Bonnin_edit.qxp 1/10/07 05:52 Page 54
Orthopaedic Surgery Ankle
Functional Outcomes Following Total Ankle Arthroplasty
a report by
M Bonnin,
1
H Kasmaoui,
1
JG Tebib
2
and M Bouysset
3
1. Santy Orthopaedic Centre, Lyon; 2. Centre Hospitalier Lyon-Sud; 3. Villefranche sur Sâone
Total ankle arthroplasty (TAA) is now a well-accepted procedure, were dead and 10 were not available for evaluation because of unrelated
indicated in cases of severe destruction of the talocrural joint. In the medical problems. Three more patients were eliminated due to a recent re-
literature, most results have been analysed in terms of survivorship and operation on the ankle (one for secondary infection, one for removal of
rate of failure.
1
Functional outcomes have been analysed through scoring bone fragments and one for tibial loosening six years after implantation).
scales (mostly the American Orthopaedic Foot and Ankle Society (AOFAS)
scoring scale
2
), which give truncated information and optimistic results A questionnaire was sent to the remaining 104 patients (107 ankles).
due to a ‘ceiling effect’.
3
Having clear knowledge of the functional Twelve patients sent back an unusable questionnaire (in our protocol no
outcomes following TAA is critical because: decision of TAA is always assistance was allowed from the medical staff to prevent any influence),
balanced with fusion; osteoarthritis (OA) of the ankle is frequently and nine did not send back the questionnaire. All nine had a visit within
observed in young and active patients, especially in post-traumatic cases; the last year and had no complications.
and a patient’s expectations of joint prosthesis are high and sometimes
unrealistic.
4
The purpose of this paper is to analyse the function and This left 85 TAAs available for evaluation, including 49 females and 34
capacity to return to sport after TAA. males (two bilateral), and 40 right and 45 left ankles. Mean age at
surgery was 60 years (range: 28–88) and the body mass index (BMI) was
Material and Method 26.8kg/m
2
(range: 19–40). The indications for surgery were post-
Between January 1997 and December 2005, 182 Salto (Tornier SA, traumatic OA in 59 cases, OA following chronic instability in 11 cases and
Montbonnot, France) TAAs were implanted by the same surgeon. This primary OA in 13 cases. The two remaining cases were desarthrodesis-
TAA is a non-cemented, mobile-bearing prosthesis with an anatomical prostheses following a fusion in a abnormal position. The mean delay
design of the talar component (see Figure 1).
1
between surgery and evaluation was 43.4 months (range: 12–100).
Among these 85 ankles, 12 (14%) had a triple arthrodesis (five were
Due to their multiple joint involvement, patients with rheumatoid arthritis performed previously and seven at the same time as the TAA).
(a total of 60 ankles) were eliminated from this study. We intended to
evaluate the functional outcome on the remaining 122 (119 patients, three The mean AOFAS score in this series was 26.4±7 pre-operatively and
bilateral cases) operated on for OA. At the time of the study, two patients 88.3±10 at last follow-up. One of these ankles had been re-operated on
13 months before evaluation for a two-step revision for infection. A
standard Salto was re-implanted with an excellent functional result.
Michel P Bonnin is an Orthopaedic Surgeon at Santy
Orthopedic Centre in Lyon. His clinical practice is dedicated
to joint arthroplasties. His core research interests include The function questionnaire sent to the patients included the items of the
clinical outcomes related to total joint arthroplasty, a field in
AOFAS scoring scale, the Foot and Ankle Ability Measure (FAAM),
5
the
which he has been lecturing and publishing for more than
10 years.
Foot Function Index (FFI)
6
and some questions about sport participation.
7
The FFI is a Visual Analogue Scale (VAS)-based questionnaire ranging
E:
mibonnin@hotmail.com
from 0 (no limitation or pain) to 10 (impossible to practise the activity,
maximum difficulty or worst pain imaginable), and the results are
Jacques G Tebib is Professor of Rheumatology at the Centre
Hospitalier Lyon-Sud. His clinical research is primarily
numeric. These questionnaires were filled out at home by the patient
focused on rheumatoid arthritis.
without any influence from the medical team.
Results
Pain
When evaluated using VAS, the mean pain level while walking with shoes
Maurice Bouysset is a Rheumatologist at Villefranche sur
Sâone. He is particularly interested in foot pathology, a field
was 1.5 (range: 0–8.9) with a median of 0.5. The mean level of the
in which he has been working for over 20 years. Dr Bouysset
maximum pain was 2.8 (range: 0–10) with a median of 1.8. The VAS results
has published several articles on this area, and was a major
of the different activities are mentioned in Table 1. Fifteen patients (18%)
contributor to the recent publication Foot and Ankle in
Rheumatoid Arthritis. reported no pain on the operated ankle in any situation and 52 (61%) only
minimal occasional pain. As a whole, then, 67 patients (79%) had no or
minimal residual pain, 17 (20%) reported a daily moderate pain (needing
medication occasionally) and one patient a severe permanent pain.
54 © TOUCH BRIEFINGS 2007
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