Cryoanalgesia of the ankle joint: clinical cases in the practice of a doctor of interventional pain treatment

Abstract

BACKGROUND: Currently, with the advent of the cryoablation device, much attention is paid to cryoanalgesia of large joints, however, the pathology of smaller structures can also bring discomfort and reduce the patient’s quality of life. The article presents 3 cases of successful treatment of ankle arthrosis at the Multi-Specialty Center for Pain Treatment and Rehabilitation «Anesta» (Arkhangelsk), presenting the author’s method of joint denervation and its detailed description.

CLINICAL CASES DESCRIPTION: Three patients were presented. The first with arthrosis of the knee and ankle joint, the second patient — after an accident with purulent-septic complications and violation of the anatomical integrity of the ankle joint, the third — with extensive concomitant pathology and severe arthrosis. All patients were satisfied with the procedure and its impact on the quality of life in the postoperative period. An anatomical rationale and a detailed description of the relevance of the ankle joint cryoanalgesia method are provided. Cryoanalgesia of the ankle joint was tested on cadaver by introducing liquid silicone into the places where the cryoprobe was installed, which confirmed the interest of the sensory branches going to the joint capsule. Due to the fact that the method is proprietary, and the use of cryoanalgesia is limited on the territory of the Russian Federation, there is very little literature data regarding the procedure for performing cryoanalgesia of the ankle joint, however, as experience is gained, we assume that this procedure will become a good alternative to surgery for arthrosis ankle joint.

CONCLUSION: The presence of pain has an extremely negative impact on the general condition of patients. The presented author’s technique can significantly improve the quality of life of many patients, minimizing pain in both large and small joints.

Keywords

cryoanalgesia / ankle joint / pain management / arthrosis / clinical case

References

[1] Cervini C. J’artrosi terminologia. Margolongo R, editor. J’artrosi. Milan: Realizzazioni scientifiche; 1996. P. 15–19. (In Italian).

[2] Cervini C. J’artrosi terminologia. Margolongo R., editor. J’artrosi. Milan: Realizzazioni scientifiche, 1996. P. 15–19.

[3] Jantzen C, Ebskov LB, Andersen KH, et al. Ankle arthrosis. Ugeskr Laeger. 2020;182(42):V04200244. (In Danish).

[4] Jantzen C., Ebskov L.B., Andersen K.H., et al. Ankle arthrosis // Ugeskr Laeger. 2020. Vol. 182, N 42. P. V04200244.

[5] Lee MS, Millward DM. Arthroscopic ankle arthrodesis. Clin Podiatr Med Surg. 2009;26(2):273–282. doi: 10.1016/j.cpm.2009.03.002

[6] Lee M.S., Millward D.M. Arthroscopic ankle arthrodesis // Clin Podiatr Med Surg. 2009. Vol. 26, N 2. P. 273–282. doi: 10.1016/j.cpm.2009.03.002

[7] Maricević A, Gekić K. Arthrodesis of the lower leg joint in posttraumatic deformity and arthrosis. Lijec Vjesn. 1989;111(11):396–399. (In Croatian).

[8] Maricević A., Gekić K. Arthrodesis of the lower leg joint in posttraumatic deformity and arthrosis // Lijec Vjesn. 1989. Vol. 111, N 11. P. 396–399.

[9] Rockett MS, Ng A, Guimet M. Posttraumatic ankle arthrosis. Clin Podiatr Med Surg. 2001;18(3):515–535.

[10] Rockett M.S., Ng A., Guimet M. Posttraumatic ankle arthrosis // Clin Podiatr Med Surg. 2001. Vol. 18, N 3. P. 515–535.

