Etiology and Treatment of Delayed-Onset Medial Malleolar Pain Following Total Ankle Arthroplasty

Lundeen, Gregory A.; Dunaway, Linda J.

doi:10.1177/1071100716643278

Cited by 22 publications

(10 citation statements)

References 36 publications

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“…The jury is still out on the optimal treatment strategy of PMFs associated with TSFs. Generally, intramedullary nails and hollow screws or cortical lag screws are direct and effective methods to treat TSFs and PMFs [ 11 , 37 – 39 ]. However, whether PMFs need to be fixed and the sequence of fixation—whether the TSFs or PMFs should be fixed first—have inadequate data [ 5 , 22 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence and missed diagnosis risk of occult posterior malleolar fractures associated with the tibial shaft fractures: a systematic review

et al. 2021

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Background Tibial shaft fractures (TSFs) combined with occult posterior malleolar fractures (PMFs) are becoming widely recognized in the field of orthopedics. The purpose of this study was to determine the clinical incidence, missed diagnosis rate, and treatment strategies of this combined injury. Methods PubMed, Cochrane, and MEDLINE Ovid databases were searched for articles of English language from 1988 to 2020, identifying 1549 papers. Results Twenty-one of the 1278 identified studies were eligible for inclusion. Each study reported on the incidence of this combined injury, and 12 studies documented the missed diagnosis rate. Seventeen studies reported surgical intervention strategies for PMFs. In the present review, PMFs frequently occurred in spiral TSFs (70%), especially distal third spiral TSFs (70.4%), based on CT scans or additional MRI. Based on the original X-ray detection, approximately 50% of PMFs were missed in patients with a combined injury. In addition, the treatment strategies for PMFs were inconsistent. Most studies (11/17) believe that specific surgical management needs to be developed based on the fragment size, displacement, and stability of the PMF. Conclusions For patients with TSFs, spiral TSFs, especially distal third spiral TSFs, are closely related to PMFs and are often not sufficiently diagnosed by X-ray alone. Advanced CT and MRI examinations can significantly reduce the missed diagnosis rate of occult PMFs. According to available literature, the treatment strategy for PMFs associated with TSFs is questionable without convincing evidence of benefit.

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Section: Discussionmentioning

confidence: 99%

Incidence and missed diagnosis risk of occult posterior malleolar fractures associated with the tibial shaft fractures: a systematic review

et al. 2021

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“…7 Wood and Deakin 25 reported a decrease of perioperative fractures and wound complications after their first 100 TAAs from 25% and 7% to 13% and 2%, respectively. 13 Lee et al 11 grouped 60 consecutive patients into group A (first 30 TAAs) and group B (second 30 TAAs). They reported a 36.7% complication rate in Group A, and a 16.7% complication rate in group B.…”

Section: Discussionmentioning

confidence: 99%

Early Outcomes and Complications Following Initiation of a Total Ankle Arthroplasty Program

Lundeen

Neary²,

Kaiser

et al. 2021

Foot & Ankle Orthopaedics

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Background: Surgeons who lack experience with total ankle arthroplasty (TAA) may remain hesitant to introduce this procedure owing to previously published results of high complication rates during initial cases. The purpose of the present study was to report the development of a TAA program through intermediate outcomes and complications for an initial consecutive series of TAA patients of a single community-based foot and ankle fellowship–trained orthopedic surgeon with little TAA experience using a co-surgeon with similar training and TAA exposure. Methods: The initial 20 patients following third-generation TAA with a single surgeon were reviewed. Clinical outcomes were measured and radiographs were evaluated to determine postoperative implant and ankle position. Complications were also measured including intraoperative, early (<3 months), and intermediate postoperative complications. Results: With a minimum follow-up of 2 years and average follow-up of 51 months (range 24-70 months), the mean American Orthopaedic Ankle & Foot Society Ankle-Hindfoot score was 87.7 (59-100) and VAS was 1.0 (0-5.5). All patients were improved following TAA. Radiographic evaluation demonstrated no evidence of component malalignment or ankle joint incongruity. There were no intraoperative complications nor any wound complications. Three patients returned to the operating room for placement of medial malleolar screw placement, and 1 had asymptomatic tibial component subsidence. Conclusions: Orthopedic surgeons with a proper background and updated training may be able to perform TAA with good outcomes. A TAA program was developed to define minimum training criteria to perform this procedure in our community. Our complication rate is consistent with those reported in the literature for experienced TAA centers, which contrasts previous literature suggesting increased complication rates and worse outcomes when surgeons perform initial TAAs. Utilization of an orthopedic co-surgeon was felt to be instrumental in the success of the program. Level of Evidence: Level IV, retrospective case series.

