https://rapm.bmj.com/content/rapm/40/5/401.full.pdf

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015

Reoperation rates are higher in total ankle arthroplasties (TAAs) compared with ankle arthrodesis. Infection rates for primary TAAs are 1.4% to 2.4%. The survival rate of TAA is approximately 75% to 90% at 10 years. Arc of motion is maintained with TAAs compared with ankle arthrodesis. Ankle arthrodesis increases arc of motion through the talonavicular joint. Several factors are strong reasons to favor ankle fusion rather than TAA. TAA and ankle arthrodesis are effective treatments of end-stage ankle arthritis but the choice must be tailored to individual patients.

Ankle Arthrodesis Versus Total Ankle Arthroplasty

Background
About 1% of adults suffer from painful osteoarthritis of the ankle. The current literature contains no information on the percentage of such patients who derive long-term relief of symptoms from conservative treatment. Advanced ankle osteoarthritis can be treated with non-joint-preserving measures, such as total ankle replacement and ankle fusion.

/pdf/total-ankle-replacement-4y2skh42v2.pdf

Total Ankle Replacement

Supramalleolar osteotomy is a joint-preserving surgical treatment for patients with asymmetric valgus or varus ankle arthritis. The primary goal of the procedure is to realign the spatial relationship between the talus and tibia and thereby normalize joint loading within the ankle. Procedures to balance the soft tissues, as well as hindfoot osteotomy and arthrodesis, may also be necessary. Clinical studies of supramalleolar osteotomy demonstrate that correction of the altered biomechanics associated with asymmetric arthritis improves functional outcomes.

Supramalleolar Osteotomies for the Treatment of Ankle Arthritis.

The patient-reported Manchester-Oxford Foot Questionnaire (MOXFQ), with 3 dimensions (Walking/standing(W/S), Pain, Social interaction(SI)) has previously been validated in patients undergoing hallux valgus surgery. A preliminary cross-sectional evaluation of its measurement properties relating to surgery on different regions of the foot and ankle is presented here. Within 4 weeks prior to foot or ankle surgery, 671of 764 consecutive eligible patients (87.8% response rate) were assessed with the: (i) MOXFQ questionnaire, (ii) SF-36 general health survey (iii) American Orthopaedic Foot & Ankle Society (AOFAS) scales. Sample characteristics: mean age 53 years 427 (63.6%) female. Patients were booked for (main) surgery on Hallux (210, 31.3%), Lesser Toes (119, 17.7%), Mid foot (22, 3.3%), Ankle/Hind foot (311, 46.3%) and whole foot/multiple regions (9, 1.3%) MOXFQ item response rates were high ( The MOXFQ demonstrates good baseline measurement properties in patients undergoing a range of foot and ankle surgery, suggesting its suitability as an outcome measure for clinical trials of foot and ankle surgery in general. The SI dimension, concerned with cosmesis and social participation has somewhat weaker properties but remains useful. Evidence for the MOXFQ9s responsiveness across the range of foot and ankle surgery is yet to be assessed.

The moxfq patient-reported questionnaire: assessment of data quality, reliability and validity in relation to foot and ankle surgery

We performed a systematic review and meta-analysis
of modern total ankle replacements (TARs) to determine the survivorship,
outcome, complications, radiological findings and range of movement,
in patients with end-stage osteoarthritis (OA) of the ankle who
undergo this procedure. We used the methodology of the Cochrane Collaboration,
which uses risk of bias profiling to assess the quality of papers
in favour of a domain-based approach. Continuous outcome scores
were pooled across studies using the generic inverse variance method
and the random-effects model was used to incorporate clinical and
methodological heterogeneity. We included 58 papers (7942 TARs)
with an interobserver reliability (Kappa) for selection, performance,
attrition, detection and reporting bias of between 0.83 and 0.98.
The overall survivorship was 89% at ten years with an annual failure
rate of 1.2% (95% confidence interval (CI) 0.7 to 1.6). The mean
American Orthopaedic Foot and Ankle Society score changed from 40 (95%
CI 36 to 43) pre-operatively to 80 (95% CI 76 to 84) at a mean follow-up
of 8.2 years (7 to 10) (p < 0.01). Radiolucencies were identified
in up to 23% of TARs after a mean of 4.4 years (2.3 to 9.6). The
mean total range of movement improved from 23° (95% CI 19 to 26)
to 34° (95% CI 26 to 41) (p = 0.01). Our study demonstrates that TAR has a positive impact on patients’
lives, with benefits lasting ten years, as judged by improvement
in pain and function, as well as improved gait and increased range
of movement. However, the quality of evidence is weak and fraught
with biases and high quality randomised controlled trials are required
to compare TAR with other forms of treatment such as fusion. Cite this article: Bone Joint J 2013;95-B:1500–7.

