Saltzman, J Bone Joint Surg Am 1999 - Triple Arthrodesis: Twenty-Five and Forty-Four-Year Average Follow-Up of the Same Patients

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Triple Arthrodesis: Twenty-Five and Forty-Four-Year Average Follow-Up of the Same Patients

Saltzman, Ponseti, et al.·J Bone Joint Surg Am·1999·210 citations·Retrospective cohort

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Background

Triple arthrodesis is used to treat major deformities of the hindfoot and is often performed in young patients. The purpose of this study was to assess the long-term outcomes of triple arthrodesis in young patients.

Methods

67 feet of 57 patients were evaluated at an average of 25 and 44 years after triple arthrodesis. The most common indication for the operation was neuromuscular imbalance of the hindfoot, which was secondary to poliomyelitis in 37 feet (55 percent), Charcot-Marie-Tooth disease in 6 (9 percent), spinal cord abnormalities in 4 (6 percent), cerebral palsy in 3 (4 percent), and Guillain-Barré syndrome in one (1 percent).

Results

52 feet (78 percent) had some residual deformity after the arthrodesis.
However, these deformities appeared to be nonprogressive between 1973 and 1994.
Pseudarthrosis occurred in 13 feet.
30 feet or ankles (45 percent) were painful at the first follow-up evaluation, and 37 feet or ankles (55 percent) were painful at the second follow-up evaluation.
Of the 30 feet or ankles that were painful at the first follow-up evaluation, 23 were painful at the second follow-up evaluation.
Of the 37 feet or ankles that were not painful at the first follow-up evaluation, 14 were painful at the second follow-up evaluation.
18 patients (32 percent) needed walking support at the time of the first follow-up, and 39 patients (68 percent) needed it at the time of the second follow-up.
2 of the patients who needed support at the first follow-up evaluation did not need it at the second follow-up evaluation.
At the first follow-up evaluation, 21 ankles (31 percent) had no radiographic evidence of degenerative changes.
However, by the second follow-up evaluation, all of the ankles had some degenerative changes.
Similar progressive arthritic findings were noted at the naviculocuneiform and tarsometatarsal joints.
According to the system of Angus and Cowell, the overall result at the time of the first follow-up was rated as good in 50 feet (75 percent) and as fair in 17 feet (25 percent).
At the time of the second follow-up, 19 feet (28 percent) were rated as good, 46 (69 percent) were rated as fair, and 2 (3 percent) were rated as poor.

Conclusions

Despite progressive symptoms and radiographic degeneration in the joints of the ankle and midfoot, 54 patients (95 percent) were satisfied with the result of the operation. The triple arthrodesis was a satisfactory solution for imbalance of the hindfoot in this group of patients.

Copyright remains with the authors and publisher.

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Effects of Bracing in Adolescents with Idiopathic Scoliosis.

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Adolescent Idiopathic Scoliosis: A New Classification to Determine Extent of Spinal Arthrodesis.

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Problems in the Management of Type III (Severe) Open Fractures: A New Classification of Type III Open Fractures.

Gustilo, Williams, et al.J Trauma19842,361 citationsRetrospective cohort

Neer Award 2005: The Grammont Reverse Shoulder Prosthesis: Results in Cuff Tear Arthritis, Fracture Sequelae, and Revision Arthroplasty.

Boileau, Hovorka, et al.J Shoulder Elbow Surg20061,115 citationsProspective cohort

A System for the Surgical Staging of Musculoskeletal Sarcoma.

Enneking, Goodman, et al.Clin Orthop Relat Res19802,112 citationsRetrospective cohort

Fracture Fixation in the Operative Management of Hip Fractures (FAITH): An International, Multicentre, Randomised Controlled Trial.

Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) InvestigatorsLancet2017310 citationsRCT

Fatty Muscle Degeneration in Cuff Ruptures. Pre- and Postoperative Evaluation by CT Scan.

Goutallier, Voisin, et al.Clin Orthop Relat Res19942,669 citationsProspective cohort

Dislocations after Total Hip-Replacement Arthroplasties.

