Malik Siddique - Academia.edu (original) (raw)

Papers by Malik Siddique

Journal of Bone Joint Surgery British Volume, Sep 1, 2012

Background The recommended indications for total ankle replacement (TAR) are limited, leaving fus... more Background The recommended indications for total ankle replacement (TAR) are limited, leaving fusion as the only definitive alternative. As longer-term clinical results become more promising, should we be broadening our indications for TAR? Materials and Methods Our single-centre series has 133 Mobility TARs with 3–48 months9 follow-up. 16 patients were excluded who were part of a separate RCT. The series was divided into two groups. ‘Ideal’ patients had all of the following criteria: age >60y, BMI Results The ‘Ideal’ group contained 44 ankles vs. 80 in the ‘Not ideal’ group (124 ankles in 117 patients). Complications were (‘Ideal’ vs. ‘Not ideal’): infection: 1 (deep) vs. 3; DVT/PE: 0; periprostheticfracture: 4 vs. 7; CRPS: 2 vs. 2; revision: 0 vs. 2. AOFAS scores showed variable significance (mean values). Pre-op: 27.9 vs. 25.7 (p = 0.459); 3months: 79.4 vs. 73.2 (p = 0.041); 6 months: 79.9 vs. 75.4 (p = 0.053); 12 months: 79.7 vs. 75.8(p = 0.228), 36 months: 77.3 vs. 79.0 (p = 0.655). Further subgroup analysis has been performed. Discussion Our results show that indications for TAR can be widened without further morbidity. Each case must be treated individually and accounted for other factors. Varus/valgus tilt can be corrected with appropriate calcaneal osteotomy +/- tendon transfers as a staged or combined procedure. TAR may be considered in younger patients based on functional and occupational demands. We may no longer be able to deter patients on BMI alone. Diabetic patients do not appear to have a higher complication rate. Conclusion We have increasing evidence that we should now be considering TAR as the primary treatment for disabling ankle arthritis rather than fusion.

Introduction There is less literature reporting outcomes following total ankle replacement (TAR) ... more Introduction There is less literature reporting outcomes following total ankle replacement (TAR) in patients presenting with a coronal plane deformity preoperatively. This study compares clinical and patient reported outcomes at 1 year between TAR patients with and without coronal plane deformity. Methods Patients from single centre prospective cohort (132) who underwent TAR between 2006 and 2010 were included. They were divided into 2 groups based on preoperative coronal plane deformity. Groups 1 and 2 had a coronal plane deformity of 10 respectively. Assessments included American Orthopaedic Foot and Ankle Score (AOFAS), Foot and Ankle Outcome Score (FAOS), SF-36 (Generic Health Measure) and complications recorded preoperatively and 3, 6 and 12 months postoperatively. Results There were 102 ankles (77.2%) in group 1 and 30 ankles (22.7%) in group 2. There was no difference in age and BMI between groups (p > 0.05). AOFAS, FAOS and SF-36 scores showed improvement for both groups ...

The effect of BMI on patient-reported outcomes following total ankle replacement (TAR) is uncerta... more The effect of BMI on patient-reported outcomes following total ankle replacement (TAR) is uncertain and the change in BMI experienced by these patients in the 5 years following surgery has not been studied. We report a series of 106 patients with complete 5-year data on BMI and patient-reported outcome scores. Patients undergoing TAR between 2006 and 2009, took part in the hospital joint registry, which provides routine clinical audit of patient progress following total joint arthroplasty; therefore, ethics committee approval was not required for this study. Data on BMI, Foot and Ankle Score (FAOS) and SF-36 score were collected preoperatively and annually postoperatively. Patients who were obese (BMI >30) had lower FAOS scores pre-operatively and at 5 years, however this did not reach significance. Both obese (p = 0.0004) and non-obese (p < 0.0001) patients demonstrated a significant improvement in FAOS score from baseline to 5 years. This improvement was more marked for the ...

Journal of Bone and Joint Surgery-british Volume, 2014

Introduction: There is paucity of literature on Gait analysis following Total Ankle Replacement (... more Introduction: There is paucity of literature on Gait analysis following Total Ankle Replacement (TAR). We aimed to study changes to gait after successful Mobility TAR. Methods: 20 patients who underwent a primary TAR, with a diagnosis of either OA or PTOA were recruited between October 2008 and March 2011. Gait analysis was carried out using the Helen Hayes marker system with VICON 3D opto-electric system pre-operatively, 3, 6 and 12 months post-operatively. Ankle kinematics and spatio-temporal parameters of gait were studied. Results: 20 patients were included. Mean age was 63.6 years (Range 43–84), mean BMI was 29.6 ± 4.08. Diagnosis was OA in 12 (52.2%) and PTOA in 8 (34.8%). Results showed increase in average and maximum range of dorsiflexion from (3° to 7°) and (11° to 17°) respectively from pre-op to 1 year, but statistically not significant (p>0.05). Of the temporal variables, Average Cadence increased from Pre-op to 1 year (102 to 106 steps/min); double support (0.35% to ...

