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    Ankle Arthritis - The Bone School

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    Ankle Arthritis

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    Ankle Arthritis - The Bone School

    Uploaded by

    karan doshi
    5 views8 pages
    Ankle Arthritis

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    Ankle Arthritis | the Bone School

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    Ankle Arthritis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    5 views8 pages

    Ankle Arthritis - The Bone School

    Uploaded by

    karan doshi
    Ankle Arthritis

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 8

    Background | The Bone School 8/9/2024, 20:22

    The Bone School


    The source for orthopaedic knowledge

    Home » Lower Limb » Foot and Ankle » Ankle osteoarthritis

    Background

    Epidemiology

    Much less common than hip and knee OA


    Patients tend to be younger

    Etiology

    Primary ankle OA is uncommon, 80% of ankle OA is post-


    traumatic

    Valderrabano et al CORR 2009


    - 406 patients with end stage ankle OA
    - 80% post-traumatic
    - 13% secondary OA
    - 9% primary OA

    Trauma

    Ankle Fracture Plafond Fracture Talus Ligament Instability

    Harris et al Foot Ankle Int 2006 Lofenberg et al Foot Ankle Int 1994
    Swierstra et al EFORT Open Rev 2022 Talus osteochondral lesions
    - 79 tibial plafond ORIF - 37 patients with chronic ankle
    - systematic review ankle fractures Talus malunion / AVN post neck
    - 2 year follow up instability
    - 25% OA fracture
    - 40% OA - 20 year follow up 13% OA

    http://www.boneschool.com/index.php/node/1754 Page 1 of 8
    Background | The Bone School 8/9/2024, 20:22

    Secondary OA

    Rheumatoid OA / Inflammatory OA / Infection / Hemochromatosis /


    Hemophilia / Charcot

    Anatomy

    Thin cartilage 1 mm

    Joint highly congruent


    - 1mm shift causes 40% decrease in contact area
    - increases tibio-talar contact stresses

    Clinically

    Pain
    - with weight bearing
    - nightime

    Stiff ankle joint

    Xray

    Ranges from anterior spurring to severe OA


    80% of post-traumatic OA is varus

    Takakura classification

    Grade Description

    1 Early sclerosis and formation of osteophytes

    2 Narrowing of the medial joint space

    3A Obliteration of the medial joint space with subcondral bone contact

    Obliteration of joint space over roof of talar dome, with subchondral bone
    3B
    contact

    4 Obliteration of joint space with complete tibiotalar contact

    Type 1: Anterior spurs

    http://www.boneschool.com/index.php/node/1754 Page 2 of 8
    Background | The Bone School 8/9/2024, 20:22

    Type 3A: Obliteration of medial joint space Type 3B:


    Obliteration medial joint space plus tibio-talar contact with varus

    http://www.boneschool.com/index.php/node/1754 Page 3 of 8
    Background | The Bone School 8/9/2024, 20:22

    Type 4 complete obliteration

    CT

    Small anterior tibial spur

    http://www.boneschool.com/index.php/node/1754 Page 4 of 8
    Background | The Bone School 8/9/2024, 20:22

    Large cysts in patient with ankle OA

    MRI

    Management

    Non Operative

    PRP

    http://www.boneschool.com/index.php/node/1754 Page 5 of 8
    Background | The Bone School 8/9/2024, 20:22

    Ding et al Int Orthop 2023


    - systematic review of 4 studies using PRP for ankle OA
    - evidence of improved pain and function at 6 months

    Hyaluronic acid

    Vannbouathong et al Foot Ankle Int 2018


    - systematic review of HA for ankle OA
    - 3 RCTs
    - evidence for improved pain with HA versus saline at 6 months

    Operative

    Options

    Arthroscopy
    Ankle distraction arthroplasty / arthrodiastasis
    Arthrodesis
    Supramalleolar osteotomy
    Arthroplasty

    Arthroscopic debridement

    Indication

    Anterior impingement
    - kissing osteophytes on anterior tibia and talar neck

    www.boneschool.com/footandankle/anteriorimpingement

    Ankle distraction arthroplasty / arthrodiastasis

    Theory

    Allows some cartilage regeneration and healing


    Young patient

    Technique

    Vumedi ankle distraction arthroplasty

    Hinged external fixation distracting joint


    - 3 - 4 months
    - distracted 5 mm

    Results

    Arshad et al Foot Ankle Surg 2022


    - systematic review distraction arthroplasty
    - most improvement at or slightly above MCID (minimal clinically
    important difference)
    - 50% revision to arthrodesis or arthroplasty

    Supramalleolar Osteotomy

    http://www.boneschool.com/index.php/node/1754 Page 6 of 8
    Background | The Bone School 8/9/2024, 20:22

    Varus OA treated with medial opening wedge supramalleolar


    osteotomy

    Indications

    Varus / valgus malalignment


    Asymmetric OA with preserved cartilage in 50% of ankle (Grade 2
    and 3A)

    Technique

    Surgical technique supramalleolar osteotomy PDF

    Surgical technique supramalleolar osteotomy video

    Results

    Butler et al KSSTA 2023


    - systematic review of 24 studies and 1200 patients
    - failure rate 7%
    - complication rate 5%
    - nonunion rate 2%

    Arthrodesis versus Arthroplasty

    Functional outcome

    http://www.boneschool.com/index.php/node/1754 Page 7 of 8
    Background | The Bone School 8/9/2024, 20:22

    Shih et al Foot Ankle Surg 2020


    - meta-analysis arthrodesis v arthroplasty last 10 years (3rd
    generation ankle arthroplasty)
    - no difference in total outcome scores / pain / gait / satisfaction
    between two groups
    - improved function and ROM with arthroplasty
    - higher complication and reoperation with arthroplasty

    Liu et al Int Orthop 2023


    - meta-analysis of 37 studies comparing arthrodesis and arthroplasty
    - Arthroplasty PROMs > arthrodesis in the short term (<2y)
    - Arthroplasty PROMs = arthrodesis in the medium term (2-5y)
    - Arthrodesis PROMs > arthroplasty in the long term (>5y)

    Revision rate

    SooHoo et al JBJS Am 2007


    - database of ankle fusions v arthroplasty
    - 5 year subtalar arthrodesis rate: ankle fusion 3%
    - 5 year subtalar arthrodesis rate: arthroplasty 0.7%

    Subtalar arthritis

    SooHoo et al JBJS Am 2007


    - database of ankle fusions v arthroplasty
    - 5 year subtalar arthrodesis rate: ankle fusion 3%
    - 5 year subtalar arthrodesis rate: arthroplasty 0.7%

    Ankle Arthrodesis

    www.boneschool.com/footandankle/anklearthrodesis

    Ankle Arthroplasty

    http://www.boneschool.com/lower-limb/foot-and-ankle/ankle-
    arthroplasty
    distraction distraction arthroplasty supramalleolar osteotomy tanaka classification
    background xray osteoarthritis MRI incidence CT causes arthroscopic debridement
    ankle OA

    ‹ Ankle osteoarthritis Up Ankle Arthrodesis ›

    http://www.boneschool.com/index.php/node/1754 Page 8 of 8

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