Joint distraction arthroplasty as an alternative treatment for ankle osteoarthritis

Objective To analyze the feasibility of Ilizarov apparatus for ankle joint distraction to treat post-traumatic ankle osteoarthritis(OA). Methods From March 2012 to May 2014, 15 patients with moderate post-traumatic ankle OA treated with foot and ankle deformities, and combined with ankle distraction surgery simultaneously by Ilizarov apparatus. The average age of patients was (35.6±6.5) years (10 Males and 5 females). Selected cases were involved in unilateral ankle disease, including 9 cases with ankle fractures medical history and 6 cases with ankle sprain medical history. Distraction was carried out for 3 months during which full weight bearing was allowed. Results Joint mobility and radiographic joint space were preserved in all 15 cases. No patients had undergone either ankle arthrodesis or total ankle arthroplasty. Ankle osteoarthritis scale (AOS) score was (33.8 ± 7.95) points before operation, (55.4 ± 5.46) points in the first year follow-up, and increased to (71.4 ± 10.19) points in the second year after operation, medical outcomes study 36-item short-form health survey (SF-36) score was (37.2 ± 4.32) points before operation, and increased to (52.8 ± 3.42) and (59.2 ± 2.95) points at 1 year and 2 years after operation, respectively, the difference between the two groups was statistically significant. The results of ankle range of motion (ROM) indicated function improved which was similar at both 1 year and 2 year's follow-up. Radiology joint space width (JSW) assessment indicated that ankle gap was improved significantly in 11 patients (73.3%, 11/15) in the first year and maintain successfully in the second year. For the rest 4 patients (26.7%, 4/15), ankle joint gap did not improved significantly, AOS and SF-36 showed clinical symptoms improved. Conclusion Ilizarov apparatus for ankle joint distraction is a promising treatment for moderate post-traumatic ankle OA at early stage of treatment, at least delaying the need for a joint fusion or total ankle arthroplasty. Key words: Osteoarthritis; External fixators; Arthroplasty; Osteogenesis, distraction