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Patients with arthritis after pilon fractures may benefit from total ankle replacement
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Total ankle replacement should be a treatment option for patients with ankle arthritis following pilon fracture and orthopedic surgeons can expect to see the same or similar patient-reported outcomes when the treatment is used for other forms of arthritis, a presenter at a meeting said.
Adam Bennett, BSc (Hons), MBBCh, MRCS, said, “Pilon fractures are high-energy complex injuries often occurring in young patients. They undergo multiple procedures. In the literature, the outcome for total ankle replacement (TAR) performed in a previously injured ankle are described under the umbrella term of post-traumatic ankle arthritis, which does not stratify previous injuries by severity. We feel pilon fractures are special cases.”
The study by Bennett and colleagues, published in Foot and Ankle Orthopedics, was the winner of the 2017 International Federation of Foot and Ankle Societies Award for Excellence.
Ankle replacement results
Bennett and colleagues reviewed patient-reported outcomes for TAR performed from March 2006 to November 2014. They collected data preoperatively and at 1 year and 2 years postoperatively that included the foot and ankle outcome scores (FAOS), WOMAC pain/stiffness/function score, SF-36 general health questionnaire, comorbidities, self-reported BMI and patient satisfaction scores. To highlight the indication for TAR, they reviewed clinical notes and radiographs and divided the indications into subgroups, which included osteoarthritis, rheumatoid arthritis, arthritis following a pilon fracture, arthritis following ankle fracture and post-traumatic arthritis without a previous fracture.
A general linear model was used to assess FAOS and SF-36 variance. The Student’s t test and chi-squared test were used to analyze demographics, and cross-tabulation and chi-squared examination was used to evaluate patient satisfaction.
Patients with pilon fractures compared with the other patients had the youngest average age and the highest BMI. The number of comorbidities was not significantly different among the subgroups.
Patient satisfaction
Through 1-year postoperatively, FAOS pain, function and stiffness scores significantly improved, but they gained no additional statistical significance by 2-year follow-up.
“The pilon fracture group had the highest improvement in the whole physical domain from baseline to 2 years,” Bennett said. “Overall, all domains improved from baseline to 2-years postoperatively.”
Concerning pain relief, patients were either very satisfied or somewhat satisfied with their TARs. About 50% of patients in the OA group were somewhat satisfied with their surgical outcomes. – by Monica Jaramillo
- Reference:
- Bennett A, et al. Foot and Ankle Orthopedics. 2017;doi.org/10.1177/2473011417S000028.
- For more information:
- Adam Bennett, BSc(Hons), MBBCh, MRCS, can be reached at Freeman Hospital, Freeman Road, Newcastle Upon Tyne NE7 7DN, United Kingdom; email: adam_bennett85@hotmail.com.
Disclosure: Bennett reports no relevant financial disclosures.