J Korean Foot Ankle Soc.  2022 Sep;26(3):118-122. 10.14193/jkfas.2022.26.3.118.

Total Ankle Arthroplasty Management and Rehabilitation

Affiliations
  • 1Department of Orthopedic Surgery, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea

Abstract

Although total ankle arthroplasty (TAA) has increased considerably in the past ten years, reflecting improvements in implant design and survivorship, the clinical outcomes have been less satisfactory than total hip or total knee arthroplasties. Several issues under debate include postoperative management and rehabilitation in TAA. Especially, there is no consensus or evidence for the most appropriate postoperative management and rehabilitation for patients undergoing TAA. This study was therefore undertaken to suggest appropriate postoperative management and rehabilitation in TAA, after reviewing published articles and focusing on the following topics: prehabilitation, hospital stay, immobilization type and duration, weight-bearing management, pharmacological treatment, and adopted rehabilitation protocols. In previous studies, the postoperative management and rehabilitation proposed depended on the surgeon’s preference, the patient's characteristics, and the associated surgical procedures performed after TAA. Nonetheless, our research indicates the best approach is to include a prehabilitation program, immobilization in the early postoperative stage (2~4 weeks), range of motion exercise with partial weight-bearing ambulation, followed by full weight-bearing ambulation after six weeks. Further studies are required to develop a standardized rehabilitation protocol and improve the overall quality of care after TAA.

Keyword

Arthroplasty; Ankle; Rehabilitation

Figure

  • Figure 1 Postoperative management with ankle brace and icing, leg elevation in early postoperative stage.


