J Korean Foot Ankle Soc.  2019 Sep;23(3):91-99. 10.14193/jkfas.2019.23.3.91.

Intermediate-Term Clinical Outcomes after Total Ankle Arthroplasty for End-Stage Rheumatoid Arthritis with Modification of Perioperative Anti-Rheumatic Medication

• Cho BK
• Ko BS

• KMID: 2458009
• DOI: http://doi.org/10.14193/jkfas.2019.23.3.91

Abstract

PURPOSE
This retrospective study reports the intermediate-term clinical outcomes including the practical function in daily and sports activities after total ankle arthroplasty for end-stage rheumatoid arthritis, as well as the effects of modification of perioperative anti-rheumatic medications.
MATERIALS AND METHODS
Twelve patients were followed for a minimum of 2 years after total ankle replacement for end-stage rheumatoid arthritis. Perioperative anti-rheumatic medications in all patients were modified based on a specific guideline. Clinical evaluations consisted of American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores. Periodic radiographic evaluation was conducted to detect changes in ankle alignment and postoperative complications.
RESULTS
Mean AOFAS, FAOS, and FAAM scores improved significantly from 37.5 to 81.2, 39.1 to 72.4, and 33.8 to 64.0 points at final follow-up, respectively (p<0.001). Functional outcomes in daily and sports activities at final follow-up were found to be 76.5 and 55.8 points for the FAOS and 70.5 and 57.5 points for the FAAM, respectively. As early postoperative complications, there was one case of local wound necrosis, one case of medial malleolar fracture, and one case of deep peroneal nerve injury. Radiological evaluation revealed two cases of asymptomatic heterotopic ossification and one case of progressive arthritis in the talonavicular joint. Reoperation was performed in only one patient (8.3%) with a medial soft tissue impingement at a mean of 35.6 months follow-up.
CONCLUSION
Total ankle arthroplasty appears to be an effective surgical option for end-stage rheumatoid arthritis. Practical functions in daily and sports activities were significantly improved at intermediate-term follow-up. Modification of perioperative anti-rheumatic medications can be one of the solutions to reduce the postoperative complication rate.

Keyword

Ankle; Rheumatoid arthritis; Arthroplasty; Outcomes; Medication

MeSH Terms

Ankle*
Arthritis
Arthritis, Rheumatoid*
Arthroplasty*
Arthroplasty, Replacement, Ankle
Follow-Up Studies
Foot
Humans
Joints
Necrosis
Ossification, Heterotopic
Peroneal Nerve
Postoperative Complications
Reoperation
Retrospective Studies
Sports
Wounds and Injuries

Figure

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  Figure 1 (A) Lateral radiograph showing the severe rheumatoid arthritis of the right ankle. (B) Lateral radiograph showing the planovalgus deformity secondary to the severe rheumatoid arthritis of the transverse tarsal joint in the contralateral foot.

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  Figure 2 Photograph showing the anterocentral approach for total ankle arthroplasty.

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  Figure 3 (A) Photograph showing the tibial window preparation. Intraoperative anteroposterior (B) and lateral (C) radiographs showing the cementless fixation of tibial and talar components.

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  Figure 4 Preoperative anteroposterior (A) and lateral (B) radiographs showing the severe ankle rheumatoid arthritis with varus malalignment in a 61-year-old female patient who had a history of the fibular fracture.

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  Figure 5 Anteroposterior (A) and lateral (B) radiographs at 3 years postoperatively show a well-maintained total ankle arthroplasty despite heterotopic ossification.

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