530531

research-article2014

FAIXXX10.1177/1071100714530531Foot & Ankle InternationalCarranza-Bencano et al

Letter to the Editor Foot & Ankle International® 2014, Vol. 35(5) 530­ © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1071100714530531 fai.sagepub.com

Author Response

Dear Editor: Thank you for forwarding us the letter by Dr Tao Yu et al commenting on our study. We hope this reply addresses their concerns and comments. First, we always do a preoperative plan. The indication for nonpreserving joint surgery was established by clinical information (deformity and motion by physical examination), radiographs, and computed tomography scan when necessary. We often use arthroscopy for other kinds of patients (joint preserving surgery). We use tibiotalocalcaneal arthrodesis (TTCA) by MIS (minimal incision surgery) when subtalar and tibiotalar joints are affected clearly. Second, the classic large incision allows good exposure of the joints (ankle and subtalar) and a complete removal of the cartilage. We did many surgeries like these. But this requires tourniquet use, a large skin incision, and extensive periosteal stripping. In certain patients, such as those with diabetes (Charcot neuroarthropathy) or multioperated trauma patients, this presents a serious risk of vascular complications, delayed wound healing, or secondary infection. Therefore, we believe that our technique could reduce this risk. We agree that intraoperative endoscopy could be helpful; however, we found a 86% (similar to conventional TTCA) fusion rate by MIS with fluoroscopy control only. Third, the cartilage is not left in the joint. An osteocartilaginous slurry is left in the joint space. We believe that it is

a biological material and it could have a highly osteogenic capacity.1 According to the literature, bone formation is based on the capacity of osteoblast cells to differentiate instead of chondrocytes depending on local factors such as partial pressure of oxygen or biomechanical stimuli.2 We believe that others factors are involved in bone fusion, such a minimal injury to the periosteal vascularity of the periarticular bone (a primary source of mesenchyme stem cells) and a correct stiffness of the osteosynthesis. A. Carranza-Bencano, MD, PhD University Hospital “Virgen del Rocio” de Sevilla, Manuel Siurot s/n 41011, Sevilla, Spain. Email: [email protected] S. Tejero, MD, PhD G. del Castillo-Blanco, MD J. J. Fernández-Torres, MD A. Alegrete-Parra, MD References 1. Carranza-Bencano A, Tejero-García S, Del Castillo-Blanco G, Fernandez-Torres JJ, Alegrete-Parra A. Isolated subtalar arthrodesis through minimal incision surgery. Foot Ankle Int. 2013;34(8):1117-1127. 2.  Bassett CAL. Current concepts of bone formation. J Bone Joint Surg. 1962;44A:1217-1244.

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