SLR - November 2012 - Jill F. Ashcraft
Reference: Saltzman CL, Hillis SL, Stolley MP, Anderson DD, Amendola A. Motion versus fixed distraction of the joint in the treatment of ankle osteoarthritis: a prospective randomized controlled trial. J Bone Joint Surg Am. 2012 Jun 6;94(11):961-70.
Scientific Literature Review
Reviewed By: Jill F. Ashcraft, DPM
Residency Program: Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
Podiatric Relevance:
Ankle osteoarthritis is a condition that foot and ankle surgeons routinely encounter. Joint distraction is a treatment approach that has generally been poorly studied, and these authors detail a prospective study of the benefits of distraction with ankle joint range of motion when compared to fixed distraction for treatment of ankle osteoarthritis.
Methods:
A prospective randomized controlled trial was performed from 2002 to 2009, screening 115 patients, of which 40 qualified after exclusion criteria (36 participated), and were randomized into one of two groups: (1) fixed ankle distraction, or (2) ankle distraction with motion, for treatment of advanced ankle osteoarthritis status post anterior osteophyte debridement. All procedures were performed utilizing the same technique and same criteria for both open and arthroscopic osteophyte resection, and application of the external fixator, by one of two surgeons. The only difference being the use of distraction rods with hinges, with the posterior rod being removed for those undergoing motion therapies. Eighteen patients were enrolled into each group being tested. Patients were followed postoperatively at three, six and nine weeks, with the fixator removed at 85-95 days. Evaluations began at one, 26, and 52 weeks, and completed at 104 weeks post fixator removal. The primary outcome was the change in Ankle Osteoarthritis Scale (AOS) score at T52, and T104. Secondary outcomes were AOS subscale scores for pain and disability, and Physical Component Summary (PCS) of the SF-36, at T1, T26, T52, and T104.
Results:
Patients were followed for 104 weeks after frame removal. Patient age, body mass, and sex of the patients were clinically similar. The primary outcome, AOS score combined from pain and disability scores, was measured. Both groups had improvements from baseline prior to surgery. The motion distraction group showed consistently greater improvement in outcomes than the fixed distraction group, specifically at T52, and T104. At T52 the AOS score was 33.1-motion, versus 54.5-fixed, and at T104 27.4-motion, versus 48.4-fixed. Secondarily, the results were similar for the separate AOS scales. No significant difference in the groups was observed at T1. PCS outcomes were better for the motion group at T26, and T104, but not at T52.
Conclusions:
These authors found in this prospective randomized controlled trial that motion with distraction when compared to fixed distraction for the treatment of ankle osteoarthritis revealed approximately 50 percent increase in beneficial outcomes to treatment as reported by patients. Although both groups had a positive trend as compared to preoperative findings, the motion group had consistently better outcomes. The authors therefore suggest use of motion with ankle distraction following osteophyte debridement for the treatment of ankle osteoarthritis.