Joint preservation of the osteoarthritic ankle using distraction arthroplasty.
BACKGROUND
In recent years ankle distraction arthroplasty has gained popularity in the treatment of ankle arthritis as a means of both maintaining range of motion and avoiding fusion. We present a retrospective review of 25 patients who have undergone ankle distraction from 1999 to 2006.


METHODS
The mean age was 43 years; 16 were male, and 7 were female. Followup was 30 months after frame removal (range, 12 to 60 months). We were able to obtain followup on 23 of 25 patients. Adjuvant procedures were performed in some cases including Achilles tendon lengthening (5), ankle arthroscopy (4), open arthrotomy (1), and supramalleolar tibial and distal fibular osteotomy to correct distal tibial deformity (6).


RESULTS
Twenty-one patients (91%) reported improved pain with those furthest post-op experiencing the best results. The average preoperative AOFAS score was 55 (range, 29 to 82), and the average postoperative score was 74 (range, 47 to 96). The difference between pre- and postoperative scores was significant (p = 0.005). SF-36 scores showed modest improvement in all components. Only two of the patients in the study underwent fusion after ankle distraction. Total ankle motion was maintained in all patients with improvement in the functional arc of motion in five patients who started with mild equinus contractures.


CONCLUSIONS
We feel that ankle distraction offers a promising solution for many people with ankle arthritis.
Hospital for Special Surgery, Limb Lengthening and Deformity Service, Foot and Ankle Service, 535 East 70th Street, New York, NY 10021, USA. ntellisi@yahoo.co.uk
Nazzar
N
Tellisi
Austin T
AT
Fragomen
Dawn
D
Kleinman
Martin J
MJ
O'Malley
S Robert
SR
Rozbruch
D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint; D001178:Arthroplasty / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000379:methods*; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult