Imaging and Treatment of Posttraumatic Ankle and Hindfoot Osteoarthritis

Abstract

Posttraumatic osteoarthritis of the ankle and hindfoot is a common and frequently debilitating disorder. 70% to 90% of ankle osteoarthritis is related to prior trauma that encompasses a spectrum of disorders including fractures and ligamentous injuries that either disrupt the articular surface or result in instability of the joint. In addition to clinical evaluation, imaging plays a substantial role in the treatment planning of posttraumatic ankle and hindfoot osteoarthritis. Imaging evaluation must be tailored to specific clinical scenarios and includes weight bearing radiography that utilizes standard and specialty views, computed tomography which can be performed with a standard or a weight bearing technique, magnetic resonance imaging, and ultrasound evaluation. This review article aims to familiarize the reader with treatment rationale, to provide a brief review of surgical techniques and to illustrate expected imaging appearances of common operative procedures performed in the setting of posttraumatic ankle and hindfoot osteoarthritis, such as joint-preserving procedures, ankle fusion, subtalar fusion, tibiotalarcalcaneal fusion and ankle arthroplasty. Preoperative findings will be discussed along with the expected postoperative appearance of various procedures in order to improve detection of their complications on imaging and to provide optimal patient care.

Supramalleolar Osteotomy vs Arthrodesis for the Treatment of Takakura 3B Ankle Osteoarthritis

“…9,31 Ankle OA may result from cartilage damage sustained at the time of injury or chronic cartilage overloading that is caused by articular incon gruity, malalignment, and instability. 10,21 Recurrent ankle sprain and fracture are the most common cause of ankle OA and lead to varus deformity in the majority, 13,22 and the talus is positioned with varus tilt, anterior extrusion, inter nal rotation, and displacement. With varus alignment of the ankle, the mechanical axis of the lower limb moves medi ally, 11 which has been associated with increased medial contact pressure and thought to be responsible for progres sive cartilage degeneration.…”

Does Concurrent Distal Tibiofibular Joint Arthrodesis Affect the Nonunion and Complication Rates of Tibiotalar Arthrodesis?

“…The primary outcome measure was nonunion rate of tibiotalar arthrodesis [ 2 ]. Union was defined based on patient reported symptoms and clinical physical examination criteria (no pain, no warmth, improvement in swelling, and stability to stress) and radiographic criteria (visible trabecular bridging across the arthrodesis site and no lucency around the hardware) [ 40 ].…”

“…Approximately 1% of the world’s population is affected with ankle osteoarthritis [ 1 ]. The posttraumatic etiology is the most common etiology of the end-stage ankle osteoarthritis [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. After failure of nonoperative treatments for severe ankle arthritis [ 5 ] including bracing/immobilization, anti-inflammatories, shoe wear and activity modification, and corticosteroid injections, patients have two operative options—arthroplasty [ 8 , 9 , 10 , 11 , 12 ] and arthrodesis [ 13 , 14 , 15 , 16 , 17 , 18 ].…”

Ankle Instability Update

“…It is usually secondary to traumatic injuries from sprains or ligament injuries, but also from intra- and extra-articular fractures. 69 CAI and deltoid ligament injuries lead to a faster onset of OA. 37 Ankle OA usually occurs in younger productive-age individuals, progressing more rapidly to advanced stages and resulting in longer time with pain and loss of function.…”