By: 31 October 2018
Total ankle arthroplasty offers patients greater range of motion and less pain

Surgical reconstruction is a life changer for people with end-stage ankle arthritis. Researchers from The Rothman Orthopaedic Institute at Jefferson Health demonstrate that surgical reconstruction boosts patients’ range of motion by more than 60 per cent and that translates to significantly less pain and better function completing everyday activities with improvement continuing for at least the first two years following surgery.

The findings will enable surgeons to not only best inform patients about what improvements to expect as they recover during the first two years after surgery but also what the surgical repair can do for them.

“They’re really dramatically better than they were before surgery on average,” said Steven Raikin, Director of Foot and Ankle Service at the Rothman Orthopaedic Institute at Jefferson Health and professor of orthopaedic surgery at Jefferson Medical College, who published the work in the Journal of Bone and Joint Surgery.

Total ankle arthroplasty, or a complete surgical replacement of the ankle joint, has only become a viable choice in the last decade. With new methods and updated devices, results from total ankle arthroplasty appear effective, but patients wanted to know more about the recovery period.

“The whole idea was to try to create expectation parameters for patients getting ankle replacements at different time periods in the first two years following surgery,” he said.

Raikin and a team of surgeons and researchers from The Rothman Institute and Thomas Jefferson University Hospital assessed more than 100 patients’ range of motion, pain levels and function completing everyday activities before surgery and then again at three months, six months, one year and two years after total ankle arthroplasty surgery.

On average, surgery improved patients’ ankle range of motion in the sagittal plane by 66 per cent, from a 20.7-degree angle before surgery to a peak of 34.3 degrees six months post-surgery. As patients’ range of motion improved, so did their quality of life.

“We are able to give a dramatic improvement in range of motion and pain with these ankle replacements,” said Raikin. Patients’ pain scores plummeted from 74 on a 100-point scale to 15 and their ability to complete everyday tasks shot up from 50 to 80 out of 100 over the two-year follow-up. These improvements also correlated strongly with enhanced ankle flexibility.

When the team analysed surgical outcomes, they found that the critical recovery window happened much earlier than they thought. The first six months post-surgery were crucial, according to their data.

Raikin said: “This is very important because we have to really motivate patients earlier on.”

Patients’ range of motion peaked at the six-month mark with improvement slowing down from there. Pain and functionality followed the same trend. Raikin is now pushing his patients in their recovery earlier and quicker as a result of this study.

That said, patients do continue to improve both their range of motion and their pain and functionality until about two years. “So, if they’re not where we expect them to be, they can still catch up,” Raikin said.

Source: Thomas Jefferson University

Reference: Benjamin A. Hendy, and others. Improvement of Outcomes During the First Two Years Following Total Ankle Arthroplasty. The Journal of Bone and Joint Surgery, 2018; 100 (17): 1473 DOI: 10.2106/JBJS.17.01021