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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?
Total ankle replacement
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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?
Complete obliteration of the ankle joint space with bone-on-bone contact; valgus ankle alignment
No joint-space narrowing, but early ankle joint sclerosis and osteophyte formation; valgus ankle alignment
Symptomatic narrowing of the ankle joint space medially; varus ankle alignment
Symptomatic narrowing of the ankle joint space laterally; neutral ankle alignment
Obliteration of the medial joint space that extends to the roof of the talar dome; varus ankle alignment
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?
Use of an external bone stimulator
Dynamization of the implants to allow controlled compression
Removal of the implants and placement of a hindfoot arthrodesis nail or plate
Injection of platelet rich plasma
Revision ankle arthrodesis with bone grafting as needed
The single rocker sole shoe modification is best indicated for relief of pain in patients with what foot or ankle pathology?
Midfoot prominences associated with Charcot arthropathy
Severe toe-tip ulcerations
End-stage tibiotalar arthritis with limited motion
Fixed ankle dorsiflexion deformity
Fixed planovalgus deformity
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?
Improper surgical procedure
Component loosening due to polyethylene wear
Lateral ligament failure
It is normal to have continued pain at 10 months following this surgery
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?
Need for revision surgery
Need for crutches or walker
Ipsilateral knee and/or hip degenerative changes
Ipsilateral midfoot and/or hindfoot degenerative changes
All of the following have been recognized as risk factors for nonunion or delayed union following subtalar arthrodesis EXCEPT:
failure of previous subtalar arthrodesis
more than 2 millimeters of avascular bone at arthrodesis site
prior ipsilateral failed tibiotalar arthrodesis
use of autograft
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?
Reconstructible ankle ligament damage
Neuropathic joint disease
Age greater than 50 years old