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Bone Cysts and Osteolysis in Ankle Replacement.

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Pre-existing bone cysts are common in patients with end-stage ankle arthritis, often missed by standard X-rays. This prevalence study highlights the need for advanced imaging before total ankle replacement (TAR) to understand cyst behavior.

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Immunology

Background:

  • Total ankle replacements (TARs) exhibit higher osteolysis rates compared to hip or knee replacements.
  • The cause of TAR osteolysis is debated: immunologic response to wear debris or expansion of pre-existing bone cysts.
  • This study investigates the prevalence of bone cysts in end-stage ankle arthritis patients before TAR.

Purpose of the Study:

  • To determine the incidence of bone cysts in patients with end-stage ankle arthritis.
  • To assess the detectability of these cysts using plain radiography versus CT scans.
  • To review existing literature on bone cysts and osteolysis in the context of TAR.

Main Methods:

  • A descriptive/prevalence study involving 120 patients with end-stage ankle arthritis.
  • Preoperative plain radiography and computed tomographic (CT) scans were analyzed for bone cysts.
  • Cysts were measured, and those within surgical resection margins were excluded.

Main Results:

  • 78% of patients had bone cysts outside surgical margins; 14% had no cysts.
  • Cysts were frequently missed on plain radiographs (60%) but detected by CT.
  • 33% of cysts exceeded 5 mm, commonly located in the medial and lateral malleoli.

Conclusions:

  • Bone cysts are prevalent in 78% of end-stage ankle arthritis patients, with 30% being larger than 5 mm.
  • Plain radiography often fails to detect these cysts, underscoring the utility of 3D imaging.
  • Preoperative 3D imaging is crucial for monitoring cyst presence, expansion, and onset post-TAR.