Search

Category: Diabetes; Other Introduction/Purpose: The diabetic foot is a major public health issue within the UK and Charcot foot deformity is a possible and challenging consequence to manage. Without treatment patients often suffer from joint instability and recurrent ulceration with possible associated infections. Surgical management of Charcot joint deformity has become a recent but important treatment. In our centre, a hybrid type fixation technique is utilised: internal fixation (plates and beaming techniques) and external fixation (circular frame). The aim is fusion beyond the zone of injury, satisfactory correction of the Charcot deformity and protection of soft tissue envelopes and maintenance of function. The aim of this study was to assess the clinical, radiological and patient reported outcomes for all patients who underwent this hybrid technique of Charcot joint reconstruction. Methods: This is a prospective observational case series of all patients who underwent surgical reconstruction of Charcot foot deformity performed under 2 consultant foot and ankle surgeons in a single centre. The duration of the study included patients operated on between 2017 to 2023 and no patients were excluded. Patient demographics, smoking status, diabetic control and BMI were recorded. Outcomes were determined from case notes and included clinical outcomes (complications, return to theatre, amputation and mortality) radiological outcomes and patient reported outcomes (MOX-FQ scores, EQ-5D and FAOS outcome scores). The follow up period was 1-7 years post operatively. Results: 44 Charcot joint reconstructions were included with operations occurring between 2017 and 2023. The mean age at the time of operation was 59.1 years (range 29 - 91 years). 25 patients were male (56.8%) and 19 were female (43.2%). There were 4 procedures with internal fixation alone (9.1%), 9 procedures with external fixation alone (20.5%) and 31 with a combination of internal and external fixation (70.5%). At the time of most recent follow up, 7 patients were deceased (16.7%) and 2 patients had major amputation on the ipsilateral side. We aim to present the rate of post-operative complications, return to theatre, radiographic outcomes and patient reported outcomes as well as the patients status at time of operation including their glucose control, smoking status and BMI. Conclusion: A hybrid type fixation with combined internal and external fixation is a viable option for patients undergoing Charcot joint reconstruction but the re-operation rate is not negligible and, although the majority of patients had no related issues, complications can occur due to the complex nature of the patient population undergoing these procedures. Patients PROMs scores improved between pre-operative scores and post-operative scores significantly. To best confirm our findings and determine which patients have the best post operative prognosis from these procedures a larger multi-centre study is required.

Category: Ankle Arthritis; Hindfoot Introduction/Purpose: Total Ankle Replacement (TAR) have a potential advantage of protecting further degradation of hindfoot joints by maintaining ankle joint motion. However, there is no study to our knowledge that directly compares hindfoot outcomes between TAR and Ankle Arthrodesis (AA) in the long term. Sokolowski et al. found that 68% of TAR patients had no radiological progression of subtalar arthritis after TAR, and 4% went on to fusion. Other studies have looked at 5 year outcomes finding higher hindfoot fusion rates post AA. However, no evaluation of the other hindfoot joints was made and no comparison made to other treatment. This study aimed to analyze the long-term rates of symptomatic hindfoot arthritis resulting in further procedures following TAR versus AA. Methods: We performed a retrospective review of all patients at our centre who had a TAR or AA since 2002. Case notes and imaging were reviewed and all instances of hindfoot treatment (injections or surgical procedures) noted. Patient were excluded who had no documentation, were followed up at other hospitals, had prior hindfoot fusion, or were having staged surgeries at the time of index treatment. Chi squared analysis was used to compare the cohorts. Results: Analysis revealed 428 eligible cases (275 TAR, 153 AA). TAR patients were older (mean age: 62 vs. 52 years, p=0.00001). Average follow up was 12.6 (1 – 21) years for TAR and 12.1 (1-21) years for AA. TAR showed lower rates of overall further hindfoot procedures compared to AA (14% vs. 24%, p=0.01), with significantly fewer hindfoot fusions (4% vs. 14%, p=0.0002). Revision rates were similar between groups (6% TAR vs. 4% AA, p=0.99). Conclusion: This study highlights higher rates of symptomatic hindfoot arthritis requiring intervention in AA compared to TAR. TAR appears to offer advantages in hindfoot preservation, with similar revision rates. Prospective studies integrating patient-reported outcomes are warranted to assess TAR versus AA efficacy on hindfoot function and overall well-being. Our findings advocate for TAR as the primary treatment for end-stage ankle arthritis, if appropriate, when considering symptomatic progression in management decisions.

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total Ankle Replacement (TAR) is an established treatment option for end-stage ankle arthritis. We analysed at minimum, 10-year patient-reported and clinical outcomes of 156 TARs from a single centre. We specifically compared outcomes between patients under 60 and over 60 at time of surgery. Methods: Data was collected retrospectively from our departmental patient database. It included all patients who underwent a TAR by a single surgeon between 2006 and 2010 and patients were divided into those under 60 and those over 60 at the time of surgery. Patient reported outcomes (PROMs), including WOMAC, SF-36 and patient satisfaction scores and complications were analysed preoperatively and at one, two, five and over 10 years postoperatively. Results: There were 156 patients included in this analysis, 61 were under 60 (mean age 50.29) and 95 were over 60 (mean age 69.12). A total of 12 patients had revision surgery, (nine in the under 60 group) and 52 patients were deceased at the time of analysis (10 in the under 60 group). At one year the over 60 group had less pain and better functional scores (p=0.02, p=0.017). At two, five and ten years there was no statistical difference in pain and function between groups. At two years the over 60s reported less stiffness and quicker return to activities of daily living (p=0.007, p=0.001). However, at five and 10 years there was no statistical difference in any domain. Conclusion: This study demonstrates that age does not correlate with a significant difference in pain or functional outcomes in patients who have TAR, at over 10 years follow up. The higher revision rates in the younger group may correlate with higher functional demand and lower mortality rate.

Category: Ankle Arthritis; Ankle Introduction/ Purpose: There is paucity of literature comparing foot and general health status including quality of life between patients presenting with Ankle/ Hindfoot, Midfoot and 1st MTPJ arthritis. The aim of this study is to compare foot specific patient reported disability and quality of life satisfaction scores between patients presenting with arthritis of either the ankle/hindfoot, midfoot or 1st MTPJ. Methods: Patients who presented between 2020 and 2021 with a diagnosis of primary Osteoarthritis (OA) in either the ankle/hindfoot (AHA), midfoot (MA) or first MTPJ (MTPJA) were included in this study. Patients with associated foot problems, bilateral presentations, previous reconstructive surgery, or underlying neurological conditions were excluded. Differences in preoperative Patient Reported Outcome Measures (PROMs) including, MOX-FQ (Domains: Pain, Walking/Standing, Social activities), EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) (Domains: Pain, symptoms, ADL, sport, Recreation, Quality of Life) were analysed. Results: 94 patients (2020-2021) were included in this study (mean age 58.50). There were 45 patients with AHA, 21 with MA and 28 with MTPJA. The AHA group reported worse pain compared to the MTPJA group (p=0.03), and the MA group (p=0.004). AHA patients had more difficulty with Sports & Recreational Activities (p=0.029). Quality of Life scores was not significantly different between the groups. MTPJA patients had more difficulty with engaging in social activities compared the AHA patients (p=0.049). Conclusion: AHA patients suffer more pain that patients with arthritis in other areas of the foot. They appear to struggle with walking and standing and have difficulty participating in sports and recreational activities. Interestingly, MTPJA patients experience the most difficulty taking part in social activities. Patients with any type of foot or ankle arthritis experience similar difficulties with their mental health and their ability to carry out activities of daily living.

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is gaining popularity as a treatment option for end stage arthritis. We analysed whether the underlying pathology leading to the arthritis has any bearing on patient reported or clinical outcomes. Methods: Patient-reported outcome measures (PROMs) for TAR performed from 2006 to 2010 by a single surgeon were reviewed. This included WOMAC score, SF-36 and patient satisfaction scores. Data was collected preoperatively and post- operatively at 1, 2, 5 and 10 year. The indications for TAR were obtained by review of clinical notes and radiographs and these included osteoarthritis (OA), inflammatory arthritis (IA), pilon fracture (PF), ankle fracture (AF), and post-traumatic arthritis without previous fracture (PTOA).PROMs were available for 156 TARs: 81 (51.9%, mean age 65.29) for OA, 28 (17.9%, mean age 65.29) for AF, 23 (14.7%, mean age 64.28) for IA, 11 (7%, mean age 55.01) for PF, and 13 (8.3%, mean age 51.08) for PTOA. Results: At 1 year WOMAC score showed significant worsening pain and stiffness on PTOA group (p=0.023, p=0.001) and worse general health and vitality for the IA group (p=0.0025, p=0.005). At 5 years The PTOA group showed significant worsening stiffness (p=0.048), social and emotional domains (p=0.004, P=0.029) and worsening pain, return recreational activities and surgery dissatisfaction (p < 0.05, p=0.032, p=0.023). At 10 years 50% of IA patients were unhappy with return to ADLs but no other difference were found between groups. There was a higher revision rate at 10 years in the PTOA group with 30.7% of patients being revised (4/13) compared to other groups (OA-6.17%, AF-3.57%, IA-4.35%, PF-9%) Conclusion: Similar outcomes in all groups were seen at 10 years but higher revision rates were present in PTOA group. In patients with PTOA careful consideration and counselling is needed prior to proceed with TAR.

Category: Other Introduction/Purpose: Steroid injection is a common treatment for Plantar fasciitis (PF) but has high recurrence rates. Platelet- rich plasma (PRP) injections have been used as an alternative treatment. Our aim was to review the effectiveness of PRP injection. Methods: All patients who underwent PRP injection for PF between 2015 and 2021 were included in this study. Clinical results and patient reported outcomes (MOX-FQ scores, EQ-5D and FAOS scores) were collected pre and post-operatively. Results: A total of 34 patients underwent PRP injection between 2015 and 2021 (mean age 34 years). There was a 71% PROMs response rate (80% female with, mean age 53). The mean duration of symptoms was 4 years and the median follow up time was 4.2 years. 77.1% were satisfied with overall outcomes of treatment with PRP injections (p < 0.05). 68.1% of patients reported satisfaction with pain relief. 74.6% were satisfied with return to activities of daily living. 72.6% were satisfied with return to recreational activities. 59% reported improvement in quality-of-life post treatment. 64% were happy to receive the same treatment again; 13.6% would not have the procedure again. 2 patients had severe pain within 2 weeks following the injection but symptoms settled. No other complications. Conclusion: PF is considered to be a self-limiting condition but can be debilitating whilst awaiting resolution of symptoms which can take upwards of 12 months to fully resolve. PRP injection provides effective pain relief for PF at 4 years follow up.

Category: Ankle Arthritis Introduction/Purpose: Step count and activity monitoring are objective tools to measure improvement in functional ability in patients undergoing Total ankle replacement (TAR); this area is underexplored in literature. Activity monitoring sensors provide additional information on physical activity and energy expenditure in addition to step counts. These carried out in a real-life environment helps us to understand the impact of intervention in improving physical activity. The aim of this study was to study physical activity patterns in the community in patients who underwent TAR surgery. Methods: 10 patients who underwent a TAR between 2017 and 2019 were recruited. Exclusion criteria included previous reconstructive surgery, h/o infection, PVD, neurological disease and other joint replacements. Written consent was obtained. Patients were provided with ActivPAL TM activity monitor to wear over a 7-day period along with a self-reported diary to record activity patterns. This was carried out pre-operatively and 2 years. Data from sensors were downloaded and activity patterns were analysed with SPSS IBM 28 statistical package. Results: 10 patients (7 males, 3 females) were recruited. Mean age of patients were 65.16 years (52.4 to 78.1yrs).there was a trend for improvement in Sitting / Lying (hours) from 121.36 to 132.56 (p=0.367) and Standing (hours) 25.53 to 33.23 (p=0.411), although this did not achieve statistical significance. Step count (in hours) improved from 8.8 hrs to 10.8 hrs (p=0.05); Step count increased from 38544 to 47074 (p=041) from pre-op to 2 years. Energy expenditure (metabolic equivalents) improved from 192.3 to 219.5 (p=0.033). Conclusion: At 2 years post-operatively, TAR patients showed considerable improvement in step count and energy expenditure compared to pre-operative levels. The results of this novel study helps us to understand the functional improvements in terms of physical activity and energy expenditure gained from TAR surgery

