Imaging of Total Ankle Arthroplasty: Normal Imaging Findings and Hardware Complications

Abstract

End-stage ankle osteoarthritis often significantly impacts patients' quality of life. This can be managed surgically either by ankle arthrodesis or total ankle arthroplasty (TAA). Although ankle arthrodesis is considered by some as the standard-of-care surgical option for this condition, it restricts range of motion and may lead to accelerated osteoarthritis of neighboring joints. Better understanding of ankle biomechanics, the biological effects of orthopaedic devices, and new surgical techniques have led to significant improvements in the designs of TAAs, and over the last several decades TAA has been used increasingly to treat patients with end-stage tibiotalar osteoarthritis. However, complication and ultimate failure rates remain greater than those seen with total knee and hip arthroplasty, and imaging is often critical in determining whether a prosthesis is beginning to fail. As a result, imagers should be familiar with the basic types of TAAs in clinical use, the normal radiographic appearances, as well as the common complications seen with this procedure.

Imaging and Treatment of Posttraumatic Ankle and Hindfoot Osteoarthritis

“…However, the rates of complications and failure with TAA remain greater than those seen in total knee and hip arthroplasty [46]. The most common indication for TAA is the treatment of advanced ankle arthropathy, failed prior ankle surgery, and ankle arthropathy with prior hindfoot or midfoot fusion for whom preserved functional range of motion is desired [47]. Appropriate patient selection is very important for a good clinical outcome of ankle arthroplasty [45,48].…”

“…Overall TAA complications may be categorized based on several parameters, such as level of risk of development of implant failure or based on the time of occurrence [50,51]. Depending on the time since surgery, complications may be categorized as intraoperative, early postoperative, or delayed [47,51]. Early postoperative complications include infection, delayed wound healing, medial malleolar stress fracture and distal tibial or fibular fractures.…”

“…Imaging evaluation of TAA includes several modalities, such as radiography, CT, MRI, and nuclear medicine studies, with serial weight bearing radiographs being the mainstay of the imaging followup. Imaging surveillance may detect early findings of aseptic loosening or infection by demonstrating subtle abnormalities, such as subsidence, early osteolysis, and angular deformities [47].…”

Evaluating and Managing the Painful Total Ankle Replacement

“…12 Plain radiographs, CT, metal artifact reduction magnetic resonance imaging (MRI), and single-photon emission CT (SPECT) may all play a role in the radiologic workup of periprosthetic fracture. 18,77 SPECT, which combines the anatomic features of CT with the function of nuclear medicine bone scans, may be especially helpful for detecting bony stress reactions after TAR. 39 Fracture location is important to note on imaging studies.…”

Weight-bearing CT Technology in Musculoskeletal Pathologies of the Lower Limbs: Techniques, Initial Applications, and Preliminary Combinations with Gait-Analysis Measurements at the Istituto Ortopedico Rizzoli

“…Total ankle replacement was developed as a long-term solution 22 to restore mobility as well as to alleviate pain in arthritic ankles, [22][23][24][25] with stability also easily achieved by arthrodesis. Moderately good clinical results were reported; however, size mismatch remains an important contributing factor to secondary complications, 22 particularly because the small numbers of indications have meant only a very small number of prosthesis designs and component sizes are available.…”