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Background: The success of total ankle replacement (TAR) must be based on restoring reasonable mechanical balance with anatomical structures that can produce mechanical joint work through elastic (eg, tendons, fascia) or viscoelastic (eg, heel pad) mechanisms, or by active muscle contractions. Yet, quantifying the work distribution across the affected joint and the neighboring foot joints after TAR is lacking. Therefore, the objective of this study was to investigate if there is a change in the joint work distribution across the Ankle, Chopart, Lisfranc and Metatarsophalangeal joints during level walking before and after patients undergo TAR. Methods: Fifteen patients with end-stage ankle osteoarthritis scheduled for primary TAR for pain relief were recruited and peer-matched with a sample of 15 control subjects. All patients underwent a 3D gait analysis before and after surgery, during which a kinetic multisegment foot model was used to quantify intersegmental joint work. Results: The contribution of the Ankle joint ( P = .007) to the total foot and ankle positive work increased significantly after TAR. In contrast, a significant decrease in the contribution to the total foot and ankle joint positive work ( P < .001) were found at the Chopart joint after TAR. The foot joints combined produced a significant increase in a net mechanical work from +0.01 J/kg before surgery to +0.05 J/kg after TAR ( P = .006). Conclusion: The findings of this study corroborate the theoretical rationale that TAR reduces significantly the compensatory strategy in the Chopart joint in patients with end-stage ankle osteoarthritis after TAR. However, the findings also showed that the contribution of the ankle joint of patients after TAR to the total foot and ankle joint positive work remained impaired compared to the control group.

Resume Introduction Quotidiennement, le chirurgien du pied et de la cheville utilise un mini-amplificateur de brillance. Nous avons souhaite quantifier son exposition aux radiations ionisantes. Hypothese L’exposition aux rayons X pour un chirurgien du pied et de la cheville utilisant un mini-amplificateur de brillance etait inferieure aux doses limites autorisees par l’autorite de surete nucleaire (20 mSv/an pour le corps et le cristallin, 150 mSv/an pour la thyroide et 500 mSv/an pour la peau et les extremites). Materiel et methodes Il s’agissait d’une serie prospective, monocentrique, mono-operateur, realisee entre fevrier 2014 et decembre 2017. Sur cette periode, les doses emises par le mini-amplificateur, d’un champ de 15 centimetres, etaient repertoriees pendant les 1064 interventions. Les doses recues par le chirurgien ont ete recueillies par trois dosimetres passifs (thorax, oculaire et main) et un actif. Une valeur de p inferieure a 5 % a ete consideree comme statistiquement significative. Resultats 64,4 % des interventions concernaient l’avant-pied, 35,3 % l’arriere-pied et la cheville et 0,3 % etaient exclusivement percutanees. Le produit dose-surface moyen par intervention etait de 3,9 cGy/cm2 ± 7. Pour la chirurgie de l’avant-pied il etait de 1,1 cGy/cm2 ± 0,9, pour la chirurgie de la cheville et de l’arriere-pied de 8,7 cGy/cm2 ± 9,7 (p Discussion/conclusion L’exposition du chirurgien du pied et de la cheville, utilisant un mini-amplificateur de brillance, etait tres inferieure aux seuils limites mais egalement aux resultats de la litterature. Niveau de preuve IV.

Background Common etiologies for post-traumatic ankle osteoarthritis are ankle fractures and chronic ankle instability. As the nature of trauma is different for these two etiologies, it might be expected that the two subtypes of post-traumatic ankle osteoarthritis would display different foot mechanics during gait. Research question The objective of this exploratory cross-sectional study was to compare the foot kinematics and kinetics of patients suffering from post-fracture ankle osteoarthritis with those of patients suffering from post-sprain ankle osteoarthritis. Methods Twenty-nine subjects with end-stage post-traumatic ankle osteoarthritis and fifteen asymptomatic control subjects participated in this study. All patients suffered from post-traumatic ankle osteoarthritis secondary to ankle-related fracture (Group 1; n = 15) or to chronic ankle instability (Group 2; n = 14). A four-segment kinematic and kinetic foot model was used to calculate intrinsic foot joint kinematics and kinetics during gait. Vector field statistical analysis MANOVA was used to assess differences between groups for the entire three-component intrinsic foot joint angles and moments. Results MANOVA showed significant differences between the groups. Post-hoc analyses suggested that the differences between post-fracture ankle osteoarthritis group and controls were caused by a combination of less adducted Shank-Calcaneus position and less plantarflexion at this joint. Post-hoc analyses also suggested that both pathological groups exhibited a decreased plantarflexion moment for Shank-Calcaneus, Chopart, Lisfranc joints compared to controls. Analyses of both pathological groups versus controls for power suggested lower Shank-Calcaneus and Lisfranc power generation during pre-swing phase. Significance No significant differences were found between the two pathological groups in this exploratory study. Alterations in foot kinematics and kinetics were mainly found about the dorsi-/plantarflexion axis during the pre-swing phase of the stance phase for both pathological groups compared to controls. Observed differences were not limited to the painful ankle joint, but seem also to have affected the kinetics of the neighbouring foot joints.

In the literature, first metatarsophalangeal joint arthrodesis with lesser metatarsal head resection seems to be a reliable procedure in rheumatoid foot deformity. Maybe this procedure could be proposed in nonrheumatoid severe forefoot deformity (hallux valgus angle >40° and lesser metatarsophalangeal dislocation). The aim of this study was to compare radiological and clinical outcomes between lesser metatarsal head resection and lesser metatarsal head osteotomy in nonrheumatoid patients. Thirty-nine patients (56 feet) suffering from well-defined nonrheumatoid severe forefoot deformity were retrospectively enrolled in our institution between 2009 and 2015. Metatarsal head resection and metatarsal head osteotomy represented 13 patients (20 feet) and 26 patients (36 feet), respectively. In this observational study, a rheumatoid population (21 patients) was included as the control. The clinical outcome measures consisted of American Orthopaedic Foot and Ankle Society score, Foot and Ankle Ability Measurement, and Short Form-36. The radiological outcomes were: intermetatarsal angle, hallux valgus angle, and metatarsophalangeal alignment. Mean follow-up was 24 months. Satisfaction rate was, respectively, 92% for resection, 91% for osteotomy procedure, and 80% for surgery in rheumatoid patients. Short Form-36 global score was, respectively, 80.7 (52.5-96.4), 76 (57.7-93), and 68.3 (22.6-86). No functional outcome difference was found between resection and osteotomy procedures, except that the metatarsal head resection group had poorer results in sports activities than the osteotomy group. Complications were similar between osteotomy and resection (p > .05). The radiological outcomes were improved significantly from preoperative to postoperative. First metatarsophalangeal joint arthrodesis with lesser metatarsal head resection in nonrheumatoid severe forefoot deformity might be a good therapeutic option.

