Department of Orthopaedics, Kantonsspital Baselland, Liestal, Switzerland.
Huashan Hospital, Orthopaedics Departement, Shanghai, China.
Foot Ankle Int. 2019 Oct;40(10):1122-1128. doi: 10.1177/1071100719859216. Epub 2019 Jul 22.
An advantage of total ankle replacement (TAR) compared to ankle fusion is that by maintaining motion, the occurrence of hypermobility of adjacent joints may be prevented. This could affect the development of symptomatic subtalar joint osteoarthritis (OA). The aim of the study was to determine the incidence of subtalar joint fusion and the progression of subtalar joint OA following TAR.
Secondary subtalar joint fusion rate was determined from a cohort of 941 patients receiving primary TAR between 2000 and 2016. The indication for fusion, the time interval from primary TAR to fusion, and the union rate were evaluated. To assess the progression of subtalar joint OA, degenerative changes of the subtalar joint were classified in 671 patients using the Kellgren-Lawrence score (KLS) prior to TAR and at latest follow-up.
In 4% (37) of the patients, a secondary subtalar joint fusion was necessary. The indication for fusion was symptomatic OA in 51% (19), hindfoot instability in 27% (10), osteonecrosis of the talus in 19% (7), and cystic changes of the talus in 3% (1) of the patients. Time from primary TAR to subtalar joint fusion due to progressive OA was 5.0 (range, 0.3-10) years and for other reasons 1.6 (range, 0.2-11.6) years ( = .3). In 68% (456) of the patients, no progression of subtalar joint OA was observed.
The incidence of secondary subtalar joint fusion was low. The most common reason for subtalar joint fusion following TAR was symptomatic OA.
Level IV, case series.
与踝关节融合相比，全踝关节置换（TAR）的一个优势是通过保持运动，相邻关节的过度活动的发生可能会被预防。这可能会影响症状性距下关节骨关节炎（OA）的发展。本研究的目的是确定 TAR 后距下关节融合和距下关节 OA 进展的发生率。
从 2000 年至 2016 年间接受初次 TAR 的 941 例患者队列中确定次要距下关节融合率。评估融合的指征、从初次 TAR 到融合的时间间隔以及融合率。为了评估距下关节 OA 的进展，在初次 TAR 前和末次随访时，使用 Kellgren-Lawrence 评分（KLS）对 671 例患者的距下关节退行性改变进行分类。
4%（37 例）的患者需要进行二次距下关节融合。融合的指征是 51%（19 例）的症状性 OA、27%（10 例）的后足不稳定、19%（7 例）的距骨坏死和 3%（1 例）的距骨囊性改变。因进行性 OA 导致初次 TAR 后距下关节融合的时间为 5.0（范围，0.3-10）年，因其他原因的时间为 1.6（范围，0.2-11.6）年（=.3）。在 68%（456 例）的患者中，未观察到距下关节 OA 的进展。
二次距下关节融合的发生率较低。TAR 后距下关节融合的最常见原因是症状性 OA。
IV 级，病例系列。
