Cho Byung-Ki, An Min-Yong, Ahn Byung-Hyun
Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Korea.
Foot Ankle Int. 2021 May;42(5):589-597. doi: 10.1177/1071100720979923. Epub 2021 Feb 9.
Total ankle arthroplasty (TAA) is known to be a reliable operative option for end-stage rheumatoid arthritis. However, higher risk of postoperative complications related to chronic inflammation and immunosuppressive treatment is still a concern. With the use of a newer prosthesis and modification of anti-rheumatic medications, we compared clinical outcomes after TAA between patients with osteoarthritis and rheumatoid arthritis.
Forty-five patients with end-stage osteoarthritis (OA group) and 19 with rheumatoid arthritis (RA group) were followed for more than 3 years after 3 component mobile-bearing TAA (Zenith). Perioperative anti-rheumatic medications were modified using an established guideline used in total hip and knee arthroplasty. Clinical evaluations consisted of American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM).
In the preoperative and postoperative evaluation at final follow-up, there were no significant differences in AOFAS, FAOS, and FAAM scores between 2 groups. Despite statistical similarity in total scores, the OA group showed significantly better scores in FAOS sports and leisure (mean, 57.4 ± 10.1) and FAAM sports activity (mean, 62.5 ± 13.6) subscales than those in the RA group (mean, 52.2 ± 9.8, = .004; and 56.4 ± 13.2, < .001, respectively). There were no significant differences in perioperative complication and revision rates between 2 groups.
Patients with end-stage ankle RA had clinical outcomes comparable to the patients with OA, except for the ability related to sports activities. In addition, there were no significant differences in early postoperative complication rates, including wound problem and infection.
Level III, prognostic, prospective comparative study.
全踝关节置换术（TAA）是终末期类风湿性关节炎一种可靠的手术选择。然而，与慢性炎症和免疫抑制治疗相关的术后并发症风险较高仍是一个令人担忧的问题。通过使用新型假体并调整抗风湿药物，我们比较了骨关节炎患者和类风湿性关节炎患者TAA术后的临床结果。
45例终末期骨关节炎患者（OA组）和19例类风湿性关节炎患者（RA组）在接受三组件活动轴承TAA（Zenith）后随访超过3年。围手术期抗风湿药物根据全髋关节和膝关节置换术的既定指南进行调整。临床评估包括美国矫形足踝协会（AOFAS）评分、足踝结果评分（FAOS）和足踝能力测量（FAAM）。
在末次随访时的术前和术后评估中，两组之间的AOFAS、FAOS和FAAM评分无显著差异。尽管总分在统计学上相似，但OA组在FAOS运动和休闲（平均57.4±10.1）和FAAM体育活动（平均62.5±13.6）子量表上的得分显著高于RA组（平均52.2±9.8，P = 0.004；和56.4±13.2，P < 0.001）。两组之间的围手术期并发症和翻修率无显著差异。
除与体育活动相关的能力外，终末期踝关节类风湿性关节炎患者的临床结果与骨关节炎患者相当。此外，包括伤口问题和感染在内的术后早期并发症发生率无显著差异。
III级，预后性前瞻性比较研究。