Background Postoperative pain following (Mobility TM) ankle arthroplasty (AA) is recognised probl... more Background Postoperative pain following (Mobility TM) ankle arthroplasty (AA) is recognised problem. This study aimed to determine pattern of postoperative pain following Ankle arthroplasty (AA). Materials and Methods In prospective observational study 135 patients who had (AA) and follow-up of 12–36 months were included. AOFAS ankle score, patients9 satisfaction, SF36 and diagrammatic mapping of postoperative pain among other parameters were collected preoperatively and postoperatively at 3 months, 6 months and the annually. Patients with AOFAS of Results From total of 135 of patients with follow-up of 12 months, (12.5%)17 patients have low AOFAS score and ankle pain, 11(12.5%) of 85 patients with 2 year follow-up and (10.6%),5 of 47 patients with 3 year follow-up. Most of patients with low AOFAS score during first year have improved but 3 patients. Different group patients developed ankle pain during the second and third year. 3 patients of 5, in year 3 follow-up have medial side ...

Bone & Joint Open, 2021

Aims A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two... more Aims A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two surgical procedures was set up to obtain high-quality evidence of effectiveness. However, the trial faced recruitment challenges and struggled to maintain recruitment rates over 30%, although this is not unusual for surgical trials. We conducted a qualitative study with the aim of gathering information about recruitment practices to identify barriers to patient consent and participation to an orthopaedic trial. Methods We collected 11 audio recordings of recruitment appointments and interviews of research team members (principal investigators and research nurses) from five hospitals involved in recruitment to an orthopaedic trial. We analyzed the qualitative data sets thematically with the aim of identifying aspects of informed consent and information provision that was either unclear, disrupted, or hindered trial recruitment. Results Recruiters faced four common obstacles when recruiti...

Foot & Ankle Orthopaedics, 2020

Category: Ankle Arthritis; Ankle Introduction/Purpose: There is paucity of literature comparing p... more Category: Ankle Arthritis; Ankle Introduction/Purpose: There is paucity of literature comparing patient reported outcomes (PROMs) between total joint arthroplasties. There is a need to study the PROMS data to understand outcomes of treatment and factors affecting outcomes. We aimed to to study the PROMs data for total ankle replacement (TAR) to 10 years. To study how PROMS outcomes of TAR compare to total hip replacement (THR) and total knee replacement (TKR) at 10 years Methods: This is a prospective data collection from local hospital joint registry. 10 year follow up data was collected from patients who underwent a total joint replacement (Hip, Knee or ankle), provided informed consent for their data. Patients who refused consent, or had cognitive language problems were not approached for participation in the registry. Self-administered questionnaire data included WOMAC scores, Foot and ankle outcomes scores (FAOS), SF-36 scores and patient satisfaction data. Data was collected a...

Foot & Ankle Orthopaedics, 2020

Category: Ankle; Ankle Arthritis; Diabetes; Midfoot/Forefoot Introduction/Purpose: The indication... more Category: Ankle; Ankle Arthritis; Diabetes; Midfoot/Forefoot Introduction/Purpose: The indications for Total Ankle Replacement (TAR) in patients with Type II Diabetes mellitus is poorly defined and there is paucity of literature reporting clinical, radiological and patient reported outcomes for TAR in this patient group. We aimed to explore the ideal pre-operative criteria for TAR in patients with Type II DM based on results from our center. Methods: We studied the x-rays, clinical findings and patient reported outcomes of surgery at pre-op and 5 years for patients who underwent a total ankle replacement at our center between 2006 and 2014 who had Type II DM. This was a retrospective study. The above findings were also compared between patients who had Type II DM vs. who were not diabetic. Pre-operative screening for diabetic patients included Hb1Ac levels, clinical reporting of swelling, warmth, erythema findings, neurovascular status including proprioception, vibration and neuro f...

Foot & Ankle Orthopaedics, 2018

Category: Hindfoot Introduction/Purpose: Arthrodesis is a safe and effective treatment for a numb... more Category: Hindfoot Introduction/Purpose: Arthrodesis is a safe and effective treatment for a number of hind and midfoot conditions. However, non-union rates have historically been reported as high as 41%. A number of factors have been identified that increase non-union rates, the most notable and readily modifiable is a patient’s smoking status. Smoking rates in the UK in 2015 were 19.3% for men and 15.3% for women. We have examined the effect of smoking status (current, ex-smokers and non-smokers) on union rates for a large cohort of patients undergoing hind or midfoot arthrodesis. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. The surgeon’s logbook was used to identify patients undergoing any hind and midfoot arthrodesis procedures from January 2010 until September 2016. Revision procedures and charcot arthropathy cases were excluded along with cases with insufficient records available. Demographic data was collected along with: joints involved...

