Background Ankle distraction arthroplasty and supramalleolar osteotomy were both options for post-traumatic varus ankle arthritis (VAA), but their comparative effectiveness was scarcely reported. This study aimed to compare the outcomes of two operative methods for treatment of Takakura-Tanaka stage 3 post-traumatic VAA. Methods This was a retrospective study, comprising 73 consecutive patients who presented with Takakura-Tanaka stage 3 post-traumatic VAA treated by either ankle distraction arthroplasty (n = 32) or supramalleolar osteotomy (n = 41) from January 2016 to December 2019. All patients had a minimum 24-month follow-up assessments. The outcome measures were visual analog scale (VAS), the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, patient-rated overall satisfaction and ankle function. Results At an average of 32 months (range, 24–52 months) follow-up, significant improvement was observed for VAS, AOFAS, range of motion (ROM) and most radiographic parameters (except for TAS and TLS for ankle distraction arthroplasty group) compared to preoperative baselines (p < 0.05) for both groups. However, both groups did not differ significantly in terms of VAS or AOFAS, excellent and good rate (78.1% versus 85.4%, p = 0.422), overall rate of postoperative complications (28.1% vs. 17.1%, p = 0.257), or various radiographic parameters (e.g. tibial anterior surface angle, talar tilt angle and tibial lateral surface angle) (all p > 0.05). The ankle distraction arthroplasty group had a better postoperative ankle motion than did the supramalleolar osteotomy group, in terms of plantarflexion (37.8 ± 4.2 vs. 30.4 ± 3.6, p = 0.006), dorsiflexion (36.5 ± 6.4 vs. 28.3 ± 5.5, p = 0.004), varus (32.1 ± 4.5 vs. 27.1 ± 3.1, p = 0.017) and valgus (28.4 ± 3.7 vs. 25.2 ± 2.8, p = 0.046). Conclusions Both operative treatments are effective for Takakura-Tanaka stage 3 post-traumatic VAA. In practice, individualized treatment option tailored to the ankle condition and patients’ specific need should be considered. Level of evidence: III, retrospective comparative series.
BackgroundIn the late stage of traumatic ankle arthritis, the pain symptoms are aggravated and the joint function is obviously limited. However, in the face of young patients with high activity requirements, there are still great challenges in how to preserve the joint and effectively treat traumatic ankle arthritis. Ankle distraction arthroplasty and supramalleolar osteotomy are both options for such medical condition, but the studies comparing their clinical outcomes have been scarce. The purpose of this study is to compare the clinical outcomes of ankle distraction arthroplasty and supramalleolar osteotomy in the treatment of severe traumatic ankle arthritis in young adult patients.MethodsThis was designed a retrospective study, enrolling 73 consecutive young adult patients who underwent ankle distraction arthroplasty (n=32) or supramalleolar osteotomy (n=41) for post-traumatic ankle arthritis from January 2017 to December 2020. All patients had at least 24-month follow-ups. The outcome measures were the comparisons of the pre- and postoperative visual analog scale (VAS) for pain relief, the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, angle range of motion (ROM), complications, patient-rated overall satisfaction and radiological evaluation of changes in ankle joint space width (JSW).ResultsSeventy-three patients (73 ankles) (100%) returned for final evaluation at an average of 32 months (range, 24 to 48 months) follow-up. At an average of 6 months follow-up, both groups achieved significantly improved VAS, AOFAS, ROM and JSW scores compared to those at baseline ( p<0.05), but not significantly differed between groups (all p>0.05). Either, both groups did not differ in in the tibial anterior surface angle(TAS), talar tilt angle(TT), tibial lateral surface angle(TLS), except for the correcting the load-bearing line of the ankle and hindfoot. However, at the last follow-up, patient satisfaction and ankle function scores in the ankle distraction arthroplasty group showed a downward trend, while the function scores in the supramalleolar osteotomy group showed an increasing trend, which was statistically significant.ConclusionsBoth ankle distraction arthroplasty and supramalleolar osteotomy are effective treatment options for the severe post-traumatic ankle arthritis in the young adult patients. From the long-term follow-up, however, supramalleolar osteotomy is better than ankle distraction arthroplasty in ankle score and patient satisfaction evaluation.Level of evidence: Level III, retrospective comparative series.
