Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report

Abstract

We applied joint distraction using an Ilizarov apparatus in 11 patients with post-traumatic osteoarthritis of the ankle to try to delay the need for an arthrodesis. Distraction for three months resulted in clinical improvement in pain and mobility for a mean of two years, with an increase in the joint space. We considered that these effects may be produced by the absence of mechanical stress on the cartilage combined with the intra-articular hydrostatic pressures during distraction. We measured these pressures during walking with distraction, and found levels very similar to those reported to improve osteoarthritic cartilage when applied in vitro.

Clinical benefit of joint distraction in the treatment of severe osteoarthritis of the ankle: Proof of concept in an open prospective study and in a randomized controlled study

“…In a retrospective study, we found that distraction of severely affected ankle joints by means of an Ilizarov external ring fixator resulted in clinical improvement (18). In a prospective, uncontrolled study of 15 patients, we showed that joint distraction for the treatment of severe ankle OA resulted in significant relief of pain after 1 year, with further improvement during the following year.…”

Motion Versus Fixed Distraction of the Joint in the Treatment of Ankle Osteoarthritis

“…Joint distraction is a promising treatment approach for ankle osteoarthritis; however, its efficacy and role are not well defined. The treatment of ankle osteoarthritis with fixed distraction with use of thin-wire external fixators has been reported in both retrospective and prospective clinical series [13][14][15] . Those studies documented measurable and clinically important improvements Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work.…”

“…The use of gradual distraction, rather than distracting the ankle in a single maneuver with the patient under anesthesia just after frame application, may have avoided the creation of the neurapraxias. After study closure, we changed our technique from intraoperative to gradual postoperative distraction under patient control, as originally described by van Valburg and colleagues 15 . Ankle motion did not significantly change from either preoperative or intraoperative values, nor did it differ between groups.…”

Posttraumatic Ankle Arthritis: An Update on Conservative and Surgical Management

“…13 Contraindications to this surgery include significant bone loss, active infection, significant boney deformity, and severe arthrosis. 13,34 Early clinical studies appear promising in decreasing pain and improving function, 55,68,90,91 especially in individuals younger than 45 years of age. 5 Complications such as painful toe flexion contractures and joint stiffness can result if the joint is excessively distracted.…”