Technique Tip: Endoscopic-Assisted Curettage and Bone Grafting of Periprosthetic Total Ankle Arthroplasty Bone Cysts

Lundeen, Gregory A.; Barousse, Patrick; Moles, Laura Hemker; Whitlow, Scott; Cassinelli, Spenser J.

doi:10.1177/1071100720961090

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…There was a success rate of 89%, with 8 of 9 cysts meeting the criteria, and no patient requiring implant revision or arthrodesis. Lundeen et al 44 reported on endoscopy-assisted curettage and bone grafting of periprosthetic cysts, which allows for better visualization and complete removal of cystic material, which could result in higher grafting fill and improved success of graft incorporation.…”

Section: Discussionmentioning

confidence: 99%

“…The authors chose this volume as it defines a cyst with 15 mm dimension in all planes. 44 Five cysts smaller than 1.75 cm 3 were identified on initial CT scan, which were not bone grafted. All 5 cysts remained of similar size on final follow-up CT scan.…”

Section: Discussionmentioning

confidence: 99%

“…As there are no accepted guidelines in the literature regarding what periprosthetic cyst size should be grafted, the authors chose 1.5 cm in all 3 axes ( x , y , z ), which equates to a volume of 1.75 cm 3 as a guideline for deciding on operative management. 44 All patients were followed up after bone grafting at 3, 6, and 12 months and thereafter annually. Patients were excluded if they had incomplete patient records or were unavailable for follow-up.…”

Section: Methodsmentioning

confidence: 99%

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CT Scan Assessment and Functional Outcome of Periprosthetic Bone Grafting After Total Ankle Arthroplasty at Medium-term Follow-up

2022

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Background Periprosthetic cysts can occur in up to 95% of total ankle arthroplasties (TAA) and have been correlated with implant failure. The aim of this study was to determine the clinical and radiologic outcomes, using computed tomographic (CT) scan, after periprosthetic cyst bone grafting and assess for the minimum cyst size that should be grafted. Methods A retrospective review was performed of all TAA procedures performed between 2007 and 2014 (n=93). A CT scan was done to assess cyst size and operative planning. Eight patients with 9 periprosthetic cysts larger than 1.75 cm3 were grafted and specimens sent for histology. The mean time to bone grafting was 7.3 (3.8-9.5) years. Functional outcome was assessed using the American Orthopaedic Foot & Ankle Society ankle score, visual analog scale, and Self-reported Foot and Ankle Score. A CT scan was performed at follow-up to assess graft incorporation and cyst size progression. The mean time to CT scan post grafting was 3.0 (0.7-4.7) years. Results There was no implant malalignment identified and no differences in the pre- and postoperative functional scores. Preoperatively cysts had a mean volume of 8.16 (2.04-14.03) cm3. The mean percentage incorporation was 89% (69%-100%). Eight of the grafted cysts were considered successful on CT, with the ninth having 69% incorporation. Five cysts were not grafted, as they were below 1.75 cm3, and remained the same size or had minimal enlargement. Conclusion The satisfactory results in this small cohort suggests that prophylactic bone grafting may extend implant survival. We recommend that periprosthetic cysts greater than 1.75 cm3 be prophylactically bone grafted, and that cysts smaller than 1.75 cm3 be monitored for progression in size. Level of Evidence: Level IV, Case Series.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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