Background This study evaluated the 3D angle between the joint moment and the joint angular velocity vectors at the intrinsic foot joints, and investigated if these joints are predominantly driven or stabilized during gait. Methods The participants were 20 asymptomatic subjects. A four-segment kinetic foot model was used to calculate and estimate intrinsic foot joint moments, powers and angular velocities during gait. 3D angles between the joint moment and the joint angular velocity vectors were calculated for the intrinsic foot joints defined as follows: ankle joint motion described between the foot and the shank for the one-segment foot model (hereafter referred as Ankle), and between the calcaneus and the shank for the multi-segment foot model (hereafter referred as Shank-Calcaneus); joint motion described between calcaneus and midfoot segments (hereafter referred as Chopart joint); joint motion described between midfoot and metatarsus segments (hereafter referred as Lisfranc joint); joint motion described between first phalanx and first metatarsal (hereafter referred as First Metatarso-Phalangeal joint). When the vectors were approximately aligned, the moment was considered to result in propulsion (3D angle o) or resistance (3D angle >120o) at the joint. When the vectors are approximately orthogonal (3D angle close to 90°), the moment was considered to stabilize the joint. Results The results showed that the four intrinsic joints of the foot are never fully propelling, resisting or being stabilized, but are instead subject to a combination of stabilization with propulsion or resistance during the majority of the stance phase of gait. However, the results also show that during pre-swing all four the joints are subject to moments that result purely in propulsion. At heel off, the propulsive configuration appears for the Lisfranc joint first at terminal stance, then for the other foot joints at pre-swing in the following order: Ankle, Chopart joint and First Metatarso-Phalangeal joint. Conclusions Intrinsic foot joints adopt a stabilized-resistive configuration during the majority of the stance phase, with the exception of pre-swing during which all joints were found to adopt a propulsive configuration. The notion of stabilization, resistance and propulsion should be further investigated in subjects with foot and ankle disorders.

In Europe, fixed-bearing implants predominate again in total ankle replacement (TAR). The present single-center single-surgeon study assesses the Hintegra® mobile-bearing implant (NEWDEAL).Between November 2008 and November 2015, 97 Hintegra® were implanted in 94 patients: mean age, 62.4±10.9 years (26-83); 59% (57/97) male; normal mean body-mass index (BMI), 27.5 ± 4.3 kg/mNinety-four TARs were analyzed at a mean 81 ± 21.6 months (19-124). Revision-free survival was 76% (95% confidence interval (95%CI): 0.66-0.8), and explantation-free survival 92% (95%CI: 0.85-1) with 10 cases of curettage and 5 explantations. Mean AOFAS score improved from 41.8 ± 12.5 (21-69) to 77.5 ± 16.5 (24-100) up (p 0.001); 75% of patients had no or only mild pain (p 0.001). Clinical ranges of motion were 8.0 ± 7.1° dorsiflexion (p 0.001) and 35.1 ± 9.4° plantar flexion (preoperatively, 34.1 ± 7.9°) (p = 0.71). Radiologically, tibial components were well-positioned; 87% of talar components were well-centered. Global ankle range of motion was 23.5 ± 10.2° (5-48) (p = 0.17). 54.6% of TARs showed posterior tibial calcification at follow-up. Risk of severe cyst (1 cm) on CT was 36% (95%CI: 23-47) at a mean 77 ± 21.9 months (18-123).Hintegra® TAR incurred a low risk of revision, and is a reliable option for ankle osteoarthritis.IV.

Locking plates are increasingly used to achieve hindfoot fusion. The objective of this study was to compare hindfoot fusion outcomes with the PEEK H-pode™ (Biotech™) locking plate and the titanium Maxlock™ (Tornier-Wright™) locking plate.A polyetheretherketone (PEEK) H-pode™ locking plate provides similar fusion rates to a titanium Maxlock™ locking plate for talo-navicular and calcaneo-cuboid arthrodesis.We conducted a retrospective comparative study in 39 patients (including 21 [54%] with pes planovalgus and 11 [28%] with neurological equinovarus deformities) who underwent talo-navicular and/or calcaneo-cuboid fusion, usually combined with subtalar fusion. The first 17 patients (January 2014-February 2016) were managed with Maxlock™ locking plates and the next 22 patients (March 2016-August 2018) with H-pode™ locking plates. These two cohorts of consecutive patients were comparable regarding age, sex distribution, body mass index, and comorbidities. At last follow-up more than 1year after surgery, we compared functional scores, pain intensity, and fusion assessed by radiographs and computed tomography (CT) (threshold set at 33%).Mean follow-up was 42months (range: 34-63months) in the Maxlock™ group and 25months (range: 12-36months) in the H-pode™ group. At last follow-up, the two groups were not significantly different for the mean values of the American Orthopedic FootAnkle Society score, European FootAnkle Society score, and visual analogue scale pain score. Neither were the two groups significantly different for talo-navicular and calcaneo-cuboid fusion by CT. In the Maxlock™ group, we found non-significant trends towards a higher proportion of patients with talo-navicular nonunion (18% vs. 5% in the H-pode™ group) and weaker talo-navicular fusion in patients with pes planovalgus (60.8% vs. 82.0%, respectively). Radiographic results overestimated the fusion rates.Talo-navicular and calcaneo-cuboid fusion was not significantly different with H-pode™ and Maxlock™ locking plates. CT was more accurate than standard radiography to assess fusion. These results underline the usefulness of PEEK locking plates for talo-navicular and calcaneo-cuboid fusion; moreover, the radiolucency of PEEK facilitates the interpretation of radiographs.IV.

Ankle osteoarthritis is a chronic debilitating disease marked by cartilage breakdown, pain and significant biomechanical impairment of the entire lower limb. Total ankle replacement (TAR) has been encouraged during the last decade as it has the potential to maintain the existing pre-operative ankle range of motion and to protect the more distally located joints of the foot. Three-dimensional gait analysis using a multi-segment foot model can provide an objective analysis of TAR for the treatment of end-stage ankle osteoarthritis. Thirty-six patients suffering from post-traumatic end-stage ankle osteoarthritis were evaluated before and after TAR. A four-segment kinematic foot model was used to calculate intrinsic foot joint kinematics during gait. Spatio-temporal parameters were also assessed. Kinematic results were compared to a control group of asymptomatic subjects. Differences in waveform patterns were mainly limited to dorsi-/plantarflexion inter-segment angles. At loading response, the Shank-Calcaneus plantarflexion angles as well as the Calcaneus-Midfoot dorsiflexion angle increased slightly in post-operative condition. During propulsion, an increase in Hallux-Metatarsus dorsiflexion angle was observed. Pain improved after surgery as supported by increased spatio-temporal parameters. While multi-segment foot and ankle kinematics were improved, they remained impaired compared to control values. This study confirms that TAR maintains the residual pre-operative range of motion after surgery from midstance to propulsion. Furthermore, the results suggest that the kinematic behavior of the foot joints distal to the affected ankle joint also improves post-operatively. The outcome of this study further emphasizes the clinical relevance of multi-segment foot modeling when assessing the outcome of TAR.