Foot & Ankle Orthopaedics, 2018

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to ... more Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be an effective treatment for end stage ankle arthritis. Achieving normal anatomical alignment has been shown to be important in long term outcomes and revision rates. Recent data from the British NJR has shown that revision rates are higher in patients with pre-operative fixed equinus. Although there is literature about surgical techniques to deal with pre-operative equinus we are not aware of any papers presenting patient outcomes. We present patient reported outcomes for our cohort of patients with pre-operative fixed equinus compared to those able to achieve a plantigrade ankle. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. A mobile bearing prosthesis was used (Mobility TAA system, DePuy, Raynham, Massachusetts, USA). Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual interval...

Trials, 2020

Background The total ankle replacement versus ankle arthrodesis (TARVA) trial aims to determine w... more Background The total ankle replacement versus ankle arthrodesis (TARVA) trial aims to determine which surgical procedure confers the greatest improvement in pain-free function for patients with end-stage ankle osteoarthritis. Both procedures are effective but there has not yet been a direct comparison to establish which is superior. This article describes the statistical analysis plan for this trial as an update to the published protocol. It is written prior to the end of patient follow-up, while the outcome of the trial is still unknown. Design and methods TARVA is a randomised, un-blinded, parallel group trial of total ankle replacement versus ankle arthrodesis. The primary outcome is the Manchester-Oxford Foot Questionnaire walking/standing domain score at 52 weeks post-surgery. Secondary outcomes include measures of pain, social interaction, physical function, quality of life, and range of motion. We describe in detail the statistical aspects of TARVA: the outcome measures, the ...

Foot & Ankle International, 2018

Background: Outcomes for total ankle replacement (TAR) performed for osteoarthritis following pil... more Background: Outcomes for total ankle replacement (TAR) performed for osteoarthritis following pilon fracture are underreported. We compared the outcomes between different indications for TAR. Methods: Patient-reported outcome measures (PROMs) for TAR performed from 2006 to 2014 by a single surgeon were reviewed. Foot and Ankle Outcome Score (FAOS), SF-36, comorbidities, self-reported body mass index (BMI), and patient satisfaction scores were reviewed. Data were collected preoperatively and at 1 and 2 years postoperatively. Clinical notes and radiographs highlighted the indication for TAR. The following subgroups were created: osteoarthritis (OA), rheumatoid arthritis (RA), pilon fracture (PF), ankle fracture (AF), and posttraumatic arthritis without previous fracture (PTOA). PROMs were available for 173 TARs: 89 (51.4%) for OA, 36 (20.8%) for AF, 21 (12.1%) for RA, 15 (8.7%) for PF, and 12 (6.9%) for PTOA. The pilon fracture group were the youngest and had the highest BMI (mean, 56...

Foot & Ankle Orthopaedics, 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: Bone strength about the components is an i... more Category: Ankle, Ankle Arthritis Introduction/Purpose: Bone strength about the components is an important factor in Arthroplasty survival. This importance has been studied in total hip & knee replacement. However, there is paucity of literature Where little has been published regarding the quality of the bone and bone mineral content postoperatively surrounding Ankle Arthroplasty and circumstances surrounding the development of stress fracture. This prospective study used a method to quantify Bone Mineral Density BMD in different regions of the surrounding bones adjacent to tibia and talar components of uncemented Mobility ankle prosthesis, and to study the effect of loading on local ankle bone in the presence of un-cemented three components ankle replacement, by analyzing the BMD of the areas around tibia and talus before and after Mobility total ankle replacement. Methods: Twenty three Ankles (7Females, 15 Males) who underwent a Mobility Total Ankle Arthroplasty (TAA) between Marc...

Foot & Ankle Orthopaedics, 2019

Category: Service improvement Introduction/Purpose: The foot and ankle services at NUTH incorpora... more Category: Service improvement Introduction/Purpose: The foot and ankle services at NUTH incorporates both elective and trauma services. The elective service carries out on average 10,500- 11,000 review appointments/ year and 4000-4500 new patient appointments/year. The waiting times for new out-patient appointments were 8-14 weeks. A new pathway was designed with the aim to improve 18 week national target compliance, improve departmental efficiency, and improve patient satisfaction. Methods: A new initial assessment clinic pathways was designed were all new patients are seen in a one hour slot one stop clinic by a dedicated Extended Scope Practitioner. History and clinical examination are taken as well as initial Proms questionnaire, x-ray assessment followed by gate analysis including pain map, treadmill assessment and plantar pressure analysis. A consultant led MDT review of the finding is performed the same week where plan for treatment or further investigations is formulated. Re...

Foot & Ankle Orthopaedics, 2019

Category: Bunion Introduction/Purpose: There is paucity of literature comparing foot and general ... more Category: Bunion Introduction/Purpose: There is paucity of literature comparing foot and general health status including quality of life between patients presenting with Hallux Valgus and Hallux Rigidus and to compare the outcomes of people how had surgery in either one. We compared foot specific patient reported disability and general health status between patients presenting with Hallux Valgus and Hallux Rigidus pre and post-surgery. Methods: All patients operated between June 2016 and December 2017 with a diagnosis of primary Hallux Valgus or Hallux Rigidus were invited to the study. Patients were grouped based on diagnosis into Group A (Hallux Valgus) and Group B (Hallux Rigidus). All patients received a Pre-Operative and post-operative questionnaire with a minimum of 6 months follow up. Differences were studied between groups for scores of MOX-FQ, EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) comparing both pre and post-operative. Results: There were 53 patients with Hal...

