Outcome After Single Technique Ankle Arthrodesis in Patients With Rheumatoid Arthritis Anterior ankle arthrodesis with cross-screw fixation. A dowel graft method used in 20 cases. Arthrodesis after failed knee arthroplasty. A nationwide multicenter investigation of 91 cases. Role of Surgical Dressings in Total Joint Arthroplasty: A Randomized Controlled Trial. [Ankle arthrodesis: critical analysis of three techniques]. Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. Minimally invasive compared with traditional transgluteal approach for total hip arthroplasty: a comparative gait analysis. Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty. Long-Term Clinical Outcomes of Cervical Disc Arthroplasty: A Prospective, Randomized, Controlled Trial. Arthroscopic mosaicplasty: long-term outcome and joint degeneration progression. Impacts of foot orthoses on pain and disability in rheumatoid arthritics. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline Comparison of the early results of minimally invasive vs standard approaches to total knee arthroplasty: a prospective, randomized study. Comparison of Autoreinfusion and Standard Drainage Systems in Total Joint Arthroplasty Patients Feasibility of a dyadic intervention for management of osteoarthritis: A pilot study with older patients and their spousal caregivers Multiple arthroscopic debridement and graft retention in septic knee arthritis after ACL reconstruction: a prospective case–control study
The established treatment for severe rheumatoid arthritis in the ankle is arthrodesis . Numerous reports in the literature describe outcomes in patients with degenerative and posttraumatic arthrosis and rheumatoid disease . This has led to results that are difficult to interpret . In addition , in the few studies that have evaluated patients with rheumatoid disease many techniques of arthrodesis are reported , further confounding assessment of one fusion method . One technique of 20 ankle fusions in patients with rheumatoid disease was evaluated . A modified Wagner arthrodesis was used through a transfibular approach using parallel compression screws . The scoring systems of Mazur et al , Moran et al , and the Short-Form-36 were used to evaluate the outcome . The mean time to followup was 3 years 10 months . Eighteen of 20 fusions obtained a solid talocrural union ( 90 % ) . No correlation was found between the scores of Mazur et al and Moran et al. Correlation was achieved between the scores for the Short Form-36 and Moran et al. The modified Wagner ankle arthrodesis is a simple , reliable , reproducible technique with a 90 % union rate . The value of the technique has been confirmed in patients with rheumatoid arthritis by evaluating the outcome using a scoring system that is vali date d and relevant to this population We report a new method of ankle arthrodesis which combines an anterior approach with a dowel technique of bone grafting and screw fixation . In 20 ankles of 20 patients , ten with osteoarthritis , eight with rheumatoid arthritis and two others , we achieved 19 solid bony fusions  and one painless fibrous ankylosis . The average time to union was 12.5 weeks . Patient satisfaction was high and the functional results were as good as for other reported methods , with fewer complications Ninety-one patients with attempted arthrodesis after failed knee arthroplasty were identified in a prospect i ve nationwide study of knee arthroplasties performed from October 1975 through January 1982 in Sweden . The study included 43 hinged or stabilized , 34 bi- or tricompartment , and 14 unicompartment endoprostheses .  Three-fourths of the failures were caused by infections . At follow-up evaluation , two patients had expired from infection and four patients had amputations . Fusion was achieved in only 50 % of 108 attempts in 91 knees . Patients with unstable joints had limited function . The fusion rate was relatively high after unicompartment endoprostheses , in cases with sustained rigid fixation , or in cases where infection was brought under control at arthrodesis . Rigid fixation was best achieved with an external double frame or an intramedullary nail . Repeated attempts were worthwhile . Removal of all foreign material , eradication of the infectious lesion , and an arthrodesis performed in a one- or two-stage procedure with insertion of gentamicin beads seemed to be the best way to combat infection . The treatment of prosthetic failures should be referred to centers with special interest in knee arthroplasty We conducted a r and omized controlled trial to compare efficacy of an occlusive