title: Pseudoaneurysm of the posterior tibial artery after manipulation under anesthesia of a total ankle replacement.
abstract: Although pseudoaneurysm of the posterior tibial artery has been reported, no investigators have discussed the development of a pseudoaneurysm after manipulation under anesthesia of a total ankle replacement. We present the case of a 59-year-old female with end-stage post-traumatic tibiotalar joint disease who underwent an uneventful INBONE® Total Ankle Replacement. She experienced continued postoperative pain and impingement after physical therapy. Consequently, she underwent manipulation under anesthesia. The manipulation provided complete and immediate pain relief. However, she developed a pseudoaneurysm of the posterior tibial artery that required vascular repair. She recovered uneventfully and was ambulating free of pain with improved functionality. Although manipulation under anesthesia of a total ankle replacement is a valuable, noninvasive tool that can provide near-immediate pain relief, it is important to realize that this distal arterial injury, although uncommon, is a possibility.
authors.affiliation: Fellowship for Foot and Ankle Reconstruction, Coordinated Health, Bethlehem, PA 18017, USA. drsbrigido@mac.com
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Brigido
authors.forename: Scott T
authors.initials: ST
authors.lastname: Bleazey
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Oskin
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Protzman
mesh_terms: D000768:Anesthesia, General; D017541:Aneurysm, False / Q000209:etiology* / Q000601:surgery; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects* / Q000534:rehabilitation; D005260:Female; D006801:Humans; D008349:Manipulation, Orthopedic / Q000009:adverse effects*; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000628:therapy*; D011859:Radiography; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: 4; manipulation; posterior tibial artery; pseudoaneurysm; total ankle replacement; total ankle replacement complications