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Evaluating and Managing the Painful Total Ankle Replacement.

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Total ankle replacements (TARs) are increasing, leading to more complications. This review outlines systematic approaches to diagnose and treat painful TARs, considering various causes and advanced imaging.

Keywords:
ankle arthritiscomplicationscystslucencyosteolysissubsidencetotal ankle arthroplastytotal ankle replacement

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Area of Science:

  • Orthopedic surgery
  • Biomedical engineering
  • Radiology

Background:

  • Total ankle replacements (TARs) have seen a significant rise over the last 20 years.
  • Improvements in implant design and surgical techniques have driven this increase.
  • Higher TAR prevalence necessitates understanding and managing potential complications.

Purpose of the Study:

  • To provide a systematic approach for evaluating patients with new-onset or persistent pain after TAR.
  • To identify common causes of TAR failure and pain.
  • To discuss diagnostic modalities and treatment options for painful TARs.

Main Methods:

  • Systematic review of literature on painful total ankle replacements.
  • Discussion of diagnostic criteria for TAR complications.
  • Outline of advanced imaging techniques (SPECT, MSK-MRI) for pathology detection.
  • Consideration of extra-articular contributing factors.

Main Results:

  • Common causes of painful TAR include infection, fracture, loosening, cysts, impingement, and nerve injury.
  • Foot and ankle alignment and adjacent joint pathology are critical factors.
  • Advanced imaging aids in accurate diagnosis of underlying issues.
  • Treatment strategies are etiology-dependent, ranging from conservative management to revision surgery or amputation.

Conclusions:

  • A systematic evaluation is crucial for diagnosing painful TARs.
  • Advanced imaging and consideration of holistic patient factors improve diagnostic accuracy.
  • Tailored treatment based on the specific etiology offers the best outcomes for patients with painful TARs.