Risks to the Blood Supply of the Talus with Four Methods of Total Ankle Arthroplasty

Abstract

All four total ankle arthroplasty systems tested posed a risk of injury to the extraosseous talar blood supply, but the risks of injury to specific arteries were higher for specific implants.

Incidence of Revision After Primary Implantation of the Salto® Mobile Version and Salto Talaris™ Total Ankle Prostheses: A Systematic Review

“…During this soft tissue dissection, the medial talar head and neck blood supply from the dorsalis pedis is at high risk of injury. This pattern of arterial injury is universal for total ankle prostheses that use an anterior approach (69,70). Knowing this, limited medial gutter debridement and care taken to minimize soft tissue stripping about the medial talar head and neck would seem prudent.…”

“…Knowing this, limited medial gutter debridement and care taken to minimize soft tissue stripping about the medial talar head and neck would seem prudent. Damage to the posterior tibial artery at the distal part of the tibia presents a moderate risk of injury during the preparation of the tibial bone surfaces and can be minimized by using exacting technique (69). Damage to the artery of the tarsal canal was considered a moderate risk of injury and can occur during placement of the various talar resection dorsal-to-plantar metallic pins if a pin is inadvertently driven through the inferior surface of the talus (69).…”

“…Damage to the posterior tibial artery at the distal part of the tibia presents a moderate risk of injury during the preparation of the tibial bone surfaces and can be minimized by using exacting technique (69). Damage to the artery of the tarsal canal was considered a moderate risk of injury and can occur during placement of the various talar resection dorsal-to-plantar metallic pins if a pin is inadvertently driven through the inferior surface of the talus (69). It is intuitive that proper metallic pin insertion technique and liberal use of intraoperative C-arm image intensification will reduce this risk pattern.…”

Injury Risk to Extraosseous Knee Vasculature During Osteotomies: A Cadaveric Study With CT and Dissection Analysis

“…Without additional anatomic dissection, chemical débridement was incomplete in the first specimen even after 12 hours, a much longer time than expected from previous studies [21,34], likely related to the more substantial soft tissue envelope around the knee compared with the foot and ankle. Therefore, more complete anatomic dissection was introduced in the study protocol and successfully tested on the second specimen to obtain complete débridement.…”

“…The artery was injected with normal saline until the effluent from the anterior tibial artery, posterior tibial artery, and peroneal artery was clear. All three effluent arteries were clamped to improve perfusion of all vessels and the major vessel was injected with a 1:2 suspension of barium sulfate powder to water, mixed with Ward's Blue Latex (Ward's Science, Rochester, NY, USA) (1 part suspension: 2 parts latex) through the cannula, as previously described [21,34].…”