SLR - August 2015 - Mina Baskhron
Reference: Nguyen MP, Pedersen DR, Gao Y, Saltzman CL, Amendola A. Intermediate-term Follow-up After Ankle Distraction for Treatment of End-stage Osteoarthritis. J Bone Joint Surg Am. 2015 Apr 1; 97 (7): 590 -6Scientific Literature Review
Reviewed By: Mina Baskhron, DPM
Residency Program: Wyckoff Heights Medical Center
Podiatric Relevance: Ankle distraction is an option when considering joint sparing procedures for ankle arthritis, especially in young patients and athletes. Ankle joint replacements continue to evolve and have become an acceptable form of treatment for end stage ankle arthritis, however patient selection it critical to success. Ankle distraction provides a joint sparing surgical treatment option for appropriate patients. The purpose of the study is to determine some predictive factors (such as age, sex, level of activity, and type of arthritis) for proper procedure selection for treatment of end-stage arthritis of the ankle.
Methods: To be considered for the study, the patients had to have unilateral isolated ankle osteoarthritis, and must have been treated for at least one year with conservative treatment. This includes three months of NSAIDS and three months of non-weight-bearing, and the ability to use ambulatory aids for non-weight-bearing. In this study, 36 patients were followed up from 2002 to 2006, with ankle radiographs, Computed Tomography and Magnetic Resonance Imaging of the ankle. All 36 patients completed the Ankle Osteoarthritis Scale and Short Form Survey.
Results: Twenty-nine patients followed up for 5-10 years after their ankle distraction. Sixteen (55 percent) of the 29 still had their native ankle joint without any further surgical intervention. The other 13 patients had either ankle arthroplasties or ankle arthrodesis at one to 10 year following the initial distraction procedure.
Conclusion: This study demonstrated that ankle function following joint distraction declines over time. The AOS score at two-year follow up is the only predictive value that was determined in this study. If there is no improvement of the AOS score at the two-year follow-up, additional surgeries, such as ankle arthroplasty or arthrodesis may be required. Further studies with a larger population and more detailed post-op function assessment will be beneficial to make an adequate surgical procedure selection.