title: The impact of diabetes on the short- to mid-term outcome of total ankle replacement.
abstract: We compared the clinical and radiographic results of total ankle replacement (TAR) performed in non-diabetic and diabetic patients. We identified 173 patients who underwent unilateral TAR between 2004 and 2011 with a minimum of two years' follow-up. There were 88 male (50.9%) and 85 female (49.1%) patients with a mean age of 66 years (sd 7.9, 43 to 84). There were 43 diabetic patients, including 25 with controlled diabetes and 18 with uncontrolled diabetes, and 130 non-diabetic patients. The clinical data which were analysed included the Ankle Osteoarthritis Scale (AOS) and the American Orthopaedic Foot and Ankle Society (AOFAS) scores, as well the incidence of peri-operative complications. The mean AOS and AOFAS scores were significantly better in the non-diabetic group (p = 0.018 and p = 0.038, respectively). In all, nine TARs (21%) in the diabetic group had clinical failure at a mean follow-up of five years (24 to 109), which was significantly higher than the rate of failure of 15 (11.6%) in the non-diabetic group (p = 0.004). The uncontrolled diabetic subgroup had a significantly poorer outcome than the non-diabetic group (p = 0.02), and a higher rate of delayed wound healing. The incidence of early-onset osteolysis was higher in the diabetic group than in the non-diabetic group (p = 0.02). These results suggest that diabetes mellitus, especially with poor glycaemic control, negatively affects the short- to mid-term outcome after TAR.
authors.affiliation: Yonsei University College of Medicine , Department of Orthopaedic Surgery, Seoul, 120-752, South Korea.
authors.forename: W J
authors.initials: WJ
authors.lastname: Choi
authors.affiliation: Sewoori Spine and Joint Hospital, Department of Orthopaedic Surgery, Daejeon, South Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Yonsei University College of Medicine , Department of Orthopaedic Surgery, Seoul, 120-752, South Korea.
authors.forename: M
authors.initials: M
authors.lastname: Lee
authors.affiliation: Yonsei University College of Medicine , Department of Orthopaedic Surgery, Seoul, 120-752, South Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Park
authors.affiliation: Yonsei University College of Medicine , Department of Orthopaedic Surgery, Seoul, 120-752, South Korea.
authors.forename: J W
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058737:Arthroplasty, Replacement, Ankle; D015897:Comorbidity; D048909:Diabetes Complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010014:Osteolysis; D011475:Prosthesis Failure; D011859:Radiography; D013977:Tibia / Q000000981:diagnostic imaging; D016896:Treatment Outcome
keywords: Diabetes mellitus; Osteolysis; Total ankle replacement; Wound complication