Superficial fibular nerve (SFN) and sural nerve are at risk during osteosynthesis of the lateral malleolus. The aim of this anatomical study was to describe the relationships of the superficial fibular and sural nerves with respect to the lateral malleolus.Nine corpses (18 ankles) were dissected, using a direct lateral approach. Measurements were recorded between the fibula and the nerves, and the pattern variations of the SFN were recorded for both right and left side to assess intra-individual variability.Distance between the tip of the lateral malleolus and the piercing of fascia cruris was 111 ± 26 mm for type 1 pattern, and range was 46-161 mm all types included. 78% (14 SFN) were type 1 pattern, 17% (3 SFN) were type 2 pattern, and 5% (1 SFN) were type 3 pattern. 44% (4 specimen) had a type 1 pattern SFN on one ankle and another pattern on the other ankle. The sural nerve was always observed just posterior to the lateral malleolus.This study demonstrated a great inter-individual variability especially for the SFN, but also an intra-individual variability with frequent different patterns between right and left leg. It is important to know the anatomical variations of the SFN and sural nerve to decrease the risk of intra operative nerve injury during direct lateral approach of lateral malleolus.

Total ankle arthroplasty (TAA), tibiotalar (TT) arthrodesis and tibiotalocalcaneal (TTC) arthrodesis are common surgical procedures that are sometimes concurrent. The functional results of TTC are deemed to be inferior because of the double joint sacrifice. Patient-Reported Outcome Measures (PROMs), as well as satisfaction scores, are commonly used to assess the outcome of these surgeries, but lack at capturing patients' ability to cope with potential functional limitations. The objective of our study was to compare the results of TAA, TT and TTC arthrodeses according to patients' point of view. We proposed two hypotheses: 1) TAA confer better results than TT arthrodeses, 2) and TT arthrodeses confer better results than TTC arthrodeses, on this specific criterion.We carried out a retrospective study integrating all TAA, TT and TTC arthrodeses performed in our center from 2010 to 2017. These surgeries were compared using PROMs (Foot Function Index (FFI), Foot and Ankle Outcome Scale (FAOS) and 12-Item Short Form Survey (SF-12)), a satisfaction rating and self-reported perceived recovery state.Fifty-one patients were included in the TAA group, 50 in the TT group and 51 in the TTC group. The mean duration of follow-up was 46±20.8 months. The TAA group had better results than the TT group regarding the FFI score and satisfaction, thus confirming our primary hypothesis. On the other hand, no significant difference was found between the TT group and the TTC group, which invalidated our secondary hypothesis. No significant difference between the groups was found regarding the distribution of patients' perceived recovery state.Our hypothesis was not confirmed. In fact, TAAs, TT and TTC arthrodeses presented substantially similar results. Although it is difficult to compare surgeries with different indications, it is surprising to find that the patients' perceived recovery state, deviating from the usual clinical and radiological results, are relatively similar.IV; Retrospective study.

Residual pain after ankle replacement may implicate lesions in posteromedial structures, including the posterior tibial pedicle and tendon. The technique described here protects these structures, by positioning a malleable plate via a medial retromalleolar counter-approach. The technique seems not to cause any specific iatrogenicity. We advocate systematic implementation of this kind of protection in ankle replacement surgery. LEVEL OF EVIDENCE: IV, retrospective study.

Hammertoe deformation is a frequent motive for consultation in forefoot surgery, and proximal interphalangeal joint arthrodesis is a classic treatment for fixed deformation, which tends to be achieved more and more thanks to specific implants. This work evaluated and compared clinical improvement, radiologic fusion, and complication rates between dynamic (Difuse®) and static (TinyFix®) implants from Biotech Ortho. A total of 95 patients (110 feet and 166 toes; 97 static and 69 dynamic implants) were included. Mean age was 63.6 (±12.6) years in the dynamic group and 62.3 (±14.01) years in the static group. Epidemiologic and intraoperative radiologic data were collected. Pain, toes deformity, complications, and radiologic findings (bone fusion and osteolysis) were recorded at 4 months postoperatively and at the last follow-up. Mean follow-up was 11.5 (range 4 to 28) months, and the position of the implants was more often satisfying in the dynamic group (p = .01). Fusion rates at 4 months were 67% and 80% in the dynamic and static groups, respectively (p = .05). Radiologic osteolysis occurred more frequently in the dynamic group (p = .05 at 4 months), and pain was still present in 3% in the dynamic group at the last follow-up compared with 7% in the static group. Complication rate was 7% in the dynamic group (implant fractures) and 4% in the static group. Revision was considered more often in the dynamic group (p = .01). The static titanium implant seems superior to the dynamic memory shape implant in Nitinol alloy with regard to fusion (p = .04), complications (p = .03), and revision rates (p = .01). The literature review seems to support the good results of static implants compared with the rest of the available arthrodesis implant solutions.

Background Although cements are widely used during arthroplasty procedures, few recommendations exist regarding their optimal usage modalities, which, nevertheless, govern the long-term surgical outcomes. No detailed information is available on how cements are used in French hospitals. The objectives of this questionnaire survey among surgeons working at a multi-site university hospital in France were to describe practices, determine whether these varied with surgeon experience, and look for differences compared to recommendations. Hypothesis Cementing techniques vary widely among surgeons at a university hospital. Material and methods A questionnaire was sent to the five orthopaedic departments of our university hospital to collect data on the surgeons (age, sex, years of experience), their practice (type of implants used, annual number of arthroplasties with each arthroplasty type and each indication, and proportion of cemented arthroplasties), the type of cement used, and the cementing technique. Results Of the 34 surgeons, 21 completed the questionnaire, 20 males and 1 female with a mean age of 41 years (range, 31–59 years) and a mean of 11 years (range, 1–29 years) of experience. High-viscosity antibiotic-loaded cement was preferred by 20 (95%) surgeons, notably for knee arthroplasties, of which the median annual numbers were 55 (range, 0–218) and 8 (range, 1–40) for primary and revision cemented procedures, respectively. Various cementing techniques in ambient air were used: 12/21 (57%) surgeons used pulsed lavage to prepare the bone before cementation and 18/21 (86%) applied the cement to both the bone cuts and the implant. Of the 18 surgeons who performed knee arthroplasties, 12 used pulsed lavage, including 9 of the 11 surgeons with more than 5 years of experience and only 3 of the 7 less experienced surgeons. Similarly, of the 12 surgeons who used pulsed lavage for cemented arthroplasties, 11 were among the 12 surgeons who performed more than 15 cemented arthroplasties annually and 1 was among the 6 who performed fewer cemented arthroplasties. Discussion Cementing techniques varied widely, reflecting the dearth of recommendations and controversial results of published studies. In our centre, the use of pulsed lavage to improve bone preparation and cement application to both the bone and the implant should be promoted, as both techniques are universally advocated. Our study demonstrates the need to provide surgeons with opportunities to exchange their experiences about the other aspects of cementing in order to harmonise practices and to optimise the use of cement. Level of evidence IV, questionnaire survey.

