Hinged Motion Distraction Surgery for Ankle Osteoarthritis

Abstract

The most frequent etiology of ankle osteoarthrosis is posttraumatic, affecting a population younger than that affecting the hip or knee. These patients usually wish to maintain their mobility and refuse an ankle fusion or even a total ankle replacement, which is why this pathology poses a challenge for the orthopedic surgeon. Within the concept of joint-preserving surgery, arthrodiastasis or ankle joint distraction arthroplasty has been shown to be beneficial in reducing pain and delaying definitive treatments on the joint (such as fusion or replacement). We describe, in this article, the hinged joint distraction technique. A total of 50 patients with posttraumatic ankle osteoarthritis with a mean age of 40.0±8.5 years were included in a prospective randomized study: 25 patients in ankle debridement alone group and 25 patients in debridement and hinged ankle distraction group. The mean follow-up was 46±12 months (range: 36 to 78 mo). The clinical and radiographic outcomes were evaluated at the 6-month and 3-year follow-up using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, SF-36 quality of life score, and Takakura ankle osteoarthritis classification. Ankle arthrodiastasis is effective in reducing pain in posttraumatic ankle arthropathy and is superior to isolated synovectomy. This technique proved to be a safe (low complication rate) and effective (adequate clinical results) procedure for the treatment of ankle osteoarthritis, especially in patients younger than 45 years of age. Level of Evidence: Diagnostic Level I—randomized controlled study. See Instructions for Authors for a complete description of levels of evidence.