antimicrobial barrier dressing and a st and ard surgical dressing in patients who underwent primary total joint arthroplasty . Two hundred sixty-two patients were r and omized to receive either an occlusive dressing or a st and ard dressing . Wounds were closed in identical fashion . Outcomes included wound complications , dressing changes , and patient satisfaction . With use of occlusive dressing ( vs st and ard dressing ) , wound complications ( including skin blistering ) were significantly ( P = 0.15 ) reduced ; there were significantly ( P < .0001 ) fewer dressing changes ; and patient satisfaction was significantly ( P < .0001 ) higher . Use of occlusive dressings can reduce wound complications and promote wound healing after total joint arthroplasty The authors analyze the r and omized use of  three ankle arthrodesis techniques .  Indications for this procedure , which are pain , instability , deformity and articular degeneration , are common to the three groups . In group I the Gatellier-Adams technique was used by transfibular approach . In group II the Kenneth-Johnson technique was adopted , using Cal and ruccio external fixator . The same surgical procedure was adopted in group III , using crossed canulated screws as fixation device . The specific advantages and disadvantages of each method are discussed . The criteria for evaluation of the results are the final roentgenographic position of the foot and the achievement of union . The critical analysis conclude that the major indications for group I technique are cases of " in situ " arthrodesis , for group II infected cases and for group III cases with severe malalignment BACKGROUND Interest in mobile-bearing total ankle arthroplasty  has increased in recent years . However , to our knowledge , no study has focused exclusively on patients with the diagnosis of inflammatory joint disease or has provided a detailed analysis of the risk factors for failure . METHODS A prospect i ve observational study of the results of cementless mobile-bearing total ankle arthroplasty  in patients with inflammatory joint disease ( mainly rheumatoid arthritis ) was conducted at two centers . Ninety-three total ankle arthroplasties were performed . The LCS ( low contact stress ) prosthesis was used initially , in nineteen ankles , between 1988 and 1992 , and a modification of the LCS prosthesis , the Buechel-Pappas design , was used in seventy-four ankles between 1993 and 1999 . Clinical and radiographic follow-up was performed at yearly intervals . Three clinical scoring systems were used , and any complication was recorded throughout follow-up . Actuarial survival ( with revision as the end point ) , multivariate analysis , and a competing risk approach were used to describe the long-term outcome . RESULTS The clinical result at one year after surgery showed a significant improvement in the scores on all three scoring systems ( p < 0.05 ) . Ankle dorsiflexion ( mean , 7 degrees ) also improved significantly ( p < 0.05 ) compared with the preoperative state . The most frequent complication was a malleolar fracture , which occurred in twenty ankles . Only when it occurred in combination with a deformity in the frontal plane did this complication have an adverse effect on the end result . At a mean follow-up of eight years , seventeen patients ( twenty-one ankles ) had died and fifteen ankles had been revised because of aseptic loosening ( six ankles ) , primary or secondary axial deformity with edge-loading ( six ankles ) , deep infection ( two ankles ) , and a severe wound-healing problem ( one ankle ) , leaving fifty-seven ankles ( 61 % ) that were evaluated . The mean overall survival rate at eight years was 84 % . An increased failure rate was encountered in ankles with a preoperative deformity in the frontal plane of > 10 degrees ( p = 0.03 ) and in ankles in which an undersized tibial component had been implanted ( p = 0.02 ) . CONCLUSIONS Mobile-bearing total ankle arthroplasty is a valid treatment option for the rheumatoid ankle if proper indications are used . Aseptic loosening and persistent deformity are the most important modes of failure BACKGROUND Minimally invasive total hip arthroplasty is purported to allow an improved and faster rehabilitation in the immediate postoperative period because of reduced soft-tissue damage compared with total hip arthroplasty performed with use of a st and ard approach . In the present study , a minimally invasive approach was compared with a traditional st and ard approach in terms of the effect on gait kinematics as demonstrated with gait analysis and electromyography . METHODS Twenty r and omized patients who underwent a primary total hip replacement with use of a minimally invasive modified Watson-Jones approach ( minimally invasive group ) were compared with a group of twenty patients who underwent a total hip arthroplasty with use of a st and ard transgluteal Hardinge approach ( st and ard group ) . All patients received the same cementless implant , inserted with use of st and ard instruments , and all operations were performed by a single , experienced surgeon . The patients were evaluated with use of three-dimensional gait analysis and dynamic electromyograms at three time points : preoperatively , ten days postoperatively , and twelve weeks postoperatively . Temporospatial and joint-kinematic parameters were evaluated . RESULTS There were no significant differences between the two groups with regard to the temporospatial variables of velocity , cadence , step length , and stride length at any tested time point . With regard to the range of motion of the operatively treated hip , the minimally invasive group had a smaller decrease at the ten-day time point in comparison with the st and ard group . However , this finding was not significant . The reduction in the range of motion was mainly caused by reduced hip extension . A compensatory increase in the pelvic tilt was observed in both groups . One patient in the st and ard group showed a positive Trendelenburg gait ten days postoperatively ; it had disappeared completely at the twelve-week time point . CONCLUSIONS With regard to gait kinematics in the early postoperative period ( three months ) , the present study showed no significant benefit for patients who underwent a total hip arthroplasty through a minimally invasive Watson-Jones approach in comparison with those who were managed with a st and ard transgluteal approach Patients with st and ard total hip arthroplasties  may have reduced hip abduction and extension moments when compared with normal nonosteoarthritic hips . In comparison , patients after resurfacing total hip arthroplasty  appear to have a near-normal gait . The authors evaluated temporal-spatial parameters , hip kinematics , and kinetics in  hip resurfacing patients compared with patients with unilateral osteoarthritic hips and unilateral st and ard total hip arthroplasties . Patients with resurfacing walked faster ( average 1.26 m/s ) and were comparable with normals . There were no significant differences in hip abductor and extensor moments of patients with resurfacing compared with patients in the st and ard hip arthroplasty group . This study showed more normal hip kinematics and functionality in resurfacing hip arthroplasty , which may be due to the large femoral head STUDY DESIGN Prospect i ve , R and omized , Single-Center , Clinical Trial . OBJECTIVE To prospect ively examine the 7 and 10-year outcomes of  cervical arthroplasty to anterior cervical discectomy and fusion ( ACDF ) . SUMMARY OF BACKGROUND DATA Degeneration of the cervical discs causing radiculopathy is a frequent source of surgical intervention , commonly treated with ACDF . Positive clinical outcomes are associated with arthrodesis techniques , yet there remains a long-term concern for adjacent segment change . Cervical disc arthroplasty has been design ed to mitigate some of the challenges associated with arthrodesis while providing for a similar positive neurological outcome . As data has been collected from numerous prospect i ve U.S. FDA IDE trials , longer term outcomes regarding adjacent segment change may be examined . METHODS As part of an FDA IDE trial , a single center collected prospect i ve outcomes data on 47 patients r and omized in a 1:1 ratio to ACDF or arthroplasty .  RESULTS Success of both surgical interventions remained high at the 10-year interval . Both arthrodesis and arthroplasty demonstrated statistically significant improvements in NDI , VAS neck and arm pain scores at all intervals including 7 and 10-year periods . Arthroplasty demonstrated an advantage in comparison to arthrodesis as measured by final 10-year NDI score ( 8 vs 16 , p = 0.0485 ) . Patients requiring re-operation were higher in number in the arthrodesis cohort ( 32 % ) in comparison to arthroplasty ( 9 % ) ( p = 0.055 ) . CONCLUSIONS At 7 and 10 years , cervical arthroplasty compares favorably to ACDF as defined by st and ard outcomes scores in a highly selected population with radiculopathy . LEVEL OF EVIDENCE 1 BACKGROUND This study aims to document the long-term results in a group of patients treated with arthroscopic mosaicplasty for knee cartilage lesions , both in terms