The outcome of total ankle replacement: A systematic review and meta-analysis

<h3>Aims</h3> The 2019 National Health Service (NHS) England <i>Long Term Plan</i><sup>1</sup> pledges to improve provision of age appropriate care for young people, and move towards service models which include 0-25 year olds. This proposal recognises the complex and diverse developmental and psychosocial needs of adolescents and young people (AYP), and the adverse consequences of a poor transition between child and adult services on health and well-being. It builds on the 2004 Department of Health guidance that hospital-based care should be provided in a location and environment that is ‘well-suited to the age and stage of development’ of children and young people.<sup>2</sup> Yet there are few published data exploring how this earlier guidance has been interpreted by trusts, and what the current admission policies for young people admitted to acute NHS Trusts in England are in terms of age and stage of development. This national service evaluation aimed to determine where adolescents who are admitted as inpatients to NHS England hospitals receive their care, and to establish what resources are available for them. <h3>Methods</h3> A multiple-choice questionnaire was distributed by email to the paediatric clinical leads of all 155 NHS England hospitals identified as having paediatric inpatient departments. Responding to the questionnaire was voluntary. The questionnaire included questions about age-related admission policies, care environment, and provision of adolescent specific facilities, services and staffing. Data were analysed using descriptive statistics in Microsoft Excel. <h3>Results</h3> Questionnaire responses were received from 115/155 paediatric departments (74% response rate). All had either a formal (n=102) or informal (n=13) policy of admitting patients to paediatric wards based on age. Most (n=63, 55%) only admitted young people under 16 years of age to a paediatric setting (table 1). 22% (n=25) of paediatric units who completed the survey had a designated inpatient ward or bay for adolescents. The most common adolescent specific staff group the paediatric departments employed for AYP to access support from as inpatients was a Child and Adolescent Mental Health Services (CAMHS) liaison nurse (n=48, 42%) (figure 1). There was no inpatient transition policy for young people in 57 (50%) of the responding paediatric departments. <h3>Conclusion</h3> There is substantial variability in the services provided to young people admitted to NHS hospitals in England. In the majority of trusts completing the survey, most young people only receive inpatient care within paediatric services until their 16th birthday. There is little evidence that ‘developmental stage’ factors into decisions regarding location and environment for inpatient care for young people. There is inconsistent availability of adolescent specific inpatient facilities and services in paediatric departments nationally. These findings suggest a failure of many NHS trusts to act upon nationally established guidance and expectations for good practice in AYP care. Understanding the reasons for this and how they should be addressed should be a priority to meet the goals of <i>The NHS Long Term Plan</i>, and effect change to improve the inpatient care received by young people in England. <h3>References</h3> Available from: https://www.longtermplan.nhs.uk/, National Health Service. Available from: https://www.gov.uk/government/publications/national-service-framework-children-young-people-and-maternity-services, Department of Health. 

/pdf/315-what-paediatric-inpatient-services-provide-for-1rexv706.pdf

315 What paediatric inpatient services provide for adolescents: a service evaluation of acute NHS trusts in England

Background: The microbiota in the intestine is made up of trillions of living bacteria that coexist with the host. Administration of antibiotics during neonatal infection causes depletion of gut flora resulting in gut dysbiosis. Over the last few decades, probiotics have been created and promoted as microbiota management agents to enrich gut flora. Probiotics decrease the overgrowth of pathogenic bacteria in the gut of preterm neonates, reducing the frequency of nosocomial infections in the Neonatal Intensive Care Unit (NICUs). Methods: The systematic review will include randomized control trials (RCTs) of premier neonates with sepsis. Studies will be retrieved from global databases like Cochrane CENTRAL, CINAHL Plus via EBSCO host, MEDLINE via PubMed, EMBASE, SCOPUS, Ovid, Web of Science, ProQuest Medical Library, Microsoft academic, and DOAJ by utilizing database-specific keywords. Screening, data extraction, and critical appraisal of included research will be carried out separately by two review writers. Findings will be reported in accordance with the PRISMS-P 2020 guidelines. Conclusions: The findings of this systematic review will help to translate the evidence-based information needed to encourage the implementation of potential research output in the field of neonatal intensive care, guide best clinical practise, assist policy making and implementation to prevent gut dysbiosis in neonates with sepsis by summarising and communicating the evidence on the topic. PROSPERO registration number: This systematic review protocol has been registered in PROSPERO (Prospective Register of Systematic Reviews) on 10th March 2022. The registration number is CRD42022315980.

https://f1000research.com/articles/11-913/pdf

N Siva

Papers

The outcome of total ankle replacement: A systematic review and meta-analysis

315 What paediatric inpatient services provide for adolescents: a service evaluation of acute NHS trusts in England

Probiotic effect in preterm neonates with sepsis - A systematic review protocol