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Updated: Sep 9, 2025
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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
Published on: January 24, 2018
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Total Ankle Replacement Outcomes in Patients With Prior Distraction Arthroplasty
Allison L Boden1, Kira Lu1, Jensen K Henry1
1Foot & Ankle Department, Hospital for Special Surgery, New York, NY, USA.
Foot & Ankle Orthopaedics
|September 3, 2025
Summary
Total ankle replacement (TAR) can effectively treat persistent ankle osteoarthritis after distraction arthroplasty. However, patients face higher reoperation risks due to prior surgeries, necessitating careful pre-operative counseling.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Reconstructive Surgery
Background:
- Distraction arthroplasty preserves the native ankle joint for osteoarthritis, potentially delaying or avoiding ankle fusion or total ankle replacement (TAR).
- No prior studies have evaluated the outcomes of TAR in patients with a history of distraction arthroplasty.
- This study investigates TAR outcomes in patients previously treated with ankle distraction arthroplasty.
Purpose of the Study:
- To describe the clinical, radiographic, and patient-reported outcomes of total ankle replacement (TAR) following prior ankle distraction arthroplasty.
- To evaluate complication rates and patient satisfaction after TAR in this specific patient cohort.
- To assess the achievement of the patient acceptable symptom state (PASS) across various PROMIS domains.
Main Methods:
- Retrospective review of 19 ankles in 17 patients who underwent TAR after ipsilateral distraction arthroplasty.
- Collection of preoperative and minimum 2-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores.
- Assessment of complication rates, reoperation rates, and achievement of PASS thresholds for satisfaction.
Main Results:
- At a mean follow-up of 4.4 years post-TAR, 94.7% of ankles remained implanted, with one revision for talar component failure and four additional reoperations.
- Significant improvements were noted in PROMIS Physical Function, Pain Interference, and Pain Intensity domains at 2-year follow-up (P < .05).
- Patient acceptable symptom state (PASS) was achieved by 65% for Physical Function, 71% for Pain Interference, and 35% for Pain Intensity.
Conclusions:
- Total ankle replacement (TAR) is a viable treatment for persistent ankle osteoarthritis symptoms after distraction arthroplasty.
- Patients with prior distraction arthroplasty may have an increased risk of reoperation due to complex surgical history.
- Appropriate patient counseling regarding potential risks, including reoperation, is crucial before proceeding with distraction arthroplasty prior to definitive treatments.