Resume Introduction L’arthrodese de la metatarso-phanlangienne (MTP) de l’hallux, decrite comme une intervention efficace et sure, presente des complications pouvant necessiter des reprises chirurgicales rarement evaluees. L’objectif de cette etude etait d’evaluer l’incidence et les resultats des reprises d’une arthrodese de la MTP de l’hallux. Hypothese L’incidence des reprises chirurgicales a la suite d’une arthrodese de la MTP1 est non negligeable et les resultats sont satisfaisants. Materiel et methodes Entre janvier 2014 et decembre 2015, dans cette etude retrospective et multicentrique (8 chirurgiens), 190 reprises chirurgicales d’avant-pieds ayant ete operes prealablement d’une arthrodese de la MTP de l’hallux ont ete incluses sans critere d’exclusion pour etre analysees avec un recul minimum de 1 an. Dans la meme periode 958 arthrodeses de premiere intention, ont ete effectuees. Resultats Le delai moyen de reprise etait de 4,6 ± 10,9 ans. Au recul moyen de 20,5 ± 7,4 mois (minimum 1 an), ont ete analysees 158 reprises [86 ablations de materiel sur gene isolee (54 %), 22 pseudarthrodeses (14 %), 13 cals vicieux (8 %), 18 metatarsalgies ou orteils en griffes (11 %) et 13 problemes de l’interphalangienne (IP) de l’hallux (8 %)] chez 135 femmes et 20 hommes, d’âge moyen 67,1 ± 10,5 ans. Les scores postoperatoires moyens etaient de 75 ± 13,9 pour l’AOFAS, et 65 ± 19,6 pour le SF36 global. En cas de pseudarthrodese, l’ablation isolee de materiel donnait de meilleurs resultats fonctionnels que l’arthrodese iterative. Les osteotomies de cals vicieux ont toutes consolide. Dans les arthroses de l’IP de l’hallux, les arthrodeses secondaires ou les arthroplasties ont donne de bons resultats. Discussion Par rapport aux resultats connus de la litterature des arthrodeses de premiere intention, les resultats de notre serie de reprises chirurgicales des arthrodeses MTP de l’hallux sont pratiquement equivalents, et sont donc consideres comme bons. Niveau de preuve IV, etude retrospective.

Background The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in nine European languages (English, German, French, Italian, Polish, Dutch, Swedish, Finnish, Turkish). From other languages under validation, the Persian version finished data acquisition and underwent further validation. Methods The Persian version of the EFAS Score was developed and validated in three stages: 1) item (question) identification (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) confirmatory analyses and responsiveness of Persian version (completed during initial validation study in nine other languages). The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory. Results The internal consistency was confirmed in the Persian version (Cronbach’s Alpha 0.82). The Standard Error of Measurement (SEM) was 0.38 and is similar to other language versions. Between baseline and follow-up, 97% of patients showed an improvement on their EFAS score, with excellent responsiveness (effect size 1.93). Conclusions The Persian EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co .

Background: Kinematic and kinetic foot models showed that computing ankle joint angles, moments and power with a one-segment foot modeling approach alters kinematics and tends to overestimate ankle joint power. Nevertheless, gait studies continue to implement one-segment foot models to assess the effect of total ankle replacement. Research question: The objective of this pilot study was to investigate the effect of the foot modeling approach (one-segment versus multi-segment) on how total ankle replacement is estimated to benefit or degrade the patient's biomechanical performance. Methods: Ten subjects with post-traumatic ankle osteoarthritis scheduled for total ankle replacement and 10 asymptomatic subjects were recruited. A one-segment and a multi-segment foot model were used to calculate intrinsic foot joints kinematics and kinetics during gait. A linear mixed model was used to investigate the effect of the foot model on ankle joint kinematic and kinetic analysis and the effect of total ankle replacement. Results: Differences in range of motion due to the foot model effect were significant for all the gait subphases of interest except for midstance. Peak power generation was significantly overestimated when computed with the one-segment foot model. Ankle and shank-calcaneus joint dorsi-/plantarflexion range of motion did not increase post-operatively except during the loading response phase. A significant 'group' effect was found for stance and pre-swing phase range of motion, with total ankle replacement patients showing lower range of motion values than controls for dorsi/plantarflexion. Significance: The outcome of this study showed that the 'foot model' had a significant effect on estimates of range of motion and power generation. The findings in our study therefore emphasize the clinical interest of multi-segment foot modeling when assessing the outcome of a therapeutic intervention.

Total ankle arthroplasty is currently an important option in the treatment of end-stage osteoarthritis. Many solutions have been proposed to meet the demanding specifications of this arthroplasty. The aim of the Quantum™ total ankle prosthesis is to develop innovative solutions to meet all of the requirements of ankle arthroplasty: reliability and reproducibility of implant positioning, wide range of sizes, quality of bone integration, and improved motion.

SB'20, 45ème Congrès de la Société de Biomécanique, Metz, France, 26-/10/2020 - 28/10/2020; The aim of this study was to calculate, for an asymptomatic healthy population, the quasi-stiffness of the intrinsic foot joints during mid-stance. This phase is characterised by a single leg support with low propulsion as it occurs before heel-off and by a presumed major contribution of the passive foot structures.

Background: The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in seven European languages (English, German, French, Italian, Polish, Dutch, Swedish). From other languages under validation, the Finnish and Turkish versions finished data acquisition and underwent further validation. Methods: The EFAS Score was developed and validated in three stages: 1) item (question) identi fication (completed during initial validation study), 2) item reduction and scale exploration (completed during initial validation study), 3) con firmatory analyses and responsiveness of Finnish and Turkish version (completed during initial validation study in seven other languages). The data were collected pre- operatively and post -operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, con firmatory analyses and responsiveness were executed using classical test theory and item response theory. Results: The internal consistency of the scale was con firmed in the Finnish and Turkish versions (Cronbach's Alpha 0.8). Responsiveness was good, with moderate to large effect sizes in both languages, and evidence of a statistically signi ficant positive association between the EFAS Score and patient - reported improvement. Conclusions: The Finnish and Turkish EFAS Score versions were successfully validated in the orthopaedic ankle and foot surgery patients, including a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.co. (C) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

The aim of this systematic review with meta-analysis was to determine the change in gait biomechanics after total ankle replacement and ankle arthrodesis for end-stage osteoarthritis. Methods Electronic databases were searched up until May 2019. Peer-reviewed journal studies including adult participants suffering from end-stage ankle osteoarthritis and reporting pre- and post-operative kinematics, kinetics and spatio-temporal effects of total ankle replacement and ankle arthrodesis during walking were included with a minimum of 12months follow-up. Seventeen suitable studies were identified and assessed according to methodological and biomechanical qualities. Meta-analysis was performed by calculating the effect size using standard mean differences between pre- and post-operative gait status. Findings Seventeen studies with a total of 883 patients were included. Meta-analysis revealed moderate evidence of an improvement in lower limb kinematics, kinetics and spatio-temporal parameters after total ankle replacement. Moderate evidence indicated an increase in ankle moment, hip range of motion and walking speed after ankle arthrodesis. Interpretation The currently available evidence base of research papers evaluating changes in gait biomechanics after total ankle replacement and ankle arthrodesis is limited by a lack of prospective research, low sample sizes and heterogeneity in the patho-etiology of ankle osteoarthritis. Following total ankle replacement, improvements were demonstrated for spatio-temporal, kinematic and kinetic gait patterns compared to the pre-operative measures. Improvements in gait mechanics after ankle arthrodesis were limited to walking speed and ankle moment. Increased hip range of motion after ankle arthrodesis could represent a sign of compensation for the lack of ankle motion.

