SLR - October 2012 - Karen Shum
Reference: Saltzman, C.L., Hills, S.L., Stolley, M.P., Anderson, D.D., & Amendola, A. (2012). Motion Versus Fixed Distraction of the Joint in the Treatment of Ankle Osteoarthritis. Journal of Bone and Joint Surgery, 94, 961-970.
Scientific Literature Review
Reviewed by: Karen Shum, DPM
Residency Program: Cedars-Sinai Medical Center, Los Angeles, CA
Podiatric Relevance:
Ankle arthrodesis remains the “gold standard” for surgical treatment of end stage ankle arthritis. Increasingly, procedures like a total ankle replacement are being performed; however, there is still a relatively high rate of revision. Additionally, long term complications involving neighboring joints are common in both ankle arthrodesis and ankle replacement. As of now, procedures for younger patients with advanced ankle arthritis are limited. Distraction arthroplasty may be a potential treatment option for younger patients with advanced ankle arthritis.
Methods:
This is a prospective randomized control trial evaluating patients with advanced ankle osteoarthritis who underwent one of two procedures with circular external fixator placement: fixed ankle distraction versus ankle distraction with motion. A total of 36 patients were randomized, 18 in each treatment group. A circular external fixator was applied and a hinged distractor was placed for patients in the motion group. Five mm of ankle distraction was achieved. Patients in the motion group started therapy one week after surgery. The external fixator was removed between 85-95 days. Follow-up was two years. Outcome measures were assessed using AOS and physical component summary of the SF-36 scores. Lateral x-rays were taken at specified intervals with the ankle maximally dorsiflexed and plantarflexed to measure range of motion.
Results:
The average age of the patients was approximately 42 years old. Patients in the motion distraction treatment group showed significant improvement in AOS scores when compared to preoperative scores. An improvement in the AOS scores was also seen in motion distraction group compared to the fixed distraction group after two years. The reported physical component summary score was better compared to pre-treatment scores. With regards to the range of motion outcomes, there was not a significant difference from the preoperative values and postoperative values and also between motion versus fixed joint distraction.
Conclusions:
This article shows that there is apparent improvement in patient reported outcomes for treatment of advanced ankle arthritis with distraction arthroplasty. Patients who underwent motion distraction of the ankle joint fared better in functional outcomes compared to those who underwent fixed distraction. Distraction arthroplasty shows promising signs treatment in advanced ankle arthritis in patients who are younger and seek joint sparing procedures.