Total Ankle Replacement Outcomes in Patients With Prior Distraction Arthroplasty.

Background: Distraction arthroplasty aims to treat ankle osteoarthritis while preserving the native ankle joint, often to prevent or delay ankle arthrodesis or total ankle replacement (TAR). No study to date has explored TAR outcomes in patients who have had prior distraction arthroplasty. Thus, this study described the clinical, radiographic, and patient-reported outcomes for TAR at minimum 2-year follow-up in patients who had undergone prior ankle distraction arthroplasty.

Methods: This retrospective review included 19 ankles in 17 patients who underwent TAR at a single institution subsequent to ipsilateral distraction arthroplasty. The primary aims were to evaluate complication rate and patient satisfaction following TAR. PROMIS scores were obtained preoperatively and at minimum 2 years postoperatively. The proportion of patients who achieved the patient acceptable symptom state (PASS) threshold for each Patient-Reported Outcomes Measurement Information System (PROMIS) domain at final follow-up was used to assess patient satisfaction following TAR.

Results: TAR was performed a mean of 5.3 ± 3.5 years following distraction arthroplasty. At mean 4.4-year follow-up after TAR, 18/19 (94.7%) ankles remained implanted. One ankle was revised because of failure of the talar component, and there were 4 additional reoperations. Radiographic complications were observed in 37% of patients at 2 years postoperatively. Patients experienced significant improvement at 2-year follow-up for PROMIS domains of Physical Function (P = .002), Pain Interference (P = .007), and Pain Intensity (P = .010). At final follow-up, PASS was achieved by 65% and 71% of patients in the Physical Function and Pain Interference domains, respectively, but only 35% in the Pain Intensity domain.

Conclusion: TAR is a viable option to treat ankle osteoarthritis symptoms that persist after distraction arthroplasty. However, many of these patients present with a complex surgical history and, therefore, may be at a greater risk for reoperation. Thus, patients should be counseled appropriately before electing to proceed with distraction arthroplasty before more definitive surgical treatment options.

Level of evidence: Level IV, case series.