Outcomes Following Cyst Curettage and Bone Grafting for the Management of Periprosthetic Cystic Evolution After AES Total Ankle Replacement
Résumé
Bone cysts associated with total ankle replacement: Since 2008, severe medium-term cystic bone evolution was reported with AES total ankle replacement, inducing risk of mechanical complications. Curettage-grafting in periprosthetic cyst: The objective of the present study was to determine whether this technique provided a therapeutic solution, avoiding implant removal and arthrodesis. Results of the various grafts used: Iliac crest autograft, calcium phosphate cement, and polymethylmethacrylate cement were used. With a 79% functional and 92% radiological failure rate, our results in periprosthetic cyst grafting are poor. The principal surgical objective, of avoiding conversion to arthrodesis, failed in 28% of cases. Our present recommendations in evolutive periprosthetic cyst after total ankle replacement: We recommend annual radiological surveillance, with computed tomography (CT) in the case of increased cyst size and/or pain, so as to be able to suggest implant removal and reconstruction-arthrodesis before the talar component collapses. Onset of pain is generally related to microfracture induced by cortical lysis, detectable on CT ahead of implant migration.