[11] Janis LR, Wilke B, Beasley BD, et al. Progressive post-traumatic ankle arthrosis treated with total ankle joint replacement: a case review. Clin Podiatr Med Surg. 2003;20(2):335–359. doi: 10.1016/S0891-8422(03)00010-7

[12] Janis L.R., Wilke B., Beasley B.D., et al. Progressive post-traumatic ankle arthrosis treated with total ankle joint replacement: a case review // Clin Podiatr Med Surg. 2003. Vol. 20, N 2. P. 335–359. doi: 10.1016/S0891-8422(03)00010-7

[13] Krause FG, Schmid T. Ankle arthrodesis versus total ankle replacement: how do I decide? Foot Ankle Clin. 2012;17(4):529–543. doi: 10.1016/j.fcl.2012.08.002

[14] Krause F.G., Schmid T. Ankle arthrodesis versus total ankle replacement: how do I decide? // Foot Ankle Clin. 2012. Vol. 17, N 4. P. 529–543. doi: 10.1016/j.fcl.2012.08.002

[15] Samanta R, Shoukrey K, Griffiths R. Rheumatoid arthritis and anaesthesia. Anaesthesia. 2011;66(12):1146–1159. doi: 10.1111/j.1365-2044.2011.06890.x

[16] Samanta R., Shoukrey K., Griffiths R. Rheumatoid arthritis and anaesthesia // Anaesthesia. 2011. Vol. 66, N 12. P. 1146–1159. doi: 10.1111/j.1365-2044.2011.06890.x

[17] Hodor L, Barkal K, Hatch-Fox LD. Cryogenic denervation of the intermetatarsal space neuroma. J Foot Ankle Surg. 1997;36(4):311–314. doi: 10.1016/s1067-2516(97)80079-8

[18] Hodor L., Barkal K., Hatch-Fox L.D. Cryogenic denervation of the intermetatarsal space neuroma // J Foot Ankle Surg. 1997. Vol. 36, N 4. P. 311–314. doi: 10.1016/s1067-2516(97)80079-8

[19] Han JR, Tran J, Agur AMR. Overview of the Innervation of Ankle Joint. Phys Med Rehabil Clin N Am. 2021;32(4):791–801. doi: 10.1016/j.pmr.2021.05.013

[20] Han J.R., Tran J., Agur A.M.R. Overview of the Innervation of Ankle Joint // Phys Med Rehabil Clin N Am. 2021. Vol. 32, N 4. P. 791–801. doi: 10.1016/j.pmr.2021.05.013

[21] Mentzel M, Fleischmann W, Bauer G, Kinzl L. Ankle joint denervation. Part 1: Anatomy — The sensory innervation of the ankle joint. Foot and Ankle Surgery. 2002;5(1):15–20. doi: 10.1046/j.1460-9584.1999.51121.x

[22] Mentzel M., Fleischmann W., Bauer G., Kinzl L. Ankle joint denervation. Part 1: Anatomy — The sensory innervation of the ankle joint // Foot and Ankle Surgery. 2002. Vol. 5, N 1. P. 15–20. doi: 10.1046/j.1460-9584.1999.51121.x

[23] Svirskii DA, Antipin EE, Bochkareva NA, et al. Cryoanalgesia. Review. Annals of Critical Care. 2020;(4):58–73. (In Russ). doi: 10.21320/1818-474X-2020-4-58-73

[24] Свирский Д.А., Антипин Э.Э., Бочкарева Н.А., и др. Криоанальгезия. Обзор литературы // Вестник интенсивной терапии им. А.И. Салтанова. 2020. N 4. P. 58–73. doi: 10.21320/1818-474X-2020-4-58-73

[25] Law L, Rayi A, Derian A. Cryoanalgesia. Treasure Island (FL): StatPearls Publishing; 2023.

[26] Law L., Rayi A., Derian A. Cryoanalgesia. Treasure Island (FL): StatPearls Publishing, 2023.

[27] Filippiadis D, Efthymiou E, Tsochatzis A, et al. Percutaneous cryoanalgesia for pain palliation: Current status and future trends. Diagn Interv Imaging. 2021;102(5):273–278. doi: 10.1016/j.diii.2020.11.007

[28] Filippiadis D., Efthymiou E., Tsochatzis A., et al. Percutaneous cryoanalgesia for pain palliation: Current status and future trends // Diagn Interv Imaging. 2021. Vol. 102, N 5. P. 273–278. doi: 10.1016/j.diii.2020.11.007

RIGHTS & PERMISSIONS

Eco-Vector