Studies concerning total ankle arthroplasty could be influenced by several forms of bias. Indepen... more Studies concerning total ankle arthroplasty could be influenced by several forms of bias. Independent national arthroplasty registries represent objective data on survival and patient reported outcomes. The aim of this study was to determine survival and identify risk factors for early failure in a nationwide series of total ankle arthroplasties from the Dutch Arthroplasty Register (LROI). Data of 810 patients, who received 836 total ankle arthroplasties between 2014 and 2020 were obtained from the Dutch Arthroplasty Register (LROI) with a median follow-up of 38 months (range 1-84 months). Survival was expressed in Kaplan-Meier analysis and associated hazard ratios for implant failure were determined. Implant failure was defined as the need for revision surgery for any reason or (pan)arthrodesis. During follow-up, we recorded 39 failures (4.7%) resulting in a implant survival of 95.3% with a median follow-up of 38 months (range 1-84 months). Medial malleolus osteotomy (HR = 2.27), previous surgery (HR = 1.83), previous osteotomy (HR = 2.82) and previous ligament reconstruction (HR = 2.83) all showed potentially clinically meaningful associations with a higher incidence of implant failure, yet only previous OCD treatment (HR = 6.21), BMI (HR = 1.09) and age (HR = 0.71) were statistically significant. Excellent short-term survival (95.3%) with a median follow-up of 38 months was reported for TAA patients from the Dutch Arthroplasty Register. Patients with a lower age, a higher BMI or who had a prior surgical OCD treatment before TAA surgery appear to have a higher risk for revision after short-term clinical follow-up. Thorough patient selection with emphasis on risk factors associated with early implant failure might be essential to improve TAA survivorship.
A rare case of tibial apophyseal fracture with extension in the antero-lateral physis and epiphys... more A rare case of tibial apophyseal fracture with extension in the antero-lateral physis and epiphysis in a 17-year-old boy is described. This type of fracture, which can be associated with intra-articular lesions and lesions of the extensor mechanism, resembles the better known distal tibial triplane fracture. Arthroscopic controlled anatomic reduction with restoration of the articular surface was achieved.
A comparison of hallux valgus angles assessed r pressure degrees (SD 5.0), respectively. The syst... more A comparison of hallux valgus angles assessed r pressure degrees (SD 5.0), respectively. The systemic difference of radiographic measurements compared with clinical
Journal of Bone and Joint Surgery-british Volume, 2017
Total ankle replacement (TAR) is increasingly used in the treatment of end-stage ankle arthropath... more Total ankle replacement (TAR) is increasingly used in the treatment of end-stage ankle arthropathy, but much debate exists about the clinical result. The goals of present study are: 1) to provide an overview of the clinical outcome of 58 TAR9s in a single centre and 2) to assess the association between radiological characteristics and clinical outcome. We reviewed a prospective included cohort of 58 TAR9s in 54 patients with a mean age of 66.9 (range 54–82) and a mean follow-up of 21.6 months (range 1.45–66.0). The TAR9s where performed by a single surgeon in a single centre (MUMC) between 2010 and 2015, using the CCI ankle replacement. A standard surgical protocol and standardized post-op rehabilitation was used. Patients were followed-up pre-op and at 1 day, 6 weeks, 3–6–12 months and yearly thereafter post-op. The AOFAS and range of motion (ROM) were assessed and all complications, re-operations and the presence of pain were recorded. Radiographic assessment consisted of the esti...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004
Ankle arthroscopy is believed to have the least vascular complications compared with other types ... more Ankle arthroscopy is believed to have the least vascular complications compared with other types of arthroscopies. We present a case of traumatic pseudoaneurysm of the anterior tibial artery after ankle arthroscopy, an extremely rare complication that was treated surgically and had an uneventful recovery.
The formation of a fibroma of the tendon sheath, a rare, slow-growing, benign tumor, usually occu... more The formation of a fibroma of the tendon sheath, a rare, slow-growing, benign tumor, usually occurs in the upper extremities of young adult males. We present an extremely rare case of a fibroma of the tendon sheath arising adjacent to the Achilles tendon within Kager's triangle in a 41-year-old female. The patient presented with progressive pain localized to the posterior aspect of the left ankle. Complete excision and histopathologic analysis of the fibroma were performed. The patient experienced an uneventful recovery after the intervention and had no evidence of recurrence after 3 months of follow-up. Fibroma of the tendon sheath should be included in the differential diagnosis when a patient presents with a painful soft tissue mass in Kager's triangle.
Avascular necrosis of the talus is a well-documented complication following fractures, although l... more Avascular necrosis of the talus is a well-documented complication following fractures, although less is known about this complication following reconstructive foot and ankle surgery. Knowledge of the blood supply of the talus is necessary for surgical dissection of the talus, especially when the approach traverses the sinus tarsi. In this article, we describe a rare case of avascular necrosis of the talus after talonavicular arthrodesis, using a medial surgical approach.