Reference

1. Cody EA, Scott DJ, Easley ME. 2018; Total ankle arthroplasty: a critical analysis review. JBJS Rev. 6:e8. doi: 10.2106/JBJS.RVW.17.00182. DOI: 10.2106/JBJS.RVW.17.00182. PMID: 30153245.
2. Massobrio M, Pellicanò G, Santilli V, Tognolo L. 2018; Total ankle replacement: indications, rehabilitation and results. Int J Foot Ankle. 2:019. doi: 10.23937/ijfa-2017/1710019. DOI: 10.23937/ijfa-2017/1710019.
3. Mazzotti A, Viglione V, Gerardi S, Bonelli S, Zielli S, Geraci G, et al. 2022; Post-operative management after total ankle arthroplasty: a systematic review of the literature. Foot Ankle Surg. 28:535–42. doi: 10.1016/j.fas.2021.05.013. DOI: 10.1016/j.fas.2021.05.013. PMID: 34088605.
Article
4. Jaggers JR, Simpson CD, Frost KL, Quesada PM, Topp RV, Swank AM, et al. 2007; Prehabilitation before knee arthroplasty increases postsurgical function: a case study. J Strength Cond Res. 21:632–4. doi: 10.1519/R-19465.1. DOI: 10.1519/R-19465.1. PMID: 17530958.
Article
5. Gocen Z, Sen A, Unver B, Karatosun V, Gunal I. 2004; The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial. Clin Rehabil. 18:353–8. doi: 10.1191/0269215504cr758oa. DOI: 10.1191/0269215504cr758oa. PMID: 15180117.
Article
6. Hsu AR, Haddad SL. 2015; Early clinical and radiographic outcomes of intramedullary-fixation total ankle arthroplasty. J Bone Joint Surg Am. 97:194–200. doi: 10.2106/JBJS.N.00227. DOI: 10.2106/JBJS.N.00227. PMID: 25653319.
Article
7. Boylan MR, Riesgo AM, Paulino CB, Sheskier SC. 2018; Does total ankle arthroplasty belong in the comprehensive care for joint replacement? J Foot Ankle Surg. 57:69–73. doi: 10.1053/j.jfas.2017.08.008. DOI: 10.1053/j.jfas.2017.08.008. PMID: 29268905.
Article
8. Bueno H, Ross JS, Wang Y, Chen J, Vidán MT, Normand SL, et al. 2010; Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006. JAMA. 303:2141–7. doi: 10.1001/jama.2010.748. DOI: 10.1001/jama.2010.748. PMID: 20516414. PMCID: PMC3020983.
Article
9. Avashia YJ, Shammas RL, Mithani SK, Parekh SG. 2017; Soft tissue reconstruction after total ankle arthroplasty. Foot Ankle Clin. 22:391–404. doi: 10.1016/j.fcl.2017.01.008. DOI: 10.1016/j.fcl.2017.01.008. PMID: 28502354.
Article
10. Phillips WA, Schwartz HS, Keller CS, Woodward HR, Rudd WS, Spiegel PG, et al. 1985; A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg Am. 67:67–78. doi: 10.2106/00004623-198567010-00010. DOI: 10.2106/00004623-198567010-00010.
Article
11. Brink O, Staunstrup H, Sommer J. 1996; Stable lateral malleolar fractures treated with aircast ankle brace and DonJoy R.O.M.-Walker brace: a prospective randomized study. Foot Ankle Int. 17:679–84. doi: 10.1177/107110079601701106. DOI: 10.1177/107110079601701106. PMID: 8946182.
Article
12. Jung HG, Lee SH, Shin MH, Lee DO, Eom JS, Lee JS. 2016; Anterior heterotopic ossification at the talar neck after total ankle arthroplasty. Foot Ankle Int. 37:703–8. doi: 10.1177/1071100716642757. DOI: 10.1177/1071100716642757. PMID: 27053404.
Article
13. Giannini S, Romagnoli M, Barbadoro P, Marcheggiani Muccioli GM, Cadossi M, Grassi A, et al. 2017; Results at a minimum follow-up of 5 years of a ligaments-compatible total ankle replacement design. Foot Ankle Surg. 23:116–21. doi: 10.1016/j.fas.2017.03.009. DOI: 10.1016/j.fas.2017.03.009. PMID: 28578794.
Article
14. Hintermann B, Ruiz R, Barg A. 2017; Dealing with the stiff ankle: preoperative and late occurrence. Foot Ankle Clin. 22:425–53. doi: 10.1016/j.fcl.2017.01.012. DOI: 10.1016/j.fcl.2017.01.012. PMID: 28502356.
15. Roukis TS. 2015; The Salto Talaris XT revision ankle prosthesis. Clin Podiatr Med Surg. 32:551–67. doi: 10.1016/j.cpm.2015.06.019. DOI: 10.1016/j.cpm.2015.06.019. PMID: 26407741.
Article
16. Elliott AD, Roukis TS. 2017; Anterior incision offloading for primary and revision total ankle replacement: a comparative analysis of two techniques. Open Orthop J. 11:678–86. doi: 10.2174/1874325001711010678. DOI: 10.2174/1874325001711010678. PMID: 28979581. PMCID: PMC5620434.
Article
17. Hofmann KJ, Shabin ZM, Ferkel E, Jockel J, Slovenkai MP. 2016; Salto Talaris total ankle arthroplasty: clinical results at a mean of 5.2 years in 78 patients treated by a single surgeon. J Bone Joint Surg Am. 98:2036–46. doi: 10.2106/JBJS.16.00090. DOI: 10.2106/JBJS.16.00090. PMID: 28002366.
18. Viste A, Al Zahrani N, Brito N, Lienhart C, Fessy MH, Besse JL. 2015; Periprosthetic osteolysis after AES total ankle replacement: conventional radiography versus CT-scan. Foot Ankle Surg. 21:164–70. doi: 10.1016/j.fas.2014.11.002. DOI: 10.1016/j.fas.2014.11.002. PMID: 26235854.
