SURGICAL DECISION MAKING IN PATIENTS WITH END-STAGE OF ANKLE OSTEOATHRITIS

Abstract

Purpose of the study - to validate the selection algorithm of surgical treatment for patients with advance stage of ankle joint deforming arthrosis based on comparative analysis of risk factors for failed cases of fusion and joint replacements. Material and methods. The authors analyzed poor treatment outcomes and reasons therefore after ankle joints fusion and replacement surgeries performed at Vreden Russian Research Institute of Traumatology and Orthopaedics starting 2003 till 2014. First study group included 63 patients who underwent biarticular fusion of ankle and subtalar joint by intramedullary locked nail; second study group included 71 patients after ankle joint replacement using the following implants: Mobility (DePuy) - 27 patients, Hintegra (NewDeal) - 37 and STAR (Waldemar Link) - 7 patients accordingly. Clinical and radiological examination of patients as well as their surveying on pain rating scale and AOFAS scale was carried out in the period starting 6 months to 10 years from surgery. Results. Study results proved that severe deformities of ankle joint bones particularly varus or valgus deformities with angle above 100 preclude the possibility to correctly position the implant components and do not promise long term and successful functional recovery. Thus, fusion of affected joint should be recommended as treatment option to patients with abovementioned heavy deformities of angle joint. Reasonable fusion angles for ankle joint around 90950 in sagittal plane could diminish potential rapid arthrosis progression in midfoot joints. Conclusion. In view of identified risk factors for development of morbid conditions that account for poor surgical outcomes of ankle joint fusion and replacement, basing on own research results and specialized literature data the authors have validated and presented the selection algorithm of surgical treatment options for patients with end stage of deforming arthrosis