Background Transcatheter occlusion of patent ductus arteriosus (PDA) has been associated with pro... more Background Transcatheter occlusion of patent ductus arteriosus (PDA) has been associated with protrusion of the occluder device into the left pulmonary artery (LPA). This study was conducted to evaluate the significance of occluder protrusion and its implications for potential obstruction of the LPA and associated decrease of left lung perfusion. Methods and Results Fifty-two patients underwent successful transcatheter PDA occlusion over a period of 5 years. In this study, 49 were reexamined between March and June 1995. In addition to clinical and echocardiographic examination, lung scintigraphy was performed. Protrusion into the LPA was present in 5 of 49 patients (10%). In these patients, maximal flow velocity in the LPA was significantly ( P <.01) increased. Decreased left lung perfusion, defined as <40% of total pulmonary blood flow, was found in 7 of 49 patients (14%). Although mean left pulmonary perfusion was significantly ( P =.02) decreased in patients with protrusion...
Background Malalignment is often postulated as an important reason for the high failure rate of t... more Background Malalignment is often postulated as an important reason for the high failure rate of total ankle replacements (TARs). The correlation between TAR malalignment and clinical outcome, however, is not fully understood. Improving and expanding radiographic TAR alignment measurements in the clinic might lead to a better insight into the correlation between malalignment and the clinical outcome. This study aims to develop and validate a tool to semi-automatic measure TAR alignment, and to improve alignment measurements on radiographs in the clinic. Methods A tool to semi-automatically measure TAR alignment on anteroposterior and lateral radiographs was developed in MATLAB. Using the principle of edge contouring and the perpendicular relationship between the anteroposterior and lateral radiographs, the exact configuration of the TAR components can be found. Two observers validated the tool by measuring TAR alignment of ten patients using the tool. The Intraclass Coefficient (ICC)...
Background: Total ankle arthroplasty is increasingly used as a treatment for endstage ankle arthr... more Background: Total ankle arthroplasty is increasingly used as a treatment for endstage ankle arthropathy. The aim of our study was to report the mid-term clinical function and survival results of Ceramic Coated Implant (CCI) ankle replacements and assess the association between the alignment of the CCI total ankle replacements and early functional outcome and complication incidence.Methods: Data of 61 patients, who received 65 CCI implants between 2010 and 2016, were obtained from a prospectively documented database. Mean follow-up time was 85.2 months (range 27-99 months). Clinical function was assessed with AOFAS questionnaire and passive range of motion (ROM). Survival analysis and elaborate radiographic analysis was performed. Furthermore, complications and re-operations were recorded for all patients Results: Progression in ROM was most seen in the first 10 months from 21.8 degrees of passive range of motion preoperative to 27.6 degrees postoperative (p< 0.001), while the AOF...
Introduction Malalignment of the Total Ankle Replacement (TAR) has often been postulated as the m... more Introduction Malalignment of the Total Ankle Replacement (TAR) has often been postulated as the main reason for the high incidence of TAR failure. As the ankle joint has a small contact area, stresses are typically high, and malalignment may lead to non-homogeneous stress distributions, including stress peaks that may initiate failure. This study aims to elucidate the effect of TAR malalignment on the contact stresses on the bone-implant interface, thereby gaining more understanding of the potential role of malalignment in TAR failure. Methods Finite Element (FE) models of the neutrally aligned as well as malaligned CCI (Ceramic Coated Implant) Evolution TAR implant (Van Straten Medical) were developed. The CCI components were virtually inserted in a generic three-dimensional (3D) reconstruction of the tibia and talus. The tibial and talar TAR components were placed in neutral alignment and in 5° and 10° varus, valgus, anterior and posterior malalignment. Loading conditions of the t...
Purpose Flat feet are an important cause of foot problems in children. The flexible flat foot is ... more Purpose Flat feet are an important cause of foot problems in children. The flexible flat foot is the most common form and is normally physiological and asymptomatic. Further assessment is necessary when a symptomatic flat foot persists. Surgical interventions are indicated when conservative therapies have failed. The Kalix arthroereisis is a surgical option and is placed in the subtalar joint of the foot, thereby preventing hyperpronation, and stabilizes the foot against excessive movements. The purpose of this study was to evaluate the functional and radiological outcomes of pediatric patients who had undergone a Kalix implantation for the treatment of a symptomatic flexible flat foot. Methods Patient files of our institution were searched for patients who underwent a Kalix implantation between 2009 and 2014. Sixteen patients (26 feet) with symptomatic flexible flat feet were clinically and radiographically evaluated in this retrospective study. The calcaneal pitch and Meary”s angl...
