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VOLUME 14 , ISSUE 2 ( May-August, 2019 ) > List of Articles

Original Article

Ankle Distraction Arthroplasty for Ankle Osteoarthritis: A Survival Analysis

Stephen Greenfield, Kelsey M Matta, Thomas H McCoy, S Robert Rozbruch, Austin T. Fragomen

Keywords : Ankle arthritis, Ankle distraction arthroplasty, Arthrodiastasis, Avascular necrosis, External fixation

Citation Information : Greenfield S, Matta KM, McCoy TH, Rozbruch SR, Fragomen AT. Ankle Distraction Arthroplasty for Ankle Osteoarthritis: A Survival Analysis. 2019; 14 (2):65-71.

DOI: 10.5005/jp-journals-10080-1429

License: CC BY-NC-SA 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Aim: The treatment algorithm for end-stage ankle arthritis is imperfect. Young or active patients are challenging to treat as fusion and replacement carry predictable consequences. Ankle distraction arthroplasty is a less commonly utilized surgical procedure for the treatment of osteoarthritis of the ankle. The purpose of this study was to report intermediate-term survival of ankle distraction and to identify factors associated with earlier time to failure. Materials and methods: A single-centre, multi-surgeon cohort of 258 cases of ankle arthritis, treated with ankle distraction or ankle distraction with supramalleolar osteotomy (SMO), was identified. Patients were contacted by phone to determine the status of the ankle (natural vs fused/replaced). Data were collected through chart review. This included patient demographics, medical comorbidities, surgical procedure, and X-ray characteristics including pattern and severity. A Cox regression model was used to determine factors associated with failure during 10 years of follow-up. Risk factors were analysed as hazard ratios (HRs) and 95% confidence intervals (CIs). Time to failure was illustrated with Kaplan–Meier (KM) curves. Results: In total, 144 cases were successfully contacted with median follow-up of 4.57 years. In total, 16.7% of ankles failed (24/144). The 5-year survival was 84% (95% CI: 78–91%). In adjusted Cox regression, female sex (HR = 2.68, p = 0.049) and avascular necrosis (AVN) of the talus (HR =3.77, p = 0.041) were significantly associated with failure risk. Conclusion: Avascular necrosis of the talus and male/female gender differences in survival were found to be significant. Our experience shows that ankle distraction is a valid and effective operation for the treatment of end-stage ankle arthritis. Clinical significance: This work is clinically significant in that it demonstrates excellent intermediate-term survival data for hinged ankle distraction for treatment of osteoarthritis of the ankle. Additionally, it evaluated patient and disease characteristics allowing improved patient counselling with regard to survival longevity. Level of evidence: IV cohort study.

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