BackgroundPost-traumatic ankle arthritis is increasing in young people and it is very important to preserve the ankle range of motion in young patients. This study aimed to compare ankle distraction arthroplasty versus supramalleolar osteotomy for post-traumatic ankle arthritis.MethodsThis retrospective study reviewed 32 consecutive patients who underwent surgery for post-traumatic ankle arthritis from January 2015 to December 2018 after failure of conservative treatment. Thirteen ankles that underwent ankle distraction arthroplasty were age-, sex-, and body mass index-matched with 19 ankles that underwent supramalleolar osteotomy. Patients returned for clinical and radiologic follow-up at an average of 32 (range, 24–48) months postoperatively. Outcomes were the comparison of the pre- and postoperative Visual Analog Scale (VAS) pain scores and American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, subjective patient-rated satisfaction, and ankle function.ResultsThe VAS and AOFAS scores of the two groups were significantly improved at final follow-up compared with preoperatively (p<0.05), but did not significantly differ between groups. The ankle distraction arthroplasty group had better postoperative ankle mobility than the supramalleolar osteotomy group. There was no significant difference between the two groups in the tibial anterior surface angle, talar tilt angle, tibial lateral surface angle, and other imaging parameters, but supramalleolar osteotomy was more effective in correcting the load-bearing line of the ankle and hindfoot. The complication rate was similar in both groupsConclusionsAnkle distraction arthroplasty and supramalleolar osteotomy both achieved good pain relief and improved function in patients with traumatic ankle arthritis.Level of evidence: Level III, retrospective comparative series.
BackgroundPost-traumatic ankle arthritis is increasing, especially in young people and currently there is still lack of solid guidelines regarding its operative treatment. Ankle distraction arthroplasty and supramalleolar osteotomy are both options for such medical condition, but the studies comparing their clinical outcomes have been scarce. This study aimed to address this issue.MethodsThis was designed a retrospective study, enrolling 73 consecutive patients who underwent ankle distraction arthroplasty (n=32) or supramalleolar osteotomy (n=41) for post-traumatic ankle arthritis from January 2015 to December 2018. All patients had at least 24-month follow-ups. The outcome measures were the comparisons of the pre- and postoperative visual analog scale (VAS) for pain relief, the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, complications, patient-rated overall satisfaction and ankle function.ResultsAt an average of 32 months (range, 24 to 48 months) follow-up, both groups achieved significantly improved VAS and AOFAS scores compared to those at baseline (all p<0.05), but not significantly differed between groups (all p>0.05). The ankle distraction arthroplasty group had better postoperative ankle mobility than the supramalleolar osteotomy group, in terms of plantarflexion (37.8±4.2 vs 30.4±3.6, P=0.022), dorsiflexion (36.5±6.4 vs 28.3±5.5, P=0.011), varus (32.1±4.5 vs 27.1±3.1, P=0.029) and valgus (28.4±3.7 vs 25.2±2.8, P=0.047). Either, both groups did not differ in in the tibial anterior surface angle, talar tilt angle, tibial lateral surface angle, except for the correcting the load-bearing line of the ankle and hindfoot. The prevalence of postoperative complication was not significantly different between both groups (28.1% vs 17.1%, P=0.257). ConclusionsBoth ankle distraction arthroplasty and supramalleolar osteotomy are effective treatment options for Takakura-Tanaka stage 3 post-traumatic ankle arthritis, but with respective advantages and disadvantages. In practice, individualized treatment option tailored to the medical conditions and patients' specific need should be considered before a decision is made.
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