Resume Introduction L’osteotomie de type Scarf est tres utilisee pour la chirurgie de l’hallux valgus en Europe. Sa fixation par vis est la regle, meme si certains ne fixent plus leur osteotomie. La fixation par plaque reste a l’etude. L’objectif de cette etude etait de comparer les resultats radiologiques de ces deux modes de fixation, ce qui a notre connaissance n’a jamais ete fait. Hypothese Par rapport a l’osteosynthese par vis, l’osteosynthese par plaque de l’osteotomie Scarf du 1er metatarsien preserve de l’impaction, sans augmenter les complications, ni le taux de recidive. Materiel et methodes L’etude, retrospective, comparait deux modes de fixation des osteotomies de type Scarf (vis vs plaque verrouillee), en analysant l’impaction secondaire du premier metatarsien (M1), la recidive (angle M1P1 > 20°) en radiographies, l’incidence des complications et la gene eventuelle sur materiel. La realisation de l’osteotomie ne differait pas entre les 2 groupes. Cinquante patients etaient inclus dans chaque groupe, en series continues entre fevrier 2014 et novembre 2015. Resultats Le recul moyen etait de 13,0 ± 2,7 mois dans le groupe vis et de 12,3 ± 1,1 mois dans le groupe plaque. Aucune complication grave n’a ete observee ; 4 retards de cicatrisation (3 plaques et 1 vis). Dans le groupe vis, etaient observees 1 impaction secondaire et 2 recidives (4 %), 1 gene sur materiel, et dans le groupe plaque, 3 recidives (6 %), pas d’impaction secondaire, 5 genes sur materiel avec 3 ablations de materiel. Discussion Aucune difference significative n’a ete montree en ce qui concerne l’impaction secondaire de M1 ou l’incidence de la recidive entre les 2 groupes : les osteotomies fixees par vis ne presentaient pas un taux de recidive plus eleve. L’osteosynthese systematique par plaque des osteotomies de Scarf n’a pas demontre de benefice par rapport a l’osteosynthese par vis. Niveau de preuve III, etude comparative en serie continue.

Resume Introduction Une des causes de reprise des protheses totales de cheville (PTC) est le descellement sur geodes. La reconstruction-arthrodese de cheville est souvent la premiere option de revision en raison d’importants defects osseux, classiquement combles par de l’auto- et/ou de l’allogreffe. Le comblement par un implant en metal trabeculaire de tantale est une alternative interessante en raison des proprietes biomecaniques de cette structure. Hypothese Le tantale utilise comme espaceur permet la stabilite primaire et favorise la consolidation de la reconstruction-arthrodese apres ablation de prothese de cheville. Materiel et methodes Onze patients ont ete operes d’une reconstruction-arthrodese apres un delai moyen de 6,9 ans suivant la pose de PTC. La hauteur moyenne de perte de substance osseuse etait de 32 mm, comblee par un implant quadrangulaire specifiquement concu (Trabecular Metal™, Zimmer/Biomet) associe a une autogreffe de crete iliaque. Dix patients ont eu une arthrodese tibio-talocalcaneenne osteosynthesee par un clou retrograde angule, et un patient une arthrodese talo-crurale avec deux plaques (antero-laterale et antero-mediale). Le suivi a ete clinique, fonctionnel (scores AOFAS et SF36) et radiologique avec des cliches simples et un controle par scanner. Resultats Au recul moyen de 19,3 mois, le score AOFAS total moyen etait de 56 (21–78) et le score SF36 moyen de 60,5 (19–84). Un patient etait perdu de vue, 4 restaient tres douloureux. L’integration du tantale etait observee chez 6 patients. Cinq patients avaient une consolidation de l’arthrodese sous-talienne et 8 une consolidation de l’arthrodese talo-crurale. Trois patients ont necessite une reprise chirurgicale. Discussion Notre hypothese n’est pas confirmee. Les resultats cliniques a plus d’un an de recul sont decevants, tout comme le nombre important de pseudarthroses et de non-integration du tantale. Ces echecs techniques peuvent etre expliques par une stabilite insuffisante du montage, et/ou par une porosite insuffisante de l’implant. Niveau de preuve IV, etude retrospective de cohorte.

En la actualidad, la colocacion de una protesis total de tobillo (PTT) es una solucion alternativa y competitiva a la artrodesis en el tratamiento de las lesiones degenerativas del tobillo. La indicacion de eleccion esta representada principalmente por la artrosis de tobillo idiopatica centrada o de origen postraumatico, asi como la artrosis de origen inflamatorio, como en la artritis reumatoide. Los pacientes jovenes y un estilo de vida activo son indicaciones controvertidas. Por el contrario la artrodesis esta indicada cuando existen antecedentes septicos, deformaciones importantes, trastornos neurologicos o motores y necrosis oseas, sobre todo astragalina o tibial. El estudio preoperatorio clinico y radiologico se centra principalmente en evaluar los defectos asociados para preparar del mejor modo posible las distintas etapas quirurgicas. Esto permite, en particular, prever la realizacion de procedimientos asociados: alargamiento de los gastrocnemios en caso de retraccion, osteotomias de realineacion en caso de deformaciones extraarticulares o de trastornos de longitud maleolar. Es importante comprender que la colocacion de una PTT debe considerarse como un procedimiento de resuperficializacion y que nunca puede corregir los defectos oseos o ligamentarios que han dado origen a las lesiones degenerativas. La experiencia adecuada del cirujano con este tipo de procedimiento permite prevenir la mayoria de las complicaciones si se sigue una tecnica quirurgica secuencial rigurosa. A largo plazo, el pronostico de las PTT se caracteriza por la aparicion de un aflojamiento relacionado con fenomenos de geodas (asociadas sin duda a reacciones de cuerpo extrano) o con la migracion de los implantes. Por tanto, es indispensable seguir a estos pacientes mediante la realizacion periodica de TC, proponiendo efectuar un injerto si el implante es estable. Los resultados reflejan en la actualidad una supervivencia promedio de alrededor del 89% a los 10 anos. Sin embargo, la mayor parte proviene de estudios de series publicadas por los propios fabricantes. Por tanto, es de esperar que la creacion reciente en Francia de un registro especifico para las PTT permita obtener resultados mas objetivos. Es indispensable responder a las multiples preguntas que plantean aun las artroplastias protesicas del tobillo.

