Do laterally wedged insoles or valgus braces unload the medial compartment of the knee in patients with osteoarthritis?

Background: The results of conservative treatment of knee osteoarthritis (OA) are generally evaluated in epidemiological studies with clinical outcome measures as primary outcomes. Biomechanical evaluation of orthoses shows that there are potentially beneficial biomechanical changes to joint loading; however, evaluation in relation to clinical outcome measures in longitudinal studies is needed.

Questions/purposes: We asked (1) is there an immediate effect on gait in patients using a laterally wedged insole or valgus knee brace; (2) is there a late (6 weeks) effect; and (3) is there a difference between subgroups within each group with respect to patient compliance, body mass index, and OA status?

Methods: This was a secondary analysis of data from a previous randomized controlled trial of patients with early medial knee OA.

High tibial osteotomy: closed wedge versus combined wedge osteotomy.

Background: High tibial osteotomy is a common procedure to treat symptomatic osteoarthritis of the medial compartment of the knee with varus alignment. This is achieved by overcorrecting the varus alignment to 2-6° of valgus. Various high tibial osteotomy techniques are currently used to this end.

Atraumatic bilateral insufficiency fractures of the talar neck in a rheumatoid patient.

We report a 73-year-old female with rheumatoid arthritis, who presented with a 1-year history of ankle pain without trauma. Conventional radiographs showed no bony abnormalities, and bone scintigraphy showed increased uptake in the neck of the left and right talus. Magnetic resonance imaging scans showed insufficiency fractures of the talar neck bilaterally.

[Osteomyelitis of the talus in a limping child].

Background: Haematogenous osteomyelitis of the talus is a rare cause of limping in children. Due to the slow onset and atypical pattern of symptoms, it is difficult to diagnose. This can result in delays in the provision of adequate treatment.

Medial knee osteoarthritis treated by insoles or braces: a randomized trial.

Background: There is controversial evidence regarding whether foot orthoses or knee braces improve pain and function or correct malalignment in selected patients with osteoarthritis (OA) of the medial knee compartment. However, insoles are safe and less costly than knee bracing if they relieve pain or improve function.

Questions/purposes: We therefore asked whether laterally wedged insoles or valgus braces would reduce pain, enhance functional scores, and correct varus malalignment comparable to knee braces.

Total knee arthroplasty after high tibial osteotomy. A systematic review.

Background: Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee arthroplasty.

Methods: A computerized search for relevant studies published up to September 2007 was performed in Medline and Embase using a search strategy that is highly sensitive to find nonrandomized studies.

Varus inclination of the proximal tibia or the distal femur does not influence high tibial osteotomy outcome.

We have analysed retrospectively the influence of different sources of knee deformity on failure of closing wedge high tibial valgus osteotomy (HTO). Preoperative frontal plane varus deformities of the lower extremity, distal femur and proximal tibia, and medial convergence of the knee joint line were assessed on a standard whole leg radiograph in 76 patients. Using the logistic regression model, the probability of survival for HTO was 77% (SD 4%) at 10-years follow-up.