Foot & Ankle Orthopaedics, 2019

Category: Ankle Arthritis Introduction/Purpose: Juvenile idiopathic arthritis is a broad term tha... more Category: Ankle Arthritis Introduction/Purpose: Juvenile idiopathic arthritis is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age persist for more than 6 weeks. It is one of the main diseases affecting Paediatric age group Joints in a form of a chronic, long standing and debilitating disease. It is estimated that 1 in 1000 children present with JIA in the UK alone. Radiographic progression of the disease occurs early, and if not addressed may result in permanent joint destruction and poor functional outcomes. The ankle is frequently involved, but it is unclear whether this is due to synovitis, tenosynovitis. To date, no evidence of combined therapies or integrated care for juvenile idiopathic arthritis patients with F&A problems exists. Methods: JIA patients with ankle involvement presented to orthopedic foot and ankle services between 2012-2017 were include. All patients had weight bearing x-rays ankle ...

The Journal of Foot and Ankle Surgery, 2019

Total ankle replacement (TAR) is an established technique for the treatment of end-stage ankle ar... more Total ankle replacement (TAR) is an established technique for the treatment of end-stage ankle arthritis. The aims of TAR include pain relief, preservation of tibiotalar movement, protection of adjacent joints, and restoration of anatomic alignment in the coronal and sagittal planes. The aims of this study were to determine the relative importance of pre- and post-TAR coronal and sagittal balance on postoperative patient-reported outcome measures (PROMs). A total of 101 ankles in 99 patients were included in this retrospective cohort study. Patients were scored preoperatively and at a minimum of 2years by using the Foot and Ankle Outcome Score (FAOS), the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle score, the Short Form-36 measures, and a set of radiographic measurements to define the sagittal and coronal alignment. There was no significant difference between the groups regarding the anterior or posterior translation of the talus preoperatively. There were no statistically significant correlations between any preoperative measure and any domain of the PROM data. Significant correlations were observed between postoperative medial distal tibial angle and the function domain of the FAOS and the AOFAS hindfoot-ankle score. Preoperative coronal and sagittal plane deformity are not markedly different, depending on the diagnosis. Preoperative deformity does not appear to correlate significantly with postoperative function, as measured by the PROM scores. Postoperative sagittal plane alignment does not correlate significantly with postoperative function, as measured by PROMs. Coronal plane alignment, as measured by the medial distal tibial angle, may be associated with postoperative function, as measured on the AOFAS hindfoot-ankle and FAOS function subscales.

Foot & Ankle Orthopaedics, 2016

Foot & Ankle Orthopaedics, 2017

Category: Ankle Arthritis, Midfoot/Forefoot Introduction/Purpose: There is wide array of outcome ... more Category: Ankle Arthritis, Midfoot/Forefoot Introduction/Purpose: There is wide array of outcome tools available for assessment of level of pain and symptoms in osteoarthritis, there are less disease and region specific outcome measures to evaluate the level of disability caused by arthritis in ankle, mid foot arthritis (including Talo-navicular joint, Calcaneo-cuboid joint and tarso metatarsal joints) and 1st Metatarso phalangeal joints. We aimed to measure the level of disability incorporating elements of physical, mental and social well-being using patient reported outcome measures as recommended by the International classification of Functioning, disability and health (ICF) Methods: This is a prospective data series, patients with arthritis of ankle, mid foot or 1st MTPJ who were diagnosed in new patient clinic were asked to take part in this survey. They completed a questionnaire consisting of MOX-FQ (Manchester Oxford Foot Questionnaire), EQ-5D (General Health Status) and FAOS...

Foot & Ankle Orthopaedics, 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Topographic pain mapping has gained popula... more Category: Ankle, Ankle Arthritis Introduction/Purpose: Topographic pain mapping has gained popularity during 20th century, providing opportunities for patients to demonstrate spatial distribution of pain. Despite this, evidence of clinical application in orthopaedics remains largely limited to spinal pathologies. We investigate how clinician interpretation of routine radiological studies compares to patient pain mapping in ankle arthritis. Methods: Between 2014 and 2016 we identified 21 patients ultimately diagnosed with ankle arthritis, who underwent comprehensive gait analysis (including topographic pain mapping) on referral to our institution. Patients were requested to map up to three pain areas, assigning a visual analogue score (VAS) of 0-10, to signify severity of pain in each area. A consultant orthopaedic foot and ankle surgeon, and orthopaedic trainees undertook blinded evaluation of relevant radiological studies, estimating patients’ mapping and VAS scores on the basis of...

