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  • SAGE Publications  (8)
  • Penner, Murray J.  (8)
  • 1
    Online Resource
    Online Resource
    Does Smoking Affect Outcome in Surgical Management of Ankle Arthritis? A COFAS Multicentre Study
    SAGE Publications ; 2016
    In:  Foot & Ankle Orthopaedics Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0016-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0016-
    Abstract: Ankle Arthritis Introduction/Purpose: Smoking has been shown to increase complication rates after ankle surgery. The aim of this study was to compare complication rates between smokers and non smokers undergoing surgery for ankle arthritis. Methods: Smokers (n=88) and non smokers (n=565) with ankle arthritis who had undergone ankle arthrodesis or ankle arthroplasty were included in the study. Multicentre, prospective data was used from the COFAS ankle arthritis database. Patients with information available on smoking habits and 2 year follow up were included Results: There was no significant difference in the overall re operation rates between smokers and non smokers. However, the amputation rate was higher in smokers (3.4%) as compared to non smokers (0.7%). AOS scores and SF 36 scores were similar in the 2 groups. A higher proportion of smokers underwent fusion (46.5%) as compared to non smokers (28.8%). Amputation rate after ankle arthrodesis was higher in smokers (4.9%) as compared to non smokers (0.6%). Conclusion: Smokers have a higher amputation rate after ankle arthrodesis or ankle arthroplasty as compared to non smokers. Information from this study can be used during counselling of surgical patients
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011416S00168
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2874570-X
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  • 2
    Online Resource
    Online Resource
    Swelling Results in Poor Outcome After Ankle Arthritis Surgery
    SAGE Publications ; 2016
    In:  Foot & Ankle Orthopaedics Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0028-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0028-
    Abstract: Ankle Arthritis Introduction/Purpose: Patients often comment on swelling after foot and ankle surgery. However the relationship between swelling and outcome has not been defined. Pinsker and Daniels demonstrated that swelling was an important aspect of outcome. The purpose of this paper was to determine the relationship between swelling score and outcome after ankle fusion and replacement. A secondary purpose was to determine how this relationship changed in time, how swelling score changed before and after surgery, and determine differences in swelling score between total ankle replacement (TAR), open ankle arthrodesis (OAA) and arthroscopic ankle arthrodesis (AAA). Methods: The MODEMS outcomes package from AAOS was used, with the validated ankle osteoarthritis score (AOS) score being used to assess outcomes in the pain and disability domains. The swelling score was indexed from 1 to 5, 1 being no swelling and five being severe swelling. Outcomes were recorded pre-operatively and annually up to 2010. Statistical analysis was performed using 95% confidence intervals and correlations being determined using Pearson’s correlation and r 2 values. Results: The swelling score was correlated with AOS score preoperatively. Postoperatively patients with a swelling score of 1 had an average AOS score of 15.1 (CI 13.3 to 16.9), a swelling score of 2 had an AOS score of 23 (CI 21.7 to 24.9), 3 an AOS of 31 (CI 29.6 to 33.1), 4 an AOS of 33.6 (CI 34.9 to 38.8), and 5 an AOS of 39 (CI 35.3 to 43.0). There was therefore a difference in outcome score for all groups of swelling score (i.e. 1 scored better than 2, 2 better than 3, 3 better than 4 and 4 better than 5). Swelling scores were the same for TAR, OAA and AAA preoperatively. Postoperatively swelling scores were lower for AAA (2.1, CI 1.9 to 2.2) compared to TAA (2.5, CI 2.4 to 2.6) and OAA (2.5, CI 2.4 t0 2.6). Conclusion: Swelling has a relationship with outcome. Swelling after surgery may result in poorer outcomes. Strategies to reduce swelling such as patient education about elevation, surgical technique and the use of compression stockings may improve outcomes. Arthroscopic surgery may have better outcomes because of the reduction in postoperative swelling.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011416S00285
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 3
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    Validity of a Revision Surgery Classification System for Ankle Arthritis Surgery
    SAGE Publications ; 2016
    In:  Foot & Ankle Orthopaedics Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0004-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0004-
