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Biomedical subjects

Stephen F Conti

Publications and source records attributed to Stephen F Conti.

10 recordsLinked to original sources
PubMed2005

Joint replacement in the hallux metatarsophalangeal joint.

Joint replacement of the hallux metatarsophalangeal joint has not enjoyed the same success as hip and knee arthroplasties. Silastic implants have achieved a high patient satisfactory rate but have caused many complications, including silicone synovitis and lymph node inflammation. Metal and polyethylene hemiarthroplasties and total toe replacements seem to be more promising although results are preliminary. Problems with these implants seem to be related to soft tissue instability of the joint; patients who have hallux rigidus have more success than patients who have hallux valgus or rheumatoid arthritis. Severe complications can be treated with removal and synovectomy or arthrodesis, depending on the length and alignment of the foot, as well as the functional demands of the patients. It would be beneficial to have more data on these implants so that improvements can be made in design and patient selection.

Arthroplasty, Replacement↗
PubMed2005

An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor hallucis longus tendon transfer.

BACKGROUND: A number of operative techniques, including decompression with debridement and flexor hallucis longus (FHL) tendon augmentation, have been described for chronic degenerative Achilles tendinosis. Decompression with debridement has been shown to be effective; however, pain and functional limitation can persist in individuals with more severe tendon involvement. Augmentation with the FHL tendon can add mechanical support; however, difficulty in achieving proper tendon tensioning and the potential to leave behind painful diseased tendon are disadvantages of the technique. The purpose of this study was to present the results of a modified technique in which the Achilles tendon is completely excised and the FHL tendon is transferred. METHODS: Fifty-six surgeries using this modified technique were done between October, 1994, and March, 2002, for patients with chronic degenerative Achilles tendinosis. Forty-four patients with and average age of 58.2 (SD 10.1) years and an average time of followup of 3.4 (SD 1.9) years were available for testing. All subjects were mailed a packet of standardized questionnaire information that included the Self-Reported Health Related Quality of Life measures Short Form (SF-36) and the subjective component of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Score. Nineteen patients returned to the clinic for objective assessment. Statistical analysis tested for a difference in the SF-36 scores between our subjects and the general United States population and for a difference in strength and range of motion between the involved and uninvolved lower extremities. RESULTS: Pain decreased in 95.5% (n = 42) patients, and 86.4% (n = 38) patients were satisfied with the result. There was no significant difference (p > .05) between the SF-36 scores obtained by our sample compared to the general United States population. The average AOFAS score for the 19 patients was 91.6 (SD 7.7). Dorsiflexion range of motion was not significantly different (p = 0.17); however, significant deficits were found in plantarflexion range of motion (p = 0.001) and plantarflexion strength (p < 0.025). Strength deficits were 30% on average; however, all but one patient could do a heel raise. CONCLUSION: Complete Achilles tendon excision reduces pain while preserving functional status. Although strength deficits persisted, these deficits did not seem to affect the functional status in this sample of patients.

Achilles Tendon↗
PubMed2005

Evidence of validity for the Foot and Ankle Ability Measure (FAAM).

BACKGROUND: There is no universally accepted instrument that can be used to evaluate changes in self-reported physical function for individuals with leg, ankle, and foot musculoskeletal disorders. The objective of this study was to develop an instrument to meet this need: the Foot and Ankle Ability Measure (FAAM). Additionally, this study was designed to provide validity evidence for interpretation of FAAM scores. METHODS: Final item reduction was completed using item response theory with 1027 subjects. Validity evidence was provided by 164 subjects that were expected to change and 79 subjects that were expected to remain stable. These subjects were given the FAAM and SF-36 to complete on two occasions 4 weeks apart. RESULTS: The final version of the FAAM consists of the 21-item activities of daily living (ADL) and 8-item Sports subscales, which together produced information across the spectrum ability. Validity evidence was provided for test content, internal structure, score stability, and responsiveness. Test retest reliability was 0.89 and 0.87 for the ADL and Sports subscales, respectively. The minimal detectable change based on a 95% confidence interval was +/-5.7 and +/--12.3 points for the ADL and Sports subscales, respectively. Two-way repeated measures ANOVA and ROC analysis found both the ADL and Sports subscales were responsive to changes in status (p < 0.05). The minimal clinically important differences were 8 and 9 points for the ADL and Sports subscales, respectively. Guyatt responsive index and ROC analysis found the ADL subscale was more responsive than general measures of physical function while the Sports subscale was not. The ADL and Sport subscales demonstrated strong relationships with the SF-36 physical function subscale (r = 0.84, 0.78) and physical component summary score (r = 0.78, 0.80) and weak relationships with the SF-36 mental function subscale (r = 0.18, 0.11) and mental component summary score (r = 0.05, -0.02). CONCLUSIONS: The FAAM is a reliable, responsive, and valid measure of physical function for individuals with a broad range of musculoskeletal disorders of the lower leg, foot, and ankle.