Category: Basic Sciences/Biologics; Ankle Introduction/ Purpose: The aim of this study was to investigate plantar pressures changes with gait in patients presenting with ankle arthritis pre and post TAR. Methods: Patients who were listed for a primary TAR with a 3 component mobile bearing prosthesis were included. Exclusion criteria included refusal of consent, previous surgery to foot, h/o infection, peripheral vascular disease, neurological disease and other LL joint replacements. Gait analysis was carried out using TekscanTM plantar preasure (PP) analysis system and PP) were recorded pre- operatively and 1 year post-operatively. Gait asymmetries were recorded in Percentage for ST parameters. 11 patients were recruited to this study. Mean age were 70.5 years. Results: Improvement centre of pressure pattern restoration and Force percentage curve (FP) patterns from pre-op to 1 Year. Improvement in foot progression angle was seen in 6 out of 11 patients (54.5%). Plantar pressure analysis showed deviation from reference ranges for 1) differences in centre of pressure (COP) 2) changes to hindfoot vs. forefoot loading ratio 3) change in loading pattern at heel in KPa (p < 0.05) 4) differences in gait parameters (reduction in cadence, walking velocity, increase in active propulsion time; p< 0.05) 5) changes to foot progression angles. These findings correlate with MOX-FQ scores (p>0.565) for pain, difficulty with walking/standing and difficulty with social activities. Gait asymmetries improved at 1 year for step velocity (76.1 to 93.4%) and mid stance time (76.04 to 93.5% in 8/11patients)(p < 0.05). Conclusion: This study shown that TAR surgery helps in restoring centre of pressure, force percentage curve patterns and reduces asymmetries in step velocity and mid stance times during gait at 1 year post surgery. Plantar pressure analysis is a useful tool to study improvement in function in this patient group.

Category: Ankle Arthritis Introduction/Purpose: Pilon fractures are challenging to manage and have poor functional outcomes and high complication rates. A significant proportion of these patients go on to develop post-traumatic ankle arthritis. Our aim was to assess the long term patient reported outcomes following pilon fracture fixation and how this compares to patients with end stage ankle osteoarthritis requiring surgical intervention in the form of total ankle arthroplasty. Methods: We retrospectively identified all patients who underwent pilon fracture fixation between April 2012 and December 2015 (Group A). Group B consisted of patients with primary ankle osteoarthritis awaiting elective total ankle replacement between 2015 and 2017. Patients completed a Patient Reported Outcome Measures questionnaire (MOX-FQ, EQ-5D and FAOS scores) pre and post-operatively. The average follow up was 8 years. Results: There were 18 patients in Group A and 22 in Group B. Ankle arthritis patients reported significantly worse score for MOXFQ Pain (P vs. AA; 39.0 ±29.5 vs. 68.0 ±27.1; p=0.001), Difficulty with Walking/ Standing (38.3±26.0 vs. 56.4±26.5; p=0.037) and difficulty with social activities (24.0 ±25.6 vs. 49.4 ±31.3; p=0.007) and FAOS domains of symptoms (68.7 vs. 52.1; p=0.005), ability to do Activities of Daily Living (18.9 vs. 27.5; p= 0.003) and Quality of life (56.6 vs. 32.5; p=0.012). There was no difference between groups for EQ-5D general health scores (78.8 vs. 68.8; p=0.156). Ankle arthritis group patients reported worse scores for mobility, ability to self-care and performed activities of daily living (p=0.012) compared to the pilon fracture group. Conclusion: Our 8 year follow up demonstrate good long term outcomes for patients following pilon fracture fixation. Patients did not develop symptomatic arthritis comparable to end stage ankle arthritis requiring surgical intervention and we therefore recommend primary treatment with fixation, irrespective of fracture severity.