Journal of Bone Joint Surgery British Volume, Sep 1, 2012

Background The recommended indications for total ankle replacement (TAR) are limited, leaving fus... more Background The recommended indications for total ankle replacement (TAR) are limited, leaving fusion as the only definitive alternative. As longer-term clinical results become more promising, should we be broadening our indications for TAR? Materials and Methods Our single-centre series has 133 Mobility TARs with 3–48 months9 follow-up. 16 patients were excluded who were part of a separate RCT. The series was divided into two groups. ‘Ideal’ patients had all of the following criteria: age >60y, BMI Results The ‘Ideal’ group contained 44 ankles vs. 80 in the ‘Not ideal’ group (124 ankles in 117 patients). Complications were (‘Ideal’ vs. ‘Not ideal’): infection: 1 (deep) vs. 3; DVT/PE: 0; periprostheticfracture: 4 vs. 7; CRPS: 2 vs. 2; revision: 0 vs. 2. AOFAS scores showed variable significance (mean values). Pre-op: 27.9 vs. 25.7 (p = 0.459); 3months: 79.4 vs. 73.2 (p = 0.041); 6 months: 79.9 vs. 75.4 (p = 0.053); 12 months: 79.7 vs. 75.8(p = 0.228), 36 months: 77.3 vs. 79.0 (p = 0.655). Further subgroup analysis has been performed. Discussion Our results show that indications for TAR can be widened without further morbidity. Each case must be treated individually and accounted for other factors. Varus/valgus tilt can be corrected with appropriate calcaneal osteotomy +/- tendon transfers as a staged or combined procedure. TAR may be considered in younger patients based on functional and occupational demands. We may no longer be able to deter patients on BMI alone. Diabetic patients do not appear to have a higher complication rate. Conclusion We have increasing evidence that we should now be considering TAR as the primary treatment for disabling ankle arthritis rather than fusion.

Introduction There is less literature reporting outcomes following total ankle replacement (TAR) ... more Introduction There is less literature reporting outcomes following total ankle replacement (TAR) in patients presenting with a coronal plane deformity preoperatively. This study compares clinical and patient reported outcomes at 1 year between TAR patients with and without coronal plane deformity. Methods Patients from single centre prospective cohort (132) who underwent TAR between 2006 and 2010 were included. They were divided into 2 groups based on preoperative coronal plane deformity. Groups 1 and 2 had a coronal plane deformity of 10 respectively. Assessments included American Orthopaedic Foot and Ankle Score (AOFAS), Foot and Ankle Outcome Score (FAOS), SF-36 (Generic Health Measure) and complications recorded preoperatively and 3, 6 and 12 months postoperatively. Results There were 102 ankles (77.2%) in group 1 and 30 ankles (22.7%) in group 2. There was no difference in age and BMI between groups (p > 0.05). AOFAS, FAOS and SF-36 scores showed improvement for both groups ...

The effect of BMI on patient-reported outcomes following total ankle replacement (TAR) is uncerta... more The effect of BMI on patient-reported outcomes following total ankle replacement (TAR) is uncertain and the change in BMI experienced by these patients in the 5 years following surgery has not been studied. We report a series of 106 patients with complete 5-year data on BMI and patient-reported outcome scores. Patients undergoing TAR between 2006 and 2009, took part in the hospital joint registry, which provides routine clinical audit of patient progress following total joint arthroplasty; therefore, ethics committee approval was not required for this study. Data on BMI, Foot and Ankle Score (FAOS) and SF-36 score were collected preoperatively and annually postoperatively. Patients who were obese (BMI >30) had lower FAOS scores pre-operatively and at 5 years, however this did not reach significance. Both obese (p = 0.0004) and non-obese (p < 0.0001) patients demonstrated a significant improvement in FAOS score from baseline to 5 years. This improvement was more marked for the ...

Journal of Bone and Joint Surgery-british Volume, 2014

Introduction: There is paucity of literature on Gait analysis following Total Ankle Replacement (... more Introduction: There is paucity of literature on Gait analysis following Total Ankle Replacement (TAR). We aimed to study changes to gait after successful Mobility TAR. Methods: 20 patients who underwent a primary TAR, with a diagnosis of either OA or PTOA were recruited between October 2008 and March 2011. Gait analysis was carried out using the Helen Hayes marker system with VICON 3D opto-electric system pre-operatively, 3, 6 and 12 months post-operatively. Ankle kinematics and spatio-temporal parameters of gait were studied. Results: 20 patients were included. Mean age was 63.6 years (Range 43–84), mean BMI was 29.6 ± 4.08. Diagnosis was OA in 12 (52.2%) and PTOA in 8 (34.8%). Results showed increase in average and maximum range of dorsiflexion from (3° to 7°) and (11° to 17°) respectively from pre-op to 1 year, but statistically not significant (p>0.05). Of the temporal variables, Average Cadence increased from Pre-op to 1 year (102 to 106 steps/min); double support (0.35% to ...