Studies concerning total ankle arthroplasty could be influenced by several forms of bias. Indepen... more Studies concerning total ankle arthroplasty could be influenced by several forms of bias. Independent national arthroplasty registries represent objective data on survival and patient reported outcomes. The aim of this study was to determine survival and identify risk factors for early failure in a nationwide series of total ankle arthroplasties from the Dutch Arthroplasty Register (LROI). Data of 810 patients, who received 836 total ankle arthroplasties between 2014 and 2020 were obtained from the Dutch Arthroplasty Register (LROI) with a median follow-up of 38 months (range 1-84 months). Survival was expressed in Kaplan-Meier analysis and associated hazard ratios for implant failure were determined. Implant failure was defined as the need for revision surgery for any reason or (pan)arthrodesis. During follow-up, we recorded 39 failures (4.7%) resulting in a implant survival of 95.3% with a median follow-up of 38 months (range 1-84 months). Medial malleolus osteotomy (HR = 2.27), previous surgery (HR = 1.83), previous osteotomy (HR = 2.82) and previous ligament reconstruction (HR = 2.83) all showed potentially clinically meaningful associations with a higher incidence of implant failure, yet only previous OCD treatment (HR = 6.21), BMI (HR = 1.09) and age (HR = 0.71) were statistically significant. Excellent short-term survival (95.3%) with a median follow-up of 38 months was reported for TAA patients from the Dutch Arthroplasty Register. Patients with a lower age, a higher BMI or who had a prior surgical OCD treatment before TAA surgery appear to have a higher risk for revision after short-term clinical follow-up. Thorough patient selection with emphasis on risk factors associated with early implant failure might be essential to improve TAA survivorship.
A rare case of tibial apophyseal fracture with extension in the antero-lateral physis and epiphys... more A rare case of tibial apophyseal fracture with extension in the antero-lateral physis and epiphysis in a 17-year-old boy is described. This type of fracture, which can be associated with intra-articular lesions and lesions of the extensor mechanism, resembles the better known distal tibial triplane fracture. Arthroscopic controlled anatomic reduction with restoration of the articular surface was achieved.
A comparison of hallux valgus angles assessed r pressure degrees (SD 5.0), respectively. The syst... more A comparison of hallux valgus angles assessed r pressure degrees (SD 5.0), respectively. The systemic difference of radiographic measurements compared with clinical
Journal of Bone and Joint Surgery-british Volume, 2017
Total ankle replacement (TAR) is increasingly used in the treatment of end-stage ankle arthropath... more Total ankle replacement (TAR) is increasingly used in the treatment of end-stage ankle arthropathy, but much debate exists about the clinical result. The goals of present study are: 1) to provide an overview of the clinical outcome of 58 TAR9s in a single centre and 2) to assess the association between radiological characteristics and clinical outcome. We reviewed a prospective included cohort of 58 TAR9s in 54 patients with a mean age of 66.9 (range 54–82) and a mean follow-up of 21.6 months (range 1.45–66.0). The TAR9s where performed by a single surgeon in a single centre (MUMC) between 2010 and 2015, using the CCI ankle replacement. A standard surgical protocol and standardized post-op rehabilitation was used. Patients were followed-up pre-op and at 1 day, 6 weeks, 3–6–12 months and yearly thereafter post-op. The AOFAS and range of motion (ROM) were assessed and all complications, re-operations and the presence of pain were recorded. Radiographic assessment consisted of the esti...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004
Ankle arthroscopy is believed to have the least vascular complications compared with other types ... more Ankle arthroscopy is believed to have the least vascular complications compared with other types of arthroscopies. We present a case of traumatic pseudoaneurysm of the anterior tibial artery after ankle arthroscopy, an extremely rare complication that was treated surgically and had an uneventful recovery.
The formation of a fibroma of the tendon sheath, a rare, slow-growing, benign tumor, usually occu... more The formation of a fibroma of the tendon sheath, a rare, slow-growing, benign tumor, usually occurs in the upper extremities of young adult males. We present an extremely rare case of a fibroma of the tendon sheath arising adjacent to the Achilles tendon within Kager&amp;amp;#39;s triangle in a 41-year-old female. The patient presented with progressive pain localized to the posterior aspect of the left ankle. Complete excision and histopathologic analysis of the fibroma were performed. The patient experienced an uneventful recovery after the intervention and had no evidence of recurrence after 3 months of follow-up. Fibroma of the tendon sheath should be included in the differential diagnosis when a patient presents with a painful soft tissue mass in Kager&amp;amp;#39;s triangle.
Avascular necrosis of the talus is a well-documented complication following fractures, although l... more Avascular necrosis of the talus is a well-documented complication following fractures, although less is known about this complication following reconstructive foot and ankle surgery. Knowledge of the blood supply of the talus is necessary for surgical dissection of the talus, especially when the approach traverses the sinus tarsi. In this article, we describe a rare case of avascular necrosis of the talus after talonavicular arthrodesis, using a medial surgical approach.
