The Orthobullets Podcast

Podiums⎪Foot & Ankle⎪The Painful Total Ankle

Nov 5, 2024
Bryan Den Hartog, an expert in foot and ankle surgery, discusses the complexities of post-operative pain from total ankle replacements. He highlights the critical challenges in diagnosis, emphasizing the need for comprehensive patient histories and advanced imaging techniques. The conversation touches on the comparison of revision rates among ankle, hip, and knee surgeries, revealing a pressing need for enhanced pain source identification. Den Hartog also shares insights on managing complications like infection and misalignment, giving a deeper understanding of this pervasive issue.
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INSIGHT

High Ankle Revision Rates

  • Total ankle replacements have a significantly higher revision rate than hip or knee replacements.
  • A 2007 study showed a 23% failure rate for total ankle replacements, highlighting the need for improvement.
ADVICE

Evaluating Painful Total Ankle

  • Evaluate the cause of pain in a total ankle replacement before treating it.
  • Consider factors like infection, loosening, cysts, malalignment, impingement, and adjacent joint pain.
ADVICE

Patient History

  • Take a thorough patient history, including underlying factors, comorbidities, previous surgeries, and pain onset.
  • Consider if the pain is acute or chronic, as startup pain suggests a loose implant.
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