tailieunhanh - Total Ankle Arthroplasty - part 9

vấn đề là Sự phát triển của thoái hóa khớp thứ phát trong các doanh subtalar, và rất thường, Ngoài ra trong các doanh talonavicular. Ngoài ra, lớp vỏ mềm mô sẹo và IS thường chuyển động trượt khác nhau giữa các mô bị tổn thương cao IS, Kết quả là độ cứng chung của toàn bộ mắt cá chân doanh phức tạp. Một arthrodesis mắt cá chân bị cô lập | 158 Chapter 10 What is Feasible problem is the development of secondary osteoarthritis in the subtalar joint and very often also in the talonavicular joint. In addition the soft-tissue mantle is often scarred and gliding movement between the different tissues is highly compromised resulting in general stiffness of the whole ankle joint complex. An isolated ankle arthrodesis may not sufficiently relieve pain and in most instances an extensive arthrodesis must be considered. Total ankle replacement together with an extensive hindfoot arthrodesis is however far better for the patient. If the risk of reinfection or reactivation of a subclinical infection can be minimized by careful preoperative investigation and appropriate perioperative antibiotic therapy then total ankle arthroplasty may be considered. The Author s Recommendation Once an active infection and or osteomyelitis have been excluded or appropriately treated total ankle replacement is undertaken without any additional modalities. During surgery however bone biopsies are harvested for bacteriologic analysis which allows if necessary specific longterm antibiotic therapy. To date late infection has not been observed in any case after total ankle arthroplasty in a previously infected ankle. In four out of six cases however subtalar fusion and in three of these four cases an additional talonavicular fusion were necessary after isolated total ankle replacement to relieve pain. Disarthrodesis When a patient undergoes ankle arthrodesis there is a significant likelihood that he or she will develop painful hindfoot arthritis necessitating additional surgical treatment. An isolated ankle fusion may be treated by a pantalar fusion with its increased functional limitations and morbidity such as the secondary degeneration of the neighboring joints. Therefore an alternative treatment could be to take down the ankle arthrodesis and convert to a total ankle arthroplasty Fig. . To date however there are no reports