SLR - January 2018 - Christopher A. Juels
Reference: Usuelli FG, Pantalone A, Maccario C, Guelfi M, Salini V. Sports and Recreational Activities Following Total Ankle Replacement. Joints. 2017 Jun;5(1):12–16.Scientific Literature Review
Reviewed By: Christopher A. Juels, DPM
Residency Program: Wheaton Franciscan Healthcare, St. Joseph Hospital, Milwaukee, WI
Podiatric Relevance: Ankle arthrodesis has traditionally been considered the standard treatment for end-stage arthritis in the ankle, but there have been proven downfalls: compensatory overload, gait change, high rates of nonunion, long rehabilitation and eventual development of adjacent joint arthritis. As newer replacement systems have been released to market, improved short- and intermediate-term outcomes have been shown. There is also a trend that patients receiving TAR have a better quality of life and physical and athletic aptitude results when compared to ankle arthrodesis. This study aims to analyze and report sports activity level before and after receiving TAR. This knowledge is important when discussing treatment options with patients and their physical therapists, giving them realistic expectations after surgery.
Methods: Retrospective reviews of 76 patients who received the Hintegra total ankle prosthesis were performed between 2011 and 2014. Patients received a preoperative evaluation and a postoperative evaluation 12 years after surgery. AOFAS functional scores, VAS pain scores, radiographic outcomes and SF-12 scores were recorded pre and postoperatively. The UCLA activity scale was used to compare pre and postoperative activity levels. The score ranges from 1 to 10, with level 1 defined as “no physical activity, dependent on others” and level 10 as “regular participation in impact sports.” Results were statistically analyzed and reported as mean averages with standard deviations, and P-values less than 0.05 were considered statistically significant.
Results: Seventy-six patients were reviewed with a mean age of 56 years old (22–79). Functional, pain and activity scores all significantly improved after receiving the TAR 1 year postoperatively. AOFAS scores went from 32.8 ± 12.7 preoperatively to 72.6 ± 3.3, SF-12 physical component summary from 34.4 ± 5.1 preoperatively to 45.4 ± 6.4 and in the SF-12 mental component summary, patients went from 39.8 ± 7.5 preoperatively to 51.4 ± 6.1 postoperatively. VAS pain score also significantly dropped from 8.7 ± 1.6 preoperatively to 2.2 ± 1.6. The UCLA activity levels increased from 2.4 ± 0.8 to 6.3 ± 2.3. 11.7 percent of patients were active in sports before surgery, and this number increased to 49.4 percent afterward. The most frequent sports included jogging, dancing, biking and skiing.
Conclusions: The authors conclude in this article that patients who underwent TAR resulted in improved pain, function and activity level. Pain and function have already been shown to significantly improve with both TAR and ankle arthrodesis. The more important takeaway is the amount of activity improvement and which activities these patients can perform. Approximately 50 percent became involved in sports activities, drastically improving their overall health and lifestyle. This information can be used as education to patients preoperatively, being able to explain to them that 50 percent of them will be able to perform activities, such as jogging, dancing, biking and skiing, if they please. This is informative to physical therapists treating these patients as well and assists them with treatment goals during the rehabilitation process. This study lacks a comparative group, and further studies comparing postoperative activity level between TAR and ankle arthrodesis would be beneficial.