Activities of Daily Living↗
PubMed2003

Foot and ankle fractures in elderly white women. Incidence and risk factors.

BACKGROUND: Although foot and ankle fractures are among the most common nonspinal fractures occurring in older women, little is known about their epidemiology. This study was designed to determine the incidence of and risk factors for foot and ankle fractures in a cohort of 9704 elderly, nonblack women enrolled in the multicenter Study of Osteoporotic Fractures. METHODS: At their first clinic visit, between 1986 and 1988, the women provided information regarding lifestyle, subjective health, and function. Bone mineral density was measured in the proximal and distal parts of the radius and in the calcaneus. The women were followed for a mean of 10.2 years, during which time 301 of them had a foot fracture and 291 had an ankle fracture. The fractures were classified with use of a modification of the Orthopaedic Trauma Association's guidelines. RESULTS: The incidence of foot fractures was 3.1 per 1000 woman-years, and the incidence of ankle fractures was 3.0 per 1000 woman-years. The most common ankle fracture was an isolated fibular fracture (prevalence, 57.6%), and the most common foot fracture was a fracture of the fifth metatarsal (56.9%). Women who sustained an ankle fracture had been slightly younger at the time of study enrollment than the women who did not sustain such a fracture (71.0 compared with 71.7 years), they had a higher body mass index (27.6 compared with 26.5), and they were more likely to have fallen within the twelve months prior to filling out the original questionnaire (38.1% compared with 29.7%). The appendicular bone mineral density was not significantly different between these two groups of subjects. Women who sustained a foot fracture had a lower bone mineral density in the distal part of the radius (0.345 g/cm (2) compared with 0.363 g/cm (2) ) and a lower calcaneal bone mineral density (0.394 g/cm (2) compared with 0.404 g/cm (2) ) than the women without a foot fracture, they were less likely to be physically active (62.3% compared with 67.8%), and they were more likely to have had a previous fracture after the age of fifty (45.5% compared with 36.8%) and to be using either long or short-acting benzodiazepines. CONCLUSIONS: Overall, foot fractures appeared to be typical osteoporotic fractures, whereas ankle fractures occurred in younger women with a relatively high body mass index.

Age Distribution↗
PubMed2002

Epidemiology of foot and ankle injuries in the workplace.

Injuries to the ankle, foot, and toes of injured workers are common. Although the workers' compensation system attempts to collect information about these injuries and report them in a meaningful way, the process is somewhat inconsistent, inaccurate, and provides information relevant to government agencies but not to physician organizations seeking to improve the prevention and treatment of work-related injuries. Several improvements in data collection could greatly increase the system's efficiency and usefulness. The first is to establish a national system of uniform data collection from each State. The second improvement involves standardization of the forms and means that the data are collected from the worker including a system to retrieve information that has been omitted during the initial encounter. The third, and most important, refinement is to change the reporting of the illness to match currently accepted medical diagnosis codes (ICD-9). Using the current system and making these improvements, the United States would be able to collect more meaningful data on work injuries in this country. From that point forward medical interventions could then be created and their effects more meaningfully analyzed. All those involved in the care and treatment of the injured worker must recognize not only the limitations of the collected data but also how this information can be manipulated. For example, whereas the total cost of benefits paid by employers increased during one decade the average cost per covered employee decreased. Employers and insurers can argue that their total costs have consistently risen but only by knowing that the cost per covered employee had decreased during that same time period can that argument be countered. Similarly, implementation of certain safety practices during a given time period may be accompanied by a reduction in the number of injuries. Changes in the laws that altered injury reporting and reduced the coverage for certain injuries, however, may have created a situation where the reported injury rates were reduced by accounting practice, not medical practice. It is also well established that insurance company profits may be linked as much to the general economy and stock market as they are to premiums and claims. It is hoped that this article begins an understanding of the extent of the problem of foot and ankle injuries in the working population. Additional statistical information on specific topics is presented elsewhere in this issue.