Category: Ankle; Hindfoot Introduction/Purpose: There is paucity of literature reporting outcomes in patients who undergo subtalar joint fusion surgery before vs. after having a Total Ankle Replacement (TAR). We aimed to study the PROMs in patients who underwent a staged approach of Subtalar arthrodesis (STJA) followed by TAR vs patients who underwent TAR followed by further STJA surgery. Methods: All patients who underwent a STJA surgery and TAR surgery (in either order) between 2006 and 2010 included in this study. patient reported outcomes including WOMAC (Western Ontario McMasters Osteoarthritis score), SF-36 general health score and patient satisfaction scores were compared between groups. They analysed pre-operatively and at 1, 2, 5 and 10 years post-operatively. Out of 210 TARs performed, 14 patients underwent a two staged procedure between 2006 and 2010 by a single surgeon. 5 patients had STJ fusion after TAR (Group A) and 9 patients had STJ fusion before TAR (Group B). Results: Mean age of Group A and B was 52.5 years and 62.1 years respectively. 1 patient in Group A and 3 patients in Group B were deceased. Both groups reported improvement in scores for WOMAC, SF -36 from pre-op to 1 year post operatively (p < 0.05) and the results plateaued to 5 years with slight decline in scores from 5 to 10 years. At 2 years, Group B reported lower scores for stiffness (9.6±11.7 vs. 64.3 ±27.4) p=0.002, At 5 years, Group A reported lower scores than group B for General health and mental health components of SF-36 scores (p=0.044); however, there was no differences between groups for WOMAC, SF-36 and patient satisfaction outcomes at 10 years post-operatively. Conclusion: There were similar outcomes reported by patients who underwent STJA either before or after TAR at average of 10 year follow up in this series

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is been extensively studied for disease severity and outcomes of surgery. It is a condition resulting in significant pain and disability. There is a lack of literature on pain and disability in ankle arthritis compared to other pathologies of the foot and ankle. We aimed to study the level of disability caused due to ankle arthritis and how it compares to other commonly reported conditions of the foot and ankle. Methods: We collected PROMs using MOX-FQ questionnaire from newly diagnosed patients under the care of 1 consultant from May 2014 to July 2014. Data was collected for 13 commonly reported conditions for forefoot (3), midfoot (3), hindfoot (5) and ankle arthritis. We grouped patients as Group A, B, C and D for forefoot, midfoot, hindfoot disorders and ankle arthritis respectively. The responses to each of the 3 domains of MOX-FQ were analysed using statistical tests for analysis of variance. Results: 136 patients took part in this study. There were 52 patients with ankle arthritis, 56 patients with forefoot conditions (19- big toe arthritis, 18 - hallux valgus and 19 – morton’s neuroma/metatarsalgia); 22 patients with midfoot disorders (15 – TMT joint arthritis, 4 – TNJ arthritis and 3 – CC joint arthritis) and 31 patients with disorders of hindfoot (9 – STJ arthritis, 6 – tib post pathology, 4 – plantar fasciitis, 3 – Haglund’s disease and 3 – achillis tendinitis). Although patients with hindfoot problems reported a trend for higher pain scores (72.0) when compared to groups A (62.6), B (64.7) and D (66.2), this failed to achieve statistical significance.Group D patients reported highest scores for difficulty with walking/standing (p=0.008) and similar levels of pain to other foot conditions (p>0.05). For Social interaction domain, all 4 groups reported similar level of restrictions in social activity, (p=0.679). Conclusion: Patients with ankle arthritis experienced higher levels of difficulty with walking and standing and similar levels of pain and restriction with social activities to patients with other foot and ankle pathologies. Further research is required to explore general health and functional limitations in lines with ICF (International Classification of Function and Disability) for ankle arthritis. (We aim to present a breakdown of pain, walking/standing and social function domains by each foot condition in comparison to ankle arthritis in the event of this abstract being accepted)

