Clinical and patient-reported outcomes following Low Intensity Pulsed Ultrasound (LIPUS, Exogen) for established post-traumatic and post-surgical nonunion in the foot and ankle. Issue 4 (June 2020)

• Record Type: Journal Article
• Authors: Majeed, Haroon; Karim, Tariq; Davenport, James; Karski, Michael; Smith, Robert; Clough, Timothy M.
• Is Part Of: Foot and ankle surgery. Volume 26:Issue 4(2020)
• Page Start: 405
• Page End: 411
• Publication Date: 2020-06
• Subjects: LIPUS -- Exogen -- Nonunion -- Delayed union; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Ankle -- surgery -- Periodicals; Foot -- surgery -- Periodicals; Ankle -- Surgery; Foot -- Surgery; Periodicals; Electronic journals; 617.58
• DOI: 10.1016/j.fas.2019.05.009
• Languages: English
• ISSNs: 1268-7731

Abstract

Highlights: A prospective study of the clinical and functional outcomes of 47 consecutive patients with established nonunion treated with LIPUS. Average duration of Exogen treatment was 6 months. Thirty-seven patients (78.7%) clinically united. Better union rates were observed in the fracture group (93%) and midfoot/forefoot group (78%) and relatively poorer results in the hindfoot fusion group (67%). Significant improvement in functional outcomes and potential cost savings were observed. Exogen for established nonunion in the foot and ankle is a safe, valuable and economically viable option as an alternative to revision surgery. Abstract: Background: Biophysical methods including Low Intensity Pulsed Ultrasound (LIPUS) are emerging as potential alternatives to revision surgery for treating established nonunions. We aim to prospectively review the clinical and patient-reported outcomes of patients treated with LIPUS following post-traumatic and post-surgical nonunions in the foot and ankle. Methods: Forty-seven consecutive patients underwent Exogen treatment. Patient-reported outcome scores included MOXFQ, EQ-5D and VAS. Patients were divided in to 3 groups: fractures (A), hindfoot procedures (B) and midfoot/forefoot procedures (C). Results: Thirty-seven patients (78.7%) clinically united, 4 patients (8.5%) noticed no significant improvement but did not want further intervention and 6 patients (12.8%) underwent revision surgery. The mean duration of Exogen treatment was 6 months. Union rates of 93%, 67% and 78% were noted in the three groups. Significant improvement in functional outcomes and potential cost savings were observed. Conclusions: Exogen for established nonunion in the foot and ankle is a safe, valuable and economically viable clinical option as an alternative to revision surgery. We observed better results in the fracture and midfoot/forefoot groups and relatively poorer results in the hindfoot fusion group.