Lewinnek, Zimmerman, et al.J Bone Joint Surg Am19782,549 citationsRetrospective cohort

Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis.

Walch, Khoury, et al.J Arthroplasty19991,142 citationsRetrospective cohort

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DenisSpine (Phila Pa 1976)19832,566 citationsRetrospective cohort

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Frankle, Vasey, et al.J Bone Joint Surg Am2005773 citationsRetrospective cohort

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A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.

Vaccaro, Oner, et al.Spine (Phila Pa 1976)2005866 citationsConsensus statement

A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds.

FLOW Investigators, Guyatt, et al.N Engl J Med2015347 citationsRCT

Curve Progression in Idiopathic Scoliosis.

Weinstein, PonsetiJ Bone Joint Surg Am1983641 citationsRetrospective cohort

Traumatic Glenohumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repairs: Significance of the Inverted-Pear Glenoid and the Humeral Engaging Hill-Sachs Lesion.

Burkhart, De BeerArthroscopy20001,884 citationsCase series

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Baumgaertner, Keggi, et al.J Bone Joint Surg Am19951,441 citationsRetrospective cohort

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Berndt, HartyJ Bone Joint Surg Am1959945 citationsBiomechanical study

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Weinstein, SPORT Investigators, et al.N Engl J Med20081,207 citationsRCT

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Herring, Browne, et al.J Pediatr Orthop1992461 citationsRetrospective cohort

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Yamaguchi, Middleton, et al.J Shoulder Elbow Surg2001498 citationsRetrospective cohort

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Burkhart, Jolson, et al.Arthroscopy1993469 citationsAnatomic study

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O'Driscoll, Morrey, et al.J Bone Joint Surg Am1991997 citationsCase series

Preoperative versus Postoperative Radiotherapy in Soft-Tissue Sarcoma of the Limbs: A Randomised Trial.

O'Sullivan, Zee, et al.Lancet20021,587 citationsRCT

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Arnoczky, WarrenAm J Sports Med19821,227 citationsAnatomic study

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MirelsClin Orthop Relat Res19891,222 citationsRetrospective cohort

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Fehlings, Rampersaud, et al.PLoS One20121,200 citationsProspective cohort

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NeerClin Orthop Relat Res19831,827 citationsReview article

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Neer, Fukuda, et al.J Bone Joint Surg Am1983774 citationsCase series

A System of Staging Musculoskeletal Neoplasms.

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Stulberg, Wallensten, et al.J Bone Joint Surg Am1981810 citationsRetrospective cohort

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Jobe, Lombardo, et al.J Bone Joint Surg Am1986758 citationsCase series

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NeerJ Bone Joint Surg Am1974598 citationsCase series

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Stiell, Worthington, et al.JAMA20011,283 citationsProspective cohort

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Gerber, Vinh, et al.J Bone Joint Surg Am1990441 citationsAnatomic study

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Snyder, Friedman, et al.Arthroscopy19901,264 citationsCase series

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NeerJ Bone Joint Surg Am1972536 citationsCase series

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Griffin, FASHIoN Study Group, et al.Lancet2018542 citationsRCT

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Dejour, Guier, et al.Knee Surg Sports Traumatol Arthrosc19941,987 citationsCase-control study

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Morrey, Chao, et al.J Bone Joint Surg Am19811,380 citationsBiomechanical study

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Burkhart, Kibler, et al.Arthroscopy20031,304 citationsReview article

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Judet, Letournel, et al.J Bone Joint Surg Am1964980 citationsCase series

Inferior Capsular Shift for Involuntary Inferior and Multidirectional Instability of the Shoulder. A Preliminary Report.

Neer, FosterJ Bone Joint Surg Am1980934 citationsCase series

The Impact of Positive Sagittal Balance in Adult Spinal Deformity.

Glassman, Schwab, et al.Spine (Phila Pa 1976)20051,878 citationsRetrospective cohort

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Bosse, Castillo, et al.N Engl J Med2002901 citationsProspective cohort

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Poppen, WalkerJ Bone Joint Surg Am1976886 citationsCase-control study

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Harms, MelcherSpine (Phila Pa 1976)20011,528 citationsCase series

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Kallmes, Jarvik, et al.N Engl J Med20091,422 citationsRCT

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A Classification for Congenital Limb Malformations.

