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End-stage ankle osteoarthritis causes severe pain and disability. There are no randomized trials comparing the 2 main surgical treatments: total ankle replacement (TAR) and ankle fusion (AF).To determine which treatment is superior in terms of clinical scores and adverse events.A multicenter, parallel-group, open-label randomized trial. (ISRCTN registry number: 60672307).17 National Health Service trusts across the United Kingdom.Patients with end-stage ankle osteoarthritis, aged 50 to 85 years, and suitable for either procedure.Patients were randomly assigned to TAR or AF surgical treatment.The primary outcome was change in Manchester-Oxford Foot Questionnaire walking/standing (MOXFQ-W/S) domain scores between baseline and 52 weeks after surgery. No blinding was possible.Between 6 March 2015 and 10 January 2019, a total of 303 patients were randomly assigned; mean age was 68 years, and 71% were men. Twenty-one patients withdrew before surgery, and 281 clinical scores were analyzed. At 52 weeks, the mean MOXFQ-W/S scores improved for both groups. The adjusted difference in the change in MOXFQ-W/S scores from baseline was -5.6 (95% CI, -12.5 to 1.4), showing that TAR improved more than AF, but the difference was not considered clinically or statistically significant. The number of adverse events was similar between groups (109 vs. 104), but there were more wound healing issues in the TAR group and more thromboembolic events and nonunion in the AF group. The symptomatic nonunion rate for AF was 7%. A post hoc analysis suggested superiority of fixed-bearing TAR over AF (-11.1 [CI, -19.3 to -2.9]).Only 52-week data; pragmatic design creates heterogeneity of implants and surgical techniques.Both TAR and AF improve MOXFQ-W/S and had similar clinical scores and number of harms. Total ankle replacement had greater wound healing complications and nerve injuries, whereas AF had greater thromboembolism and nonunion, with a symptomatic nonunion rate of 7%.National Institute for Health and Care Research Heath Technology Assessment Programme.

Interest in the history of Rutland, England’s smallest county, goes back a long way. It was in 1684 that James Wright, having profited from a sojourn in the Tower of London to undertake his researc...

The purpose of this study was to determine whether the application of near infrared (NIR) light could positively modulate symptoms associated with restless legs syndrome (RLS). Twenty-one subjects with RLS were treated with NIR three times weekly for four weeks. Baseline measures of: (1) international restless legs syndrome rating scale (IRLSRS) score; (2) Semmes Weinstein monofilament (SWM) test; (3) visual analog pain scale (VAS); (4) ankle-brachial index (ABI); and (5) sonographic imaging of the popliteal and posterior tibial arteries were compared to post-treatment values. NIR (850 nm) was delivered transcutaneously at 8 J/cm(2) to four locations on each leg and the plantar surface of each foot. A pre-test-post-test one group design was employed. Baseline and post-treatment measures were compared using either a dependent t-test when data were normal or the Wilcoxon signed rank test in the absence of normality. A significant improvement in IRLSRS scores was observed. Sensation improved from less than protective in 16.6% of sites tested at the baseline to 13.4% post-intervention. There was a significant improvement in ABI scores. VAS and sonographic imaging measures other than ABI remained unchanged. The use of NIR to modulate symptoms associated with RLS was supported by the data.

The short-term results of silastic implant of the first metatarsophalangeal joint (MTPJ) have been successful. However, reservations exist regarding long-term results. The aim of this study was to evaluate long-term outcome of silastic implant prosthesis in treatment of hallus rigidus.This was a retrospective study, with 108 feet in 83 patients, operated upon between 1988 and 2003. Mean age at operation was 55 years (SD 8.1) with a follow-up period of 8.5 years. Outcome measures included the American Orthopaedic Foot and Ankle Scoring system(AOFAS), passive and active arc of motion. Patients' satisfaction was assessed using the visual analogue scale. All the patients had anteroposterior and oblique views and were assessed for loosening and osteolysis. Pedobarographic studies were performed using the Musgrave Footprint. Complications and revisions were recorded.The mean total AOFAS score was 77.5 (SD 13.4). Mean active and passive arc of motions were 36.8 degrees (SD 19.13) and 46.82 degrees (SD 17.19), respectively. Patient satisfaction showed mean VAS of 7.73 (SD 2.41). Prostheses were removed in three feet at three, five and seven years respectively because of persistent pain. Radiologically 25 feet (23 %) had osteolysis but were non progressive and didn't correlate with the functional outcome.We can conclude that silastic implant arthroplasty is an effective procedure in hallux rigidus management with satisfactory functional outcome and high patient satisfaction.