Session 4: Foot/ankle
Torsdag den 23. oktober
09:30 – 10:30
Lokale: Reykjavik
Chairmen: Jørgen Baas / Johnny Frøkjær
37. Postoperative oxygenation and metabolism of the soft tissue covering total ankle replacement
Frank Linde, Niels Christian Jensen, Kristian Kibak Nielsen, Hanne Birke-Sørensen
Department of Orthopaedics, University Hospital of Aarhus
Background: Up to one third of total ankle
replacements (TAR) are followed by
wound healing complications. Even
minor complications are potentially
catastrophic as they may lead to loss of
the prosthesis.
Purpose / Aim of Study: The aim was to obtain knowledge
regarding the oxygen pressure and the
metabolism in the soft tissue after TAR.
Materials and Methods: Fifteen TAR patients were included.
Transcutaneous oxygen tension (tcpO2)
was measured at both sides of the
incision site preoperatively, 3 hours
postoperatively and daily the following 6
days or until discharge from the hospital
and finally at 3 weeks follow-ups.
Microdialysis catheters were placed
subcutaneously at both sides of the
incision during the operation. Samples
for analysis of the local metabolism
were harvested each half hour for 3
hours after the operation and then every
2 hours during daytime
Findings / Results: TcpO2 was normal the first 3 hours
postoperatively. At the 2nd
postoperative day it has dropped to
median 20% of the preoperative values
and stayed low until the 4th day. Day 6 it
has increased to median 45%, and 3
weeks postoperatively it had reached a
normal level. No sign of anaerobic
metabolism was found, and none of the
15 patients developed skin complications.
Conclusions: The oxygen tension in the soft tissue
adjacent to the skin incision after TAR
may be critical low during the 2nd to 4th
day after operation. These data may
serve as guide for timing and duration of
interventions for optimization
postoperative care after TAR and other
major foot operations.
38. Completeness and data validity in the Danish Achilles Tendon Rupture Database
Michael Bilde Kuhlman, Anders Troelsen, Kristoffer Barfod
Orthopaedic surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital, Hvidovre, Denmark
Background: Orthopaedic surgeons treat acute
Achilles tendon rupture (ATR)
differently as there is currently no
consensus on the preferred treatment.
Data from the Danish Achilles Tendon
Rupture Database (DADB) can, for the
first time, offer quality monitoring of
treatment and may shed light on outcomes
of different treatments provided that
data are complete and valid.
Purpose / Aim of Study: The aim of this study was to test the
completeness and validity of data in DADB.
Materials and Methods: DADB was established in April 2012.
Currently, five Danish Orthopaedic
Departments enter data such as general
patient demographics and acute ATR
treatment and outcome specifics. The
study period was 1st of October 2012 to
30th of September 2013.
Two primary outcome parameters were
assessed: 1) Completeness of data was
assessed using data generated at one
institution. Data from DADB was compared
to medical records. The proportion of
patients with acute ATR registered in
DADB was assessed. Eighty percent
completeness was considered
satisfactory. 2) Validity of data
entered in to DADB was performed on the
same dataset. Data from DADB was
compared to medical records. Only
complete (100%) agreement between DADB
and medical records were considered valid.
Findings / Results: Eighty-five patients were registered in
DADB. Of these, 73 (86%) were males.
Median age was 40.3 years (25-75% IQR:
35.0-51.9). Overall, 87.1% of data from
DADB was consistent with medical
records. The validity (consistency with
medical records) of the individual
parameters assessed range from
50.6-92.9%. Data completeness in DADB
was 82.5%.
Conclusions: In conclusion, this study shows that
DADB offer satisfactory data
completeness and validity for future
purposes of quality monitoring and
research. Improved data validity can be
achieved through clarifying data
parameter definitions.
39. Survival of 308 total ankle replacement. A 1-14 years follow-up.
Niels Chr. Jensen
Orthopaedic, University Hospital Aarhus
Background: As total ankle replacement (TAR)
becomes a white spread solution to
degenerative ankle disease it is
important to know the results after TAR.
Purpose / Aim of Study: The aim of this study is to describe the
failure pattern and the survival rate of
the STAR TAR.
Materials and Methods: It is a single center prospective study of
308 STAR TAR. 231 with osteoarthrosis
(OA) and 77 had rheumatoid arthritis
(RA) were done in a period from 1998 to
the 1. of June 2012. Failure was defined
as failure of one or more prosthetic
component.
Findings / Results: Twenty-five with OA and 17 with RA
were failures. Fifteen OA and 4 RA
were late failures where only the
polyethylene component was broken or
worn. Seven OA and 3 RA patients had
a revision. Ten RA and 7 OA had an
arthrodesis.
One, 5 and 10 Year survival rate
survival rate for OA was 0.97, 0,90 and
0,77 respectively. One, 5 and 10 year
survival rate for RA was 0,90, 0,84 and
0,75.