    Abstract: Ankle Arthritis Introduction/Purpose: Reoperations may be a better way of tracking adverse outcomes than complications. Repeat surgery causes cost to the system, and often indicate failure of the primary procedure resulting in the patient not achieving the expected improvement in pain and function. Understanding the cause of repeat surgery at the primary site may result in design improvements to implants or improvements to fusion techniques resulting in better outcomes in the future. Repeat operations around the primary site may also be relevant to the primary surgery. The COFAS group have designed a reoperation classification system. The purpose of this study was to outline the inter and intra observer reliability of this classification scheme. Methods: To verify the inter- and intra-observer reliability of this new coding system, six fellow ship trained practicing foot and ankle Orthopaedic surgeons were asked to classify 61 repeat surgeries. The six surgeons read the operation reports in random order, and reread the reports 2 weeks later in a different order. Reliability was determined using regression analysis and intraclass correlation coefficients (ICC) were calculated and proportions of agreement. The agreement between pairs of readings (915 for inter observer for the first and second read; 61 readings with 15 comparisons) was determined by seeing how often each observer agreed. This was repeated for the 366 ratings for intra observer readings (61 times 6). Results: The inter-observer reliability test on the first read had a mean intra-class correlation coefficient (ICC) of 0.89, range 0.80 to 0.96. For 61 cases, 45 (74%) observations that were given the same code across all six observers for the first read. The inter-observer reliability test on the second read had a mean ICC of 0.94, range .90 to to 1.0. There were 43 (72%) observations that were the same across all six observers. Of all pairs (915 in total) there was agreement in 804 pairs for the first reading (88%). For the second reading there was agreement in 801 pairs (86%). The observers agreed with themselves in the intra-observer observation 324 times out of 366 paired readings (89% agreement of pairs). Conclusion: The COFAS classification of reoperations for end stage ankle arthritis was reliable. This scheme potentially could be applied to other areas of Orthopaedic surgery and should replace the Claiden Dindo modifications that do not accurately reflect Orthopaedic outcomes. As complications are hard to define and lack consistent terminology (Mercer) reoperations and resource utilization (extra clinic visits, extra days in hospital and extra hours of surgery may be more reliable measures of the negative effects of surgery.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011416S00047
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 4
    Online Resource
    Online Resource
    Association of Ankle Arthritis Score With Need for Revision Surgery
    SAGE Publications ; 2017
    In:  Foot & Ankle International Vol. 38, No. 9 ( 2017-09), p. 939-943
    Details
    In: Foot & Ankle International, SAGE Publications, Vol. 38, No. 9 ( 2017-09), p. 939-943
    Abstract: The Ankle Arthritis Score (AAS) is a new patient-reported outcome derived from the Ankle Osteoarthritis Scale (AOS). This study analyzed longitudinally collected data from a cohort of patients in the Canadian Orthopaedic Foot and Ankle Society (COFAS) Ankle Arthritis Study in order to evaluate whether the postoperative AAS is associated with need for revision surgery. Methods: A multicenter, prospective, ankle-reconstruction study enrolled 653 ankles undergoing total ankle replacement (TAR) or ankle arthrodesis (AA). The AAS was given at baseline and annually during postoperative follow-up. Time to revision surgery was modeled using a proportional hazards model. The final sample included 531 ankles in 509 patients. Results: Sixty-two patients underwent metal-component revision and 8 underwent arthrodesis revision during the follow-up time period. The remaining 461 unrevised ankles (300 TAR, 161 AA) had a minimum follow-up of 2 years (average of 3.4 years). Revision surgery after TAR was found to be associated with a higher postoperative AAS and a longer follow-up. The hazard ratio for the AAS indicated that for every 1-point increase in the score, the rate of revision surgery after TAR was 1 percentage point higher. Conclusions: TAR patients who reported higher levels of postoperative functional impairment, as indicated by a higher AAS, were more likely to require metal-component revision surgery. After adjustment for other patient factors, the risk of revision surgery increased with length of follow-up after TAR. This study provides further evidence for the utility of the AAS in the clinical setting. Level of Evidence: Level III, retrospective cohort study.
