SLR - November 2012 - John Mostafa(2)
Reference: Smith N, Beaman D, Rozbruch R, Glazebrook,M. Evidence-Based Indications for Distraction Ankle Arthroplasty, Foot & Ankle International. 33(8): 632-36, 2012
Scientific Literature Review
Reviewed by: John Mostafa, DPM
Residency Program: Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
Podiatric Relevance:
Distraction ankle arthroplasty has gained recent spotlight as an alternative to ankle arthrodesis and total joint replacement for ankle problems. Indications have included arthritides due to trauma, DJD, ligamentous instability, congenital deformities, chondrolysis and OCD lesions, but lack of evidence to support these indications call for further high level quality studies.
Methods:
This study was a systematic review of all the literature from 2010 and 2011 that met study inclusion and exclusion criteria using Pubmed and EMBASE database with keywords such as “ankle,” “distraction,” and “arthroplasty.” A total of 171 articles were identified and further narrowed down to only 30 pertinent studies describing the specific indications in question. The articles were then reviewed and assigned a classification of level of evidence (I-IV). The articles were also assigned a grade of recommendation (A-I) based on the level of evidence.
Results:
Based on the literature reviewed, there is insufficient or conflicting evidence not allowing a recommendation for or against intervention for any of the accepted indications for distraction ankle arthroplasty (Grade I). The majority of evidence available is expert opinion and case reports. The only indications that had level II, III & IV studies supporting its use was for post-traumatic OA. Indications for OCD lesions only had one level IV study and one case report to support its use. The other indications only had case reports and expert opinions supporting it.
Conclusions:
This study illustrated that there are only level V and very few level II, III & IV trials for the indications described for distraction ankle arthroplasty. There were no identified level I studies within this systematic review supporting the accepted indications for distraction ankle arthroplasty. Properly designed randomized controlled trials are needed to evaluate the need for distraction ankle arthroplasty as an alternative to arthrodesis or total ankle joint replacement.