Distraction Arthroplasty for Ankle Osteoarthritis
Ankle distraction arthroplasty has been gaining popularity as an alternative to fusion and prosthetic replacement. Unloading arthritic ankle joint reverses the sclerotic process and protects the remaining cartilage. Published series reveal pain relief wit
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Austin T. Fragomen and S. Robert Rozbruch
Contents
16.1
16.1
Introduction ..............................................
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16.2
Clinical Experience ..................................
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16.3 16.3.1 16.3.2 16.3.3 16.3.4
Surgical Technique................................... Overview .................................................... Preoperative Evaluation ............................. Frame Application ..................................... Postoperative Management ........................
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16.4
Current Recommendations and Trends ................................................
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References ...............................................................
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A.T. Fragomen, MD (*) • S.R. Rozbruch, MD Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA e-mail: [email protected]; [email protected]
Introduction
Ankle distraction arthroplasty has been gaining popularity internationally as an alternative to fusion and prosthetic arthroplasty for the treatment of ankle arthritis. Many authors have reported success using this technique with improvement in functional outcome scores (Van Valburg et al. 1995, 1999; Saltzman and Buckwalter 1999; van Roermund et al. 2002; Marijnissen et al. 2002, 2003; Ploegmakers et al. 2005; Paley and Lamm 2005; Paley et al. 2008; Tellisi et al. 2009; Intema et al. 2011). Those that have seen positive clinical effects presume that there is a biological explanation behind these successes. It is known that mechanical loading of arthritic joints will lead to sclerosis and abnormal remodeling of the of subchondral bone (Arokoski et al. 2000; Lajeunesse 2004; Brandt et al. 2009). Further loading of the abnormal subchondral bone leads to increased damage of the underlying articular cartilage (Radin and Rose 1986). Many have postulated that unloading the joint will reverse the sclerosis of the subchondral bone, protect the remaining cartilage, and even allow for cartilage repair (Buckwalter and Mankin 1998; Saltzman and Buckwalter 1999). Adequate joint distraction directly unloads the mechanical stress from the arthritic joint (Fragomen et al., presented LLRS 2011). With the joint distracted, the repair process can then progress uninhibited by compressive forces normally present between the joint surfaces. Distraction also allows for
M. Kocaoğlu et al. (eds.), Advanced Techniques in Limb Reconstruction Surgery, DOI 10.1007/978-3-642-55026-3_16, © Springer Berlin Heidelberg 2015
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A.T. Fragomen and S.R. Rozbruch
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intermittent pistonning within the joint during ambulation. This pistonning then creates intermittent joint fluid pressure that in turn stimulates the regenerating articular cartilage (Van Valburg et al. 1998). Most surgeons feel that joint distraction reduces pain through multiple processes. These include a change in subchondral sclerosis and a degree of articular cartilage reparative activity. Animal data has supported this contention and h
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