Potential Complications of Subtalar Arthroeresis

Even though this is a relatively simple short reversible procedure, potential complications, as with any surgical procedure, could occur including but not limited to:

 

"Sprained Ankle Syndrome"

This is discomfort to the outer ankle ligaments due to a new stretch placed on the ligaments. This is further discussed in the Post-op Course section of this web-site. This should be a temporary symptom and will most likely dissipate. However, it is possible that the ligaments, for whatever reason, are not able to adjust to the new position leading to several months of discomfort, pain, limitation to walking/standing and may lead to removal of the implant. This is not a problem with the implant but one of the soft tissues. If this does occur, the "sprained ankle" feeling should dissipate after the removal of the implant since there is no longer a strain on the ligament.

 

Displacement / Migration of the Implant

Even though the implant is inserted correctly at the time of surgery it is possible for it to shift or displace. Every sinus tarsi is different and the implant may need to "seek its own" position. The implant is just inserted into the sinus tarsi, it is not drilled or cemented. If displacement of the implant is to occur it will have happened within the first 4 weeks post-op. Although it is possible for it to displace after the 4 week period I have never heard of any reported case of this with the HyProCure^TM Implant. If displacement does occur and the implant is not in the most desirable location I recommend the following guidelines. If the implant is holding correction and the patient has no pain or discomfort, I will leave the implant alone. If there is loss of correction, the implant will have to be repositioned and the patient will have to be careful with the way they walk, etc., during the 4 to 6 weeks it takes for the fibrotic tissue to hold the implant in place. It is possible that even with the ideal placement surgically and optimum patient compliance that the implant will still displace and migrate. This is due to anatomical variations within the sinus tarsi and inability for the soft tissues to hold the implant in place.

 

Inability to place a HyProCure^TM Implant within the Sinus Tarsi

A rare but possible complication. Even though clinically, radiographically, etc. it appears that the patient's sinus tarsi would accept the implant, it is possible that due to the osseous anatomy, severity of the deformity, etc., an implant may not be able to be inserted into the sinus tarsi. Another possibility is that even if the implant was placed within the sinus tarsi, when the foot is put through the range-of-motion there is displacement of the implant. If the implant will not hold correction intra-op it should not be left within the sinus tarsi in the hope that it will hold post-op. The implant should be removed and the patient will need to have some other form of surgical intervention.

 

Infection

It is a widely accepted practice that even when there are no risk factors, it is better to give at least a pre-op antibiotic before a subtalar arthroeresis procedure. High risk patients should also be followed-up with a regimen of post-op antibiotic therapy for 7 to 10 days as indicated. If a serious deep infection does occur following a subtalar arthroeresis procedure, the implant should be removed and an incision and drainage procedure should be performed and appropriate antibiotic coverage should be initiated. Once the infection is fully resolved, re-implantation can occur.

 

Possibility of Fracture of the Talus or Calcaneus

Although no knowledge of this exists with the HyProCure^TM Implant it is possible for this to occur. The weight of the body is dispersed behind the implant and in front of the implant. The HyProCure^TM Implant just turns the negative space into a positive space.

 

Synovitis / Bursitis / Capsulitis

These are various soft tissue inflammatory reactions to the new position of the sinus tarsi. For many patients, the abnormal motion of the talus on the calcaneus has resulted in many different types of disease processes and abnormal soft tissue compensations. Once the sinus tarsi is re-aligned it is possible to irritate or exacerbate these soft-tissues reactions.
Need for further surgery

 

If there is an intolerance of the soft tissues to adjust to the new correction, or if there is displacement/shifting of the implant, further surgery will be necessary.

 

Increased Pain to the Knees, Hips, Back

Although never reported it is possible that by repositioning the talus on the calcaneus there could be new pain to these other areas. However, in the majority of patients who underwent subtalar arthroeresis procedure with the HyProCure^TM Implant there is partial to full resolution of pain to these areas.

 

Other

Complications associated with surgery or the administration of medications or anesthesia.