An Analysis of the Use of the Kellgren and Lawrence Grading System to Evaluate Peritalar Arthritis Following Total Ankle Arthroplasty

Background: The Kellgren and Lawrence grading system (KLGS) has been used throughout the literature for the radiographic staging of osteoarthritis (OA) of the peritalar joints. Despite its widespread use, the KLGS has never been validated for use in this clinical circumstance. The purpose of this study was to determine the inter- and intrarater reliability of the KLGS in the assessment of radiographic progression of OA in the peritalar joints following total ankle replacement (TAR). Methods: One hundred twenty pre- and minimum 5-year postoperative weight-bearing lateral radiographs following 60 consecutive cases of TAR were utilized. Each individual film was considered separately for the purposes of this study. Of those films, 93 and 98 were found to have adequate visualization of the subtalar (STJ) and talonavicular (TNJ) joints, respectively. Three qualified reviewers graded the films according to the KLGS on 2 separate occasions, with 1 month separating the 2 readings. The results were analyzed for intra- and interobserver reliability. The degree of agreement was analyzed using the weighted kappa (κw) statistic, Fleiss’s kappa (Fleiss’s κ), and percentage agreement Results: Interrater agreements were moderate (κw = 0.37 ± 0.06; Fleiss’s κ = 0.21 ± 0.03) for the STJ to fair (κw = 0.43 ± 0.06; Fleiss’s κ = 0.25 ± 0.03) for the TNJ. Intrarater agreements for the STJ were moderate (mean κw = 0.43 ± 0.07) and moderate for the TNJ as well (mean κw = 0.46 ± 0.07). The reliability of the KLGS, although not originally designed for use in the setting of inflammatory arthropathy, was not notably affected when being used to grade inflammatory versus noninflammatory arthropathy. Conclusions: The KLGS is likely not a reliable tool for grading the degree of OA present in the peritalar joints prior to treatment and following TAR for research purposes. Using the KLGS in the setting of inflammatory arthritis versus OA did not produce any notable differences in the observed reliability. It is important to remember this has not been assessed in the clinical environment. Further work is required to determine the optimal method for assessment of peritalar OA. Level of Evidence: Level II, prospective comparative study. </jats:sec

Ruptured intracranial infectious aneurysms: Single Canadian center experience

Background: Ruptured intracranial infected aneurysms (IIAs) are relatively rare, but they portend high mortality. To the best of our knowledge, there is no Canadian case series on IIA, as well there is a relative paucity of international published experiences. Our purpose is to share the experience of a single Canadian tertiary center in managing ruptured IIA and to conduct a systematic review. Methods: We did a retrospective case review series of adult patients with ruptured IIA treated at our institution. Second, we conducted a systematic review of the literature on ruptured IIA between 2011 and 2021 inclusive. Results: At our institution, of a total eight cases with ruptured IIA, four were treated endovascularly and two by surgical bypass. For the systematic review, we included nine noncomparative studies with a total of 509 patients (318 males) and at least 437 ruptured IIA aneurysms. Favorable outcome was specified for 63.3% of patients (n = 57). Regarding ruptured IIA, favorable clinical outcome was described in 59.3% (n = 16). Conclusion: This study highlights a single Canadian tertiary center experience in the management of IIA and compares it to the global trends of the past 10 years in a systematic review. </jats:sec

Closure of legacy waste rock piles : can we achieve passive treatment to manage residual seepage in the short term?

Closure and reclamation of waste rock piles using engineered cover systems and water treatment of seepage is a common technique for management of acid rock drainage/metal leaching (ARD/ML) to mitigate adverse impacts to the receiving environment. Linking cover system performance (i.e. net percolation and/or oxygen ingress) to impacts to the receiving environment provides a rational basis for cover system design criteria. Two general models are used in the mining industry to predict long-term seepage and closure costs. One model assumes that loading of contaminants to the environment will remain unchanged under reduced flux rates (net percolation) where contaminant concentrations increase proportionally as a function of decreasing flow; the other assumes that a reduction in the flux rate will result in decreased contaminant loads for constant contaminant concentrations in flow. Both models will have a transition point at which reduced loading to the receiving environment will occur as the flux decreases. Enterprise Cape Breton Corporation implemented a program for the closure of historic coal mines located near Sydney, Nova Scotia, Canada, with Public Works and Government Services Canada providing project management. The Victoria Junction waste rock pile was reclaimed with an engineered cover system comprising a 60 mil HDPE geomembrane, a granular drainage layer and an overlying growth medium. It was estimated following closure that active treatment of seepage waters impacted by ARD/ML would be required for ~20 years before passive treatment systems could be established; however, this has occurred within seven years with significant cost savings realised. Reclamation of the site reduced the risk of potential loading under various failure scenarios. An acidity mass balance was used to provide an understanding of past (uncovered waste rock pile and active treatment), current (covered waste rock pile and passive treatment) and long-term (100 years) loading under progressive changes to water collection and treatment activities. The acidity mass balance will serve to inform management decisions in ongoing closure planning. The case study presented here demonstrates that it is possible to eliminate the need for active treatment of seepage for legacy sites.Non UBCUnreviewedOthe