Continuous Infragluteal Sciatic Nerve Block for Postoperative Pain Control After Total Ankle Arthroplasty

2014 ◽  
Vol 7 (4) ◽  
pp. 271-276 ◽  
Author(s):  
Diana Starr Young ◽  
Adam Cota ◽  
Ruth Chaytor
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Case Series ◽  
Oral Morphine ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Opioid Analgesia ◽  
Postoperative Pain Control ◽  
Ankle Arthroplasty ◽  
Ankle Replacement

Continuous peripheral nerve blocks (CPNB) for postoperative pain control are being used more frequently for total ankle arthroplasty. The purpose of this study was to compare the amount of opioid analgesia used in patients with an infragluteal CPNB to that of patients with no CPNB for postoperative pain management after total ankle replacement. A retrospective cohort study was performed on 78 consecutive patients who had a total ankle arthroplasty from October 2006 to June 2013. The primary outcome measure was opioid analgesia use in the first 48 hours postoperatively. The mean postoperative narcotic use in oral morphine equivalents was 64.6 mg in the CPNB group compared to 129.6 mg in the no CPNB group ( P < .001). Using an infragluteal CPNB as a means of postoperative pain control in patients undergoing a total ankle replacement is associated with significantly decreased opioid use compared to patients receiving no CPNB. Levels of Evidence: Therapeutic, Level IV, case series

scholarly journals Safety and Effectiveness of Outpatient Total Ankle Arthroplasty

2021 ◽  
Vol 6 (4) ◽  
pp. 247301142110578
Author(s):  
Shahin Kayum ◽  
Sahil Kooner ◽  
Ryan M. Khan ◽  
Mansur Halai ◽  
Adam Awoke ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Pain ◽  
Pain Control ◽  
Primary Outcome ◽  
Case Series ◽  
Total Ankle Arthroplasty ◽  
Postoperative Pain Control ◽  
Ankle Arthroplasty ◽  
Secondary Outcomes ◽  
Numeric Scale

Background: Total ankle arthroplasty (TAA) is a surgical procedure commonly reserved for patients suffering from symptomatic end-stage ankle arthritis. As the number of TAAs increases, so does the associated economic burden. Given these economic constraints, there has been interest in the feasibility of outpatient TAA. The purpose of this study is to evaluate the safety, efficacy, and satisfaction of patients undergoing outpatient TAA. Methods: This is a retrospective case series of consecutive patients who underwent outpatient TAA from July 2018 to June 2019. Inclusion criteria included any patient undergoing a primary TAA in the outpatient setting. This was defined as discharge on the same day of surgery or within 12 hours of surgery. All surgeries were completed by a single experienced surgeon through an anterior approach using the Cadence Total Ankle System. Prior to surgery, all patients received a popliteal nerve block. Patients were then discharged home with oral analgesic and a popliteal nerve catheter, which they removed after 48 hours. The primary outcome of interest was postoperative pain control, which was measured using a numeric scale. Secondary outcomes included complication rate, readmission rate, and patient satisfaction. A review of the current literature was then completed to supplement our results. Results: In total, 41 patients were included in our analysis. In terms of the primary outcome, the average numeric scale score was 1.98, indicating excellent pain control. Additionally, nearly all 41 patients stated they were very satisfied with their postoperative pain control regimen. In terms of secondary outcomes, the majority of patients stated they were satisfied with discharge on the same day as surgery. There were no readmissions or major complications in our outpatient TAA cohort. When asked if they would recommend the care they experienced to a friend with the same condition, 95% of patients said that they would recommend this care pathway. Our literature review included 5 original studies, which were all retrospective level IV studies. These studies uniformly demonstrated the safety and efficacy of outpatient TAA. Conclusions: The results of our study demonstrate the outpatient TAA is associated with excellent pain control using a multidisciplinary pain approach. The use of standardized outpatient postoperative pathways was effective in preventing readmissions and complications, while still resulting in high patient satisfaction scores. A review of the literature complemented our results, as there are largely no significant differences between outpatient and inpatient TAA. Level of Evidence: Level IV, case series.

scholarly journals Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty

2018 ◽  
Vol 40 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Federico G. Usuelli ◽  
Camilla Maccario ◽  
Francesco Granata ◽  
Cristian Indino ◽  
Venus Vakhshori ◽  
...  
Keyword(s):  
Short Form ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Plate Removal ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Patient Reported

