Total Ankle Arthroplasty for Rheumatoid Arthritis in Japanese Patients: A Retrospective Study of Intermediate to Long-Term Follow-up. Issue 4 (28th December 2017)

• Record Type: Journal Article
• Authors: Hirao, Makoto; Hashimoto, Jun; Tsuboi, Hideki; Ebina, Kosuke; Nampei, Akihide; Noguchi, Takaaki; Tsuji, Shigeyoshi; Nishimoto, Norihiro; Yoshikawa, Hideki
• Is Part Of: JB & JS open access. Volume 2:Issue 4(2017)
• Publication Date: 2017-12-28
• Subjects: Orthopedic surgery -- Periodicals; Orthopedic surgery; Periodicals; 617.4705
• DOI: 10.2106/JBJS.OA.17.00033
• Languages: English
• ISSNs: 2472-7245

Abstract

Abstract : Background: Outcomes after total ankle arthroplasty (TAA) combined with additive techniques (augmentation of bone strength, control of soft-tissue balance, adjustment of the loading axis) for the treatment of rheumatoid arthritis were evaluated after intermediate to long-term follow-up. The influences of biologic treatment on the outcomes after TAA were also evaluated. Methods: We performed a retrospective observational study involving 50 ankles (44 patients) that underwent TAA for the treatment of rheumatoid arthritis. The mean duration of follow-up was 7.1 years. Clinical outcomes were evaluated with use of the Japanese Society for Surgery of the Foot (JSSF) scale score and a postoperative self-administered foot-evaluation questionnaire (SAFE-Q). Radiographic findings were evaluated as well. These parameters also were compared between patients managed with and without biologic treatment. Results: This procedure significantly improved the clinical scores of the JSSF rheumatoid arthritis foot and ankle scale (p < 0.0001). Forty-eight of the 50 ankles had no revision TAA surgery. Subsidence of the talar component was seen in 8 ankles (6 in the biologic treatment group and 2 in the non-biologic treatment group); 2 of these ankles (both in the biologic treatment group) underwent revision TAA. The social functioning score of the SAFE-Q scale at the time of the latest follow-up was significantly higher in the biologic treatment group (p = 0.0079). The dosage of prednisolone (p = 0.0003), rate of usage of prednisolone (p = 0.0001), and disease-activity score (p < 0.01) at the time of the latest follow-up were all significantly lower in the biologic treatment group. Conclusions: TAA is recommended for the treatment of rheumatoid arthritis if disease control, augmentation of bone strength, control of soft-tissue balance, and adjustment of the loading axis are taken into account. The prevention of talar component subsidence remains a challenge in patients with the combination of subtalar fusion, rheumatoid arthritis, and higher social activity levels. Level of Evidence: TherapeuticLevel III . See Instructions for Authors for a complete description of levels of evidence.