Background Postoperative pain following (Mobility TM) ankle arthroplasty (AA) is recognised probl... more Background Postoperative pain following (Mobility TM) ankle arthroplasty (AA) is recognised problem. This study aimed to determine pattern of postoperative pain following Ankle arthroplasty (AA). Materials and Methods In prospective observational study 135 patients who had (AA) and follow-up of 12–36 months were included. AOFAS ankle score, patients9 satisfaction, SF36 and diagrammatic mapping of postoperative pain among other parameters were collected preoperatively and postoperatively at 3 months, 6 months and the annually. Patients with AOFAS of Results From total of 135 of patients with follow-up of 12 months, (12.5%)17 patients have low AOFAS score and ankle pain, 11(12.5%) of 85 patients with 2 year follow-up and (10.6%),5 of 47 patients with 3 year follow-up. Most of patients with low AOFAS score during first year have improved but 3 patients. Different group patients developed ankle pain during the second and third year. 3 patients of 5, in year 3 follow-up have medial side ...

Bone & Joint Open, 2021

Aims A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two... more Aims A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two surgical procedures was set up to obtain high-quality evidence of effectiveness. However, the trial faced recruitment challenges and struggled to maintain recruitment rates over 30%, although this is not unusual for surgical trials. We conducted a qualitative study with the aim of gathering information about recruitment practices to identify barriers to patient consent and participation to an orthopaedic trial. Methods We collected 11 audio recordings of recruitment appointments and interviews of research team members (principal investigators and research nurses) from five hospitals involved in recruitment to an orthopaedic trial. We analyzed the qualitative data sets thematically with the aim of identifying aspects of informed consent and information provision that was either unclear, disrupted, or hindered trial recruitment. Results Recruiters faced four common obstacles when recruiti...

Foot & Ankle Orthopaedics, 2020

Category: Ankle Arthritis; Ankle Introduction/Purpose: There is paucity of literature comparing p... more Category: Ankle Arthritis; Ankle Introduction/Purpose: There is paucity of literature comparing patient reported outcomes (PROMs) between total joint arthroplasties. There is a need to study the PROMS data to understand outcomes of treatment and factors affecting outcomes. We aimed to to study the PROMs data for total ankle replacement (TAR) to 10 years. To study how PROMS outcomes of TAR compare to total hip replacement (THR) and total knee replacement (TKR) at 10 years Methods: This is a prospective data collection from local hospital joint registry. 10 year follow up data was collected from patients who underwent a total joint replacement (Hip, Knee or ankle), provided informed consent for their data. Patients who refused consent, or had cognitive language problems were not approached for participation in the registry. Self-administered questionnaire data included WOMAC scores, Foot and ankle outcomes scores (FAOS), SF-36 scores and patient satisfaction data. Data was collected a...

Foot & Ankle Orthopaedics, 2020

Category: Ankle; Ankle Arthritis; Diabetes; Midfoot/Forefoot Introduction/Purpose: The indication... more Category: Ankle; Ankle Arthritis; Diabetes; Midfoot/Forefoot Introduction/Purpose: The indications for Total Ankle Replacement (TAR) in patients with Type II Diabetes mellitus is poorly defined and there is paucity of literature reporting clinical, radiological and patient reported outcomes for TAR in this patient group. We aimed to explore the ideal pre-operative criteria for TAR in patients with Type II DM based on results from our center. Methods: We studied the x-rays, clinical findings and patient reported outcomes of surgery at pre-op and 5 years for patients who underwent a total ankle replacement at our center between 2006 and 2014 who had Type II DM. This was a retrospective study. The above findings were also compared between patients who had Type II DM vs. who were not diabetic. Pre-operative screening for diabetic patients included Hb1Ac levels, clinical reporting of swelling, warmth, erythema findings, neurovascular status including proprioception, vibration and neuro f...

Foot & Ankle Orthopaedics, 2018

Category: Hindfoot Introduction/Purpose: Arthrodesis is a safe and effective treatment for a numb... more Category: Hindfoot Introduction/Purpose: Arthrodesis is a safe and effective treatment for a number of hind and midfoot conditions. However, non-union rates have historically been reported as high as 41%. A number of factors have been identified that increase non-union rates, the most notable and readily modifiable is a patient’s smoking status. Smoking rates in the UK in 2015 were 19.3% for men and 15.3% for women. We have examined the effect of smoking status (current, ex-smokers and non-smokers) on union rates for a large cohort of patients undergoing hind or midfoot arthrodesis. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. The surgeon’s logbook was used to identify patients undergoing any hind and midfoot arthrodesis procedures from January 2010 until September 2016. Revision procedures and charcot arthropathy cases were excluded along with cases with insufficient records available. Demographic data was collected along with: joints involved...

