Debridement and hinged motion distraction is superior to debridement alone in patients with ankle osteoarthritis: a prospective randomized controlled trial

Abstract

Purpose To evaluate and compare complication rates and postoperative outcomes in patients with ankle debridement alone vs. debridement and hinged ankle distraction arthroplasty. Methods A total of 50 patients with posttraumatic ankle osteoarthritis (OA) with a mean age of 40.0 ± 8.5 years were included into this prospective randomized study: 25 patients in ankle debridement alone group and 25 patients in debridement and hinged ankle distraction group. The mean follow-up was 46 ± 12 months (range 36-78 months). The clinical and radiographic outcomes were evaluated at the 6-month and 3-year follow-up using the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, SF-36 quality of life score, and van Dijk OA classification. A Kaplan-Meier survival analysis was performed to calculate the 3-year and 5-year survival rates. Results Both patient groups experienced significant pain relief, functional improvement, and improvement in quality of life postoperatively. In total, 26 major secondary procedures were performed. The overall survival rates in the debridement and ankle distraction group were 19 of 25 (74%) and 15 of 25 (59%) at 3 years and 5 years, respectively. The overall survival rates in the ankle debridement alone group were 12 of 25 (49%) and 9 of 25 (34%) at 3 years and 5 years, respectively. Conclusions The study demonstrated comparable postoperative functional outcome and quality of life. However, rate of postoperative revision surgery was substantially higher in ankle debridement alone group. Level of evidence Randomized controlled study, Level I.

Ankle osteoarthritis: comprehensive review and treatment algorithm proposal

“…without osteomyelitis), severe circulatory insufficiency, and neuropathies (52). The specific contraindications are severe OA of the entire joint and the patient's objection to the postoperative unloading protocol and rehabilitation.…”

“…The external fixator should remain in place for at least 3 months to obtain a beneficial effect on the cartilage. This technique has proven to be valuable in reducing pain in up to 70% of cases throughout the first 5 years; however, the results decline over time and the improvement is only hypothetical, as studies have not found any evidence that joint distraction leads to marked chondral regeneration ( 52 ).…”

“…This is the only universally accepted joint-preserving procedure. Osteotomies are indicated in cases of ankle malalignment (up to 70% of post-traumatic ankle OA manifests a varus ankle) ( 52 ); the rationale is to transfer the axis of force transmission from the most to the least damaged portion of the joint and osteotomies are performed above the ankle joint (supra-malleolar), below this joint line (inframalleolar) or both. It has been shown to reduce pain in between 70 and 75% of cases and even defers the need for definitive procedures such as arthrodesis or total ankle arthroplasty (TAA) ( 52 , 53 , 54 ).…”

Osteoartrite do tornozelo

“…Ambas as opções de tratamento podem ajudar a retardar a necessidade de procedimentos de não preservação articular (artrodese ou artroplastia). 54,55 Osteotomias ao redor do tornozelo O papel das osteotomias supramaleolares é fundamentado no reequilíbrio das forças na articulação do tornozelo e tem como objetivos realinhar o retropé, transferir o eixo de sustentação articular para o compartimento com menor degeneração e normalizar a direção do vetor de força do tríceps sural para retardar a progressão da artrite na articulação do tornozelo. [56][57][58] Os princípios das osteotomias supramaleolares são:…”

“…Both treatment options can help delay the need for nonsparing procedures (arthrodesis or arthroplasty). 54,55 Osteotomies around the ankle The role of supramalleolar osteotomies is based on force rebalancing in the ankle joint; these procedures aim to realign the hindfoot, transfer the joint support axis to the less degenerate compartment and normalize the direction of the sural triceps force vector to delay ankle joint arthritis progression. [56][57][58] The principles of supramalleolar osteotomy are the following:…”