Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK; Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK.
Department of Orthopaedics, Northumbria Healthcare NHS Trust, North Shields, UK.
J Foot Ankle Surg. 2023 Jul-Aug;62(4):595-600. doi: 10.1053/j.jfas.2022.12.005. Epub 2023 Jan 2.
Rehabilitation for patients after total ankle replacement traditionally involves weeks of immobilization in a plaster cast followed by progressive mobilization. In a small randomized trial, we compared teh outcomes of patients who received a 3-component cementless, unconstrained, mobile-bearing prosthesis and were initially immobilised in a plaster cast for 6 weeks to thoese who received the same prosthesis but were allowed to mobilise early. Gait, clinical, patient-reported, and radiologic outcomes were measured. The study included 20 patients, 10 in the plaster cast group and 10 in the early mobilization group, and the demographics of the groups did not differ significantly. All patients were followed-up for 24 months. There were no significant differences between the 2 groups 2 years after surgery in ankle dorsiflexion, spatiotemporal gait characteristics, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, Timed Up and Go Test times, WOMAC (pain, stiffness, function) scores, SF-36 (quality-of-life) scores, or patient satisfaction (pain relief, daily-living, recreational activities, and overall) (all p > .05). Bone mineral density decrease of the medial malleolus and increase at middle tibia, calculated with DEXA scans, was significantly better in early mobilization than plaster cast group at one and 2 years postoperatively, but this was also the case preoperatively. The lack of differences in outcomes suggests that early ankle mobilization may be a safe and reliable method to enhance recovery following ankle arthroplasty with a 3-component cementless, unconstrained, mobile-bearing prosthesis. Compared to traditional plaster casting, patients who are engaged in early mobilization after arthroplasty may enjoy similar functional, mobility, quality-of-life, pain relief, activity level, and satisfaction outcomes.
传统上，全踝关节置换术后患者的康复包括数周的石膏固定，然后逐渐活动。在一项小型随机试验中，我们比较了接受三组件非骨水泥、非约束性、活动衬垫假体且最初用石膏固定 6 周的患者与接受相同假体但早期活动的患者的结果。测量了步态、临床、患者报告和影像学结果。该研究纳入了 20 名患者，10 名在石膏固定组，10 名在早期活动组，两组患者的人口统计学特征无显著差异。所有患者均随访 24 个月。术后 2 年，两组在踝关节背屈、时空步态特征、美国矫形足踝协会踝关节-后足评分、计时起立行走测试时间、WOMAC（疼痛、僵硬、功能）评分、SF-36（生活质量）评分或患者满意度（疼痛缓解、日常生活、娱乐活动和整体）方面均无显著差异（均 P >.05）。DEXA 扫描计算的内侧踝骨密度下降和胫骨中段骨密度增加，早期活动组优于石膏固定组，术后 1 年和 2 年差异有统计学意义，但术前也是如此。结果无差异表明，早期踝关节活动可能是一种安全可靠的方法，可增强三组件非骨水泥、非约束性、活动衬垫假体踝关节置换术后的恢复。与传统石膏固定相比，接受关节置换术后早期活动的患者可能会获得相似的功能、活动能力、生活质量、疼痛缓解、活动水平和满意度。