of clinical outcome and joint degeneration progression , evaluated by radiographs . METHODS 26 patients ( 19 men and 7 women , mean age 29 years , mean BMI 23 ) treated arthroscopically with mosaicplasty for cartilage defects of the femoral condyles ( mean/median/mode size 1.9 st and ard deviation , SD 0.6 cm(2 ) ) were prospect ively evaluated at 12 years follow-up . The clinical outcome was analyzed with IKDC and Tegner scores . Range of motion , transpatellar and suprapatellar circumferences were also measured . Radiographs with weight-bearing antero-posterior and Rosenberg projections were used for radiological evaluation in 18 patients , applying both Kellgren-Lawrence score and a direct joint line measurement to assess osteoarthritis . RESULTS A significant improvement in all clinical scores was obtained from the basal evaluation to the 12-year follow-up ( IKDC subjective score from 36.8 st and ard deviation , SD 13.0 to 77.3 st and ard deviation , SD 20.6 , P<0.0005 ; Tegner score from 2.9 st and ard deviation , SD 1.3 to 5.2 st and ard deviation , SD 2.5 , P<0.0005 ) , and better results in patients with a higher pre-injury activity level and those requiring fewer plugs . The radiographic evaluation showed significantly poorer Kellgren-Lawrence scores and a reduction of the joint line in the treated compartments . Knees with 3 - 4 plugs presented a significantly higher joint degeneration level with respect to those implanted with 1 - 2 plugs . CONCLUSIONS Mosaicplasty is an effective surgical option for small lesions of the femoral condyles . Although joint degeneration progression was present at 12 years , this did not affect significantly the clinical outcome which was satisfactory at long-term follow-up Rheumatoid arthritis ( RA ) frequently causes  foot pain and swelling that affect ambulation . Pharmaceutical management of pain and disability is st and ard in clinical practice . The use of functional posted foot orthoses , as an adjunct to pharmaceutical treatment , is a promising treatment for managing  foot pain and disability in RA . Its effectiveness , however , has not been rigorously evaluated . We performed a double-blind clinical trial using foot orthoses vs. placebo orthoses in the management of the rheumatoid arthritic foot , while subjects continued customary treatment . On the basis of findings of no effect on disability and pain measures , this study indicates no benefit of functional posted foot orthoses over placebos # # # # What you need to know What is the role of arthroscopic surgery in degenerative knee disease ? An expert panel produced these recommendations based on a linked systematic review triggered by a r and omised trial published in The BMJ in June 2016 , which found that , among patients with a degenerative medial meniscus tear , knee arthroscopy was no better than exercise therapy . The panel make a strong recommendation against arthroscopy for degenerative knee disease . Box 1 shows all of the articles and evidence linked in this Rapid Recommendation package . The infographic provides an overview of the absolute benefits and harms of arthroscopy in st and ard GRADE format . Table 2 below shows any evidence that has emerged since the publication of this article . # # # # Box 1 : Linked articles in this BMJ Rapid Recommendations # # # What you need to know What is the role of arthroscopic surgery in degenerative knee disease ? An expert panel produced these recommendations based on a linked systematic review triggered by a r and omised trial published in The BMJ in June 2016 , which found that , among patients with a degenerative medial meniscus tear , knee arthroscopy was no better than exercise therapy . The panel make a strong recommendation against arthroscopy for degenerative knee disease . Box 1 shows all of the articles and evidence linked in this Rapid Recommendation package . The infographic provides an overview of the absolute benefits and harms of arthroscopy in st and ard GRADE format . Table 1 below shows any evidence that has emerged since the publication of this article . Box 1 # # # Linked articles in this BMJ Rapid Recommendations A prospect i ve , r and omized study was performed to compare early clinical and radiographic outcomes of total knee arthroplasty using either st and ard or minimally invasive surgical approaches . Fifty-nine patients were r and omized into 3 groups : a st and ard median parapatellar incision ( n = 19 ) , a " mini mid-vastus " ( n = 20 ) , or a " quad sparing " group ( n = 20 ) . The procedures were performed by a single surgeon using similar perioperative protocol s at 