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a leading cause of pain and disability. The effect of this condition on physical and mental health is similar to end stage hip arthritis. There is paucity of literature on PROMS outcomes following total ankle replacements (TAR) in comparison to total hip replacement (THR) or knee replacement (TKR). We aimed to study the 5 year outcomes of TAR in comparison with TKR and THR Methods: PROMS data from patients who underwent a primary THR, TKR or TAR from March 2003 to 2013 were collected from our hospital patient registry. They were divided into 3 groups based on the type of primary joint replacement. Patient demographics and patient reported outcomes (WOMAC, SF-36 scores and patient satisfaction scores at follow up) were compared at pre-op and 5 year follow up. Results: There was data available on 1920 THR, 2582 TKR and 248 TAR patients. Pre-operatively, TAR patients reported higher function scores when compared to THR and TKR (40.2 vs. 34.2 and 35.8; p < 0.05). For SF-36 scores, there was no difference between groups for general health, role emotional components (P>0.05); TAR patients reported similar scores to TKRs for physical domains; to THRs for the mental domains (P>0.05). At 5 years post-op, TARs reported lower scores than THRs and TKRs for function and stiffness. For SF-36 scores, TARs reported similar outcomes to THR and TKR for mental health components (p>0.05), similar scores to TKR for 3/4 physical domains (p < 0.05), but lower satisfaction rates for ADL and recreation when compared to THR (P < 0.05). Conclusion: TAR patients had similar outcomes to THR or TKR patients for disease specific and mental health domains, and lower patient satisfaction rates in terms of pain relief, ADL and recreation. Further research is warranted including clinical outcomes along with PROMS with a long term follow up.

Category: Ankle Arthritis Introduction/Purpose: Pre-operative templating using plane radiographs is of great importance in planning arthroplasty of the hip and knee. Its role in total ankle arthroplasty (TAR) is less clear. Being able to use the best fitting implant is of paramount importance for transferring forces through the ankle joint. This contributes to the longevity of the TAR prosthesis. It is unclear whether pre-operative templating is more accurately performed using an AP radiograph or 3-Dimensional (3D) imaging using MRI or CT. We sought to compare the accuracy of pre-operative templating with an AP radiograph versus CT/MRI, in relation to the size of the implanted prosthesis. Methods: 29 patients undergoing TAR with BOX™ TAR between July 2014 and September 2015 were included in the study. Data was collected prospectively using a TAR database. Pre-operative templating of Tibial and Talar width using AP Radiographs was performed and recorded onto the database (Fig1). The implant sizes used was also recorded in the database (small, medium or large). Patients were part of an ongoing clinical trial which has ethics committee approval. 26 patients in this cohort underwent pre-operative CT or MRI assessment and were suitable for inclusion in the study (CT=6, MRI =20). These scans were reviewed retrospectively by two separate authors (AF and JR) to assess for Tibial and Talar width in the Coronal plane at the midpoint of the Tibia in the Sagittal plane (Fig2). A third author (MS), the lead surgeon, resolved any disagreements on measurements. The authors were blinded to the implant size used. Results: For templating the Tibial width the AP radiograph predicted the implant size 42.3% of the time while using CT/MRI scan predicted the implant size correctly 80.8% of the time. For templating the Talar width the AP radiograph predicted the implant size 42.3% of the time while using CT/MRI scan predicted the implant size correctly 84.6% of the time. The odds ratio for CT/MRI predicting the implant correctly over the AP radiograph was 5.72 (CI = 1.7 – 19.9) for the tibial component and 7.50 (CI = 2.0- 28.0) for the talar component. These values were statistically significant. Conclusion: For pre-operative templating we found 3D templating with an MRI or CT scan to be significantly more accurate than using an AP radiograph. We advise the use of MRI or CT as the most effective way to plan for TAR. MRI and CT are now frequently performed in orthopaedic centres as routine investigations. These modalities have the added benefit of assessing surrounding joints and soft tissues to aid accurate diagnosis. The limitations of this study lie in the small study size and the retrospective methodology.

