Residual pain due to soft-tissue impingement after uncomplicated total ankle replacement

B. S. Kim, MD, Orthopaedic Surgeon, Assistant Professor1 ; W. J. Choi, MD, Orthopaedic Surgeon, Assistant Professor2; J. Kim, MD, Orthopaedic Surgeon3; and J. W. Lee, MD, PhD, Orthopaedic Surgeon, Professor2
+ Author Affiliations

1Inha University Graduate School of Medicine, Department of Orthopaedic Surgery, 7-206, 3-ga, Sinheung-dong, Jung-gu, Incheon 400-711, Korea.
2Yonsei University College of Medicine, Department of Orthopaedic Surgery, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea.
3Busan Veterance Hospital, Department of Orthopaedic Surgery, 420, Baegyang-daero, Sasang-gu, Busan 617-717, Korea.
Correspondence should be sent to Professor J. W. Lee; e-mail: ljwos@yuhs.ac

We report the incidence and intensity of persistent pain in patients with an otherwise uncomplicated total ankle replacement (TAR). Arthroscopic debridement was performed in selected cases and the clinical outcome was analysed.

Among 120 uncomplicated TARs, there was persistent pain with a mean visual analogue scale (VAS) of 2.7 (0 to 8). The intensity of pain decreased in 115 ankles (95.8%). Exercise or walking for more than 30 minutes was the most common aggravating factor (62 ankles, 68.1%). The character of the pain was most commonly described as dull (50 ankles, 54.9%) and located on the medial aspect of the joint (43 ankles, 47.3%).

A total of seven ankles (5.8%) underwent subsequent arthroscopy. These patients had local symptoms and a VAS for pain ≥ 7 on exertion. Impingement with fibrosis and synovitis was confirmed. After debridement, the median VAS decreased from 7 to 3 and six patients were satisfied. The median VAS for pain and the American Orthopaedic Foot and Ankle Society score of the ankles after debridement was similar to that of the uncomplicated TARs (p = 0.496 and p = 0.066, respectively).

Although TAR reduces the intensity of pain, residual pain is not infrequent even in otherwise uncomplicated TARs and soft-tissue impingement is the possible cause.

Cite this article: Bone Joint J 2013;95-B:378–83.


No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by J. Scott and first-proof edited by D. Rowley.
Supplementary material. A table detailing the seven patients who received arthroscopic debridement due to painful impingement is available alongside the electronic version of this article on our website www.bjj.boneandjoint.org.uk


Josh Sandberg

Josh Sandberg is the President of Ortho Spine Partners and Partner for The De Angelis Group. He also serves as Co-Founder and Editor of OrthoSpineNews.

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