title: Partial transmalleolar approach for lateral impingement after total ankle arthroplasty: a case report.
abstract: Advances in implant technology have made total ankle arthroplasty an increasingly popular alternative to arthrodesis for the management of ankle arthritis. However, a frequent complication of the procedure is nerve impingement related to either to heterotrophic bone growth or the prosthesis itself. Successful resolution of this complication presents a challenge to clinicians. We present a case of lateral impingement following total ankle arthroplasty that was successfully treated using a partial transmalleolar approach to effect a partial osteotomy of the lateral malleolus and create a fragment attached to the anterior talofibular and calcaneofibular ligaments. This approach provides a good operative field in the lateral gutter with minimal soft tissue impairment. It also facilitates curettage, and resolution of tissue impingement. The osteotomy site healed fully by 3 months postoperative, and the pain around the lateral malleolus resolved. Furthermore, the patient's score on the Japanese Society for Surgery of the Foot Ankle/Hindfoot Scale improved from 33 preoperatively to 82 at 6 months postoperative.
authors.affiliation: Chief Physician, Department of Rheumatology, Yugawara Hospital, Kanagawa, Japan. Electronic address: matumot-tky@umin.ac.jp.
authors.forename: Takumi
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: Professor, Faculty of Medical Science for Health, Teikyo Heisei University, Tokyo, Japan; Visiting Department Director, Department of Rheumatology, Yugawara Hospital, Kanagawa, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakamura
authors.affiliation: Chief Physician, Department of Rheumatology, Yugawara Hospital, Kanagawa, Japan.
authors.forename: Ayumi
authors.initials: A
authors.lastname: Miura
authors.affiliation: Chief Physician, Department of Rheumatology, Yugawara Hospital, Kanagawa, Japan.
authors.forename: Gen
authors.initials: G
authors.lastname: Momoyama
authors.affiliation: Assistant Director, Yugawara Hospital, Kanagawa, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Ito
mesh_terms: D000368:Aged; D000843:Ankle Joint; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects*; D005260:Female; D005360:Fibula / Q000601:surgery*; D006801:Humans; D010003:Osteoarthritis / Q000601:surgery*; D054850:Osteophyte / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D016059:Range of Motion, Articular; D013628:Talus / Q000601:surgery
keywords: fibula osteotomy; impingement; revision; surgical complications; total ankle replacement