Abstract
BackgroundAnkle joint distraction arthroplasty (AJDA) is an alternative surgical procedure for the management of moderate to severe ankle osteoarthritis. However, the benefit of this procedure and failure relative factors are still in debate. The purpose of the current study was to evaluate the functional outcomes of AJDA in treatment of moderate to severe ankle OA and to evaluate the relative factors correlated with treatment failure.MethodsForty-six van Dijk stages II and III ankle osteoarthritis patients were included. Fifteen males and 31 females with a mean age of 54.8 (range, 42–71) years were followed with a mean of 42.8 (range, 24–68) months. The Ankle Osteoarthritis Scale (AOS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used for functional outcome evaluation. The talar tilt (TT) angle and ankle joint space distance (AJSD) were evaluated. The risk ratio (RR) was calculated for each potential failure relative factor.ResultsThe AOS and AOFAS scores were significantly improved at the last follow-up time (P < 0.01). The AJSD was improved in 61% of patients and with a significant improvement compared with the preoperative conditions (P < 0.01). The TT angle and range of motion reached no significant difference. The failure rate was 21.7%. Patients with large TT (≥5°) angle (RR = 3.81, 95% CI 1.28–11.33, P = 0.02) and obesity (RR = 3.58, 95% CI 1.30–9.89, P = 0.01) were found to have positive correlation with failure. No correlation was found between failure and gender, or overweight, or side, or age, or type and stage of OA, or pin infection.ConclusionsThe current study confirmed the early functional outcomes of ankle distraction arthroplasty. However, this procedure still has a relatively high failure rate, especially for those obese patients and patients with large TT angles.
Highlights
Ankle joint distraction arthroplasty (AJDA) is an alternative surgical procedure for the management of moderate to severe ankle osteoarthritis
The ankle joint space distance (AJSD) was significantly improved with a Discussion Joint distraction arthroplasty with external fixation is a low-risk procedure that offers a promising solution to a complex problem [21] and has evolved as an alternative treatment to joint-sacrificing procedures like ankle arthrodesis or replacement [9, 10, 13]
Buckwalter [31] commented that van Valburg and colleagues’ report added a potentially important new approach to the treatment of ankle OA, especially for young active people, and called for long-term studies with objective parameters to prove whether joint distraction could be the treatment of choice for ankle OA
Summary
Ankle joint distraction arthroplasty (AJDA) is an alternative surgical procedure for the management of moderate to severe ankle osteoarthritis. Ankle OA is one of the most common joint diseases and is a significant source of pain and disability for middle-aged and elderly people throughout the world [1] It has many etiologies, and the posttraumatic OA that follows rotational ankle fractures or recurrent ligamentous instability is much more common [2, 3]. Ankle joint distraction arthroplasty (AJDA) is an alternative treatment method for moderate to severe ankle OA [10, 11]. This procedure was proved by basic and clinical researches that chondrocyte reparative. The evidence-based literature that exists to support this procedure is still insufficient [9, 23], and the failure relative factors of this procedure are still in debate [12, 18, 20]
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