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Published on: January 24, 2018
Ankle Distraction Arthroplasty: Indications, Technique, and Outcomes
Mitchell Bernstein1, Jay Reidler, Austin Fragomen
1From the Department of Orthopaedic Surgery, Loyola University Chicago Stritch School of Medicine, Chicago, IL (Dr. Bernstein), the Department of Orthopaedics, Johns Hopkins University, Baltimore, MD (Dr. Reidler), and the Department of Orthopaedic Surgery, Hospital for Special Surgery, Cornell University, New York, NY (Dr. Fragomen and Dr. Rozbruch).
Ankle distraction surgery uses external fixation to unload the ankle joint, potentially aiding cartilage repair and delaying the need for fusion or replacement in younger arthritis patients.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Regenerative medicine
Background:
- Ankle arthritis affects younger patients, often necessitating joint-sparing or joint-replacement surgeries.
- Current treatments like ankle arthrodesis (fusion) and total ankle arthroplasty have limitations, particularly for active individuals.
- Ankle distraction presents a potential alternative to preserve joint function and delay definitive procedures.
Purpose of the Study:
- To evaluate ankle distraction as a joint-sparing treatment for ankle arthritis.
- To assess the potential for cartilage repair and long-term clinical benefits.
- To determine the efficacy in delaying or avoiding ankle arthrodesis or total ankle arthroplasty.
Main Methods:
- Ankle distraction involves external fixation to mechanically unload the ankle joint.
- Adjunct procedures may address malalignment, contractures, or osteophytes.
- Patients perform weight-bearing and range-of-motion exercises during treatment.
Main Results:
- The procedure allows for stable, congruent ankle motion under reduced mechanical load.
- Many patients experience lasting clinical benefits, potentially avoiding future fusion or replacement.
- Clinical improvements are gradual, often becoming apparent over a year after frame removal.
Conclusions:
- Ankle distraction is a viable alternative for younger patients with ankle arthritis.
- It offers potential for cartilage repair and significant delay of definitive surgical intervention.
- Patient counseling regarding slow, long-term recovery and potential complications is essential.
