Sports and Recreational Activities following Total Ankle Replacement

Abstract

Purpose In literature, there is a controversy regarding whether patients who have undergone total ankle replacement (TAR) can participate in sports and recreational activities. The purpose of this study was to report change in sports activity level after TAR. Methods A retrospective study was performed, enrolling 76 patients with symptomatic end-stage ankle arthritis who underwent TAR from May 2011 to October 2014. Patients were mainly males (44/76; 58%) and 56 years old on average (range: 22.3–79.6 years) at the time of surgery. They were treated with mobile-bearing prosthesis implanted with an anterior approach. Patients were evaluated preoperatively and 12 months postoperatively. Pain and function were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, the visual analog scale (VAS) pain score, and the 12-Item Short Form Health Survey (SF-12) – physical component summary (PCS) and mental component summary (MCS). Activity level was assessed with the University of California at Los Angeles (UCLA) activity scale. Results At 12 months postoperatively, statistically significant increase was reported for AOFAS scores (from 32.8 ± 12.7 preoperatively to 72.6 ± 13.3; p < 0.001), SF-12 PCS (from 34.3 ± 5.1 preoperatively to 45.4 ± 6.4; p < 0.001), and SF-12 MCS (from 39.8 ± 7.5 preoperatively to 51.4 ± 6.1; p < 0.001). A statistically significant decrease was detected in VAS pain score (from 8.7 ± 1.6 preoperatively to 2.2 ± 1.6; p < 0.001). The UCLA activity levels increased significantly from 2.4 ± 0.8 to 6.3 ± 2.3 ( p < 0.001). Conclusion Pain and function significantly improved in patients affected by ankle osteoarthritis, who underwent TAR, at 1-year follow-up. In addition, activity level showed a significant increase respect to preoperative condition. Level of Evidence Level IV, retrospective case series.

Effect of Total Ankle Arthroplasty and Ankle Arthrodesis for Ankle Osteoarthritis: A Comparative Study

“…In the SF-12 MCS scale, the patients’ scores before endoprosthesis surgery were significantly higher than that before arthrodesis (43.3 to 35.7), but after the surgery, the results were comparable (p=0.119). Usuelli et al showed that SF-12 PCS increased from 34.3 to 45.4 points 12 months after ankle endoprosthesis, while MCS scores increased from 39.8 to 51.4 [22]. Those results are similar to ours.…”

Return to Sports and Activity After Total Ankle Arthroplasty and Arthrodesis: A Systematic Review

“…There were a total of 7 retrospective studies, including 3 studies addressing return to sports after TAR, 8,25,60 2 after AA, 1,30 and 2 studies comparing sport levels after TAR versus AA. 12,52 One study demonstrated a 4-fold increase in sports activity following TAR at 12 months, 60 and the most frequent postoperative activities included swimming, gardening, hiking, cycling/biking, dancing, and even higher-impact activities such as jogging, skiing, and martial arts. 8,60 In a study of 117 primary TARs comparing mobile-bearing versus fixed-bearing prosthesis, Indino et al 25 found that there was no significant difference in return to sports and physical activities between implants at 1 year of follow-up.…”

“…Of the patients participating in regular or intense sports activity, only 4% of patients mentioned substantial pain during sports (3% during hiking on rough terrain, 1% during dancing). 8 Usuelli et al 60 created a resource for sport recommendations following TAR, which included a “not recommended” designation for basketball, beach volleyball, climbing, horseback riding, ice hockey, ice skating and skating, jogging, martial arts, mountain biking, paragliding and skydiving, rugby, soccer, volleyball, water skiing, and windsurfing.…”

“…12 Overall, patients demonstrated a shift toward low-impact sports following TAR 8,40 ; however, several studies reported that patients were occasionally able to return to moderate- to high-impact sports following TAR, most commonly jogging. 25,60,63…”

“…Four studies reported significant improvements in sports participation, 25,60 step activity, 54 and ankle functional measures and patient-reported outcomes 38 as early as 12 months after TAR or AA. The remainder of included studies reported sports participation levels throughout a range of follow-up from 24 to 120 months.…”