Jastifer James, Coughlin Michael J, Hirose Christopher
Borgess Orthopedics, Kalamazoo, MI, USA
St. Alphonsus Medical Group, Boise, ID, USA St. Alphonsus Coughlin Clinic, Boise, ID, USA.
Foot Ankle Int. 2015 Jan;36(1):11-7. doi: 10.1177/1071100714549190. Epub 2014 Sep 8.
Both total ankle arthroplasty (TAA) and ankle arthrodesis are options for the treatment of ankle arthritis and have been shown to improve gait postoperatively. Little is known about the postoperative performance of these patients on uneven surfaces.
Between 2010 and 2013, 77 consecutive patients were enrolled in a prospective study and completed 12 months of follow-up. Patients received either a TAA (61 patients) or an ankle arthrodesis (16 patients). Preoperatively, at 6 months and 12 months postoperatively, patients were evaluated clinically and functionally on stairs, an inclined ramp, and an uneven surface. Patients graded their function on these surfaces using a visual analog scale (VAS) in addition to standard clinical grading scales.
There was no statistically significant difference between the patient groups preoperatively (all P > .05). Both TAA and ankle arthrodesis groups had high patient satisfaction, 3.5 and 3.4 out of 4.0, respectively. Both groups had improvement in Buechel-Pappas scores, VAS pain scores, AOFAS Ankle Hindfoot scores, and functional scores (all P values < .05). TAA patients had a significantly better outcome than the arthrodesis patients in the Buechel-Pappas scale (P = .036), AOFAS Ankle Hindfoot score (P = .03), ankle dorsiflexion (P < .001), ankle plantarflexion (P < .001), walking upstairs (P = .013), walking downstairs (P = .012), and walking uphill (P = .016).
Patients with TAA and ankle arthrodesis had improved performance walking on uneven surfaces at 12 months of follow-up compared to preoperatively. TAA patients had higher scores than the ankle arthrodesis patients walking upstairs, downstairs, and uphill.
Level II, prospective cohort study.
全踝关节置换术（TAA）和踝关节融合术都是治疗踝关节关节炎的选择，且已证明术后可改善步态。对于这些患者在不平整路面上的术后表现知之甚少。
2010年至2013年期间，77例连续患者纳入一项前瞻性研究并完成12个月随访。患者接受了TAA（61例患者）或踝关节融合术（16例患者）。术前、术后6个月和12个月，对患者在楼梯、倾斜坡道和不平整路面上进行临床和功能评估。除标准临床分级量表外，患者还使用视觉模拟量表（VAS）对这些路面上的功能进行评分。
术前患者组间无统计学显著差异（所有P>.05）。TAA组和踝关节融合术组患者满意度均较高，分别为4.0分中的3.5分和3.4分。两组的Buechel-Pappas评分、VAS疼痛评分、美国足踝外科协会（AOFAS）踝与后足评分及功能评分均有改善（所有P值<.05）。在Buechel-Pappas量表（P=.036）、AOFAS踝与后足评分（P=.03）、踝关节背屈（P<.001）、踝关节跖屈（P<.001）、上楼梯（P=.013）、下楼梯（P=.012）和上坡行走（P=.016）方面，TAA患者的结局明显优于踝关节融合术患者。
与术前相比，TAA和踝关节融合术患者在随访12个月时在不平整路面上行走的表现有所改善。TAA患者在上楼梯、下楼梯和上坡行走时的得分高于踝关节融合术患者。
二级，前瞻性队列研究。