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    URL: Article
    DOI: 10.1177/1071100717712891
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
    detail.hit.zdb_id: 2129503-7
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  • 5
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    The Impact of Concomitant Ipsilateral Knee Pain on Functional Outcomes in Total Ankle Arthroplasty
    SAGE Publications ; 2022
    In:  Foot & Ankle Specialist Vol. 15, No. 3 ( 2022-06), p. 244-251
    Details
    In: Foot & Ankle Specialist, SAGE Publications, Vol. 15, No. 3 ( 2022-06), p. 244-251
    Abstract: In end-stage ankle arthritis, little is known about the impact of concomitant knee pathology, including the impact of ipsilateral knee pain on total ankle arthroplasty (TAA) outcomes. The aim of this study was to determine the prevalence of ipsilateral preoperative knee pain in patients undergoing TAA and analyze its impact on patient-reported functional outcome measures (PROMs). A retrospective review was performed on the Vancouver End Stage Ankle Arthritis Database at a single institution. In total, 114 patients were studied, with patient demographics collected preoperatively, including the presence or absence of knee pain. Postoperative follow-up was performed at 5 years, primarily analyzing disease-specific PROMs, including the Ankle Osteoarthritis Score (AOS) and Ankle Arthritis Score (AAS). Multivariate mixed-effects linear regression models compared the scores between the groups. In total, 31 patients (27.2%) presented with concomitant ipsilateral knee pain. Despite more females in the knee pain group (64.5% vs 36.1%) there were no other significant differences at baseline between the knee pain and no knee pain groups in terms of demographics or baseline primary disease specific PROMs. At 5 years, the patients with knee pain had significantly worse AAS (37.9 ± 23.8 vs 21.2 ± 16.3, P = .004) and AOS total scores (38.1 ± 24.1 vs 21.9 ± 15.5, P = .005) compared with the no-knee pain group. Both groups improved significantly from baseline across all outcome measures; however, the magnitude of improvement was less in the knee pain group. Our study demonstrated that over one-quarter of patients with end-stage ankle arthritis undergoing TAA present with ipsilateral concomitant knee pain. If present, it is associated with worse functional outcomes at the 5-year mark. Further studies are needed to evaluate if knee pain influences complications, implant failure rates, and survival. Levels of Evidence: Level III
    Type of Medium: Online Resource
    ISSN: 1938-6400 , 1938-7636
    URL: Article
    DOI: 10.1177/1938640020950893
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2411886-2
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  • 6
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    Prospective Randomized Controlled Trial of Hindfoot and Ankle Fusions Treated With rhPDGF-BB in Combination With a β-TCP-Collagen Matrix
    SAGE Publications ; 2015
    In:  Foot & Ankle International Vol. 36, No. 7 ( 2015-07), p. 739-748
    Details
    In: Foot & Ankle International, SAGE Publications, Vol. 36, No. 7 ( 2015-07), p. 739-748
    Abstract: Ankle and hindfoot arthrodesis is often supplemented with autograft to promote bony union. Autograft harvest can lead to increased perioperative morbidity. Purified recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) has stimulated bone formation in mandibular defects and hindfoot fusion. This randomized controlled trial evaluated the efficacy and safety of rhPDGF-BB combined with an injectable, osteoconductive beta-tricalcium phosphate (β-TCP)–collagen matrix versus autograft in ankle and hindfoot fusions. Methods: Seventy-five patients requiring ankle or hindfoot fusion were randomized 5:1 for rhPDGF-BB/β-TCP-collagen (treatment, n = 63) or autograft (control, n = 12). Prospective analysis included 142 autograft control subjects from another clinical trial with identical study protocols. Standardized operative and postoperative protocols were used. Patients underwent standard internal fixation augmented with autograft or 0.3 mg/mL rhPDGF-BB/β-TCP-collagen. Radiologic, clinical, and quality-of-life outcomes were assessed over 52 weeks. Primary outcome was joint fusion (50% or more osseous bridging on computed tomography) at 24 weeks. Secondary outcomes included radiographs, clinical healing status, visual analog scale pain score, American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale score, Foot Function Index score, and Short Form-12 score. Noninferiority P values were calculated. Results: Complete fusion of all involved joints at 24 weeks as indicated by computed tomography was achieved in 53 of 63 (84%) rhPDGF-BB/β-TCP-collagen-treated patients and 100 of 154 (65%) autograft-treated patients ( P 〈 .001). Mean time to fusion was 14.3 ± 8.9 weeks for rhPDGF-BB/β-TCP-collagen patients versus 19.7 ± 11.5 weeks for autograft patients ( P 〈 .01). Clinical success at 52 weeks was achieved in 57 of 63 (91%) rhPDGF-BB/β-TCP-collagen patients and 120 of 154 (78%) autograft patients ( P 〈 .001). Safety-related outcomes were equivalent. Autograft controls had 2 bone graft harvest infections. Conclusions: Application of rhPDGF-BB/β-TCP-collagen was a safe, effective alternative to autograft for ankle and hindfoot fusions, eliminating the pain and morbidity associated with autograft harvesting. Level of Evidence: Level I, prospective randomized study.
