Comparison of distraction arthroplasty alone versus combined with arthroscopic microfracture in treatment of post-trauma
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RESEARCH ARTICLE
Open Access
Comparison of distraction arthroplasty alone versus combined with arthroscopic microfracture in treatment of posttraumatic ankle arthritis Kaibin Zhang, Yiqiu Jiang, Jing Du, Tianqi Tao, Wang Li, Yang Li and Jianchao Gui*
Abstract Background: This study aims to compare clinical outcomes of distraction arthroplasty alone versus combined with arthroscopic microfracture in treating post-traumatic ankle arthritis. Methods: The study cohort consisted of 96 patients (96 ankles) who underwent distraction arthroplasty alone or combined with arthroscopic microfracture between May 2005 and April 2012. Patients were divided into the distraction group (n = 46) and the combined group (n = 50). The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS), and ankle activity score (AAS) were used to compare the clinical outcomes between groups. Arthritis severity was assessed on the radiograph. Results: At the mean follow-up period of 30.8 ± 3.1 and 31.4 ± 3.6 months, respectively, no severe complications occurred and no further surgical interventions for symptomatic arthritis were required in both groups. The AOFAS scores improved significantly in the combined group than in the distraction group (59.0 ± 4.7 and 58.0 ± 4.9 preoperatively versus 85.0 ± 4.9 and 88.9 ± 5.4 at final visit, P < 0.001). The AAS scores were also significantly higher in the combined group (3.6 ± 1.1 and 3.3 ± 1.0 preoperatively versus 6.5 ± 1.1 and 7.1 ± 1.3 at final visit, P = 0.009). Pain was significantly alleviated in the combined group by the VAS scores (6.4 ± 0.9 and 6.7 ± 0.9 preoperatively versus 2.3 ± 0.8 and 2.0 ± 0.7 at final visit, P = 0.040). The combined group achieved better radiographic arthritis severity decrease than the distraction group (P = 0.012). Conclusions: Compared to distraction arthroplasty alone, distraction arthroplasty combined with arthroscopic microfracture can offer better functional recovery, pain relief, and ankle arthritis resolution for treating posttraumatic ankle arthritis. Keywords: Distraction arthroplasty, Microfracture, Ankle arthritis, Arthroscopy, Cartilage
Background Post-traumatic arthritis is a clinically very common disease accounting for 65–80% of secondary ankle arthritis, which can cause severe pain and limited joint mobility. A large number of persons worldwide are affected by this disease [1, 2]. Generally, post-traumatic arthritis is characterized by articular cartilage damage to varying degrees [3]. The goals for treatment of ankle arthritis * Correspondence: [email protected] Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, ChangLe Road 68, Nanjing 210000, Jiangsu Province, People’s Republic of China
include pain relief, improvement of joint function, and prevention of further osteoarthritic progression. Various surgical techniques have been used to treat posttraumatic arthritis, such as ankle arthrodesis, total ankle arthroplasty, and distraction arthroplasty [4]. Bone marrow stimulation procedures, such as
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