Overnight Admission After Total Ankle Replacement: Is It Safe?

To evaluate readmission, complication, and nonscheduled contact rates to the out-patient clinic within the first 3 months following total ankle replacement in patients planned for overnight admission. Data were collected retrospectively on all patients treated during the period the December 11, 2015 to the December 1, 2019 with 3 months of follow-up for all patients. In the study 116 patients were included. No difference in patient characteristics, readmission rates, complication rates or number of nonscheduled contacts to the outpatient clinic was found between patients discharged after 1 day when compared to those admitted >1 day. Around 58.6% was discharged as planned. The overall readmission and complication rates were 2.6% and 6.0% respectively, 20.7% had a nonscheduled contact to the out-patient clinic. No differences in prevalence of the different complications, reasons for readmission or reasons for contact to the out-patient clinic were found between overnight admission and inpatient admission. Total ankle placement with overnight admission is safe, but patient selection with a thorough plan for analgesics after discharge and optimal cast appliance is necessary.

[Ankle arthrosis].

Symptomatic ankle arthrosis affects 1-4% of the population, and the most common aetiology is post-traumatic. Symptoms include pain, swelling and reduced range of motion. Diagnosis is based on weight-bearing X-rays of the ankle joint, and treatment depends on the arthrosis grade and patient characteristics. Non-operative therapy, i.e. physiotherapy, analgesics, injection therapy and/or braces/orthoses is first-line treatment, as we argue in this review. Arthroscopy can be an effective treatment for some patients, but in case of severe arthrosis, osteotomies, total ankle replacement or arthrodesis may be necessary.

The Effect of a Single Hyaluronic Acid Injection in Ankle Arthritis: A Prospective Cohort Study.

Nonoperative measures are often used as first line treatment in ankle osteoarthritis. One of these measures consists of hyaluronic acid injections in the affected ankle joint, but efficiency of this treatment is uncertain. The purpose of the study was to evaluate the effect on Self-reported Foot and Ankle Score, visual analog scale score at rest, and visual analog scale score at activity 6 months after a single dose of hyaluronic acid in patients with ankle osteoarthritis. Patients were included from December 2017 to March 2019. A single intra-articular injection of Cingal or MonoVisc was administered. Age, gender, osteoarthritis-grade, Self-reported Foot and Ankle Score, visual analog score at activity, and at rest before injection and after 6 months was registered. A total of 33 patients were included, with 14 lost to follow-up. Four were treated with MonoVisc and were excluded to reduce confounding. The remaining 15 patients were included for analysis. Median Self-reported Foot and Ankle Score remained unchanged (p = .06), whereas visual analog score at activity went from 7 to 6 (.02) and visual analog score at rest was reduced from 4 to 3 (.02). Subgroup analysis on arthrosis grade (grade I-II and III-IV) showed no statistically significant changes for all variables even though patients with grade III-IV arthrosis seemed to benefit more from the treatment. The results indicate that a single injection of hyaluronic acid is insufficient to produce at clinically relevant response after 6 months even though there is a high risk of underpowering because of a small patient population.

[Isolated lesions to the sural nerve. Causes, claims review procedure and compensation]. / Isoleret nervus suralis-skade. Arsager, anerkendelsespraksis og erstatning

INTRODUCTION: The present paper describes the surgical procedure that typically causes a lesion of the sural nerve and the most common symptoms of such lesion. The medical and legal aspects in relation to the Patient Insurance Association (PIA) are discussed. MATERIALS AND METHODS: The study includes 29 cases with an isolated lesion of the sural nerve during the period 1996 to 2004. We registered gender, age, disease, type of operation, compensable claims, degree of impairment, symptoms, need for medication, supplementary examination, size of compensation, time from operation to filing of claims and time from filing to final resolution. RESULTS: A total of 52% of the lesions were caused by venous surgery, 27.7% by Achilles tendon surgery. A total of 38% of the patients underwent further examination, and 7% had to receive treatment in specialised pain-clinics. The following symptoms were typical: reduced sensibility or numbness, weakness of the foot, reduced range of motion, pain in the heel, radiating pain to the forefoot, more constant burning pain and painful paraestesia or hypersensibility. A total of 52% of the claims were considered compensable, 38% according to "the specialist rule" (Section 2.1.1) and 13.8% according to "the tolerance rule" (Section 2.1.4). The median amount of compensation was DKK 29,731. The mean casework time in the PIA was 278 days. CONCLUSION: Lesion of the sural nerve most frequently occurs after surgery to the Achilles tendon or after venous surgery, leading to symptoms varying from loss of sensibility to severe hypersensibility and burning paraestesia. With the significant anatomical variation and the documented risk of disabling damage following lesion to the sural nerve, the surgeon needs to be very attentive when operating in the proximity of the sural nerve.