Background: Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proven to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with follow-up of at least 2 years. Methods: This prospective study included 89 patients who underwent transfibular total ankle arthroplasty from May 2013 to February 2016. The mean age was 53.2 ± 13.5 years. All patients were followed for at least 24 months postoperatively with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiographically preoperatively and at 6, 12, and 24 months postoperatively. Results: At 24 months postoperatively, patients demonstrated statistically significant improvement in the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score from 33.8 ± 14.3 to 88.5 ± 6.6 ( P < .001), visual analog scale (VAS) from 80.5 ± 17.0 to 14.1 ± 9.2 ( P < .001), and Short Form-12 Physical and Mental Composite Scores from 29.9 ± 6.7 and 43.3 ± 8.6 to 47.0 ± 7.6 and 53.3 ± 8.1, respectively ( P < .001). In addition, ankle dorsiflexion and plantarflexion improved from 6.2 ± 5.5 and 9.6 ± 5.8 degrees to 24.2 ± 7.9 and 18.1 ± 7.6 degrees, respectively ( P < .001). Radiographically, patients demonstrated maintained neutral alignment of the ankle at 24 months. No patient demonstrated any radiographic evidence of tibial or talar lucency at final follow-up. Seven patients underwent reoperation for removal of symptomatic hardware (6 fibular plates, 1 syndesmotic screw); 2 patients experienced delayed wound healing. The first one was treated with plate removal and flap coverage. The second one required fibular plate removal. One patient developed a postoperative prosthetic infection requiring operative debridement, removal of implants, and placement of an antibiotic spacer. Conclusion: This study found that transfibular total ankle replacement was a safe and effective option for patients with ankle arthritis resulting in improvements in patient-reported outcomes, range of motion, and radiographic parameters. However, further studies are required to determine the mid- and long-term performance of these implants. Level of Evidence: Level IV, case series.

scholarly journals Adverse Events in Total Ankle Arthroplasty, Analysis of the FDA Medical and User Facility Device Experience Database

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Karim Mahmoud ◽  
Sreenivasulu Metikala ◽  
Kathryn O’Connor ◽  
Daniel Farber
Keyword(s):  
Adverse Events ◽  
Aseptic Loosening ◽  
Mandatory Reporting ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Mode Of Failure ◽  
User Facility

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement has become a popular treatment option for end stage ankle arthritis. Most of the reports of adverse events following total ankle replacement have been from high volume institutions and are subject to either observational or selection bias as well as potential under-reporting as they do not include the experience of community and lower volume centers and surgeons. The FDA’s Medical and User Facility Device Experience (MAUDE) Database provides a more complete scope of adverse events due to the mandatory reporting requirements by the FDA of implant manufactures. We reviewed the database to identify the common modes of failure and complications of total ankle implants Methods: We retrospectively reviewed reports of the MAUDE database from November 2011 to September 2018 regarding all total ankle implants. Each device in the MAUDE database is classified with a 3-letter code, we identified the 2 codes assigned to total ankle arthroplasty devices, and manually searched the FDA’s published Device Classification list for adverse events. All events were reviewed and classified. Data related to patient age or sex, surgeon, medical center location are not available in the database Results: We identified 1000 adverse reports in the period between November 2011 and September 2018. After exclusion of duplicate reports for single events or reports irrelevant to total ankle arthroplasty, a total of 697 adverse event reports were noted. The most common mode of failure was aseptic loosening (21%), followed by infection (16%), alignment and mechanical issues (instability, malalignment, malposition, stiffness, impingement) (15%), implantation issues (pin, screw or drill breakage, alignment guide problems) (9%), polyethylene related problems (wear, displaced or fractured implants) (7%), bony and soft tissue overgrowth (6%), and peri-prosthetic fractures (5%). Conclusion: Our analysis reveals that the most reported mode of failure was aseptic loosening followed by infection. However, it is notable that there are a significant number of issues with implant alignment and mechanics, complications during implantation and polyethylene component failure that are under-reported in the literature. Knowledge of these adverse events may help surgeons avoid similar complications as well as lead to improvement in component implantation and design

scholarly journals Evaluation of a pilot regimen for postoperative pain control in patients receiving oral morphine pre-operatively