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    URL: Article
    DOI: 10.1177/1071100715576370
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 7
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    Measuring the Operative Treatment Effect in End-Stage Ankle Arthritis: Are We Asking the Right Questions? A COFAS Multicenter Study
    SAGE Publications ; 2017
    In:  Foot & Ankle International Vol. 38, No. 10 ( 2017-10), p. 1064-1069
    Details
    In: Foot & Ankle International, SAGE Publications, Vol. 38, No. 10 ( 2017-10), p. 1064-1069
    Type of Medium: Online Resource
    ISSN: 1071-1007 , 1944-7876
    URL: Article
    DOI: 10.1177/1071100717714953
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2017
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  • 8
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    Is the Canadian Orthopaedic Foot and Ankle Society Ankle Arthritis Score (COFAS AAS) Associated with the Need for Revision Surgery?
    SAGE Publications ; 2016
    In:  Foot & Ankle Orthopaedics Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0003-
    Details
    In: Foot & Ankle Orthopaedics, SAGE Publications, Vol. 1, No. 1 ( 2016-08-01), p. 2473011416S0003-
    Abstract: Ankle Arthritis Introduction/Purpose: There has been limited evidence to support the effective use of a patient reported outcome measure (PROM) for patients that have undergone surgical treatment for end-stage ankle arthritis (ESAA). This study used longitudinally collected patient-data from a cohort of patients in the Canadian Orthopaedic Foot and Ankle Society (COFAS) ankle arthritis study to evaluate whether the post-operative COFAS Ankle Arthritis Score (COFAS AAS), a patient-reported outcome (PROs), was associated with need for revision surgery. Methods: Between 2001 and 2010, a cohort of 623 patients and 653 ankles undergoing total ankle replacement or ankle arthrodesis were enrolled in a multicenter prospective ankle reconstruction study. At pre-surgical baseline, key patient level variables were collected including demographics, body mass index, and comorbidities. The COFAS AAS, a patient-reported outcome measure was collected at baseline and annually post-surgically. Time to revision surgery was modeled using a proportional hazards model which controlled for age, sex, BMI, diabetic status, smoking status, inflammatory arthritis, and surgery on the right or left side and time varying PROs. Results: 531 ankles in 509 patients with complete pre and post-operative data were included. Seventy of the cohort underwent metal component revision procedures during the follow up time period . The remaining 461 unrevised ankles had a minimum 2 year follow up (average of 3.4 years). Baseline COFAS AAS, age, sex, side, BMI, diabetic status, smoking status, and inflammatory arthritis were not statistically associated with the need for revision surgery. However, revision surgery was found to be associated with a higher post-operative COFAS AAS, and with a longer follow-up. The hazard ratio for the COFAS AAS indicates that for every one-point increase in the score, the rate of revision surgery was one percentage point higher at each post-operative time point. Conclusion: This study demonstrated that patients who reported higher levels of post-operative functional impairment, as indicated by a higher COFAS AAS, were more likely to undergo a revision surgery. This finding is also based on duration of follow-up, with the risk of revision surgery rising with length of follow up. This study provides further evidence for the utility of the COFAS AAS in the clinical setting. Further investigation is warranted to better understand the COFAS AAS’s ability to measure clinically meaningful change in an individual patient not requiring revision surgery.
    Type of Medium: Online Resource
    ISSN: 2473-0114 , 2473-0114
    URL: Article
    DOI: 10.1177/2473011416S00035
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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