Gutter Impingement After Total Ankle Arthroplasty

Background: Symptomatic gutter impingement after ankle arthroplasty has been reported with various designs. However, the incidence and origin of impingement have not been fully elucidated. Furthermore, the outcome of patients following gutter debridement has not been reported. Methods: A review of 489 total ankle replacements was performed to calculate the incidence of symptomatic gutter impingement in 4 different devices and between the presenting causes of arthritis. The incidence of gutter impingement was determined for patients with and without preemptive gutter resection at the time of implantation. The functional outcome of 30 of the 34 patients who had subsequent gutter debridement was determined with 3 different outcome instruments. Results: Symptomatic gutter disease occurred in 34 of 489 cases (7%) followed for a minimum of 1 year (range, 1-12 years). There was a 2% incidence of gutter disease in the 194 ankles that had prophylactic gutter resection at the time of implantation and a 7% incidence in the 295 ankles that did not have gutter resection at the time of implantation. When the ankle treated with an Agility (DePuy Orthopaedics, Inc, Warsaw, IN) device was excluded, there was a 2% and an 18% incidence of gutter disease in the 2 groups, respectively (P <.05). There was no difference in the incidence of gutter disease between the various implants and origins of ankle arthritis. Postoperative outcomes were favorable in the 27 patients who did not have another procedure after the initial gutter debridement. Seven patients (21%) required reoperation. Conclusion: Prophylactic gutter resection should be considered at the time of implantation to reduce the incidence of postoperative symptoms. Although most patients had favorable outcomes following gutter debridement, there was a high reoperation rate. Level of Evidence: Level III, retrospective comparative series.