1 hospital . Postoperatively , the quad sparing group demonstrated some statistically significant ( P < .05 ) improvement in week 2 and greater but not in weeks 1 and 6 compared to the other groups . No significant differences occurred regarding postoperative complications or radiographic alignment of the implants . In conclusion , our study demonstrated that the quad sparing group had some improved early results without compromising safety or efficacy The purpose of this study was to compare the costs and outcomes of the postoperative autoreinfusion device , the Constavac ™ , with the st and ard suction device , the Hemovac ™ , in which blood drainage is discarded , in patients undergoing total joint arthroplasty of the knee or hip . At the completion of the surgical procedure , a total of 91 subjects were r and omly assigned to one of the two device groups . The findings of this study , which included a limited homogeneous sample , do not support the use of the Constavac ™ device in patients undergoing total joint arthroplasty This study evaluated a novel intervention for older osteoarthritis ( OA ) patients and their spousal caregivers that consisted of st and ard patient education supplemented by information related to effectively managing arthritis as a couple . Twenty-four female OA patients and their husb and s were r and omly assigned to either an educational intervention that was targeted at both patient and spouse or to a patient education intervention that was targeted at only the patient . Findings revealed that both interventions were evaluated favorably but the couple intervention was better attended than the patient intervention . In addition , patients in the couple intervention experienced greater increased efficacy in managing arthritis pain and other symptoms . The findings of this pilot study point to the utility of a dyadic intervention approach to management of OA in late life Purpose This study was undertaken to prospect ively analyse , at a mean five-year follow-up , the clinical , functional , and radiographic outcomes in patients who developed postoperative acute septic knee arthritis following anterior cruciate ligament ( ACL ) reconstruction using hamstring autograft .  We also assessed the effect of multiple arthroscopic debridement and graft retention on the functional outcomes in comparison with the matched control group . Methods From a consecutive case series of 2,560 ACL-injured patients who were treated with arthroscopic ACL reconstruction , we report on 24 cases with postoperative septic knee arthritis . These patients were individually matched for age , sex , comorbidity , body mass index ( BMI ) and preinjury Tegner activity scale in a ratio of 1/1 . Clinical , laboratory , synovial fluid analysis and culture were performed . Arthroscopic debridement and graft retention was done for all cases , in addition to antibiotic therapy IV . A detailed physical examination , KT1000 laxity testing , Lysholm knee score , Tegner activity level scale , International Knee Documentation Committee ( IKDC ) , and Knee Injury and Osteoarthritis Outcome Score ( KOOS ) were completed . Results In all cases , treatment of infection was successful after a median of three ( range one to six ) repeated arthroscopic graft debridement and retention , in addition to antibiotic therapy IV . At an average of five years follow-up , two patients had over five millimetres manual maximum side-to-side difference in laxity . There were no significant differences between groups regarding Lysholm score , IKDC and KOOS . Median final Tegner activity score was 5.5 versus 7 in the control group ( p = 0.004 ) . Complications included graft rupture in three patients , loss of range of motion in five , Sudeck ’s atrophy in one and moderate joint narrowing in two . There were no recurrences of septic arthritis or bone infection . Conclusion Graft retention seems not only possible but appropriate in view of the experience presented in this article for postoperative septic knee arthritis using hamstring autograft . A potential residual complication is arthrofibrosis , which deserves maximum attention
Regardless of the method ological limitations it can be concluded that both interventions show clinical improvement and in line with current literature neither procedure is superior to the other
Background While arthrodesis is the st and ard treatment of a severely arthritic ankle joint , total ankle arthroplasty has become a popular alternative .
This review provides clinical outcomes and complications of both interventions in patients with rheumatoid arthritis .