SLR - December 2014 - Ashley Bowles

Outcome of Total Ankle Arthroplasty in Patients with Rheumatoid Arthritis and Noninflammatory Arthritis: A Multicenter Cohort Study Comparing Clinical Outcome and Safety

Reference: Pedersen E, Pinsker E, Younger AS, Penner MJ, Wing KJ, Dryden PJ, Glazebrook M, Daniels TR. Outcome of Total Ankle Arthroplasty in Patients with Rheumatoid Arthritis and Noninflammatory Arthritis: A Multicenter Cohort Study Comparing Clinical Outcome and Safety. J Bone Joint Surg Am. 2014 Nov 5;96(21):1768-75.

Scientific Literature Review

Reviewed By: Ashley Bowles, DPM
Residency Program: Bethesda Memorial Hospital

Podiatric Relevance: Rheumatoid arthritis often results in degeneration of the ankle and hindfoot joints. Treatment for end-stage ankle arthritis includes arthrodesis or arthroplasty. Patients with rheumatoid arthritis have demonstrated a higher risk of wound complications and infection after ankle replacement. In this article, the authors compared intermediate-term clinical outcomes and safety of total ankle arthroplasty in patients with rheumatoid arthritis and patients with non-inflammatory arthritis. The authors state that a comparison of large groups with similar demographics has not been reported in studies of total ankle arthroplasty in the rheumatoid population.

Methods: The authors conducted a multicenter, prospective study comparing total ankle arthroplasty in fifty patients with rheumatoid arthritis to fifty patients with noninflammatory arthritis. The two groups were matched for age within ten years, prosthesis type and length of follow-up. Complications were noted in each group. Overall outcome was measured by the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) Health Survey in both groups. Patients were included if diagnosed with end-stage ankle arthritis amenable to surgical treatment with arthroplasty, confirmed rheumatoid arthritis and noninflammatory arthritis in each cohort. Concomitant and prior surgical procedures for correction were documented.

Results: From 2001 to 2008, fifty ankles with rheumatoid arthritis that underwent total ankle arthroplasty were matched with fifty noninflammatory arthritis patients that underwent total ankle arthroplasty. The rheumatoid cohort included 70 percent women and the noninflammatory cohort consisted of 58 percent women. The average age for the rheumatoid group was 58.5 (55.2 to 61.8) and 61.2 (58.8 to 63.5) in the control group. Thirty-one patients in the rheumatoid arthritis group underwent concomitant procedures during total ankle replacement and eleven patients in the noninflammatory arthritis group underwent concomitant procedures. Clinical outcomes were measured preoperatively and postoperatively, indicating a higher mean AOS score in the rheumatoid arthritis group preoperatively. This difference disappears postoperatively and both groups had similar levels of pain. The mean SF-36 PCS scores were similar for both groups preoperatively and both groups improved significantly following total ankle arthroplasty. The noninflammatory arthritis group experienced nine (18%) complications compared to the eight (16 percent) complications in the rheumatoid arthritis cohort. The average time to revision was forty-three months in the rheumatoid arthritis group and seventy-eight months in the noninflammatory arthritis group. One (2 percent) rheumatoid arthritis patient experienced a wound infection.

Conclusions: Patients with rheumatoid arthritis demonstrate greater preoperative pain than noninflammatory arthritis patients. Both groups showed significant pain relief postoperatively. This study demonstrates low complication rates and significant functional outcomes in both arthritic populations. Total ankle arthroplasty is a viable and safe option for patients with rheumatoid arthritis. 

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