summary Ankle Arthritis is degenerative joint disease of the tibiotalar joint that can be broken into three main types: osteoarthritis, post-traumatic arthritis, and inflammatory arthritis. Diagnosis is primarily made with plain radiographs of the ankle. Treatment can be nonoperative or operative depending on patient age, patient activity demands, severity of arthritis, and presence of tibiotalar deformity. Epidemiology Incidence less common than OA of knee and hip Etiology Pathophysiology causes include post-traumatic arthritis most common etiology, accounting for greater than 2/3 of all ankle arthritis primary osteoarthritis accounts for less than 10% of all ankle arthritis other etiologies include rheumatoid arthritis, osteonecrosis, neuropathic, septic, gout, and hemophiliac pathoanatomy nonanatomic fracture healing alters the joint contact forces of the ankle and changes the load bearing mechanics of the ankle joint loss of cartilage on the talar body and tibial plafond results in joint space narrowing, subchondral sclerosis and eburnation Anatomy Osteology a ginglymus joint that includes the tibia, talus, and fibula talar dome is biconcave with a central sulcus Range of motion ankle dorsiflexion: 20 degrees ankle plantar flexion: 50 degrees Takakura Classification Stage I Early sclerosis and osteophyte formation, no joint space narrowing Stage II Narrowing of medial joint space (no subchondral bone contact) Stage IIIA Obliteration of joint space at the medial malleolus, with subchondral bone contact Stage IIIB Obliteration of joint space over roof of talar dome, with subchondral bone contact Stage IV Obliteration of joint space with complete tibiotalar contact Presentation Symptoms pain with weight bearing loss of motion Physical exam joint effusion pain with ROM testing, loss of ROM compared to the contralateral side angular deformity may be present depending on the history of trauma Imaging Radiographs recommended views weight bearing AP, lateral, and obliques radiographic findings include loss of joint space subchondral sclerosis and cysts eburnation possible angular deformity Treatment Nonoperative activity modification, bracing to immobilize the ankle, and NSAIDS indications indicated as first line of treatment in mild disease single rocker sole shoe modification can improve gait and pain symptoms Arizona brace (gauntlet ankle brace) Operative surgical management indications indicated upon failure of conservative treatment in a patient with radiographic evidence of ankle arthritis Techniques Ankle debridement with anterior tibial/dorsal talar exostectomy indications mild disease with pain during push off Distraction arthroplasty controversial ideal candidate younger than 45 yrs with post-traumatic arthritis indications well-preserved ankle ROM moderate to severe arthritis congruent tibiotalar surface also for partial AVN talus Supramalleolar osteotomy indications near-normal ROM minimal talar-tilt or varus heel alignment medially focused ankle arthritis stage 2 or 3a according to the Takakura-Tanaka classification for varus-type osteoarthritis Arthrodesis indications posttraumatic or inflammatory arthritis, malalignment (with osteotomy) young, high demand laborers outcomes reliable relief of pain and return to activities of daily living complications long term studies demonstrate subtalar arthrosis 50% of patients demonstrated subtalar arthrosis 10 years following ankle arthrodesis in one study risk factors for nonunion include smoking, adjacent joint fusion, history of failed previous arthrodesis, and avascular necrosis revision arthrodesis union rates are 85% or greater Arthroplasty indications patient selection is crucial indications posttraumatic or inflammatory arthritis, elderly patient contraindications uncorrectable deformity, severe osteoporosis, talus osteonecrosis, charcot joint, ankle instability, obesity, and young laborers increase the risk of failure and revision techniques new generation arthroplasty minimizes bony resection, retains soft tissue stabilizers, and relies on anatomic balancing outcomes recent 5-10 year outcome studies demonstrate up to 90% good to excellent clinical results, long-term studies are still pending on the newest generation of ankle arthroplasty increased gait speed and stride length complications syndesmosis nonunion include wound infection, deep infection, and osteolysis
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Tibiotalar Arthrodesis Andrew Hsu Foot & Ankle - Ankle Arthritis Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. STAR Total Ankle Arthroplasty Orthobullets Team Foot & Ankle - Ankle Arthritis
QUESTIONS 1 of 16 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ13.191) A 43-year-old woman complains of ankle pain with weightbearing for the last 2 years. She plays tennis and regularly walks 5 miles a day for exercise, but has had to give up these activities over the last few months because of pain. NSAIDs and bracing have provided her temporary relief. An injection into her ankle joint provided temporary near-complete relief. She would like to proceed with a surgical intervention following a shared decision making discussion. Which of the following options will most likely provide pain relief and allow her to return to her previous activity level? QID: 4826 FIGURES: A B Type & Select Correct Answer 1 Arthroscopic debridement 5% (271/5101) 2 Supramalleolar osteotomy 65% (3311/5101) 3 Talar resurfacing 2% (107/5101) 4 Total ankle replacement 