Department of Orthopaedic Surgery, Nara Medical University, Nara, Japan.
Bone Joint J. 2019 Apr;101-B(4):443-446. doi: 10.1302/0301-620X.101B4.BJJ-2018-0812.R2.
Total ankle arthroplasty (TAA) has become the most reliable surgical solution for patients with end-stage arthritis of the ankle. Aseptic loosening of the talar component is the most common complication. A custom-made artificial talus can be used as the talar component in a combined TAA for patients with poor bone stock of the talus. The purpose of this study was to investigate the functional and clinical outcomes of combined TAA.
Ten patients (two men, eight women; ten ankles) treated using a combined TAA between 2009 and 2013 were matched for age, gender, and length of follow-up with 12 patients (one man, 11 women; 12 ankles) who underwent a standard TAA. All had end-stage arthritis of the ankle. The combined TAA features a tibial component of the TNK ankle (Kyocera, Kyoto, Japan) and an alumina ceramic artificial talus (Kyocera), designed using individualized CT data. The mean age at the time of surgery in the combined TAA and standard TAA groups was 71 years (61 to 82) and 75 years (62 to 82), respectively. The mean follow-up was 58 months (43 to 81) and 64 months (48 to 88), respectively. The outcome was assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, the Ankle Osteoarthritis Scale (AOS), and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q).
The mean preoperative JSSF score of the combined TAA and standard TAA groups was 44 (sd 11) and 49 (sd 10), respectively. The mean postoperative JSSF scores were 89 (sd 6.1) and 72 (sd 15), respectively. The mean postoperative JSSF score of the combined TAA group was significantly higher (p = 0.0034). The mean preoperative AOS scores for pain and function in the combined TAA and standard TAA groups were 5.8 (sd 3.3) and 5.5 (sd 3.1), and 8.6 (sd 1.3), and 7.1 (sd 2.9), respectively. The mean postoperative AOS scores of pain and function were 2.5 (sd 2.5) and 2.2 (sd 1.9), and 2.5 (sd 3.3) and 3.4 (sd 2.9), respectively. There were no significant differences between the two groups in terms of postoperative AOS scores. The mean postoperative SAFE-Q scores were: for pain, 76 (sd 23) and 70 (sd 23); for physical function, 66 (sd 25) and 55 (sd 27); for social function, 73 (sd 35) and 62 (sd 34); for shoe-related, 73 (sd 19) and 65 (sd 26); and for general health, 78 (sd 28) and 67 (sd 29), respectively. There were no significant differences between the two groups in terms of postoperative SAFE-Q scores.
Combined TAA resulted in better clinical results than standard TAA. Cite this article: Bone Joint J 2019;101-B:443-446.
全踝关节置换术（TAA）已成为治疗踝关节终末期关节炎患者最可靠的手术方法。距骨部件的无菌性松动是最常见的并发症。对于距骨骨量差的患者，可以使用定制的人工距骨作为 TAA 的距骨部件。本研究的目的是研究 TAA 联合治疗的功能和临床结果。
2009 年至 2013 年间，10 例（2 男 8 女；10 例踝关节）患者接受了 TAA 联合治疗，与接受标准 TAA 治疗的 12 例（1 男 11 女；12 例踝关节）患者相匹配，这些患者的年龄、性别和随访时间均匹配。所有患者均患有踝关节终末期关节炎。TAA 联合治疗采用 TNK 踝关节（京瓷，日本京都）的胫骨部件和氧化铝陶瓷人工距骨（京瓷），使用个体化 CT 数据设计。TAA 联合治疗和标准 TAA 组患者的平均手术年龄分别为 71 岁（61 岁至 82 岁）和 75 岁（62 岁至 82 岁）。平均随访时间分别为 58 个月（43 个月至 81 个月）和 64 个月（48 个月至 88 个月）。采用日本足踝外科协会（JSSF）踝关节-后足量表、踝关节骨关节炎量表（AOS）和自我管理足部评估问卷（SAFE-Q）评估结果。
TAA 联合治疗和标准 TAA 组患者术前 JSSF 评分分别为 44（标准差 11）和 49（标准差 10），术后分别为 89（标准差 6.1）和 72（标准差 15）。TAA 联合治疗组术后 JSSF 评分明显更高（p = 0.0034）。TAA 联合治疗和标准 TAA 组患者术前 AOS 疼痛和功能评分分别为 5.8（标准差 3.3）和 5.5（标准差 3.1），8.6（标准差 1.3）和 7.1（标准差 2.9），术后分别为 2.5（标准差 2.5）和 2.2（标准差 1.9），2.5（标准差 3.3）和 3.4（标准差 2.9）。两组患者术后 AOS 评分无显著差异。术后 SAFE-Q 评分分别为：疼痛为 76（标准差 23）和 70（标准差 23）；躯体功能为 66（标准差 25）和 55（标准差 27）；社会功能为 73（标准差 35）和 62（标准差 34）；鞋相关功能为 73（标准差 19）和 65（标准差 26）；一般健康状况为 78（标准差 28）和 67（标准差 29）。两组患者术后 SAFE-Q 评分无显著差异。
与标准 TAA 相比，TAA 联合治疗可获得更好的临床效果。