Background Transcatheter occlusion of patent ductus arteriosus (PDA) has been associated with pro... more Background Transcatheter occlusion of patent ductus arteriosus (PDA) has been associated with protrusion of the occluder device into the left pulmonary artery (LPA). This study was conducted to evaluate the significance of occluder protrusion and its implications for potential obstruction of the LPA and associated decrease of left lung perfusion. Methods and Results Fifty-two patients underwent successful transcatheter PDA occlusion over a period of 5 years. In this study, 49 were reexamined between March and June 1995. In addition to clinical and echocardiographic examination, lung scintigraphy was performed. Protrusion into the LPA was present in 5 of 49 patients (10%). In these patients, maximal flow velocity in the LPA was significantly ( P <.01) increased. Decreased left lung perfusion, defined as <40% of total pulmonary blood flow, was found in 7 of 49 patients (14%). Although mean left pulmonary perfusion was significantly ( P =.02) decreased in patients with protrusion...
Background Malalignment is often postulated as an important reason for the high failure rate of t... more Background Malalignment is often postulated as an important reason for the high failure rate of total ankle replacements (TARs). The correlation between TAR malalignment and clinical outcome, however, is not fully understood. Improving and expanding radiographic TAR alignment measurements in the clinic might lead to a better insight into the correlation between malalignment and the clinical outcome. This study aims to develop and validate a tool to semi-automatic measure TAR alignment, and to improve alignment measurements on radiographs in the clinic. Methods A tool to semi-automatically measure TAR alignment on anteroposterior and lateral radiographs was developed in MATLAB. Using the principle of edge contouring and the perpendicular relationship between the anteroposterior and lateral radiographs, the exact configuration of the TAR components can be found. Two observers validated the tool by measuring TAR alignment of ten patients using the tool. The Intraclass Coefficient (ICC)...
Background: Total ankle arthroplasty is increasingly used as a treatment for endstage ankle arthr... more Background: Total ankle arthroplasty is increasingly used as a treatment for endstage ankle arthropathy. The aim of our study was to report the mid-term clinical function and survival results of Ceramic Coated Implant (CCI) ankle replacements and assess the association between the alignment of the CCI total ankle replacements and early functional outcome and complication incidence.Methods: Data of 61 patients, who received 65 CCI implants between 2010 and 2016, were obtained from a prospectively documented database. Mean follow-up time was 85.2 months (range 27-99 months). Clinical function was assessed with AOFAS questionnaire and passive range of motion (ROM). Survival analysis and elaborate radiographic analysis was performed. Furthermore, complications and re-operations were recorded for all patients Results: Progression in ROM was most seen in the first 10 months from 21.8 degrees of passive range of motion preoperative to 27.6 degrees postoperative (p< 0.001), while the AOF...
Introduction Malalignment of the Total Ankle Replacement (TAR) has often been postulated as the m... more Introduction Malalignment of the Total Ankle Replacement (TAR) has often been postulated as the main reason for the high incidence of TAR failure. As the ankle joint has a small contact area, stresses are typically high, and malalignment may lead to non-homogeneous stress distributions, including stress peaks that may initiate failure. This study aims to elucidate the effect of TAR malalignment on the contact stresses on the bone-implant interface, thereby gaining more understanding of the potential role of malalignment in TAR failure. Methods Finite Element (FE) models of the neutrally aligned as well as malaligned CCI (Ceramic Coated Implant) Evolution TAR implant (Van Straten Medical) were developed. The CCI components were virtually inserted in a generic three-dimensional (3D) reconstruction of the tibia and talus. The tibial and talar TAR components were placed in neutral alignment and in 5° and 10° varus, valgus, anterior and posterior malalignment. Loading conditions of the t...
Purpose Flat feet are an important cause of foot problems in children. The flexible flat foot is ... more Purpose Flat feet are an important cause of foot problems in children. The flexible flat foot is the most common form and is normally physiological and asymptomatic. Further assessment is necessary when a symptomatic flat foot persists. Surgical interventions are indicated when conservative therapies have failed. The Kalix arthroereisis is a surgical option and is placed in the subtalar joint of the foot, thereby preventing hyperpronation, and stabilizes the foot against excessive movements. The purpose of this study was to evaluate the functional and radiological outcomes of pediatric patients who had undergone a Kalix implantation for the treatment of a symptomatic flexible flat foot. Methods Patient files of our institution were searched for patients who underwent a Kalix implantation between 2009 and 2014. Sixteen patients (26 feet) with symptomatic flexible flat feet were clinically and radiographically evaluated in this retrospective study. The calcaneal pitch and Meary”s angl...
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