Introduction Foot and ankle surgeons make daily use of mini-C-arm fluoroscopes. The present study aimed to quantify associated radiation doses. Hypothesis X-ray exposure for foot and ankle surgeons using a mini-C-arm fluoroscope is below the nuclear safety authority authorized doses of 20 mSv/year for the whole body and crystalline lens, 150 mSv/year for the thyroid and 500 mSv/year for the skin and limbs. Material and methods A single-center, single-surgeon prospective series was treated between February 2014 and December 2017. Doses emitted by the mini-C-arm (15 cm field) were recorded during 1,064 operations. Doses received by the surgeon were recorded by 3 passive dosimeters (thorax, eyes and hands) and 1 active dosimeter. The significance threshold was set at p Results A total of 64.4% of procedures concerned the forefoot, 35.3% the hindfoot and ankle, and 0.3% were strictly percutaneous. Mean dose-area product (DAP) per procedure was 3.9 cGy/cm2 ± 7: in forefoot surgery, 1.1 cGy/cm2 ± 0.9, and in hindfoot and ankle surgery 8.7 cGy/cm2 ± 9.7 (p Discussion/conclusion The exposure of foot and ankle surgeons using mini-C-arms was well below threshold, and also lower than in the literature. Level of evidence IV.

Resume Introduction Les ciments sont regulierement utilises en chirurgie orthopedique lors des arthroplasties mais peu de recommandations existent concernant leur bon usage, alors que celui-ci conditionne les resultats a long terme de la chirurgie. Les modalites d’utilisation des ciments dans des centres hospitaliers francais ne sont pas connues avec precision. Nous avons donc mene une enquete prospective au sein d’un centre hospitalier universitaire (CHU) multisite afin de : (1) connaitre les pratiques ; (2) distinguer si des differences sont observees selon l’experience des chirurgiens ; (3) preciser d’eventuelles differences par rapport aux recommandations. Hypothese Il existe une grande heterogeneite des pratiques de cimentation dans un centre universitaire. Materiel et methodes Une enquete, a l’aide d’un questionnaire, a ete diffusee aupres de 5 services de chirurgie orthopedique de notre etablissement. D’une part, les chirurgiens renseignaient âge, sexe, nombre d’annees d’experience, type d’implants, nombre de poses annuelles par type d’implant et par indication, et taux de protheses cimentees. D’autre part, ils precisaient la reference de ciment utilisee et leur technique de cimentation. Resultats Vingt-et-un chirurgiens orthopediques ont repondu a l’enquete. Vingt sur 21 etaient des hommes, d’une moyenne d’âge de 41 ans [31–59] et 11 ans [1–29] d’experience. Les chirurgiens utilisaient majoritairement (20/21 [95 %]) un ciment de haute viscosite impregne d’antibiotique, surtout dans l’arthroplastie du genou avec un nombre median de 55 [0–218] poses primaires par an et 8 [1–40] reprises. Les techniques de cimentation en air ambiant etaient variees : 57 % (12/21) utilisaient le lavage pulse pour preparer l’os avant cimentation, 86 % (18/21) realisaient une double cimentation (os et implant). Parmi les 18 chirurgiens qui pratiquaient l’arthroplastie du genou, 9/11 des chirurgiens experimentes (> 5 ans d’experience) utilisaient plus le lavage pulse contre seulement 3/7 des chirurgiens moins experimentes. De meme, 11/12 des utilisateurs habituels du ciment (> 15 protheses cimentees par an) utilisaient plus le lavage pulse contre seulement 1/6 des utilisateurs occasionnels du ciment. Discussion Les techniques de cimentation etaient heterogenes, du fait du peu de recommandations et d’une litterature controversee. Pour notre etablissement, une amelioration de la preparation de l’os avec utilisation du lavage pulse et de la double cimentation sont a encourager puisque ces pratiques font consensus dans la litterature. Pour les autres etapes de cimentation, notre etude montre la necessite d’un partage d’experience pour harmoniser les pratiques et promouvoir une utilisation optimale des ciments. Niveau de preuve IV, enquete par questionnaire.

[PubMed Central:\hrefhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240628PMC6240628] [DOI:\hrefhttps://dx.doi.org/10.1093/ofid/ofy26910.1093/ofid/ofy269] [PubMed:\hrefhttps://www.ncbi.nlm.nih.gov/pubmed/3029248130292481]; International audience; Local injection of a bacteriophages mix during debridement, antibiotics and implant retention ("DAIR") was performed to treat a relapsing Staphylococcus aureus chronic prosthetic joint infection (PJI). This salvage treatment was safe and associated with a clinical success. Scientific evaluation of the potential clinical benefit of bacteriophages as antibiofilm treatment in PJI is now feasible and required.

Introduction First metatarsophalangeal (MTP1) joint arthrodesis, described as a safe and effective procedure, has complications that may require surgical revision. These complications are rarely studied. The aim of this study was to determine the incidence and outcomes of revision surgery after MT1 arthrodesis. Hypothesis The incidence of surgical revision after MTP1 arthrodesis is not insignificant; however, the outcomes are satisfactory. Materials and methods In this multicenter retrospective study between January 2014 and December 2015, 190 forefoot revisions in patients who had previously undergone MTP1 arthrodesis were included by 8 surgeons. There were no exclusion criteria and all patients had at least 1 year of follow-up. Over the same period, 958 primary MTP1 arthrodesis procedures were performed. Results The mean time to revision was 4.6 ± 10.9 years. At a mean follow-up of 20.5 ± 7.4 months, 158 cases were available for analysis in 135 women and 20 men who had a mean age of 67.1 ± 10.5 years. These revision procedures were carried out because of discomfort related to the hardware at the arthrodesis site (n = 86, 54%), nonunion (n = 22, 14%), malunion (n = 13, 8%) metatarsalgia or claw toe (n = 18, 11%) and first interphalangeal (IP1) joint disorders (n = 13, 8%). The mean postoperative scores were 75 ± 13.9 for the AOFAS and 65 ± 19.6 for the SF36 total. In the nonunion cases, removal of the hardware led to better outcomes than repeating the arthrodesis procedure. Osteotomy in the malunion cases healed successfully. In the cases of IP1 osteoarthritis, secondary arthrodesis or arthroplasty led to good outcomes. Discussion Relative to published results of primary MTP1 arthrodesis, the outcomes in our series of revision MTP1 arthrodesis surgery cases are practically equivalent, thus considered acceptable. Level of evidence IV, Retrospective study.

