Total Ankle Replacement for Osteoarthritis Following Pilon Fracture of the Tibia

Outcomes for total ankle replacement (TAR) performed for osteoarthritis following pilon fracture are underreported. We compared the outcomes between different indications for TAR.

Patient-reported outcome measures (PROMs) for TAR performed from 2006 to 2014 by a single surgeon were reviewed. Foot and Ankle Outcome Score (FAOS), SF-36, comorbidities, self-reported body mass index (BMI), and patient satisfaction scores were reviewed. Data were collected preoperatively and at 1 and 2 years postoperatively. Clinical notes and radiographs highlighted the indication for TAR. The following subgroups were created: osteoarthritis (OA), rheumatoid arthritis (RA), pilon fracture (PF), ankle fracture (AF), and posttraumatic arthritis without previous fracture (PTOA). PROMs were available for 173 TARs: 89 (51.4%) for OA, 36 (20.8%) for AF, 21 (12.1%) for RA, 15 (8.7%) for PF, and 12 (6.9%) for PTOA. The pilon fracture group were the youngest and had the highest BMI (mean, 56.5 years; mean BMI, 31.6 kg/m²). No difference was found in number of reported comorbidities ( P > .05).

Significant improvement in FAOS scores was seen in all subgroups from preoperatively to 1 year ( P = .01, .05, and .03). SF-36 had similar results for all subgroups with improvement in all parameters by 2 years. Significant improvement in role physical and role emotional domains was seen by 1 year following TAR ( P = .018 and P = .042). Patient satisfaction scores were similar in each group. There was no major difference in any of the reported outcomes between subgroups by 2 years postoperatively.

We found similar outcomes for patients who underwent TAR after pilon fracture compared to other indications.

Level III, comparative study.