Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 15 , ISSUE 3 ( September-December, 2020 ) > List of Articles

Original Article

Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty

Amgad M Haleem, Sherif Galal, Ogonna K Nwawka, Angela Balagadde, Eugene W Borst, Huong T Do, Douglas N Mintz, S Robert Rozbruch

Citation Information : Haleem AM, Galal S, Nwawka OK, Balagadde A, Borst EW, Do HT, Mintz DN, Rozbruch SR. Short-term Results of Magnetic Resonance Imaging after Ankle Distraction Arthroplasty. 2020; 15 (3):157-162.

DOI: 10.5005/jp-journals-10080-1512

License: CC BY-NC-SA 4.0

Published Online: 01-12-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Background: Ankle distraction arthroplasty has emerged as an alternative treatment for ankle arthritis. There are few reports on the magnetic resonance imaging (MRI) findings after distraction arthroplasty. This study sought to determine whether there are positive changes on MRI after ankle distraction and improvements on X-ray. Additionally, patient-reported outcomes and joint range of motion (ROM) after ankle distraction are described. Materials and methods: Thirty-two patients (mean age 49 years) who underwent ankle distraction had pre-operative and one-year postoperative MRIs, which were graded using a modified whole-organ magnetic resonance imaging score (WORMS). Ankle joint space and ROM were measured. A non-validated three-item questionnaire was administered to assess functional outcomes. Results: Although the anterior quadrant of the ankle showed a trend to improvement in cartilage morphology on the postoperative MRI, the WORMS did not demonstrate a significant difference in any of its subcategories. While reduction in joint osteophytes was observed and maintained short term, this was mainly due to resection intraoperatively. X-rays revealed a significant increase in joint space, and there was a significant increase in ankle dorsiflexion. Eight-seven percent of the patients were satisfied with their functional outcome. Conclusion: At short-term follow-up, MRI scores after ankle distraction arthroplasty did not demonstrate significant improvement despite positive changes on X-ray and improved clinical outcomes and ankle ROM. Further study on larger patient numbers with longer follow-up is required. Level of evidence: IV, Case Series


