Herrera-Pérez Mario, Valderrabano Victor, Godoy-Santos Alexandre L, de César Netto César, González-Martín David, Tejero Sergio
Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain.
Department of Surgery, Universidad de La Laguna, Tenerife, Spain.
EFORT Open Rev. 2022 Jul 5;7(7):448-459. doi: 10.1530/EOR-21-0117.
Ankle osteoarthritis (OA) is much less frequent than knee or hip OA, but it can be equally disabling, greatly affecting the quality of life of the patients. Approximately 80% of ankle OA is post-traumatic, mainly secondary to malleolar fractures, being another of the main causes untreated in chronic instability. The average age of the patient affected by ankle OA is around 50 years, being therefore active patients and in working age who seek to maintain mobility and remain active. The authors conducted a comprehensive review of the conservative, medical, and surgical treatment of ankle OA. Initial conservative treatment is effective and should be attempted in any stage of OA. From a pharmacological point of view, non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular infiltrations can produce temporary relief of symptoms. After the failure of conservative-medical treatment, two large groups of surgical treatment have been described: joint-preserving and joint-sacrificing procedures. In the early stages, only periarticular osteotomies have enough evidence to recommend in ankle OA with malalignment. Both ankle arthrodesis and ankle replacement can produce satisfactory functional results if correctly indicated in the final stages of the disease. Finally, the authors propose a global treatment algorithm that can aid in the decision-making process.
踝关节骨关节炎（OA）的发病率远低于膝关节或髋关节OA，但它同样会导致残疾，对患者的生活质量产生重大影响。约80%的踝关节OA为创伤后所致，主要继发于踝关节骨折，这也是慢性踝关节不稳未得到治疗的主要原因之一。踝关节OA患者的平均年龄约为50岁，因此这些患者正值活跃期且处于工作年龄，他们希望保持活动能力并继续活跃生活。作者对踝关节OA的保守治疗、药物治疗和手术治疗进行了全面综述。初始保守治疗是有效的，应在OA的任何阶段尝试。从药理学角度来看，非甾体抗炎药（NSAIDs）和关节内注射可暂时缓解症状。在保守药物治疗失败后，已描述了两大类手术治疗方法：保留关节和牺牲关节的手术。在早期阶段，只有关节周围截骨术有足够证据可推荐用于伴有畸形的踝关节OA。如果在疾病的最后阶段正确选择，踝关节融合术和踝关节置换术均可产生满意的功能结果。最后，作者提出了一种全面的治疗算法，可辅助决策过程。
