Our Summary

This research paper is a review of surgical procedures involving the back part of the ankle and hindfoot (known as ‘posterior ankle and hindfoot arthroscopy’ or PAHA) carried out between December 2009 to July 2016. The study aimed to document the rate of complications that occurred during these procedures and if these were linked to certain factors like the patient’s age, sex, or specifics of the surgery.

A total of 232 patients underwent 251 of these surgeries. The reasons for the surgeries varied, but the most common was posterior ankle impingement (37%), followed by a disorder of the flexor hallux longus (14%) - a muscle in the foot that helps with balance and movement.

Of all the surgeries, 6.8% had complications. The most frequent complication was damage to the nerves that help with sensation (about 4% of all surgeries), and issues with wound healing (about 1.6% of all surgeries). Of the nerve-related issues, seven healed on their own, but three needed additional surgery.

The study found that using an extra entry point on the back side of the ankle during surgery (known as an ‘accessory posterolateral portal’) significantly increased the risk of nerve complications.

This information can help surgeons make better decisions when diagnosing, planning treatment, and performing surgery for patients who might benefit from this kind of procedure.

FAQs

  1. What was the most common reason for patients undergoing posterior ankle and hindfoot arthroscopy (PAHA)?
  2. What was the most common complication from these surgeries and what was the rate of occurrence?
  3. Did the study find any factors, such as using an accessory posterolateral portal, that significantly increased the risk of complications during surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about arthroscopy is to follow post-operative instructions carefully, including rest, elevation, ice, and physical therapy as recommended. Adhering to these instructions can help ensure a successful recovery and minimize the risk of complications. Additionally, patients should communicate any concerns or changes in symptoms to their medical team promptly.

Suitable For

Patients who are typically recommended for arthroscopy, particularly posterior ankle and hindfoot arthroscopy, include those with posterior ankle impingement, disorders of the flexor hallux longus, and other conditions that affect the back part of the ankle and hindfoot. These patients may have symptoms such as pain, limited range of motion, and difficulty walking or performing daily activities.

It is important for patients to undergo a thorough evaluation by a healthcare provider to determine if they are suitable candidates for arthroscopy. Factors such as age, overall health, and the specific nature of the condition will be taken into consideration when deciding on the most appropriate treatment plan. Additionally, patients should be informed of the potential risks and complications associated with arthroscopy, as well as the expected outcomes and recovery process.

Timeline

Before arthroscopy:

  1. Patient experiences pain and discomfort in the ankle or hindfoot.
  2. Patient undergoes diagnostic tests like X-rays, MRI, or physical examination to determine the cause of the pain.
  3. A decision is made to proceed with arthroscopy as a minimally invasive surgical option.

After arthroscopy:

  1. Patient undergoes the arthroscopic procedure to address the specific issue in the ankle or hindfoot.
  2. Patient may experience some discomfort and swelling post-surgery.
  3. Patient is monitored for any complications like nerve damage or wound healing issues.
  4. Patient undergoes rehabilitation and physical therapy to aid in recovery and improve range of motion.
  5. Patient follows up with the surgeon for post-operative care and monitoring of the surgical site.

What to Ask Your Doctor

  1. What is the reason for recommending arthroscopy in my case?
  2. What are the potential benefits of arthroscopy for my condition?
  3. What are the potential risks and complications associated with arthroscopy?
  4. What is the success rate of arthroscopy for my specific condition?
  5. Are there any alternative treatments to arthroscopy that I should consider?
  6. What is the recovery process like after arthroscopy?
  7. How long will it take for me to fully recover and return to normal activities?
  8. Are there any specific lifestyle changes or precautions I should take after arthroscopy?
  9. How many arthroscopy procedures have you performed for this specific condition?
  10. Are there any specific factors about my case (age, sex, etc.) that may impact the success of arthroscopy?

Reference

Authors: Chinnakkannu K, Barbachan Mansur NS, Glass N, Phisitkul P, Amendola A, Femino JE. Journal: Foot Ankle Int. 2023 May;44(5):385-391. doi: 10.1177/10711007231157714. Epub 2023 Mar 22. PMID: 36946561