SLR - March 2018 - Jason P. Havey
Reference: Usuelli FG, Pantalone A, Maccario C, Guelfi M, Salini V. Sports and Recreational Activities Following Total Ankle Replacement. Joints 2017; 5:12–16Scientific Literature Review
Reviewed By: Jason P. Havey, DPM
Residency Program: Hennepin County Medical Center, Minneapolis, MN
Podiatric Relevance: The gold standard for end-stage ankle arthritis is arthrodesis. Many patients are hesitant when presented with the option of fusion and opt for alternative procedures. Ankle implant technology is ever evolving, but survival rate at this point is not enough to replace arthrodesis as the gold standard. This article reviews change in sports and activity in patients who have undergone total ankle arthroplasty at a 12-month follow-up for the purpose of highlighting the benefit of TAR versus arthrodesis for active adults.
Methods: Retrospective reviews of 76 patients who underwent total ankle replacement for end-stage ankle arthritis from 2011–2014. Average age of patient was 56 years old. All TAR done with Hintegra implant by single surgeon. Patient follow-up at 12 months assessed via AOFAS ankle and hindfoot score, VAS, SF-12, PCS, MCS and UCLA activity score.
Results: Statistically significant improvement noted in AOFAS score, VAS, SF-12, PCS, MDC and UCLA compared to preoperative scores. 11.7 percent of patients noted participation in sports preoperatively compared with 49.4 percent of patients at a 12-month follow-up. No objective data was obtained to evaluate how well patients functioned in sports compared to preoperative status. Notably, 14 of 76 patients reported return to high-impact activity, such as jogging/martial arts.
Conclusions: There is no consensus on what level, if any participation in sport, is recommended after TAR. The authors conclude that the data from this study indicates TAR is a better choice versus arthrodesis for younger, active, healthy patients who suffer from posttraumatic end-stage ankle arthritis. One-year follow-up indicates increase in sports after TAR with nearly 50 percent of patients participating in some aspect of sports, including jogging, skiing, cycling or dancing, postoperatively. Without longer follow-up, no conclusions can be made regarding polyethylene wear or fracture. Additional long-term concerns are increased BMI and implant survivability for younger patients.