Conclusions: There is a relatively high early failure
rate especially for the RA patients the
late failures are dominated by failure of
the polyethylene component. Despite the
relatively high failure rate 223(97%) of
231 OA TAR is still in place and 67(87%)
of 77 RA TAR is still in place.
40. Five year survival rate of STAR ankle replacement
Johnny Frøkjær, Lasse Petersen
Orthopedic department, foot & ankle section, Odense University Hospital; Orthopedic department, Odense University Hospital
Background: Total ankle replacement has become a
good alternative to arthrodesis in the
treatment of ankle arthrosis in selected
patients.
Results have been variable, therefore
we find it of interest to report our
results.
Purpose / Aim of Study: The aim of the study was to find our
five year survival rate, for the STAR
ankle replacement, at our institution.
Materials and Methods: We evaluated the intermediate
prosthesis survival rate of 200 STAR
ankle replacements, inserted in 196
patients between 2004 and 2013 at our
department. 109 were men and 87
women. Four patients were operated
bilaterally.
Surgical concept was to align the ankle
during first surgical procedure, if there
was any alignment. Patients were seen
annually until at least six years after
index surgery.
We retrospectively evaluated the
prosthesis survival, using our
database, where data were continously
registred at surgery and at follow up.
Furthermore patient records were
used, to exclude surgery at other
hospitals.
Revision was defined as "removal or
exchange of one or more components
with the exception of incidental
exchange of the polyethylene insert"
The surgical guide system was
changed during this period
Findings / Results: Ten patients had a revision performed,
four of these were among the first ten
patients operated - illustrating the
steep learning curve. Additional three
patients had the polyethylene liner
exchanged.
Using the above mentioned end point,
5 year survival rate for the STAR ankle
replacement is 94% (95% CI-interval
0,89-0,99)
Conclusions: We find the intermediate survival rate
of the STAR ankle replacement
excellent.
Learning curve problems could only be
detected for the first surgeon, while
problems for next two surgeons were
eliminated.
We will continue to follow our patients,
with regular controls, and will report
further survival rates.
41. No correlation between Bone cyst volume and clinical symptoms in patients with ankle replacement
Ellen Hamborg-Petersen, Trine Torfing, Janni Jensen, Johnny Frøkjær
Ortopædkirurgisk Afdeling, OUH; Radiologisk Afdeling, OUH
Background: Periprosthetic bone cysts are a known
side effect following a total ankle
replacement (TAR), possibly
threatening the long-term survival of
the implant.
Purpose / Aim of Study: The primary purpose of this
retrospective study was to investigate
the correlation between AOFAS score,
VAS score, function, age of implant
and periprosthetic cyst volume after
TAR.
Materials and Methods: 40 consecutive patients with a
Scandinavian Total Ankle
Replacement were seen for a yearly
control from 16.09.11-17.05.12. Forty-
one ankles were evaluated, mean age
was 61.6 years (40-79) and mean
follow up time was 36 months (3-72).
The replacements were radiologically
evaluated for cysts using Weight-
bearing Multi-Planar Reconstructed
Fluoroscopic imaging followed by
clinical tests measuring the patients
AOFAS score, VAS score and
function. Plots of the residual did not
fulfill the normal distribution. For this
reason all analyses were performed
using non-parametric tests (Spearman
rho).
Findings / Results: No statistical significant correlation
was found between the cyst volume
and any of the variables: AOFAS score
(rho=0.005, p=0.974, 95% CI:-0.307 to
0.316), VAS score (rho=0.137,
p=0.399, 95% CI:-0.182 to 0.430),
Function (rho=-0.062, p=0.706, 95%
CI:-0.371 to 0.258) and ankle
replacement age (rho=0.229, p= 0.149,
95% CI:-0.084 to 0.502).
Conclusions: No correlation between total cyst
volume and AOFAS score, VAS score
and function was found. No correlation
between age of TAR and total cyst
volume was found. The significance of
periprosthetic cysts in ankles is still not
clear. All patients will be followed with
regular controls in the future to
observe further cyst development and
aseptic loosening of the prosthesis.
42. Clinical outcome in 308 total ankle replacement. A 1-14 years follow-up.
Kristian Kibak Nielsen, Niels Christian Jensen, Claus Sundstrup, Frank Linde
Section of foot and Ankle Surgery., University Hospital of Aarhus. Aarhus. Denmark.
Background: As total ankle replacement (TAR)
becomes a generally accepted treatment
for degenerative ankle disease, it is
important to know the clinical outcome
after TAR.
Purpose / Aim of Study: The aim of this study is to describe the
clinical outcome in STAR TAR
Materials and Methods: This is a single centre prospective study
of 308 STAR TAR, performed from 1998
to 1. June 2012. Two hundred and thirty
one patients with osteoarthrosis (OA)
and 77 with rheumatoid arthritis (RA).