Foot & Ankle Orthopaedics, 2018

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to ... more Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has been shown to be an effective treatment for end stage ankle arthritis. Achieving normal anatomical alignment has been shown to be important in long term outcomes and revision rates. Recent data from the British NJR has shown that revision rates are higher in patients with pre-operative fixed equinus. Although there is literature about surgical techniques to deal with pre-operative equinus we are not aware of any papers presenting patient outcomes. We present patient reported outcomes for our cohort of patients with pre-operative fixed equinus compared to those able to achieve a plantigrade ankle. Methods: This is a single surgeon, retrospective cohort study of consecutive cases. A mobile bearing prosthesis was used (Mobility TAA system, DePuy, Raynham, Massachusetts, USA). Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual interval...

Trials, 2020

Background The total ankle replacement versus ankle arthrodesis (TARVA) trial aims to determine w... more Background The total ankle replacement versus ankle arthrodesis (TARVA) trial aims to determine which surgical procedure confers the greatest improvement in pain-free function for patients with end-stage ankle osteoarthritis. Both procedures are effective but there has not yet been a direct comparison to establish which is superior. This article describes the statistical analysis plan for this trial as an update to the published protocol. It is written prior to the end of patient follow-up, while the outcome of the trial is still unknown. Design and methods TARVA is a randomised, un-blinded, parallel group trial of total ankle replacement versus ankle arthrodesis. The primary outcome is the Manchester-Oxford Foot Questionnaire walking/standing domain score at 52 weeks post-surgery. Secondary outcomes include measures of pain, social interaction, physical function, quality of life, and range of motion. We describe in detail the statistical aspects of TARVA: the outcome measures, the ...

Foot & Ankle International, 2018

Background: Outcomes for total ankle replacement (TAR) performed for osteoarthritis following pil... more Background: Outcomes for total ankle replacement (TAR) performed for osteoarthritis following pilon fracture are underreported. We compared the outcomes between different indications for TAR. Methods: Patient-reported outcome measures (PROMs) for TAR performed from 2006 to 2014 by a single surgeon were reviewed. Foot and Ankle Outcome Score (FAOS), SF-36, comorbidities, self-reported body mass index (BMI), and patient satisfaction scores were reviewed. Data were collected preoperatively and at 1 and 2 years postoperatively. Clinical notes and radiographs highlighted the indication for TAR. The following subgroups were created: osteoarthritis (OA), rheumatoid arthritis (RA), pilon fracture (PF), ankle fracture (AF), and posttraumatic arthritis without previous fracture (PTOA). PROMs were available for 173 TARs: 89 (51.4%) for OA, 36 (20.8%) for AF, 21 (12.1%) for RA, 15 (8.7%) for PF, and 12 (6.9%) for PTOA. The pilon fracture group were the youngest and had the highest BMI (mean, 56...

Foot & Ankle Orthopaedics, 2019

Category: Ankle, Ankle Arthritis Introduction/Purpose: Bone strength about the components is an i... more Category: Ankle, Ankle Arthritis Introduction/Purpose: Bone strength about the components is an important factor in Arthroplasty survival. This importance has been studied in total hip & knee replacement. However, there is paucity of literature Where little has been published regarding the quality of the bone and bone mineral content postoperatively surrounding Ankle Arthroplasty and circumstances surrounding the development of stress fracture. This prospective study used a method to quantify Bone Mineral Density BMD in different regions of the surrounding bones adjacent to tibia and talar components of uncemented Mobility ankle prosthesis, and to study the effect of loading on local ankle bone in the presence of un-cemented three components ankle replacement, by analyzing the BMD of the areas around tibia and talus before and after Mobility total ankle replacement. Methods: Twenty three Ankles (7Females, 15 Males) who underwent a Mobility Total Ankle Arthroplasty (TAA) between Marc...

Foot & Ankle Orthopaedics, 2019

Category: Service improvement Introduction/Purpose: The foot and ankle services at NUTH incorpora... more Category: Service improvement Introduction/Purpose: The foot and ankle services at NUTH incorporates both elective and trauma services. The elective service carries out on average 10,500- 11,000 review appointments/ year and 4000-4500 new patient appointments/year. The waiting times for new out-patient appointments were 8-14 weeks. A new pathway was designed with the aim to improve 18 week national target compliance, improve departmental efficiency, and improve patient satisfaction. Methods: A new initial assessment clinic pathways was designed were all new patients are seen in a one hour slot one stop clinic by a dedicated Extended Scope Practitioner. History and clinical examination are taken as well as initial Proms questionnaire, x-ray assessment followed by gate analysis including pain map, treadmill assessment and plantar pressure analysis. A consultant led MDT review of the finding is performed the same week where plan for treatment or further investigations is formulated. Re...

Foot & Ankle Orthopaedics, 2019

Category: Bunion Introduction/Purpose: There is paucity of literature comparing foot and general ... more Category: Bunion Introduction/Purpose: There is paucity of literature comparing foot and general health status including quality of life between patients presenting with Hallux Valgus and Hallux Rigidus and to compare the outcomes of people how had surgery in either one. We compared foot specific patient reported disability and general health status between patients presenting with Hallux Valgus and Hallux Rigidus pre and post-surgery. Methods: All patients operated between June 2016 and December 2017 with a diagnosis of primary Hallux Valgus or Hallux Rigidus were invited to the study. Patients were grouped based on diagnosis into Group A (Hallux Valgus) and Group B (Hallux Rigidus). All patients received a Pre-Operative and post-operative questionnaire with a minimum of 6 months follow up. Differences were studied between groups for scores of MOX-FQ, EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) comparing both pre and post-operative. Results: There were 53 patients with Hal...

