PhD defence J.A. (Annika) Willems

Below is a brief summary of the dissertation:

This thesis covers three subjects: osteoarthritis, objective bone union assessment and extracorporeal shock wave therapy (ESWT). Chapter 2 of this thesis shows a randomized study in patients with osteoarthritis in the medial compartment of the knee and with a varus deformity. Pain in the medial compartment of the knee can be reduced by correcting the varus deformity to a valgus deformity. This can be done by two different techniques, the open wedge or closed wedge osteotomy. De results of this study showed that accurate corrections can be achieved by both techniques. Chapter 3 is a study in patients with talocrural arthrodesis. It has been thought that osteoarthritis develops in adjacent joints after talocrural arthrodesis. This retrospective study showed that patients indeed develop osteoarthritis after talocrural arthrodesis. Chapter 4 and 5 are both systematic reviews in which we investigated how bone union can be accurately and objectively assessed. In chapter 4 we included animal studies that performed CT to assess bone union and mechanical or histological testing to measure bone strength. In chapter 5 we investigated how other clinical studies about foot and ankle arthrodesis assessed bone union with CT. In chapter 6 and 7 we investigated the effectivity of ESWT to stimulate bone union. The systematic review in chapter 6 showed that ESWT may be effective to treat delayed and nonunion fractures. The randomized study in chapter 7 could not prove that ESWT is an effective treatment for decreasing the number of delayed unions after talocrural arthrodesis.