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Outcome of Total Ankle Arthroplasty in Patients with Rheumatoid Arthritis and Noninflammatory Arthritis: A Multicenter Cohort Study Comparing Clinical Outcome and Safety

Pedersen, Elizabeth MD, FRCSC; Pinsker, Ellie BA⪼ Younger, Alastair S.E. MB ChB, ChM, FRCSC; Penner, Murray J. MD, FRCSC; Wing, Kevin J. MD, FRCSC; Dryden, Peter J. MSc, MD, FRCSC; Glazebrook, Mark MSc, PhD, MD, FRCSC; Daniels, Timothy R. MD, FRCSC

Journal of Bone & Joint Surgery - American Volume: 5 November 2014 - Volume 96 - Issue 21 - p 1768–1775
doi: 10.2106/JBJS.M.01164
Scientific Articles
Supplementary Content
Disclosures

Background: Patients with rheumatoid arthritis often have degeneration of the ankle and ipsilateral hindfoot joints. Patients with rheumatoid arthritis undergoing total ankle arthroplasty have a higher risk of wound breakdown and infection. We compared intermediate-term clinical outcomes after total ankle arthroplasty in patients with rheumatoid arthritis and patients with noninflammatory arthritis.

Methods: Fifty patients with rheumatoid arthritis were compared with fifty patients with noninflammatory arthritis (the control group), matched for age within ten years, prosthesis type, and follow-up time. All patients underwent total ankle arthroplasty. Revisions and major complications were noted. Outcome scores included the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) Health Survey.

Results: The groups were similar with respect to body mass index and length of follow-up (mean, 63.8 months for the rheumatoid arthritis group and 65.6 months for noninflammatory arthritis group); the rheumatoid arthritis group was younger (mean, 58.5 years compared with 61.2 years). The mean AOS pain scores were significantly different in the rheumatoid arthritis and noninflammatory arthritis groups preoperatively (p < 0.01), but were similar following total ankle arthroplasty (mean and standard deviation, 18.5 ± 17.8 for the rheumatoid arthritis group and 19.7 ± 16.5 for the noninflammatory arthritis group; p = 0.93). Both groups showed significant improvement (p < 0.05) with regard to the AOS scores for pain and disability and SF-36 physical component summary scores following surgery. Postoperatively, AOS disability and SF-36 physical component summary scores were better for patients with noninflammatory arthritis. There were seven revisions in the rheumatoid arthritis group and five in noninflammatory arthritis group. There was one major wound complication in the rheumatoid arthritis cohort and none in the control cohort.

Conclusions: Patients with rheumatoid arthritis benefit from total ankle arthroplasty and have similar outcomes to patients with noninflammatory arthritis. The overall pain and disability were worse for patients with rheumatoid arthritis than for those with noninflammatory arthritis preoperatively, but this did not negatively influence their final outcomes. When properly treated, patients with rheumatoid arthritis achieve good results.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Division of Orthopaedic Surgery, University of Alberta, 11202 76th Avenue, Edmonton, AB T6G 0K1, Canada. E-mail address: melizabethpedersen@gmail.com

2Division of Orthopaedic Surgery, St. Michael’s Hospital, 800–55 Queen Street East, Toronto, ON M5C 1R6, Canada. E-mail address for E. Pinsker: pinskere@smh.ca. E-mail address for T.R. Daniels: danielst@smh.ca

3Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, 560–1144 Burrard Street, Vancouver, BC V6Z 2A5, Canada. E-mail address: asyounger@shaw.ca

4Division of Distal Extremities, Department of Orthopaedics, University of British Columbia, 1000–1200 Burrard Street, Vancouver, BC V6Z 2C7, Canada. E-mail address: penner@vbjc.ca

5Rebalance MD, 104–3551 Blanshard Street, Victoria, BC V8Z 0B9, Canada. E-mail address: pjdryden@telus.net

6Queen Elizabeth II Health Sciences Center, Halifax Infirmary (Suite 4867), 1796 Summer Street, Halifax, NS B3H 3A7, Canada. E-mail address: markglazebr@ns.sympatico.ca

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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