Joint Distraction of Osteoarthritic Ankle Attractive Alternative to...

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Joint Distraction of Osteoarthritic Ankle Attractive Alternative to

Arthrodesis

NEW YORK (Reuters Health) Dec 09 - Using an external fixation frame to

eliminate contact between the degenerating articular surfaces may become the

treatment of choice for severe osteoarthritis of the ankle, according to

studies conducted in Belgium and the Netherlands.

After performing the procedure on patients with severe pain, functional

impairment and limited joint mobility, Dr. Floris P. J. G. Lafeber, of the

University Medical Center Utrecht, and associates observed significant

clinical improvement in three quarters of the cohort, with improvement

increasing over time.

In an open prospective study, 57 patients being considered for arthrodesis

received the new procedure between May 1993 and September 2000. Arthroscopic

debridement was required by 35 patients prior to distraction.

Following placement of an Ilizarov external ring fixator, " distraction of

the tibiotalar joint was performed twice a day for 0.5 mm each until a total

distraction of at least 5 mm (as seen radiographically during full weight

bearing) was reached. " Patients were permitted full weight bearing within a

week, and ankle distraction was maintained for 3 months.

The investigators describe the results in the November issue of Arthritis

and Rheumatism.

One year after the procedure, pain scores among the 39 patients who had not

dropped out of the trial had decreased by an average of 38%, while function

scores increased 69%, " clinical condition " by 120%, and joint mobility by

8%. Among the 19 patients followed for 3 years, function had improved by a

further 20% and clinical condition by 43%.

To make sure that the improvement was not related to the prior debridement,

Dr. Lafeber's group also conducted a randomized controlled trial in which 9

patients were treated with the fixator (following debridement in 7), and 8

patients comprised a debridement control group.

Among those who underwent joint distraction, clinical improvement was

similar to that observed in the open trial and significantly greater than

that in the debridement group. In fact, 3 of the control patients underwent

successful joint distraction between 4 and 11 months later.

Dr. Lafeber and his associates believe that their success with joint

distraction " creates the possibility for developing this technique for the

treatment of osteoarthritis of the knee and hip. " They conclude, " The

social, medical, and economic impact of delaying or even eliminating the

need for arthrodesis or endoprosthesis would be great. "

Arthritis Rheum 2002;46:2893-2902.