Postoperative weightbearing following ankle arthrodesis

Abstract

Aims Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens. Patients and Methods MEDLINE, Web of Science, Embase, and Scopus databases were searched for studies reporting outcomes following ankle arthrodesis, in which standardized postoperative rehabilitation regimens were employed. Eligible studies were grouped according to duration of postoperative nonweightbearing: zero to one weeks (group A), two to three weeks (group B), four to five weeks (group C), or six weeks or more (group D). Outcome data were pooled and compared between groups. Outcomes analyzed included union rates, time to union, clinical scores, and complication rates. Results A total of 60 studies (2426 ankles) were included. Mean union rates for groups A to D were 93.2%, 95.5%, 93.0%, and 93.0%, respectively. Mean time to union was 10.4 weeks, 14.5 weeks, 12.4 weeks, and 14.4 weeks for groups A to D, respectively. Mean complication rates were 22.3%, 23.0%, 27.1%, and 28.7% for groups A to D, respectively. Reporting of outcome scores was insufficient to conduct meaningful analysis. Conclusion Outcomes following ankle arthrodesis appear to be similar regardless of the duration of postoperative nonweightbearing, although the existing literature is insufficient to make definitive conclusions. Cite this article: Bone Joint J 2019;101-B:1256–1262

The need for a paradigm shift in the rehabilitation of elective foot and ankle reconstructive surgery patients? An annotation

“…As such, the time frame for starting weight bearing or functional rehabilitation is open to interpretation by individual clinicians. This is evident in the literature as some weight bearing may begin as early as immediately 16 and as late as 12 weeks post-surgery. 17 Protected weight bearing is discussed in a number of papers, utilising external fixator frames, 17 casts, boots, splints and braces.…”

“…17 Protected weight bearing is discussed in a number of papers, utilising external fixator frames, 17 casts, boots, splints and braces. 16 Three studies stated that they relied on radiographic findings to determine whether full or partial weight bearing would be allowed. 15,18,20 Outcomes following ankle arthrodesis including union and complication rate appear to be similar, regardless of the period of non-weight bearing; whether that be 0e1 weeks or beyond 6 weeks.…”

“…15,18,20 Outcomes following ankle arthrodesis including union and complication rate appear to be similar, regardless of the period of non-weight bearing; whether that be 0e1 weeks or beyond 6 weeks. 16 One paper 19 compared two different surgical techniques and their functional outcomes including gait analysis, ITT (isolated tibiotalar) versus CTTC (combined tibiotalocalcaneal). The CTTC patient group had early weight bearing at 3 weeks compared to the ITT group.…”

“…The papers located indicate a wide variety of underlying pathologies as the cause for surgery including ankle arthritis, 17,18 and trauma, 15 or mixed populations including inflammatory disease (OA). 16,19,20 Whilst age and other demographics are reported well in the papers, there is little information regarding comorbidities that may be important in terms of post-operative recovery and complications, for example diabetes. Each of the studies had small numbers of participants (highest n ¼ 60), with only one study using a power calculation to identify their sample size required.…”

“…In the review of ankle arthrodesis, 13 different outcome scores were utilised across 41 studies. 16 Furthermore the time points post-operatively for the collection of these outcomes are not standardised. Outcomes are discussed by type below.…”