Introduction One of the reasons for revision of total ankle replacement (TAR) implants is loosening due to subchondral cysts. Reconstruction and fusion of the ankle is often the first choice for revision procedures due to the large bone defects, which are typically filled with autograft and/or allograft. Filling the defect with a trabecular metal tantalum implant is a potential alternative given the biomechanical properties of this component. Hypothesis Using tantalum as a spacer provides primary stability and contributes to fusion of the ankle joint after removal of failed TAR implants. Methods Eleven patients underwent arthrodesis an average of 6.9 years after TAR. The mean height of the bone defect was 32 mm. It was filled with a specially designed quadrangular implant (Trabecular Metal™, Zimmer/Biomet) combined with an iliac crest graft. Ten patients underwent tibio-talo-calcaneal (TTC) arthrodesis fixed with an angled retrograde nail and one patient underwent talocrural arthrodesis fixed with two plates (anterolateral and anteromedial). The clinical, functional (AOFAS and SF36 scores) and radiological (plain X-rays and CT scan) outcomes were determined. Results At a mean follow-up of 19.3 months, the mean total AOFAS score was 56 (21–78) and the mean SF36 score was 60.5 (19–84). One patient was lost to follow-up and four patients still had pain. The tantalum implant was integrated in six patients. Five patients achieved fusion of the subtalar joint and 8 achieved fusion of the talocrural joint. Three patients required surgical revision. Discussion Our hypothesis was not confirmed. The clinical outcomes after more than 1 year of follow-up are disappointing, as was the large number of nonunion cases and the lack of tantalum integration. These technical failures can be explained by insufficient construct stability and/or insufficient implant porosity. Level of Evidence IV (retrospective cohort study).

Category: Basic Sciences/Biologics Introduction/Purpose: A scientifically sound validated foot and ankle specific outcome measure for different European languages is still missing. Indeed, language-specific cross cultural validation in other languages than English is largely absent. Some outcome measures were validated for specific pathologies such as hallux valgus, ankle arthritis or flatfoot. The European Foot and Ankle Society (EFAS) established in 2013 a Score Committee to develop, validate, and publish a new score, the “EFAS Score”, which is not specific for single pathologies for different European languages. The principal aim of this project was to develop and validate the EFAS Score simultaneously for different European languages. Methods: The EFAS Score was developed and validated in three stages: 1) item (question) identification, 2) item reduction and scale exploration, 3) confirmatory analyses and responsiveness. The following score specifications were chosen: scale/subscale (Likert 0-4), questionnaire based, outcome measure, patient related outcome measurement. For stage 3, data were collected pre- operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using analyses from classical test theory and item response theory. Results: Stage 1 resulted in 31 general and 7 sports related questions. In Stage 2, a 6-item general EFAS Score was constructed using English, German, French and Swedish language data. In Stage 3, internal consistency of the scale was confirmed in seven languages: the original four languages, plus Dutch, Italian and Polish (Cronbach’s Alpha >0.86 in all language versions). Responsiveness was good, with moderate to large effect sizes in all languages, and significant positive association between the EFAS Score and patient-reported improvement. No sound EFAS Sports Score could be constructed. Conclusion: The multi-language EFAS Score has been successfully validated for orthopaedic foot and ankle surgery populations incorporating a wide variety of foot and ankle pathologies, including language-specific validation in seven languages so far (English, German, French, Swedish, Dutch, Italian, Polish). Validation for other languages (Danish, Finnish, Norwegian, Portuguese, Spanish, Turkish) is in progress. All validated score versions are freely available at www.efas.co .

Introduction The Scarf osteotomy is a commonly used surgical procedure for treating hallux valgus in Europe. Screw fixation is standard practice, although some surgeons now go without internal fixation. Plate fixation is still being studied. The aim of this study was to compare the radiological outcomes of these fixation methods, which has not been performed up to now. Hypothesis : Relative to screw fixation, plate fixation of a Scarf osteotomy of the first metatarsal (M1) prevents secondary impaction, without increasing the complication rate or recurrence rate. Materials and methods A retrospective study was performed of two internal fixation methods for Scarf osteotomy (screw vs. plate), by analyzing the secondary impaction of the first metatarsal, recurrence of the hallux valgus (angle M1P1 > 20) on X-rays, incidence of complications and potential discomfort related to the hardware. The osteotomy procedure was the same in both groups: 50 patients were included consecutively in each fixation group between February 2014 and November 2015. Results The mean follow-up was 13.0 ± 2.7 months in the screw group and 12.3 ± 1.1 months in the plate group. There were no severe complications, although four cases of delayed wound healing occurred (3 in plate group, 1 in screw group). In the screw group, there was one case of secondary impaction, two cases of recurrence (4%) and one case of discomfort. In the plate group, there were no cases of impaction, three recurrences (6%) and five cases of discomfort, leading to plate removal in three of these cases. Discussion There was no significant difference between groups in the M1 secondary impaction rate or recurrence rate: screw fixation did not lead to a higher recurrence rate. Systematic fixation with a locked plate for Scarf osteotomy had no advantages over screw fixation in our study. Level of evidence II, Comparative study with continuous cohorts.

Resume Introduction La restitution de l’anatomie native permet d’ameliorer la longevite de l’arthroplastie alors que l’augmentation de la lateralisation femorale accentue les contraintes en torsion ce qui peut entrainer des anomalies de fixation prothetique. Ayant remarque plusieurs cas de liseres autour des pivots lateralises sans ciment (Corail™, DePuy), nous avons evalue sur une large serie l’effet de la lateralisation. Les objectifs de notre etude etaient par rapport a une serie de pivots standard de dessin identique : (1) d’evaluer l’osteo-integration radiologique autour des tiges lateralisees ; (2) d’evaluer leur survie. Hypothese Les tiges lateralisees, pourtant utilisees a bon escient lorsque l’anatomie du patient le justifiait, avaient un risque plus important d’anomalie d’osteo-integration. Materiels et methodes Une serie continue de 807 protheses totales de hanche de premiere intention implantees entre 2006 et 2010 (798 patients, âge moyen 65 ± 14,2 ans) a ete analysee retrospectivement : 280 tiges lateralisees (169 KHO [Hight Offset], 111 KLA [coxa vara]) et 527 tiges standard (KA) ont ete analysees a un recul moyen de 2,3 ans (1–7). L’evaluation clinique comportait le score de Postel Merle d’Aubigne (PMA). La fixation osseuse et la stabilite des implants etaient evaluees selon le score de Engh et Massin et le score ARA sur les cliches radiographiques au recul. Les lateralisations femorale, acetabulaire et globale etaient analysees en pre- et postoperatoire. L’evasement femoral ou indice de Noble etait calcule. La survie a ete evaluee selon la methode de Kaplan-Meier (evenement : reprise chirurgicale pour anomalie de fixation aseptique). Resultats Le score PMA passait de 12 (10–15) en preoperatoire a 17,7 (14–18) (p Conclusion Dans la serie lateralisee, il existe un risque de non-fixation significativement plus important (5 cas soit 1,8 %) que dans la serie de reference standard (aucun descellement). Nos resultats nous incitent a etre vigilants sur l’optimisation de la fixation primaire des tiges lateralisees. Niveau de preuve Etude retrospective cas temoin – Niveau III.

