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The Science Behind Periprosthetic Aseptic Osteolysis in Total Ankle Replacement

  • Orfan Arafah
  • Murray J. Penner
Chapter

Abstract

In foot and ankle literature, firm evidence about the etiology, pathophysiology, natural history, and optimal treatments of ankle periprosthetic osteolysis is still lacking. In contrast to osteolysis around hip arthroplasty, factors other than polyethylene debris, such as reaction to necrotic tissue, micromotion at the implant-bone interface, and high fluid pressure may play a key role in osteolysis around total ankle replacement. Annual radiographic surveillance is recommended for early detection and treatment of osteolysis. Computerized tomography showed superiority in both detecting cysts and accurately determining their sizes if compared to standard radiography. The benefit of early surgical intervention in progressive osteolysis may outweigh the risks of catastrophic failure associated with longer conservative management. For total ankle replacement metallic components deemed to be stable, cysts debridement with impaction bone grafting and polyethylene exchange is usually all that is required. If one or both components are deemed to be unstable, component revision is required in addition to cyst debridement and impaction bone grafting. A foot and ankle surgeon who is an expert in both primary and revision total ankle replacement should manage treatment of osteolysis associated with total ankle replacement.

Keywords

Arthroplasty Bone graft Complications Revision Subsidence 

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Orthopaedic (49)College of Medicine, King Khalid University Hospital/King Saud UniversityRiyadhSaudi Arabia
  2. 2.Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
  3. 3.Department of OrthopaedicsSt. Paul’s Hospital, Vancouver Coastal Health Authority and Providence Health CareVancouverCanada

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