What variables influence final range of motion following Total Ankle Arthroplasty. Kevin T. Grosshans MD Mark S. Myerson MD

Transcription

1 What variables influence final range of motion following Total Ankle Arthroplasty Kevin T. Grosshans MD Mark S. Myerson MD

2 Disclosures My disclosure is in the Final AOFAS Mobile App I have no potential conflicts with this presentation

3 Purpose To retrospectively review previous total ankles and examine what variables may contribute to an acceptable final motion outcome. This information could help in distinguishing which patients are more appropriate candidates for an arthroplasty versus an arthrodesis.

4 Methods Retrospective analysis of 163 primary total ankles performed between 2009 and 2012 using a single implant (Tournier Salto Talaris) Radiographs examined for the presence of flexion/extension views at 12 month followup. 78 patients had complete radiographs.

5 Methods All 78 patients had radiographs analyzed to assess tibiotalar ROM at 12 month follow-up. Cobb angle difference measured from tangents to tibial keel and bottom of talar component 6,15

6 Methods All 78 ranked based on ROM at 12 months. Top and bottom 25 selected for study cohorts Each cohort further analyzed for. Pre-operative tibiotalar motion (measure in a similar fashion) Pre-operative diagnosis Prior or concurrent procedures on the foot or ankle Age and BMI Post-operative protocol, including time to weight bearing, time to start of physical therapy, duration and frequency of therapy Information gathered from radiographs, chart, and by phone interview. Consent obtained at time of phone interview.

7 Results No difference in age or BMI between the two groups (p=0.52, p=0.14 respectively) No difference in the post-operative protocols Time to weight bearing was 5.52 weeks and 5.42 weeks in the top and bottom groups, respectively (p=0.85) Time to start of PT was 4.96 weeks and 4.77 weeks in the top and bottom groups, respectively (p=0.80) Frequency and duration of PT were the same (p=0.47, p=0.67 respectively)

8 ROM Results Top 25 Bottom 25 Top 25 increased from 28.9 o to 33.3 o Bottom 25 decreased from 17.9 o to 12.3 o p=0.0 for comparison of post-op ROM between groups 0 Pre-op ROM Post-op ROM

9 Pre-operative Diagnosis Top 25 group -Large number of primary OA resulting from previous ankle instability, varus or valgus Bottom 25 group -Large number of post-traumatic OA patients Post-traumatic OA (n=4) Primary OA (n=21) Post-traumatic OA (n=12) Primary OA (n=11) RA (n=1)

10 Conclusion As expected, pre-operative range of motion had a large impact on post-operative motion Post-traumatic arthritis patients were more likely to have poor motion outcomes, where as patients with previous varus or valgus instability had the best motion outcomes. Time to weight bearing and use of PT did not differ in the two cohorts.

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