Accidents, Occupational↗
PubMed2002

Complications of total ankle replacement.

Total ankle arthroplasty with second-generation prostheses is gaining popularity. Complications do and will occur with this group of replacements, just as they do with all other arthroplasties, whether at the knee, hip, elbow, shoulder, or wrist. Even if the complications are understood and the preventative measures or solutions are well thought out, there is occasionally no clear-cut answer to the problem. Although there are many obstacles to a successful outcome, most of the complications reported here are preventable with good patient selection and technique or at least treatable once they occur.

Arthritis↗
PubMed2002

Revision ankle arthrodesis.

Between 1996 and 1999, we performed successful revision ankle arthrodesis for aseptic nonunion in 10 patients using external fixation with bone graft and an implantable bone stimulator. The etiology of the ankle arthrosis in the patients was post-traumatic in eight and rheumatologic in two. The average age of the patients was 54. On average, each patient had received 2.5 previous surgeries (range, 1 to 5) prior to the original fusion attempt. Fusion occurred in all 10 of these patients at an average of 12.8 weeks following revision (range, nine to 20 weeks). Complications occurred in two patients: one had a pin tract infection which resolved with local pin care and oral antibiotics; the second patient had a varus malalignment which was accommodated with orthotics. This patient also had a deep peroneal nerve neuropraxia which resolved with observation. We evaluated all 10 patients with clinical and radiographic examination, and determined their functional results for a duration of follow-up of 15 months (range, six to 36 months). Using a modification of the AOFAS ankle/hindfoot scoring system, the results were: three excellent, four good, two fair, and one poor. All but one of these patients were satisfied with the outcome of this procedure. Radiographic analysis supported good clinical alignment and solid fusion.

Adult↗
PubMed2002

Osteolysis of structural autograft after calcaneocuboid distraction arthrodesis for stage II posterior tibial tendon dysfunction.

Surgical treatment of stage II posterior tibial tendon dysfunction that fails nonoperative treatment is amenable to operative treatment. This commonly consists of a medial soft-tissue reconstruction and lateral column lengthening. We report on 32 patients undergoing distraction calcaneocuboid arthrodesis using an autogenous tricortical iliac crest graft. Almost 50% of patients did not go on to complete and uneventful incorporation of the graft at the arthrodesis site. Two different types of failure were noted. The first was classic nonunion which maintained structural integrity of the graft. The second was osteolysis and collapse of the graft accompanying the nonunion. Risk factors included smoking, K-wire fixation and possibly larger deformities requiring Achilles tendon lengthening. Complications of nonunion were salvageable with reoperation.

Adult↗
PubMedDate not supplied

The effect of pulsed electromagnetic fields on hindfoot arthrodesis: a prospective study.

The aim of this study was to evaluate the effect of pulsed electromagnetic fields in a consecutive series of 64 patients undergoing hindfoot arthrodesis (144 joints). All patients who underwent elective triple/subtalar arthrodesis were randomized into control and pulsed electromagnetic field study groups. Subjects in the study group had an external pulsed electromagnetic fields device applied over the cast for 12 hours a day. Radiographs were taken pre- and postoperatively until radiographic union occurred. A senior musculoskeletal radiologist, blinded to the treatment scheme, evaluated the radiographic parameters. The average time to radiographic union in the control group was 14.5 weeks in 33 primary subtalar arthrodeses. There were 4 nonunions. The study group consisted of 22 primary subtalar arthrodeses and 5 revisions. The average time to radiographic union was 12.9 weeks (P =.136). The average time to fusion of the talonavicular joint in the control group was 17.6 weeks in 19 primary procedures. In the pulsed electromagnetic fields group of 20 primary and 3 revision talonavicular arthrodeses, the average time to radiographic fusion was 12.2 weeks (P =.003). For the 21 calcaneocuboid arthrodeses in control group, the average time to radiographic fusion was 17.7 weeks; it was 13.1 weeks (P =.010) for the 19 fusions in the study group. This study suggests that, if all parameters are equal, the adjunctive use of a pulsed electromagnetic field in elective hindfoot arthrodesis may increase the rate and speed of radiographic union of these joints.

Arthrodesis↗