Lara Taylor R, Waples William W, Simon Peter, Lyons Steven T
Florida Orthopedic Institute, Tampa, FL.
University of South Florida Morsani College of Medicine, Tampa, FL.
J Foot Ankle Surg. 2023 May-Jun;62(3):553-555. doi: 10.1053/j.jfas.2022.12.013. Epub 2023 Jan 10.
Prior studies have demonstrated a high incidence of ankle osteoarthritis (OA) in patients undergoing total knee arthroplasty (TKA) as well as inferior outcomes in the setting of ankle OA or hindfoot malalignment. Little is known about the effect of the 2 most common surgical treatments for ankle OA, ankle arthrodesis and total ankle arthroplasty (TAA) on TKA. This hypothesis is that the preservation of ankle motion afforded by total ankle arthroplasty may reduce pathologic stresses across the knee joint. This study compares outcomes of patients who underwent both TKA and TAA versus those that underwent TKA and ankle arthrodesis. We retrospectively reviewed a cohort of patients who had undergone TKA and either TAA or ankle arthrodesis at this institution, examining knee injury and OA outcome scores, foot and ankle ability measure scores, revision surgery, knee range of motion, and pain. There were 69 eligible subjects, 13 who had undergone total knee arthroplasty and total ankle arthroplasty and 56 who had undergone TKA and ankle arthrodesis. No significant differences were observed in KOOS Jr scores, FAAM scores, incidence of revision, knee range of motion, or pain at final follow up (p > .05). Mean follow-up time was 46 months after both surgeries were completed. Equivalent outcomes were observed between the 2 groups. The presence of a TKA should not alter the indications for treatment of ankle OA with TAA versus arthrodesis. Further studies are needed as these relatively rare concomitant procedures are likely to become more common in the future.
先前的研究表明，接受全膝关节置换术（TKA）的患者中踝关节骨关节炎（OA）的发生率很高，并且在踝关节OA或后足畸形的情况下预后较差。关于踝关节OA的两种最常见手术治疗方法，即踝关节融合术和全踝关节置换术（TAA）对TKA的影响，人们知之甚少。本研究的假设是，全踝关节置换术所保留的踝关节活动度可能会减少膝关节的病理应力。本研究比较了接受TKA和TAA的患者与接受TKA和踝关节融合术的患者的预后情况。我们回顾性分析了在本机构接受TKA并同时接受TAA或踝关节融合术的一组患者，检查膝关节损伤和OA结局评分、足踝功能测量评分、翻修手术、膝关节活动范围和疼痛情况。共有69名符合条件的受试者，其中13名接受了全膝关节置换术和全踝关节置换术，56名接受了TKA和踝关节融合术。在末次随访时，两组在膝关节损伤和骨关节炎疗效评分（KOOS Jr）、足踝能力测量（FAAM）评分、翻修发生率、膝关节活动范围或疼痛方面均未观察到显著差异（p>0.05）。两次手术完成后的平均随访时间为46个月。两组观察到了相似的结果。TKA的存在不应改变TAA与关节融合术治疗踝关节OA的适应症。由于这些相对罕见的联合手术在未来可能会变得更加普遍，因此需要进一步的研究。