SwansonJ Hand Surg Am1976429 citationsReview article

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PipkinJ Bone Joint Surg Am1957445 citationsCase series

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Anderson, Park, et al.J Bone Joint Surg Am1975416 citationsCase series

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Herring, Browne, et al.J Bone Joint Surg Am2004143 citationsProspective cohort

The Role of the Scapula in Athletic Shoulder Function.

KiblerAm J Sports Med19981,240 citationsReview article

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Watson, BalletJ Hand Surg Am19841,138 citationsRetrospective cohort

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Valle, PaproskyJ Bone Joint Surg Am2003199 citationsRetrospective cohort

The Tibial Plateau Fracture. The Toronto Experience 1968--1975.

Schatzker, Bruce, et al.Clin Orthop Relat Res19791,029 citationsRetrospective cohort

Surgical Dislocation of the Adult Hip a Technique with Full Access to the Femoral Head and Acetabulum without the Risk of Avascular Necrosis.

Ganz, Berlemann, et al.J Bone Joint Surg Br20011,367 citationsCase series

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Hertel, Leunig, et al.J Shoulder Elbow Surg2004837 citationsProspective cohort

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Fisher, Fourney, et al.Spine (Phila Pa 1976)20101,224 citationsConsensus statement

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Triple Arthrodesis: Twenty-Five and Forty-Four-Year Average Follow-Up of the Same Patients

Saltzman, Ponseti, et al.·J Bone Joint Surg Am·1999·210 citations·Retrospective cohort

|

Background

Triple arthrodesis is used to treat major deformities of the hindfoot and is often performed in young patients. The purpose of this study was to assess the long-term outcomes of triple arthrodesis in young patients.

Methods

67 feet of 57 patients were evaluated at an average of 25 and 44 years after triple arthrodesis. The most common indication for the operation was neuromuscular imbalance of the hindfoot, which was secondary to poliomyelitis in 37 feet (55 percent), Charcot-Marie-Tooth disease in 6 (9 percent), spinal cord abnormalities in 4 (6 percent), cerebral palsy in 3 (4 percent), and Guillain-Barré syndrome in one (1 percent).

Results

52 feet (78 percent) had some residual deformity after the arthrodesis.
However, these deformities appeared to be nonprogressive between 1973 and 1994.
Pseudarthrosis occurred in 13 feet.
30 feet or ankles (45 percent) were painful at the first follow-up evaluation, and 37 feet or ankles (55 percent) were painful at the second follow-up evaluation.
Of the 30 feet or ankles that were painful at the first follow-up evaluation, 23 were painful at the second follow-up evaluation.
Of the 37 feet or ankles that were not painful at the first follow-up evaluation, 14 were painful at the second follow-up evaluation.
18 patients (32 percent) needed walking support at the time of the first follow-up, and 39 patients (68 percent) needed it at the time of the second follow-up.
2 of the patients who needed support at the first follow-up evaluation did not need it at the second follow-up evaluation.
At the first follow-up evaluation, 21 ankles (31 percent) had no radiographic evidence of degenerative changes.
However, by the second follow-up evaluation, all of the ankles had some degenerative changes.
Similar progressive arthritic findings were noted at the naviculocuneiform and tarsometatarsal joints.
According to the system of Angus and Cowell, the overall result at the time of the first follow-up was rated as good in 50 feet (75 percent) and as fair in 17 feet (25 percent).
At the time of the second follow-up, 19 feet (28 percent) were rated as good, 46 (69 percent) were rated as fair, and 2 (3 percent) were rated as poor.

Conclusions

Despite progressive symptoms and radiographic degeneration in the joints of the ankle and midfoot, 54 patients (95 percent) were satisfied with the result of the operation. The triple arthrodesis was a satisfactory solution for imbalance of the hindfoot in this group of patients.

Copyright remains with the authors and publisher.

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