Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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Intermediate-Term Clinical Outcomes after Total Ankle Arthroplasty for End-Stage Rheumatoid Arthritis with Modification of Perioperative Anti-Rheumatic Medication

말기 류마티스성 발목관절염에 대한 인공관절 전치환술 및 항류마티스 약물 조절 후의 중기 추시 임상 결과

  • Cho, Byung-Ki (Department of Orthopedic Surgery, Chungbuk National University College of Medicine) ;
  • Ko, Ban-Suk (Department of Orthopedic Surgery, Chungbuk National University College of Medicine)
  • 조병기 (충북대학교 의과대학 정형외과학교실) ;
  • 고반석 (충북대학교 의과대학 정형외과학교실)
  • Received : 2019.05.23
  • Accepted : 2019.07.10
  • Published : 2019.09.15
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Abstract

Purpose: This retrospective study reports the intermediate-term clinical outcomes including the practical function in daily and sports activities after total ankle arthroplasty for end-stage rheumatoid arthritis, as well as the effects of modification of perioperative anti-rheumatic medications. Materials and Methods: Twelve patients were followed for a minimum of 2 years after total ankle replacement for end-stage rheumatoid arthritis. Perioperative anti-rheumatic medications in all patients were modified based on a specific guideline. Clinical evaluations consisted of American Orthopaedic Foot and Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM) scores. Periodic radiographic evaluation was conducted to detect changes in ankle alignment and postoperative complications. Results: Mean AOFAS, FAOS, and FAAM scores improved significantly from 37.5 to 81.2, 39.1 to 72.4, and 33.8 to 64.0 points at final follow-up, respectively (p<0.001). Functional outcomes in daily and sports activities at final follow-up were found to be 76.5 and 55.8 points for the FAOS and 70.5 and 57.5 points for the FAAM, respectively. As early postoperative complications, there was one case of local wound necrosis, one case of medial malleolar fracture, and one case of deep peroneal nerve injury. Radiological evaluation revealed two cases of asymptomatic heterotopic ossification and one case of progressive arthritis in the talonavicular joint. Reoperation was performed in only one patient (8.3%) with a medial soft tissue impingement at a mean of 35.6 months follow-up. Conclusion: Total ankle arthroplasty appears to be an effective surgical option for end-stage rheumatoid arthritis. Practical functions in daily and sports activities were significantly improved at intermediate-term follow-up. Modification of perioperative anti-rheumatic medications can be one of the solutions to reduce the postoperative complication rate.

Keywords

References

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