Total ankle arthroplasty results using fixed bearing CT-guided patient specific implants in posttraumatic versus nontraumatic arthritis.

BACKGROUND: Patients who undergo total ankle arthroplasty (TAA) for end-stage posttraumatic ankle osteoarthritis have previously reported more complications and lower satisfaction than those with non-traumatic etiologies. The purpose of this study was to evaluate clinical and radiographic outcomes in these two patient groups after TAA using a newer generation implant. METHODS: Patients underwent TAA with a third generation implant using CT-based patient-specific cutting guides. Patients were evaluated clinically using the Foot and Ankle Ability Measure (FAAM) and radiographically at a mean follow up of 32, and 24 months respectively. RESULTS: Forty-one patients were studied (26 posttraumatic, 15 nontraumatic). There were no significant differences between the two study groups in FAAM scores (p=0.3423) and radiographic measurements. CONCLUSION: We were able to show comparable results in terms of patient satisfaction, short term clinical and radiographic results between traumatic and nontraumatic patients using newer patient specific implant systems.

Arthroscopic Management of Osteoid Osteoma of the Ankle Joint: A Systematic Review of the Literature.

Osteoid osteomas (OOs) are rare benign bone tumors that may occur in various joints including the ankle. These tumors are generally removed via open surgical excision or radiofrequency ablation. However, when they occur intra-articularly, these treatments are more difficult to perform because of more difficult access and the increased risk of damaging articular cartilage. Therefore, some have advocated for the use of arthroscopy to treat these cases. This systematic review aims to investigate the safety and efficacy of arthroscopic treatment for intra-articular OO of the ankle. Using Medline and Embase, we systematically reviewed the literature as of May 31, 2017. All articles published on and before that date were reviewed by 2 independent reviewers. Seventeen articles containing a total of 27 cases were included in the review. Most reported cases were in the talar neck, followed by the distal tibia. Of all the cases, only 2 recurrences were reported (in the same patient), and no complications were reported. Therefore, these cases demonstrate arthroscopic excision of intra-articular OO of the ankle as a safe and effective alternative to open surgical excision and radiofrequency ablation, with a success rate of 96%. However, all articles found were case studies or small case series owing to the rarity of this disease. In the future, analyses of case series with larger case collections should be performed.

Continuous Infragluteal Sciatic Nerve Block for Postoperative Pain Control After Total Ankle Arthroplasty.

Continuous peripheral nerve blocks (CPNB) for postoperative pain control are being used more frequently for total ankle arthroplasty. The purpose of this study was to compare the amount of opioid analgesia used in patients with an infragluteal CPNB to that of patients with no CPNB for postoperative pain management after total ankle replacement. A retrospective cohort study was performed on 78 consecutive patients who had a total ankle arthroplasty from October 2006 to June 2013. The primary outcome measure was opioid analgesia use in the first 48 hours postoperatively. The mean postoperative narcotic use in oral morphine equivalents was 64.6 mg in the CPNB group compared to 129.6 mg in the no CPNB group (P < .001). Using an infragluteal CPNB as a means of postoperative pain control in patients undergoing a total ankle replacement is associated with significantly decreased opioid use compared to patients receiving no CPNB. LEVELS OF EVIDENCE: Therapeutic, Level IV, case series.

Incidence of symptomatic deep venous thrombosis after Achilles tendon rupture.

Deep venous thrombosis (DVT) is a significant source of morbidity and mortality and is associated with many orthopedic procedures. Previous studies have reported highly variable DVT rates in patients with Achilles tendon rupture undergoing operative and nonoperative treatment. We performed a retrospective chart review for all patients who underwent Achilles tendon repair at our institution from January 2006 to February 2012. Patient data were collected from the electronic medical record system. A total of 115 patients were eligible for the present study. Of these patients, 27 (23.47%) with a surgically treated Achilles tendon rupture developed a symptomatic DVT either while waiting for, or after, surgical intervention, with approximately one third of these diagnosed before surgical intervention. Of the 27 patients with DVT, 3 had a proximal DVT and 24 had a distal DVT. One patient developed a pulmonary embolism. The DVT incidence was greater in the 2 older age groups (40 to 59 and 60 to 79 years) compared individually with the younger age group (20 to 39 years; p < .0026 and p < .0014, respectively). We have shown a high incidence of DVT after Achilles tendon rupture. We recommend a high level of suspicion for the signs and symptoms of DVT during the follow-up period. In addition, patient education and early mobilization should be advocated, especially for patients older than 40 years. Additional randomized controlled trials investigating any benefits to pharmaceutical DVT prophylaxis in this population are needed to establish evidence-based recommendations.