Total Ankle Arthroplasty for Rheumatoid Arthritis in Japanese Patients

Abstract

Background:Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (augmentation of bone strength, control of soft-tissue balance, adjustment of the loading axis) for the treatment of rheumatoid arthritis were evaluated after intermediate to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated.Methods:We performed a retrospective observational study involving 50 ankles (44 patients) that underwent TAA for the treatment of rheumatoid arthritis. The mean duration of follow-up was 7.1 years. Clinical outcomes were evaluated with use of the Japanese Society for Surgery of the Foot (JSSF) scale score and a postoperative self-administered foot-evaluation questionnaire (SAFE-Q). Radiographic findings were evaluated as well. These parameters also were compared between patients managed with and without biologic treatment.Results:This procedure significantly improved the clinical scores of the JSSF rheumatoid arthritis foot and ankle scale (p < 0.0001). Forty-eight of the 50 ankles had no revision TAA surgery. Subsidence of the talar component was seen in 8 ankles (6 in the biologic treatment group and 2 in the non-biologic treatment group); 2 of these ankles (both in the biologic treatment group) underwent revision TAA. The social functioning score of the SAFE-Q scale at the time of the latest follow-up was significantly higher in the biologic treatment group (p = 0.0079). The dosage of prednisolone (p = 0.0003), rate of usage of prednisolone (p = 0.0001), and disease-activity score (p < 0.01) at the time of the latest follow-up were all significantly lower in the biologic treatment group.Conclusions:TAA is recommended for the treatment of rheumatoid arthritis if disease control, augmentation of bone strength, control of soft-tissue balance, and adjustment of the loading axis are taken into account. The prevention of talar component subsidence remains a challenge in patients with the combination of subtalar fusion, rheumatoid arthritis, and higher social activity levels.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Modified Anterolateral Approach for Total Ankle Arthroplasty

“…A retrospective, observational study of 36 consecutive ankles receiving a mobile-bearing ankle prosthesis design (The FINE mobile-bearing prosthesis; Teijin-Nakashima Medical Co, Ltd, Okayama, Japan) 5 for treatment of end-stage ankle deformity or destruction from January 2019 to December 2020 was performed. Thirteen ankles underwent TAA with the conventional anterior approach, and the remaining 23 ankles underwent the modified anterolateral approach.…”

“…The duration of casting was not changed if malleolar osteotomy was added, as in malleolar fracture cases, but when patients were allowed full weightbearing, it was with an attached ankle brace to avoid an ankle sprain. 5 Such intraoperative events mentioned above are described in Table 2. After suture removal was completed, range of motion exercise was started, and at the same time, gait exercise was also started.…”

“…Teijin-Nakashima Medical Co, Ltd, Okayama, Japan) 5 for treatment of end-stage ankle deformity or destruction from January 2019 to December 2020 was performed. Thirteen ankles underwent TAA with the conventional anterior approach, and the remaining 23 ankles underwent the modified anterolateral approach.…”

“…Surgery was carried out as described previously using mobile-bearing ankle prosthesis design (The FINE mobile-bearing prosthesis; Teijin-Nakashima Medical Co, Ltd, Okayama, Japan). 5 After preparation for tibia and talus implantation, medial malleolar lengthening osteotomy (preserving the periosteum) was added when tightness of the soft tissues was not acceptable. 2,5 Routine wound closure with careful suturing of the ankle joint capsule and extensor retinaculum was completed (Figure 3A, B).…”

“…5 After preparation for tibia and talus implantation, medial malleolar lengthening osteotomy (preserving the periosteum) was added when tightness of the soft tissues was not acceptable. 2,5 Routine wound closure with careful suturing of the ankle joint capsule and extensor retinaculum was completed (Figure 3A, B). The subcutaneous layer was sutured with 3-0 absorbable thread, as much as possible.…”