There was 197 TAR in OA patients and
56 TAR in RA patients who had the
primary TAR in place and a complete
standard scoring at follow up. The
AOFAS hind foot score and
retrospective VAS-score for pain was
used for evaluation
Findings / Results: In the RA group the preoperativ AOFAS
hind foot score changed from 31 to a
postoperative score of 73. In the OA
group the score changed from
preoperative 49, to a postoperative
score of 75.
All RA patients and 89% of the OA
patients had a significant improvement in
VAS pain score.
Conclusions: Both RA and OA patients improves after
TAR in both AOFAS hind foot score and
VAS pain score.
43. Functional rehabilitation of patients with acute Achilles tendon rupture: A meta-analysis of current evidence.
Kristoffer Weisskirchner Barfod, Troels Mark-Christensen, Thomas Kallemose, Anders Troelsen
Department of Orthopedic Surgery, Clinical Orthopedic Research Hvidovre, Copenhagen University Hospital Hvidovre; , Physiotherapist at Fysiocenter Århus
Background: The optimal treatment for acute Achilles
tendon rupture (ATR) is continuously
debated. Recent studies have proposed that
the choice of either operative or non-
operative treatment may not be as important
as the following rehabilitation, suggesting
that functional rehabilitation should be
preferred over traditional immobilization.
Purpose / Aim of Study: The purpose of this meta-analysis of
randomized, controlled trials (RCT’s) was to
compare functional rehabilitation to
immobilization in the rehabilitation of ATR.
Materials and Methods: This meta-analysis was conducted using the
databases: PubMed, Embase, Rehabilitation
& Sports Medicine Source, Amed, Cinahl,
Cochrane and PEDro using the search
terms: “Achilles tendon”, “rupture”,
“mobilization” and “immobilization”. Seven
RCT’s involving 427 participants were
eligible for inclusion, with a total of 211
participants treated functionally and 216
treated with immobilization.
Findings / Results: Re-rupture rate, other complications,
strength, range of motion, duration of sick
leave, return to sport and patient satisfaction
was examined. There were no statistically
significant differences between groups. A
trend favoring functional rehabilitation was
seen regarding the examined outcomes.
Conclusions: Functional rehabilitation after acute
Achilles tendon rupture does not
increase the rate of re-rupture or other
complications. There is a trend towards
earlier return to work and a significant
increased patient satisfaction using
functional rehabilitation. The present
literature is of low to average quality and
the basic constructs of the examined
treatment and study protocols vary
considerably. Larger, randomized
controlled trials using validated outcome
measures are needed to confirm the
findings.
44. Severely reduced functional outcome at mean 9 year follow-up after complications associated with acute Achilles tendon rupture
Kristoffer Weisskirchner Barfod, Thor Magnus Sveen, Ann Ganestam, Lars Bo Ebskov, Marko Nabergoj, Anders Troelsen
Orthopaedic surgery, Clinical Orthopaedic Research Hvidovre, Copenhagen University Hospital, Hvidovre, Denmark; Orthopaedic surgery, Copenhagen University Hospital, Køge
Background: Treatment of acute Achilles tendon rupture
is highly debated. In the pursuit of the best
treatment severity of complications is
important.
Purpose / Aim of Study: To investigate the long term effect of deep
infection, sural nerve injury and re-rupture in
the treatment of acute Achilles tendon
rupture.
Materials and Methods: 324 patients made a claim to the Danish
Patient Insurance in the period 1992 to 2010
due to a complication after acute Achilles
tendon rupture. Of those 150 agreed to
receive written information concerning the
investigation and 98 patients (m/f = 63/35)
returned the Achilles tendon Total Rupture
Score (ATRS) and the Short Form-36 (SF-
36) questionnaires. Patients suffering from
deep infection (n=8), Sural nerve injury
(n=5) and re-rupture (n=16) were invited to
participate in a follow up investigation.
Findings / Results: The mean follow up period was 8.9
years (3;21). Looking at the whole
population a mean ATRS of 50 (SD 30)
was found; in comparison healthy
subjects have a median of 100 (94;100).
The summary scores of SF-36 were PCS
= 42 (SD 12) and MCS = 52 (SD 11); in
comparison healthy subjects have a
mean of 50 for both scores. No
differences were found comparing the
subpopulations who suffered from a
deep infection, injury to the Sural nerve
or re-rupture. The physical evaluation
investigating tendon length and heel-rise
work revealed a statistically significant
difference between the affected and the
unaffected limb after re-rupture (p<0.01)
but not after injury to the Sural nerve
(n.s.) and deep infection (n.s.).
Conclusions: The investigated patients who suffered from
a complication after acute Achilles tendon
rupture had a remarkable reduction of the
ATRS and PCS at mean 9 year follow up.
Patients suffering from re-rupture had a
significant elongation of the tendon and
reduction of strength in the affected limb.