Category: Ankle Arthritis Introduction/Purpose: There is paucity of literature relating to information needs of patients in Orthopaedic Surgery, despite the fact that Orthopaedic Surgeons in the UK welcome the use of patient decision aids for joint replacement surgery. This multi- centre study aimed to study the information needs of patients for surgical treatment of ankle arthritis from 6 different hospitals across the North East region of England. Methods: Ethical permissions were obtained for this multi-centre qualitative research study. The study recruited 18 patients from 6 hospitals across the North East of England. They were invited to take part in patient focus group meetings. 3 focus groups were conducted with 4-8 patients/ group. These groups were facilitated by independent researchers using a semi-structured discussion approach. Patients were asked for their views on information needs for surgical treatment of ankle arthritis. The focus group meetings were digitally recorded and transcribed verbatim. Data was analysed using the nVIVO software with framework analysis. Results: The analysis highlighted 4 main themes: A) Factors influencing surgical decision making B) Information needs of patients C) Information provision and D) Patient expectations. Theme B is discussed in detail for this abstract. Primary information needs requested by over 70% of patients were: 1. Desire to meet with patients who had undergone similar surgical procedure 2. Information on post-operative rehabilitation 3. Information on return to work and driving 4. Experience of consultant team 5. Written information regarding procedures (advantages, disadvantages, survivorship and outcomes) and 6. Personalized decision support based on individual patient’s lifestyle and preferences. These components form the Preoperative/information ‘6 pack’. Conclusion: When developing information materials and decision tools for patients, providing them with the Ankle Arthritis ‘6 pack’ will enable them to make a more informed choice of the surgical options offered by the consultant.

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) is a relatively uncommon joint replacement procedure. Only 631 TAR operations were performed in the UK in 2014. However, its popularity is increasing as a suitable alternative to ankle fusion in patients with end stage ankle arthritis. A rare complication of TAR surgery is the development of a Venous Thromboembolism (VTE), including Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). We sought to investigate the effectiveness of our own peri-operative management and VTE prophylaxis protocol in the prevention of symptomatic VTE, in patients undergoing TAR surgery in our tertiary referral hospital. Methods: We conducted a retrospective cohort study of prospectively collected data in patients undergoing TAR with Mobility TAR (Depuy™, Leeds, United Kingdom) between March 2006 and May 2012. All patients were treated according to a pre-defined protocol. Patients undergoing TAR were not given VTE prophylaxis unless there were specific indications of increased risk of VTE - such as cardiac risk factors or post-operative air travel. A Vacuum Assisted Closure (VAC™) device was applied post operatively to increase the speed of wound healing, creating a negative pressure environment preventing dehiscence. Patients were not immobilised post operatively but rested for 5 days with the index leg elevated, while ankle movement was encouraged. Patients were mobilised early (5-7days). We reviewed all post-operative clinical follow up for 6 months, the time chosen as a cut off for an incident of DVT to be attributable to the surgery. Results: A cohort of 200 TARs were assessed. The mean age of the cohort was 61.7 years of age (range 31.0-89.4). There were no recorded deaths. There were 125 male and 75 female patients with 85 Left and 115 Right TAR procedures performed. In total 31 patients (15.5%) were given chemoprophylaxis in the post-operative period on clinical grounds. 187 (73.4%) patients were mobilised early (5-7days) post-operatively; with 2 (0.8%) mobilised with partial weight bearing and 21 (4.6%) mobilised non-weight bearing. In the mobilised early subgroup of patients only 10 (5%) had problems and required subsequent immobilisation. The majority of post-operative problems were caused by post-operative peri-prosthetic fracture (n=8, 4%) and wound break down (n=2, 1%). Conclusion: This study highlights that there is a need for further research into the use of VTE prophylaxis in TAR. In addition we feel that chemoprophylaxis should not be considered the panacea for reducing the incidence of VTE in patients undergoing TAR. We suggest post-operative limb elevation, haematoma evacuation and use of VAC treatment should be prioritised with early mobilisation and full weight bearing. Furthermore this study suggests judicious VTE chemoprophylaxis should be given on clinicians’ judgement tailored to individual patient requirements. This will hopefully avoid unnecessary costs and possible complications of anticoagulation such as bleeding, delayed wound healing and thrombocytopenia.

