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Motion Versus Fixed Distraction of the Joint in the Treatment of Ankle Osteoarthritis: A Prospective Randomized Controlled Trial

Saltzman, Charles L. MD; Hillis, Stephen L. PhD; Stolley, Mary P. RN, MS; Anderson, Donald D. PhD; Amendola, Annunziato MD

Journal of Bone & Joint Surgery - American Volume: 6 June 2012 - Volume 94 - Issue 11 - p 961–970
doi: 10.2106/JBJS.K.00018
Scientific Articles
Supplementary Content

Background: Initial reports have shown the efficacy of fixed distraction for the treatment of ankle osteoarthritis. We hypothesized that allowing ankle motion during distraction would result in significant improvements in outcomes compared with distraction without ankle motion.

Methods: We conducted a prospective randomized controlled trial comparing the outcomes for patients with advanced ankle osteoarthritis who were managed with anterior osteophyte removal and either (1) fixed ankle distraction or (2) ankle distraction permitting joint motion. Thirty-six patients were randomized to treatment with either fixed distraction or distraction with motion. The patients were followed for twenty-four months after frame removal. The Ankle Osteoarthritis Scale (AOS) was the main outcome variable.

Results: Two years after frame removal, subjects in both groups showed significant improvement compared with the status before treatment (p < 0.02 for both groups). The motion-distraction group had significantly better AOS scores than the fixed-distraction group at twenty-six, fifty-two, and 104 weeks after frame removal (p < 0.01 at each time point). At 104 weeks, the motion-distraction group had an overall mean improvement of 56.6% in the AOS score, whereas the fixed-distraction group had a mean improvement of 22.9% (p < 0.01).

Conclusion: Distraction improved the patient-reported outcomes of treatment of ankle osteoarthritis. Adding ankle motion to distraction showed an early and sustained beneficial effect on outcome.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address: Charles.saltzman@hsc.utah.edu

2Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Medical Center (152), 601 Highway 6 West, Iowa City, IA 52246. E-mail address: steve-hillis@uiowa.edu

3Department of Orthopaedics & Rehabilitation, University of Iowa Healthcare, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for M.P. Stolley: patty-stolley@uiowa.edu. E-mail address for A. Amendola: ned-amendola@uiowa.edu

4Department of Orthopaedics & Rehabilitation and Department of Biomedical Engineering, Orthopaedic Biomechanics Laboratory, University of Iowa, 2181 Westlawn, Iowa City, IA 52242. E-mail address: don-anderson@uiowa.edu

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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