Foot & Ankle Orthopaedics, 2019

Category: Ankle Arthritis Introduction/Purpose: Juvenile idiopathic arthritis is a broad term tha... more Category: Ankle Arthritis Introduction/Purpose: Juvenile idiopathic arthritis is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age persist for more than 6 weeks. It is one of the main diseases affecting Paediatric age group Joints in a form of a chronic, long standing and debilitating disease. It is estimated that 1 in 1000 children present with JIA in the UK alone. Radiographic progression of the disease occurs early, and if not addressed may result in permanent joint destruction and poor functional outcomes. The ankle is frequently involved, but it is unclear whether this is due to synovitis, tenosynovitis. To date, no evidence of combined therapies or integrated care for juvenile idiopathic arthritis patients with F&A problems exists. Methods: JIA patients with ankle involvement presented to orthopedic foot and ankle services between 2012-2017 were include. All patients had weight bearing x-rays ankle ...

The Journal of Foot and Ankle Surgery, 2019

Total ankle replacement (TAR) is an established technique for the treatment of end-stage ankle ar... more Total ankle replacement (TAR) is an established technique for the treatment of end-stage ankle arthritis. The aims of TAR include pain relief, preservation of tibiotalar movement, protection of adjacent joints, and restoration of anatomic alignment in the coronal and sagittal planes. The aims of this study were to determine the relative importance of pre- and post-TAR coronal and sagittal balance on postoperative patient-reported outcome measures (PROMs). A total of 101 ankles in 99 patients were included in this retrospective cohort study. Patients were scored preoperatively and at a minimum of 2years by using the Foot and Ankle Outcome Score (FAOS), the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot-ankle score, the Short Form-36 measures, and a set of radiographic measurements to define the sagittal and coronal alignment. There was no significant difference between the groups regarding the anterior or posterior translation of the talus preoperatively. There were no statistically significant correlations between any preoperative measure and any domain of the PROM data. Significant correlations were observed between postoperative medial distal tibial angle and the function domain of the FAOS and the AOFAS hindfoot-ankle score. Preoperative coronal and sagittal plane deformity are not markedly different, depending on the diagnosis. Preoperative deformity does not appear to correlate significantly with postoperative function, as measured by the PROM scores. Postoperative sagittal plane alignment does not correlate significantly with postoperative function, as measured by PROMs. Coronal plane alignment, as measured by the medial distal tibial angle, may be associated with postoperative function, as measured on the AOFAS hindfoot-ankle and FAOS function subscales.

Foot & Ankle Orthopaedics, 2016

Foot & Ankle Orthopaedics, 2017

Category: Ankle Arthritis, Midfoot/Forefoot Introduction/Purpose: There is wide array of outcome ... more Category: Ankle Arthritis, Midfoot/Forefoot Introduction/Purpose: There is wide array of outcome tools available for assessment of level of pain and symptoms in osteoarthritis, there are less disease and region specific outcome measures to evaluate the level of disability caused by arthritis in ankle, mid foot arthritis (including Talo-navicular joint, Calcaneo-cuboid joint and tarso metatarsal joints) and 1st Metatarso phalangeal joints. We aimed to measure the level of disability incorporating elements of physical, mental and social well-being using patient reported outcome measures as recommended by the International classification of Functioning, disability and health (ICF) Methods: This is a prospective data series, patients with arthritis of ankle, mid foot or 1st MTPJ who were diagnosed in new patient clinic were asked to take part in this survey. They completed a questionnaire consisting of MOX-FQ (Manchester Oxford Foot Questionnaire), EQ-5D (General Health Status) and FAOS...

Foot & Ankle Orthopaedics, 2017

Category: Ankle, Ankle Arthritis Introduction/Purpose: Topographic pain mapping has gained popula... more Category: Ankle, Ankle Arthritis Introduction/Purpose: Topographic pain mapping has gained popularity during 20th century, providing opportunities for patients to demonstrate spatial distribution of pain. Despite this, evidence of clinical application in orthopaedics remains largely limited to spinal pathologies. We investigate how clinician interpretation of routine radiological studies compares to patient pain mapping in ankle arthritis. Methods: Between 2014 and 2016 we identified 21 patients ultimately diagnosed with ankle arthritis, who underwent comprehensive gait analysis (including topographic pain mapping) on referral to our institution. Patients were requested to map up to three pain areas, assigning a visual analogue score (VAS) of 0-10, to signify severity of pain in each area. A consultant orthopaedic foot and ankle surgeon, and orthopaedic trainees undertook blinded evaluation of relevant radiological studies, estimating patients’ mapping and VAS scores on the basis of...