BACKGROUND:Despite reports of favorable short- and mid-term outcomes with direct plantar plate repair, there is scarce data in the literature with follow up greater than two years. PURPOSE:To examine long-term clinical and patient-reported outcomes with isolated 2nd metatarsophalangeal joint (MTPJ) dorsal approach plantar plate repair STUDY DESIGN: Prospective cohort of consecutive patients METHODS: Data were longitudinally collected from patients undergoing 2nd MTPJ dorsal approach plantar plate repair for metatarsalgia in our practice from November 2011 to March 2012. Outcomes included a structured clinical assessment, VAS for pain and Foot and Ankle Outcome Scores (FAOS) at two years and 9+ years post-operatively. RESULTS:Fifty-three consecutive patients (53 joints; 50 women, 3 men) with mean age of 58.2 ± 9.8 years completed a two-year follow up exam demonstrating normalized toe position, strength, range of motion and stability. Eighteen patients developed post-operative dorsal joint arthrofibrosis and 16 elected for a minor percutaneous soft tissue release on the toe prior to this follow up visit. FAOS scores were significantly improved in 3 of 5 domains at two years. Thirty-two (32/53, 60%) patients completed assessments at a median 9.6 years post-operatively. At this time, scores were significantly improved from both baseline and 2 years in all 5 FAOS domains. Seventy-eight percent (25/32) of patients reported they were satisfied or extremely satisfied and would have the procedure again. CONCLUSION:The 2nd MTPJ dorsal approach plantar plate repair appears to be safe and effective at alleviating pain and restoring function at long-term follow up. LEVEL OF CLINICAL EVIDENCE:Therapeutic level 4.
The purpose of this study was to identify if complicated open reduction internal fixation (ORIF) of calcaneal fractures (i.e. requiring bone graft) performed in the outpatient setting poses an excess risk for 30-day complications compared to inpatient procedures. We included patients who underwent ORIF of the calcaneus involving the use of bone graft utilizing CPT code 28420 from the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) between 2014 and 2019. Postoperative complications, demographic data, patient characteristics, and operative factors were compared between groups. T-tests were performed to assess univariate associations between outpatient status and surgical/patient demographics for continuous variables while chi-squared tests were performed to evaluate categorical variables. A total of 113 patients were included, experiencing a 2.6% short term complication rate (3/113). All 3 complications occurred in the outpatient setting. 51.3% of surgeries were performed on an inpatient basis. In the univariate analysis, there were no statistically significant differences between inpatient and outpatient 30-day postoperative complication rates. Although more complications were recognized in the outpatient population, this did not reach statistical significance and suggests that complicated calcaneal ORIF procedures involving bone graft may be performed in the outpatient setting without posing an excess risk.
A cost-effectiveness analysis (CEA) is a type of health economics model that uses a systematic approach to simplify the complexities that exist in health-care decision-making. A CEA aids in medical decision-making by considering both the costs of a treatment and how effective that treatment is for at least 2 competing strategies. This article reviews major concepts of CEA including results interpretation, key attributes of CEA that make it differ from cost analysis , uncertainty surrounding analysis, and how/why CEA is an important contributor to the medical literature.
BACKGROUND:Although considerable literature can be found on the outcome of total ankle replacement (TAR), only a few studies have reported the results of the fixed-bearing Cadence prosthesis. This noninventor study reports a consecutive series of 60 Cadence TAR systems with a mean of 2.9 years' follow-up, focusing on clinical and radiographic outcomes and early complications. This study is the first to assess true postoperative radiographic ankle prosthesis range of motion (ROM) and to report an unanticipated serious adverse device effect.METHODS:Sixty patients who underwent primary TAR with the Cadence prosthesis between July 2016 and July 2019 were clinically and radiographically evaluated preoperatively and at last follow-up after the procedure. Revisions, additional procedures, implant failure, and complications were reported according to the classifications of Vander Griend and Glazebrook. Radiographic outcomes included radiographic TAR ROM, bone-implant interface, and alignment parameters.RESULTS:The survival rate of the prosthesis was 98.3%. The mean radiographic ankle ROM at the last follow-up was 24 degrees (9 degrees of dorsiflexion and 15 degrees of plantarflexion). The coronal and sagittal alignment of TAR was 90.8 degrees and 3.9 degrees, respectively. Bone-implant interface analysis revealed osteolysis in 9 ankles (15%) and radiolucent lines in 33 ankles (55%) occurring at both component interfaces. Intraoperative complications were 3 periprosthetic malleolar fractures (5%). Five talar implant fractures (implant failure of 8.3%) were observed, and 1 unexplained persistent pain that required a conversion from TAR to a tibiotalocalcaneal arthrodesis.CONCLUSION:Clinical, radiograph ROM, implant position outcomes, and survival rate at an early-term follow-up of 2.9 years were similar to those reported in recent Cadence studies. However, this study reports 5 unanticipated talar implant fractures and a high rate of posterior radiolucent lines.LEVEL OF EVIDENCE:Level IV, retrospective case series.
There are over 350,000 bunion surgeries performed in the USA annually, making it one of the most common elective forefoot surgeries. Studies have suggested that as many as 10% of patients remain dissatisfied after bunion surgery. The purpose of this study is to evaluate if radiographic variables are associated with patient satisfaction at 1 year postoperatively. We performed a secondary analysis of prospectively collected data on 69 consecutive adult patients (mean age 45 ± 14 years, 91% female [63/69]) who underwent isolated hallux valgus surgery from January 2016 to January 2017. Subjects completed a standardized 4-item survey inquiring about their satisfaction with regards to pain relief, overall operative result, cosmetic appearance, and ability to wear desired shoe gear. Conventional radiographic indices for hallux valgus were examined preoperatively and 3 months postoperatively. An association model using backward stepwise logistic regression was utilized to determine which variables, if any, are most important in explaining patient satisfaction after surgery. Sixty-nine subjects completed the 4-item satisfaction survey with 53.6% (37/69) of subjects answering they were fully satisfied on all aspects of the survey at 12 months postoperatively. In the final regression model, no radiographic or demographic variables were associated with patient satisfaction including shoe gear, cosmetic appearance, pain relief, and overall operative result. Radiographic variables did not appear to be associated with patient satisfaction at one year postoperatively in our study. Factors such as quality of life, anxiety levels, fear of surgery, and/or preoperative expectations may offer more insight into satisfaction; however, further research should be performed to examine this further.