Category: Ankle Arthritis Introduction/Purpose: Little long term data is available on patient-reported outcome measures (PROMs) following total ankle replacement in patients with posttraumatic osteoarthritis (PTOA), osteoarthritis (OA) and rheumatoid arthritis (RA). Patients with post-traumatic osteoarthritis have previously been felt to have poorer short and long term results following total ankle replacement, due to younger age, higher activity levels and greater patient expectations. We report the 3 and 5 year outcomes for patients who underwent total ankle replacement with a mobile bearing prosthesis, comparing prospectively collected PROMs data for PTOA patients with those with OA and RA. Methods: We analysed patient demographic data, American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Scores (FAOS), the SF-36 Health Survey, and patient satisfaction scores, collected preoperatively and up to five years postoperatively. Results: The study included 109 consecutive patients with total ankle replacement (58 OA, 21 RA, 30 PTOA). At one and two years postoperatively, the PTOA group reported significantly better scores on the general health domain of the SF-36. At three and five years postoperatively, there was a trend for better scores in the PTOA group for all domains of the SF36, however none of these reached significance (P>0.05). At one year postoperatively, the PTOA group and the RA group had better FAOS results for pain than the OA group. There were no significant differences in FAOS scores between groups at three or five years. There were no significant differences in AOFAS scores or in patient reported satisfaction at any measured time point. Conclusion: Our findings suggest that patients with posttraumatic osteoarthritis of the ankle can expect comparable five year outcomes after total ankle replacement with a mobile bearing prosthesis as patients with osteoarthritis and rheumatoid arthritis.

The integration of Artificial Intelligence (AI) in education is transforming the traditional learning landscape by personalizing curriculum and enhancing student engagement. This review paper explores the potential of AI-based systems to tailor educational experiences to individual student needs. Through a comprehensive analysis of recent literature, we examine various AI technologies--such as machine learning, natural language processing, and adaptive learning systems--that facilitate personalized learning paths. By analyzing case studies and empirical evidence, we highlight how these systems can assess student performance, identify learning gaps, and adapt instructional content accordingly. The review identifies key benefits of AI in education, including improved learning outcomes, increased motivation, and enhanced accessibility for diverse learners. However, challenges such as data privacy, algorithmic bias, and the need for teacher training are also addressed. Furthermore, we discuss the implications of AI integration for educators and policymakers, emphasizing the necessity of ethical frameworks and guidelines to govern the use of AI in educational settings. This paper concludes by suggesting directions for future research, including the exploration of AI's impact on collaborative learning and the potential for AI to support lifelong learning initiatives. By leveraging AI technologies, educational institutions can create more inclusive, effective, and responsive learning environments that cater to the unique needs of each student, ultimately fostering a more equitable educational landscape. This review aims to contribute to the ongoing discourse on the role of AI in education and provide insights for stakeholders looking to implement AI-driven solutions in curriculum design and instructional strategies. [ABSTRACT FROM AUTHOR]