Peripheral Nerve Injuries in Total Ankle Arthroplasty

Total ankle arthroplasty (TAA) is becoming more and more accepted as a viable alternative to end-stage ankle arthritis. This study was designed to retrospectively look at nerve injuries associated with TAA. The approach and surgical technique differ from other total joint surgeries in that several nerves are in close proximity to the incision. The superficial peroneal branches over the dorsum of the foot and anterior ankle are always in the subcutaneous tissues when the incision is made and almost universally identified and retracted, possibly over-aggressively. If a lateral incision is used, the SPN is also susceptible to injury here, as shown in the recent literature. The deep peroneal nerve (DPN) is usually lateral to the deep dissection, but is also temporarily retracted from its native location, and the possibility of injury is present. The tibial nerve (TN) is in close proximity to the saw blade when the tibia is cut and resected.

Eight hundred total ankle arthroplasties were retrospectively reviewed by chart review. These cases had been followed with a standard questionnaire and were treated between 1984 and 2004 by a single surgeon. Forty-two (5.2%) injuries to the superficial peroneal nerve were found, with varying degrees of symptomatology. There were no injuries to the deep peroneal or tibial nerves.

Total ankle arthroplasty is becoming an increasingly used surgical option for end-stage ankle arthritis. The approach and instrumentation are in close proxixmity to three nerves in four locations, the SPN, DPN, and TN. The SPN was the only nerve that was injured in a retrospective review of 800 TAAs. There appears to be a reasonably low risk of nerve injury and lower morbidity associated with TAA.