HTML PDF Share
  1. Fuchs S, Sandmann C, Skwara A, et al. Quality of life 20 years after arthrodesis of the ankle. A study of adjacent joints. J Bone Joint Surg Br 2003;85(7):994–998. DOI:10.1302/0301-620x.85b7.13984.
  2. Thomas R, Daniels TR, Parker K. Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis. J Bone Joint Surg Am 2006;88(3):526–535. DOI:10.2106/JBJS.E.00521.
  3. Jastifer JR, Coughlin MJ. Long-term follow-up of mobile bearing total ankle arthroplasty in the United States. Foot Ankle Int 2014;36(2):143–150. DOI: 10.1177/1071100714550654.
  4. de Asla RJ, Ellis S, Overley B, et al. Total ankle arthroplasty in the setting of valgus deformity. Foot Ankle Spec 2014;7(5):398–402. DOI: 10.1177/1938640014549535.
  5. Brunner S, Barg A, Knupp M, et al. The Scandinavian total ankle replacement: long-term, eleven to fifteen-year, survivorship analysis of the prosthesis in seventy-two consecutive patients. J Bone Joint Surg Am 2013;95(8):711–718. DOI: 10.2106/JBJS.K.01580.
  6. Kraal T, van der Heide HJ, van Poppel BJ, et al. Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease. Bone Joint J 2013;95-B(12):1656–1661. DOI: 10.1302/0301-620X.95B12.32146.
  7. van Valburg AA, van Roermund PM, Lammens J, et al. Can Ilizarov joint distraction delay the need for an arthrodesis of the ankle? A preliminary report. J Bone Joint Surg Br 1995;77(5):720–725.
  8. van Valburg AA, van Roermund PM, Marijnissen AC, et al. Joint distraction in treatment of osteoarthritis: a two-year follow-up of the ankle. Osteoarthritis Cartilage 1999;7(5):474–479.
  9. Marijnissen AC, Hoekstra MC, Pre 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.
  10. Tellisi N, Fragomen AT, Kleinman D, et al. Joint preservation of the osteoarthritic ankle using distraction arthroplasty. Foot Ankle Int 2009;30(4):318–325. DOI: 10.3113/FAI.2009.0318.
  11. van Valburg AA, van Roermund PM, Marijnissen AC, et al. Joint distraction in treatment of osteoarthritis (II): effects on cartilage in a canine model. Osteoarthritis Cartilage 2000;8(1):1–8. DOI: 10.1053/joca.1999.0263.
  12. Wiegant K, van Roermund PM, Intema F, et al. Sustained clinical and structural benefit after joint distraction in the treatment of severe knee osteoarthritis. Osteoarthritis Cartilage 2013;21(11):1660–1667. DOI: 10.1016/j.joca.2013.08.006.
  13. Yanai T, Ishii T, Chang F, et al. Repair of large full-thickness articular cartilage defects in the rabbit: the effects of joint distraction and autologous bone-marrow-derived mesenchymal cell transplantation. J Bone Joint Surg Br 2005;87(5):721–729. DOI: 10.1302/0301-620X.87B5.15542.
  14. Morse KR, Flemister AS, Baumhauer JF, et al. Distraction arthroplasty. Foot Ankle Clin 2007;12(1):29–39. DOI: 10.1016/j.fcl.2006.11.003.
  15. van Roermund PM, Marijnissen AC, Lafeber FP. 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.
  16. van Valburg AA, van Roy HL, Lafeber FP, et al. Beneficial effects of intermittent fluid pressure of low physiological magnitude on cartilage and inflammation in osteoarthritis. An in vitro study. J Rheumatol 1998;25(3):515–520.
  17. Aldegheri R, Trivella G, Saleh M. Articulated distraction of the hip. Conservative surgery for arthritis in young patients. Clin Orthop Relat Res 1994(301):94–101.
  18. Marijnissen AC, 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.
  19. Ploegmakers JJ, van Roermund PM, van Melkebeek J, et al. Prolonged clinical benefit from joint distraction in the treatment of ankle osteoarthritis. Osteoarthritis Cartilage 2005;13(7):582–588. DOI: 10.1016/j.joca.2005.03.002.
  20. 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. Osteoarthritis Cartilage 2011;19(6):668–675. DOI: 10.1016/j.joca.2011.02.005.
  21. Lamm BM, Gourdine-Shaw M. MRI evaluation of ankle distraction: a preliminary report. Clin Podiatr Med Surg 2009;26(2):185–191. DOI: 10.1016/j.cpm.2008.12.007.
  22. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16(4):494–502. DOI: 10.1136/ard.16.4.494.
  23. Firth GB, McMullan M, Chin T, et al. Lengthening of the gastrocnemius-soleus complex: an anatomical and biomechanical study in human cadavers. J Bone Joint Surg Am 2013;95(16):1489–1496. DOI: 10.2106/JBJS.K.01638.
  24. Inda DA, Blyakher A, O’Malley MJ, et al. Distraction arthroplasty for the ankle using the Ilizarov frame. Tech Foot Ankle Surg 2003;2(4):249–253. DOI: 10.1097/00132587-200312000-00005.
  25. Fragomen AT, McCoy TH, Meyers KN, et al. Minimum distraction gap: how much ankle joint space is enough in ankle distraction arthroplasty? HSS J 2014;10(1):6–12. DOI: 10.1007/s11420-013-9359-3.
  26. Peterfy CG, Guermazi A, Zaim S, et al. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004;12(3):177–190. DOI: 10.1016/j.joca.2003.11.003.
  27. Kanbe K, Hasegawa A, Takagishi K, et al. Arthroscopic findings of the joint distraction for the patient with chondrolysis of the ankle. Diagn Ther Endosc 1997;4(2):101–105. DOI: 10.1155/DTE.4.101.
  28. Van Meegeren ME, Van Veghel K, De Kleijn P, et al. Joint distraction results in clinical and structural improvement of haemophilic ankle arthropathy: a series of three cases. Haemophilia 2012;18(5):810–817. DOI: 10.1111/j.1365-2516.2012.02805.x.
  29. Lee DK. Ankle arthroplasty alternatives with allograft and external fixation: preliminary clinical outcome. J Foot Ankle Surg 2008;47(5):447–452. DOI: 10.1053/j.jfas.2008.04.011.
  30. Paley D, Lamm BM, Purohit RM, et al. Distraction arthroplasty of the ankle—how far can you stretch the indications? Foot Ankle Clin 2008;13(3):471–484, ix. DOI: 10.1016/j.fcl.2008.05.001.
  31. Sinitski EH, Hansen AH, Wilken JM. Biomechanics of the ankle-foot system during stair ambulation: implications for design of advanced ankle-foot prostheses. J Biomech 2012;45(3):588–594. DOI: 10.1016/j.jbiomech.2011.11.007.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.