Introduction Defined as osteoarthritis of the tibiotalar joint Epidemiology less common than OA of knee and hip 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 Classification 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 bone 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 Operative surgical management indications indicated upon failure of conservative treatment in a patient with radiographic evidence of ankle arthritis Surgical 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 ideal for the elderly, less active patient 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 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 10/4/2016 Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Tibiotalar Arthrodesis Andrew Hsu Foot & Ankle - Ankle Arthritis Technique Guide 10/4/2016 Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. STAR Total Ankle Arthroplasty Orthobullets Team Foot & Ankle - Ankle Arthritis
QUESTIONS 1 of 12 1 2 3 4 5 6 7 8 9 10 11 12 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 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? Review Topic QID: 583 FIGURES: A B 1 Improper surgical procedure 6% (156/2659) 2 Component loosening due to polyethylene wear 8% (202/2659) 3 Lateral ligament failure 1% (37/2659) 4 Syndesmotic nonunion 83% (2218/2659) 5 It is normal to have continued pain at 10 months following this surgery 1% (38/2659) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (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? Review Topic QID: 501 FIGURES: A 1 Need for revision surgery 1% (38/2589) 2 Hardware failure 2% (51/2589) 3 Need for crutches or walker 0% (12/2589) 4 Ipsilateral knee and/or hip degenerative changes 6% (168/2589) 5 Ipsilateral midfoot and/or hindfoot degenerative changes 89% (2315/2589) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (OBQ08.257) All of the following have been recognized as risk factors for nonunion or delayed union following subtalar arthrodesis EXCEPT: Review Topic QID: 643 1 smoking 1% (9/1614) 2 failure of previous subtalar arthrodesis 1% (22/1614) 3 more than 2 millimeters of avascular bone at arthrodesis site 3% (54/1614) 4 prior ipsilateral failed tibiotalar arthrodesis 6% (91/1614) 5 use of autograft 89% (1434/1614) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 5 (OBQ11.10) The single rocker sole shoe modification is best indicated for relief of pain in patients with what foot or ankle pathology? Review Topic QID: 3433 1 Midfoot prominences associated with Charcot arthropathy 18% (370/2040) 2 Severe toe-tip ulcerations 9% (177/2040) 3 End-stage tibiotalar arthritis with limited motion 61% (1241/2040) 4 Fixed ankle dorsiflexion deformity 8% (173/2040) 5 Fixed planovalgus deformity 3% (70/2040) ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 3 (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? Review Topic QID: 475 FIGURES: A B 1 Posttraumatic arthritis 1% (17/1598) 2 Reconstructible ankle ligament damage 3% (51/1598) 3 Neuropathic joint disease 88% (1399/1598) 4 Inflammatory arthritis 8% (122/1598) 5 Age greater than 50 years old 0% (5/1598) ML 1 Select Answer to see Preferred Response PREFERRED RESPONSE 3 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
Ankle Arthritis in 45-year-old male (C2885) Foot & Ankle - Ankle Arthritis 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 Would you try additional nonoperative treatment modalities in this patient? 11/12/2017 6137 52 11 Ankle arthritis (C2372) Foot & Ankle - Ankle Arthritis HPI - Pilon fracture operated 4 years ago. Bone scan and CT scan rule out osteomyelitis. Assuming on has evaluated for, and eliminated any infection, how would you treat this patient? 9/21/2015 322 2 7 residual deformity of treated club foot (C1941) Foot & Ankle - Ankle Arthritis HPI - Bilateral club feet treated by multi-surgeries in the early childhood. How would you treat this patient? 6/9/2014 297 1 24