RESEARCH - Total ankle replacement in patients with rheumatoid arthritis

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Clin Orthop Relat Res. 2004 Jul;(424):32-8. Links

Total ankle replacement in patients with rheumatoid arthritis.

Hospital for Special Surgery-Weill Medical College of Cornell University,

535 East 70th Street, New York City, NY 10021, USA.

Patients with rheumatoid arthritis commonly experience involvement of the

ankle and hindfoot. Severe pain and functional limitations may develop as a

result of tibiotalar arthritis, requiring surgical treatment. The advantages

of total ankle arthroplasty over ankle arthrodesis include preservation of

motion and decreased stresses on the midfoot and subtalar joints. Previous

experience with early design ankle replacements revealed high complication

rates and as much as 75% of component loosening. Modern ankle implants have

been designed to achieve uncemented fixation with less articular constraint.

Patients with rheumatoid arthritis who had total ankle replacement using two

different types of second-generation ankle implants were examined clinically

and radiographically. The average postoperative American Orthopaedic Foot

and Ankle Society ankle-hindfoot score was 81 of a possible 100, at a mean

of 6.4 years after surgery. Radiographically, 88.5% of implants were stable

without evidence of subsidence at a mean of 6.3 years. Three tibial

components had subsided at an average of 7 years. There was evidence of

tibial osteolysis with the Buechel Pappas Low Contact Stress implant in

11.5% of patients. Total ankle replacement in patients with rheumatoid

arthritis, using a second-generation prosthesis, can provide reliable relief

of pain and good functional results at intermediate-term followup, although

the incidence of osteolysis warrants close followup.

PMID: 15241141

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus & db=pubmed & cmd=R\

etrieve & dopt=abstractplus & list_uids=15241141

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