BackgroundAES mobile-bearing total ankle replacement was developed from the Buechel Pappas model. It was withdrawn in 2009, after identification of a higher than expected complication rate. The purpose of the current study was to analyse clinical outcomes, failures and survival of the initial series of 50 AES published in 2009.MethodsIn this single-centre continuous prospective study (2003-2006), 50 AES prostheses were included. Pre-operative osteoarthritis was mainly post-traumatic (50%) and secondary to instability (36%). All patients were assessed with clinical and radiographic follow-up at six months, one year, two years and every two to three years thereafter. A CT-scan was systematically performed before procedure, and at two years, five years and ten years. At last follow-up, all patients with TAR had a functional (SF 36, AOFAS) and clinical assessment. All complications or surgical events were analysed.ResultsThe mean follow-up was ten ± two years (range, 9-13). The mean AOFAS score was 75 points (range, 26-100). The mean SF 36 score was 69 points (range, 35-97). There was a significant deterioration in AOFAS score at five years and at last follow-up (p < 0.05). Fifteen TARs underwent reoperation for cyst curettage-graft because of development of periprosthetic lesions. Six of them ended up with prosthesis removal-arthrodesis. At the last follow-up, 14 TARs were removed for arthrodesis. Of the 30 prostheses seen at last follow-up, four are awaiting prosthesis removal-arthrodesis and one for cyst curettage-graft. The ten year survivorships free of any prosthesis removal or arthrodesis and free of any reoperation were 68% (95% CI, 55-85) and 57% (95% CI, 44-74), respectively.ConclusionOur data suggested a high rate of reoperation. Overall ten year survival was lower than with other designs, particularly due to cyst lesions. Level of evidence: Level IV, prospective case series

Resume Introduction Le benefice des protheses de cheville par rapport a l’arthrodese est debattu, mais la qualite de vie apres ces deux interventions a rarement ete evaluee. Aussi, nous avons mene une etude cas temoin afin de comparer : (1) la qualite de vie et (2) les capacites fonctionnelles et sportives. Hypothese Les resultats fonctionnels, les capacites sportives et la qualite de vie apres prothese (prothese totale de cheville – PTC) sont meilleurs qu’apres arthrodese de cheville. Materiel et methodes Deux series continues de 59 protheses et de 46 arthrodeses (operes entre 1997 et 2009) ont ete evaluees retrospectivement par un questionnaire comportant les items fonctionnels du score American Orthopaedic Foot and Ankle Society (AOFAS), le score Foot Function Index (FFI), le score Foot Ankle Ability Measure (FAAM), et le 36-Item Short-Form Health Survey (SF-36). Resultats Quatre vingt-trois reponses (79 % de la serie globale) ont ete appariees en deux groupes : 32 PTC (âge a l’intervention : 51,4 ans [21–63] ; recul : 52,2 mois [30–146] ; âge a la revision : 55,8 ans [26–67] ; IMC : 27,7 [21,7–36,7]) et 22 arthrodeses (âge a l’intervention : 50,1 ans [24–72] ; recul : 57,9 mois [12–147] ; âge a la revision : 54,9 ans [31–75] ; IMC : 26,8 [17,6–37]) (NS sur tous les items entre deux groupes). Les resultats sur la douleur etaient meilleurs apres PTC mais sans difference statistiquement significative : AOFAS douleur (/40) 28,1 ± 8,2 vs 24,5 ± 9,6 ; FFI douleur 16,6 ± 18,8 vs 24,3 ± 21,5. Le score global FFI (/100) etait meilleur (p = 0,048) apres PTC (16,2 ± 16,5 vs 24,8 ± 18,2). Le niveau sportif global moyen par rapport a l’etat anterieur a la pathologie etait relativement bas dans les 2 groupes mais significativement (p = 0,007) plus eleve dans le groupe PTC : score FAAM (/100) sport 49,5 ± 24,4 vs 29,8 ± 26,2. Les scores de qualite de vie SF-36 physique, psychique et global n’etaient pas significativement differents apres PTC et arthrodese : score de sante mental 63,1 ± 14,7 vs 57,8 ± 21,5 score de sante physique 61,3 ± 17,8 vs 53,7 ± 23,9, score global 63,2 ± 16,4 vs 55,9 ± 23,5. Discussion Tres peu de publications decrivent les activites et la qualite de vie apres PTC et apres arthrodese. Malgre des faiblesses, notre etude comparative objective une tendance a de meilleurs resultats fonctionnels apres PTC qu’apres arthrodese de cheville sans que la difference entre les deux groupes soit tres significative. En revanche, il n’y avait pas de difference en terme de qualite de vie. Apres les doutes engendres par les publications d’osteolyses peri-prothetiques severes a moyen terme avec certains modeles de PTC, ces resultats nous encouragent a poursuivre l’implantation et le developpement des PTC. Niveau d’evidence Etude retrospective comparative de niveau III.

Resume Introduction Les resultats a moyen terme des protheses totales de cheville (PTC) sont satisfaisants mais les taux de revision lies aux osteolyses peri-prothetiques sont eleves avec la prothese AES. Hypothese L’analyse radioclinique et les resultats histopathologiques des revisions prothetiques permettent d’expliquer le taux eleve d’osteolyses des protheses de cheville AES. Patients et methode Dans notre serie prospective de 84 protheses de cheville AES (2003–2008), 25 (dont trois deux fois) ont ete reprises pour osteolyse (delai moyen de 59,8 mois). Les implants etaient revetus d’hydroxyapatite (HA) pour huit patients et de titane-hydroxyapatite (Ti-HA) pour les autres. Pour tous les patients, nous avons analyse les radiographies selon le protocole Besse et al. et l’evolution du score AOFAS. Les 94 prelevements histologiques realises lors de la reprise ont ete relus en recherchant specifiquement tout materiel exogene. Resultats Macroscopiquement lors de la reprise chirurgicale, nous n’avons pas note de metallose ni d’usure du polyethylene. Le score AOFAS global et douleur ont diminue respectivement de 89,7/100 a un an postoperatoire versus 72,9 avant la reprise et de 32,5/40 un an postoperatoire versus 20,6/40 avant reprise mais 25 % des patients avaient un score global inchange. Radiologiquement, tous les patients avaient des lesions d’osteolyses tibiales et taliennes, 45 % une lyse corticale et 25 % un effondrement de l’implant dans les geodes. Sur tous les prelevements, on retrouvait une reaction inflammatoire granulomateuse macrophagique au contact d’un materiel exogene, les geodes etaient caracterisees par des remaniements necrotiques. Une partie de ce materiel exogene etait identifiable a l’examen histologique optique : polyethylene dans 95 % des cas, metal dans 60 % des cas (100 % des PTC revetues HA versus 33,3 % PTC revetues Ti-HA). Il s’y associait un materiel de nature indetermine : pigment brunâtre pour les PTC revetues Ti-HA (33,3 %) et corps floconneux pour 44,4 % des PTC revetues HA et 18,2 % des PTC revetues Ti-HA. Discussion Le phenomene d’osteolyse peri-prothetique reste mal compris meme si les particules d’usure des implants paraissent etre en cause. Tous les patients ayant eu des implants revetus HA avec quille tibiale modulaire avaient des particules de metal dans les tissus peri-prothetiques. La nature exacte des particules n’a pas pu etre identifiee. Le revetement bicouche Titane-HA pourrait etre un facteur de delamination par fretting, le temps que l’ancrage biologique osseux se fasse. Niveau d’evidence Etude prospective de cohorte – Niveau IV.