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Neurological injury rate of 16% reported with total ankle arthroplasty
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SAN DIEGO — Results of a retrospective study of total ankle arthroplasty in 145 patients with primary or end-stage osteoarthritis showed a 16% rate of neurological injury.
This injury was associated with reduced patient satisfaction and poorer clinical outcomes using the American Orthopaedic Foot and Ankle Society score compared to patients who underwent total ankle arthroplasty (TAA) but did not sustain such an injury, according to Min-Cheol Kim, MD, of Gwangju, Republic of Korea.
At the American Academy of Orthopaedic Surgeons Annual Meeting, here, Kim noted the patients all underwent TAA with the Hintegra Total Ankle Prosthesis (Integra Lifesciences) between 2005 and 2011. They were followed for a mean of 41.3 months and there were a total of 145 ankles.
“Neurological injury after total ankle arthroplasty [TAA] is considerable,” Kim said.
He noted there were 23 nerve injuries, which included nine posterior tibial nerve injuries and six injuries each of the superficial and the deep peroneal nerves. In addition, there was one injury each to the saphenous and sural nerves.
“The prevalence of neurological injury after ankle arthroplasty is reported to vary from 2.4% to 21%, which is known to be caused by various situations during surgery,” Kim said.
Based on the results, neurologic injury was significantly associated with the development of post-traumatic osteoarthritis. However, Kim and colleagues found no significant association between neurologic injury and what he described as potential predisposing factors to such an injury, such as age, gender, BMI and the duration of the patient’s symptoms preoperatively.
“All of the nerve injuries recovered completely or incompletely,” Kim said. – by Susan M. Rapp
Reference:
Kim M-C, et al. Paper #259. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 14-18, 2017; San Diego.
Perspective
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Stephen A. Brigido, DPM, FACFAS
As a surgeon who has performed TAR routinely, I found these results interesting. Injuries to the posterior tibial and deep peroneal nerves can be debilitating to the patient and affect both the physical outcomes and patient satisfaction in a negative way. The posterior tibial nerve is at risk with the tibial resection both during cutting and removal of the posterior tibia. Surgeons can find themselves being aggressive trying to remove the posterior lip of the tibia from the posterior joint capsule. The deep peroneal nerve is at risk during dissection, as well as with retraction of the deep soft tissue. Appropriate retraction is not only important to prevent nerve injury, but will also minimize the risk of wound formation of the skin at the level of the ankle joint. In our institution, we find the most commonly injured nerve during TAR is the superficial peroneal nerve as it crosses the anterior ankle. This is at risk both during the surgical dissection and while the cut guides are placed on the anterior aspect of the ankle and leg. Although patients will describe a feeling of numbness on the anterior leg and dorsal foot, injury to this nerve does little to affect function or long-term outcomes.
Patient selection, good surgical technique and appropriate postoperative rehabilitation will ensure patients receive all the great benefits of improved function and mobility that TAR has to offer.
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