Bone, union and Osteoarthritis

Research output: Types of ThesisDoctoral ThesisInternal

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Abstract

In the first part of this thesis, we elaborated on surgical treatments for knee and ankle osteoarthritis (OA). In the knee, we investigated with a randomized controlled trial (RCT) whether open wedge high tibia osteotomies (HTO) and closed wedge HTO can accurately correct varus malformation (chapter 2). Our results showed that both techniques can be used to achieve accurate corrections. In the ankle, we assessed whether talocrural arthrodesis induces OA development in adjacent joints, or if OA is already pre-existing (chapter 3). This was done by performing a retrospective cohort study. The study showed that OA progresses after talocrural arthrodesis, especially in patients without pre-existing OA. However, the clinical impact of the progression seems to be limited.

The second part of this thesis is about objective bone union assessment. With a systematic review in animal studies, we searched for CT parameters that can reliably represent bone union after a surgery, fracture or arthrodesis (chapter 4). From this study, CT-assessed torsional rigidity and callus density seem the most promising parameters to represent actual bone union. A second systematic review was performed in clinical studies, to investigate which methods are currently used to assess bone union after foot or ankle arthrodesis (chapter 5). Based on the results of this review we would advise to calculate percentage fusion and apply a 30% fusion threshold to distinguish fused from non-fused joints.

The third part of this thesis is about extracorporeal shock wave therapy, to stimulate bone union after fracture or arthrodesis. We performed a systematic review to present the currently available literature on the effectiveness of ESWT as a treatment for delayed-union and nonunion fractures (chapter 6). Based on this study it seems that ESWT is as effective as surgical treatment for treatment of delayed-unions and nonunions. Lastly, a RCT was performed to investigate whether ESWT can reduce the number of delayed-unions after talocrural arthrodesis (chapter 7). Our results did not show a significant effect between number of delayed-unions in patients treated with ESWT versus patients without ESWT. Therefore, this study could not prove that ESWT is an effective treatment to decrease the number of delayed unions after talocrural arthrodesis.
Original languageEnglish
Awarding Institution
  • Erasmus University Rotterdam
Supervisors/Advisors
  • Bierma-Zeinstra, Sita M.A., Supervisor
  • Meuffels, Duncan, Co-supervisor
  • van der Jagt, Olav, Co-supervisor
Award date10 Apr 2024
Place of PublicationRotterdam
Print ISBNs978-94-6483-755-1
Publication statusPublished - 10 Apr 2024

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