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Ankle Arthritis
Posted: Nov 12 2017 #(C2885)
A

Ankle Arthritis in 45M

HPI

45-year-old male with severe ankle pain following nonoperative treatment of ankle fracture when he was 23 years old. Patient has received cortisone injections, stem cell treatments, and has used a brace on/off for the last 2 years

PMH

Ankle fracture 20 years prior. No health issues. Non smoker

PE

Healthy appearing. No skin issues. Good distal pulses.

Poll
1 of 9
1. In addition to plain AP and LAT radiographs of the ankle, what additional imaging would you obtain to guide management?
No - AP and LAT radiographs are sufficient
51%
62/120
Yes - additional radiographic views (aXR)
3%
4/120
Yes - CT scan of the ankle (CT)
33%
40/120
Yes - MRI scan of the ankle (MRI)
3%
4/120
Yes - aXR + CT
2%
3/120
Yes - aXR + MRI
0%
0/120
Yes - CT + MRI
0%
0/120
Yes - aXR + CT + MRI
2%
3/120
Outside my area of expertise - best if I don't vote
3%
4/120
2. How would you manage this patient?
Nonoperative
0%
1/112
Operative
95%
107/112
Outside my area of expertise - best if I don't vote
3%
4/112
3. If you choose Nonoperative management, what would be your most preferred modality?
I would not choose Nonoperative management
77%
957/1238
Yes - Pain medications only
5%
65/1238
Yes - Orthosis
11%
144/1238
Yes - PRP injections
4%
60/1238
Yes - Stem cell injections
0%
12/1238
4. If you choose Operative management, what surgery would you perform?
Ankle fusion
63%
775/1218
Total ankle arthroplasty
31%
389/1218
Ankle osteotomy
4%
54/1218
5. If choosing to perform an ankle fusion, what Approach / Fixation method would you use?
Arthroscopic assisted / cannulated screws
30%
319/1058
Anterior approach / anterior plate
26%
278/1058
Lateral approach / cannulated screws
24%
254/1058
Lateral approach / plate fixation
6%
65/1058
Posterior approach / cannulated screws
3%
42/1058
Posterior approach / plate fixation
1%
21/1058
Anterior approach / cannulated screws
7%
79/1058
6. If performing an ankle arthroplasty, do you think you could reliably convert it to an arthrodesis in the future?
Yes - and get the same result as an arthrodesis now.
16%
167/996
Yes - but require some shortening
44%
442/996
No - will be problematic to convert an arthroplasty to an arthrodesis in the future.
23%
233/996
Yes - but will need to do include the subtalar joint in a tibiotalocalcaneal fusion.
15%
154/996
7. If performing an ankle arthrodesis, do you think you can reliably and safely convert to an ankle arthroplasty in the future?
Yes
37%
368/983
No
62%
615/983
8. If choosing to perform a total ankle arthroplasty, what would be your main reason for this?
Better pain control
14%
139/962
Improved range of motion of ankle
61%
595/962
Improved gait
23%
228/962
9. If choosing to perform an ankle fusion, what would be your main reason?
More reliable pain control
52%
513/974
Decreased need for revision surgery
43%
425/974
Improved gait
3%
36/974
PROCEDURE #1

NO DESCRIPTION

PROCEDURE #2

Total ankle replacement

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OUTCOMES
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