Surgical Treatment of Bony and Soft-Tissue Impingement in Total Ankle Arthroplasty.
BACKGROUND
Impingement may be an underreported problem following modern total ankle replacements (TARs). The etiology of impingement is unclear and likely multifactorial. Because of the lack of conservative treatment options for symptomatic impingement after TAR, surgery is often necessary.


METHODS
We retrospectively identified a consecutive series of 1001 primary TARs performed between January 1998 and December 2014. We identified patients who required a secondary surgery to treat soft-tissue and bony impingement by either an open or arthroscopic procedure. Functional and clinical outcomes, including secondary procedures, infections, complications, and failure rates, were recorded.


RESULTS
In all, 75 patients (7.5%) required either open (n = 49) or arthroscopic debridement for impingement after TAR; 44 patients had >12 months of follow-up, with a follow-up of 26.5 months after their debridement procedure. The mean time to the debridement procedure for all prostheses was 29.3 months, with an average of 38.7 months in STAR, 21.8 months in INBONE, and 10.5 months in Salto Talaris patients. Of the patients with more than 1 year's follow-up from their debridement, 84.1% were asymptomatic; 9 patients (20.4%) had repeat operations after their debridement procedure. Of these, 5 patients required a repeat debridement of their medial or lateral gutters for a failure rate of 11.4%.


CONCLUSIONS
Both arthroscopic and open treatment of impingement after total ankle arthroplasty are safe and effective in improving function and pain. Although the rates for revision impingement surgery are higher in arthroscopic compared with open procedures, they are not significantly so. Therefore, we recommend arthroscopic surgery whenever possible because of earlier time to weight bearing and mobility.


METHODS
Level IV.
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina (CEG).|Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (SBA, ME, JAN, JKD).
Christopher E
CE
Gross
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina (CEG).|Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (SBA, ME, JAN, JKD).
Samuel B
SB
Adams
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina (CEG).|Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (SBA, ME, JAN, JKD).
Mark
M
Easley
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina (CEG).|Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (SBA, ME, JAN, JKD).
James A
JA
Nunley
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina (CEG).|Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina (SBA, ME, JAN, JKD).
James K
JK
DeOrio
D000843:Ankle Joint / Q000601:surgery*; D058737:Arthroplasty, Replacement, Ankle / Q000009:adverse effects*; D001182:Arthroscopy; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies
arthroscopy; impingement; total ankle arthroplasty