Comparison of Treatment Outcomes of Arthrodesis and Two Generations of Ankle Replacement Implants
| Autor: | John D. Maskill, Michael S. Orendurff, J. Chris Coetzee, Michael E. Brage, Michael Houghton, James Davitt, William R. Ledoux, Jane B. Shofer, Bruce J. Sangeorzan, Marisa Rose Benich, John G. Anderson, Sigvard T. Hansen, Donald R. Bohay |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Arthrodesis medicine.medical_treatment Ankle replacement Treatment outcome 03 medical and health sciences Arthroplasty Replacement Ankle Disability Evaluation 0302 clinical medicine Tar (tobacco residue) medicine Humans Orthopedics and Sports Medicine Prospective Studies Prospective cohort study Aged Pain Measurement Aged 80 and over 030222 orthopedics Pain Postoperative business.industry Arthritis 030229 sport sciences General Medicine Middle Aged Arthroplasty Surgery Standard error Treatment Outcome Regression Analysis Female business Body mass index Ankle Joint |
| Zdroj: | The Journal of bone and joint surgery. American volume. 99(21) |
| ISSN: | 1535-1386 |
| Popis: | Background We analyzed self-reported outcomes in a prospective cohort of patients treated with ankle arthrodesis or total ankle replacement (TAR) during a time of transition from older to newer-generation TAR implants. Methods We performed a prospective cohort study comparing outcomes in 273 consecutive patients treated for ankle arthritis with arthrodesis or TAR between 2005 and 2011. Adult patients with end-stage ankle arthritis who were able to walk and willing and able to respond to surveys were included in the study. Patients were excluded when they had another lower-limb problem that might affect walking. At baseline and at 6, 12, 24, and 36-month follow-up visits, participants completed a pain score, a Musculoskeletal Function Assessment (MFA), and a Short Form-36 (SF-36) survey. Results There was significant mean improvement in most outcomes after surgery regardless of procedure. In general, the greatest improvement occurred during the first 6 months of follow-up. Linear mixed-effects regression adjusted for differences at baseline in age, body mass index (BMI), and surgery type showed that at 6 months the scores were improved by a mean (and standard error) of 12.6 ± 0.7 (33%) on the MFA, 22.0 ± 1.4 (56%) on the SF-36 Physical Functioning (PF) scale, 32.4 ± 1.6 (93%) on the SF-36 Bodily Pain (BP) scale, and 4.0 ± 0.2 (63%) on the pain rating scale. The mean improvements in the MFA and SF-36 PF scores over the 3-year follow-up period were significantly better after the TARs than after the arthrodeses, with differences between the 2 groups of 3.6 ± 1.6 (p = 0.023) and 7.5 ± 2.9 (p = 0.0098), respectively. The differences between the 2 groups were slightly greater when only the newer TAR devices were compared with the arthrodeses (MFA = 3.8 ± 1.8 [p = 0.031], SF-36 PF = 8.8 ± 3.3 [p = 0.0074], SF-36 BP = 7.3 ± 3.6 [p = 0.045], and pain score = 0.8 ± 0.4 [p = 0.038]). Conclusions Patients reported improved comfort and function after both surgical treatments. The average improvement in the MFA and SF-36 PF scores was better after TAR than after arthrodesis, particularly when the TAR had been done with later-generation implants. Younger patients had greater functional improvements than older patients. Level of evidence Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|