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“…Coronal plane instability may occur over time, possibly resulting in soft tissue overload and cyst formation. 1,8,13,18,29 Theoretically, such complications could be avoided with the use of a fixed-bearing TAA system, as long as the position of the components is adjusted to the individual anatomy and kinematic of the ankle.…”

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confidence: 99%

Axial Rotational Alignment in Mobile-Bearing Total Ankle Arthroplasty

et al. 2020

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Background: The presence of an interface between the tibial component and the polyethylene insert (PI) in mobile-bearing total ankle arthroplasty (TAA) may allow the talus to adapt its axial position according to the patient’s anatomy. However, little is known about differences of the axial talar rotation between patients following mobile-bearing TAA. Therefore, the aim of this study was to assess the relative axial rotation between the talar and tibial component intraoperatively and after a minimum follow-up of 3 years following mobile-bearing TAA. Methods: The relative axial rotation between the talar and the tibial component was measured intraoperatively in a cohort of 58 patients who underwent mobile-bearing TAA. In addition, it was measured on weightbearing computed tomography (CT) scans in 48 patients after a mean of 6.3 (3.0-16.3) years following mobile-bearing TAA. The pre- and postoperative alignment of the ankle joint/tibial component and hindfoot assessed on conventional radiographs was correlated with the intra- and postoperatively determined relative axial rotation of the talar and tibial component. Results: The mean intra- and postoperative axial talar component position was 1.7 (range, 14 internal to 14 external) and 1.4 (range, 12 internal to 20 external) degrees toward internal when compared to the tibial component ( P = .960). The preoperative sagittal alignment of the distal tibia correlated with the intraoperatively determined relative axial rotation between the talar and the tibial component ( P = .019). Conclusion: The wide range of the relative axial rotation between the tibial and talar component suggests that it is crucial to allow the talus to intraoperatively find a position that corresponds to the patient’s individual anatomy. The fact that the range of axial rotation was similar after a minimum of 3 years measured under weightbearing conditions suggests that structural changes of the osteoarthritic ankle may be the main determining factors for the axial rotational position of the talus. Our findings improve current understanding of proper implant position during TAA. In addition, the current study provides a reliable method to assess the postoperative axial position of the prosthesis components. The high interindividual variability of the relative rotation between the tibial and talar component in the axial plane suggests that axial malpositioning following TAA may be a more common issue than currently expected. Our findings may help to improve the assessment of patients with persistent pain following TAA. Level of Evidence: Level III, comparative series.

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Etiology and Treatment of Delayed-Onset Medial Malleolar Pain Following Total Ankle Arthroplasty

Abstract: Level IV, case series.

Cited by 22 publications

References 36 publications

Incidence and missed diagnosis risk of occult posterior malleolar fractures associated with the tibial shaft fractures: a systematic review

Incidence and missed diagnosis risk of occult posterior malleolar fractures associated with the tibial shaft fractures: a systematic review

Early Outcomes and Complications Following Initiation of a Total Ankle Arthroplasty Program

Axial Rotational Alignment in Mobile-Bearing Total Ankle Arthroplasty

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