Article
19. Usuelli FG, Indino C, Maccario C, Manzi L, Romano F, Aiyer A, et al. 2019; A modification of the fibular osteotomy for total ankle replacement through the lateral transfibular approach. J Bone Joint Surg Am. 101:2026–35. doi: 10.2106/JBJS.19.00307. DOI: 10.2106/JBJS.19.00307. PMID: 31764365.
Article
20. Cody EA, Taylor MA, Nunley JA 2nd, Parekh SG, DeOrio JK. 2019; Increased early revision rate with the INFINITY total ankle prosthesis. Foot Ankle Int. 40:9–17. doi: 10.1177/1071100718794933. DOI: 10.1177/1071100718794933. PMID: 30175612.
Article
21. Saltzman CL, McIff TE, Buckwalter JA, Brown TD. 2000; Total ankle replacement revisited. J Orthop Sports Phys Ther. 30:56–67. doi: 10.2519/jospt.2000.30.2.56. DOI: 10.2519/jospt.2000.30.2.56. PMID: 10693083.
Article
22. Mayle RE Jr, DiGiovanni CW, Lin SS, Tabrizi P, Chou LB. 2007; Current concepts review: venous thromboembolic disease in foot and ankle surgery. Foot Ankle Int. 28:1207–16. doi: 10.3113/FAI.2007.1207. DOI: 10.3113/FAI.2007.1207. PMID: 18021595.
Article
23. Warwick D, Friedman RJ, Agnelli G, Gil-Garay E, Johnson K, FitzGerald G, et al. 2007; Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events: findings from the Global Orthopaedic Registry. J Bone Joint Surg Br. 89:799–807. doi: 10.1302/0301-620X.89B6.18844. DOI: 10.1302/0301-620X.89B6.18844. PMID: 17613508.
24. Barg A, Henninger HB, Hintermann B. 2011; Risk factors for symptomatic deep-vein thrombosis in patients after total ankle replacement who received routine chemical thromboprophylaxis. J Bone Joint Surg Br. 93:921–7. doi: 10.1302/0301-620X.93B7.26257. DOI: 10.1302/0301-620X.93B7.26257. PMID: 21705564.
Article
25. Ajis A, Henriquez H, Myerson M. 2013; Postoperative range of motion trends following total ankle arthroplasty. Foot Ankle Int. 34:645–56. doi: 10.1177/1071100713481433. DOI: 10.1177/1071100713481433. PMID: 23478890.
Article
26. Kotela A, Wilk-Frańczuk M, Jaczewska J, Żbikowski P, Łęgosz P, Ambroziak P, et al. 2017; Perioperative physiotherapy for total ankle replacement in patients with inherited bleeding disorders: outline of an algorithm. Med Sci Monit. 23:498–504. doi: 10.12659/MSM.898075. DOI: 10.12659/MSM.898075. PMID: 28129322. PMCID: PMC5292987.
Article
27. DiLiberto FE, Aslan DH, Houck JR, Ho BS, Vora AM, Haddad SL. 2020; Overall health and the influence of physical therapy on physical function following total ankle arthroplasty. Foot Ankle Int. 41:1383–90. doi: 10.1177/1071100720942473. DOI: 10.1177/1071100720942473. PMID: 32749159.
Article
28. Jones C, Rush S, Berlet GC, Regina J, Penner M, Brigido SA, et al. 2015; Understanding the postoperative course and rehabilitation protocol for total ankle arthroplasty. Foot Ankle Spec. 8:203–8. doi: 10.1177/1938640015583298. DOI: 10.1177/1938640015583298. PMID: 25878081.
Article
29. Prusinowska A, Krogulec Z, Turski P, Przepiórski E, Małdyk P, Księżopolska-Orłowska K. 2015; Total ankle replacement - surgical treatment and rehabilitation. Reumatologia. 53:34–9. doi: 10.5114/reum.2015.50555. DOI: 10.5114/reum.2015.50555. PMID: 27407223. PMCID: PMC4847308.
Article
30. Hintermann B, Knupp M, Zwicky L, Barg A. 2012; Total ankle replacement for treatment of end-stage osteoarthritis in elderly patients. J Aging Res. 2012:345237. doi: 10.1155/2012/345237. DOI: 10.1155/2012/345237. PMID: 22720158. PMCID: PMC3375014.
Article
31. Frane N, Bandovic I, Hu V, Bitterman A. 2020; Return-to-driving recommendations after lower-extremity orthopaedic procedures. JBJS Rev. 8:e20.00066. doi: 10.2106/JBJS.RVW.20.00066. DOI: 10.2106/JBJS.RVW.20.00066. PMID: 33298680.
32. McDonald EL, Shakked R, Nicholson K, Daniel JN, Pedowitz DI, Winters BS, et al. 2021; Return to driving after foot and ankle surgery: a novel survey to predict passing brake reaction time. Foot Ankle Spec. 14:32–8. doi: 10.1177/1938640019890970. DOI: 10.1177/1938640019890970. PMID: 31904291.
Article
33. Bhowmik-Stoker M, Mathew KK, Chen Z, Chen AF, Hozack WJ, Mahoney O, et al. 2022; Return to work and driving after robotic arm-assisted total knee arthroplasty. Arthroplast Today. 16:219–23. doi: 10.1016/j.artd.2022.06.002. DOI: 10.1016/j.artd.2022.06.002. PMID: 35880225. PMCID: PMC9307493.
Article
Full Text Links
  • JKFAS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr