SLR - July 2015 - Jennifer A. Lipman
Reference: Ramaskandhan JR, Kakwani R, Kometa S, Bettinson K, Siddique MS. Two-year outcomes of MOBILITY Total Ankle Replacement. J Bone Joint Surg Am. 2014 Apr 2;96(7):e53.Scientific Literature Review
Reviewed By: Jennifer A. Lipman, DPM
Residency Program: Cambridge Health Alliance
Podiatric Relevance: The podiatric surgeon frequently encounters arthritis of the ankle during in their practice. There are varying etiologies for this condition, including osteoarthritis, rheumatoid arthritis and posttraumatic arthritis. Total ankle replacement has been an option for many years but with higher complication rates and varying outcomes in terms of patient satisfaction. Newer designs have had more encouraging results, but there has been limited research in outcomes in younger populations, mainly those with posttraumatic arthritis. This study’s aim was to determine whether total ankle replacement in a younger population produced outcomes as good as those in more traditionally studied older populations.
Methods: One hundred and six patients who underwent total ankle replacement with MOBILITY Total Ankle System by a single surgeon were divided into three groups based on etiology of their ankle arthritis. Each group was evaluated preoperatively and then at one and two years postoperatively using AOFAS score. Additional information including age, height, weight, BMI, comorbid conditions, FAOS, quality of life and patient satisfaction was also gathered.
Results: As predicted, the mean patient age for the posttraumatic osteoarthritis group was significantly younger than the osteoarthritis group at 54.8 years versus 64.4 years. Patients with rheumatoid arthritis had significantly lower BMI than patients in the other two groups. Comorbid conditions did not significantly differ between groups. There were no significant differences between AOFAS scores preoperatively but at one year follow up both the posttraumatic arthritis and rheumatoid arthritis had between results than the osteoarthritis group. This between groups difference was gone by two years postoperatively. All groups had similar complication rates.
Conclusions: The authors concluded that there were similar outcomes and patient satisfaction between the three groups undergoing total ankle replacement with the MOBILITY Total Ankle System. Traditionally, when encountering a younger patient with a severely arthritic ankle joint, standard surgical intervention included ankle arthrodesis without good support for ankle replacement in this population. Based on these results, when the podiatric physician encounters a younger patient with posttraumatic osteoarthritis, total ankle replacement with one of the newer systems is a viable option. Further studies comparing total ankle replacement and ankle arthrodesis in this younger population with posttraumatic osteoarthritis would be helpful to further help the clinician with their decision making process.