Effect of Distraction Arthroplasty in the Treatment of Moderate-to-Severe Ankle Arthritis.

Objective: Currently, the traditional treatment of moderate-to-severe ankle arthritis is joint fusion or joint replacement. The aim of this article is to explore the clinical efficacy of distraction arthroplasty in the treatment of moderate-to-severe ankle arthritis.
Methods: A retrospective analysis was conducted with a total of 34 cases who were diagnosed with moderate-to-severe ankle arthritis and treated by distraction arthroplasty from January 2007 to November 2021. The average age was 42.3 years. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and pain visual analog scale (VAS) were used to evaluate ankle pain and functional improvement before surgery and at the last follow-up. Based on age, the patients were divided into the ≤45-year-old group [young group, 15 cases, age (36.37 ± 4.31) years old] and the >45-year-old group [middle-aged and elderly group, 19 cases, age (53.74 ± 3.17) years old]. The analysis included comparing preoperative and postoperative AOFAS ankle-hindfoot and VAS scores and the influence of age on distraction arthroplasty.
Results: All 34 patients were followed up, and the follow-up time ranged from 13 to 143 months, with an average of 45.3 months. The follow-up times for the young and middle-to-elderly groups were (33.19 ± 21.37) months and (55.63 ± 29.69) months, respectively. At the last follow-up, the AOFAS ankle-hindfoot and VAS scores were significantly improved compared with the preoperative assessment (p < 0.05). According to the etiological analysis, except for Pilon fracture, which showed no differences pre- and postoperation in the AOFAS ankle-hindfoot score and VAS score (p > 0.05), all other patients showed significant differences in these two scores (p < 0.05). The difference in preoperative AOFAS ankle-hindfoot scores between the young and middle-to-elderly groups was statistically significant (t = 3.422, p = 0.021). The preoperative and postoperative comparison of preoperative VAS scores, AOFAS ankle-hindfoot scores, and VAS scores before and after surgery showed no differences (p > 0.05). The joint space width (JSW) of 10 patients who were followed up for more than 5 years was (2.9 ± 0.5) mm. Two patients who were followed up for more than 10 years showed 3.3 and 3.0 mm, respectively, JSW.
Conclusion: Distraction arthroplasty with the Ilizarov external fixator can achieve satisfactory results in the treatment of moderate-to-severe ankle arthritis (except arthritis caused by Pilon fracture surgery). Age has no statistical impact on the efficacy of distraction arthroplasty.
(© 2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)