Patient characteristics as predictors of clinical outcome of distraction in treatment of severe ankle osteoarthritis

Abstract

Osteoarthritis (OA) is a slowly progressive joint disease. Joint distraction can be a treatment of choice in case of severe OA. Prediction of failure will facilitate implementation of joint distraction in clinical practice. Patients with severe ankle OA, who underwent joint distraction were included. Survival analysis was performed over 12 years (n ¼ 25 after 12 years). Regression analyses were used to predict failures and clinical benefit at 2 years after joint distraction (n ¼ 111). Survival analysis showed that 44% of the patients failed, 17% within 2 years and 37% within 5 years after joint distraction (n ¼ 48 after 5 years). Survival analysis in subgroups showed that the percentage failure was only different in women (30% after 2 years) versus men (after 11 years still no 30% failure). In the multivariate analyses female gender was predictive for failure 2 years after joint distraction. Gender and functional disability at baseline predicted more pain. Functional disability and pain at baseline were associated with more functional disability. Joint distraction shows a longterm clinical beneficial outcome. However, failure rate is considerable over the years. Female patients have a higher chance of failure during follow-up. Unfortunately, not all potential predictors could be investigated and other clinically significant predictors were not found. ß

Intermediate-Term Follow-up After Ankle Distraction for Treatment of End-Stage Osteoarthritis

“…A previous study in the Netherlands showed a 27% rate of failure at seven years in a cohort of twenty-seven patients, although the authors did not clearly define their inclusion criteria or the degree of preoperative osteoarthritis 18 . We observed a higher failure rate, with 45% of our patients having undergone a conversion procedure by a mean of 8.3 ± 2.2 years, a finding similar to those in a recent review by Marijnissen et al 35 . Although the surgery provided younger patients with the use of their native ankle joint for a few more years while they were in their peak of productivity (mean age at surgery, 41.5 ± 9.1 years), patients should be well informed of the expected outcomes and the commitment of living with the distraction device for three months.…”

“…If patients did not obtain improvement by two years, it was unlikely that they would eventually benefit from ankle distraction. In comparison, Marijnissen et al reported that failure tended to occur early in some patients: 17% of the failures occurred within two years and 37%, by five years 35 . In their regression analysis, the only factor that was predictive of outcome was female sex.…”

Joint distraction in advanced haemophilic ankle arthropathy

“…The rate of failure (requiring ankle arthrodesis or TAR) ranged between 6.2% and 44% [2][3][4][5][6][7][8][9][10]. The study with the longest follow-up [9] showed that 44% of the patients experienced failure, 17% within 2 years Table 1. Primary data and results in the literature on ankle joint distraction (AJD) for advanced ankle osteoarthritis.…”

“…The types of studies reported on ankle joint distraction in patients with OA without haemophilia provide a low level of evidence (level IV). Table 1 summarizes the primary characteristics and results of the literature on ankle joint distraction in OA [2][3][4][5][6][7][8][9][10].…”

“…The reported mean follow-ups vary from 1 year to 12 years [3-118-16]. The percentage of good results (clinical improvement) ranged between 73% and 91% [2][3][4][5][6][7][8][9][10]. The rate of failure (requiring ankle arthrodesis or TAR) ranged between 6.2% and 44% [2][3][4][5][6][7][8][9][10].…”