New Surgical Approach and Rehabilitation After Cemented Total Ankle Arthroplasty

According to the conventional postoperative procedure after total ankle arthroplasty (TAA) for end-stage osteoarthritis (OA) and rheumatoid arthritis (RA), mobilization and weight-bearing are currently started after completion of wound healing. Recently, an early rehabilitation program after cemented TAA with a modified anterolateral approach has been attempted because this approach could provide stable wound healing. To investigate the possibility of expediting rehabilitation, this study evaluated the feasibility, safety, and universality of an early rehabilitation program after cemented TAA using a modified anterolateral approach, even when a surgeon was completely changed.

This retrospective, observational study investigated 13 consecutive ankles (OA: 11 ankles, RA: two ankles) that had undergone cemented TAA with a modified anterolateral approach. As an early rehabilitation program, after early dorsiflexion mobilization (day three), full weight-bearing/gait exercise was started seven days after surgery (10 days after if malleolar osteotomy was added). Postoperative wound complications were observed and recorded. The number of days of hospitalization was also evaluated. Range of motion (ROM) of dorsiflexion/plantarflexion was measured. Patients also completed the self-administered foot evaluation questionnaire (SAFE-Q) and the Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot score preoperatively and at the final follow-up.

No postoperative complications related to wound healing were observed even after the early rehabilitation program. The duration of hospitalization was shorter (23.5 days) than our previous experience after a conventional rehabilitation program (36-38 days). ROM for both dorsiflexion (from 4.6° to 16.5°; p=0.002) and plantarflexion (from 27.7° to 37.7°; p=0.019) increased significantly, and all indices of the SAFE-Q score and the JSSF score showed highly significant improvement.

An early rehabilitation program was feasible and safe following the modified anterolateral approach. Although these points were confirmed with a cemented TAA system at present, further innovations in postoperative rehabilitation after TAA are expected.