8% (393/5101) 5 Ankle arthrodesis 19% (982/5101) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ13.245) Medial opening wedge supramalleolar osteotomy is considered a treatment option for ankle osteoarthritis. In which of the following scenarios would this procedure be most appropriate? QID: 4880 Type & Select Correct Answer 1 Complete obliteration of the ankle joint space with bone-on-bone contact; valgus ankle alignment 1% (51/4116) 2 No joint-space narrowing, but early ankle joint sclerosis and osteophyte formation; valgus ankle alignment 9% (359/4116) 3 Symptomatic narrowing of the ankle joint space medially; varus ankle alignment 80% (3311/4116) 4 Symptomatic narrowing of the ankle joint space laterally; neutral ankle alignment 4% (154/4116) 5 Obliteration of the medial joint space that extends to the roof of the talar dome; varus ankle alignment 5% (206/4116) L 2 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic (SBQ12FA.32) A 52-year-old male sustains a talus fracture that is treated with immediate reduction and internal fixation. He subsequently develops talar dome avascular necrosis and is treated with the surgery shown in Figures A and B. He shows no evidence of healing at 12 months postoperatively and has continuous pain with ambulation; his incisions are well-healed and his subtalar motion remains full and pain-free upon examination. What is the most appropriate treatment for him at this time? QID: 3839 FIGURES: A B Type & Select Correct Answer 1 Use of an external bone stimulator 4% (65/1824) 2 Dynamization of the implants to allow controlled compression 2% (37/1824) 3 Removal of the implants and placement of a hindfoot arthrodesis nail or plate 12% (221/1824) 4 Injection of platelet rich plasma 0% (6/1824) 5 Revision ankle arthrodesis with bone grafting as needed 81% (1474/1824) L 2 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ11.10) The single rocker sole shoe modification is best indicated for relief of pain in patients with what foot or ankle pathology? QID: 3433 Type & Select Correct Answer 1 Midfoot prominences associated with Charcot arthropathy 19% (509/2737) 2 Severe toe-tip ulcerations 8% (228/2737) 3 End-stage tibiotalar arthritis with limited motion 60% (1647/2737) 4 Fixed ankle dorsiflexion deformity 8% (230/2737) 5 Fixed planovalgus deformity 4% (109/2737) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.197) A 65-year-old man complains of ankle pain refractory to bracing, physical therapy and NSAIDS. A radiograph is provided in Figure A. He is treated with ankle arthroplasty but continues to have pain and limited ambulation 10 months following surgery. Physical exam is notable for well healed incisions and no instability with anterior drawer and inversion testing. A current radiograph is provided in Figure B. Which of the following is the most likely cause of the continued pain? QID: 583 FIGURES: A B Type & Select Correct Answer 1 Improper surgical procedure 6% (211/3335) 2 Component loosening due to polyethylene wear 9% (294/3335) 3 Lateral ligament failure 1% (49/3335) 4 Syndesmotic nonunion 82% (2721/3335) 5 It is normal to have continued pain at 10 months following this surgery 1% (49/3335) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (OBQ08.115) At long-term follow-up, patients undergoing the procedure shown in Figure A have been shown to have significant rates of findings of which of the following? QID: 501 FIGURES: A Type & Select Correct Answer 1 Need for revision surgery 2% (65/3241) 2 Hardware failure 2% (66/3241) 3 Need for crutches or walker 0% (16/3241) 4 Ipsilateral knee and/or hip degenerative changes 7% (234/3241) 5 Ipsilateral midfoot and/or hindfoot degenerative changes 88% (2852/3241) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ08.257) All of the following have been recognized as risk factors for nonunion or delayed union following subtalar arthrodesis EXCEPT: QID: 643 Type & Select Correct Answer 1 smoking 0% (11/2268) 2 failure of previous subtalar arthrodesis 2% (36/2268) 3 more than 2 millimeters of avascular bone at arthrodesis site 3% (73/2268) 4 prior ipsilateral failed tibiotalar arthrodesis 6% (126/2268) 5 use of autograft 89% (2015/2268) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic (OBQ08.89) A 57-year-old male has right ankle pain for 6 years and has failed conservative management. Radiographs of the ankle are shown in Figures A and B. Which of the following is a contraindication for a total ankle arthroplasty? QID: 475 FIGURES: A B Type & Select Correct Answer 1 Posttraumatic arthritis 1% (18/2104) 2 Reconstructible ankle ligament damage 3% (68/2104) 3 Neuropathic joint disease 88% (1841/2104) 4 Inflammatory arthritis 8% (164/2104) 5 Age greater than 50 years old 0% (7/2104) L 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic
C - Core L 3 FREE PDF Foot & Ankle Orthopaedics Total Ankle Arthroplasty: Summary of Current Status Kathryn O’Connor 1University of Pennsylvania Philadelphia PA USA See all articles by this author Search Google Scholar for this author Sandra Klein MD Patrick Ebeling MD Adolph Samuel Flemister MD Phinit Phisitkul MD American Orthopaedic Foot & Ankle Society (AOFAS) Evidence-Based Medicine Committee Foot & Ankle - Ankle Arthritis Kathryn O’Connor 1University of Pennsylvania, 15 views 0.0
All Videos (0) Podcasts (1) Foot & Ankle⎪Ankle Arthritis Orthobullets Team Foot & Ankle - Ankle Arthritis Listen Now 14:1 min 12/11/2019 369 plays 5.0 (2)
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