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.
Coester LM, Saltzman CL, Leupold J, et al. Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Jt Surg Am 2001;83(2):219. DOI: 10.2106/00004623-200102000-00009. http://www.ejbjs.org/cgi/content/abstract/83/2/219%5Cnhttp://www.ejbjs.org/cgi/reprint/83/2/219.pdf.
Bugbee WD, Khanna G, Cavallo M, et al. Bipolar fresh osteochondral allografting of the tibiotalar joint. J Bone Joint Surg Am 2013;95(5): 426–432. DOI: 10.2106/JBJS.L.00165.
Daniels TR, Younger AS, Penner M, et al. Intermediate-term results of total ankle replacement and ankle arthrodesis. J Bone Joint Surg Am 2014;96(2):135–142. DOI: 10.2106/JBJS.L.01597.
Penner M, Davis WH, Wing K, et al. The infinity total ankle system: early clinical results with 2- to 4-year follow-up. Foot Ankle Spec 2018;11(4):193864001877760. DOI: 10.1177/1938640018777601.
Marijnissen ACA, Van Roermund PM, Van Melkebeek J, et al. Clinical benefit of joint distraction in the treatment of severe osteoarthritis of the ankle: proof of concept in an open prospective study and in a randomized controlled study. Arthritis Rheum 2002;46(11): 2893–2902. DOI: 10.1002/art.10612.
Intema F, Thomas TP, Anderson DD, et al. Subchondral bone remodeling is related to clinical improvement after joint distraction in the treatment of ankle osteoarthritis. Osteoarthr Cartil 2011;19(6): 668–675. DOI: 10.1016/j.joca.2011.02.005.
van Roermund PM, Marijnissen ACA, FPJG Lafeber. Joint distraction as an alternative for the treatment of osteoarthritis. Foot Ankle Clin 2002;7(3):515–527. DOI: 10.1016/S1083-7515(02)00027-X.
van Valburg A, van Roermund P, Lammens J, et al. Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report. J Bone Jt Surg Br 1995;77(5):720–725. DOI: 10.1302/0301-620X.77B5.7559696. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&l ist_uids=7559696.
Zhang K, Jiang Y, Du J, et al. Comparison of distraction arthroplasty alone versus combined with arthroscopic microfracture in treatment of post-traumatic ankle arthritis. J Orthop Surg Res 2017;12(1):45. DOI: 10.1186/s13018-017-0546-7.
Barg A, Amendola A, Beaman DN, et al. Ankle joint distraction arthroplasty. Foot Ankle Clin 2013;18(3):459–470. DOI: 10.1016/j. fcl.2013.06.005.
Bernstein M, Reidler J, Fragomen A, et al. Ankle distraction arthroplasty. J Am Acad Orthop Surg 2017;25(2):89–99. DOI: 10.5435/JAAOS-D-14-00077.
Saltzman CL, Hillis SL, Stolley MP, et al. Motion versus fixed distraction of the joint in the treatment of ankle osteoarthritis: a prospective randomized controlled trial. J Bone Joint Surg Am 2012;94(11):961–970. DOI: 10.2106/JBJS.K.00018.
Zhao HM, Liang XJ, Li Y, et al. Supramalleolar osteotomy with distraction arthroplasty in treatment of Varus ankle osteoarthritis with large talar tilt angle: a case report and literature review. J Foot Ankle Surg 2017;56(5):1125–1128. DOI: 10.1053/j.jfas.2017.04.022.
Zhao H, Qu W, Li Y, et al. Functional analysis of distraction arthroplasty in the treatment of ankle osteoarthritis. J Orthop Surg Res 2017;12(1):18. DOI: 10.1186/s13018-017-0519-x.
Giannini S, Buda R, Faldini C, et al. The treatment of severe posttraumatic arthritis of the ankle joint. J Bone Jt Surg - Ser A 2007;89(Suppl. 3):15–28. DOI: 10.2106/JBJS.G.00544.
Ploegmakers JJW, van Roermund PM, van Melkebeek J, et al. Prolonged clinical benefit from joint distraction in the treatment of ankle osteoarthritis. Osteoarthr Cartil 2005;13(7):582–588. DOI: 10.1016/j.joca.2005.03.002.
Marijnissen ACA, Hoekstra MCL, Pré BC, et al. Patient characteristics as predictors of clinical outcome of distraction in treatment of severe ankle osteoarthritis. J Orthop Res 2014;32(1):96–101. DOI: 10.1002/jor.22475.
Nguyen MP, Pedersen DR, Gao Y, et al. Intermediate-term follow-up after ankle distraction for treatment of end-stage osteoarthritis. J Bone Joint Surg Am 2015;97(7):590–596. DOI: 10.2106/JBJS.N.00901.
Gomez JA, Matsumoto H, Roye DP, et al. Articulated hip distraction: a treatment option for femoral head avascular necrosis in adolescence. J Pediatr Orthop 2009;29(2):163–169. DOI: 10.1097/BPO.0b013e31819 903b9.