Anaesthesia ◽  
2000 ◽  
Vol 55 (12) ◽  
pp. 1208-1212 ◽  
Author(s):  
J. E. Peacock ◽  
B. M. Wright ◽  
M. R. Withers ◽  
J. B. Luntley ◽  
R. E. Atkinson
Keyword(s):  
Postoperative Pain ◽  
Pain Control ◽  
Oral Morphine ◽  
Postoperative Pain Control

scholarly journals Nottingham Experience with The Fixed Bearing Infinity Total Ankle Replacement

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0042
Author(s):  
Hatem Salem-Saqer ◽  
Martin Raglan ◽  
Sunil Dhar
Keyword(s):  
Complication Rate ◽  
Weight Bearing ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Implant Design ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
End Stage

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is increasingly used for treatment of end stage arthritis of the ankle; improvements continue to evolve in implant design and instrumentation. We present our experience of the Infinity Total Ankle Arthroplasty (Wright Medical), a fixed bearing 4th generation implant with improved instrumentation Methods: This is a retrospective review of prospectively collected data. From October 2016 to July 2019, we identified 92 (52M/40F) who had the infinity Total Ankle Replacement. This review is of 70 patients with a minimum of 1 year follow up (33M,37F). The mean age was 67.5 years (33-87); 32 right side and 38 left no bilaterals. The indication for surgery was end stage Osteoarthritis in 52, post traumatic arthritis 12, inflammatory arthritis 4, conversion of fusion to TAR 2. The preoperative deformity was graded according to the COFAS classification. All patients had follow up at 6 weeks, 3,6 and 12 months and then annually, with MOXFQ questionnaire and weight bearing radiographs. Results: TAA was performed with the use of fluoroscopy. 77% (54/70) had concomitant procedures as listed in Table.5% (4/70) had complications consisting of, 1 DVT, 1 intra operative medial malleolus fracture, 1 EHL tendon laceration and 1 wound break down. There were no deep or superficial infections. Improvement in clinical outcome and PROMS data was noted on follow up. The MOXFQ for Pain improved from 72 pre-op to 25 at 1year (p<0.001). The outcome for Walking improved from 83 pre-op to 30 at one year (p<0.001). Radiological alignment was maintained asymptomatic posterior heterotopic ossification was noted in 23(16%) patients, lucent lines under the tibial implant were noted in 4 ankles and 1 fibula erosion. 2 TAA (3%) needed to be revised due to malpositioning. Conclusion: Our results show significant improvement in patient outcomes, a short recovery time and marked improvement in mobility post operatively with a very low complication rate, we had no deep infection to date. Two implants were revised which we attribute to the learning curve at the start of practice. This implant is fluoroscopically navigated allowing precise implantation with dedicated instrumentation and we feel this attributed to the low complication rate and good results in our short-term study [Table: see text]

A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty

2017 ◽  
Vol 39 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Todd R. Borenstein ◽  
Kapil Anand ◽  
Quanlin Li ◽  
Timothy P. Charlton ◽  
David B. Thordarson
Keyword(s):  
Wound Infection ◽  
Pain Control ◽  
Perioperative Complications ◽  
Case Series ◽  
Arterial Occlusion ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Ankle Arthroplasty ◽  
Wound Breakdown

Background: Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. Outpatient TAA are increasingly common and have been shown to decrease costs compared to inpatient surgery. However, there are very few studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive patients who received outpatient TAA to identify complication rates. Methods: The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum 6-month follow-up were reviewed. All patients received popliteal and saphenous blocks prior to surgery and were managed with oral pain medication postoperatively. All received a STAR total ankle. Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and perioperative complications including wound breakdown, infection, revision, and nonrevision surgeries were observed. Mean follow-up was 16.6 ± 9.1 months (range, 6-42 months). Results: There were no readmissions for pain control and 1 patient had a wound infection. The overall complication rate was 15.4%. One ankle (1.5%) had a wound breakdown requiring debridement and flap coverage. This patient thrombosed a popliteal artery stent 1 month postop. The 1 ankle (1.5%) with a wound infection occurred in a patient with diabetes, obesity, hypertension, and rheumatoid arthritis. Conclusion: This study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory experience with no readmissions for pain control and 1 wound infection. The 1 wound breakdown complication (1.5%) was attributed to arterial occlusion and not outpatient management. Level of Evidence: Level IV, retrospective case series.

scholarly journals Two-Year Outcomes of Total Ankle Replacement with the Cadence Total Ankle Replacement System

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
Timothy R. Daniels ◽  
Shahin Kayum ◽  
Ryan M. Khan ◽  
Anastasia Sanjevic
Keyword(s):  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
X Rays ◽  
Ankle Osteoarthritis ◽  
Ankle Arthroplasty ◽  
Post Surgery ◽  
Ankle Replacement ◽  
Two Component ◽  
Replacement System ◽  
End Stage

Category: Ankle, Ankle Arthritis Introduction/Purpose: Over the last few decades, total ankle replacement (TAR) emerged as a reliable treatment option in end-stage ankle osteoarthritis (OA) while preserving motion and physiological load. The Cadence™ prosthesis, manufactured by Integra LifeSciences, is a two-component, fixed-bearing implant with minimal tibial and talar resection and has been in clinical use since June 2016. The purpose of this study is to assess the two-year validated clinical outcome scores and radiological parameters of the Cadence™ prosthesis at our hospital. Methods: Thirty-one consecutive patients who received the Cadence™ prosthesis between June 2016 and December 31st, 2016 were enrolled. All patients who underwent a primary TAR with the Cadence™ prosthesis and who had at least two years follow- up were included. All surgeries were performed by a single surgeon with experience in total ankle arthroplasty. At the yearly clinical evaluation, patients were administered the Ankle Osteoarthritis Scale (AOS) and the Short Form Health Survey (SF-36), and their radiological outcomes pre and post-surgery were assessed. Results: Thirty-one patients fulfilled the inclusion criteria. Forty ancillary procedures were performed on twenty-four TAR’s. Radiological analyses showed preoperative talar sagittal translation with 25 anterior, 2 posterior, and 4 neutral. Sagittal translation decreased from an average 3.11 mm to 1.0 mm. Eleven ankles had a perioperative talar Varus and Valgus deformity that was corrected, with neutral alignment in all. At the two-year clinic visit, x-rays showed no lucencies or stress fractures and none of the ankles required revision of metal components. The pre and post-operative pain and disability scores displayed major improvement wherein AOS pain scores decreased -20.28 ± 14.34 points from an average of 47.86 points while AOS disability scores decreased -32.11 ± 22.70 from an average of 57.15 points. Conclusion: The overall outcome of the total ankle arthroplasty with the Cadence™ prosthesis showed excellent clinical and radiological outcomes. Compelling clinical evidence shows that the quality of life, functional measures, and pain in patients suffering from end-stage arthritis significantly improved following surgery with the Cadence™ total ankle replacement system. The semi- constrained design of this two-component implant and utilization of biased polyethylene inserts allowed for correction of the talus in both the sagittal (talar anterior / posterior translation) and coronal planes (talar varus / valgus).

scholarly journals Clinical and Radiological Outcomes of Transfibular Total Ankle Arthroplasty at 2-years Follow-up

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005
Author(s):  
Francesco Granata ◽  
Camilla Maccario ◽  
Luigi Manzi ◽  
Eric Tan ◽  
Federico Giuseppe Usuelli
Keyword(s):  
Functional Limitation ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthritis ◽  
Hindfoot Alignment ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Patient Reported ◽  
American Orthopaedic

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a highly limiting pathology that causes pain and functional limitation with subsequent deterioration of quality of life. With recent advances in surgical instrumentation and techniques, prosthetic replacement of the ankle has proved to be a valid alternative to arthrodesis with comparable outcomes. The purpose of this study was to evaluate clinical and radiological findings in a transfibular total ankle replacement with two years follow-up. Methods: This prospective study included 59 patients who underwent transfibular total ankle arthroplasty from May 2013 to December 2015. The mean age was 51.6 ± 13.4 years. All patients were followed for at least 24 months postoperative with an average follow-up of 42.0 ± 23.5 months. Patients were assessed clinically and radiologically preoperatively and at 6, 12, and 24 months postoperatively. Results: At 24 months, patients demonstrated statistically significant improvement in the American Orthopaedic Foot and Ankle Society score from 33.6 to 88.1 (P<0.01), VAS scale from 79.3 to 14.0 (P<0.01) and SF-12 Physical and Mental Composite Scores from 29.9 and 44.6 to 74.4 and 95.3, respectively (P<0.01). Ankle dorsiflexion and plantarflexion improved from 5.5 and 8.8 degrees to 24.2 and 20.0 degrees, respectively (P<0.01). Radiographically, patients demonstrated neutral alignment of the ankle with a tibio-talar ratio of 34.9 ± 9.2 and hindfoot alignment view angle of 1.2 ± 7.0 degrees. No patient demonstrated any radiographic evidence of tibial or talar lucency at 24 months. Seven patients underwent reoperation for removal of symptomatic hardware; one patient developed a postoperative prosthetic infection requiring placement of an antibiotic spacer. Conclusion: This study demonstrates that transfibular total ankle replacement is a safe and effective option for the patients for ankle arthritis with improvements in patient-reported outcomes, range of motion, and radiological parameters. However, further studies are required to determine the mid- and long-term performance of these implants.

scholarly journals Restoration of Talar Height using a Modular Revision Prosthesis after Failed Total Ankle Arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Brian Steginsky ◽  
Steven L. Haddad
Keyword(s):  
Postoperative Complications ◽  
Bone Loss ◽  
Ankle Arthrodesis ◽  
Cement Augmentation ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
The Mean

Category: Ankle Introduction/Purpose: Talar component subsidence is the most common indication for revision total ankle replacement. The management of talar bone loss and alteration in the ankle joint center of rotation is challenging following component subsidence. Unfortunately, ankle arthrodesis as a salvage procedure for failed ankle arthroplasty has been associated with high rates of nonunion and collapse. Equally unfortunate, there is paucity in the literature on revision total ankle arthroplasty. The purpose of this study was to report the early outcomes of revision total ankle replacement using a modular prosthesis and metal/cement augmentation to reconstitute talar height following catastrophic failure of the index total ankle arthroplasty. Methods: Retrospective review was performed on sixteen patients who underwent revision total ankle replacement for failed arthroplasty associated with talar component subsidence and subsequent talar bone loss. All patients underwent revision arthroplasty using a revision modular ankle prosthesis and had a minimum of one-year follow-up. Demographic data, postoperative complications, original prosthesis, and concomitant procedures were recorded. Radiographic measurements were performed at three time-points (preoperative, immediately after surgery, and at most recent follow-up) to evaluate alignment of the prosthesis, talar height, and ankle range of motion. Implant survivorship was determined. Failure was defined as >2 mm of talar subsidence, conversion to ankle arthrodesis or below the knee amputation, and/or revision of the prosthesis. Ankle Osteoarthritis Score (AOS), Foot Function Index (FFI), and visual analog score (VAS) were collected at the most recent postoperative visit. Results: Patient follow-up ranged from 12.1 –20.6 months, with a mean follow-up of 15.0 months. The mean preoperative and immediate postoperative talar height was 28.7 mm and 33.4 mm, respectively. There was a significant improvement in talar height of 4.7 mm after revision total ankle replacement (P<0.001). Talar height was maintained at most recent follow-up. The mean preoperative and postoperative radiographic arc of motion was 19.5° and 24.0°, respectively. Two patients, with a mean BMI of 43.5, developed >2 mm of talar subsidence (one patient required revision surgery). The mean postoperative AOS and FFI was 25.0 and 28.8, respectively. The majority of patients (84%) were satisfied with their outcome, and all patients would choose to undergo the same procedure again (vs. arthrodesis or amputation). Conclusion: Revision ankle replacement using a modular prosthesis with metal/cement augmentation allows restoration of talar height. Though we recognize this data constitutes a very early follow up, this cohort has utilized the revision ankle implant with significant repetitive load after which older generation implants underwent secondary subsidence due to poor talar bone stock. Early outcomes demonstrate a predictable method to salvage catastrophic prosthesis failure associated with severe talar subsidence and deformity. The risk of postoperative complications, although moderate, is an acceptable alternative to lower limb amputation/arthrodesis. Further follow-up is warranted to determine functional outcomes and longevity of revision implant systems.

Sign in / Sign up

Export Citation Format

Share Document